One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

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Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

European Heart Journal ◽

10.1093/ehjci/ehaa946.1819 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Merino Argos ◽

I Marco Clement ◽

S.O Rosillo Rodriguez ◽

L Martin Polo ◽

E Arbas Redondo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

University Hospital ◽

Temperature Management ◽

Performance Category ◽

Neurological Outcomes ◽

Cardiac Care Unit ◽

Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

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Abstract 115: One-Year Outcomes in Individual Domains of the Cerebral Performance Category Extended

Circulation ◽

10.1161/circ.138.suppl_2.115 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Katharyn L Flickinger ◽

Melissa J Repine ◽

Stephany Jaramillo ◽

Allison C Koller ◽

Margo Holm ◽

...

Keyword(s):

Cardiac Arrest ◽

Return To Work ◽

Short Term Memory ◽

Demographic Data ◽

Cerebral Performance Category ◽

Logical Thinking ◽

Short Term ◽

Performance Category ◽

Term Memory

Introduction: Cognitive and physical impairments are common in cardiac arrest survivors. Global measures including the Modified Rankin Scale (mRS), Cerebral Performance Category (CPC) and the 10-domain CPC-Extended (CPC-E) tend to improve over 1 year. The CPC-E is scored from 1-5 with higher scores signifying greater impairment. However, with the CPC-E, individual functional domains (alertness, logical thinking, attention, motor skills, short-term memory, basic and complex activities of daily living (ADL), mood, fatigue, and return to work) may recover at different rates. Hypothesis: We hypothesized that patients would have recovery in all domains of the CPC-E at 1 year after index cardiac arrest. Methods: A prospective cohort study of cardiac arrest survivors was conducted between 2/1/16 and 5/31/17. Chart review was done for baseline demographic data. Outcome measures including mRS, CPC, and CPC-E scores were assessed at discharge, 3 months, 6 months, and 1 year. We defined recovery of a CPC-E domain when >90% of patients had scores of 1-2 in that domain. Results: Of 71 subjects, 35 completed the CPC-E at discharge, 35 at 3 months, 25 at 6 months and 31 at 1 year. The most common reasons for exclusion were patient declined or were lost to follow up. The majority (N=37; 52%) were female, with a mean (SD) age of 58(17) years. Most arrests occurred out of hospital (N= 49; 69%), 27 (38%) had a shockable rhythm and the majority (N=37; 54%) were discharged home. CPC-E domains of alertness (N=35, 100%) logical thinking (N=35; 100%), and attention (N=33; 94%) recovered by hospital discharge. BADLs were recovered by 3 months (N=33; 94%). The majority of patients (N=24;77%) experienced slight-to-no disability or symptoms (mRS 0-2 / CPC 1-2) at 1 year follow up. CPC-E short term memory (67%), motor (87%), mood (87%), fatigue (13%), complex ADL (74%), and return to work (55%) did not recover fully by 1 year. Conclusions: In survivors of cardiac arrest, CPC-E domains of alertness, logical thinking, and attention recover rapidly, while domains of short term memory, motor, mood, fatigue, complex ADL and ability to return to work are chronically impaired 1 year after arrest. Interventions to improve recovery in these domains are needed.

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Pediatric patients with poor neurological status and arteriovenous malformation hemorrhage: an outcome analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10355 ◽

2011 ◽

Vol 7 (5) ◽

pp. 462-467 ◽

Cited By ~ 13

Author(s):

Ash Singhal ◽

Tara Adirim ◽

Doug Cochrane ◽

Paul Steinbok

Keyword(s):

