A national population-based study of patients, bystanders and contextual factors associated with resuscitation in witnessed cardiac arrest: insight from the french RéAC registry

Abstract Background In out-of-hospital cardiac arrest (OHCA), bystander initiated cardiopulmonary resuscitation (CPR) increases the chance of return of spontaneous circulation and survival with a favourable neurological status. Socioeconomic disparities have been highlighted in OHCA field. In areas with the lowest average socioeconomic status, OHCA incidence increased, and bystander CPR decreased. Evaluations were performed on restricted geographical area, and European evaluation is lacking. We aimed to analyse, at a national level, the impact of area-level social deprivation on the initiation of CPR in case of a witnessed OHCA. Methods We included all witnessed OHCA cases with age over 18 years from July 2011 to July 2018 form the OHCA French national registry. We excluded OHCA occurred in front of rescue teams or in nursing home, and patients with incomplete address or partial geocoding. We collected data from context, bystander and patient. The area-level social deprivation was estimated by the French version of the European Deprivation Index (in quintile) associated with the place where OHCA occurred. We assessed the associations between Utstein variables and social deprivation level using a mixed-effect logit model with bystander-initiated CPR. Results We included 23,979 witnessed OHCA of which 12,299 (51%) had a bystander-initiated CPR. More than one third of the OHCA (8,326 (35%)) occurred in an area from the highest quintile of social deprivation. The higher the area-level deprivation, the less the proportion of bystander-initiated CPR (56% in Quintile 1 versus 48% in Quintile 5). The In the multivariable analysis, bystander less often began CPR in areas with the highest deprivation level, compared to those with the lowest deprivation level (OR=0.69, IC95%: 0.63-0.75). Conclusions The level of social deprivation of the area where OHCA occurred was associated with bystander-initiated CPR. It decreased in the more deprived areas although these areas also concentrate more younger patients.

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Abstract 33: Impact of Delayed Time to Defibrillation on Neurological and Functional Status Among Survivors of In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.116.suppl_16.ii_930-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Paul S Chan ◽

Harlan M Krumholz ◽

Graham Nichol ◽

Brahmajee K Nallamothu

Keyword(s):

Cardiac Arrest ◽

Functional Status ◽

Vegetative State ◽

Neurological Status ◽

National Registry ◽

Hospital Size ◽

Risk Patients ◽

The Impact ◽

Delayed Time ◽

Hospital Cardiac Arrest

Background: Expert guidelines advocate defibrillation within 2 minutes of an in-hospital cardiac arrest due to ventricular arrhythmias. However, the impact of delayed defibrillation on neurological and functional status at discharge among survivors is unknown. Methods: We identified 6,744 patients with cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals within the National Registry of Cardiopulmonary Resuscitation. Using multivariable logistic regression that adjusted for demographics, clinical variables, hospital site, hospital-level variables (hospital size, monitored bed or intensive care status), and admitting diagnoses, we examined the association between delayed defibrillation (>2 minutes) and neurological and functional status at discharge using the previously developed Cerebral and Overall Performance Categories. Performance categories were dichotomized as no major disability vs. major disability and/or vegetative state. Results: The median time to defibrillation was 1 minute (interquartile range:< 1 to 3 minutes), with delayed defibrillation found in 2,000 (29.7%) patients. Overall, 2,311 (34.3%) patients survived to hospital discharge [n=1,863 (39.3%) for prompt defibrillation; n=448 (n=22.4%) for delayed defibrillation]. Among those surviving to discharge, delayed defibrillation was associated with a lower likelihood of no major disability in neurological status (adjusted OR of 0.73; 95% CI: 0.57 to 0.94; p=0.01) and functional status (adjusted OR of 0.73; 95% CI: 0.55 to 0.96; p=0.02). Conclusion : Delayed defibrillation is associated with worse neurological and functional status among survivors of in-hospital cardiac arrests. Minimizing time to defibrillation represents a major opportunity to improve neurological and functional status in these high-risk patients.

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Revisiting Loneliness: Individual and Country-Level Changes

International Perspectives on Aging - Social Exclusion in Later Life ◽

10.1007/978-3-030-51406-8_8 ◽

2021 ◽

pp. 99-117

Author(s):

Deborah Morgan ◽

Lena Dahlberg ◽

Charles Waldegrave ◽

Sarmitė Mikulionienė ◽

Gražina Rapolienė ◽

...

