scholarly journals Beyond return of spontaneous circulation: update on post-cardiac arrest management in the intensive care unit

2021 ◽  
Vol 62 (08) ◽  
pp. 444-451 ◽  
Author(s):  
YW Chia ◽  
◽  
SL Lim ◽  
JK Loh ◽  
BSH Leong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Spontaneous Circulation ◽  
Health Concern ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Number Of Patients ◽  
Chain Of Survival ◽  
Resuscitated Patients

A well-functioning chain of survival is critical for good outcomes following out-of-hospital cardiac arrest, a major public health concern in Singapore. While the percentage of survivors to hospital admission has increased over the years, the percentage of survivors to hospital discharge and the number of patients with good neurological recovery can be greatly improved. This underscores the urgent need to focus on ‘post-cardiac arrest care’, the fifth link in the chain of survival, to improve the outcomes of patients who are admitted to the intensive care unit (ICU) after return of spontaneous circulation. This review builds on earlier recommendations of the Singapore National Targeted Temperature Management Workgroup in 2017 to provide a focused update on post-cardiac arrest management and a practical guide for physicians managing resuscitated patients with cardiac arrest in the ICU.

Abstract 349: Target Temperature Management After Return of Spontaneous Circulation Did Not Ameliorate Mid-term (30 to 90-day) Neurological Improvement in Out-of-hospital Cardiac Arrest Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Hiromichi Naito ◽  
Takashi Yorifuji ◽  
Tetsuya Yumoto ◽  
Tsuyoshi Nojima ◽  
Noritomo Fujisaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Analysis ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Return Of Spontaneous Circulation ◽  
Neurological Improvement ◽  
Hospital Cardiac Arrest

Introduction: Mid/long-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors have not been extensively studied. Targeted temperature management (TTM) after return of spontaneous circulation is one known therapeutic approach to ameliorate short-term neurological improvement of OHCA patients; however, the prognostic significance of TTM in the mid/long-term clinical setting have not been defined. Hypothesis: TTM would confer additional improvement of OHCA patients’ mid-term neurological outcomes. Methods: Retrospective study using the Japanese Association for Acute Medicine OHCA Registry (Jun 2014 - Dec 2017): a nationwide multicenter registry. Patients who did not survive 30 days after OHCA, those with missing 30-day Cerebral Performance Category (CPC) scores, and those < 18 years old were excluded. Primary endpoint was alteration of neurological function evaluated with 30-day and 90-day CPC. Association between application of TTM (33-36°C) and mid-term CPC alteration was evaluated. Multivariable logistic regression analysis was used for the primary outcome; results are expressed with odds ratio (OR) and 95% confidence interval (CI). Results: We included 2,905 in the analysis. Patient characteristics were: age: 67 [57 - 78] years old, male gender: 70.8%, witnessed collapse: 81.4%, dispatcher instruction for CPR: 51.6%, initial shockable rhythm: 67.0%, and estimated cardiac origin: 76.5%. TTM was applied to 1,352/2,905 (46.5%) patients. Thirty-day CPC values in surviving patients were: CPC 1: 1,155/2,905 (39.8%), CPC 2: 321/2,905 (11.1%), CPC 3: 497/2,905 (17.1%), and CPC 4: 932/2,905 (32.1%), respectively. Ninety-day CPC values were: CPC 1: 866/1,868 (46.4%), CPC 2: 154/1,868 (8.2%), CPC 3: 224/1,868 (12.0%), CPC 4: 392/1,868 (20.1%), and CPC 5: 232/1,868 (12.4%), respectively. Of 1,636 patients with 90-day survival, 28 (1.7%) demonstrated improved CPC at 90 days, whereas, 133 (8.1%) showed worsened CPC at 90 days compared with 30-day CPC, respectively. Multivariable logistic regression analysis revealed TTM did not result in favorable mid-term neurological changes (adjusted OR: 1.44, 95% CI: 0.48 - 4.31). Conclusions: TTM may not contribute to the beneficial effect on OHCA patients’ mid-term neurological changes.

scholarly journals Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

2019 ◽  
Vol 27 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Veerapong Vattanavanit ◽  
Supattra Uppanisakorn ◽  
Thanapon Nilmoje
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Medical Intensive Care Unit ◽  
Heart Association ◽  
Temperature Management ◽  
Medical Intensive Care ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

scholarly journals Withdrawal of Life-Sustaining Therapy in Intensive Care Unit Patients Following Out-Of-Hospital Cardiac Arrest: An Australian Metropolitan ICU Experience

2022 ◽  
Author(s):  
Nilesh Anand Devanand ◽  
Mohammed Ishaq Ruknuddeen ◽  
Natalie Soar ◽  
Suzanne Edwards
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Length Of Stay ◽  
Motor Response ◽  
Temperature Management ◽  
Icu Patients ◽  
Icu Length Of Stay ◽  
Clinical Records ◽  
Hospital Cardiac Arrest

Abstract Objective: To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA).Methods: A retrospective review of ICU data from patient clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, clinical attributes and targeted temperature management were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 hours) and late (ICU length of stay ≥72 hours). Factors independently associated with WLST were determined by multivariable binary logistic regression using a backward elimination method, and results were depicted as odds ratios (OR) with 95% confidence intervals (CI).Results: The study selection criteria resulted in a cohort of 260 ICU patients post-OHCA, with a mean age of 58 years and the majority were males (178, 68%); 151 patients (58%) died, of which 145 (96%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 38.90, 95% CI 4.55–332.57; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day 3 post-OHCA was the strongest factor associated with delayed WLST (OR 91.59, 95% CI 11.66–719.18; p < 0.0001).Conclusion: The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day 3 post-OHCA are independently associated with WLST.

