Abstract 239: The Effect of an Interdisciplinary Simulation Training Program on Translational Outcomes for In-Hospital Cardiopulmonary Arrests

Purpose: High-quality cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) is the primary component influencing return of circulation (ROSC) and survival to hospital discharge, but few hospitals regularly track these metrics. Other studies have demonstrated significant improvements in survival after IHCA events following implementation of a dedicated code team training program. Therefore, we developed a unique curriculum for a Code Team Training (CTT) course, and evaluated its post-implementation effect on CPR quality and post-IHCA patient outcomes at our institution. Methods: CPR quality data was prospectively collected for quality improvement purposes once our institution had that capability, with 12-months pre-CTT and 21 months post-CTT. Pre-CTT data shaped the elements of the four-hour CTT course that included didactics, small group sessions, and high-fidelity simulation exercises. A total of 456 multi-professional code team members were trained in 22 courses. Data collection included CPR quality and translational outcomes for events where CPR was performed, except the ED. CodeNet® software was used for CPR quality measures, cardiac rhythm, defibrillation metrics, use of continuous waveform capnography, and pauses in compressions. Target metrics for CPR quality were based on 2015 AHA guidelines. Key translational outcomes measures included event location, ROSC, and survival to hospital discharge. Results: CPR quality was obtained from 140 of 230 (61%) in- and out-of-hospital pulseless adult cardiac arrest events over 33 months (50 [36%] before CTT and 90 [64%] following the first course). There was no significant difference between groups in terms of event location within the hospital nor initial event rhythm. A total of 116,908 chest compressions were evaluated. Median compressions in target rate improved from 32% before CTT to 49% after CTT (p<0.05). When accounting for target rate and depth, the median compressions rate improved to 38% post-CTT compared to 31% pre-CTT (p<0.05). While compression depth had a non-statistically significant decline (90.8% pre-CTT and 83.4% post-CTT), mean rate and median rate-in-target improved from 119.99 +/- 15.6 cpm and 32.4% pre-CTT to 113.7 +/- 16.1 cpm and 48.6% post-CTT (p<0.05). The rate of ROSC improved from 60% (30 of 50) to 78% (70 of 90) after implementation of CTT (p=0.003), excluding IHCA in the ED. Index IHCA survival rate for our institution improved from 26% to 33% before and after CTT [p-value NS], which far surpasses the national average (23.8%). Conclusions: After the initiation of a CTT course that targets key code team member personnel, CPR quality significantly improved, which was associated with an increase in ROSC and a trend towards increased survival for in-hospital cardiac arrest patients.

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P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz746.1063 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Rodriguez ◽

J Caro-Codon ◽

J R Rey-Blas ◽

S O Rosillo ◽

O Gonzalez ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Percutaneous Treatment ◽

Valvular Disease ◽

Temperature Management ◽

P Value ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

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Abstract 11901: CPR Quality During the COVID-19 Pandemic - More Evidence of Collateral Damage During Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.11901 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Jocasta Ball ◽

Ziad Nehme ◽

Melanie Villani ◽

Karen L Smith

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

Healthcare Services ◽

Quality Data ◽

Independent Effect ◽

Compression Rate ◽

Post Shock ◽

Cpr Quality ◽

Using Data ◽

Hospital Cardiac Arrest

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses <6 seconds, post-shock pauses <5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p<0.001) as did the proportion with pre-shock pauses <6 seconds (54% vs 62%, p=0.019) and post-shock pauses <5 seconds (68% vs 82%, p<0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p<0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses<6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses<5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.

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Abstract 15: Increasing Compression Rate and Depth Positively Correlate with End-Tidal Carbon Dioxide During Actual CPR Performance

Circulation ◽

10.1161/circ.130.suppl_2.15 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kelsey Sheak ◽

Douglas J Wiebe ◽

Saeed Babaeizadeh ◽

Trevor C Yuen ◽

Dana Zive ◽

...

