Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol

2020 ◽  
Vol 12 (5) ◽  
pp. 202-207
Author(s):  
Mark Durham ◽  
Pete Westhead ◽  
David Griffiths ◽  
Richard Lyon ◽  
Margaret Lau-Walker
Keyword(s):  
Cardiac Arrest ◽  
Neuromuscular Blockade ◽  
Patient Outcomes ◽  
East Coast ◽  
Service Evaluation ◽  
Spontaneous Circulation ◽  
Airway Control ◽  
Adverse Incident ◽  
The Mean ◽  
A Minor

Background: Since 2016, critical care paramedics from the South East Coast Ambulance Service have offered neuromuscular blockade to patients for ventilatory/airway control after cardiac arrest. Aims: To examine the first cases of paramedic-delivered neuromuscular blockade, and evaluate the prevalence of its use and safety. Methods: Retrospective service evaluation of patients receiving post-arrest paralysis during the study period from 1 April 2016 until 31 July 2017. Findings: The study included 127 patients. The mean age of administration was 63 years, mean weight was 80 kg (SD: 19 kg), dose was 1 mg/kg and median time from rocuronium administration to hospital was 32 minutes (IQR 20–43 minutes). Three patients (2.3%) experienced a minor adverse incident. There were no major airway complications, nor other significant adverse incidents. Thirty-seven patients (31%) survived to discharge. Conclusion: From this patient group, paramedic-administered rocuronium in intubated patients who have experienced a cardiac arrest and a return of spontaneous circulation appears to be safe, but further interventional research is required to determine whether this improves patient outcomes.

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

scholarly journals Association between Achievement of Estimated Average Glucose Level and 6-Month Neurologic Outcome in Comatose Cardiac Arrest Survivors: A Propensity Score-Matched Analysis

2019 ◽  
Vol 8 (9) ◽  
pp. 1480
Author(s):  
Yong Hun Jung ◽  
Byung Kook Lee ◽  
Kyung Woon Jeung ◽  
Dong Hun Lee ◽  
Hyoung Youn Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Glucose Level ◽  
Neuron Specific Enolase ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Glucose Levels ◽  
Neurologic Outcomes ◽  
The Mean ◽  
Average Glucose

We investigated whether achieving estimated average glucose (EAG) levels versus achieving standard glucose levels (180 mg/dL) was associated with neurologic outcome in cardiac arrest survivors. This single-center retrospective observational study included adult comatose cardiac arrest survivors undergoing therapeutic hypothermia (TH) from September 2011 to December 2017. EAG level was calculated using HbA1c obtained after the return of spontaneous circulation (ROSC), and the mean glucose level during TH was calculated. We designated patients to the EAG or standard glucose group according to whether the mean blood glucose level was closer to the EAG level or 180 mg/dL. Patients in the EAG and standard groups were propensity score- matched. The primary outcome was the 6-month neurologic outcome. The secondary outcomes were hypoglycemia (≤70 mg/dL) and serum neuron-specific enolase (NSE) at 48 h after ROSC. Of 384 included patients, 137 (35.7%) had a favorable neurologic outcome. The EAG group had a higher favorable neurologic outcome (104/248 versus 33/136), higher incidence of hypoglycemia (46/248 versus 11/136), and lower NSE level. After propensity score matching, both groups had similar favorable neurologic outcomes (24/93 versus 27/93) and NSE levels; the EAG group had a higher incidence of hypoglycemia (21/93 versus 6/93). Achieving EAG levels was associated with hypoglycemia but not neurologic outcome or serum NSE level.

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

scholarly journals Use of a simulation-based advanced resuscitation training curriculum: Impact on cardiopulmonary resuscitation quality and patient outcomes

2019 ◽  
Vol 21 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Amanda K Young ◽  
Michael J Maniaci ◽  
Leslie V Simon ◽  
Philip E Lowman ◽  
Ryan T McKenna ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Patient Outcomes ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Odds Ratios ◽  
Rates Of Return ◽  
Return Of Spontaneous Circulation ◽  
Resuscitation Training ◽  
Hospital Cardiac Arrest

