Abstract 9114: Impact of the Number of Prehospital Defibrillation Attempts on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest and Shockable Rhythm

Background: Early return of spontaneous circulation (ROSC) leads to survival with a favorable neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). For the early ROSC, defibrillation plays a crucial role for OHCA with shockable rhythm. However, little is known about the relation between the number of prehospital defibrillation attempts or etiology of OHCA and neurologically intact survival. Methods: Using a nationwide OHCA registry database from 2005 to 2017 in Japan, a cohort of 1,527,447 patients with OHCA were retrospectively analyzed. We included the patients of witnessed OHCAs with initial shockable rhythm. The relation between early ROSC, defined as prehospital ROSC achieved with defibrillation ≤3 times without adrenaline, and a neurologically intact survival rate (cerebral performance category score of 1 or 2 at 1 month) was evaluated. We also analyzed factors related to the successful early ROSC, including etiology of OHCA. Results: A total of 75,342 patients were included. Among patients with OHCA and prehospital ROSC, neurologically intact survival rates were better in patients who achieved early ROSC than their counterpart (62% vs. 36%, p<0.001). Success in early ROSC was an independent predictor of neurologically intact survival after adjustment of multiple cofounders (Table). Multivariate analysis showed cerebral vascular disease as an etiology of OHCA was a predictor of early ROSC (odds ratio 1.15, 95% confidence interval 1.03-1.29, p=0.02), but was significantly associated with a poor neurologic outcome at 1 month (Table). Conclusions: Success in early ROSC was associated with neurologically intact survival in patients with OHCA and initial shockable rhythm. Patients with OHCA due to cerebral vascular disease were likely to be resuscitated from cardiac arrest by defibrillations but had a poor neurologic outcome.

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Abstract 01: The Importance of Time to Cooling in Out-Of-Hospital Cardiac Arrest Patients to Influence Neurologically Intact Survival: A Sub-Analysis of the Princess Trial

Circulation ◽

10.1161/circ.140.suppl_2.01 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Akil Awad ◽

Fabio Silvio Taccone ◽

Martin Jonsson ◽

Sune Forsberg ◽

Jacob Hollenberg ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Life Support ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Control Group ◽

Shockable Rhythm ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Background: Early initiation of hypothermia has shown to be important to reduce brain injuries in experimental cardiac arrest models. The aim of this study was to investigate the association between time to initiate cooling and neurological intact survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: A secondary analysis of prospectively collected data from the PRINCESS trial (NCT01400373) including 677 OHCA patients randomized to transnasal evaporative intra-arrest cooling or standard advanced life support and cooling started subsequent to hospital arrival. Time to randomization was used a proxy measurement for time to initiate cooling. An early treatment group was defined as patients randomized by the EMS <20 minutes from the time of the cardiac arrest. Propensity scores were used to find matching patients in the control group. Patients with initial shockable rhythms were analyzed as a predefined subgroup. The primary outcome was good neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Secondary outcome was complete recovery (CPC 1). Results: In total 406 patients were randomized <20 minutes from the cardiac arrest and were propensity score matched (1:1). In the propensity score matched analysis the proportion of patients with CPC 1-2 was 21.7% in the intervention and 17.2% in the control group, odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.21, p=0.273. In patients with initial shockable rhythm (79 intervention, 79 control) the difference in CPC 1-2 was 48.1% versus 32.0%, OR 2.05, 95%CI 1.00-4.21, p=0.0498. The proportion of patients with complete neurologic recovery, CPC 1, was 19.7% in the intervention and 13.3% in the control group, OR 1.60, 95% CI 0.92-2.79, p=0.097. In patients with initial shockable rhythm the proportion with CPC 1 was 45.6% versus 24.6%, OR 2.81, 95% CI 1.23-6.42, p=0.014. Conclusions: In this ancillary study of OHCA patients receiving intra-arrest cooling, there were differences in survival with good neurologic outcome and in complete neurological recovery in favor of early intra-arrest cooling patient group compared to standard care. These differences were statistically significant in the subgroup of patients with initial shockable rhythms.

