scholarly journals Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

2020 ◽  
Author(s):  
German Alberto Devia ◽  
Norberto Navarrete ◽  
Zaira Melina Rojas Ortiz
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
Cardiac Arrest Patient ◽  
University Hospital ◽  
Bedside Ultrasound ◽  
Emergency Rooms ◽  
Significant Difference ◽  
The University

Abstract Background: The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective: This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients, and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and Methods: This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor, Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results: Of a total of 108 patients the median of the age was 71 years, 65.8% were male subjects, the most frequent cause for cardiac arrest was the cardiogenic shock(32.4%). ROSC was observed in 41 cases(37.9%) and survival at discharge was 18 cases(16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion: There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

scholarly journals Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
German Devia Jaramillo ◽  
Norberto Navarrete Aldana ◽  
Zaira Rojas Ortiz
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
Cardiac Arrest Patient ◽  
University Hospital ◽  
Bedside Ultrasound ◽  
Emergency Rooms ◽  
Significant Difference ◽  
The University

Abstract Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

scholarly journals Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

2020 ◽  
Author(s):  
German Alberto Devia ◽  
Norberto Navarrete ◽  
Zaira Melina Rojas Ortiz
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
University Hospital ◽  
Bedside Ultrasound ◽  
Emergency Rooms ◽  
Significant Difference ◽  
Ultrasound Assessment ◽  
The University

Abstract Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound.Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients, and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms.Materials and Methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor, Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient.Results Of a total of 108 patients the median of the age was 71 years, 65.8% were male subjects, the most frequent cause for cardiac arrest was the cardiogenic shock(32.4%). ROSC was observed in 41 cases(37.9%) and survival at discharge was 18 cases(16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC.Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

scholarly journals Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1197
Author(s):  
Yolima Cossio ◽  
Marta-Beatriz Aller ◽  
Maria José Abadias ◽  
Jose-Manuel Domínguez ◽  
Maria-Soledad Romea ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Healthcare Systems ◽  
University Hospital ◽  
Emergency Rooms ◽  
Daily Number ◽  
Patient Demographics ◽  
Significant Difference ◽  
The University ◽  
Hospital Wards ◽  
Second Wave

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. Conclusions: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

Abstract 13292: Comparison of Outcomes Between Pulseless Electrical Activity by Electrocardiography and Pulseless Myocardial Activity by Echocardiography in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Romolo Gaspari ◽  
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
Secondary Outcome ◽  
Shockable Rhythm ◽  
Cardiac Electrical Activity ◽  
Hospital Cardiac Arrest

Objective: To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo. Methods: This is a secondary analysis of a previously published prospective study at twenty hospitals. Patients presenting after out-of-hospital arrest were included. The cardiac electrical activity was defined by ECG and contemporaneous myocardial activity was defined by bedside echo. Myocardial activity by echo was classified as myocardial asystole- -the absence of myocardial movement, pulseless myocardial activity (PMA)--visible myocardial movement but no pulse, and myocardial fibrillation- -visualized fibrillation. Primary outcome was the prevalence of discordance between electrical activity and myocardial activity. Secondary outcome was survival to hospital discharge. Results: 793 patients and 1943 pauses in CPR were included. 28.6% of CPR pauses demonstrated a difference in electrical activity (ECG) and myocardial activity (echo), 5.0% with asystole (ECG) and PMA (echo), and 22.1% with PEA (ECG) and myocardial asystole (echo). Survival to hospital admission for patients with PMA (echo) was 29.1% (95%CI-23.9-34.9) compared to those with PEA (ECG) (21.4%, 95%CI-17.7-25.6). Twenty-five percent of the 32 pauses in CPR with a shockable rhythm by echo demonstrated a non-shockable rhythm by ECG and were not defibrillated. One of these patients survived, a patient with asystole on ECG and vfib by echo survived because vfib was identified on ECG during a subsequent pause and was defibrillated. Conclusion: Patients in cardiac arrest commonly demonstrate different electrical (ECG) and myocardial activity (echo). Further research is needed to better define cardiac activity during cardiac arrest and to explore outcome between groups defined by electrical and myocardial activity.

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.

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.

Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Gunnar W Skjeflo ◽  
Eirik Skogvoll ◽  
Jan Pål Loennechen ◽  
Theresa M Olasveengen ◽  
Lars Wik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Multivariate Regression ◽  
Life Support ◽  
Controlled Trial ◽  
Pulseless Electrical Activity ◽  
Qrs Complex ◽  
Epinephrine Administration ◽  
Hospital Cardiac Arrest

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

Sign in / Sign up

Export Citation Format

Share Document