Abstract 13193: Hispanics/Latinos Lack Access to Hospitals With Therapeutic Hypothermia Programs Following Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Nicholas Morris ◽  
Michael Mazzeffi ◽  
Patrick McArdle ◽  
Teresa May ◽  
Greer Waldrop ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Therapeutic Hypothermia ◽  
Secondary Analysis ◽  
Ethnic Disparities ◽  
The United States ◽  
Black Patients ◽  
To Receive ◽  
Racial Ethnic ◽  
Hospital Cardiac Arrest

Introduction: Variation exists in outcomes following out-of-hospital cardiac arrest (OHCA), but whether racial/ethnic disparities exist in post-arrest provision of therapeutic hypothermia (TH) is unknown. Hypothesis: Racial/ethnic disparities exist in the utilization of guideline-recommended TH following OHCA. Methods: We performed a retrospective analysis of a cohort of 96,695 patients who survived to hospital admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~40% of the United States, from 2013 through 2019. Our primary exposure was race/ethnicity, and the primary outcome was utilization of TH. We performed a secondary analysis to assess for racial/ethnic disparities in the reasons why TH was not used (supplemental data element data available since 2016). Results: Among 96,695 patients [mean (SD) age 61.4 (16.3) years, 24.6% Black, 8.0% Hispanic/Latino, 63.4% White] that survived to hospital admission following OHCA, 54,687 (56.6%) did not receive TH. Using a mixed-effects model that adjusted for patient, arrest, neighborhood, and hospital factors with state of arrest modeled as a random intercept to account for clustering, we found that Hispanics/Latinos were less likely to receive TH than Whites (Odds Ratio [OR] 0.79, 95 % Confidence Interval [CI] 0.75-0.83). When the clustering variable was changed from the state of arrest to the admitting hospital, Hispanics/Latinos were more likely to receive TH (OR 1.07, 95% CI 1.00 to 1.14). In the 22,896 patients with data regarding why they did not receive TH, a higher percentage of Hispanics/Latinos compared to Blacks and Whites did not receive TH due to lack of a TH program at the hospital (4.0% vs. 2.5 % vs 1.8%, p < .001). No disparity in TH utilization was found for Black patients. Conclusion: We found disparities in access to TH for Hispanics/Latinos following OHCA. Reassuringly, we did not find any disparity in TH utilization for Black patients.

Abstract 13150: Racial/Ethnic Disparities of the Impact of the COVID-19 Pandemic Out-of-Hospital Cardiac Arrest (OHCA) in Texas

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Summer Chavez ◽  
Ryan Huebinger ◽  
Kevin Schulz ◽  
Hei Kit Chan ◽  
Micah Panczyk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
Mixed Effect ◽  
Neurological Outcomes ◽  
Random Intercept ◽  
Hispanic Patients ◽  
The Impact ◽  
Racial Ethnic

