scholarly journals Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S90-S99
Author(s):  
Takefumi Kishimori ◽  
Tasuku Matsuyama ◽  
Kosuke Kiyohara ◽  
Tetsuhisa Kitamura ◽  
Haruka Shida ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Regression Analyses ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background Little is known about the association between prehospital cardiopulmonary resuscitation duration for adults with out-of-hospital cardiac arrest and outcome by the location of arrests. This study aimed to investigate the association between prehospital cardiopulmonary resuscitation duration and one-month survival with favourable neurological outcome. Methods We analysed 276,391 adults aged 18 years and older with out-of-hospital cardiac arrest of medical origin before emergency medical service arrival. Prehospital cardiopulmonary resuscitation duration was defined as the time from emergency medical service-initiated cardiopulmonary resuscitation to prehospital return of spontaneous circulation or to hospital arrival. The primary outcome was one-month survival with favourable neurological outcome (cerebral performance category 1 or 2). The association between prehospital cardiopulmonary resuscitation duration and favourable neurological outcome was assessed using univariable and multivariable logistic regression analyses. Results The proportion of favourable neurological outcomes was 2.3% in total, 7.6% in public locations, 1.5% in residential locations and 0.7% in nursing homes ( P < 0.001). In univariable and multivariable logistic regression analyses, longer prehospital cardiopulmonary resuscitation duration was associated with poor neurological outcome, regardless of arrest location ( P for trend < 0.001). Patients with shockable rhythm in both public and residential locations had better neurological outcome than those in nursing homes at any time point, and residential and public locations had a similar neurological outcome tendency among patients with shockable rhythm. Conclusions Longer prehospital cardiopulmonary resuscitation duration was independently associated with a lower proportion of patients with favourable neurological outcomes. Moreover, the association between prehospital cardiopulmonary resuscitation duration and neurological outcome differed according to the location of arrest and the first documented rhythm.

Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Chisato Okamoto ◽  
Yoshio Tahara ◽  
Atsushi Hirayama ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Favorable Outcome ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

scholarly journals Shockable Rhythm at Hospital Arrival as the Predictor of Favourable Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest (OHCA) Receiving Extracorporeal Cardiopulmonary Resuscitation (ECPR)

2021 ◽  
Author(s):  
Pei-I Su ◽  
Min-Shan Tsai ◽  
Wei-Ting Chen ◽  
Chih-Hung Wang ◽  
Wei-Tien Chang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Multiple Logistic Regression ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Introduction: For patients with out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation under advanced life support, extracorporeal cardiopulmonary resuscitation (ECPR) is the only lifesaving option. This study aimed to analyse the predictors of favourable neurological outcomes (FO, cerebral performance category 1-2) at hospital discharge among patients with OHCA following ECPR.Methods: In this single-centre retrospective study, 126 patients with OHCA who received ECPR between January 2012 and December 2019 were enrolled. The primary outcome was the FO at hospital discharge. The predictors of FO were assessed using multiple logistic regression analysis. Patients with an initial shockable rhythm were further analysed according to the cardiac rhythm at the time of hospital arrival. Results: Among the patients who received ECPR, the FO at hospital discharge was 21%. Certain resuscitation variables were associated with FO including witnessed collapse (P=0.014), bystander CPR (P=0.05), shorter no-flow time (P=0.008), and a shockable rhythm at hospital arrival (P=0.009). Multiple logistic regression showed that a shockable rhythm at hospital arrival was the only independent predictor of FO at discharge (odds ratio, 3.012; 95% confidence interval, 1.06-8.53; P=0.038). Among patients with an initial shockable rhythm, the group with a shockable rhythm at hospital arrival had a FO of 30%, which was significantly higher than the 11% in the non-shockable rhythm group (P=0.043).Conclusions: In patients with OHCA who received ECPR, a shockable rhythm at the time of hospital arrival was associated with favourable neurological outcomes at discharge. The ECPR selection criteria could consider the rhythm at hospital arrival.

Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Yudai Tamura ◽  
Hiroto Suzuyama ◽  
Eiji Taguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Intervention Period ◽  
Post Intervention ◽  
Shockable Rhythm ◽  
Time Period ◽  
Simulation Based ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA. Methods: A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods. Results: There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period. Conclusion: A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.

scholarly journals Emergency Medical Service Dispatch Cardiopulmonary Resuscitation Prearrival Instructions to Improve Survival From Out-of-Hospital Cardiac Arrest

Circulation ◽  
2012 ◽  
Vol 125 (4) ◽  
pp. 648-655 ◽  
Author(s):  
E. Brooke Lerner ◽  
Thomas D. Rea ◽  
Bentley J. Bobrow ◽  
Joe E. Acker ◽  
Robert A. Berg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

scholarly journals Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
SungJoon Park ◽  
Sung Woo Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Dong-Hyun Jang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Patient Characteristics ◽  
Related Factors ◽  
Neurological Outcomes ◽  
Upper Limit ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Off Time

Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

scholarly journals Impact of Cardiopulmonary Resuscitation Duration on the Neurological Outcomes of Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
HISSAH ALBINALI ◽  
Arwa Alumran ◽  
Saja AlRayes
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Bivariate Analysis ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Secondary Hospital ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: Patients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.Objectives: The study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.Methods: Data were collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between 2015 and 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death.Results: Bivariate analysis showed no significant association between cerebral performance category (CPC) outcomes and duration of CPR, gender and cause of death whereas there is statistically significant between CPC and age. (p = 0.001). However, a good CPC outcome was reported with a (mean) limited duration of 8.1 min of CPR; whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min (mean). Similarly, youthfulness was associated with good CPC outcomes as revealed by the mean age of 5.8 years, whereas a mean rank of 14.9 years was aligned with a poor CPC outcome.Conclusion: Cardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Other variables may have a more significant effect.

scholarly journals Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Akiko Higashi ◽  
Taka-aki Nakada ◽  
Taro Imaeda ◽  
Ryuzo Abe ◽  
Koichiro Shinozaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Flow Duration ◽  
Over Time

Abstract Introduction Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR) over time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been insufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating ECPR had decreased LFD over the last 15 years of experience at an academic tertiary care hospital, which in turn improved the outcomes of in-hospital CA (IHCA). Methods This was a single-center retrospective observational study of ECPR patients between January 2003 and December 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program were initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological outcome was analyzed using multiple logistic regression analysis. Then, the temporal changes in LFD were investigated. Results Of 175 study subjects who received ECPR, 117 had IHCA. In the multivariate logistic regression, IHCA patients with shorter LFD experienced significantly increased 90-day survival and favorable neurological outcomes (LFD per minute, 90-day survival: odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.94–1.00, P = 0.032; 90-day favorable neurological outcome: OR = 0.97, 95% CI = 0.94–1.00, P = 0.049). In the study period, LFD significantly decreased over time (slope − 5.39 [min/3 years], P < 0.0001). Conclusion A shorter LFD was associated with increased 90-day survival and favorable neurological outcomes of IHCA patients who received ECPR. The quality improvement in administering ECPR over time, including the RRS program and the ECMO program, appeared to ameliorate clinical outcomes.

Abstract 457: Comparison of Effect of Audio-Instructed and Video-Instructed Dispatcher-Assisted Cardiopulmonary Resuscitation on Resuscitation Outcomes After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sun Young Lee ◽  
Kyoung Jun Song ◽  
Sang Do Shin ◽  
Ki Jeong Hong ◽  
Kim Jong Hwan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Time Interval ◽  
Good Neurological Outcome ◽  
Video Group ◽  
Hospital Cardiac Arrest

Introduction: This study aimed to compare the effect of audio-instructed dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) and video-instructed DA-CPR on resuscitation outcome after out-of-hospital cardiac arrest (OHCA) in the real world. Methods: A cross-sectional study was conducted for resuscitation-attempted adult OHCAs of 2017 in Seoul, Korea. Seoul implemented video-instructed DA-CPR program in 2017. According to the protocol, when dispatcher detected OHCA, they checked two condition: 1) more than two bystanders were in the scene, 2) they could handle a video-call. If both conditions were met, dispatcher initiated the CPR instruction and called back a video-call to the caller for instructing CPR via video (video group). Unless, standard audio-instructed DA-CPR was provided (audio group). The primary outcome was survival to discharge. The secondary outcome was good neurological outcome at hospital discharge. The tertiary outcome was early instruction time interval (ITI, time from call to the initiation of CPR instruction≤ 90 seconds). The study outcomes were compared between audio and video group. A multivariable logistic regression analysis was performed and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated adjusting for potential confounders. Propensity score matching (PSM) method was used to increase comparability of two groups and same logistic regression model was analyzed for the PSM population. Results: A total of 1,720 eligible OHCA cases (1,489 in audio and 231 in video group) were evaluated. The median seconds of ITI was 136 seconds in audio group and 122 seconds in the video group (p=0.12). Survival to discharge was 8.9% in audio group and 14.3% in video group (p<0.01). Good neurological outcome was 5.8% in audio group and 10.4% in video group (p<0.01). Compared with audio group, the AORs (95% CIs) for survival to discharge, good neurological outcome and early ITI of the video group were 1.20 (0.74 to 1.94), 1.28 (0.73 to 2.26) and 1.00 (0.70 t0 1.43), respectively. PSM population showed similar results with original population. Conclusion: Compared with audio-instructed DA-CPR, video-instructed DA-CPR was not associated with survival improvement in the observational study.

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