Abstract 14493: Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Shaveta Khosla ◽  
Marina Del Rios ◽  
Pavitra Kotini-shah ◽  
E Bradshaw B Bunney ◽  
Teri Campbell ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Arrest ◽  
Age Distribution ◽  
Temporal Distribution ◽  
Healthcare Facility ◽  
Bivariate Analysis ◽  
Chi Square ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method: Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Results: A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion: A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID-19 on OHCA survival needs to be examined further in future studies.

scholarly journals Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Andrew Fu Wah Ho ◽  
Nurun Nisa Amatullah De Souza ◽  
Audrey L. Blewer ◽  
Win Wah ◽  
Nur Shahidah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Care ◽  
Survival Rates ◽  
Prehospital Emergency Care ◽  
Shockable Rhythm ◽  
Automated External Defibrillation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Hospital Cardiac Arrest

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

scholarly journals Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243757
Author(s):  
Joongyub Lee ◽  
Woojoo Lee ◽  
Yu Jin Lee ◽  
Hyunman Sim ◽  
Won Kyung Lee
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Directed Acyclic Graph ◽  
Neurological Recovery ◽  
Outcome Variable ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Male Patients ◽  
Unbiased Estimates ◽  
Hospital Cardiac Arrest

Introduction Few studies have focused on enhancing causality and yielding unbiased estimates on the effectiveness of bystander cardiopulmonary resuscitation (BCPR) on the outcomes of out-of-hospital cardiac arrest (OHCA) in a real-world setting. Therefore, this study evaluated the effect of BCPR on the outcomes of OHCA and its differences according to the characteristics of OHCA. Methods This study enrolled all patients with OHCA of cardiac etiology treated by emergency medical services (EMS) in Korea from 2012 to 2015. The endpoints were survival and neurological recovery at discharge, and the main exposure was BCPR conducted by a layperson. The effect of BCPR was analyzed after adjusting for confounders, determined using a directed acyclic graph, by inverse probability of treatment weighting (IPTW) and model-based standardization (STR). Moreover, differences in subgroups and time trends were evaluated. Results Among 10,505 eligible patients after excluding those with missing data on BCPR, 7,721 patients received BCPR, accounting for 74.3% of EMS-treated OHCA patients. BCPR increased the odds of survival and good neurological recovery at discharge by 1.67- (95% confidence interval (CI): 1.44–1.93) and 1.93- (95% CI: 1.56–2.39) fold, respectively, in the IPTW analysis. These findings were comparable to those obtained with STR. The odds ratios were 2.39 (95% CI: 1.91–2.94) and 2.70 (95% CI: 1.94–3.41), respectively, in the sensitivity analysis of the missing BCPR information considering confounders and the outcome variable. However, the effect of qualified BCPR was not evenly distributed, and it did not increase with time. BCPR was likely to be more effective in male patients aged <65 years, those who experienced an OHCA in a private place or non-capital region, and those with shockable rhythm at the scene. Conclusion Based on data from a nationwide registry, the estimated effect of BCPR on survival and neurological recovery was moderate and did not improve from 2012 to 2015.

scholarly journals Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuling Chen ◽  
Peng Yue ◽  
Ying Wu ◽  
Jia Li ◽  
Yanni Lei ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Indirect Effect ◽  
Prospective Observational Study ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA), a global health problem with a survival rate ranging from 2 to 22% across different countries, has been a leading cause of premature death for decades. The aim of this study was to evaluate the trends of survival after OHCA over time and its relationship with bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, return of spontaneous circulation (ROSC), and survived event. Methods In this prospective observational study, data of OHCA patients were collected following the “Utstein style” by the Beijing, China, Emergency Medical Service (EMS) from January 2011 (data from February to June in 2011 was not collected) to October 2016. Patients who had a cardiac arrest and for whom an ambulance was dispatched were included in this study. All cases were followed up to determine hospital discharge or death. The trend of OHCA survival was analyzed using the Chi-square test. The relationship among bystander CPR, initial shockable rhythm, ROSC, survived event, and OHCA survival rate was analyzed using multivariate path analyses with maximum standard likelihood estimation. Results A total of 25,421 cases were transferred by the Beijing EMS; among them, 5042 (19.8%) were OHCA (median age: 78 years, interquartile range: 63–85, 60.1% male), and 484 (9.6%) received bystander CPR. The survival rate was 0.6%, which did not improve from 2012 to 2015 (P = 0.569). Overall, bystander CPR was indirectly associated with an 8.0% (β = 0.080, 95% confidence interval [CI] = 0.064–0.095, P = 0.002) increase in survival rate. The indirect effect of bystander CPR on survival rate through survived event was 6.6% (β = 0.066, 95% CI = 0.051–0.081, P = 0.002), which accounted for 82.5% (0.066 of 0.080) of the total indirect effect. With every 1 increase in survived event, the possibility of survival rate will directly increase by 53.5% (β = 0.535, 95% CI = 0.512–0.554, P = 0.003). Conclusions The survival rate after OHCA was low in Beijing which has not improved between 2012 and 2015. The effect of bystander CPR on survival rate was mainly mediated by survived event. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002149 (2 May, 2012, retrospectively registered). http://www.chictr.org.cn/showproj.aspx?proj=7400

