scholarly journals Cohort study on the factors associated with survival post-cardiac arrest

2015 ◽  
Vol 133 (6) ◽  
pp. 495-501 ◽  
Author(s):  
Cássia Regina Vancini-Campanharo ◽  
Rodrigo Luiz Vancini ◽  
Claudio Andre Barbosa de Lira ◽  
Marília dos Santos Andrade ◽  
Aécio Flávio Teixeira de Góis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Survival Rate ◽  
Ventricular Fibrillation ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Factors Associated ◽  
One Year

CONTEXT AND OBJECTIVE: Cardiac arrest is a common occurrence, and even with efficient emergency treatment, it is associated with a poor prognosis. Identification of predictors of survival after cardiopulmonary resuscitation may provide important information for the healthcare team and family. The aim of this study was to identify factors associated with the survival of patients treated for cardiac arrest, after a one-year follow-up period. DESIGN AND SETTING: Prospective cohort study conducted in the emergency department of a Brazilian university hospital. METHODS: The inclusion criterion was that the patients presented cardiac arrest that was treated in the emergency department (n = 285). Data were collected using the In-hospital Utstein Style template. Cox regression was used to determine which variables were associated with the survival rate (with 95% significance level). RESULTS: After one year, the survival rate was low. Among the patients treated, 39.6% experienced a return of spontaneous circulation; 18.6% survived for 24 hours and of these, 5.6% were discharged and 4.5% were alive after one year of follow-up. Patients with pulseless electrical activity were half as likely to survive as patients with ventricular fibrillation. For patients with asystole, the survival rate was 3.5 times lower than that of patients with pulseless electrical activity. CONCLUSIONS: The initial cardiac rhythm was the best predictor of patient survival. Compared with ventricular fibrillation, pulseless electrical activity was associated with shorter survival times. In turn, compared with pulseless electrical activity, asystole was associated with an even lower survival rate.

Abstract 052: Improved Hospital Outcomes With Hypokalemia on Admission in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Angelo de la Rosa ◽  
Manuel Tapia ◽  
Yong Ji ◽  
Basil Saour ◽  
Mikhail Torosoff
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Mortality ◽  
Electrical Activity ◽  
Therapeutic Hypothermia ◽  
Multivariate Logistic Regression Analysis ◽  
Pulseless Electrical Activity ◽  
Older Age ◽  
Chi Square

Purpose: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia. Methods: Results of initial admission laboratory studies, medical history, and echocardiogram in 203 consecutive cardiac arrest patients (59 females, 59+/- 15 years old) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Increased mortality was noted with older age, decreased admission pH, elevated admission lactate, lower admission hemoglobin, and pulseless electrical activity or asystole as presenting rhythms (Table). Admission hypokalemia and ventricular fibrillation/tachycardia were associated with improved hospital mortality (Table). Potassium was significantly lower in patients admitted with ventricular fibrillation/tachycardia (3.897+/-0.92) as compared to patients with asystole (4.674+/-1.377) or pulseless electrical activity (4.491+/-1.055 mEq/dL, p<0.0001). In multivariate logistic regression analysis, independent predictors of increased hospital mortality included increased admission potassium (OR 2.0, 95%CI 1.291-3.170, p=0.002)), older age (OR 1.04, 95%CI 1.007-1.071, p=0.017), admission PEA (OR 3.7, 95%CI 1.358-10.282, p=0.011 when compared to ventricular fibrillation/tachycardia) or asystole (OR 17.2, 95%CI 4.423-66.810, p<0.001 when compared to ventricular fibrillation/tachycardia); while decreased mortality was associated with higher hemoglobin (OR 0.8, 95%CI 0.665-0.997, p=0.047). Conclusions: Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.

scholarly journals Advantages of a cohort study on cardiac arrest conducted by nurses

2015 ◽  
Vol 49 (5) ◽  
pp. 762-766
Author(s):  
Cássia Regina Vancini Campanharo ◽  
Rodrigo Luiz Vancini ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
Ruth Ester Assayag Batista ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Neurological Status ◽  
University Hospital ◽  
Training Strategy ◽  
Factors Associated ◽  
Disease Outcomes ◽  
Telephone Calls ◽  
One Year ◽  
And Training

AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.RESULTSOf the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.CONCLUSIONCohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

scholarly journals P003: Which factors predict resuscitation outcomes in patients arriving to the emergency department in cardiac arrest? A SHoC series study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S57-S58
Author(s):  
P. Atkinson ◽  
N. Beckett ◽  
D. Lewis ◽  
J. Fraser ◽  
A. Banerjee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Odds Ratio ◽  
Cardiac Rhythm ◽  
Point Of Care ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Successful Resuscitation

Introduction: The decision as to whether to end resuscitation for pre-hospital cardiac arrest (CA) patients in the field or in the emergency department (ED) is commonly made based upon standard criteria. We studied the reliability of several easily determined criteria as predictors of resuscitation outcomes in a population of adults in CA transported to the ED. Methods: A retrospective database and chart analysis was completed for patients arriving to a tertiary ED in cardiac arrest, between 2010 and 2014. Patients were excluded if aged under 19. Multiple data were abstracted from charts using a standardized form. Regression analysis was used to compare criteria that predicted return of spontaneous circulation (ROSC) and survival to hospital admission (SHA). Results: 264 patients met the study inclusion criteria. Logistic regression was used to identify predictors of ROSC and SHA. The criteria that emerged as significant predictors for ROSC included; longer ED resuscitation time (Odds ratio 1.11 (1.06- 1.18)), witnessed arrest (Odds ratio 9.43 (2.58- 53.0)) and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 3.23 (1.07-9.811)) over Asystole. Receiving point of care ultrasound (PoCUS; Odds ratio 0.22 (0.07-0.69)); and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 4.10 (1.43-11.88)) were the significant predictors for SHA. Longer times for ED resuscitation was close to reaching significance for predicting SHA Conclusion: Our results suggest that both fixed and adaptable factors, including increasing resuscitation time, and PoCUS use in the ED were important independent predictors of successful resuscitation. Several commonly used criteria were unreliable predictors.

