scholarly journals Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Jun Wei Yeo ◽  
Zi Hui Celeste Ng ◽  
Amelia Xin Chun Goh ◽  
Jocelyn Fangjiao Gao ◽  
Nan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Meta Analysis ◽  
High Volume ◽  
Spontaneous Circulation ◽  
Sensitivity Analyses ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Interhospital Transfer ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

Abstract 12185: Impact of Cardiac Arrest Centers on the Survival of Nontraumatic Out-of-Hospital Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jun Wei Yeo ◽  
Celeste Z Ng ◽  
Amelia X Goh ◽  
Jocelyn F Gao ◽  
Nan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
High Volume ◽  
Sensitivity Analyses ◽  
Shockable Rhythm ◽  
Meta Analyses ◽  
Favorable Neurological Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: The role of cardiac arrest centers (CAC) in out-of-hospital cardiac arrest (OHCA) is uncertain, especially since CACs are inconsistently defined. This study seeks to address knowledge gaps by assessing the impact of CACs on nontraumatic OHCA patients as a whole and among specific subgroups. Methods: In this review, Medline, Embase, and Cochrane CENTRAL were searched from inception to 9 March 2021. Studies were included if they compared CAC vs non-CAC among adult patients with nontraumatic OHCA. CACs were explicitly named by study authors and were capable of appropriate interventions. Data abstraction and quality assessment were independently conducted by two authors, and a third author resolved discrepancies. Main outcomes were survival and survival with favorable neurological outcome at hospital discharge or at 30 days. Meta-analyses were performed for adjusted (aOR) and crude (OR) odds ratios. Sensitivity analyses were conducted for wider definitions of CAC such as high volume centers or improved post-resuscitation care, and subgroups analysed to account for heterogeneity. Results: The search yielded 4544 articles, and 36 were included for analysis. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR = 1.88, 95% CI 1.53 to 2.31), even when including high volume centers (aOR = 1.68, 95% CI 1.30 to 2.16), or when including improved care centers (aOR = 2.16, 95% CI 1.76 to 2.64) as CACs. Survival significantly increased with treatment at CAC (aOR = 1.92, 95% CI 1.59 to 2.31), even when including high volume centers (aOR = 1.74, 95% CI 1.38 to 2.18), or when including improved care centers (aOR = 1.97, 95% CI 1.71 to 2.26) as CACs. The effect on favorable neurological outcome was more pronounced among patients with shockable rhythm (p = 0.03) and on survival among patients without prehospital ROSC (p = 0.005). Findings were robust to sensitivity analyses, with no publication bias detected. Conclusion: CACs improved survival and neurological outcomes for nontraumatic OHCA patients despite varying definitions of CAC. Patients with shockable rhythms and without prehospital ROSC appeared to yield greater benefit from CACs. Evidence for bypassing hospitals or inter-hospital transfer remains inconclusive.

Abstract 12258: Out-of-hospital Cardiac Arrest With Initially Shockable Rhythm: What Are the Outcomes if No Shock is Given?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yan Xiong ◽  
Ahamed H Idris
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Multiple Variable ◽  
Multiple Variable Regression ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Attempt

Background: Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with a shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. Objectives: To describe demographics, pre-hospital characteristics, interventions, and outcomes in OHCA patients with an initially shockable rhythm who did and did not get shocked in the field in DFW ROC site. Methods: We included all non-traumatic OHCA cases ≥18 years old with VF or VT as first known rhythms, who were treated and transported to a hospital within the DFW ROC site between 2006 - 2011. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multiple variable regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. Results: Included were 882 adult non-traumatic OHCA cases with VF or VT as first known rhythms; mean (±SD) age was 60 ± 15 years, 71% male, bystander witnessed 56%, bystander resuscitation attempt 43%, public arrest location 26%, EMS response time 4.7 ± 2.3 min, 26.9% (237) had ROSC in the field, 14.9% (131) survived to hospital discharge; 93.4% (824) of all patients were shocked, while 6.6% (58) were not shocked. Of the 6.6% (58) who were not shocked, 12.1% (7) achieved ROSC in the field and 8.6% (5) survived to hospital discharge. For those not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.354 (95% CI 0.158-0.791, p=0.011) and 0.189 (95% CI 0.039-0.911, p=0.038), respectively; and for survival to hospital discharge they were 0.522 (95% CI 0.205-1.331, p=0.173) and 0.498 (95% CI 0.088-2.810, p=0.430), respectively. Conclusions: In the DFW ROC site, 6.6% of OHCA victims with an initially shockable rhythm did not receive a shock, which was significantly associated with decreased ROSC in the field. More patients survived who were shocked in the field, but this difference was not significant after adjustment for Utstein variables.

Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience

2007 ◽  
Vol 16 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Robyn Peters ◽  
Mary Boyde
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
High Rate ◽  
Hospital Data ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Resuscitation Training ◽  
Hospital Cardiac Arrest

Background Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training. Objectives To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest. Methods An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model. Results Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge. Conclusions The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.

Abstract 206: Cardiopulmonary Resuscitation Process Measures Associated With Return of Spontaneous Circulation in Non-Shockable Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jose M Juarez ◽  
Allison C Koller ◽  
Robert H Schmicker ◽  
Seo Young Park ◽  
David D Salcido ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Duty Cycle ◽  
Spontaneous Circulation ◽  
Research Network ◽  
Process Measures ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Purpose: Survival rates after non-shockable out-of-hospital cardiac arrest (OHCA) remain low despite advances in resuscitation. Cardiopulmonary resuscitation (CPR) process measures may inform treatment strategies. We hypothesized that CPR process measures would be associated with return of spontaneous circulation (ROSC) and patient electrocardiogram (ECG) transitions. Methods: We obtained defibrillator monitor data for emergency medical service (EMS)-treated non-shockable OHCA from the Resuscitation Outcomes Consortium (ROC), an OHCA research network (U.S./Canada). We extracted ECG data from EMS defibrillator files and parsed cases into compression-free analyzable segments using custom MATLAB software. Two data abstractors classified segment rhythms as PEA, asystole, ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), or ROSC. We calculated CPR process measures (average rate, depth, duration, leaning proportion, chest compression fraction, and duty cycle) for CPR bouts preceding every ECG segment. We used mixed effects models controlling for subject to test associations between individual CPR process measures and the bout-level outcomes ROSC and shockable rhythm. Results: We analyzed 1893 cases consisting of 7981 CPR bouts. Case initial rhythms were asystole (68.2%), PEA (24.9%), or NSA-AED (6.9%). Segment rhythm classifications were asystole (78.1%), PEA (20.4%), ROSC (5.5%), VF (1.4%), and PVT (0.07%). Regression model results are shown in Table 1. Chest compression fraction was most strongly associated with ROSC and shockable rhythm. Depth was also associated with shockable rhythm. Leaning proportion and duty cycle were not associated with either outcome. Conclusions: In cases of non-shockable OHCA, CPR quality measures were associated with ROSC and transition to a shockable rhythm at the bout level.

Abstract 146: Association of Epinephrine Prior to Defibrillation with Survival in Patients with In-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Erin Evans ◽  
Morgan B Swanson ◽  
Nicholas Mohr ◽  
Boulos Nassar ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
First Line ◽  
Lower Odds ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Get With The Guidelines ◽  
Current Guidelines ◽  
Hospital Cardiac Arrest ◽  
First Line Treatment

Background: Prompt defibrillation is a first line treatment for in-hospital cardiac arrest (IHCA) due to a shockable rhythm, with epinephrine recommended only when defibrillation is ineffective. However, empirical data regarding epinephrine prior to first defibrillation for shockable IHCA and its association with survival are unavailable. Methods: Using 2000-2018 Get with the Guidelines Resuscitation data, we identified adults ( > 18 years) with an index IHCA due to an initial shockable rhythm. We conducted a time-dependent propensity-matched analysis to evaluate the association of epinephrine prior to first defibrillation with survival to discharge and acute resuscitation survival (i.e., return of spontaneous circulation for > 20 minutes). Results: Among 34,688 subjects, 10,057 (29.0%) received epinephrine before defibrillation. Median age was 67 years in both groups. Compared to defibrillation first, patients in the epinephrine first group were less likely to have myocardial infarction or heart failure, but more likely to have renal failure, sepsis and pneumonia, be located in an intensive care unit, and already receiving mechanical ventilation (P <0.001 for all). Treatment with epinephrine first was strongly associated with a delay in first defibrillation (median 3 min vs. 0 min; P <0.001). In propensity-matched analysis, epinephrine prior to defibrillation was associated with lower odds of survival to discharge (OR: 0.81, 95% CI 0.76 - 0.86) and acute resuscitation survival (OR: 0.79, 95% CI 0.74 - 0.84). Early epinephrine was associated with lower survival (OR: 0.87, 95% CI 0.78-0.97) and acute resuscitation survival (OR for acute resuscitation survival: 0.83, 95% CI 0.74-0.93) even in patients who received defibrillation within 2 minutes. Conclusions: Despite a strong emphasis on prompt defibrillation in current guidelines, nearly 1 in 3 patients with IHCA due to a shockable rhythm received epinephrine prior to first defibrillation. Epinephrine before defibrillation was associated with worse survival outcomes. Although delays in defibrillation were more common in the early epinephrine group, early epinephrine remained associated with worse outcomes even in patients who received prompt defibrillation.

