Abstract 14159: Characteristics and Outcomes in COVID-19 Pediatric In-Hospital Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Kasper G Lauridsen ◽  
Todd Sweberg ◽  
Sarah E Haskell ◽  
Orsola Gawronski ◽  
Dana E Niles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Mixed Effects ◽  
Survival Outcomes ◽  
Multivariate Logistic Regression ◽  
Quality Improvement Collaborative ◽  
Return Of Spontaneous Circulation ◽  
Pediatric Resuscitation ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: Survival of adult patients with COVID-19 who had an in-hospital cardiac arrest (IHCA) are poor. Characteristics and outcomes for pediatric IHCA patients with COVID-19 are unknown. Hypothesis: We hypothesized that pediatric COVID-19 patients would have worse survival outcomes when compared to non-COVID patients. Methods: A multicenter, multinational cohort of pediatric IHCA in the pediRES-Q collaborative were reviewed (March 1, 2020 - April 1, 2021). We characterized patients with COVID-19 compared to patients without COVID-19 and investigated whether COVID-19 was associated with survival outcomes using multivariate logistic regression with mixed effects. Results: We identified 362 pediatric IHCAs of which 14 were COVID-19 positive. For non-COVID-19 vs COVID-19 patients respectively, median [Q1; Q3] age was 1.0 [0.3; 7.1] vs. 7.1 [1.5; 14.0] years and 42% vs. 43% were female. Immediate cause of arrest was hypotension: 8% vs. 43%, respiratory decompensation: 19% vs. 21%, and hypoxia 22% vs. 36% for non-COVID-19 vs. COVID-19 patients. For non-COVID-19 vs COVID-19 patients, total CPR duration was 10 [4; 33] min vs 19 [5; 33] min (for non-return of spontaneous circulation (ROSC) cases only: 35 [20; 55] min vs 34 [24; 34] min). For non-COVID-19 vs COVID-19 patients, ROSC was 79% vs. 57%, aOR: 0.48 (95% CI: 0.24-0.98), survival to hospital discharge was 45% vs. 29%, aOR: 0.63 (95% CI: 0.25-1.57) and survival with favorable neurological outcome was 39% vs. 21%, aOR: 0.51 (95% CI: 0.16-1.65). Conclusions: In a pediatric resuscitation quality improvement collaborative, pediatric IHCA patients with COVID-19 were older when compared to non-COVID-19 patients. Median CPR duration was >30 minutes for COVID-19 non-survivors, COVID-19 patients had lower chance of ROSC when compared to non-COVID-19 patients but considerably better survival outcomes than those reported for adults.

Abstract 124: Chest Compression Pause Duration is Associated with Worse Survival Outcomes Following Pediatric In-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Kasper Glerup Lauridsen ◽  
Ryan W Morgan ◽  
Robert A Berg ◽  
Dana E Niles ◽  
Monica E Kleinman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Pause Duration ◽  
Spontaneous Circulation ◽  
Survival Outcomes ◽  
Lower Odds ◽  
Return Of Spontaneous Circulation ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest (IHCA) survival outcomes is unknown. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. Methods: Cohort study of all index pediatric IHCAs (<18 years of age) ≥1 min in the Pediatric Resuscitation Quality (PediRES-Q) Network from July 2015 through December 2019. We used multivariate logistic regression with mixed effects and robust standard errors to analyze association of 5-sec increments of longest CC pause duration with survival and neurologic outcomes. Favorable neurological outcome was defined as Pediatric Cerebral Performance Category (PCPC) at discharge ≤3 or no change from baseline. Results: We identified 371 index IHCAs: median [Q1,Q3] age 2.6 [0.6,9.4] years, female 46%, shockable rhythm 13%, CPR duration 23 [9,47] min. Median length of the longest pause was 17 [8,27] sec. Each 5 sec increase in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome, even after adjusting for age, defibrillation, intubation, extracorporeal CPR, illness category, hypotension as etiology for arrest, CC depth, and clustering by site (aOR 0.94 [95% CI:0.88-0.99], p=0.04). Analyses controlling for the same factors demonstrated an association of longest pause duration with lower odds for survival to hospital discharge (aOR 0.94 [95% CI: 0.90-0.99, p=0.02) and return of spontaneous circulation (aOR 0.91 [(95% CI: 0.86-0.96], p=0.001). Conclusions: Longest CC pause duration is associated with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation following pediatric IHCA, even when controlling for known confounders and clustering by site. Each 5 sec. increment in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome.

