The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause – aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM)

Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. The minimum requirements of therapy modalities for the cardiac arrest centre are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities such as echocardiography, computed tomography and magnetic resonance imaging, and a protocol outlining transfer of selected patients to cardiac arrest centres with additional resources (out-of-hospital cardiac arrest hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.

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Abstract 252: Resuscitation in Prehospital Stage: Effectiveness and Influencing Factors

Circulation ◽

10.1161/circ.142.suppl_4.252 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Anita Abula ◽

Aija Maca ◽

Oskars Kalejs

Keyword(s):

Cardiac Arrest ◽

Influencing Factors ◽

Sudden Cardiac Arrest ◽

Heart Rhythm ◽

Public Health Issue ◽

Public Places ◽

Successful Resuscitation ◽

The Public ◽

Significant Difference ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest or sudden cardiac death is one of the leading causes of death all over the world. Of particular importance is out-of-hospital cardiac arrest (OHCA) - an important overworld public health issue. In order to help these people and improve their chances of survival, it is necessary to provide assistance as soon as possible. Bystanders are usually non-medical persons why it is more complicated to implement. The objectives of the study were to research effectiveness and influencing factors of resuscitation in prehospital stage and create suggestions and methodical recommendations as possible. Materials and Methods: A retrospective study was developed, which summarizes and analyzes the electronic call cards (IEK) of the Emergency Medical service of Latvia (EMS) for 2018 and 2019. IEK were selected that identified “successful resuscitation” and “unsuccessful resuscitation” as a complication of diagnosis (classification developed and validated by EMS of Latvia). Results: Overall 2538 resuscitations were performed, of which 27,6% were successful resuscitation. About a quarter (24,2%) of all resuscitations happened in a public place. The increase in the number of successful resuscitations is observed for resuscitation events that happened in public places. In most of cardiac arrest cases, bystanders did not perform CPR (60,3%). Arrival time of EMS in 2018 was 7,52 - 8,44 minutes and in 2019 was 7,75 - 8,23 minutes. The research shows that approximately 23% of cases the first monitored rhythm by EMS were VF/pVT. There is a significant difference in the increase in successful resuscitations if EMS performed defibrillation during the call. Conclusions: The most important influencing factors in the outcome of resuscitation are the patient’s age, the location, the first aid provided by bystanders, the time until the arrival of EMS and the first observed heart rhythm in a patient with cardiac arrest. It is necessary to create a register of AED (automated external defibrillator) devices in Latvia and their locations, to ensure the availability of data to the EMS service and the public.

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Contacts to the healthcare system prior to out-of-hospital cardiac arrests

European Heart Journal ◽

10.1093/ehjci/ehaa946.0766 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Zylyftari ◽

S.G Moller ◽

M Wissenberg ◽

F Folke ◽

C.A Barcella ◽

...

Keyword(s):

Cardiac Arrest ◽

General Population ◽

Healthcare System ◽

Early Identification ◽

Sudden Cardiac Arrest ◽

Funding Source ◽

Horizon 2020 ◽

One Year ◽

Public Grant ◽

Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

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High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2005.04.039 ◽

2005 ◽

Vol 46 (3) ◽

pp. 432-437 ◽

Cited By ~ 157

Author(s):

Ivan Laurent ◽

Christophe Adrie ◽

Christophe Vinsonneau ◽

Alain Cariou ◽

Jean-Daniel Chiche ◽

...

Keyword(s):

Cardiac Arrest ◽

High Volume ◽

High Volume Hemofiltration ◽

Hospital Cardiac Arrest

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Out-of-hospital sudden cardiac arrest in children with congenital heart defects

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-312621 ◽

2017 ◽

Vol 103 (1) ◽

pp. 57-60 ◽

Cited By ~ 1

Author(s):

Jarle Jortveit ◽

Jakob Klcovansky ◽

Gaute Døhlen ◽

Leif Eskedal ◽

Sigurd Birkeland ◽

...

Keyword(s):

Cardiac Arrest ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Heart Defects ◽

Sudden Cardiac Arrest ◽

Supplementary Information ◽

Clinical Registry ◽

Birth Registry ◽

Live Births ◽

Hospital Cardiac Arrest

AimsOut-of-hospital sudden cardiac arrest (SCA) is a rare but devastating event in children and adolescents. The risk is assumed to be higher in children with congenital heart defects (CHDs) than in healthy individuals. The aim of the present study was to investigate the rate of and survival after out-of-hospital cardiac arrest in children 2–18 years old with CHDs.Methods and resultsData concerning all live births in Norway between 1994 and 2009 were retrieved from the Medical Birth Registry of Norway, the patient administrative systems at all hospitals in Norway, the Oslo University Hospital’s Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and supplementary information for the deceased children was retrieved from medical records at Norwegian hospitals. Among the 943 871 live births in Norway from 1994 to 2009, 11 272 (1.2%) children had a CHD. We identified 11 (0.1%) children 2–18 years old with CHDs who experienced out-of-hospital SCA. The estimated rate of out-of-hospital SCA in children 2–18 years old with CHD was 10 per 100 000 person-years. Early cardiopulmonary resuscitation was initiated in all patients. Three children survived.ConclusionsThe incidence of and survival after out-of-hospital SCA in children with CHDs were comparable to the reported rates in the general child population.

