scholarly journals Anticoagulation therapy could improve the restoration of sinus rhythm and spontaneous circulation in hospital patients with CPR

2019 ◽  
Vol 47 (12) ◽  
pp. 5957-5966
Author(s):  
Hai Wang ◽  
Zheng-Hai Bai ◽  
Jun-Hua Lv ◽  
Jiang-Li Sun ◽  
Yu Shi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sinus Rhythm ◽  
Anticoagulation Therapy ◽  
Spontaneous Circulation ◽  
Spontaneous Respiration ◽  
Single Centre ◽  
Exclusion Criteria ◽  
Hospital Patients ◽  
Hospital Cardiac Arrest

Objective To analyse the role of anticoagulation therapy in cardiopulmonary resuscitation (CPR) following an in-hospital cardiac arrest. Methods This single-centre retrospective cohort study enrolled patients treated with in-hospital CPR that met the inclusion and exclusion criteria. The patients were divided into a without anticoagulation group and an anticoagulation group. The main outcome measures were the restoration of spontaneous respiration, restoration of sinus rhythm (ROSR), restoration of spontaneous circulation (ROSC) and the hospital mortality. Results The study analysed 344 patients: 272 in the without anticoagulation group and 72 in the anticoagulation group. Multiple logistic regression analyses demonstrated that anticoagulation therapy improved ROSR (adjusted odds ratio [OR] 2.21, 95% confidence interval [CI] 1.23, 3.96) and ROSC (adjusted OR 1.91, 95% CI 1.08, 3.40), but it did not improve the restoration of spontaneous respiration (adjusted OR 1.64, 95% CI 0.72, 3.76) and hospital survival (adjusted OR 0.90, 95% CI 0.40, 1.99). Conclusion Anticoagulation therapy improved ROSR and ROSC, but did not decrease the mortality rate of hospitalized patients undergoing CPR following in-hospital cardiac arrest.

PaRamEDIc assessment of laCTate in OHCA and survival to hospital (PREDICT protocol)

2021 ◽  
Vol 13 (3) ◽  
pp. 100-104
Author(s):  
Karl Charlton ◽  
Hayley Moore
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Prognostic Role ◽  
Single Centre ◽  
Intravenous Access ◽  
Secondary Outcomes ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Studies suggest that blood lactate differs between survivors and non-survivors of out-of-hospital cardiac arrest who are transported to hospital. The prognostic role of lactate taken during out-of-hospital cardiac arrest remains unexplored. Aims: To measure the association between lactate taken during out-of-hospital cardiac arrest, survival to hospital and 30-day mortality. Methods: This is a feasibility, single-centre, prospective cohort study. Eligible for inclusion are patients aged ≥18 years suffering out-of-hospital cardiac arrest, receiving cardiopulmonary resuscitation, in the catchment of Newcastle or Gateshead hospitals, who are attended to by a study-trained specialist paramedic. Exclusions are known/apparent pregnancy, blunt or penetrating injury as primary cause of out-of-hospital cardiac arrest and an absence of intravenous access. Between February 2020 and March 2021, 100 participants will be enrolled. Primary outcome is survival to hospital; secondary outcomes are return of spontaneous circulation at any time and 30-day mortality.

Abstract 189: Time to Awakening in Women Compared to Men After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby Shelton ◽  
Stacie L Daugherty ◽  
Edward Havranek
Keyword(s):  
Cardiac Arrest ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Therapeutic Interventions ◽  
Care Hospital ◽  
Single Center ◽  
Men And Women ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

scholarly journals Role of coronary angiography for out-of-hospital cardiac arrest survivors according to postreturn of spontaneous circulation on an electrocardiogram

Medicine ◽  
2017 ◽  
Vol 96 (7) ◽  
pp. e6123 ◽  
Author(s):  
Tae Rim Lee ◽  
Sung Yeon Hwang ◽  
Won Chul Cha ◽  
Tae Gun Shin ◽  
Min Seob Sim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Spontaneous Circulation ◽  
Hospital Cardiac Arrest