Arteriovenous Malformation ◽

Pediatric Patients ◽

Vegetative State ◽

Cerebral Performance Category ◽

Neurological Status ◽

Severe Disability ◽

Outcome Analysis ◽

Performance Category ◽

Mild Disability

Object In general, patients who present with low Glasgow Coma Scale (GCS) scores and/or fixed and dilated pupils are not expected to do well following arteriovenous malformation (AVM) hemorrhage. However, there is a sense among neurosurgeons that pediatric patients may make a better recovery than adults following such an event. There have been few studies focusing on the outcome of pediatric patients with poor neurological status following AVM hemorrhage. The purpose of this study was to characterize functional outcome in pediatric patients with severe disability after AVM hemorrhage. Methods This was a retrospective analysis of clinical presentation and outcome in 15 patients seen at the authors' pediatric hospital presenting with low GCS scores (defined as GCS ≤ 8) following AVM hemorrhage. Results Initial GCS scores ranged from 3 to 6, and 11 of 14 patients had fixed pupils on clinical examination (data were not available in 1 patient). Eight of 15 patients suffered primarily a lobar hemorrhage, 3 suffered primarily infratentorial bleeding, 2 suffered primarily hemorrhages of the basal ganglia, and 2 suffered intraventricular hemorrhage. The overall mortality rate was 20% (3 of 15 patients). The clinical outcome of survivors was defined by the Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) scores at follow-up. One year after AVM hemorrhage, 7 (58%) of the 12 surviving patients showed normal or mild disability (PCPC Score 1 or 2), whereas 5 (42%) of 12 patients had moderate or severe disability (PCPC Score 3 or 4). No patients were in a coma or vegetative state, and 11 (92%) of the 12 patients were functioning independently (POPC Score 1, 2, or 3) 1 year after AVM hemorrhage. All patients were functionally independent by last follow-up, with 8 patients (67%) in the normal or mild disability PCPC category, and 4 in the moderate category (PCPC Score 3). All 12 survivors made a meaningful recovery and went on to live independent lives. Conclusions Pediatric patients suffering AVM hemorrhage have a good outcome and are able to function independently, despite a poor neurological state initially.

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Abstract 11816: Sustained Ventricular Fibrillation During CPR as the Strongest Predictor for the Favorable Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients; The Multicenter Prospective Study of SAVE-J

Circulation ◽

10.1161/circ.132.suppl_3.11816 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takahiro Nakashima ◽

Yoshio Tahara ◽

Satoshi Yasuda ◽

Naoto Morimura ◽

Ken Nagao ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

Multivariate Logistic Regression Analysis ◽

Favorable Outcome ◽

Initial Rhythm ◽

Group A ◽

Group B ◽

Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be effective in out-of-hospital cardiac arrest (OHCA) patients in whom ventricular fibrillation (VF) as an initial rhythm were refractory to conventional cardiopulmonary resuscitation (CPR). However, it remains unclear whether ECPR is effective even though cardiac rhythm would change from VF to non-VF during CPR. Methods: This multicenter prospective observational study was conducted in 46 hospitals. A total of 457 patients with OHCA aged 20-74 years in whom initial rhythm was VF and the duration from collapse to hospital arrival was within 45 minutes were originally registered. After given CPR for more than 15 minutes in hospital, these patients received combination therapy with ECPR including therapeutic hypothermia (TH), or not received. The patients underwent ECPR (n=250) were classified into the following 2 groups according to rhythm changes during CPR; Group-A (sustained VF; n=127) and Group-B (changing from VF initially to non-shockable rhythm; n=123). The endpoint was a favorable outcome defined as Cerebral Performance Category 1-2 at 6 months after collapse. Results: There were no significant differences of age, sex, time from collapse to ECPR start and the rate of TH between the 2 groups. The rate achieving favorable outcome was significantly higher in Group-A than Group-B. (19.7% vs. 3.3%, p<0.001) (Figure1). When focusing on sustained VF (Group-A), the rate achieving favorable outcome improved about 5.5-fold by ECPR (ECPR, n=127; 19.7% vs. non-ECPR, n=55; 3.6%, p<0.001) (Figure2). In the multivariate logistic-regression analysis, sustained VF during CPR was the strongest predictor for the favorable outcomes among the pre-hospital parameters including age, bystander CPR and time from collapse to ECPR (Odds ratio 4.43, p=0.018). Conclusions: These findings indicates that the patients with sustained VF seem to be a particular population that could merit ECPR.

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(A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001506 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s43-s43

Author(s):

M.E. Ong ◽

P. Sultana ◽

S. Fook-Chong ◽

A. Annitha ◽

S.H. Ang ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Admission ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Secondary Outcome ◽

Number Needed To Treat ◽

Performance Category ◽

Traumatic Cardiac Arrest

ObjectiveTo compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.MethodsThis is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.ResultsA total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).ConclusionA resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.

