Abstract WP477: Neuro-Cognitive Outcomes After Transitioning to Pit Crew Model for Out of Hospital Cardiac Arrest

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Shravani Vindhyal ◽  
Paul Nduna ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Cognitive Outcomes ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: Survival and neurological outcomes from the out of hospital cardiac arrest (OHCA) varies from one region to another depending on the different practices followed by the emergency personnel. Our study looked into neuro-cognitive outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected by the emergency medical services (EMS) before transitioning (from 2010 - 2012) and after transitioning (from 2013-2016) to the pit crew approach. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcomes were the average number of pauses >10 seconds and the cerebral performance post return of spontaneous circulation (ROSC) Results: The average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 56% vs 47% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Conclusion: This focused model of high-quality CPR performance with the individualized assigned task has shown a declining trend in the rates of cerebral disability especially with moderate and severe cerebral performance including the patients in coma or vegetative state. More studies with better neuro-cognitive follow-up care after ROSC is needed to further establish the superiority of pit crew model approach.

Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Paul M Ndunda ◽  
Shravani Vindhyal ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardio Pulmonary Resuscitation ◽  
Improved Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

Abstract 10100: Early Prediction of Neurological Outcome at 30 Days After Return of Spontaneous Circulation From Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Norihiro Nishioka ◽  
Daisuke Kobayashi ◽  
Takeyuki Kiguchi ◽  
Tetsuhisa Kitamura ◽  
Taku Iwami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Laboratory Data ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Calibration Plot ◽  
Early Prediction ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Validation Set ◽  
Hospital Cardiac Arrest

Aim: To develop and validate a model for early prediction of neurological outcomes in non-traumatic out-hospital cardiac arrest (OHCA) patients. Methods: We analyzed the data of adult non-traumatic cardiac arrest patients who experienced return of spontaneous circulation (ROSC) and were admitted to the intensive care unit between January 2013 and December 2017 from the database of a multicenter registry. We allocated 1329 patients who were admitted from 2013 to 2015 to the derivation set and 1025 patients admitted from 2016 to 2017 to the validation set. The primary outcome was the dichotomized Cerebral Performance Category at 30 days. We developed 2 models: model 1 including variables except for laboratory data and model 2 including all variables with laboratory data immediately available after ROSC. Logistic regression with least absolute shrinkage and selection operator regularization was used for model development. The C-statistics for discrimination, the prognostic ability, and calibration of the prediction model were assessed in the validation set. The reclassification of model 2 compared to model 1 was also evaluated by continuous net reclassification index (NRI). Results: The C-statistics [95% confidence intervals] of model 2 and 1 in validation set was 0.940 [0.921-0.959] and 0.935 [0.914-0.957], respectively (Figure 1). The calibration plot showed that both models were well-calibrated to observed neurological outcomes (Figure 2). The model 2 reclassified patients better than the model 1 (NRI: 0.663, p < 0.001). A web-based calculator based on these models was developed that allows clinicians to input the predictor variables needed for the probability of good or poor neurological outcomes (https://pcas-prediction.shinyapps.io/pcas_lasso/). Conclusion: The prediction tool including detailed in-hospital information showed good performance to predict neurological outcomes at 30 days in patients with ROSC after OHCA.

Abstract 346: Targeted Temperature Management is Associated with Improved Neurological Outcomes in Witnessed Out-of-hospital Cardiac Arrest Patients Who Achieve Early Return of Spontaneous Circulation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nobuyuki Enzan ◽  
Ken-ichi Hiasa ◽  
Kenzo Ichimura ◽  
Masaaki Nishihara ◽  
Takeshi Iyonaga ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Propensity Score Matching Analysis ◽  
Hospital Cardiac Arrest

Background: Previous randomized controlled trials demonstrated the efficacy of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) patients with both shockable and non-shockable rhythm. Real-world evidence for TTM using large OHCA database are scarce, and no study has investigated the relationship between TTM and time-to-return of spontaneous circulation (ROSC). Methods: The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients with witnessed non-traumatic OHCA who had been resuscitated and were in a coma were included. Eligible patients were divided into two groups according to the use of TTM. The primary outcome was defined as a Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The propensity score matching analysis was used. The cubic spline analysis of the odds ratio of CPC 1-2 for TTM use by time-to-ROSC was performed. Results: Out of 34,754 patients with OHCA, 5,261 patients were included. The mean age was 70.3 years, and 3,417 (65.0%) were male. CPC 1-2 was more frequently observed in the TTM group in propensity score matching analysis (15.1% vs. 8.5%; odds ratio 1.92; 95% confidence interval 1.04-3.53; P=0.037). The cubic spline analysis showed that TTM was associated with CPC 1-2 in witnessed OHCA patients, which did not reach statistical significance in patients with time-to-ROSC longer than 50 min. Conclusions: TTM was associated with better neurological outcomes in witnessed OHCA patients, especially when patients were resuscitated within 50 min after collapse.

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.

scholarly journals Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792095856
Author(s):  
Doo Youp Kim ◽  
Jin Sup Park ◽  
Sun Hak Lee ◽  
Jeong Cheon Choe ◽  
Jin Hee Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

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