Background Despite a continued focus on improved cardiopulmonary resuscitation quality, survival remains low from in-hospital cardiac arrest. Advanced Resuscitation Training has been shown to improve survival to hospital discharge and survival with good neurological outcome following in-hospital cardiac arrest at its home institution. We sought to determine if Advanced Resuscitation Training implementation would improve patient outcomes and cardiopulmonary resuscitation quality at our institution. Methods This was a prospective, before–after study of adult in-hospital cardiac arrest victims who had cardiopulmonary resuscitation performed. During phase 1, standard institution cardiopulmonary resuscitation training was provided. During phase 2, providers received the same quantity of training, but with emphasis on Advanced Resuscitation Training principles. Primary outcomes were return of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Secondary outcomes were cardiopulmonary resuscitation quality parameters. Results A total of 156 adult in-hospital cardiac arrests occurred during the study period. Rates of return of spontaneous circulation improved from 58.1 to 86.3% with an adjusted odds ratios of 5.31 (95% CI: 2.23–14.35, P < 0.001). Survival to discharge increased from 26.7 to 41.2%, adjusted odds ratios 2.17 (95% CI: 1.02–4.67, P < 0.05). Survival with a good neurological outcome increased from 24.8 to 35.3%, but was not statistically significant. Target chest compression rate increased from 30.4% of patients in P1 to 65.6% in P2, adjusted odds ratios 4.27 (95% CI: 1.72–11.12, P = 0.002), and target depth increased from 23.2% in P1 to 46.9% in P2, adjusted odds ratios 2.92 (95% CI: 1.16–7.54, P = 0.024). Conclusions After Advanced Resuscitation Training implementation, there were significant improvements in cardiopulmonary resuscitation quality and rates of return of spontaneous circulation and survival to discharge.

scholarly journals Towards the Prediction of Rearrest during Out-of-Hospital Cardiac Arrest

Entropy ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 758
Author(s):  
Andoni Elola ◽  
Elisabete Aramendi ◽  
Enrique Rueda ◽  
Unai Irusta ◽  
Henry Wang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Arrest ◽  
Patient Outcomes ◽  
Learning Model ◽  
Spontaneous Circulation ◽  
Operating Characteristics ◽  
Machine Learning Model ◽  
Validation Procedure ◽  
Electrocardiogram Ecg ◽  
Hospital Cardiac Arrest

A secondary arrest is frequent in patients that recover spontaneous circulation after an out-of-hospital cardiac arrest (OHCA). Rearrest events are associated to worse patient outcomes, but little is known on the heart dynamics that lead to rearrest. The prediction of rearrest could help improve OHCA patient outcomes. The aim of this study was to develop a machine learning model to predict rearrest. A random forest classifier based on 21 heart rate variability (HRV) and electrocardiogram (ECG) features was designed. An analysis interval of 2 min after recovery of spontaneous circulation was used to compute the features. The model was trained and tested using a repeated cross-validation procedure, on a cohort of 162 OHCA patients (55 with rearrest). The median (interquartile range) sensitivity (rearrest) and specificity (no-rearrest) of the model were 67.3% (9.1%) and 67.3% (10.3%), respectively, with median areas under the receiver operating characteristics and the precision–recall curves of 0.69 and 0.53, respectively. This is the first machine learning model to predict rearrest, and would provide clinically valuable information to the clinician in an automated way.

scholarly journals SUDDEN CARDIAC ARREST IN PATIENTS OVER 60 YEARS OF AGE IN THE OPERATION AREA OF EMERGENCY MEDICAL SERVICE IN SIEDLCE IN 2013-2017

2020 ◽  
Vol 7 (3) ◽  
pp. 170-177
Author(s):  
Agnieszka Hawrylewicz-Łuka ◽  
Robert Gałązkowski ◽  
Daniel Celiński ◽  
Krzysztof Mitura ◽  
Leszek Szpakowski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Human Life ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Time Range ◽  
Emergency Medical ◽  
Qualitative Variables ◽  
The Mean

Introduction: Sudden cardiac arrest is an integral part of the end of every human life. The aim: To analyze and determine the characteristics of the geriatric patients with sudden cardiac arrest. Material and methods: This was a retrospective study covering the operation area of the Emergency Medical Service in Siedlce. Time range: from January 1, 2013 to December 31, 2017. The Chi2 test was used to assess the significant differences between the analyzed qualitative variables. The level of significance was 0.05. Results: Out of 182,584 emergency medical records collected over 5 years, 5682 cases were manually selected as interventions for a patient with sudden cardiac arrest. This represented 3.11% of all medical services provided, from which a group of n = 3840 patients over 60 years of age was selected. The patient had usually between 75 and 90 years of age. The mean age was 75.55 years. The mean arrival time to such a patient was 10.28 min. The most common ECG rhythm was asystole, followed by return of spontaneous circulation (ROSC) in 12.71% of cases (n = 67). No mechanical chest compression equipment was used. Most often adrenaline and fluid therapy were administered after obtaining intravenous access. Mostly, the witness of the event did not undertake rescue activities. The mean resuscitation time was 48.11 min in the case of ROSC, and 36.98 minutes, if there was no ROSC. Conclusions: In the studied group of patients over 60 years, the chances of ROSC clearly decreased with age.