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. The CDC has declared that the COVID-19 pandemic has disproportionately affected many racial and ethnic minority groups. However, the influence of the COVID-19 pandemic on OHCA incidence and outcomes in different races and ethnicities is unknown. Purpose: To describe racial/ethnic disparities in OHCA incidence, processes of care and outcomes in Texas during the COVID-19 pandemic. Methods: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES) comparing adult OHCA from the pre-pandemic period (March 11 - December 31, 2019) to the pandemic period (March 11- December 31, 2020). The racial and ethnic categories were White, Black, Hispanic or Other. Outcomes were rates of BCPR, AED use, sustained ROSC, prehospital termination of resuscitation (TOR), survival to hospital admission, survival to discharge and good neurological outcomes. We fit a mixed effect logistic regression model, with EMS agency designated as the random intercept to obtain aORs. We adjusted for the pandemic and other covariates. Results: A total of 8,070 OHCAs were included. The proportion of cardiac arrests increased for Blacks (903 to 1, 113, 24.9% to 25.5%) and Hispanics (935 to 1,221, 25.8% to 27.5%) and decreased for Whites (1 595 to 1,869, 44.0% to 42.1%) and Other (194 to 220, 5.4% to 5.0%) patients. Compared to Whites, Black (aOR = 0.73, 95% CI 0.65-0.82) and Hispanic patients (aOR = 0.78, 95% CI 0.68-0.87) were less likely to receive BCPR. Compared to Whites, Blacks were less likely to have sustained ROSC (aOR = 0.81, 95% CI 0.70-0.93%), with lower rates of survival to hospital admission (aOR = 0.87, 95% CI 0.75-1.0), and worse neurological outcomes (aOR = 0.45, 95% 0.28-0.73). Hispanics were less likely to have prehospital TOR compared to Whites (aOR = 0.86, 95% CI = 0.75-0.99). The Utstein bystander survival rate was worse for Blacks (aOR = 0.72, 95% CI 0.54-0.97) and Hispanics (aOR = 0.71, 95% 0.53-0.95) compared to Whites. Conclusion: Racial and ethnic disparities persisted during the COVID-19 pandemic in Texas.

scholarly journals Successful Use of Therapeutic Hypothermia in a Pregnant Patient

2015 ◽  
Vol 42 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Kevin N. Oguayo ◽  
Ola O. Oyetayo ◽  
David Stewart ◽  
Steven M. Costa ◽  
Richard O. Jones
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Multidisciplinary Approach ◽  
Short Term Memory ◽  
Memory Loss ◽  
Pregnant Patient ◽  
The United States ◽  
Successful Outcome ◽  
Neurologic Recovery ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is a leading cause of death in the United States. Pregnant women are not immune to cardiac arrest, and the treatment of such patients can be difficult. Pregnancy is a relative contraindication to the use of therapeutic hypothermia after cardiac arrest. A 20-year-old woman who was 18 weeks pregnant had an out-of-hospital cardiac arrest. Upon her arrival at the emergency department, she was resuscitated and her circulation returned spontaneously, but her score on the Glasgow Coma Scale was 3. After adequate family discussion of the risks and benefits of therapeutic hypothermia, a decision was made to initiate therapeutic hypothermia per established protocol for 24 hours. The patient was successfully cooled and rewarmed. By the time she was discharged, she had experienced complete neurologic recovery, apart from some short-term memory loss. Subsequently, at 40 weeks, she delivered vaginally a 7-lb 3-oz girl whose Apgar scores were 8 and 9, at 1 and 5 minutes respectively. To our knowledge, this is only the 3rd reported case of a successful outcome following the initiation of therapeutic hypothermia for out-of-hospital cardiac arrest in a pregnant woman. On the basis of this and previous reports of successful outcomes, we recommend that therapeutic hypothermia be considered an option in the management of out-of-hospital cardiac arrest in the pregnant population. To facilitate a successful outcome, a multidisciplinary approach involving cardiology, emergency medicine, obstetrics, and neurology should be used.

scholarly journals Hispanic/Latino‐Serving Hospitals Provide Less Targeted Temperature Management Following Out‐of‐Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Nicholas A. Morris ◽  
Michael Mazzeffi ◽  
Patrick McArdle ◽  
Teresa L. May ◽  
Greer Waldrop ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ethnic Disparities ◽  
The United States ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Targeted Temperature Management ◽  
Community Level ◽  
Temperature Management ◽  
Hospital Cardiac Arrest ◽  
White Patients

