scholarly journals Evaluation of prognostic prediction models for out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792096691
Author(s):  
Yat Hei Lo ◽  
Yuet Chung Axel Siu
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Prediction Models ◽  
Model Development ◽  
Spontaneous Circulation ◽  
Emergency Team ◽  
Survival Score ◽  
Prognostic Prediction ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Introduction: Accurate prognostic prediction of out-of-hospital cardiac arrest is challenging but important for the emergency team and patient’s family members. A number of prognostic prediction models specifically designed for out-of-hospital cardiac arrest are developed and validated worldwide. Objective: This narrative review provides an overview of the prognostic prediction models out-of-hospital cardiac arrest patients for use in the emergency department. Discussion: Out-of-hospital cardiac arrest prognostic prediction models are potentially useful in clinical, administrative and research settings. Development and validation of such models require prehospital and hospital predictor and outcome variables which are best in the standardised Utstein Style. Logistic regression analysis is traditionally employed for model development but machine learning is emerging as the new tool. Examples of such models available for use in the emergency department include ROSC After Cardiac Arrest, CaRdiac Arrest Survival Score, Utstein-Based Return of Spontaneous Circulation, Out-of-Hospital Cardiac Arrest, Cardiac Arrest Hospital Prognosis and Cardiac Arrest Survival Score. The usefulness of these models awaits future studies.

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.

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Prediction Models ◽  
Patient Characteristics ◽  
Research Direction ◽  
Medical Emergency ◽  
Aggregated Data ◽  
Academic Publications ◽  
Relationship Of ◽  
Hospital Cardiac Arrest

Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

scholarly journals Prognostic value of changes in the cardiac arrest rhythms from the prehospital stage to the emergency department in out-of-hospital cardiac arrest patients without prehospital returns of spontaneous circulation: A nationwide observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257883
Author(s):  
Jae Guk Kim ◽  
Hyungoo Shin ◽  
Jun Hwi Cho ◽  
Hyun Young Choi ◽  
Wonhee Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Discharge ◽  
Prognostic Value ◽  
Spontaneous Circulation ◽  
Shock Group ◽  
Electrical Shock ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background This study aimed to assess the prognostic value of the changes in cardiac arrest rhythms from the prehospital stage to the ED (emergency department) in out-of-hospital cardiac arrest (OHCA) patients without prehospital returns of spontaneous circulation (ROSC). Methods This retrospective analysis was performed using nationwide population-based OHCA data from South Korea between 2012 and 2016. Patients with OHCA with medical causes and without prehospital ROSC were included and divided into four groups according to the nature of their cardiac arrest rhythms (shockable or non-shockable) in the prehospital stage and in the ED: (1) the shockable and shockable (Shock-Shock) group, (2) the shockable and non-shockable (Shock-NShock) group, (3) the non-shockable and shockable (NShock-Shock) group, and (4) the non-shockable and non-shockable (NShock-NShock) group. The presence of a shockable rhythm was confirmed based on the delivery of an electrical shock. Propensity score matching and multivariate logistic regression analyses were used to assess the effect of changes in the cardiac rhythms on patient outcomes. The primary outcome was sustained ROSC in the ED; the secondary outcomes were survival to hospital discharge and good neurological outcomes at hospital discharge. Results After applying the exclusion criteria, 51,060 eligible patients were included in the study (Shock-Shock, 4223; Shock-NShock, 3060; NShock-Shock, 11,509; NShock-NShock, 32,268). The propensity score-matched data were extracted from the six comparative subgroups. For sustained ROSC in the ED, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01) and NShock-NShock (P <0.01), Shock-NShock showed a lower likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), NShock-Shock showed a higher likelihood NShock-NShock (P <0.01). For survival to hospital discharge, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed a higher likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), of sustained ROSC in the ED. For good neurological outcomes, Shock-Shock showed higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed better likelihood than NShock-NShock (P <0.01), NShock-Shock showed a better likelihood than NShock-NShock (P <0.01). Conclusion Sustained ROSC in the ED may be expected for patients with shockable rhythms in the ED compared with those with non-shockable rhythms in the ED. For the clinical outcomes, survival to hospital discharge and neurological outcomes, patients with Shock-Shock showed the best outcome, whereas patients with NShock-NShock showed the poorest outcome and Shock-NShock showed a higher likelihood of achieving survival to hospital discharge with no significant differences in the neurological outcomes compared with NShock-Shock.

The cardiac arrest survival score: A predictive algorithm for in-hospital mortality after out-of-hospital cardiac arrest

Resuscitation ◽  
2019 ◽  
Vol 144 ◽  
pp. 46-53 ◽  
Author(s):  
Prakash Balan ◽  
Brian Hsi ◽  
Manoj Thangam ◽  
Yelin Zhao ◽  
Dominique Monlezun ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Predictive Algorithm ◽  
Survival Score ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

scholarly journals Association Between Duration of Return of Spontaneous Circulation and Favorable Outcomes After Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Huixin Lian ◽  
Andong Xia ◽  
Xinyan Qin ◽  
Sijia Tian ◽  
Xuqin Kang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Core Outcome ◽  
Return Of Spontaneous Circulation ◽  
Emergency Department Arrival ◽  
Duration Time ◽  
Hospital Cardiac Arrest

Abstract Background: Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR), but the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest (OHCA).Methods: In this retrospective observational study from a single center in Beijing, we analyzed the records of 126 OHCA patients who achieved ROSC between January 1, 2020, and December 31, 2020. ROSC duration was defined as the entire time of ROSC from heartbeat or pulse present upon arrival at hospital or arrest again during CPR. The primary outcome was survival at 30 days with favorable neurological outcome. The probability of survival after OHCA as related to CPR duration time was further analyzed using the Probability Density Function (PDF) and the empirical Cumulative Density Functions (CDFs), and compared with ROSC sustained until emergency department arrival and ROSC sustained at least 20 minutes. Results: Among all 126 OHCA patients who achieved ROSC, the median ROSC duration time was 13.6 minutes. There were no significant differences between ROSC sustained until emergency department arrival and sustained at least 20 minutes in the 24-hour survival rate (31.3% [31/99] vs. 35.7% [10/30]; P=0.835), 30-day survival rate (23.2% [23/99] vs. 25.0% [7/30]; P=0.991), or survival at 30 days with cerebral performance category (CPC) 1–2 (18.2% [18/99] vs. 10.7% [3/30]; P=0.435). The Kolmogorov-Smirnov test values from the empirical CDFs with ROSC sustained until hospital arrival and ROSC at least 20 minutes were 0.4444, 0.2000, and 0.2353 for CPC 1 or 2, CPC 3 or 4, and CPC 5 respectively.Conclusions: ROSC duration was directly associated with 24-hour survival, 30-day survival and 30-day survival with favorable neurological outcomes after OHCA. ROSC as a core outcome element of CPR should be defined as sustained at least 20 minutes or until arrival at the emergency department, and as a basic standard for evaluating resuscitation success after OHCA.

scholarly journals Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hyun-Jin Bae ◽  
Chang Hwan Sohn ◽  
Sung-Eun Cho ◽  
Jeongeun Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Rank Correlation ◽  
Spontaneous Circulation ◽  
Emergency Department Overcrowding ◽  
Neurologic Outcomes ◽  
Traumatic Cardiac Arrest ◽  
Occupancy Rates ◽  
Hospital Cardiac Arrest

Abstract Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

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