Keyword(s):

Social Deprivation ◽

Multivariable Analysis ◽

Deprivation Level ◽

Macro Level ◽

Cross Sectional ◽

Country Level ◽

Frequency Of Contact ◽

Health Aging ◽

Partnership Status ◽

Micro Level

AbstractThe links between loneliness and overall morbidity and mortality are well known, and this has profound implications for quality of life and health and welfare budgets. Most studies have been cross-sectional allowing for conclusions on correlates of loneliness, but more recently, some longitudinal studies have revealed also micro-level predictors of loneliness. Since the majority of studies focused on one country, conclusions on macro-level drivers of loneliness are scarce. This chapter examines the impact of micro- and macro-level drivers of loneliness and loneliness change in 11 European countries. The chapter draws on longitudinal data from 2013 and 2015 from the Survey of Health, Aging, and Retirement in Europe (SHARE), combined with macro-level data from additional sources. The multivariable analysis revealed the persistence of loneliness over time, which is a challenge for service providers and policy makers. Based on this cross-national and longitudinal study we observed that micro-level drivers known from previous research (such as gender, health and partnership status, frequency of contact with children), and changes therein had more impact on loneliness and change therein than macro-level drivers such as risk of poverty, risk of social deprivation, level of safety in the neighbourhood.

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Abstract 13150: Racial/Ethnic Disparities of the Impact of the COVID-19 Pandemic Out-of-Hospital Cardiac Arrest (OHCA) in Texas

Circulation ◽

10.1161/circ.144.suppl_2.13150 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Summer Chavez ◽

Ryan Huebinger ◽

Kevin Schulz ◽

Hei Kit Chan ◽

Micah Panczyk ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Minority Groups ◽

Ethnic Disparities ◽

Mixed Effect ◽

Neurological Outcomes ◽

Random Intercept ◽

Hispanic Patients ◽

The Impact ◽

Racial Ethnic

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. The CDC has declared that the COVID-19 pandemic has disproportionately affected many racial and ethnic minority groups. However, the influence of the COVID-19 pandemic on OHCA incidence and outcomes in different races and ethnicities is unknown. Purpose: To describe racial/ethnic disparities in OHCA incidence, processes of care and outcomes in Texas during the COVID-19 pandemic. Methods: We used data from the Texas Cardiac Arrest Registry to Enhance Survival (CARES) comparing adult OHCA from the pre-pandemic period (March 11 - December 31, 2019) to the pandemic period (March 11- December 31, 2020). The racial and ethnic categories were White, Black, Hispanic or Other. Outcomes were rates of BCPR, AED use, sustained ROSC, prehospital termination of resuscitation (TOR), survival to hospital admission, survival to discharge and good neurological outcomes. We fit a mixed effect logistic regression model, with EMS agency designated as the random intercept to obtain aORs. We adjusted for the pandemic and other covariates. Results: A total of 8,070 OHCAs were included. The proportion of cardiac arrests increased for Blacks (903 to 1, 113, 24.9% to 25.5%) and Hispanics (935 to 1,221, 25.8% to 27.5%) and decreased for Whites (1 595 to 1,869, 44.0% to 42.1%) and Other (194 to 220, 5.4% to 5.0%) patients. Compared to Whites, Black (aOR = 0.73, 95% CI 0.65-0.82) and Hispanic patients (aOR = 0.78, 95% CI 0.68-0.87) were less likely to receive BCPR. Compared to Whites, Blacks were less likely to have sustained ROSC (aOR = 0.81, 95% CI 0.70-0.93%), with lower rates of survival to hospital admission (aOR = 0.87, 95% CI 0.75-1.0), and worse neurological outcomes (aOR = 0.45, 95% 0.28-0.73). Hispanics were less likely to have prehospital TOR compared to Whites (aOR = 0.86, 95% CI = 0.75-0.99). The Utstein bystander survival rate was worse for Blacks (aOR = 0.72, 95% CI 0.54-0.97) and Hispanics (aOR = 0.71, 95% 0.53-0.95) compared to Whites. Conclusion: Racial and ethnic disparities persisted during the COVID-19 pandemic in Texas.

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How Do Floods and Drought Impact Economic Growth and Human Development at the Sub-National Level in India?