scholarly journals Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 314-321 ◽  
Author(s):  
Jason E. Buick ◽  
Steve Lin ◽  
Valeria E. Rac ◽  
Steven C. Brooks ◽  
Gérald Kierzek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Response Times ◽  
Spontaneous Circulation ◽  
Public Access ◽  
Health Concern ◽  
Bivariate Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

ABSTRACT Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

Abstract 408: Predictors of Survival to Hospital Discharge, a Machine Learning Modelfor Out-Of-Hospital Cardiac Arrest in the Young

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Alyssa Vermeulen ◽  
Hoang Nguyen ◽  
Hai Nguyen ◽  
Teri Campbell ◽  
Marina Del Rios
Keyword(s):  
Machine Learning ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Sampling Technique ◽  
Healthcare Facility ◽  
Machine Learning Techniques ◽  
Positive Trend ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest

Background: Many efforts in the area of Out of Hospital Cardiac Arrest (OHCA) have been made to enhance diagnosis, interventions, and increase survival; there is little data on OHCA in the young (1-35 years old). Machine learning (ML) enhances medical diagnosis and decision making with recent models allowing clinicians better control and interpretation of their features. Objective: To develop a machine learning model to predict a young patient with OHCA survival to hospital discharge. The ML model will be used to identify important factors contributing to this predictive model. Methods: Utilizing the CARES database in Chicago, IL, from 2013 to 2017, all OHCA in ages 1-35 years were analyzed; the primary outcome of interest is survival to hospital discharge. Eight machine learning techniques were applied to classify survival to hospital discharge. XGBoost was used with decision trees. Synthetic Minority Over-sampling Technique was used to over-sample the under-represented population. All statistics were performed using Python. Results: 744 events were analyzed from 2013 to 2017. Median age was 24.6 years, of these 19.2% were 18 years and younger. The sample was 46% black, 31% caucasian and 19% Hispanic and 68% were male. Presumed cardiac etiology was identified in 61%; 13% had a shockable rhythm; 59% of events were unwitnessed. The model was able to classify survival and death with an accuracy of 90% and AUC of 0.98. Strongest positive correlation of survival to discharge was seen with sustained ROSC, first rhythm type being a shockable rhythm, and use of hypothermia. There was correlation with the year arrest occurred, with positive trend of survival over the study period time. There was a positive trend toward survival with advanced airway and epinephrine use. There was a negative trend toward survival with unwitnessed arrest and location outside of home or healthcare facility. Conclusions: The XGBoost model showed excellent classification of those who survive to discharge and die with OHCA in those 1-35 years old. Most rhythms in this population were not shockable rhythms despite over half of arrests being presumed cardiac in nature. Standard machine learning models can help identify and determine relevant interventions to improve OHCA in the young.

Abstract 16428: Characteristics and Impact of Bystander Cardiopulmonary Resuscitation Following Pediatric Out of Hospital Cardiac Arrest in the United States: A Study From the Cardiac Arrest Registry to Enhance Survival (CARES)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maryam Y Naim ◽  
Rita V Burke ◽  
Bryan F McNally ◽  
Robert A Berg ◽  
Kimberly Vellano ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
The United States ◽  
Hispanic Children ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Few Data ◽  
Hospital Cardiac Arrest

