scholarly journals Insights from patients screened but not randomised in the HYPERION trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. B. Lascarrou ◽  
Gregoire Muller ◽  
Jean-Pierre Quenot ◽  
Nicolas Massart ◽  
Mickael Landais ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Prognostic Significance ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Haemodynamic Instability ◽  
Inclusion Criteria ◽  
Performance Category ◽  
Shockable Rhythm ◽  
Patient Selection Criteria ◽  
Few Data

Abstract Background Few data are available about outcomes of patients screened for, but not enrolled in, randomised clinical trials. Methods We retrospectively reviewed patients who had non-inclusion criteria for the HYPERION trial comparing 33 °C to 37 °C in patients comatose after cardiac arrest in non-shockable rhythm, due to any cause. A good neurological outcome was defined as a day-90 Cerebral Performance Category score of 1 or 2. Results Of the 1144 patients with non-inclusion criteria, 1130 had day-90 information and, among these, 158 (14%) had good functional outcomes, compared to 7.9% overall in the HYPERION trial (10.2% with and 5.7% without hypothermia). Considerable centre-to-centre variability was found in the proportion of non-included patients who received hypothermia (0% to 83.8%) and who had good day-90 functional outcomes (0% to 31.3%). The proportion of patients with a good day-90 functional outcome was significantly higher with than without hypothermia (18.5% vs. 11.9%, P = 0.003). Conclusion Our finding of better functional outcomes without than with inclusion in the HYPERION trial, despite most non-inclusion criteria being of adverse prognostic significance (e.g., long no-flow and low-flow times and haemodynamic instability), raises important questions about the choice of patient selection criteria and the applicability of trial results to everyday practice. At present, reserving hypothermia for patients without predictors of poor prognosis seems open to criticism.

Abstract 240: Are the Same Resuscitation Protocols Needed for Highly Aged Victims With Out-of-Hospital Cardiac Arrest as Middle or Younger Aged?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiroyuki Hanada ◽  
Yoshio Tahara ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
Kunihiro Nishimura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Total Population ◽  
Cerebral Performance Category ◽  
Population Based ◽  
Aged Patients ◽  
Performance Category ◽  
Aging Society ◽  
Shockable Rhythm ◽  
Activity Of Daily Life ◽  
Hospital Cardiac Arrest

Backgrounds: The population of elderly people aged 65 years or older in 2014 is 33 million, and the aging rate (proportion of the total population) is 26.0% in Japan. Victims facing to out of hospital cardiac arrest (OHCA) are getting older and older. Emergency medical system (EMS) in Japan must do the same resuscitation protocols once called to the patient with OHCA, even when he or she is very old and activity of daily life is very low. We need to clarify whether same resuscitation protocols are required to very highly aged patients with OHCA or not. Methods and Results: From January 2005 through December 2014, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 1,299,784). The percentage of patients with OHCA aged more than 80 years old was increasing from 37.1% in 2005 to 47.8% in 2014 by 1% each year. Survival at one month after OHCA with cerebral performance category (CPC) scale 1 or 2 were 4,368 out of total 318,590 OHCA (1.4%) in 80’s, 1043 out of 126,546 (0.8%) in 90’s, and 35 out of 5,544 (0.6%) in aged more than 100 (from 100 to 114). Survival at one month after OHCA with CPC scale 1 or 2 was 11.084 out of 234,366 (4.7%) in 50- 60’s. Patients with witnessed OHCA with shockable rhythm and by-stander CPR survived to CPC 1 or 2 at one month after OHCA were 8.0% in 80’s, 4.1% in 90’s, 0 in aged more than 100, and 22.2% in 50-60’s respectably. Conclusion: Number of survivors with CPC 1 or 2 were very few in patients with OHCA aged more than 80 years old, but still existed. Although the same resuscitation protocols are needed for highly aged victims with OHCA, another system which arrow EMS to stop resuscitation should be established in the highly aging society.

scholarly journals Early myoclonus following anoxic brain injury

2018 ◽  
Vol 8 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Alexandra S. Reynolds ◽  
Benjamin Rohaut ◽  
Manisha G. Holmes ◽  
David Robinson ◽  
William Roth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Outcomes ◽  
Clinical Characteristics ◽  
Cerebral Performance Category ◽  
Adult Survivors ◽  
Performance Category ◽  
Clinical Criteria ◽  
Cortical Myoclonus ◽  
Electrographic Seizures ◽  
Video Eeg