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Impact of Specific Emergency Measures on Survival in Out-of-Hospital Traumatic Cardiac Arrest

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001308 ◽

2021 ◽

pp. 1-6

Author(s):

Dominique Savary ◽

François Morin ◽

Delphine Douillet ◽

Adrien Drouet ◽

François Xavier Ageron ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Cerebral Performance Category ◽

Tension Pneumothorax ◽

Advanced Life Support ◽

Neurological Status ◽

Performance Category ◽

Traumatic Cardiac Arrest ◽

Pelvic Stabilization ◽

The Impact

Abstract Introduction: The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA. Methods: This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2). Results: In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx). Conclusion: Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

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Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000060 ◽

2020 ◽

Vol 35 (2) ◽

pp. 141-147 ◽

Cited By ~ 1

Author(s):

Joshua M. Tobin ◽

William D. Ramos ◽

Joel Greenshields ◽

Stephanie Dickinson ◽

Joseph W. Rossano ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Age Groups ◽

Cerebral Performance Category ◽

Age Group ◽

Performance Category ◽

Bystander Cardiopulmonary Resuscitation ◽

Group Survival ◽

Bystander Cpr

AbstractIntroduction:The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.Hypothesis/Problem:The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.Methods:The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).Results:Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10–6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01–2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86–2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91–1.84; P = .157).Conclusion:In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.

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Abstract 13013: Survival After In-Hospital Cardiopulmonary Resuscitation for Cardiac Arrest in Patients With COVID-19: An Updated Meta-Analysis

Circulation ◽

10.1161/circ.144.suppl_2.13013 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Archana Pattupara ◽

Devika Aggarwal ◽

Kirtipal S Bhatia ◽

Olga Gomez-Rojas ◽

vardhmaan jain ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurological Recovery ◽

Term Survival ◽

Performance Category ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Several small studies have reported variable outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19. A clear estimate is important in prognostication and guiding resuscitation efforts and policies for these patients. Methods: A search of PubMed, Embase, and Scopus databases was conducted to identify studies reporting outcomes after IHCA in adult patients with confirmed COVID-19. The cumulative characteristics of the patients were described. The primary outcome studied was survival at 30 days or at hospital discharge (short term survival). Additional outcomes of interest were proportional prevalence of the initial rhythm at arrest, return of spontaneous circulation (ROSC), and neurological recovery (defined as Cerebral Performance Category Score of 1-2 ). Metanalysis of proportions was performed utilizing the Metaprop command. A random effects model was chosen to account for interstudy variance. Results: A total of 13 eligible studies were identified and included in the analyses. Out of all the hospitalized patients with COVID-19, 1,618 underwent advanced cardiac resuscitation after an IHCA. Patients who had a cardiac arrest had a median age between 50-69 years. IHCA occurred predominantly in men, and in the ICU setting. Shockable rhythms were identified in 8% (95% CI 5-10%, I2; 56%) and non-shockable rhythms in 89% (95% CI 85-94% I2; 84%) of patients (Fig. 1a). ROSC was achieved in 40% (95% CI 31-48% I2; 90%) (Fig. 1b). Only 7 % ( 95% CI 3-12% I2; 86%) of patients survived at 30 days/hospital discharge (Fig. 1c). Neurological recovery was seen in 5% (95% CI 3-9% I2; 67%) of patients who suffered a IHCA (Fig. 1d). Conclusions: Our meta-analysis demonstrates the majority of the cardiac arrests in patients with COVID-19 have non-shockable rhythms. Survival rate in these patients is low, and neurological recovery is unfavorable. This study provides further insight in guiding resuscitation efforts in these patients.

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Abstract 2018: Cardiac Arrest in the Emergency Department: A Report from the National Registry of Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.116.suppl_16.ii_436-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Robert G Kayser ◽