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P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest

EP Europace ◽

10.1093/europace/euaa162.103 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Goto ◽

A Funada ◽

T Maeda ◽

F Okada ◽

Y Goto

Keyword(s):

Cardiac Arrest ◽

Cerebral Performance Category ◽

Flow Duration ◽

Shockable Rhythm ◽

Number Of Patients ◽

Initial Rhythm ◽

The Relationship ◽

Neurologically Intact ◽

Utstein Style ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA. Purpose The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA. Methods We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site. Results The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to <10%, <5%, and <1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to <10%, <5%, and <1%, were 10, 11, and 15 minutes, respectively. Conclusions In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be <17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.

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How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

10.21203/rs.3.rs-106512/v1 ◽

2020 ◽

Author(s):

Byuk Sung Ko ◽

Youn-Jung Kim ◽

Kap Su Han ◽

You Hwan Jo ◽

Jonghwan Shin ◽

...

Keyword(s):

Cardiac Arrest ◽

Odds Ratio ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Shockable Rhythm ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

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Association of subsequent shock after conversion to shockable rhythm with outcomes stratified by the type of initial non-shockable rhythm in children with out-of-hospital cardiac arrest

EP Europace ◽

10.1093/europace/euab116.349 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

Y Goto ◽

A Funada ◽

T Maeda ◽

Y Goto

Keyword(s):

Cardiac Arrest ◽

Prognostic Significance ◽

Cerebral Performance Category ◽

Pulseless Electrical Activity ◽

Delivery Time ◽

Shock Delivery ◽

Shockable Rhythm ◽

Significant Difference ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research) Background/Introduction: The rhythm conversion from initial non-shockable to shockable rhythm during cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA) in children with an initial non-shockable rhythm. However, the prognostic significance of rhythm conversion stratified by the type of initial non-shockable rhythm is still unclear. Purpose We aimed to investigate the association of subsequent shock after rhythm conversion to shockable rhythm with neurologically intact survival and shock delivery time (time from EMS-initiated CPR to first shock delivery) by the type of initial non-shockable rhythm in children with OHCA. Methods We analysed the records of 19,095 children (age <18 years) with OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 13-year period (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category score of 1 to 2. Patients were divided into the initial pulseless electrical activity (PEA) (n = 3,326 [17.4%]) and initial asystole (n = 15,769 [82.6%]) groups. Results The proportion of patients who received subsequent shock after conversion to shockable rhythm was significantly higher in the initial PEA than in the initial asystole groups (3.3% [109/3,326] vs. 1.4% [227/15,769], p < 0.0001). The shock delivery time was significantly shorter in the initial PEA than in the initial asystole groups (median [IQR], 8 min [5 min – 12 min] vs. 10 min [6 min – 16 min], p < 0.01). Among the initial PEA patients, there was no significant difference between subsequently shocked (10.0% [11/109]) and subsequently non-shocked patients (6.0% [192/3,217], p = 0.10) regarding the rate of 1-month neurologically intact survival. However, after adjusting for 9 pre-hospital variables, subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.16–5.16], p = 0.018). Among the initial asystole patients, the rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked (4.4% [10/227]) than in the subsequently non-shocked (0.7% [106/15,542], p < 0.0001). A multivariate logistic regression model showed that subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted OR, 9.77 [95% CI, 4.2–22.5], p < 0.0001). Conclusions In children with OHCA with an initial non-shockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered <10 min from EMS-initiated CPR regardless of the type of initial rhythm.