BackgroundIt is unknown whether postanoxic cortical and subcortical myoclonus are distinct entities with different prognoses.MethodsIn this retrospective cohort study of 604 adult survivors of cardiac arrest over 8.5 years, we identified 111 (18%) patients with myoclonus. Basic demographics and clinical characteristics of myoclonus were collected. EEG reports, and, when available, raw video EEG, were reviewed, and all findings adjudicated by 3 authors blinded to outcomes. Myoclonus was classified as cortical if there was a preceding, time-locked electrographic correlate and otherwise as subcortical. Outcome at discharge was determined using Cerebral Performance Category.ResultsPatients with myoclonus had longer arrests with less favorable characteristics compared to patients without myoclonus. Cortical myoclonus occurred twice as often as subcortical myoclonus (59% vs 23%, respectively). Clinical characteristics during hospitalization did not distinguish the two. Rates of electrographic seizures were higher in patients with cortical myoclonus (43%, vs 8% with subcortical). Survival to discharge was worse for patients with myoclonus compared to those without (26% vs 39%, respectively), but did not differ between subcortical and cortical myoclonus (24% and 26%, respectively). Patients with cortical myoclonus were more likely to be discharged in a comatose state than those with subcortical myoclonus (82% vs 33%, respectively). Among survivors, good functional outcome at discharge was equally possible between those with cortical and subcortical myoclonus (12% and 16%, respectively).ConclusionsCortical and subcortical myoclonus are seen in every sixth patient with cardiac arrest and cannot be distinguished using clinical criteria. Either condition may have good functional outcomes.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p = 0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p = 0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Abstract 13945: Central Cannulation During Pediatric Extracorporeal Cardiopulmonary Resuscitation is Faster Than Peripheral Approaches

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra M Marquez ◽  
Mariella Vargas-Gutierrez ◽  
Mark Todd ◽  
Geraldine Goco ◽  
Michael-Alice Moga ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Time Interval ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Performance Category ◽  
Regression Methods ◽  
Shockable Rhythm ◽  
Pediatric Icu ◽  
Central Cannulation

Introduction: Favorable survivorship after pediatric extracorporeal cardiopulmonary resuscitation (ECPR) may be limited by prolonged resuscitations. Surgical cannulation metrics for pediatric ECPR have not been widely reported by centers that use time interval benchmarks with a cardiovascular service responding to different hospital locations. Hypothesis: We hypothesize that survival is associated with resuscitation duration, and cannulation duration differs between peripheral and central approaches. Methods: This was a single-center retrospective study of patients 0-18 years with in-hospital ECPR between January 2015 and December 2020. Primary outcome was survival to hospital discharge. Secondary outcomes were odds of favorable neurologic outcome (dichotomized pediatric cerebral performance category), total resuscitation duration defined as cardiac arrest start to ECMO flow start (CA-ECMO), and cannulation duration. Non-parametric and regression methods were used. Results: Of the 92 events that met ECPR criteria, median weight and age were 4 months (IQR 1 month, 16 years) and 4.4 kg (range 1.9-133 kg). Cannulation occurred in the cardiac intensive care unit (ICU) (66%, 61 of 92), followed by operating room (13%, 12 of 92), pediatric ICU (12%, 11 of 92), and catheterization lab (9%, 8 of 92). Central cannulation was performed in 43% (40 of 92), and 21% (19 of 92) had open chests at the time of the event. Median duration of CA-ECMO was 35 min (IQR 26, 45 min); cannulation duration was 11 min (IQR 5, 16.5 min) for central compared to 18.5 min (IQR 12, 23 min) for peripheral approaches (P=0.01). Survival was 40% (37 of 92), and favorable neurologic outcome occurred in 38% (35 of 92). Survival (adjusted OR, 0.94; 95% CI 0.91-0.99, P=0.018) and favorable neurologic outcome (adjusted OR, 0.95; 95% CI 0.917-1.000, P=0.053) were associated with CA-ECMO duration after adjusting for cannulation approach, location, difficulty, shockable rhythm, and weight. Conclusion: In pediatric in-hospital ECPR, total CA-ECMO duration remains a key metric associated with patient outcomes. Central cannulation is faster than peripheral approaches. Since cannulation strategy alters CPR maneuvers, CPR effectiveness with each approach needs further study.