Joseph P Ornato ◽

Mary Ann Peberdy

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Discharge Rate ◽

Traumatic Injury ◽

Cerebral Performance Category ◽

Secondary Analysis ◽

National Registry ◽

Performance Category ◽

Neurologic Outcomes

Background: Little is known about cardiac arrests (CA) in the Emergency Department (ED). The objective of this study was to determine the characteristics of ED CA’s. Methods: Included were 60,852 adult, in-patient CA index events in the National Registry of Cardiopulmonary Resuscitation. Multiple regression analysis compared ED CA with those occurring in the ICU, telemetry, or general floors. Subgroup analysis examined traumatic vs. non-traumatic ED CA and ED CA occurring after a successful pre-hospital resuscitation (recurrent) vs. primary ED CA. Results: In multivariate analysis, ED location significantly predicted improved survival to discharge (OR 0.74, 95% CI[0.67–0.82], p<0.0001). Patients with CA occurring in the ED had better Cerebral Performance Category scores (ED 1.59, ICU 1.73, Tele 1.96, Floor 1.69, p<0.0001), shorter mean post-event length of stays (ED 8.6, ICU 17.5, Tele 16.5, Floor 14.2 days, p<0.0001) and were less likely to be declared DNR (ED 23.0%, ICU 31.7%, Tele 28.8%, Floor 31.8%, p<0.0001) than CA in other locations. Secondary analysis showed that ED patients with recurrent CA were less likely to survive to discharge (10.1% vs. 24.6%, p<0.0001) and were more likely to be declared DNR (27.9% vs. 22.2%, p<0.0006.) than primary ED CA. Mean length of stay for survivors in both groups was similar (8.85 vs. 8.54 days, p=ns). Major traumatic injury preceded 6.3% of all ED CA. Patients whose ED CA was related to traumatic injury were younger (46.2 vs. 65.0 years, p<0.001), more likely to be male (78.2% vs. 58.1, p<0.0001), less likely to have the CA caused by an arrythmia (23.6% vs. 32.5%, p<0.0008), and more likely to have the CA preceded by hypotension or shock (41.6% vs. 29.0%, p<0.0001) than ED patients whose CA was not due to traumatic injury. ED trauma CA patients had a significantly lower survival to discharge rate than ED patients whose CA was not due to trauma (7.5% vs. 23.8%, p<0.0001). Conclusions: ED CA patients are a unique population and have better survival and neurologic outcomes compared to patients in other hospital locations. Primary ED CA patients have a better chance of survival to discharge than those who re-arrest following a successful pre-hospital resuscitation. Traumatic ED CA patients have worse outcomes than non-traumatic CA.

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Abstract 204: Conventional vs. Compression-Only Cardiopulmonary Resuscitation for Geriatric Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.204 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Hiroki Ueyama ◽

Yosuke Homma ◽

Hiroyasu Shimizu ◽

Tetsuya Inoue ◽

Hiraku Funakoshi

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Scale Score ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Category Scale ◽

Performance Category ◽

Adjusted Analysis ◽

Significant Difference ◽

Hospital Cardiac Arrest

Introduction: Compression-only cardiopulmonary resuscitation (CPR) and conventional CPR (30:2, chest compression and rescue breathing) performed by bystanders are known to have similar outcomes in adults. This study aimed to investigate if this difference is applicable in geriatric populations as well. Methods: We conducted a prospective observational study using the All-Japan Utstein Registry to enroll geriatric patients (≥75 years) who experienced out-of-hospital cardiac arrest that was witnessed by bystanders in Japan from January 1, 2009 to December 31, 2013. The primary outcome was favorable neurological function 1 month after the event, which was defined as a Cerebral Performance Category Scale score of 1 or 2. The secondary outcomes were return of spontaneous circulation (ROSC), 1-month survival, and favorable overall function 1 month after the event, which was defined as an Overall Performance Category Scale score of 1 or 2. Outcomes of compression-only CPR and conventional CPR were compared using multivariable logistic regression analyses. Results: Of the 58,072 enrolled patients, 13,248 (22.8%) received conventional CPR whereas 44,824 (77.2%) received compression-only CPR. Favorable neurological outcomes were achieved in 708 (5.3%) patients receiving CPR and 1799 (4.0%) patients receiving compression-only CPR. A crude analysis of neurologically favorable survival revealed superiority of conventional CPR [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.24–1.48; P < 0.001]], but it was no longer statistically significant after multivariable adjustment (OR, 1.09; 95% CI, 0.93–1.27; P = 0.29). Similarly, multivariable adjusted analysis of favorable overall function survival showed no significant difference (OR, 1.08; 95% CI, 0.92–1.26; P = 0.38) between conventional and compression-only CPR. Conventional CPR demonstrated better outcomes in multivariable adjusted analysis of ROSC and 1 month survival (OR, 1.30; 95% CI, 1.22–1.40; P < 0.001 and OR, 1.13. 95% CI, 1.04–1.23; P = 0.003, respectively). Conclusions: The superiority of conventional CPR in geriatric populations was not proven. Thus, we conclude that compression-only CPR is an adequate means of resuscitation in geriatric populations.

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