Abstract 290: The Association of Regional Intra-arrest Transport Practices for Out-of-hospital Cardiac Arrest with Survival and Neurological Status at Hospital Discharge

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Brian E Grunau ◽  
Takahisa Kawano ◽  
Masashi Okubo ◽  
Joshua Reynolds ◽  
Matthieu Heidet ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Patient Outcomes ◽  
Patient Survival ◽  
Secondary Analysis ◽  
Neurological Status ◽  
Spontaneous Circulation ◽  
Regional Level ◽  
Regional Clusters ◽  
Hospital Cardiac Arrest

Background: There is substantial regional variation in out-of-hospital cardiac arrest (OHCA) outcomes. We investigated whether regional-level intra-arrest transport practices were associated with patient outcomes. Methods: We performed a secondary analysis of the “CCC Trial” dataset, which included EMS-treated adult non-traumatic OHCA enrolled from 49 regional clusters. The exposure of interest was regional-level intra-arrest transport practices (RIATP), calculated as the proportion of cases within the enrolling cluster transported prior to return of spontaneous circulation (“intra-arrest transport”), divided into quartiles. We fit a multilevel mixed-effects logistic regression model to estimate the association of RIATP quartile and both survival and favorable neurologic status (mRS ≤ 3) at hospital discharge, adjusted for patient-level Utstein variables. Results: We included all 26,148 CCC-enrolled patients, 36% of whom were female, 97% were treated with prehospital ALS, and 23% had shockable initial rhythms. The median RIATP of the 49 clusters was 20% (IQR 6.2 - 30%). The figure shows outcomes stratified by RIATP quartile. Compared to the first quartile (<6.2%), increasing RIATP had the following adjusted associations with: (i) favourable neurological status: OR 0.87 (95% CI 0.60-1.26), 0.74 (95% CI 0.51-1.07), 0.36 (95% CI 0.25-0.53); and (ii) survival: 0.63 (95% CI 0.47-0.85), 0.60 (95% CI 0.45-0.79), 0.44 (95% CI 0.33-0.59). Conclusion: Treatment within a region that utilizes intra-arrest transport less frequently was associated with improved patient survival. These results may, in part, explain differences between regional OHCA survival outcomes.

Serum Copeptin Levels Predict the Return of Spontaneous Circulation and the Short-Term Prognosis of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Control Study

2020 ◽  
Vol 35 (2) ◽  
pp. 120-127
Author(s):  
Sümeyye Cakmak ◽  
Ozgur Sogut ◽  
Levent Albayrak ◽  
Ayla Yildiz
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Accurate Prediction ◽  
Blood Gas ◽  
Short Term ◽  
Return Of Spontaneous Circulation ◽  
Copeptin Level ◽  
Prediction Of Survival ◽  
The Mean ◽  
Hospital Cardiac Arrest

AbstractIntroduction:Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Biomarkers can be used for early and accurate prediction of survival and prognosis following resuscitation after CA, but none of those identified so far are sufficient by themselves.Hypothesis/Problem:The goal of this study was to investigate the predictive power of the serum copeptin level for determining the return of spontaneous circulation (ROSC) and prognosis of patients with non-traumatic out-of-hospital cardiac arrest (OHCA) who underwent cardiopulmonary resuscitation (CPR).Methods:A total of 76 consecutive consenting adult patients who were diagnosed as non-traumatic OHCA and 63 age- and sex-matched healthy controls were enrolled. The patients were divided into two groups based on whether or not they had ROSC. The ROSC group was divided into two sub-groups according to whether death occurred within 24 hours or after 24 hours following ROSC. Serum copeptin, high-sensitivity cardiac troponin (hs-cTnI), creatine kinase-muscle/brain (CK-MB), glucose, and blood gas values were compared between the groups.Results:Serum copeptin levels were significantly higher in the patient group than control group (P <.001). Receiving operator characteristic analysis revealed a cut-off copeptin level of 27.29pmol/L, with 98.7% sensitivity and 100.0% specificity, for distinguishing patients from controls. Serum copeptin levels were significantly lower in the ROSC group than non-ROSC group (P = .018). Additionally, the mean serum hs-cTnI level was significantly higher in the ROSC group than non-ROSC group (P = .032). However, there were no significant differences in the mean serum glucose level and CK-MB levels or arterial blood gas levels between the ROSC and non-ROSC groups (all P >.05).Ten (38.5%) of the patients died within the first 24 hours after ROSC, whereas 16 (61.5%) survived longer than 24 hours. Serum copeptin levels were significantly lower in patients who survived longer than 24 hours compared with those who died within the first 24 hours. Moreover, the mean CPR duration was significantly lower in patients surviving more than 24 hours compared with less than 24 hours.Conclusion:The serum copeptin level may serve as a guide in diagnostic decision making to predict ROSC in patients undergoing CPR and determining the short-term prognosis of patients with ROSC.