Abstract 132: Neurological Favorable Outcome Associated With Number of Prehospital Defibrillation Attempts in Out-of-Hospital Cardiac Arrest Without Return of Spontaneous Circulation on Scene

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Seulki Choi ◽  
Tae Han Kim ◽  
Ki Jeong Hong ◽  
Sung Wook Song ◽  
Joo Jeong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Discharge Rate ◽  
Spontaneous Circulation ◽  
Successful Resuscitation ◽  
Return Of Spontaneous Circulation ◽  
Hospital Transport ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The early and timely defibrillation in shockable rhythm of out-of-hospital cardiac arrest (OHCA) by prehospital EMS providers is crucial for successful resuscitation. In emergency medical service (EMS) system, where advanced cardiac life support could not be fully provided before hospital transport, optimal range of prehospital defibrillation attempts is debatable. We evaluated association between number of prehospital defibrillation attempts and survival outcomes in OHCA patients who were unresponsive to field resuscitation and defibrillations. Methods: This is a retrospective observational study using nationwide OHCA registry of Korea from 2013 to 2016. Adult EMS treated OHCA with presumed cardiac origin with shockable initial ECG rhythm were enrolled. Final analysis was performed in patients who did not achieve return of spontaneous circulation (ROSC) on scene before hospital transport. We categorized number of prehospital defibrillation attempt into 3 groups: ≤3 attempts, 4-5 attempts and ≥6 attempts. Primary outcome was favorable neurological outcome at hospital discharge. Multivariable logistic regression modeling was used to evaluate association between neurological outcome and defibrillation attempts. Result: Total 6,679 patients were enrolled for final analyzed. Among total ≤3 defibrillations were attempted in 5015 patients (75.1%), 1050 patients (15.7%) for 4-5 attempts, 614 patient. (9.2%) for ≥6 attempts. Although survival to discharge rate was highest in group with ≤3 defibrillation attempts (8.1% vs. 7.0% vs. 2.9%, p<0.01), survival rate with favorable neurological outcome was highest in group with 4-5 defibrillation attempts (3.0% vs. 4.5% vs. 2.1%, p=0.02). As 4-5 attempts group reference, adjusted odds ratio for favorable neurological outcome of ≤3 attempts was 0.66 (95% CI 0.46 - 0.94) and of ≥6 attempts was 0.47 (95% CI 0.25 - 0.89). Conclusion: For patients with shockable initial cardiac rhythm who were unresponsive to filed defibrillation and resuscitation, moderate amount of defibrillation attempt was associated with favorable neurological outcome compared to fewer defibrillation attempts and prolonged number of defibrillation attempts on scene.

Abstract 342: The Relationship Between Time Interval From Collapse to Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ken Nagao ◽  
Yoshio Tahara ◽  
Hiroshi Nonogi ◽  
Naohiro Yonemoto ◽  
David F Gaieski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Time Interval ◽  
Return Of Spontaneous Circulation ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Background: Early cardiopulmonary resuscitation (CPR) and early defibrillation are critical to survival from out-of-hospital cardiac arrest (OHCA). However, few studies have investigated the relationship between time interval from collapse to return of spontaneous circulation (ROSC) and neurologically intact survival. Methods: From the All-Japan OHCA Utstein Registry between 2005 and 2015, we enrolled adult patients achieving prehospital ROSC after witnessed OHCA, inclusive of arrest after emergency medical service responder arrival. The study patients were divided into two groups according to initial cardiac arrest rhythm (shockable versus non-shockable). The collapse-to-ROSC interval was calculated as the time interval from collapse to first achievement of prehospital ROSC. The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: A total of 69,208 adult patients achieving prehospital ROSC after witnessed OHCA were enrolled; 23,017(33.3%) the shockable arrest group and 46,191 (66.7%) the non-shockable arrest group. The shockable arrest group compared with the non-shockable arrest group had significantly shorter collapse-to-ROSC interval (16±10 min vs. 20±13 min, P<0.001) and significantly higher frequency of the favorable neurological outcome (54.9% vs. 15.3%, P<0.001). Frequencies of the favorable neurological outcome after shockable OHCA decreased to 1.2% to 1.5% with every minute that the collapse-to-ROSC interval was delayed (78% at 1 minute of collapse, 68% at 10 minutes, 44% at 20 minutes, 34% at 30 minutes, 16% at 40 minutes, 4% at 50 minutes and 0% at 60 minutes, respectively, P<0.001), and those after non-shockable OHCA decreased to 0.8% to 1.8% with every minute that the collapse-to-ROSC interval was delayed (40% at 1 minute of collapse, 26% at 10 minutes, 11% at 20 minutes, 5% at 30 minutes, 2% at 40 minutes, 0% at 50 minutes and 0% at 60 minutes, respectively, P<0.001). Conclusions: Termination of the collapse-to-ROSC interval to achieve neurologically intact survival after witnessed OHCA was 50 minutes or longer irrespective of initial cardiac arrest rhythm (shockable versus non-shockable), although the neurologically intact survival rate was difference between the two groups.