scholarly journals Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

2020 ◽  
Author(s):  
Atsunori Tanimoto ◽  
Kazuhiro Sugiyama ◽  
Maki Tanabe ◽  
Kanta Kitagawa ◽  
Ayumi Kawakami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical Service Personnel ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome.Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology.Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

Abstract 144: Good Neurological Survival After Cardiac Arrest with Initial Shockable Rhythm Increased Year by Year but with Unshockable Rhythm Did Not in Japan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroyuki Hanada ◽  
Hiroshi Nonogi ◽  
Ken Nagao
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Population Based ◽  
Performance Category ◽  
Shockable Rhythm ◽  
Rate Of Increase ◽  
New Strategy ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Backgrounds: Early good cardiopulmonary resuscitation (CPR) and early defibrillation are essential for good neurological survival (GNS) in out-of-hospital cardiac arrest (OHCA). Both automated external defibrillator (AED) equipped in public place and CPR educated people in Japan have been increased. We hypothesized that GNS in patients resuscitated from initial shockable rhythm have been increasing in Japan and that GNS from initial unshockable rhythm might not. Methods and Results: From January 2005 through December 2012, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 925,288). We identified 73,751 witnessed cardiogenic cardiac arrest with the age >18 years old and transported to hospitals within 60 minutes from the witness. Among them, 18,436 cases had the initial shockable rhythm of ventricular fibrillation (VF) or pulsless ventricular tachycardia (VT) and 55,315 cases had the initial unshockable rhythm of pulseless electrical activity (PEA) or asystole (Asys). GNS was defined as cerebral performance category scale 1 or 2 one month after the arrest. Results were shown in the figure. Although the rate of increase in number of OHCA with unshockable arrest over the year was greater than that with shockable arrest, GNS ratio was increasing only in OHCA with shockable arrest. Conclusion: Good neurological survival resuscitated from initial arrest rhythm with VF/VT had been increasing year by year, but that with PEA/Asys was very low and not changed these 8 years in Japan. We need new strategy for those OHCA patients with initial unshockable rhythm.

Abstract 16428: Characteristics and Impact of Bystander Cardiopulmonary Resuscitation Following Pediatric Out of Hospital Cardiac Arrest in the United States: A Study From the Cardiac Arrest Registry to Enhance Survival (CARES)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maryam Y Naim ◽  
Rita V Burke ◽  
Bryan F McNally ◽  
Robert A Berg ◽  
Kimberly Vellano ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
The United States ◽  
Hispanic Children ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Few Data ◽  
Hospital Cardiac Arrest

Introduction: Bystander cardiopulmonary resuscitation (BCPR) is associated with improved outcome in adult out-of-hospital cardiac arrest (OHCA). There are few data on the prevalence and impact of BCPR on children. Hypothesis: We aimed to characterize BCPR in pediatric OHCA and test the hypothesis that BCPR would occur infrequently and would be associated with neurologically favorable survival at hospital discharge from a large cardiac arrest registry in the United States. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years of age and non-traumatic OHCA from January 1, 2013 through December 31, 2014. Neurologically favorable survival was defined as a Cerebral Performance Category Scale of 1 or 2. Results: A total of 2,176 cardiac arrests were evaluated. Most patients were infants (62%) or adolescents (19%). Most arrests occurred at home (86%), were unwitnessed (75%), and had a non-shockable rhythm (93%). BCPR was provided in 49%, most commonly by a family member (71%). BCPR was more common for white (60%) compared to black (42%) and Hispanic children (44%) (p<0.001). Overall, BCPR was associated with a higher rate of neurologically favorable survival (11% vs. 7%, odds ratio [OR]1.6 95% confidence interval [CI] 1.2-2.3). In sub-group analyses, BCPR was associated with a higher rate of neurologically favorable survival for out of home arrests (34% vs. 15%, OR 2.9, 95% CI 1.6-5.3), and arrests presenting in a shockable rhythm (48% vs. 32%, OR 2.0 95% CI 1.0-4.0). For infants BCPR was not associated with survival (6.4% vs. 6.0%, OR 1.1 95% CI 0.7-1.7) or neurologically favorable survival (5.2% vs. 5.0%, OR 1.1 95% CI 0.6-1.8). Conclusion: BCPR was provided in just under 50% of pediatric OHCAs and was more common for white compared to black and Hispanic children. BCPR was associated with improved survival that was most notable in out of home arrests, with over twice as many patients having neurologically favorable survival. Though infants comprised the largest age group, no effect of BCPR outcome was observed. This impact of BCPR suggests the need for a public health strategy to improve the provision of BCPR, and the need for an alternative strategy for some groups including infants.

