PaRamEDIc assessment of laCTate in OHCA and survival to hospital (PREDICT protocol)

2021 ◽  
Vol 13 (3) ◽  
pp. 100-104
Author(s):  
Karl Charlton ◽  
Hayley Moore
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Prognostic Role ◽  
Single Centre ◽  
Intravenous Access ◽  
Secondary Outcomes ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Studies suggest that blood lactate differs between survivors and non-survivors of out-of-hospital cardiac arrest who are transported to hospital. The prognostic role of lactate taken during out-of-hospital cardiac arrest remains unexplored. Aims: To measure the association between lactate taken during out-of-hospital cardiac arrest, survival to hospital and 30-day mortality. Methods: This is a feasibility, single-centre, prospective cohort study. Eligible for inclusion are patients aged ≥18 years suffering out-of-hospital cardiac arrest, receiving cardiopulmonary resuscitation, in the catchment of Newcastle or Gateshead hospitals, who are attended to by a study-trained specialist paramedic. Exclusions are known/apparent pregnancy, blunt or penetrating injury as primary cause of out-of-hospital cardiac arrest and an absence of intravenous access. Between February 2020 and March 2021, 100 participants will be enrolled. Primary outcome is survival to hospital; secondary outcomes are return of spontaneous circulation at any time and 30-day mortality.

scholarly journals Anticoagulation therapy could improve the restoration of sinus rhythm and spontaneous circulation in hospital patients with CPR

2019 ◽  
Vol 47 (12) ◽  
pp. 5957-5966
Author(s):  
Hai Wang ◽  
Zheng-Hai Bai ◽  
Jun-Hua Lv ◽  
Jiang-Li Sun ◽  
Yu Shi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sinus Rhythm ◽  
Anticoagulation Therapy ◽  
Spontaneous Circulation ◽  
Spontaneous Respiration ◽  
Single Centre ◽  
Exclusion Criteria ◽  
Hospital Patients ◽  
Hospital Cardiac Arrest

Objective To analyse the role of anticoagulation therapy in cardiopulmonary resuscitation (CPR) following an in-hospital cardiac arrest. Methods This single-centre retrospective cohort study enrolled patients treated with in-hospital CPR that met the inclusion and exclusion criteria. The patients were divided into a without anticoagulation group and an anticoagulation group. The main outcome measures were the restoration of spontaneous respiration, restoration of sinus rhythm (ROSR), restoration of spontaneous circulation (ROSC) and the hospital mortality. Results The study analysed 344 patients: 272 in the without anticoagulation group and 72 in the anticoagulation group. Multiple logistic regression analyses demonstrated that anticoagulation therapy improved ROSR (adjusted odds ratio [OR] 2.21, 95% confidence interval [CI] 1.23, 3.96) and ROSC (adjusted OR 1.91, 95% CI 1.08, 3.40), but it did not improve the restoration of spontaneous respiration (adjusted OR 1.64, 95% CI 0.72, 3.76) and hospital survival (adjusted OR 0.90, 95% CI 0.40, 1.99). Conclusion Anticoagulation therapy improved ROSR and ROSC, but did not decrease the mortality rate of hospitalized patients undergoing CPR following in-hospital cardiac arrest.

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.

Abstract 189: Time to Awakening in Women Compared to Men After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby Shelton ◽  
Stacie L Daugherty ◽  
Edward Havranek
Keyword(s):  
Cardiac Arrest ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Therapeutic Interventions ◽  
Care Hospital ◽  
Single Center ◽  
Men And Women ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

scholarly journals Role of coronary angiography for out-of-hospital cardiac arrest survivors according to postreturn of spontaneous circulation on an electrocardiogram

Medicine ◽  
2017 ◽  
Vol 96 (7) ◽  
pp. e6123 ◽  
Author(s):  
Tae Rim Lee ◽  
Sung Yeon Hwang ◽  
Won Chul Cha ◽  
Tae Gun Shin ◽  
Min Seob Sim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Spontaneous Circulation ◽  
Hospital Cardiac Arrest

