Abstract 9499: Prehospital Factors Associated With Cardiopulmonary Resuscitation Performance in Out-of-Hospital Cardiac Arrests

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Melanie Villani ◽  
Ziad Nehme ◽  
Emily Andrew ◽  
Jocasta Ball ◽  
Karen Smith
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Services ◽  
Care Facility ◽  
Performance Outcomes ◽  
Fire Fighter ◽  
Target Range ◽  
Factors Associated ◽  
Female Sex ◽  
Target Depth

Introduction: Although high quality cardiopulmonary resuscitation (CPR) has been associated with improvements in survival from cardiac arrest, little is known about the arrest factors that influence CPR performance. This study examined the association between CPR performance and patient and arrest factors in out-of-hospital cardiac arrest (OHCA). Methods: A retrospective observational study using data from a statewide cardiac arrest registry in Victoria, Australia. The study included 2,408 adult, medical OHCA patients who arrested between 11 February 2019 and 10 February 2021. Fractional and logistic regression models were used to analyse factors associated with CPR performance outcomes, including the proportion of compressions at target depth and target rate and a compression fraction ≥90%. Results: The median proportion of compressions at target depth and target rate were 80% (interquartile range [IQR] 58, 92.5) and 62% (IQR 40, 79), respectively, and 70% achieved a compression fraction ≥90%. After multivariable adjustment, achieving a compression depth in the target range was associated with female sex (OR 1.14 [95% CI: 1.02, 1.28]), patient weight (per 10 kg increase, OR 1.08 [95% CI: 1.05, 1.12]), aged care facility location (OR 0.74 [95% CI: 0.58, 0.94]), fire-fighter presence (OR 1.29 [95% CI: 1.14, 1.46]), resuscitation duration (per 5 min increase, OR 1.08 [95% CI: 1.06, 1.10]) and number of rescuers (per 1 person increase, OR 1.06 [95% CI: 1.03, 1.09]). Achieving compressions within target rate were associated with public location (OR 0.81 [95% CI: 0.72, 0.91]) and fire-fighter presence (OR 1.12 [95% CI: 1.02, 1.24]). Achieving a compression fraction ≥90% was associated with female sex (OR 0.75 [95% CI: 0.62, 0.91]), arrests witnessed by emergency services (OR 0.44 [95% CI: 0.32, 0.61]), initial shockable rhythms (OR 0.66 [95% CI: 0.53, 0.81]), fire-fighter presence (OR 1.24 [95% CI: 1.01, 1.54]) and resuscitation duration (per 5 min increase, OR 1.05 [95% CI: 1.02, 1.08]). Conclusion: This study demonstrates that several prehospital factors that are associated with CPR performance which may help inform operational strategies to improve OHCA outcomes.

scholarly journals Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience

2021 ◽  
Vol 10 (2) ◽  
pp. 339
Author(s):  
Vassili Panagides ◽  
Henrik Vase ◽  
Sachin P. Shah ◽  
Mir B. Basir ◽  
Julien Mancini ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Univariate Analysis ◽  
Cerebral Performance Category ◽  
Neurological Impairment ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Factors Associated ◽  
Analysis Survival

Background: Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Methods: We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. Results: Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.

scholarly journals Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study

2019 ◽  
Vol 41 (21) ◽  
pp. 1961-1971 ◽  
Author(s):  
Wulfran Bougouin ◽  
Florence Dumas ◽  
Lionel Lamhaut ◽  
Eloi Marijon ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Conditional Logistic Regression ◽  
Time Duration ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Factors Associated ◽  
Hospital Survival ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest ◽  
Extracorporeal Cpr

Abstract Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

Factors Associated with Survival and Neurological Outcome after Cardiopulmonary Resuscitation of Neurosurgical Intensive Care Unit Patients

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 838-846 ◽  
Author(s):  
Hyeong-Joong Yi ◽  
Young-Soo Kim ◽  
Yong Ko ◽  
Suck-Jun Oh ◽  
Kwang-Myung Kim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Factors Associated ◽  
Neurosurgical Patients ◽  
Neurosurgical Intensive Care ◽  
Vestibular Reflex ◽  
Neurosurgical Intensive Care Unit