Abstract Background Variation exists in outcomes following out‐of‐hospital cardiac arrest (OHCA), but whether racial and ethnic disparities exist in post‐arrest provision of targeted temperature management (TTM) is unknown. Methods and Results We performed a retrospective analysis of a prospectively collected cohort of patients who survived to admission following OHCA from the Cardiac Arrest Registry to Enhance Survival, whose catchment area represents ~50% of the United States from 2013‐2019. Our primary exposure was race/ethnicity and primary outcome was utilization of TTM. We built a mixed‐effects model with both state of arrest and admitting hospital modeled as random intercepts to account for clustering. Among 96,695 patients (24.6% Black, 8.0% Hispanic/Latino, 63.4% White), a smaller percentage of Hispanic/Latino patients received TTM than Black or White patients (37.5% vs. 45.0 % vs 43.3%, P < .001) following OHCA. In the mixed‐effects model, Black patients (Odds Ratio [OR] 1.153, 95% Confidence Interval [CI] 1.102‐1.207, P < .001) and Hispanic/Latino patients (OR 1.086, 95% CI 1.017‐1.159, P < .001) were slightly more likely to receive TTM compared to White patients, perhaps due to worse admission neurological status. We did find community level disparity as Hispanic/Latino‐serving hospitals (defined as the top decile of hospitals that cared for the highest proportion of Hispanic/Latino patients) provided less TTM (OR 0.587, 95% CI 0.474 to 0.742, P < .001). Conclusions Reassuringly, we did not find evidence of intrahospital or interpersonal racial or ethnic disparity in the provision of TTM. However, we did find inter‐hospital, community level disparity. Hispanic/Latino‐serving hospitals provided less guideline‐recommended TTM after OHCA.

Abstract 184: Racial Disparities in Out-Of-Hospital Cardiac Arrest Interventions and Survival in the Pragmatic Airway Resuscitation Trial

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Joshua R Lupton ◽  
Robert Schmicker ◽  
Jestin Carlson ◽  
Clifton W Callaway ◽  
Heather Herren ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Racial Disparities ◽  
Secondary Analysis ◽  
Laryngeal Tube ◽  
Advanced Airway ◽  
Black Patients ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest ◽  
White Patients

Background: Prior studies have reported racial disparities in survival from out-of-hospital cardiac arrest (OHCA). However, these studies did not evaluate how emergency medical services (EMS) provider assessment of race impacts OHCA interventions and survival. Our objective was to evaluate racial disparities in OHCA airway management and patient outcomes in the multicenter Pragmatic Airway Resuscitation Trial (PART). Methods: We conducted a secondary analysis of adult OHCA patients enrolled in PART. Trial subjects were randomized to initial advanced airway management with laryngeal tube or endotracheal intubation. The primary independent variable was patient race (categorized by EMS as white, black, and other). We used general estimating equations (GEE) to examine the association of race (white or black) with airway attempt success, 72-hour survival, and survival to hospital discharge, adjusting for sex, age, witness status, bystander CPR, initial rhythm, arrest location, and randomization cluster. Results: Of 3002 patients, race was 1537 white, 860 black, and 605 other. Median times (min [interquartile range]) from dispatch to arrival (5.4 [2.8] vs. 5.0 [2.3]), arrival to CPR (2.2 [2.7] vs. 2.0 [2.7]), and arrival to airway attempt (12.2 [7.6] vs. 11.0 [7.4]) were longer for black compared to white patients, respectively. Black patients had lower unadjusted odds of shockable rhythms (OR 0.59; 95% CI 0.47, 0.74), bystander CPR (0.47; 0.39, 0.56), and survival to discharge (0.68; 0.50, 0.92) than white patients. After adjustment for confounders, black race was not associated with airway success (OR 1.13; 95% CI 0.9, 1.41), 72-hr survival (1.06; 0.81, 1.30), or survival to discharge (0.82; 0.57, 1.19). Conclusions: Although black patients had lower odds of shockable rhythms and bystander CPR, airway success and survival odds were similar to white patients. Further studies are needed to better understand disparities in survival from OHCA.

scholarly journals Sex differences in survival after out-of-hospital cardiac arrest: a meta-analysis