Climate ◽

10.3390/cli8110123 ◽

2020 ◽

Vol 8 (11) ◽

pp. 123

Author(s):

Upali Amarasinghe ◽

Giriraj Amarnath ◽

Niranga Alahacoon ◽

Surajit Ghosh

Keyword(s):

Economic Growth ◽

Human Development ◽

Geographical Area ◽

National Level ◽

Large Area ◽

Indian States ◽

Mitigation And Adaptation ◽

Large Geographical Area ◽

Substantial Investment ◽

The Impact

This paper tries to shift the focus of research on the impact of natural disasters on economic growth from global and national levels to sub-national levels. Inadequate sub-national level information is a significant lacuna for planning spatially targeted climate change adaptation investments. A fixed-effect panel regression analyses of 19 states from 2001 to 2015 assess the impacts of exposure to floods and droughts on the growth of gross state domestic product (GSDP) and human development index (HDI) in India. The flood and drought exposure are estimated using satellite data. The 19 states comprise 95% of the population and contribute 93% to the national GDP. The results show that floods indeed expose a large area, but droughts have the most significant impacts at the sub-national level. The most affected GSDPs are in the non-agriculture sectors, positively by the floods and negatively by droughts. No significant influence on human development may be due to substantial investment on mitigation of flood and drought impacts and their influence on better income, health, and education conditions. Because some Indian states still have a large geographical area, profiling disasters impacts at even smaller sub-national units such as districts can lead to effective targeted mitigation and adaptation activities, reduce shocks, and accelerate income growth and human development.

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THE IMPACT OF TARGETED TRAINING OF MEDICAL INTERNS ON THE SURVIVAL OF CARDIAC ARREST IN THE EMERGENCY ROOM

International Journal of Advanced Research ◽

10.21474/ijar01/13855 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1167-1176

Author(s):

Benmessaoudfz a ◽

◽

Tadilijawad b ◽

Kettani Ali ◽

Ahlam Chaieri ◽

...

Keyword(s):

Cardiac Arrest ◽

Medical Training ◽

Discharge Rate ◽

National Registry ◽

Primary Objective ◽

University Hospital ◽

Significant Difference ◽

Medical Interns ◽

The Impact

Introduction:The prognosis of patients with cardiac arrest is closely related to the quality of cardiopulmonary resuscitation (CPR). The aim of this work was to assess the impact of targeted training on CPR, in accordance with the latest international recommendations, on the management of cardiac arrests in SAUV. Methods:This is a prospective study carried out between January 1 and December 31, 2011 at the SAUV of Ibn Sina University Hospital in Rabat, including all adult patients who experienced cardiac arrest after admission. The main primary objective is to evaluate the impact of targeted training of medical interns on the survival of cardiac arrest in the ER expressed by the Hospital Discharge Survival (HDS) rate. Secondary objectives include the rate of recovery of circulatory activity (RCA), 48-hour survival, and quality of CPR performance. Results:342 patients were included, 159 before and 183 after training. There was no significant difference in terms of recovery from spontaneous circulation, 48h survival or discharge rate at home without sequelae. On the other hand, there was a statistically significant improvement in all the quality criteria for performing CPR. Conclusion:This work shows that the introduction of short training courses such improves the quality of CPR. The lack of impact on the improvement of patient survival seems to be related to numerous shortcomings, in particular basic medical training in emergency medicine, organization and protocolization of care, equipment of emergency rooms, supervision of emergency clerkship and the existence of a CA national registry. These are all areas to be developed in order to improve the prognosis of CA in our hospital structure.

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Prognostic Value of Early Intermittent Electroencephalography in Patients after Extracorporeal Cardiopulmonary Resuscitation

Journal of Clinical Medicine ◽

10.3390/jcm9061745 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1745 ◽

Cited By ~ 1

Author(s):

Yong Oh Kim ◽

Ryoung-Eun Ko ◽

Chi Ryang Chung ◽

Jeong Hoon Yang ◽

Taek Kyu Park ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Observational Study ◽

Primary Endpoint ◽

Prognostic Value ◽

Multivariable Analysis ◽

Neurological Status ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurological Outcomes ◽