P1709A comprehensive meta-analysis on the impact of cardiopulmonary resuscitation guideline changes on outcomes after in- and out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Nas ◽  
R Te Grotenhuis ◽  
J L Bonnes ◽  
J Thannhauser ◽  
J Furlaneto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Positive Impact ◽  
Guideline Development ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Improved Outcomes ◽  
Resuscitation Guidelines ◽  
Before And After ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Studies on international registries report improved outcomes after in- and out-of-hospital cardiac arrest over the last decade. The 2015 resuscitation guidelines incorporate initiatives derived from both guidelines 2005 and 2010, respectively. Purpose In order to assess the impact of these respective updates, we aim to provide the most comprehensive quantitative summary of comparative studies that specifically focused on outcomes before and after guideline updates. Methods PubMed, Web-of-Science, Embase and The Cochrane Libraries were searched for studies that compared clinical outcomes of patients resuscitated in the period before and after introduction of guidelines 2010 and 2005, respectively. Results For studies on guidelines 2010 vs. 2005 (n=6; 1,002 patients), the pooled estimate did not indicate a difference [OR 1.29 (95% CI 0.74–2.25) p=0.372] in return of spontaneous circulation (ROSC). For survival to discharge a significant benefit [OR 1.70 (1.01–2.84) p=0.045] was observed for patients resuscitated according to guideline 2010. As for guidelines 2005 vs. 2000 (n=23; 40,859 patients), the pooled estimates for ROSC, survival to admission, to discharge and favourable neurologic outcome consistently indicated benefit for guideline 2005 [OR 1.21 (1.04–1.42) p=0.014; OR 1.34 (1.09–1.65) p=0.005; OR 1.46 (1.25–1.70) p<0.001; OR 1.35 (1.01–1.81) p=0.040]. Conclusions This comprehensive meta-analysis quantifies the positive impact of resuscitation guideline updates on outcomes and supports the current way of guideline development. While there is robust evidence for improved overall outcomes after guidelines 2005, the 2010 guideline benefit was restricted to improved survival to discharge. In terms of quality control, our findings call for continued initiatives to monitor outcomes after guideline updates. Acknowledgement/Funding None

scholarly journals Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohammed S. Alshahrani ◽  
Hassan W. Aldandan
Keyword(s):  
Cardiac Arrest ◽  
Sodium Bicarbonate ◽  
Observational Studies ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Current Evidence ◽  
Cochrane Library ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a common cause of death worldwide (Neumar et al., Circulation 122:S729–S767, 2010), affecting about 300,000 persons in the USA on an annual basis; 92% of them die (Roger et al., Circulation 123:e18–e209, 2011). The existing evidence about the use of sodium bicarbonate (SB) for the treatment of cardiac arrest is controversial. We performed this study to summarize the evidence about the use of SB in patients with out-of-hospital cardiac arrest (OHCA). Methods We searched PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library, until June 2019, for randomized controlled trials (RCTs) and observational studies that used SB in patients with OHCA. Outcomes of interest were the rate of survival to discharge, return of spontaneous circulation (ROSC), sustained ROSC, and good neurological outcomes at discharge. Odds ratio (OR) with their 95% confidence interval (CI) were pooled in a random or fixed meta-analysis model. Results A total of 14 studies (four RCTs and 10 observational studies) enrolling 28,412 patients were included; of them, eight studies were included in the meta-analysis. The overall pooled estimate did not favor SB or control in terms of survival rate at discharge (OR= 0.66, 95% CI [0.18, 2.44], p=0.53) and ROSC rate (OR= 1.54, 95% CI [0.38, 6.27], p=0.54), while the pooled estimate of two studies showed that SB was associated with less sustained ROSC (OR= 0.27, 95% CI [0.07, 0.98], p=0.045) and good neurological outcomes at discharge (OR= 0.12, 95% CI [0.09, 0.15], p<0.01). Conclusion The current evidence demonstrated that SB was not superior to the control group in terms of survival to discharge and return of spontaneous circulation. Further, SB was associated with lower rates of sustained ROSC and good neurological outcomes.

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