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Neurological prognostication tools in out‐of‐hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13177 ◽

2018 ◽

Vol 62 (10) ◽

pp. 1412-1420 ◽

Cited By ~ 1

Author(s):

M. Winther‐Jensen ◽

C. Hassager ◽

J. F. Lassen ◽

L. Køber ◽

C. Torp‐Pedersen ◽

...

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Units ◽

Hospital Cardiac Arrest

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Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽

10.1161/circ.130.suppl_2.219 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Markus Keferböck ◽

Philip Datler ◽

Mario Krammel ◽

Elisabeth Lobmeyer ◽

Alexander Nürnberger ◽

...

Keyword(s):

Cardiac Arrest ◽

Outcome Measures ◽

Primary Outcome ◽

Sudden Cardiac Arrest ◽

Cerebral Performance Category ◽

Medical Personnel ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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Abstract 135: N-Terminal Pro-B-Type Natriuretic Peptide May Serve as a Prognostic Indicator for 30-Day Mortality Following Out-Of-Hospital Cardiac Arrest, Whereas Both High-Sensitivity Cardiac Troponin-T and Copeptin Did Not Yield Prognostic Information

Circulation ◽

10.1161/circ.140.suppl_2.135 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Reidun Aarsetoey ◽

Torbjorn Omland ◽

Helge Rosjo ◽

Heidi Strand ◽

Hildegunn Aarsetoey ◽

...

Keyword(s):

Cardiac Arrest ◽

Troponin T ◽

Univariate Analysis ◽

Heart Rhythm ◽

Cox Proportional Hazards Model ◽

Prognostic Indicators ◽

Prognostic Information ◽

Coronary Syndrome ◽

Significant Difference ◽

Hospital Cardiac Arrest

Introduction: Sudden cardiac arrest (SCA) may be due to different underlying conditions. Prior heart disease is a major risk factor, and coronary artery disease is the most common underlying cause. Hs-cTnT and copeptin are used for early diagnosis of acute myocardial infarction, and may also serve as prognostic indicators following an acute coronary syndrome. NT-proBNP is a marker of heart failure and may act as a predictor of mortality in SCA patients. These three biomarkers in relation to ventricular fibrillation (VF) and asystole on scene during resuscitation has not, to our knowledge, been evaluated. Hypothesis: We hypothesized that early-on levels of hs-cTnT, copeptin and NT-proBNP may relate to prognosis. Methods: From February 2007 until November 2010 blood samples were collected from patients aged > 18 years with out-of-hospital cardiac arrest of assumed cardiac origin. EDTA-blood was drawn during or immediately after termination of cardiopulmonary resuscitation or at hospital admission. Hs-cTnT, copeptin and NT-proBNP were all measured by standardized methods. Patients were classified according to first recorded heart rhythm. Both univariate and multivariate analyses, adjusted for age and gender, were performed using a Cox Proportional-Hazards model. Results: A total of 115 patients were included, 77 patients with VF and 38 patients with asystole as first recorded heart rhythm. Forty-four patients (38,3%) survived to 30-day follow-up. There was no significant difference in hs-cTnT (p = 0.71) or copeptin (p = 0.43) between non-survivors and survivors. The mean NT-proBNP level was significantly elevated in non-survivors compared to survivors, p = 0.001. The hazard ratio (HR) in the univariate analysis for patients with NT-proBNP in the highest quartile (Q4) compared to the lowest quartile (Q1) was 4.68 (95% CI 2.05-10.68), p = < 0.001, and in the multivariate analysis HR was 2.52 (95% CI 0.97-6.53), p = 0.058. All patients in the asystole group died. Only NT-proBNP differed between the two groups, with significantly higher values in the asystole group, p = < 0.001. Conclusion: Applying hs-cTnT, copeptin and NT-proBNP for assessment of prognosis in SCA patients with either VF or asystole, only NT-proBNP was found to yield prognostic information.

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Abstract 18: Analyzing Heart Rhythm During Chest Compressions in Out-of-Hospital Cardiac Arrest Patients Using New Algorithm for Automated External Defibrillators

Circulation ◽

10.1161/circ.138.suppl_2.18 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Corina de Graaf ◽

Stefanie G Beesems ◽

Ronald E Stickney ◽

Paula Lank ◽

Fred W Chapman ◽

...