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Abstract 9502: Prehospital Variables Associated With Neurologically Intact Survival in Elderly Survivors After Out-of-Hospital Cardiac Arrest: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽

10.1161/circ.144.suppl_2.9502 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Akira Funada ◽

Yoshikazu Goto ◽

Masayuki Takamura

Keyword(s):

Cardiac Arrest ◽

Service Providers ◽

Recursive Partitioning ◽

Age Groups ◽

Cerebral Performance Category ◽

Multivariate Logistic Regression Analysis ◽

Population Based ◽

Shockable Rhythm ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Introduction: Prehospital variables associated with neurologically intact survival in elderly survivors after out-of-hospital cardiac arrest (OHCA) are unclear and could differ according to age. Methods: We evaluated 6,349 elderly patients with OHCA (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC) and survived for at least 1-month after OHCA. Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients were divided into three groups by age (65-74, 75-89, or ≥ 90 years). The time from call receipt to ROSC was calculated. Results: The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years were 66.5% (2,079/3,125), 52.9% (1,557/2,943), and 42.7% (120/281), respectively (p for trend < 0.001). In multivariate logistic regression analysis, initial shockable rhythm and witnessed arrest were significantly associated with 1-month CPC 1-2 for all age groups (Table). However, the presence of bystander cardiopulmonary resuscitation (CPR) was significantly associated with 1-month CPC 1-2 only for patients aged 65-74 years. Time from call receipt to ROSC was not associated with 1-month CPC 1-2 for patients aged ≥ 90 years. In recursive partitioning analysis, the best single predictor for 1-month CPC 1-2 was initial shockable rhythm for all age groups. The next predictor for patients aged 65-74 years with initial shockable rhythm was the presence of bystander CPR, whereas the witnessed arrest was the next predictor for patients aged 65-74 years with initial non-shockable rhythm and other age groups regardless of the initial rhythm. Conclusions: Prehospital variables associated with neurologically intact survival in elderly survivors after OHCA varied with age.

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Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

Annals of Intensive Care ◽

10.1186/s13613-019-0593-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Ferran Rueda ◽

Germán Cediel ◽

Cosme García-García ◽

Júlia Aranyó ◽

Marta González-Lopera ◽

...

Keyword(s):

Cardiac Arrest ◽

Tissue Injury ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Home Setting ◽

Growth Differentiation Factor 15 ◽

Poor Outcome ◽

Differentiation Factor ◽

Hospital Cardiac Arrest ◽

Early Predictor

Abstract Background Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA). Methods Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed. Results Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients. Conclusions After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.

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Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Scientific Reports ◽

10.1038/s41598-020-79283-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yo Sep Shin ◽

Youn-Jung Kim ◽

Seung Mok Ryoo ◽

Chang Hwan Sohn ◽

Shin Ahn ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Low Flow ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Status ◽

Good Neurologic Outcome ◽

Hospital Stays ◽

Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

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Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽

10.1161/circ.130.suppl_2.219 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Markus Keferböck ◽

Philip Datler ◽

Mario Krammel ◽

Elisabeth Lobmeyer ◽

Alexander Nürnberger ◽

...

Keyword(s):

Cardiac Arrest ◽

Outcome Measures ◽

Primary Outcome ◽

Sudden Cardiac Arrest ◽

Cerebral Performance Category ◽

Medical Personnel ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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Abstract 113: Signs of Perfusion During Cardiopulmonary Resuscitation as Noted by First Responders is Predictive of Good Neurologic Outcome in Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.113 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Johanna C Moore ◽

Michael Grahl ◽

Tracy Marko ◽

Ariel Blythe-Reske ◽

Amber Lage ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Cerebral Performance Category ◽