Neurological Prognosis

The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG scan within 96 h after ECPR. The primary endpoint was neurological status upon discharge from the hospital assessed with a Cerebral Performance Categories (CPC) scale. Among 69 adult cardiac arrest patients who underwent ECPR, 17 (24.6%) patients had favorable neurological outcomes (CPC score of 1 or 2). Malignant EEG patterns were more common in patients with poor neurological outcomes (CPC score of 3, 4 or 5) than in patients with favorable neurological outcomes (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcomes. In multivariable analysis, malignant EEG patterns and duration of cardiopulmonary resuscitation were significantly associated with poor neurological outcomes. In this study, malignant EEG patterns within 96 h after cardiac arrest were significantly associated with poor neurological outcomes. Therefore, an early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

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Impact of Specific Emergency Measures on Survival in Out-of-Hospital Traumatic Cardiac Arrest

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001308 ◽

2021 ◽

pp. 1-6

Author(s):

Dominique Savary ◽

François Morin ◽

Delphine Douillet ◽

Adrien Drouet ◽

François Xavier Ageron ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Cerebral Performance Category ◽

Tension Pneumothorax ◽

Advanced Life Support ◽

Neurological Status ◽

Performance Category ◽

Traumatic Cardiac Arrest ◽

Pelvic Stabilization ◽

The Impact

Abstract Introduction: The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA. Methods: This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2). Results: In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx). Conclusion: Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

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The impact of ventricular fibrillation amplitude on successful cardioversion, resuscitation duration, and survival after out-of-hospital cardiac arrest

Critical Care and Resuscitation ◽

10.51893/2021.2.oa7 ◽

2021 ◽

Vol 23 (2) ◽

pp. 202-210

Author(s):

Ziad Nehme ◽

◽

Steffi Burns ◽

Jocasta Ball ◽

Stephen Bernard ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Hospital Discharge ◽

Medical Service ◽

Multivariable Analysis ◽

Shock Amplitude ◽

International Data ◽

Low Amplitude ◽

The Impact ◽

Hospital Cardiac Arrest

OBJECTIVE: We sought to examine the incidence of low amplitude ventricular fibrillation and its impact on successful cardioversion, duration of resuscitation, and survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective analysis from a statewide registry. SETTING: Victoria, Australia. PARTICIPANTS: Consecutive initial ventricular fibrillation arrests with an emergency medical service (EMS)-attempted resuscitation between 1 February 2019 and 30 January 2020. MAIN OUTCOME MEASURES: Survival to hospital discharge, successful cardioversion, and duration of resuscitation. RESULTS: Of the 471 initial ventricular fibrillation arrests, 429 (91.1%) had sufficient electrocardiogram data for review. The median initial and final ventricular fibrillation amplitude did not differ (0.3 mV; interquartile range [IQR], 0.2–0.5 mV). The final pre-shock amplitude was ≤ 0.1 mV (very fine) and ≤ 0.2 mV (fine) in 22.8% and 37.5% of cases respectively. In a multivariable analysis, only the time between emergency call and first defibrillation was associated with a low initial ventricular fibrillation amplitude ≤ 0.2 mV (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02–1.13; P = 0.004). After adjustment for arrest factors, every 0.1 mV increase in final amplitude was independently associated with survival to hospital discharge (aOR, 1.26; 95% CI, 1.14–1.39; P < 0.001) and initial cardioversion success (aOR, 1.19; 95% CI, 1.07–1.32; P = 0.001). The duration of resuscitation also increased by 1.7 minutes (95% CI, 1.03–2.36; P < 0.001) for every 0.1 mV increase in final amplitude. CONCLUSION: More than one-third of initial ventricular fibrillation OHCA cases were low in amplitude. Comparative international data are needed to better understand how low amplitude ventricular fibrillation rhythms confound the measurement of OHCA interventions and international benchmarks for survival outcomes.