Keyword(s):

Cardiac Arrest ◽

Negative Impact ◽

Pulseless Electrical Activity ◽

Heart Rhythm ◽

Chest Compressions ◽

Study Region ◽

Automated External Defibrillators ◽

Conventional Analysis ◽

Hospital Cardiac Arrest ◽

Conventional Algorithm

Purpose: Automated external defibrillators (AED) prompt the rescuer to stop cardiopulmonary resuscitation (CPR) for ECG analysis. Any interruption of CPR has a negative impact on outcome. We prospectively evaluated a new algorithm (cprINSIGHT) which can analyse the ECG while rescuers continue CPR. Methods: We analysed data from patients with attempted resuscitation from OHCA who were connected to an AED with cprINSIGHT (Stryker Physio-Control LIFEPAK CR2) between June 2017 and June 2018 in the Amsterdam Resuscitation Study region. The first analysis in the CR2 is a conventional analysis; subsequent analyses use the cprINSIGHT algorithm. This algorithm classifies the rhythm as shockable (S), non-shockable (NS), or no decision. If no decision, the AED prompts for a pause in CPR and uses its conventional algorithm. The characteristics of the first 3 cprINSIGHT analyses (analyses 2-4) were analysed. Ventricular fibrillation (VF) cases were both coarse and fine VF with a lower threshold of 0.08 mV. Results: Data from 132 consecutive OHCA cases were analysed. The initial recorded rhythm was VF or pulseless ventricular tachycardia (VT) in 35 cases (27%), pulseless electrical activity in 34 cases (25%) and asystole in 63 cases (48%). In 114 cases (86%), 1 or more cprINSIGHT analyses were done. Analyses 2-4 covered 90% of all cprINSIGHT analyses. The analyzed rhythm was VF/VT in 12-17%, organised QRS rhythm in 29-35% and asystole in 51-56% (see table). cprINSIGHT reached a S or NS decision in 65-74% of cases, with a sensitivity of 90-100% and a specificity of 100%. When it reached no decision, the rhythm was asystole in 65-79% of analyses, VF/VT in 0-9% and QRS rhythm in 18-27%; conventional analysis followed. Chest compression fraction was 85-88%, CPR fraction was 99%. Conclusion: This new algorithm analysed the ECG without need for a pause in chest compressions 65-74% of the time and had 90-100% sensitivity and 100% specificity when it made a shock or a no shock decision.

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Association of beta-blockers and first-registered heart rhythm in out-of-hospital cardiac arrest: real-world data from population-based cohorts across two European countries

EP Europace ◽

10.1093/europace/euaa124 ◽

2020 ◽

Vol 22 (8) ◽

pp. 1206-1215

Author(s):

Carlo A Barcella ◽

Talip E Eroglu ◽

Michiel Hulleman ◽

Asger Granfeldt ◽

Patrick C Souverein ◽

...

Keyword(s):

Cardiac Arrest ◽

The Netherlands ◽

Beta Blocker ◽

Beta Blockers ◽

Pulseless Electrical Activity ◽

Heart Rhythm ◽

Real World Data ◽

Shockable Rhythm ◽

Receptor Blockers ◽

Hospital Cardiac Arrest

Abstract Aims Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA. Methods and results We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands. Beta-blocker use was defined as exposure to either non-selective beta-blockers, β1-selective beta-blockers, or α-β-dual-receptor blockers within 90 days prior to OHCA. We calculated odds ratios (ORs) for the association of beta-blockers with first-registered heart rhythm using multivariable logistic regression. We identified 23 834 OHCA-patients in Denmark and 1584 in the Netherlands: 7022 (29.5%) and 519 (32.8%) were treated with beta-blockers, respectively. Use of non-selective beta-blockers, but not β1-selective blockers, was more often associated with non-shockable rhythm than no use of beta-blockers [Denmark: OR 1.93, 95% confidence interval (CI) 1.48–2.52; the Netherlands: OR 2.52, 95% CI 1.15–5.49]. Non-selective beta-blocker use was associated with higher proportion of pulseless electrical activity (PEA) than of shockable rhythm (OR 2.38, 95% CI 1.01–5.65); the association with asystole was of similar magnitude, although not statistically significant compared with shockable rhythm (OR 2.34, 95% CI 0.89–6.18; data on PEA and asystole were only available in the Netherlands). Use of α-β-dual-receptor blockers was significantly associated with non-shockable rhythm in Denmark (OR 1.21; 95% CI 1.03–1.42) and not significantly in the Netherlands (OR 1.37; 95% CI 0.61–3.07). Conclusion Non-selective beta-blockers, but not β1-selective beta-blockers, are associated with non-shockable rhythm in OHCA.

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

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919830896 ◽

2019 ◽

Vol 27 (3) ◽

pp. 155-161 ◽

Cited By ~ 1

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.

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