scholarly journals Challenges of one-year longitudinal follow-up of a prospective, observational cohort study using an anonymised database: recommendations for trainee research collaboratives

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dmitri Nepogodiev ◽  
Keyword(s):  
Cohort Study ◽  
Cohort Studies ◽  
Gastrointestinal Surgery ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Data Completeness ◽  
Factors Associated ◽  
Number Of Patients ◽  
One Year

Abstract Background Trainee research collaboratives (TRCs) have pioneered high quality, prospective ‘snap-shot’ surgical cohort studies in the UK. Outcomes After Kidney injury in Surgery (OAKS) was the first TRC cohort study to attempt to collect one-year follow-up data. The aims of this study were to evaluate one-year follow-up and data completion rates, and to identify factors associated with improved follow-up rates. Methods In this multicentre study, patients undergoing major gastrointestinal surgery were prospectively identified and followed up at one-year following surgery for six clinical outcomes. The primary outcome for this report was the follow-up rate for mortality at 1 year. The secondary outcome was the data completeness rate in those patients who were followed-up. An electronic survey was disseminated to investigators to identify strategies associated with improved follow-up. Results Of the 173 centres that collected baseline data, 126 centres registered to participate in one-year follow-up. Overall 62.3% (3482/5585) of patients were followed-up at 1 year; in centres registered to collect one-year outcomes, the follow-up rate was 82.6% (3482/4213). There were no differences in sex, comorbidity, operative urgency, or 7-day postoperative AKI rate between patients who were lost to follow-up and those who were successfully followed-up. In centres registered to collect one-year follow-up outcomes, overall data completeness was 83.1%, with 57.9% (73/126) of centres having ≥95% data completeness. Factors associated with increased likelihood of achieving ≥95% data completeness were total number of patients to be followed-up (77.4% in centres with < 15 patients, 59.0% with 15–29 patients, 51.4% with 30–59 patients, and 36.8% with > 60 patients, p = 0.030), and central versus local storage of patient identifiers (72.5% vs 48.0%, respectively, p = 0.006). Conclusions TRC methodology can be used to follow-up patients identified in prospective cohort studies at one-year. Follow-up rates are maximized by central storage of patient identifiers.

scholarly journals Efficience of Cardiopulmonary Resuscitation in Emergency Medical Service and University Hospital

2013 ◽  
Vol 13 (1) ◽  
pp. 3-6
Author(s):  
Anita Kaleja ◽  
Elina Snucina ◽  
Indulis Vanags
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Complete Recovery ◽  
Adult Patients ◽  
University Hospital ◽  
Short Term ◽  
Hospital Cardiac Arrest

Summary Introduction.Survival rate among patients with cardiac arrest remains unclear. Return of spontaneous circulation (ROSC) is just the first step toward the goal of complete recovery from cardiac arrest. It depends on quality of cardiopulmonary resuscitation (CPR) during resuscitation and factors of postresuscitation care. Regular CPR analysis has not been carried out in Latvia. Aim of the study was to evaluate survival rate among patients with out-of-hospital cardiac arrest and in-hospital cardiac arrest. Materials and methods. The study was conducted in the State Emergency service of Latvia and Pauls Stradins Clinical University Hospital during 15 months in 2010/2011. There were 221 adult patients with in-hospital cardiac arrest and 162 adult patients with out-of-hospital cardiac arrest and performed CPR included in retrospective research. The information was analyzed by medical records. The obtained results were expressed in percents and compared, using the Pearson’s Chi-square (Pearson χ2) test. Results. The short-term ROSC was achieved among patients with out-of-hospital cardiac arrest (OHCA) in 62 cases and among patients with in-hospital cardiac arrest (IHCA) in 186 cases. Survival to discharge was achieved in 20.3% among patients with OHCA and 15.8% among patients with IHCA. The most commonly used CPR algorithm was pulseless electrical activity/asystole (72 - 73%). Short-term ROSC was achieved most frequently by ventricular fibrillation/pulseless ventricular tachycardia (41.3-56%), but the largest number of unsuccessful CPR episodes was observed by pulseless electrical activity/ asystole. Conclusion. Results of CPR were different among patients with OHCA and IHCA. ROSC is rhythm-specific outcome.

scholarly journals Death by Disimpaction: A Bradycardic Arrest Secondary to Rectal Manipulation

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Christopher S. Sampson ◽  
Cory M. Shea
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Rare Case ◽  
Patient Monitoring ◽  
Pulseless Electrical Activity ◽  
Daily Basis ◽  
Abdominal Distention ◽  
Rectal Examination ◽  
Cardiac Monitor

Rectal examination and fecal disimpaction are common procedures performed in the Emergency Department on a daily basis. Here, we report a rare case of a patient suffering a cardiac arrest and ultimately death likely due to rectal manipulation. A 66-year-old male presented to the Emergency Department (ED) with a complaint of abdominal distention and constipation. A rectal exam was performed. During the examination the patient became apneic. On the cardiac monitor the patient was found to be in pulseless electrical activity with a bradycardic rate. Our recommendation would be to provide adequate analgesia and close patient monitoring of those undergoing this procedure especially patients with significant stool burdens.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Neurological Outcome ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Good Neurological Outcome ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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