scholarly journals Association Between Hospital Resuscitation Champion and Survival for In‐Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Jesse L. Chan ◽  
Jessica Lehrich ◽  
Brahmajee K. Nallamothu ◽  
Yuanyuan Tang ◽  
Mary Kennedy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Survival Rates ◽  
Critical Factor ◽  
Survival Outcomes ◽  
Study Cohort ◽  
Calculated Risk ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background Although many hospitals have resuscitation champions, it is unknown if hospitals with very active physician or nonphysician champions have higher survival rates for in‐hospital cardiac arrest (IHCA). Methods and Results We surveyed adult hospitals in Get With The Guidelines‐Resuscitation about resuscitation practices, including about their resuscitation champion. Hospitals were categorized as having a very active physician champion, a very active nonphysician champion, or other (no champion or not very active champion). For each hospital, we calculated risk‐standardized survival rates for IHCA during the period of 2016 to 2018 and categorized them into quintiles of risk‐standardized survival rates. The association between a hospital's resuscitation champion type and their quintile of survival was evaluated using multivariable hierarchical proportional odds logistic regression. Overall, 192 hospitals (total of 44 477 IHCAs) comprised the study cohort. Risk‐standardized survival rates for IHCA varied widely between hospitals (median: 24.7%; range: 9.2%–37.5%). Very active physician champions were present in 29 (15.1%) hospitals, 64 (33.3%) had very active nonphysician champions, and 99 (51.6%) did not have a very active champion. Compared with sites without a very active resuscitation champion, hospitals with a very active physician champion were 4 times more likely to be in a higher survival quintile, even after adjusting for resuscitation practices across hospital groups (adjusted odds ratio [OR], 3.90; 95% CI, 1.39–10.95). In contrast, there was no difference in survival between sites without very active champions and those with very active non‐physician champions (adjusted OR, 1.28; 95% CI, 0.62–2.65). Conclusions The background and engagement level of a resuscitation champion is a critical factor in a hospital's survival outcomes for IHCA.

Abstract 245: Role of the Resuscitation Champion on Survival Outcomes for In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jesse Chan ◽  
Brahmajee K Nallamothu ◽  
Yuanyuan Tang ◽  
Paul Chan
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Critical Factor ◽  
Nationwide Survey ◽  
Survival Outcomes ◽  
Study Cohort ◽  
Logistic Regression Models ◽  
Final Study ◽  
Clinical Background ◽  
Hospital Cardiac Arrest

Background: Hospitals vary markedly in survival rates for their patients with in-hospital cardiac arrest (IHCA). Although many sites have resuscitation champions, whether a resuscitation champion’s clinical background and intensity of engagement distinguishes sites with higher cardiac arrest survival rates remains unknown. Methods: We conducted a nationwide survey of adult hospitals participating in GWTG-Resuscitation to elicit detailed information on resuscitation practices, including of their resuscitation champion. Risk-standardized survival rates for IHCA for 2016-2017 were calculated for each hospital, and these were then used to categorize hospitals into quintiles of performance. The association between a resuscitation champion’s clinical background and intensity of engagement (categorized as very active non-physician champion, very active physician champion, and all others) and quintiles of survival was evaluated using multivariable hierarchical proportional odds logistic regression models. Results: Overall, 200 of 218 eligible adult hospitals (91.7%) completed the study survey and 190 facilities with > 10 cases comprised the final study cohort. Risk-standardized survival rates after IHCA varied substantially (median: 24.7%; range: 9.2% to 37.5%). One-third (63/190 [33.2%]) of hospitals had a very active non-physician champion, 29 (15.3%) had a very active physician champion, and the remaining 98 (51.2%) had a resuscitation champion not perceived to be very active or had no champion. Compared to sites with very active non-physician champions, those with a very active physician champion had 5-fold higher odds (adjusted OR, 5.15 [95% CI: 2.13-12.5]) of being in a higher survival quintile category, whereas there was no difference in survival outcomes between sites with less active or no resuscitation champions and very active non-physician champions (adjusted OR, 0.94 [95% CI: 0.52-1.77]) . Conclusions: Although most hospitals have resuscitation champions, the background and engagement level of a resuscitation champion is a critical factor in a hospital’s survival outcomes for IHCA. Hospitals with the highest survival rates for IHCA are more likely to have very active physician resuscitation champions.