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Abstract 367: Ventricular Assist Device Association in Improving Outcomes in Patients Resuscitated From Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.367 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Julie Tram ◽

Andrew Pressman ◽

Nai-Wei Chen ◽

David Berger ◽

Joseph B Miller ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Primary Objective ◽

Ventricular Assist Devices ◽

Ventricular Assist ◽

Assist Devices ◽

The Impact ◽

Hospital Cardiac Arrest ◽

Improved Outcome

Introduction: There has been continued debate and limited research on the efficacy of ventricular assist devices such as intra-aortic balloon pumps and Impella devices on improving survival outcomes in post cardiac arrest patients. Objective: The primary objective of this study is to assess whether the use of ventricular assist devices is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan. Methods: We matched cardiac arrest cases from 2014-2017 in the Michigan CARES Registry (CARES) and the Michigan Inpatient Database (MIDB) using probabilistic linkage. Ventricular assist devices (VAD) are defined as either Intra-aortic balloon pump (IABP) or Impella device identified using ICD-9 or 10 procedure codes. Multilevel, multivariable regression analyses were employed to evaluate the impact of device use on survival to hospital discharge, adjusting for variables normally predictive of cardiac arrest survival (age, location, witnessed, shockable rhythm). Results: A total of 3,790 CARES cases were matched with the MIDB of which 183 (4.8%) received IABP, 50 (1.3%) received impella devices, and 1,131 (29.8%) survived to hospital discharge. VAD use was associated with improved survival to discharge (OR=2.07, 95% CI 1.55, 2.77). IABP were used more frequently and associated with an improved outcome (OR=2.16, 95%CI 1.59, 2.93) compared to the Impella device (OR=1.72, 95% CI 0.96, 3.06). In a multivariable model, however, VAD use was no longer associated with an improved outcome (aOR =0.95, 95% CI 0.69, 1.31). In the subset of patients with a diagnosis of cardiogenic shock (n=725) we identified an improved survival to discharge with VAD use (OR= 1.84 95% CI 1.24, 2.73). IABP use was more frequent and associated with an improved outcome (OR=1.98, 95% CI 1.32, 2.98). After adjusting for patient characteristics, VAD use increased the odds of an improved outcome by 14% but was not statistically significant (aOR = 1.14, 95% CI 0.74, 1.77 ). Conclusion: Although limited by a low frequency of use, VAD or IABP alone was associated with improved outcome for post arrest care. However, in a multivariable analysis, VAD use was not associated with an independent improvement in post arrest survival.

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Abstract 332: Long-term Post-discharge Survival and Healthcare Utilization Following Out-of-hospital Cardiac Arrest: Insights From a Novel Province-wide Linkage

Circulation ◽

10.1161/circ.142.suppl_4.332 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Christopher B Fordyce ◽

Brian E Grunau ◽

Meijiao Guan ◽

May K Lee ◽

Nathaniel M Hawkins ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Composite Endpoint ◽

Post Discharge ◽

Hospital Factors ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with poor short-term outcomes. However, the impact of pre- and in-hospital factors on long-term outcomes is ill-defined, mainly related to challenges combining disparate data sources. Methods: We linked adult non-traumatic EMS-treated OHCAs from the British Columbia Cardiac Arrest Registry (Jan 2009 - Dec 2016) to provincial datasets describing co-morbidities, medications, procedures, mortality, and hospital admission and discharge. Among hospital-discharge survivors, we examined the 3-year composite endpoint of mortality ± all-cause readmission using the Kaplan-Meier (KM) method and multivariable Cox model for predictors. Results: Of 10,876 successfully linked OHCAs, 1325 survived to hospital discharge: mean age 62.8 years, 77.9% male, 72.6% shockable rhythms, 60.1% non-public locations, 69.1% bystander CPR, and 30.3% STEMI. During admission, 78.6% required mechanical ventilation, 69.1% received coronary angiography (37.5% PCI, 10.3% CABG), and 24.8% received an ICD. At 3 years post-discharge, the estimated KM event rates were 15.9% (95% CI 13.9%, 19.3%) for mortality and 68.2% (95% CI 65.3%, 71.0%) for mortality and readmission, which differed by age, initial rhythm, and arrest location ( Figure ). Following multivariable analysis, patients with a history of HF [HR 1.62 (95% CI 1.34 - 1.96)], age >75 [1.62 (1.35, 1.96)], anticoagulation use [2.55 (1.36, 4.79)], non-shockable rhythm [1.29 (1.07, 1.55)] and non-public arrest location [1.21(1.04, 1.40)] were more likely to experience the composite endpoint; those receiving coronary angiography were less likely [0.79 (0.64, 0.98)]. Conclusions: The long-term death or readmission risk persists even among OHCA hospital-discharge survivors, and is associated with both pre- and in-hospital factors. An enriched, linked dataset detailing the entire OHCA “journey” may be a promising tool to identify care and treatment gaps.

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