Introduction: Bystander cardiopulmonary resuscitation (BCPR) is associated with improved outcome in adult out-of-hospital cardiac arrest (OHCA). There are few data on the prevalence and impact of BCPR on children. Hypothesis: We aimed to characterize BCPR in pediatric OHCA and test the hypothesis that BCPR would occur infrequently and would be associated with neurologically favorable survival at hospital discharge from a large cardiac arrest registry in the United States. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years of age and non-traumatic OHCA from January 1, 2013 through December 31, 2014. Neurologically favorable survival was defined as a Cerebral Performance Category Scale of 1 or 2. Results: A total of 2,176 cardiac arrests were evaluated. Most patients were infants (62%) or adolescents (19%). Most arrests occurred at home (86%), were unwitnessed (75%), and had a non-shockable rhythm (93%). BCPR was provided in 49%, most commonly by a family member (71%). BCPR was more common for white (60%) compared to black (42%) and Hispanic children (44%) (p<0.001). Overall, BCPR was associated with a higher rate of neurologically favorable survival (11% vs. 7%, odds ratio [OR]1.6 95% confidence interval [CI] 1.2-2.3). In sub-group analyses, BCPR was associated with a higher rate of neurologically favorable survival for out of home arrests (34% vs. 15%, OR 2.9, 95% CI 1.6-5.3), and arrests presenting in a shockable rhythm (48% vs. 32%, OR 2.0 95% CI 1.0-4.0). For infants BCPR was not associated with survival (6.4% vs. 6.0%, OR 1.1 95% CI 0.7-1.7) or neurologically favorable survival (5.2% vs. 5.0%, OR 1.1 95% CI 0.6-1.8). Conclusion: BCPR was provided in just under 50% of pediatric OHCAs and was more common for white compared to black and Hispanic children. BCPR was associated with improved survival that was most notable in out of home arrests, with over twice as many patients having neurologically favorable survival. Though infants comprised the largest age group, no effect of BCPR outcome was observed. This impact of BCPR suggests the need for a public health strategy to improve the provision of BCPR, and the need for an alternative strategy for some groups including infants.

scholarly journals Survival of In-Hospital Cardiac Arrest in COVID-19 Infected Patients

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1315
Author(s):  
Mohammad Aldabagh ◽  
Sneha Wagle ◽  
Marie Cesa ◽  
Arlene Yu ◽  
Muhammad Farooq ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Arrest ◽  
Medical Center ◽  
Survival Rates ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Shockable Rhythm ◽  
Artery Disease ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Background: There are limited data regarding the outcome of in-hospital cardiopulmonary resuscitation (CPR) in COVID-19 patients. In this study, we compared the outcomes of in-hospital cardiac arrests (IHCA) before and at the peak of the COVID-19 pandemic at Montefiore Medical Center in the Bronx, New York, United States. We also identified the most common comorbidities associated with poor outcomes in our community. Methods: This was a multi-site, single-center, retrospective, observational study. Inclusion criteria for COVID patients were all confirmed positive cases who had in-hospital cardiac arrest (IHCA) between 1 March 2020 and 30 June 2020. The non-COVID cohort included all cardiac arrest cases who had IHCA in 2019. We excluded all out-of-hospital cardiac arrest (OHCA). We compared actual survival to that predicted by the GO-FAR score, a validated prediction model for determining survival following IHCA. Results: There were 334 cases in 2019 compared to 450 cases during the specified period in 2020. Patients who initially survived cardiac arrest but then had their code statuses changed to do not resuscitate (DNR) were excluded. Groups were similar in terms of sex distribution, and both had an average age of about 66 years. Seventy percent of COVID patients were of Black or Hispanic ethnicity. A shockable rhythm was present in 7% of COVID patients and 17% of non-COVID patients (p < 0.05). COVID patients had higher BMI (30.7 vs. 28.4, p < 0.05), higher prevalence of diabetes mellitus (58% vs. 38%, p < 0.05), and lower incidence of coronary artery disease (22% vs. 35%, p < 0.05). Both groups had almost similar predicted average survival rates based on the GO-FAR score, but only 1.5% of COVID patients survived to discharge compared to 7% of non-COVID patients (p < 0.05). Conclusion: The rate of survival to hospital discharge in COVID-19 patients who suffer IHCA is worse than in non-COVID patients, and lower than that predicted by the GO-FAR score. This finding may help inform our patient population about risk factors associated with high mortality in COVID-19 infection, as well as educate hospitalized patients and healthcare proxies in the setting of code status designation.

scholarly journals Gender Based Differences in Outcomes among Resuscitated Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Author(s):  
Purav Mody ◽  
Ambarish Pandey ◽  
Arthur S. Slutsky ◽  
Matthew W. Segar ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Do Not Resuscitate ◽  
Logistic Regression Models ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Resuscitated Patients ◽  
Gender Based ◽  
Hospital Cardiac Arrest