scholarly journals Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest

2019 ◽  
Vol 130 (3) ◽  
pp. 414-422 ◽  
Author(s):  
Nicholas G. Bircher ◽  
Paul S. Chan ◽  
Yan Xu ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Epinephrine Administration ◽  
Time To Initiation ◽  
Adjusted Logistic Regression ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest ◽  
Index Cases

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Because the extent to which delays in initiating cardiopulmonary resuscitation (CPR) versus the time from CPR to defibrillation or epinephrine treatment affects survival remains unknown, it was hypothesized that all three independently decrease survival in in-hospital cardiac arrest. Methods Witnessed, index cases of cardiac arrest from the Get With The Guidelines–Resuscitation Database occurring between 2000 and 2008 in 538 hospitals were included in this analysis. Multivariable risk-adjusted logistic regression examined the association of time to initiation of CPR and time from CPR to either epinephrine treatment or defibrillation with survival to discharge. Results In the overall cohort of 57,312 patients, there were 9,802 survivors (17.1%). Times to initiation of CPR greater than 2 min were associated with a survival of 14.7% (91 of 618) as compared with 17.1% (9,711 of 56,694) if CPR was begun in 2 min or less (adjusted odds ratio [95% CI], 0.68 [0.54 to 0.87]; P < 0.002). Times from CPR to either defibrillation or epinephrine treatment of 2 min or less were associated with a survival of 18.0% (7,654 of 42,475), as compared with 15.0% (1,680 of 11,227) for 3 to 5 min (reference, 0 to 2 min; adjusted odds ratios [95% CI], 0.83 [0.78 to 0.88]; P < 0.001), 12.8% (382 of 2,983) for 6 to 8 min (0.67 [0.60 to 0.76], P < 0.001), and 13.7% (86 of 627) for 9 to 11 min (0.54 [0.42 to 0.69], P < 0.001). Conclusions Delays in the initiation of CPR and from CPR to defibrillation or epinephrine treatment were each associated with lower survival.

Prehospital study of survival outcomes from out-of-hospital cardiac arrest in ST-elevation myocardial infarction in Queensland, Australia (the PRAISE study)

2020 ◽  
pp. 204887262090752
Author(s):  
Brendan V Schultz ◽  
Tan N Doan ◽  
Emma Bosley ◽  
Brett Rogers ◽  
Stephen Rashford
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Univariate Analysis ◽  
Survival Outcomes ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Hospital Cardiac Arrest

Aim Patients that experience an out-of-hospital cardiac arrest in the context of a paramedic-identified ST-segment elevation myocardial infarction are a unique cohort. This study identifies the survival outcomes and determinants of survival in these patients. Methods A retrospective analysis was undertaken of all patients, attended between 1 January 2013 and 31 December 2017 by the Queensland Ambulance Service, who had a ST-segment elevation myocardial infarction identified by the attending paramedic prior to deterioration into out-of-hospital cardiac arrest. We described the ‘survived event’ and ‘survived to discharge’ outcomes of patients and performed univariate analysis and multivariate logistic regression to identify factors associated with survival. Results In total, 287 patients were included. Overall, high rates of survival were reported, with 77% of patients surviving the initial out-of-hospital cardiac arrest event and 75% surviving to discharge. Predictors of event survival were the presence of an initial shockable rhythm (adjusted odds ratio 8.60, 95% confidence interval (CI) 4.16–17.76; P < 0.001) and the administration of prehospital medication for subsequent primary percutaneous coronary intervention (adjusted odds ratio 2.54, 95% CI 1.17–5.50; P = 0.020). These factors were also found to be associated with survival to hospital discharge, increasing the odds of survival by 13.74 (95% CI 6.02–31.32; P < 0.001) and 6.96 (95% CI 2.50–19.41; P < 0.001) times, respectively. The administration of prehospital fibrinolytic medication was also associated with survival in a subgroup analysis. Conclusion This subset of out-of-hospital cardiac arrest patients was found to be highly salvageable and responsive to resuscitative measures, having arrested in the presence of paramedics and presented with an identified reversible cause.

