scholarly journals Ionized calcium level at emergency department arrival is associated with return of spontaneous circulation in out-of-hospital cardiac arrest

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0240420
Author(s):  
Sun Ju Kim ◽  
Hye Sim Kim ◽  
Sung Oh Hwang ◽  
Woo Jin Jung ◽  
Young Il Roh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Calcium Level ◽  
Spontaneous Circulation ◽  
Ionized Calcium ◽  
Return Of Spontaneous Circulation ◽  
Emergency Department Arrival ◽  
Hospital Cardiac Arrest

scholarly journals Association Between Duration of Return of Spontaneous Circulation and Favorable Outcomes After Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Huixin Lian ◽  
Andong Xia ◽  
Xinyan Qin ◽  
Sijia Tian ◽  
Xuqin Kang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Core Outcome ◽  
Return Of Spontaneous Circulation ◽  
Emergency Department Arrival ◽  
Duration Time ◽  
Hospital Cardiac Arrest

Abstract Background: Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR), but the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest (OHCA).Methods: In this retrospective observational study from a single center in Beijing, we analyzed the records of 126 OHCA patients who achieved ROSC between January 1, 2020, and December 31, 2020. ROSC duration was defined as the entire time of ROSC from heartbeat or pulse present upon arrival at hospital or arrest again during CPR. The primary outcome was survival at 30 days with favorable neurological outcome. The probability of survival after OHCA as related to CPR duration time was further analyzed using the Probability Density Function (PDF) and the empirical Cumulative Density Functions (CDFs), and compared with ROSC sustained until emergency department arrival and ROSC sustained at least 20 minutes. Results: Among all 126 OHCA patients who achieved ROSC, the median ROSC duration time was 13.6 minutes. There were no significant differences between ROSC sustained until emergency department arrival and sustained at least 20 minutes in the 24-hour survival rate (31.3% [31/99] vs. 35.7% [10/30]; P=0.835), 30-day survival rate (23.2% [23/99] vs. 25.0% [7/30]; P=0.991), or survival at 30 days with cerebral performance category (CPC) 1–2 (18.2% [18/99] vs. 10.7% [3/30]; P=0.435). The Kolmogorov-Smirnov test values from the empirical CDFs with ROSC sustained until hospital arrival and ROSC at least 20 minutes were 0.4444, 0.2000, and 0.2353 for CPC 1 or 2, CPC 3 or 4, and CPC 5 respectively.Conclusions: ROSC duration was directly associated with 24-hour survival, 30-day survival and 30-day survival with favorable neurological outcomes after OHCA. ROSC as a core outcome element of CPR should be defined as sustained at least 20 minutes or until arrival at the emergency department, and as a basic standard for evaluating resuscitation success after OHCA.

Abstract 234: Validation of a Termination-of-resuscitation Rule for Patients with Refractory Out-of-hospital Cardiac Arrest at an Emergency Department in Japan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Medical Service ◽  
Basic Life Support ◽  
Life Support ◽  
High Specificity ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Using Data ◽  
Hospital Cardiac Arrest

Introduction: In Japan, emergency medical service (EMS) providers are prohibited from cardiopulmonary resuscitation (CPR) termination in the field and must transport all out-of-hospital cardiac arrest (OHCA) patients to a hospital, regardless of the return of spontaneous circulation (ROSC). We previously developed a termination of resuscitation (TOR) rule for emergency department physicians (ED-TOR) treating OHCA patients using data from the All-Japan Utstein Registry between 2005 and 2009, when CPR was performed according to the 2005 guidelines. The ED-TOR rule recommends CPR termination when patients in the emergency department meet all of the following criteria: initial unshockable rhythm, arrest unwitnessed by bystanders and no prehospital ROSC. Hypothesis: We aimed to validate the ED-TOR rule using more recent data, where CPR was performed according to the 2010 and 2015 guidelines, comparing the relevance of the ED-TOR rule with the universal basic life support TOR (BLS-TOR) rule, which consists of the following criteria: no prehospital ROSC, unwitnessed arrest by EMS providers and no shock received. Methods: We analysed 552,554 OHCA patients (age ≥ 18 years) treated by EMS providers. OHCA patients witnessed by EMS providers were excluded. Data were obtained from a prospectively recorded All-Japan Utstein Registry from 2013 to 2017. The study endpoints were specificity and a positive predictive value (PPV) for predicting 1-month mortality after OHCA with the ED-TOR and BLS-TOR rules. Results: The overall 1-month survival rate was 4.3% (23,733/552,554). The proportions of OHCA patients who fulfilled the ED-TOR and BLS-TOR criteria were 59.6% and 83.8%, respectively. The specificity and PPV of the ED-TOR and BLS-TOR rules for predicting 1-month mortality were 93.2% (95% confidence interval [CI], 92.8%-93.5%) and 99.5% (95% CI, 99.5%-99.5%) and 82.6% (95% CI, 82.1%-83.1%) and 99.1% (95% CI, 99.1%-99.1%), respectively. Conclusions: The ED-TOR rule was successfully validated using more recent data from a Japanese registry where CPR was performed according to the 2010 and 2015 guidelines. The ED-TOR rule was slightly superior to the BLS-TOR rule in Japanese EMS systems showing high specificity and PPV for predicting 1-month mortality.

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 P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jocelyn Berdowski ◽  
Andra Schmohl ◽  
Rudolph W Koster
Keyword(s):  
Cardiac Arrest ◽  
World Wide ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Return Of Spontaneous Circulation ◽  
Resuscitation Guidelines ◽  
Rhythm Analysis ◽  
New Guidelines ◽  
Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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.

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