Keyword(s):

Cardiac Arrest ◽

Linear Regression Analysis ◽

Ventilation Rate ◽

Quality Data ◽

Depth Range ◽

Rate Range ◽

Resuscitation Guidelines ◽

Cpr Quality ◽

End Tidal ◽

Hospital Cardiac Arrest

Background: Current resuscitation guidelines suggest the use of continuous capnography to monitor the effectiveness of CPR. While laboratory data support this concept, little published clinical data exist to support this recommendation. The quantitative relationship between chest compression (CC) delivery and capnographic measurement (specifically, end-tidal CO 2 (ETCO 2 )) is poorly understood, and has important implications for CPR quality assessment. Objectives: We hypothesized that increasing rate and depth of CC will be associated in real-time with increasing ETCO 2 during both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Methods: In a multicenter cohort study, we captured time synchronized ETCO 2 and CPR quality data from resuscitation events at 4 sites between 04/2006 [[Unable to Display Character: –]] 05/2013 using CPR-sensing defibrillators (Philips Mrx-QCPR). ETCO 2 and CC rate and depth were averaged over 15-sec epochs. A linear regression analysis was performed to evaluate the relationship between CCs and ETCO 2 . Results: 29,028 epochs were processed for analysis from 583 arrest events (227 IHCA, 356 OHCA). Average age of the entire cohort was 63.7±17.1 and 213 (37%) were female. ROSC was achieved in 42% of IHCA patients and 27% of OHCA patients. CC rate range was 95-125 per min, CC depth range was 31-59 mm and ventilation rate range was 4-48 per min. CC rate was not significantly associated with ETCO 2 . CC depth was significantly associated with increased ETCO 2 . For every 10 mm increase in depth, ETCO 2 increased by 1.4 mmHg (p<.001). Ventilation rate was inversely related to higher ETCO 2 . For every 10 breaths per min increase in ventilation rate, ETCO 2 was decreased by 3.0 mmHg (p<.001) (see table). Conclusions: ETCO 2 during CPR directly correlated with CC depth, supporting the possible role of capnography as an approach to monitor the quality of CPR delivery. Confounding by ventilation rate may be an important consideration for future work.

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Abstract 12494: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Circulation ◽

10.1161/circ.144.suppl_2.12494 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Rahaf Al Assil

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Rural Areas ◽

Survival Rates ◽

Vancouver Island ◽

P Value ◽

Urban Settings ◽

Rural Settings ◽

Gender Based ◽

Hospital Cardiac Arrest

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). We sought to examine the association of the modifiable and non-modifiable OHCA characteristics and patient outcomes with rural settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% Female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value<.001) . Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.

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Abstract 126: Intravenous Versus Intraosseous Epinephrine Administration for Pediatric Patients with Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.126 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Masashi Okubo ◽

Cameron Dezfulian ◽

Francis X Guyette ◽

Christian Martin-Gill ◽

Sylvia Owusu-Ansah ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Propensity Score ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Pediatric Patients ◽

Propensity Score Analysis ◽

Epinephrine Administration ◽

Significant Difference ◽

Hospital Cardiac Arrest

Introduction: The 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation recommend intravenous (IV) or intraosseous (IO) epinephrine administration for pediatric patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether the route of epinephrine administration affects patient outcomes. Our objective was to evaluate the association between the route of epinephrine administration and survival. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry, a prospective multicenter OHCA registry from 2011 through 2015 in North America. We included pediatric patients (≤18 years) with OHCA for whom emergency medical services (EMS) providers attempted resuscitation and administered epinephrine via IV or IO. We excluded patients who received endotracheal epinephrine, received both IV and IO epinephrine, received IV epinephrine with failed IO access, and received IO epinephrine with failed IV access. The primary outcome was survival to hospital discharge. We used multivariable logistic regression and adjusted for age, sex, initial rhythm, location of arrest, witness status, receiving layperson cardiopulmonary resuscitation, 9-1-1 call to EMS arrival, and advanced airway management. We also conducted a propensity score matching analysis with the same covariates. Results: Of the eligible 831 pediatric patients with OHCA, 226 (27.2%) received IV epinephrine and 605 (72.8%) IO epinephrine. Median interval between 9-1-1 call and epinephrine administration was 16.4 minutes (interquartile range [IQR] 12.9-21.0) in IV group and 16.2 minutes (IQR 12.8-20.0) in IO group. In the logistic regression model, the adjusted odds ratio (OR) of the IO group for survival to hospital discharge was 0.99 (95% confidence interval [CI] 0.41-2.40), compared with the IV group. Similarly, in the propensity score analysis, 218 patients underwent matching with good balance (standardized differences <0.25 for all covariates) and the OR of the IO group for survival to hospital discharge was 1.00 (95% CI 0.38-2.62). Conclusions: We observed no significant difference in survival to hospital between pediatric patients with OHCA who received epinephrine via IV and IO routes.

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MP03: Predicting survival after pediatric out-of-hospital cardiac arrest

CJEM ◽

10.1017/cem.2017.169 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S65-S66

Author(s):

I. Drennan ◽

K. Thorpe ◽

S. Cheskes ◽

M. Mamdani ◽

D. Scales ◽

...

