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.

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

scholarly journals Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175257 ◽  
Author(s):  
Hiroyuki Koami ◽  
Yuichiro Sakamoto ◽  
Ryota Sakurai ◽  
Miho Ohta ◽  
Hisashi Imahase ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Abstract 13721: The Monitoring of rSO2 Value During CPR is Useful for High-Quality CPR

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yoshihito Ogawa ◽  
Tadahiko Shiozaki ◽  
Tomoya Hirose ◽  
Mitsuo Ohnishi ◽  
Goro Tajima ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Clinical Utility ◽  
Spontaneous Circulation ◽  
Regional Cerebral Oxygen Saturation ◽  
High Quality ◽  
Specificity And Sensitivity ◽  
Single Center Study ◽  
Manual Chest Compression ◽  
Hospital Cardiac Arrest

[Background] Recently, the patients with out-of-hospital cardiac arrest are increasing. It is very important to do chest compression continuously for the return of spontaneous circulation (ROSC). But we can not but stop chest compression during checking pulse every few minutes. We reported that Regional cerebral Oxygen Saturation (rSO2) value was not elevated by manual chest compression and mechanical chest compression increased a little rSO2 value on CPR without ROSC and rSO2 value became a good parameter of ROSC in single center study. [Purpose] The purpose of this study is to evaluate clinical utility of rSO2 value during CPR in multicenter study. [Method] Retrospectively, we considered the rSO2 value of the out-of -hospital cardiac arrest patients from December 2012 to December 2014 in multicenter. During CPR, rSO2 were recorded continuously from the forehead of the patients by TOS-OR (Japan). CPR for patients with OHCA was performed according to the JRC-guidelines 2010. [Result] 252 patients with OHCA were included in this study. The rSO2 value on arrival, during CPR and ROSC were 44.4±8.9%, 45.4±9.7%, 58.6±9.2%. In ROSC, with rSO2 cutoff value of 52.7%, the specificity and sensitivity were 80% and 79%, respectively. The negative predict value was 99.2%, respectively. It means little possible to ROSC, if the rSO2 value is less than 52.7%. So, it may be possible to reduce the frequency of checking pulse during CPR. [Conclusion] The monitoring of rSO2 value could reduce the frequency of checking pulse during CPR and do chest compression continuously.

Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Andy T Tran ◽  
Anthony Hart ◽  
John Spertus ◽  
Philip Jones ◽  
Bryan McNally ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Risk Adjustment ◽  
Quality Measures ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Logistic Regression Models ◽  
Adjustment Model ◽  
Risk Adjustment Model ◽  
Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

Abstract 313: Visualizing Out-Of-Hospital Cardiac Arrest in the Young: A Network Analysis of the Cardiac Arrest Registry for Enhanced Survival in Chicago

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Alyssa Vermeulen ◽  
Marina Del Rios ◽  
Teri L Campbell ◽  
Hai Nguyen ◽  
Hoang H Nguyen
Keyword(s):  
Cardiac Arrest ◽  
Network Analysis ◽  
Emergency Room ◽  
American Indians ◽  
Network Models ◽  
Spontaneous Circulation ◽  
Data Set ◽  
Qualitative And Quantitative ◽  
Complex Network Models ◽  
Hospital Cardiac Arrest

Introduction: The interactions of various variables on out-of-hospital cardiac arrest (OHCA) in the young (1-35 years old) outcomes are complex. Network models have emerged as a way to abstract complex systems and gain insights into relational patterns among observed variables. Hypothesis: Network analysis helps provide qualitative and quantitative insights into how various variables interact with each other and affect outcomes in OHCA in the young. Methods: A mixed graphical network analysis was performed using variables collected by CARES. The network allows the visualization and quantification of each unique interaction between two variables that cannot be explained away by other variables in the data set. The strength of the underlying interaction is proportional to the thickness of the connections (edges) between the variables (nodes). We used the mgm package in R. Results: Figure 1 shows the network of the OHCA in the young cases in Chicago from 2013 to 2017. There are apparent clusters. Sustained return of spontaneous circulation and hypothermia are strongly correlated with survival and neurological outcomes. This cluster is in turn connected to the rest of the network by survival to emergency room. The interaction between any two variables can also be quantified. For example, American Indians cases occur more often in disadvantaged locations when compared to Whites (OR 4.5). The network also predicts how much one node can be explained by adjacent nodes. Only 20% of survival to emergency room is explained by its adjacent nodes. The remaining 80% is attributed to variables not represented in this network. This suggests that interventions to improve this node is difficult unless further data is available. Conclusion: Network analysis provides both a qualitative and quantitative evaluation of the complex system governing OHCA in the young. The networks predictive capability could help in identifying the most effective interventions to improve outcomes.

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tae Yun Kim ◽  
Sun Woo Lee ◽  
Kyuseok Kim ◽  
Joong Eui Rhee ◽  
Sung Koo Jung
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Controlled Clinical Trial ◽  
Emergency Medical Service System ◽  
Short Term ◽  
Combined Administration ◽  
Before And After ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

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