Background: Studies examining gender-based differences in outcomes of out-of-hospital cardiac arrest patients have demonstrated that despite a higher likelihood of return of spontaneous circulation, women do not have higher survival. Methods: Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the Continuous Chest Compression trial were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time and duration of resuscitation. Do Not Resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in post resuscitation outcomes were modified by baseline prognosis. The analysis was replicated among Amiodarone, Lidocaine, or Placebo Cardiac Arrest trial participants. Results: Among 4,875 successfully resuscitated patients, 1,825 (37.4%) were women and 3,050 (62.6%) were men. Women were older (67.5 vs. 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% vs. 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% vs. 64.5%) or had shockable rhythm (24.3% vs. 44.6%, p<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% vs. 32.1%, p=0.009) and had WLST (32.8% vs. 29.8%, p=0.03). Discharge survival was significantly lower in women (22.5% vs. 36.3%, p<0.001, adjusted odds ratio [OR] 0.78, 95% confidence interval [C.I.] 0.66 - 0.93, p=0.005). The association between gender and discharge survival was modified by DNR and WLST order status such that women had significantly reduced discharge survival among patients who were not made DNR (31.3% vs. 49.9%, p=0.005, adjusted OR 0.74, 95% C.I. 0.60 - 0.91) or did not have WLST (32.3% vs. 50.7%, p=0.002, adjusted OR 0.73, 95% C.I. 0.60 - 0.89). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% vs. 7.4%, p=0.90) or had WLST (2.8% vs. 2.4%, p=0.93). Consistent patterns of association between gender and post-resuscitation outcomes were observed in the secondary cohort. Conclusions: Among resuscitated out-of-hospital cardiac arrest patients, discharge to survival was significantly lower in women compared with men especially among patients considered to have a favorable prognosis.

Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Arnaud Gille ◽  
Richard Chocron ◽  
Anna Ozguler ◽  
Xavier JOUVEN ◽  
Alain Cariou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Low Flow ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Younger Age ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

Effect of chest-compression-only bystander cardiopulmonary resuscitation on the likelihood of initial shockable rhythm after out-of-hospital cardiac arrest: a propensity matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Funada ◽  
Y Goto ◽  
T Maeda ◽  
H Okada ◽  
M Takamura
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr

Abstract Background/Introduction Shockable rhythm after cardiac arrest is highly expected after early initiation of bystander cardiopulmonary resuscitation (CPR) owing to increased coronary perfusion. However, the relationship between bystander CPR and initial shockable rhythm in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that chest-compression-only CPR (CC-CPR) before emergency medical service (EMS) arrival has an equivalent effect on the likelihood of initial shockable rhythm to the standard CPR (chest compression plus rescue breathing [S-CPR]). Purpose We aimed to examine the rate of initial shockable rhythm and 1-month outcomes in patients who received bystander CPR after OHCA. Methods The study included 59,688 patients (age, ≥18 years) who received bystander CPR after an OHCA with a presumed cardiac origin witnessed by a layperson in a prospectively recorded Japanese nationwide Utstein-style database from 2013 to 2017. Patients who received public-access defibrillation before arrival of the EMS personnel were excluded. The patients were divided into CC-CPR (n=51,520) and S-CPR (n=8168) groups according to the type of bystander CPR received. The primary end point was initial shockable rhythm recorded by the EMS personnel just after arrival at the site. The secondary end point was the 1-month outcomes (survival and neurologically intact survival) after OHCA. In the statistical analyses, a Cox proportional hazards model was applied to reflect the different bystander CPR durations before/after propensity score (PS) matching. Results The crude rate of the initial shockable rhythm in the CC-CPR group (21.3%, 10,946/51,520) was significantly higher than that in the S-CPR group (17.6%, 1441/8168, p&lt;0.0001) before PS matching. However, no significant difference in the rate of initial shockable rhythm was found between the 2 groups after PS matching (18.3% [1493/8168] vs 17.6% [1441/8168], p=0.30). In the Cox proportional hazards model, CC-CPR was more negatively associated with the initial shockable rhythm before PS matching (unadjusted hazards ratio [HR], 0.97; 95% confidence interval [CI], 0.94–0.99; p=0.012; adjusted HR, 0.92; 95% CI, 0.89–0.94; p&lt;0.0001) than S-CPR. After PS matching, however, no significant difference was found between the 2 groups (adjusted HR of CC-CPR compared with S-CPR, 0.97; 95% CI, 0.94–1.00; p=0.09). No significant differences were found between C-CPR and S-CPR in the 1-month outcomes after PS matching as follows, respectively: survival, 8.5% and 10.1%; adjusted odds ratio, 0.89; 95% CI, 0.79–1.00; p=0.07; cerebral performance category 1 or 2, 5.5% and 6.9%; adjusted odds, 0.86; 95% CI, 0.74–1.00; p=0.052. Conclusions Compared with S-CPR, the CC-CPR before EMS arrival had an equivalent multivariable-adjusted association with the likelihood of initial shockable rhythm in the patients with OHCA due to presumed cardiac causes that was witnessed by a layperson. Funding Acknowledgement Type of funding source: None

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