Abstract 588: Extracorporeal Cardiopulmonary Resuscitation for Induction of Hypothermia in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
Takaeo Mukouyama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Control Group ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hypothermia Group ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Therapeutic hypothermia is beneficial to neurological outcome for comatose survivors after out-of-hospital cardiac arrest. However, there are few data of extracorporeal cardiopulmonary resuscitation (ECPR) for induction of hypothermia for patients with out-of-hospital cardiac arrest. We did a prospective study of ECPR with hypothermia for patients with out-of-hospital cardiac arrest. The criteria for inclusion were an age of 18 to 74 years, a witnessed cardiac arrest, collapse-to-patient’s-side interval <15 minutes, cardiac arrest due to presumed cardiac etiology, and persistent cardiac arrest on ER arrival in spite of the prehospital defibrillations. After arrival at the emergency room, cardiopulmonary bypass plus intra-aortic balloon pumping was immediately performed, and then coronary reperfusion therapy during cardiac arrest was added if needed. Mild hypothermia (34°C for 3 days) was immediately induced during cardiac arrest or after return of spontaneous circulation. We selected suitable patients who received conventional CPR with normothermia among a prospective multi-center observational study of patients who had out-of-hospital cardiac arrest in Kanto region of Japan “the SOS-KANTO study” for the control group. The primary endpoint was favorable neurological outcome at the time of hospital discharge. A total of 558 patients were enrolled; 127 received ECPR with hypothermia and 431 received conventional CPR with normothermia. The ECPR with hypothermia group had significantly higher frequency of the favorable neurological outcome than the conventional CPR with normothermia group (12% vs. 2%, unadjusted odds ratio, 8.1; 95% CI; 3.2 to 20.0). The adjusted odds ratio for the favorable neurological outcome after ECPR with hypothermia was 7.4 (95% CI; 2.8 to 19.3, p<0.0001). Among the ECPR with hypothermia group, early attainment of a target core temperature of 34°C increased its efficacy (adjusted odds ratio, 0.99; 95% CI; 0.98 to 1.00, p=0.04). ECPR with hypothermia improved the chance of neurologically intact survival for adult patients with out-of-hospital cardiac arrest, and the early attainment of a target temperature enhanced its efficacy.

Abstract 252: The Association of Award Recognition From Get With the Guidelines-Resuscitation with Improved Survival Rates in In-Hospital Cardiac Arrest Events

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Kathie Thomas ◽  
Art Miller ◽  
Greg Poe
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Survival Rate ◽  
Discharge Rate ◽  
Survival Rates ◽  
Improvement Program ◽  
Award Winning ◽  
National Survival ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background and Objectives: It is estimated that over 200,000 adults experience in-hospital cardiac arrest each year. Overall survival to discharge has remained relatively unchanged for decades and survival rates remain at about 20% (Elenbach et al., 2009). Get With The Guidelines-Resuscitation (GWTG-R) is an in-hospital quality improvement program designed to improve adherence to evidence-based care of patients who experience an in-hospital resuscitation event. GWTG-R focuses on four achievement measures. The measures for adult patients include time to first chest compression of less than or equal to one minute, device confirmation of correct endotracheal tube placement, patients with pulseless VF/VT as the initial documented rhythm with a time to first shock of less than or equal to two minutes, and events in which patients were monitored or witnessed at the time of cardiac arrest. The objective of this abstract is to examine the association between hospital adherence to GWTG-R and in-hospital cardiac arrest survival rates. Methods: A retrospective review of adult in-hospital cardiopulmonary arrest (CPA) patients (n=1849) from 21 Michigan, Illinois, and Indiana hospitals using the GWTG-R database was conducted from January 2014 through December 2014. This study included adult CPA patients that did and did not survive to discharge. Results: The review found that hospitals that had attained 84.6% or higher thresholds in all four achievement measures for at least one year, which is award recognition status, had a significantly improved in-hospital CPA survival to discharge rate of 29.6%. Hospitals that did not obtain award status had a CPA survival to discharge rate of 24.3%. The national survival rate for in-hospital adult CPA survival to discharge is 20%. Hospitals that did not achieve award recognition status still demonstrated improvement in survival rate when compared to the national survival rate, indicating the importance of a quality improvement program such as GWTG-R. No significant difference was found between in-hospital adult CPA survival rate and race between GWTG-R award winning and non-award winning hospitals. Hospitals that earned award recognition from GWTG-R had a survival to discharge rate of 30.2% for African Americans and 29.6% for whites. Hospitals that were did not earn award recognition from GWTG-R had a survival to discharge rate of 20.0% for African Americans and 20.1% for whites. Conclusions: Survival of in-hospital adult CPA patients improved significantly when GWTG-R measures are adhered to. Survival of in-hospital adult CPA patients also improves with implementation of GWTG-R. It is crucial that hospitals collect and analyze data regarding resuscitation processes and outcomes. Quality improvement measures can then be implemented in order to assist with improving in-hospital CPA survival rates.