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Hao Lei ◽  
Jiahui Hu ◽  
Leiling Liu ◽  
Danyan Xu
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Hospital Admission ◽  
Meta Analysis ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Treatment Measures ◽  
Clinically Significant ◽  
To Receive ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of sudden cardiac death worldwide. Researchers have found significant pathophysiological differences between females and males and clinically significant sex differences related to medical services. However, conflicting results exist and there is no uniform agreement regarding sex differences in survival and prognosis after OHCA. Therefore, we investigated the relationship between the prognosis of OHCA and sex factors. Methods We comprehensively searched the PubMed, Embase, and Cochrane databases and obtained a total of 1042 articles, from which 33 studies were selected for inclusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model. Results The meta-analysis included 1,268,664 patients. Compared with males, females were older (69.7 years vs. 65.4 years, p < 0.05) and more frequently suffered OHCA without witnesses (58.39% vs 62.70%, p < 0.05). Females were less likely to receive in-hospital interventions than males. There was no significant difference between females and males in the survival from OHCA to hospital admission (OR 0.99, 95% CI 0.89–1.1). However, females had lower chances for survival from hospital admission to discharge (OR 0.59, 95% CI 0.48–0.73), overall survival to hospital discharge (OR 0.73, 95% CI 0.62–0.86), and favorable neurological outcomes (OR 0.62, 95% CI 0.47–0.83) compared with males. Conclusions Our results indicate that the overall discharge survival rate of females is lower than that of males, and females face a poor prognosis of the nervous system. This is likely related to the pathophysiological characteristics of females, more conservative treatment measures compared with males, and different post-resuscitation care. However, these findings should be interpreted with caution due to the presence of several confounding factors.

scholarly journals Persistent Racial/Ethnic Disparities in Out-of-Hospital Cardiac Arrest

2021 ◽  
Vol 78 (2) ◽  
pp. 314-316
Author(s):  
Aditya C. Shekhar ◽  
Christopher Mercer ◽  
Robert Ball ◽  
Ira Blumen
Keyword(s):  
Cardiac Arrest ◽  
Ethnic Disparities ◽  
Racial Ethnic ◽  
Hospital Cardiac Arrest

scholarly journals Minimising delays in commencing therapeutic hypothermia after out-of-hospital cardiac arrest: the importance of a multi-disciplinary team approach

2010 ◽  
Vol 9 (1) ◽  
pp. 35-39
Author(s):  
Viral Kumar Patel ◽  
◽  
Paul Hayden ◽  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Team Approach ◽  
Mean Delay ◽  
Resuscitation Guidelines ◽  
Hospital Cardiac Arrest ◽  
Multi Disciplinary Team ◽  
Patient Episode

Therapeutic hypothermia (TH) is now a well established therapy in resuscitation guidelines. We retrospectively analysed our first 18 months’ data for all patients who underwent TH for out-of-hospital cardiac arrest (OHCA), measuring delays incurred during each patient episode, safety, and ICU outcomes. Sixteen patients received TH for OHCA. A mean delay of 248mins occurred following hospital admission to commencing therapy. Seven patients survived to hospital discharge with a 6 month Glasgow Outcome Score of 4-5 in 100%. A questionnaire evaluating 30 first responders’ familiarity and knowledge of TH demonstrated poor awareness and knowledge, with most viewing it with low priority. TH is a safe and easy to achieve therapy, however in practice there are significant delays in commencing treatment.