scholarly journals Evaluation of prognostic prediction models for out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792096691
Author(s):  
Yat Hei Lo ◽  
Yuet Chung Axel Siu
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Prediction Models ◽  
Model Development ◽  
Spontaneous Circulation ◽  
Emergency Team ◽  
Survival Score ◽  
Prognostic Prediction ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Introduction: Accurate prognostic prediction of out-of-hospital cardiac arrest is challenging but important for the emergency team and patient’s family members. A number of prognostic prediction models specifically designed for out-of-hospital cardiac arrest are developed and validated worldwide. Objective: This narrative review provides an overview of the prognostic prediction models out-of-hospital cardiac arrest patients for use in the emergency department. Discussion: Out-of-hospital cardiac arrest prognostic prediction models are potentially useful in clinical, administrative and research settings. Development and validation of such models require prehospital and hospital predictor and outcome variables which are best in the standardised Utstein Style. Logistic regression analysis is traditionally employed for model development but machine learning is emerging as the new tool. Examples of such models available for use in the emergency department include ROSC After Cardiac Arrest, CaRdiac Arrest Survival Score, Utstein-Based Return of Spontaneous Circulation, Out-of-Hospital Cardiac Arrest, Cardiac Arrest Hospital Prognosis and Cardiac Arrest Survival Score. The usefulness of these models awaits future studies.

scholarly journals Association of ambient temperature with the outcomes in witnessed out-of-hospital cardiac arrest patients: a population-based observational study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chiwon Ahn ◽  
Jihoon Kim ◽  
Wonhee Kim ◽  
In Young Kim ◽  
Hyun Young Choi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ambient Temperature ◽  
Primary Outcome ◽  
Meteorological Data ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Metropolitan Cities ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Abstract This study aimed to identify the association between ambient temperature (AT) and patient outcome of witnessed out-of-hospital cardiac arrest (OHCA) occurring outdoors. This retrospective nationwide, population-based cohort study recruited witnessed adult OHCA patients in South Korea from January 2012 to December 2016. Meteorological data of 17 metropolitan cities and provinces were retrieved from the Korea Meteorological Administration database. Primary outcome was sustained return of spontaneous circulation (ROSC) in hospital. Secondary outcome was survival to hospital discharge. By the standard of quartile categories of AT (Q1 = 7.1 °C; Q2 = 17.7 °C; Q3 = 23.5 °C), three comparative analyses for ROSC and survival were performed between low and high AT groups. Propensity score matching (1:1) was performed for both AT groups. Among the 142,906 OHCA patients, 1,295 were included. In the multivariate analysis for matched groups by the standard of 7.1 °C (Q1), proportion of ROSC was significantly higher in the high AT-Q1 group than in the low AT-Q1 group (adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.19–3.44). No significant difference in survival was shown between both AT-Q1 groups (aOR 1.24, 95% CI 0.61–2.52). In the standard of 17.7 °C (Q2) and 23.5 °C (Q3), no significant differences in ROSC and survival were found between the low and high AT groups. In conclusion, no obvious correlation existed between AT and patient outcomes such as sustained ROSC or survival to discharge in this study.

scholarly journals In-hospital cardiac arrest incidence and outcomes in the era of COVID-19: an observational study in a Singapore hospital

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ting Lyu ◽  
Faheem Ahmed Khan ◽  
Shanaz Matthew Sajeed ◽  
Amit Kansal ◽  
Monika Gulati Kansal ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Primary Outcome ◽  
Hospital Admissions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Code Blue ◽  
Secondary Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background COVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period. Methods We conducted a retrospective study in a tertiary care hospital in Singapore. The study compared the incidence and outcomes of code blue activations over a 3-month period from March to May 2020 (COVID-19 period) with the same months in 2019 (pre-COVID-19 period). The primary outcome of the study was the rate of survival to hospital discharge for IHCA. The secondary outcomes included incidence of all code blue activation per 1000 hospital admissions, incidence of IHCA per 1000 hospital admissions. Outcomes The rate of survival to hospital discharge for IHCA was 5.88% in the COVID-19 period as compared to 10.0% in the pre-COVID-19 period [odds ratio (OR), 0.72; 95% confidence interval (CI), 0.26-1.95]. Compared to pre-COVID-19 period, there were more IHCA incidences per 1000 hospital admissions in the COVID-19 period (1.86 vs 1.03; OR, 1.81; 95% CI, 0.78-4.41). Conclusions The study observed a trend towards higher incidence of IHCA and lower rate of survival to hospital discharge during COVID-19 pandemic compared to pre-COVID-19 period.

scholarly journals Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm

2019 ◽  
Vol 8 (5) ◽  
pp. 644 ◽  
Author(s):  
Kap Su Han ◽  
Sung Woo Lee ◽  
Eui Jung Lee ◽  
Su Jin Kim
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Prognostic Significance ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Shockable Rhythm ◽  
Control And Prevention ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.

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