Abstract 39: Atropine for Patients with Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ken Nagao ◽  
Tetsuya Sakamoto ◽  
Masaki Igarashi ◽  
Shinichi Ishimatsu ◽  
Akira Sato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Life Support ◽  
Multiple Logistic Regression Analysis ◽  
Pulseless Electrical Activity ◽  
Similar Frequency ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

BACKGROUND AHA guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for asystole or pulseless electrical activity (PEA), because atropine has improved survival to hospital admission in a retrospective review (Ann Emerg Med, 1984), and is inexpensive, easy to administer, and has few side effects. However, there are insufficient data in humans. METHODS We assessed the effects of atropine in 7,443 adults patients with asystole or PEA arrest from the SOS-KANTO study: a prospective, multicenter, observational trial. The medications for asystole or PEA arrest were managed according to the advanced cardiovascular life support algorithm of the CPR guidelines (i.e. a 1-mg dose of epinephrine was administered intravenously every 3 to 5 minutes and a1-mg dose of atropine was administered intravenously every 3 to 5 minutes; maximum total of 3 doses). The primary endpoint was a favorable neurological outcome 30 days after cardiac arrest. RESULTS Of the 7,443 adult patients who had out-of-hospital cardiac arrest with asystole or PEA, I,708(23%) were treated with epinephrine and atropine and 5,735(77%) were treated with epinephrine. At baseline, the epinephrine and atropine group had significantly higher proportions of cardiac cause, witnessed arrest, and bystander CPR attempt than the epinephrine group. However, the two groups had a similar frequency of the favorable neurological outcome (0.3% in each group, p=0.805). Multiple logistic-regression analysis showed that the adjusted odds ratio for the favorable neurological outcome was 0.6 (95% CI 0.2–1.7, p=0.37) after epinephrine and atropine (compared with epinephrine). On the other hand, the epinephrine and atropine group had significantly higher rate of return of spontaneous circulation (ROSC) than the epinephrine group (35% vs. 23%, p<0.0001), and the adjusted odds ratio for ROSC was 1.6 (95% CI 1.4 –1.7, p<0.0001) after epinephrine and atropine (compared with epinephrine). CONCLUSIONS We demonstrated that administration of atropine during management of asystole or PEA arrest did not increase the frequency of favorable neurological outcome, although the atropine favored initial ROSC.

Abstract 10476: Patient Characteristics and Survival Outcomes of Cardiac Arrest in the Cardiac Catheterization Laboratory: Insights from Get with the Guidelines-Resuscitation Registry

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
John J Lopez ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
American Heart ◽  
Patient Characteristics ◽  
Lower Survival Rate ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: The characteristics and outcomes of in-hospital cardiac arrest (IHCA) in the cardiac catheterization laboratory (CCL) have not been well-described. We compared the characteristics and outcomes of patients with an IHCA in the CCL versus those in the operating room (OR) and the intensive care unit (ICU). Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation® registry, we identified patients 18 years of age or older with an IHCA in the CCL, OR, or ICU between 2000 and 2019. We compared rates of survival to discharge for patients in the CCL, OR, and ICU. Additionally, we examined predictors of survival to discharge for patients with IHCA in the CCL. Results: There were 6866, 5181, and 181,832 patients with an IHCA in the CCL, OR, and ICU, respectively. Patients with IHCAs in the CCL were more likely to have a shockable cardiac arrest rhythm as compared with those in the OR and ICU. Overall, 2614 (38.1%) patients with IHCA in the CCL survived to discharge, as compared with 30,833 (16.9%) from the ICU and 2096 (40.5%) from the OR. After adjustment for 27 patient and cardiac arrest factors, patients with IHCA in CCL were more likely to survive to discharge as compared with those with IHCA from the ICU (odds ratio, 1.37 [95% CI: 1.29-1.46], p<0.001). In contrast, they were less likely to survive to discharge as compared with those with IHCA in the OR (odds ratio, 0.81 [95% CI: 0.69-0.94], p=0.006). Predictors of survival to discharge in patients with IHCA in the CCL included white race, pulseless ventricular tachycardia/fibrillation, and IHCA during normal hours and on weekdays, while having myocardial infarction during this or prior hospitalization was associated with less survival to discharge. (Table). Conclusion: IHCA in the CCL is not uncommon and has a lower survival rate as compared with IHCA in other procedural areas such as the OR. The reasons for this difference deserve further study given that response to IHCAs in both settings should be similar.

Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Yunshu Zhou ◽  
Paul Chan ◽  
Saket Girotra
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Time Intervals ◽  
Hierarchical Regression Model ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( > 25 percentile points) at 26.8% and by at least 2 quartiles ( > 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

scholarly journals LO08: Effect of an intact “chain of survival” sequence on survival to discharge from out-of-hospital cardiac arrest

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S30
Author(s):  
D.L. Andrusiek ◽  
R.B. Abu-Laban ◽  
J.M. Tallon ◽  
S. Sheps ◽  
K. Joseph
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Endotracheal Intubation ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Research Network ◽  
Independent Effect ◽  
Chain Of Survival ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: The “chain of survival” is a 5-link theoretical construct that has been central to cardiac arrest resuscitation for over 40 years. Although the role of each link has been extensively studied, little is known about the impact of performing the chain of survival in sequence. The purpose of this study was to estimate the proportion of out-of-hospital cardiac arrest (OHCA) responses by Emergency Medical Services (EMS) that had an intact chain of survival sequence response, and the effect of this on survival to hospital discharge. Methods: We conducted a prospective cohort study of adult (&gt;age 20 years) OHCA patients using data collected between 2005-2007 by the Resuscitation Outcomes Consortium (ROC). ROC is a research network involving 10 research sites and 264 EMS agencies across North America. Using routinely collected data, we coded cases as receiving an intact or non-intact chain of survival sequence based on EMS cardio pulmonary resuscitation (CPR), rhythm analysis or defibrillation, epinephrine administration or endotracheal intubation, and transport to a hospital with an electrophysiology lab or percutaneous coronary intervention capability, contingent on the patient’s condition when EMS arrived. Multiple variable logistic regression was performed, adjusting for known (Utstein) survival predictors, to estimate the independent effect of intact chain of survival sequence on survival to hospital discharge. REB approval was obtained. Results: We enrolled12,821 OHCA cases, of which, 29.4% (n=3,773) had an intact chain of survival and 7.6% (n=972) survived to hospital discharge. Cases with an intact chain of survival were younger, and more likely to arrest in public, receive bystander CPR, occur in the USA and specific ROC sites, and had faster EMS response times. The adjusted odds ratio of survival to hospital discharge with an intact chain of survival sequence was 2.4 (95% CI: 2.1-2.8). A sensitivity analysis of 4,056 cases with known timing of endotracheal intubation found a similar adjusted odds ratio of 2.1 (95% CI: 1.6-2.8). Conclusion: Our results indicate that OCHA resuscitation with an intact chain of survival occurs in approximately 1/3 of cases, and results in over a two-fold increase in the odds of surviving to hospital discharge. Initiatives to improve EMS teamwork and increase the proportion of OHCA resuscitation with an intact chain of survival appear to be warranted.

scholarly journals Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry

2021 ◽  
Vol 10 (3) ◽  
pp. 439
Author(s):  
Hwan Song ◽  
Hyo Kim ◽  
Kyu Park ◽  
Soo Kim ◽  
Won Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Coronary Angiography ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
High Risk Patients ◽  
Neurologic Outcomes ◽  
Risk Patients ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

The effect of early coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation (STE) is still controversial. It is not known which subgroups of patients without STE are the most likely to benefit. The objective of this study was to evaluate the association between emergency CAG and neurologic outcomes and identify subgroups with improved outcomes when emergency CAG was performed. This prospective, multicenter, observational cohort study was based on data from the Korean Hypothermia Network prospective registry (KORHN-PRO) 1.0. Adult OHCA patients who were treated with targeted temperature management (TTM) without any obvious extracardiac cause were included. Patients were dichotomized into early CAG (≤24 h) and no early CAG (>24 h or not performed) groups. High-risk patients were defined as having the Global Registry of Acute Coronary Events (GRACE) score > 140, time from collapse to return of spontaneous circulation (ROSC) > 30 min, lactate level > 7.0 mmol/L, arterial pH < 7.2, cardiac enzyme elevation and ST deviation. The primary outcome was good neurologic outcome at 6 months after OHCA. Of the 1373 patients from the KORHN-PRO 1.0 database, 678 patients met the inclusion criteria. The early CAG group showed better neurologic outcomes at 6 months after cardiac arrest (CA) (adjusted odds ratio: 2.21 (1.27–3.87), p = 0.005). This was maintained even after propensity score matching (adjusted odds ratio: 2.23 (1.39–3.58), p < 0.001). In the subgroup analysis, high-risk patients showed a greater benefit from early CAG. In contrast, no significant association was found in low-risk patients. Early CAG was associated with good neurologic outcome at 6 months after CA and should be considered in high-risk patients.

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