P2670Predictors of survival to discharge in the acute myocardial infarction patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y.-C Wu ◽  
J.-L Lin ◽  
Y.-H Liu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Sinus Rhythm ◽  
Hba1c Level ◽  
Spontaneous Circulation ◽  
Older Age ◽  
Vessel Occlusion ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. Predictors of mortality in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA were not well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was survival to discharge. The survival rate was 55.6%. Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (correlation coefficient, CC: 0.635; p<0.001), ST elevation myocardial infarction (CC: 0.550; p=0.003), sinus rhythm on first ECG (CC: 0.474; p=0.012) and higher HDL (CC: 0.471; p=0.0027) were associated better outcome (survival and neurological recovery). However, older age (CC: −0.564; p=0.002), ST depression on first ECG post resuscitation (CC: −0.481; p=0.011), hyperglycemia (CC: −0.419; p=0.030), higher HbA1C level (CC: −0.569; p=0.007), and hyperkalemia (CC: −0.612; p=0.001) were associated with worse outcome (Mortality). In conclusion, in the AMI patients presenting with OHCA after ROSC, unshockable rhythm during CPR, older age, non-sinus rhythm and ST segment depression on first ECG post resuscitation, hyperglycemia, higher HbA1C level, lower HDL level, and hyperkalemia were associated with higher hospital mortality.

Agreement Between Paramedic-Estimated Weights and Subsequent Hospital Measurements in Adults with Out-of-Hospital Cardiac Arrest

1994 ◽  
Vol 9 (1) ◽  
pp. 54-56 ◽  
Author(s):  
Daniel R. Martin ◽  
David M. Soria ◽  
Charles G. Brown ◽  
Paul E. Pepe ◽  
Edgar Gonzalez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pearson Correlation ◽  
Spontaneous Circulation ◽  
Retrospective Data Analysis ◽  
Measured Weight ◽  
Body Weights ◽  
Hospital Patients ◽  
Study Population ◽  
Pearson Correlation Analysis ◽  
Hospital Cardiac Arrest

AbstractObjective:To assess the accuracy of paramedic estimates of adult body weights in cardiac arrest cases.Hypothesis:Paramedics could accurately estimate the weights of out-of-hospital cardiac arrest patients.Design:Retrospective data analysis of a 15-month, multicenter study involving nontraumatic out-of-hospital cardiac arrest patients. Paramedic estimates of body weights were compared to weights measured in the hospital. Patients were included in the analysis only if both a paramedic weight and a measured in-hospital weight were recorded.Setting:Six urban emergency medical services systems.Participants:The study population included adults with return of spontaneous circulation who subsequently were admitted to the hospital.Measurements:Pearson correlation analysis of paramedic-estimated weights and measured weights.Results:Among the 133 study patients, the correlation coefficient (R) for paramedic estimates and the actual measured weight was 0.93. Paramedic estimates of weight were within 10% of the measured weights in 74% of the patients, and within 20% of measured weights in 93% of the patients.Conclusion:Paramedic weight estimates correlated well with measured weights.

scholarly journals Temperature post out-of-hospital cardiac arrest: the TOPCAT study

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A6.1-A6
Author(s):  
Richard Lyon
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Single Centre ◽  
Oesophageal Temperature ◽  
Arterial Blood ◽  
The Relationship ◽  
Hospital Cardiac Arrest

IntroductionOut-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only postreturn of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between body temperature post OHCA and outcome is still poorly defined.MethodsProspective observational study of all OHCA patients admitted to a single centre for a 14-month period. Oesophageal temperature was measured in the Emergency Department and Intensive Care Unit (ICU). Select patients had prehospital temperature monitoring.Results164 OHCA patients were included in the study. 105 (64.0%) were pronounced dead in the Emergency Department. 59 (36.0%) were admitted to ICU for cooling; 40 (24.4%) died in ICU and 19 (11.6%) survived to hospital discharge. Patients who achieved ROSC and had oesophageal temperature measured prehospital (n=29) had a mean prehospital temperature of 33.9°C (95% CI 33.2 to 34.5). All patients arriving in the ED post OHCA had a relatively low oesophageal temperature (34.3°C, 95% CI 34.1 to 34.6). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.7°C vs 34.3°C, p<0.05). Patients surviving to hospital discharge also took longer to reach target MTH temperature than non-survivors (2 h 48 min vs 1 h 32 min, p<0.05). There was no difference in mean arterial blood pressure on arrival in the ED between survivors and non-survivors.ConclusionsFollowing OHCA all patients have oesophageal temperatures below normal in the prehospital phase and on arrival in the Emergency Department. This questions the need for prehospital cooling post-OHCA patients. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying oesophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.