Abstract P65: Community Based Application of Therapeutic Hypothermia for Survivors of Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Roger Getts ◽  
David Fedor ◽  
Vincent J Vanston ◽  
Mary Triano ◽  
John Prior
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Mild Therapeutic Hypothermia ◽  
Community Based ◽  
Simple Protocol ◽  
The Us ◽  
Good Neurologic Outcome ◽  
The Mean ◽  
Mean Time

Objectives: To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting. Background: Implementation of therapeutic hypothermia for survivors of cardiac arrest in the US has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community level. Scranton, Pennsylvania is a just such a community. It has 75,000 people served by 3 hospitals with 700 acute care beds. Methods: At three community hospitals, after return of spontaneous circulation (ROSC) survivors of cardiac arrest were treated with mild therapeutic hypothermia using ice and cooling blankets or suits in order to achieve a goal temperature of 32 to34 degrees C for 24 hours. After ROSC, the timing goals of therapeutic hypothermia were to cool patients within 4 hours, to achieve goal temperature within 8 hours, and to maintain goal temperature for 24 hours. Results: Beginning in 2004, 27 survivors of cardiac arrest were managed with therapeutic hypothermia. The mean time from ROSC to initiation of therapeutic hypothermia was 2.8 hours (range, 0.4 – 6.3 hours), the mean time from ROSC to goal temperature was 6.9 hours (range, 1.9 –15 hours), and the mean time maintained at goal temperature was 26.7 hours (range, 12–39 hours). Once patients achieved goal temperature, 4.3% of the temperature readings were above 34 degrees C, reflecting undercooling, while 13.4% of the readings were below 32 degrees C, indicative of overcooling. Overall survival until hospital discharge with good neurologic outcome was 52%, compared to only 12% (p < 0.001) among historical controls with cardiac arrest. There were no major complications attributable to the procedure. Conclusion: A simple protocol of mild therapeutic hypothermia using locally-available resources is technically feasible and safe in a community-based setting.

scholarly journals The Cardiac Arrest Support Tier: a service evaluation

2020 ◽  
Vol 5 (2) ◽  
pp. 38-47
Author(s):  
Matthew Metcalf ◽  
Matthew Robinson ◽  
Pippa Hall ◽  
James Goss
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Service Evaluation ◽  
Spontaneous Circulation ◽  
Ambulance Service ◽  
Online Questionnaire ◽  
Hazardous Area ◽  
Response Team ◽  
Full Complement ◽  
Hospital Cardiac Arrest

Aim: This service evaluation seeks to determine whether the pre-hospital Cardiac Arrest Support Tier (CAST), implemented by a Hazardous Area Response Team (HART), was clinically effective, feasible and acceptable during its pilot year.Methods: Chest compression feedback, provision of Return of Spontaneous Circulation (ROSC) care and CAST paramedic exposure to Out-of-Hospital Cardiac Arrest (OHCA) were audited. The number of incidents that CAST responded to and the number of staff it committed were also assessed. An online questionnaire was used to gauge acceptability of the project among frontline Ambulance Service Trust staff.Results: CAST attended 178 OHCAs and committed a median of three (IQR 2‐3) paramedics to each incident. In comparison to data from both South Western Ambulance Service Foundation Trust (SWASFT) and the National Ambulance Service in England, CAST delivered the full complement of post-ROSC care more frequently during the same period (CAST = 80% vs SWASFT = 68.5% vs England = 77.46%). CAST paramedics had a median exposure to 15.5 (IQR 12‐19) OHCAs during the pilot year. Unfortunately, chest compression feedback was unavailable due to ongoing equipment inaccuracies and failure.Additionally 64.6% (n = 42/65) of SWASFT respondents believed CAST to be beneficial to resuscitation attempts, 63.1% (n = 41/65) would like CAST to continue to support resuscitation attempts in the future and 55.6% (n = 35/63) felt supported by CAST staff on scene.Conclusion: CAST is logistically feasible, is acceptable to the majority of SWASFT staff and demonstrated the successful delivery of evidence-based practice (EBP) to OHCA incidents.

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