scholarly journals Association of subsequent shock after conversion to shockable rhythm with outcomes stratified by the type of initial non-shockable rhythm in children with out-of-hospital cardiac arrest

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Significance ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Delivery Time ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research) Background/Introduction: The rhythm conversion from initial non-shockable to shockable rhythm during cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA) in children with an initial non-shockable rhythm. However, the prognostic significance of rhythm conversion stratified by the type of initial non-shockable rhythm is still unclear. Purpose We aimed to investigate the association of subsequent shock after rhythm conversion to shockable rhythm with neurologically intact survival and shock delivery time (time from EMS-initiated CPR to first shock delivery) by the type of initial non-shockable rhythm in children with OHCA. Methods We analysed the records of 19,095 children (age &lt;18 years) with OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 13-year period (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category score of 1 to 2. Patients were divided into the initial pulseless electrical activity (PEA) (n = 3,326 [17.4%]) and initial asystole (n = 15,769 [82.6%]) groups. Results The proportion of patients who received subsequent shock after conversion to shockable rhythm was significantly higher in the initial PEA than in the initial asystole groups (3.3% [109/3,326] vs. 1.4% [227/15,769], p &lt; 0.0001). The shock delivery time was significantly shorter in the initial PEA than in the initial asystole groups (median [IQR], 8 min [5 min – 12 min] vs. 10 min [6 min – 16 min], p &lt; 0.01). Among the initial PEA patients, there was no significant difference between subsequently shocked (10.0% [11/109]) and subsequently non-shocked patients (6.0% [192/3,217], p = 0.10) regarding the rate of 1-month neurologically intact survival. However, after adjusting for 9 pre-hospital variables, subsequent shock with a delivery time of &lt;10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.16–5.16], p = 0.018). Among the initial asystole patients, the rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked (4.4% [10/227]) than in the subsequently non-shocked (0.7% [106/15,542], p &lt; 0.0001). A multivariate logistic regression model showed that subsequent shock with a delivery time of &lt;10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted OR, 9.77 [95% CI, 4.2–22.5], p &lt; 0.0001). Conclusions In children with OHCA with an initial non-shockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered &lt;10 min from EMS-initiated CPR regardless of the type of initial rhythm.

scholarly journals Vasoactive-Inotropic Score and Vasoactive-Ventilation-Renal Score as Outcome Predictors for Children on Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 9 ◽  
Author(s):  
Ira Shukla ◽  
Sheila J. Hanson ◽  
Ke Yan ◽  
Jian Zhang
Keyword(s):  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Primary Diagnosis ◽  
Research Network ◽  
Outcome Predictors ◽  
Performance Category ◽  
Inotropic Score ◽  
Multivariable Analyses ◽  
Overall Performance ◽  
Vasoactive Inotropic Score

We aimed to determine the association of vasoactive-inotropic score (VIS) and vasoactive-ventilation-renal (VVR) score with in-hospital mortality and functional outcomes at discharge of children who receive ECMO. A sub-analysis of the multicenter, prospectively collected data by the Collaborative Pediatric Critical Care Research Network (CPCCRN) for Bleeding and Thrombosis on ECMO (BATE database) was conducted. Of the 514 patients who received ECMO across eight centers from December 2012 to February 2016, 421 were included in the analysis. Patients &gt; 18 years of age, patients placed on ECMO directly from cardiopulmonary bypass or as an exit procedure, or patients with an invalid or missing VIS score were excluded. Higher VIS (OR = 1.008, 95% CI: 1.002–1.014, p = 0.011) and VVR (OR: 1.006, 95% CI: 1.001–1.012, p = 0.023) were associated with increased mortality. VIS was associated with worse Pediatric Cerebral Performance Category (PCPC) (OR = 1.027, 95% CI: 1.010–1.044, p = 0.002) and Pediatric Overall Performance Category (POPC) score (OR = 1.023, 95% CI: 1.009–1.038, p = 0.002) at discharge. No association was found between VIS or VVR and Functional Status Score (FSS) at discharge. Using multivariable analyses, controlling for ECMO mode, ECMO location, ECMO indication, primary diagnosis, and chronic diagnosis, extremely high VIS and VVR were still associated with increased mortality.

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