Keyword(s):

Patient Outcome ◽

Logistic Regression ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Median Time ◽

Predictive Ability ◽

Spontaneous Circulation ◽

Primary Objective ◽

P Value ◽

Hospital Cardiac Arrest

Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) is unique in terms of epidemiology, treatment, and outcomes. There is a paucity of literature examining predictors of survival to help guide resuscitation in this population. Objective: The primary objective was to examine predictors of survival to hospital discharge. The secondary objective was to determine the probability of return of spontaneous circulation (ROSC) over the duration of resuscitation. Methods: We performed a retrospective cohort study of non-traumatic OHCA (<18 years) treated by EMS from the Toronto Regional RescuNET Epistry-Cardiac Arrest database from 2006 to 2015. We used competing risk analysis to calculate the probability of ROSC over the duration of resuscitation. We then used multivariable logistic regression to examine the role of Utstein factors and duration of resuscitation in predicting survival to hospital discharge. Candidate variables were limited to Utstein factors and duration of resuscitation due to the number of events. We used area under the receiver operating characteristic (ROC) curve (AUC) to determine the predictive ability of our logistic regression model. Results: A total of 658 patients met inclusion criteria. Survival to discharge was 10.2% with 70.1% of those children having a good neurologic outcome. The overall median time to ROSC was 23.9 min. (IQR 15.0,36.7). However, the median time to ROSC for survivors was significantly shorter than the time to ROSC for patients who died in hospital (15.9 (IQR 10.6 to 22.8) vs. 33.2 (IQR 22.0 to 48.6); P value <0.001). There was a decrease in the odds of survival of 14% per minute during the first 25 minutes of cardiac arrest. Older age (OR 0.9, 95% CI 0.86,0.99), and longer duration of resuscitation (OR 0.9, 95% CI 0.88,0.93) were associated with worse outcome while initial shockable rhythm (OR 5.8, 95% CI 2.0,16.5), and witnessed arrests (OR 2.4, 95% CI 1.10,5.30) were associated with improved patient outcome. The AUC for the Utstein factors was fair (0.77). Including duration of resuscitation improved the discrimination of the model to 0.85. Conclusion: Inclusion of duration of resuscitation improved the performance of our model compared to Utstein factors alone. However, our results suggest there are a number of other important factors for predicting patient outcome from pediatric OHCA.

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Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study

BMC Emergency Medicine ◽

10.1186/s12873-021-00542-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Son Ngoc Do ◽

Chinh Quoc Luong ◽

Dung Thi Pham ◽

My Ha Nguyen ◽

Tra Thanh Ton ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Survival Rates ◽

Trauma System ◽

First Aid ◽

System Of Care ◽

Healthcare Personnel ◽

Significant Difference ◽

Poor Outcomes ◽

Hospital Cardiac Arrest

Abstract Background Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Methods We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). Conclusion In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

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P2825ICD implantation in secondary prevention after an out-of-hospital cardiac arrest. Does age really matter?

European Heart Journal ◽

10.1093/eurheartj/ehz748.1135 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Baldi ◽

S Buratti ◽

R Rordorf ◽

A Vicentini ◽

A Sanzo ◽

...

Keyword(s):