Abstract 152: Cerebral Oximetry During Pediatric In-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Ivie D Esangbedo ◽  
Prakadeshwari Rajapreyar ◽  
Matthew Kirschen ◽  
Richard Hanna ◽  
Dana E Niles ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Logistic Regression ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
Congenital Heart ◽  
Spontaneous Circulation ◽  
Cerebral Oximetry ◽  
Return Of Spontaneous Circulation ◽  
Pediatric Resuscitation ◽  
Hospital Cardiac Arrest

Introduction: Cerebral near-infrared spectroscopy (NIRS) measuring regional oxygen saturation (rSO 2 ) during cardiopulmonary resuscitation (CPR) is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in adults, with limited data in children. We hypothesized mean cerebral rSO 2 during pediatric in-hospital cardiac arrest (IHCA) would be associated with return of spontaneous circulation (ROSC). Methods: Consecutive case series of pediatric IHCA events with rSO 2 data reported between 2016-2020 by 3 sites to the Pediatric Resuscitation Quality (pediRES-Q) collaborative. We excluded patients with CPR duration ≤2 minutes or who had return of circulation via extracorporeal membrane oxygenation. We calculated mean rSO 2 for duration of CPR and the primary outcome measure was ROSC. Exploratory sensitivity analyses were performed for cutoffs of mean rSO 2 >25, >30, >35, >40 and >50%. Analysis was done using independent samples t test, Exact logistic regression and Fisher’s exact test. Results: Of 36 events (26 index), median age was 3 [IQR 1,7.8] months; 29 (80.5%) had congenital heart disease and 15 (41.7%) had single ventricle (SV) physiology. Median CPR duration was 7.5 [IQR 3.8, 32.2] minutes and 28/36 (77.8%) had ROSC. Mean intra-arrest cerebral rSO 2 was 44.2% (±19.5) for ROSC vs. 37.4% (±15) for non-ROSC group ( p =0.267). Using Exact logistic regression, there was no association found between rSO 2 and ROSC, even after controlling for age, presence of congenital heart disease, and SV physiology. Using mean rSO 2 cutoffs >25, >30, >35, >40, and >50%, we found no significant association with ROSC. We found same result in the SV subgroup. Conclusion: In this small pediatric cohort of predominantly cardiac patients, there was no significant association between cerebral rSO 2 during pediatric cardiac arrest and ROSC, even after controlling for important confounders of age and SV physiology. More extensive studies using larger populations, and evaluating intra-arrest change in cerebral rSO 2 from baseline, are warranted to provide more insight into the possibilities of using rSO 2 to guide CPR.

scholarly journals Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175257 ◽  
Author(s):  
Hiroyuki Koami ◽  
Yuichiro Sakamoto ◽  
Ryota Sakurai ◽  
Miho Ohta ◽  
Hisashi Imahase ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jocelyn Berdowski ◽  
Andra Schmohl ◽  
Rudolph W Koster
Keyword(s):  
Cardiac Arrest ◽  
World Wide ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Return Of Spontaneous Circulation ◽  
Resuscitation Guidelines ◽  
Rhythm Analysis ◽  
New Guidelines ◽  
Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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