scholarly journals "Teamwork cooperation": Nurse’s experience of cardiac arrest nursing care

2019 ◽  
Vol 2 (2) ◽  
pp. 41-46
Author(s):  
Arif Wahyu Setyo Budi ◽  
Yati Afiyanti ◽  
Yustan Azidin
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Nursing Care ◽  
Health Personnel ◽  
Phenomenological Approach ◽  
Spontaneous Circulation ◽  
Care Process ◽  
Major Theme ◽  
Return Of Spontaneous Circulation ◽  
Life Threatening

Background : Emergency conditions are conditions that occur suddenly and are very life-threatening, so help must be given quickly, precisely and correctly. One of the life-threatening conditions is cardiac arrest, which is a condition where the heart cannot function anymore, and requires collaboration between health personnel in providing help and this always ends in death. The incidence of cardiac arrest at the Ulin Regional General Hospital during May to June 2017 was 88 cases and most of the deaths occurred in patients. Cardiac arrest can still be saved by the correct nursing care process so that return of spontaneous circulation can occur.Purpose : Identify and explore the experience of nurses doing nursing care for cardiac arrest.Methods: This type of research is qualitative with a phenomenological approach. The number of participants in this study were 9 nurses in the emergency room and intensive care unit. The process of retrieving data using interview guides, and data analysis using Colaizzy.Results: This study obtained a major theme, "Collaborative Teamwork" when providing nursing care for cardiac arrest. This theme was formed from two sub-themes namely "division of job teams", "collaboration" and KIE to the patient's family.The participant describing the existence of maintained teamwork can help smooth the process of nursing cardiac arrest so that patients can return to the condition of return of spontaneous circulation.

scholarly journals Peripartum Cardiomyopathy with Respiratory Failure and Cardiac Arrest

2018 ◽  
Vol 1 (1-3) ◽  
pp. 11-16
Author(s):  
Sakura Minami ◽  
Hayato Taniguchi ◽  
Takeru Abe ◽  
Tomoki Doi ◽  
Ichiro Takeuchi
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Heart Diseases ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Postpartum Woman ◽  
Return Of Spontaneous Circulation ◽  
Vv Ecmo

We describe the case of a 33-year-old female who went into cardiac arrest outside the hospital 7 days postpartum. We diagnosed her with peripartum cardiomyopathy (PPCM). After the return of spontaneous circulation, she suffered from acute pulmonary edema and hypoxia. The patient received intensive care after gaining return of spontaneous circulation. We also present an effective use of venovenous extracorporeal membrane oxygenation (VV-ECMO), which led to a rather short stay in the intensive care unit (ICU). An echocardiogram showed global hypokinesis with an ejection fraction of 28% and a left ventricular dilation with a diastolic dimension. The patient’s lungs recovered steadily during her stay in the ICU. VV-ECMO was disconnected on the seventh day of hospitalization, and intubation was withdrawn on the tenth day. On the thirteenth day, she was released from the ICU and transferred to another hospital. If a pregnant or postpartum woman presents with cardiopulmonary arrest, heart diseases such as PPCM should be considered.

Abstract 418: Categorization of Post-Cardiac Arrest Patients According to the Pattern of Amplitude-Integrated Electroencephalography After Return of Spontaneous Circulation: Analysis of Long-Term Prognosis

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kazuhiro Sugiyama ◽  
Kazuki Miyazaki ◽  
Yuichi Hamabe
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Neurological Function ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Good Outcome ◽  
Long Term Prognosis ◽  
One Year

Introduction: Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG easily interpreted by emergency physicians and intensivists at the bedside. We previously reported that categorizing post-cardiac arrest patients according to the pattern of aEEG, after return of spontaneous circulation (ROSC), could help predict the neurological function at hospital discharge (Critical Care. 2018;20:226). In post-cardiac arrest patients, increasing importance is being placed on long-term prognosis. In this study we evaluated the neurological outcome of patients in each category from our previous study, one year after cardiac arrest. Methods: We assessed the outcomes of patients who received post-cardiac arrest care, including targeted temperature management (TTM) and aEEG monitoring, in our tertiary emergency center, between March 2013 and April 2017. The patients were divided into four categories: C1 included those who displayed continuous normal voltage (CNV), within 12 hours of ROSC, and the best aEEG pattern in post-cardiac arrest patients; C2 included those who recovered CNV between 12 and 36 hours after ROSC; C3 included those with no CNV up to 36 hours after ROSC; and C4 included those who revealed burst suppression any time after ROSC. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2, one year after cardiac arrest. Results: A total of 60 patients, with a median age of 60 years, were assessed; of them, 41 (68%) had an initial shockable rhythm. A good outcome was recorded in 18/19 (95%) C1 patients, 8/14 (57%) C2 patients, 1/10 (10%) C3 patients, and 0/14 C4 patients. Three patients could not be categorized because the recording period was too short. Conclusion: The categorization of post-cardiac arrest patients according to the pattern of aEEG after ROSC may be useful to predict long-term neurological function. C1 patients had excellent prognosis, while C3 and C4 patients had poor prognosis. However, one patient in the C3 group had CPC 3 at hospital discharge and then recovered to CPC 2 within one year. Withdrawal of care should be considered cautiously, using a multimodal approach, for patients in this category. C2 patients have borderline prognosis and are targets for intensive post-cardiac neurological care.

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