First Responders ◽

Small Sample ◽

Neurologic Outcome ◽

Discharge Data ◽

Good Neurologic Outcome ◽

Neurologically Intact

Background: Rates of neurologically intact survival after cardiac arrest remain abysmal. Neuro-prognostication intra-arrest is challenging, with few real-time factors that can be used to determine patient prognosis. During the implementation of a new cardiopulmonary resuscitation (CPR) protocol in a large urban pre-hospital system, first responders prospectively recorded the presence of signs of perfusion during CPR. Hypothesis: Positive signs of perfusion would be a predictor of a good neurologic outcome in this observational study, as defined by Cerebral Performance Category (CPC) Score of 1 or 2. Methods: Basic life support first responders (n = 420) and paramedics (n = 207) underwent training including didactic and hands-on sessions to learn the new protocol, which included active compression-decompression CPR with an impedance threshold device. In addition to patient demographics and circumstances of cardiac arrest, signs of perfusion during CPR were prospectively recorded and included improved color, pulse during CPR, gasping, and movement during CPR. Chart review was performed to determine CPC score at discharge. Data were analyzed using descriptive statistics and calculation of unadjusted odds ratios. Results: The new protocol began May 1, 2017. Cases from May 2017-November 2017 (n= 102) were reviewed, with complete data available for 96 patients (94%). The median age was 56 (range 25-97), 54/91 (59%) male, 43/102 (42%) witnessed, 31/90 (34%) shockable rhythm, and 51/102 (50%) receiving bystander CPR. Improved color during CPR was seen in 23/102 (23%), pulse during CPR in 17/102 (17%), gasping in 18/102 (18%), and movement during CPR in 5/102 (5%). Any sign of perfusion during CPR was seen in 47/102 (46%), and 13/96 (13.5%) had a CPC score of 1 or 2 at discharge. The unadjusted OR for any sign of perfusion during CPR for a CPC score of 1 or 2 was 26 (95% CI 3 - 213) and for any sign of perfusion during CPR for ROSC was 9 (95% CI 3 - 24). Conclusions: Positive signs of perfusion during CPR noted by first responders strongly predicted ROSC and neurologically intact survival in this small sample. This suggests the importance of prospectively recording signs of perfusion during resuscitation, and communicating these observations during transfer of care.

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Abstract 240: Are the Same Resuscitation Protocols Needed for Highly Aged Victims With Out-of-Hospital Cardiac Arrest as Middle or Younger Aged?

Circulation ◽

10.1161/circ.138.suppl_2.240 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Hiroyuki Hanada ◽

Yoshio Tahara ◽

Satoshi Yasuda ◽

Teruo Noguchi ◽

Kunihiro Nishimura ◽

...

Keyword(s):

Cardiac Arrest ◽

Total Population ◽

Cerebral Performance Category ◽

Population Based ◽

Aged Patients ◽

Performance Category ◽

Aging Society ◽

Shockable Rhythm ◽

Activity Of Daily Life ◽

Hospital Cardiac Arrest

Backgrounds: The population of elderly people aged 65 years or older in 2014 is 33 million, and the aging rate (proportion of the total population) is 26.0% in Japan. Victims facing to out of hospital cardiac arrest (OHCA) are getting older and older. Emergency medical system (EMS) in Japan must do the same resuscitation protocols once called to the patient with OHCA, even when he or she is very old and activity of daily life is very low. We need to clarify whether same resuscitation protocols are required to very highly aged patients with OHCA or not. Methods and Results: From January 2005 through December 2014, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 1,299,784). The percentage of patients with OHCA aged more than 80 years old was increasing from 37.1% in 2005 to 47.8% in 2014 by 1% each year. Survival at one month after OHCA with cerebral performance category (CPC) scale 1 or 2 were 4,368 out of total 318,590 OHCA (1.4%) in 80’s, 1043 out of 126,546 (0.8%) in 90’s, and 35 out of 5,544 (0.6%) in aged more than 100 (from 100 to 114). Survival at one month after OHCA with CPC scale 1 or 2 was 11.084 out of 234,366 (4.7%) in 50- 60’s. Patients with witnessed OHCA with shockable rhythm and by-stander CPR survived to CPC 1 or 2 at one month after OHCA were 8.0% in 80’s, 4.1% in 90’s, 0 in aged more than 100, and 22.2% in 50-60’s respectably. Conclusion: Number of survivors with CPC 1 or 2 were very few in patients with OHCA aged more than 80 years old, but still existed. Although the same resuscitation protocols are needed for highly aged victims with OHCA, another system which arrow EMS to stop resuscitation should be established in the highly aging society.

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