scholarly journals 446 Relationship between out of hospital cardiac arrest and COVID-19 pandemic: impact on outcome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Fulvio Lorenzo Francesco Giovenzana ◽  
Cinzia Franzosi ◽  
Paola Genoni ◽  
Michele Golino ◽  
Marta Foieni ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
First Aid ◽  
Spontaneous Circulation ◽  
Significant Difference ◽  
Few Data ◽  
Two Peaks ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Second Peak

Abstract Aims During 2020, Italy was hit by the pandemic of the ‘Coronavirus disease 2019’ (COVID-19) with an incidence/100 000 citizens characterized by two peaks. An increase in out-of-hospital cardiac arrest (OHCA) mortality during the first pandemic peak has already been described, but there are few data on the whole year. The goal of our study is to evaluate the impact of the pandemic on post-OHCA mortality. Methods We considered patients with OHCA in Varese territory from January to December 2020 with medical aetiology according with Utstein 2014 classification. The primary endpoint of the study was the assessment of acute post-arrest mortality and which parameters influence this outcome. In particular, both the role of pandemic peaks (‘first peak’ from 11 March 2020 to 23rd May 2020 and ‘second peak’ from 7 October 2020 to 31 December 2020) and the average rescue times, i.e.: (i) interval between OHCA and call for first aid (delay in activation of assistance); (ii) the interval between the call and the arrival of the rescue vehicles (delay in the arrival of the first aid) and finally; (iii) the time between the arrival of the rescue vehicles and the end of Cardiopulmonary Resuscitation (CPR), interrupted due to death or Recovery of Spontaneous Circulation (ROSC). Finally, we performed a multivariate analysis to assess which of the variables considered had the greatest impact on the outcome. Results We analysed 708 patients (mean age 76 + 14.09 years; 40% women). Overall mortality was 89%. During the peaks there was an increase in mortality compared to the pre-pandemic period (first peak 96% vs. 83%, OR 4.49; second peak 92% vs. 83%, OR 2.45) (Figure 1). The time between the collapse and the call for help was significantly higher during the first pandemic peak compared to the second peak and the pre-pandemic period (P = 0.003); the time between the call and the arrival on the patient was significantly longer during both pandemic peaks than in the previous period (P = 0.002) and there was no significant difference in CPR duration time between the periods analysed. In a multivariate model, the only time associated with an increase in mortality is the period between the call for help and the arrival on the patient, regardless of the COVID-19 pandemic. Conclusions During the COVID-19 pandemic there has been an increase in mortality of patients with OHCA. Among the variables considered, the increase in mortality is mainly associated with the delay in the arrival of emergency vehicles on site. This delay, although decreasing, was also maintained during the second peak of the pandemic.

scholarly journals Early lactate and glucose kinetics following return to spontaneous circulation after out-of-hospital cardiac arrest

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Pedro Freire Jorge ◽  
Rohan Boer ◽  
Rene A. Posma ◽  
Katharina C. Harms ◽  
Bart Hiemstra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Physiological Stress ◽  
Spontaneous Circulation ◽  
Strenuous Exercise ◽  
Rapid Rate ◽  
Glucose Kinetics ◽  
Initial Value ◽  
Extreme Stress ◽  
Arterial Ph ◽  
Hospital Cardiac Arrest

Abstract Objective Lactate has been shown to be preferentially metabolized in comparison to glucose after physiological stress, such as strenuous exercise. Derangements of lactate and glucose are common after out-of-hospital cardiac arrest (OHCA). Therefore, we hypothesized that lactate decreases faster than glucose after return-to-spontaneous-circulation (ROSC) after OHCA. Results We included 155 OHCA patients in our analysis. Within the first 8 h of presentation to the emergency department, 843 lactates and 1019 glucoses were available, respectively. Lactate decreased to 50% of its initial value within 1.5 h (95% CI [0.2–3.6 h]), while glucose halved within 5.6 h (95% CI [5.4–5.7 h]). Also, in the first 8 h after presentation lactate decreases more than glucose in relation to their initial values (lactate 72.6% vs glucose 52.1%). In patients with marked hyperlactatemia after OHCA, lactate decreased expediently while glucose recovered more slowly, whereas arterial pH recovered at a similar rapid rate as lactate. Hospital non-survivors (N = 82) had a slower recovery of lactate (P = 0.002) than survivors (N = 82). The preferential clearance of lactate underscores its role as a prime energy substrate, when available, during recovery from extreme stress.

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