Abstract 317: Effect of Intra-arrest Induction of Therapeutic Hypothermia on Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
◽  
John Freese ◽  
Jeffrey Rabrich ◽  
Mark Menegus ◽  
Todd Slesinger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Phase I ◽  
Therapeutic Hypothermia ◽  
Phase Ii ◽  
Care Pathway ◽  
Rapid Infusion ◽  
Successful Resuscitation ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: The resuscitation literature has recently suggested that the prehospital initiation of therapeutic hypothermia following successful resuscitation does not alter outcomes among patients who suffer sudden out-of-hospital cardiac arrest (OOHCA). We sought to assess the impact of earlier, intra-arrest induction of therapeutic hypothermia on OOHCA survival. Methodology: Out-of-hospital cardiac arrest data from two consecutive twelve-month periods was analyzed: August 1, 2009 - July 31, 2010 (Phase I), August 1, 2010 - July 31, 2011 (Phase II). In Phase I, paramedics in this urban system transported OOHCA patient to participating Cardiac Arrest Centers where the use of therapeutic hypothermia had been incorporated to the standard post-resuscitation care pathway. In Phase II, paramedics initiated hypothermia during the initial resuscitation effort through the rapid infusion of large-volume, ice-cold saline. Consistent with the Utstein definitions, analyses utilized only those cases which were bystander witnessed and of cardiac etiology. Results: There were 1,487 and 850 bystander witnessed arrests of cardiac etiology in the two phases. Patient and arrest characteristics for the two groups did not differ with respect to age, gender, race, response time, bystander witnessed status, or the frequency of bystander CPR. Return of spontaneous circulation (ROSC), sustained ROSC, survival to hospital admission and survival to hospital discharge did not differ significantly from Phase I to Phase II: 40.82% vs 39.59% (p=.54), 31.10% vs 31.17% (p=0.58), 27.15% vs 24.88% (p=0.27), and 6.62% vs 6.19% (p=0.41). In addition, among those survivors for whom neurologic status is known, the intra-arrest initiation of therapeutic hypothermia did not significantly change the proportion of survivors considered neurologically intact (76.47% vs 70.37%, all p=0.59). Conclusions: The intra-arrest initiation of therapeutic hypothermia did not alter outcomes among OOHCA patients, demonstrating neither harm nor benefit. Whether this is due to a lack of continuation of hypothermia following hospital admission or a true lack of benefit requires further collaborative work between the prehospital and hospital communities.

scholarly journals Racial and Ethnic Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: An Analysis of 45 States and the District of Columbia

2021 ◽  
Vol 18 (6) ◽  
pp. 2921
Author(s):  
Jay J. Xu ◽  
Jarvis T. Chen ◽  
Thomas R. Belin ◽  
Ronald S. Brookmeyer ◽  
Marc A. Suchard ◽  
...  
Keyword(s):  
United States ◽  
District Of Columbia ◽  
Ethnic Disparities ◽  
The United States ◽  
Attributable Mortality ◽  
Race Ethnicity ◽  
Using Data ◽  
Rate Ratios ◽  
Degree Of Association ◽  
Racial Ethnic

The coronavirus disease 2019 (COVID-19) epidemic in the United States has disproportionately impacted communities of color across the country. Focusing on COVID-19-attributable mortality, we expand upon a national comparative analysis of years of potential life lost (YPLL) attributable to COVID-19 by race/ethnicity (Bassett et al., 2020), estimating percentages of total YPLL for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, non-Hispanic Asians, and non-Hispanic American Indian or Alaska Natives, contrasting them with their respective percent population shares, as well as age-adjusted YPLL rate ratios—anchoring comparisons to non-Hispanic Whites—in each of 45 states and the District of Columbia using data from the National Center for Health Statistics as of 30 December 2020. Using a novel Monte Carlo simulation procedure to perform estimation, our results reveal substantial racial/ethnic disparities in COVID-19-attributable YPLL across states, with a prevailing pattern of non-Hispanic Blacks and Hispanics experiencing disproportionately high and non-Hispanic Whites experiencing disproportionately low COVID-19-attributable YPLL. Furthermore, estimated disparities are generally more pronounced when measuring mortality in terms of YPLL compared to death counts, reflecting the greater intensity of the disparities at younger ages. We also find substantial state-to-state variability in the magnitudes of the estimated racial/ethnic disparities, suggesting that they are driven in large part by social determinants of health whose degree of association with race/ethnicity varies by state.

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