Cardiac Arrest ◽

Secondary Prevention ◽

Elderly Patients ◽

Hospital Discharge ◽

The Elderly ◽

Elderly Group ◽

Significant Difference ◽

One Year ◽

The Moment ◽

Hospital Cardiac Arrest

Abstract Background The implantation of an implantable cardioverter defibrillator (ICD) in secondary prevention is a class I indication for patients with an estimated survival more than 1 year with a good functional status. However, in the elderly population, it is often difficult to estimate the expected survival, especially after an acute event such as an out-of-hospital cardiac arrest (OHCA). Purpose To evaluate 1-year survival after OHCA of patients older than 80 compared to those younger than 80. Methods We considered all the patients who suffered an OHCA in our Province (55ehz748.1135 inhabitants in northern Italy) from October 1st 2014 to November 30th 2017 stratified in two groups accordingly to their age at the moment of OHCA: elderly group (≥80 years old) and non-elderly group (<80 years old). Results In the period analysis resuscitation was attempted in 1464 OHCA patients: 632 of the elderly group (mean age of 86.4±4.4 years) and 832 of the non-elderly group (mean age of 63.4±13.8 years). The two groups were different at baseline. In the non-elderly group there were more males (74.5% vs 42.4%, p<0.001), more cases of medical etiology (95.9% vs 91.2%, p<0.001), a higher rate of bystander CPR (39.4% vs 23.4%, p<0.001) and more shockable rhythms at presentation (25.5% vs 7.9%, p<0.001), whilst a home location of the event was more frequent in the elderly group (81.3% vs 77%, p=0.048). No differences were found regarding both the percentage of not witnessed cardiac arrest (27.5% in elderly and 26% in non-elderly, p=0.57) and the time of EMS arrival (11:36 mins in elderly and 11:23 mins in young, p=0.64). Non-elderly patients showed a significantly higher rate of survival both to hospital admission (25.2% vs 6.8%, p<0.001), to hospital discharge (12.1% vs 1.7%, p<0.001) and at 1 year after the event (10.2% vs 1.6%, p<0.001, Figure 1 - left) as compared to older ones. However, when considering only those patients discharged alive we found a non-significant difference in one-year survival (84.2% vs 90.9%, p=0.64, Figure 1 – right). Conclusions Elderly patients have a worst prognosis in the acute phase after an OHCA. However, after hospital discharge, older and younger patients showed a similar 1-year survival. This result highlights how age should not be considered alone to decide whether an ICD in secondary prevention could be indicated or not in older OHCA survivors.

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Abstract 9382: Outcomes After Traumatic Out-of-Hospital Cardiac Arrest in Vietnam: A Multicenter Prospective Cohort Study

Circulation ◽

10.1161/circ.144.suppl_2.9382 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Son N Do ◽

Chinh Q Luong ◽

Dung T Pham ◽

My H Nguyen ◽

Tra T Ton ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Trauma System ◽

First Aid ◽

System Of Care ◽

Healthcare Personnel ◽

Significant Difference ◽

Multicenter Prospective Observational Study ◽

Critical Components ◽

Hospital Cardiac Arrest

Introduction: Pre-hospital services are not well developed in Vietnam, especially the immature of a trauma system of care. The prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. This study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Hypothesis: Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Methods: We performed a multicenter prospective observational study of consecutive patients (>16 years) presenting with traumatic OHCA to 3 central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients with traumatic OHCA and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results: Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 26.1% (29/111) of the patients were taken by the emergency medical services (EMS), 90% (27/30) received pre-hospital advanced airway, and 54.7% (29/53) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P>0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P=0.649; respectively). Conclusion: Improvements are needed in the EMS in Vietnam, such as increasing bystander first-aid and developing a trauma system of care, as well as developing a standard emergency first-aid program for both healthcare personnel and the community.

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Abstract 345: The Effects of Epinephrine on the Outcomes of Patients With Out-of-Hospital Cardiac Arrest Based on a Propensity Analysis: A Nationwide Observational Study

Circulation ◽

10.1161/circ.138.suppl_2.345 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

YuSung Lee ◽

YoungSun Ro ◽

KyoungJun Song ◽

SangDo Shin

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Negative Impact ◽

P Value ◽

Cross Sectional ◽

Neurologic Recovery ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Hospital Cardiac Arrest

Background: Although prehospital epinephrine is frequently used in patients with out-of-hospital cardiac arrest (OHCA), its evidence is unclear. Recent studies have shown that the use of prehospital epinephrine increased the rate of return of spontaneous circulation but has a negative impact on outcomes. The aim of this study was to investigate the effect of prehospital epinephrine on the outcomes of OHCA. Methods: This study was a cross-sectional study using nationwide OHCA registry in Korea from 2015 to 2016. All EMS-treated adults OHCAs with presumed cardiac etiology were included. Patients who were witnessed by EMS provider were excluded. The primary outcome was neurologically favorable survival to discharge. We compared the primary outcomes between the prehospital epinephrine group and non-prehospital epinephrine group using a propensity score matching analysis and a multivariable logistic regression. Results: Among 58922 patients with OHCA, 37635 were included in the analysis. There were 3256 patients who received prehospital epinephrine. In the propensity score matching analysis, 3239 patients were enrolled in each group. Survival to discharge and good neurologic recovery were 5.0% and 2.5% in prehospital epinephrine group and 9.4% and 5.9% in non-prehospital epinephrine group (all p-value<o.o1). There was significant difference in good neurologic recovery between prehospital epinephrine group and non-prehospital epinephrine group after adjusting for covariates (adjusted OR, 0.38, 95% CI, 0.28-0.51). Similar results were observed for survival to discharge (adjusted OR, 0.47, 95% CI, 0.38-0.58). Conclusions: In Korean patients with OHCA, prehospital epinephrine increased the probability of ROSC, but decreased good neurologic recovery and survival to discharge.

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