Abstract OBJECTIVE: We investigated predictors of survival and the neurological outcomes of neurosurgical patients who experienced cardiac arrest and received cardiopulmonary resuscitation after being admitted to the neurosurgical intensive care unit. METHODS: A retrospective study was conducted of adult patients in the neurosurgical intensive care unit who had experienced cardiac arrest and received cardiopulmonary resuscitation. Factors relevant to the cardiac arrest (before and after arrest) were used to study association with survival (immediate or short-term) and neurological outcome (unconscious or conscious) via statistical methods. RESULTS: Immediate survival was seen in 105 patients (49%), 19 survived until hospital discharge, and 11 were still alive at the conclusion of this study. Of the immediate survivors, 41 patients were conscious and 64 were unconscious. Multivariate analysis showed increased mortality in patients with infection, asystole, or resuscitation time exceeding 30 minutes (P &lt; 0.05). Additional factors associated with high in-hospital mortality included lack of spontaneous respiration, no caloric-vestibular reflex, and unconsciousness after resuscitation (P &lt; 0.05). In addition, neurological recovery was poor in patients with infection, asystole, no caloric-vestibular reflex, conscious recovery, or resuscitation lasting more than 30 minutes (P &lt; 0.05). CONCLUSION: Even after initially successful resuscitation, survival and neurological recovery is quite dismal in patients with cerebral lesions. Prognostic factors for neurosurgical patients should be assessed on an individual basis to determine medical futility in the early post-resuscitation period.

scholarly journals When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

2020 ◽  
pp. emermed-2019-209291 ◽  
Author(s):  
Lin Zhang ◽  
Menyue Luo ◽  
Helge Myklebust ◽  
Chun Pan ◽  
Liang Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Services ◽  
Public Awareness ◽  
Survival Rates ◽  
Process Compliance ◽  
Barriers To Implementation ◽  
Prolonged Delay ◽  
Hospital Cardiac Arrest

BackgroundSeveral Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China.MethodsWe retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process.ResultsOf the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20–60) min and 115 (IQR 90–153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations.ConclusionsThe OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: A Danish nationwide multicentre study

2021 ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Good Neurological Outcome ◽  
Strict Adherence ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to to describe the gradual implementation, survival and adherence to the national consensus with respect to use of ECPR for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving ECPR for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day survival. Results A total of 259 patients were included in the study. Thirty-day survival was 26% and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories (CPC) (CPC 1–2)) was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 minutes, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had a threefold higher survival rate compared to patients without signs of life (45% versus 13%, p < 0.001). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with ECPR for OHCA. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S R Moerk ◽  
C Stengaard ◽  
L Linde ◽  
J E Moller ◽  
J B Andreasen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Good Neurological Outcome ◽  
Strict Adherence ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking. Purpose To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome. Methods Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality. Results A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow &lt;100 minutes, pH &gt;6.8 and lactate &lt;15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH &lt;6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels &gt;15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p&lt;0.001) Conclusion A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensus Signs of life during CPR

Factors Associated With Survival Following Extracorporeal Cardiopulmonary Resuscitation in Children

2020 ◽  
Vol 11 (3) ◽  
pp. 265-274
Author(s):  
John Nicholas Melvan ◽  
Joel Davis ◽  
Micheal Heard ◽  
Jaimin R. Trivedi ◽  
Michael Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
Cardiopulmonary Resuscitation ◽  
Congenital Heart ◽  
Significant Risk ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Logistic Regression Models ◽  
Factors Associated

Objectives: We examined a large single-institution experience in extracorporeal cardiopulmonary resuscitation (ECPR) in children having cardiac arrest refractory to conventional resuscitation measures with focus on factors affecting survival. Methods: Between 2002 and 2017, 184 children underwent ECPR at our institution. We entered demographic, anatomic, clinical, surgical, and ECPR support details into a multivariable logistic regression models to determine factors associated with mortality. Results: Median age was 54 days (interquartile range [IQR]: 11-272). In all, 157 (85%) patients had primary cardiac disease, including 136 (74%) with congenital heart disease (71 with single ventricle). Extracorporeal cardiopulmonary resuscitation occurred following cardiac surgery in 124 (67%) patients. Median cardiopulmonary resuscitation (CPR) duration was 27 minutes (IQR: 18-40) and median support duration was 3.0 days (IQR: 1.6-5.3). Overall, ECPR was weaned in 115 (63%), with 79 (43%) surviving to hospital discharge. Survival for patients with congenital heart disease, noncongenital cardiac, and noncardiac pathologies was 44%, 71%, and 15%, respectively. On multivariable regression analysis, risk factors associated with mortality were presupport pH <7.1 (odds ratio [OR] = 3.7, 95% confidence interval [CI]: 1.11-12.41, P = .033), mechanical complications (OR = 8.33, 95% CI: 1.91-36.25, P = .005), neurologic complications (OR = 6.27, 95% CI: 1.40-28.10, P = .017), and renal replacement therapy (OR = 3.31, 95% CI: 1.03-10.66, P = .045). Conclusions: Extracorporeal cardiopulmonary resuscitation plays a valuable role salvaging children with refractory cardiac arrest. Survival varies with underlying pathology and can be expected even with relatively longer CPR durations. Efforts to improve systemic output before and after institution of ECPR might mitigate some of the significant risk factors for mortality.

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