Neurological and Clinical Outcomes After In-Hospital Cardiac Arrest Following a New Legislation on Life-Sustaining Treatments

2020 ◽  
Author(s):  
Sang-beom Jeon ◽  
Hyunjo Lee ◽  
Bobin Park ◽  
Soh Hyun Choi ◽  
Yoon-Hee Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Clinical Performance ◽  
Early Time ◽  
Rapid Response Team ◽  
Neurological Status ◽  
Neurological Recovery ◽  
The Awakening ◽  
Before And After ◽  
Response Team ◽  
Hospital Cardiac Arrest

Abstract Background: The precise neurological profiles after in-hospital cardiac arrest (IHCA) are yet to be elucidated. We aimed to evaluate the neurological profiles of patients with IHCA from early time to long-term follow-up and the changes in their neurological outcomes after implementing legislation on the cessation of life-sustaining treatments.Methods: A national legislation allowing the withdrawal of life-sustaining treatments was implemented in South Korea on February 4, 2018. For this prospective cohort study, we established a neurological rapid response team on March 21, 2017, and serially evaluated the neurological status of patients with IHCA from the initial resuscitation to 12 months after the onset of IHCA. The primary outcome was good neurological status defined as a Clinical Performance Category score (range from 1 to 5, with higher scores indicating greater disability) of 1−2 at 12 months after IHCA. The secondary outcomes were the awakening and neurological recovery during the first week and the survival at 12 months. The outcomes were also compared between before and after the implementation of the legislation.Results: Of 291 adult patients with IHCA, 144 were included in the Before Period, and 147 were included in the After Period. Physician Orders for Life-Sustaining Treatments were made in 63 (42.9%) patients in the After Period. On the first day and during the first week after IHCA, the awakening was achieved in 21.0% and 40.9%, respectively, and neurological recovery in 4.1% and 15.8%, respectively. The proportion of patients with good neurological status at 12 months was not significantly different between the Before Period (19.0%) and the After Period (15.1%; p = 0.37). Awakening (40.0% vs. 42.2%; p = 0.65) and neurological recovery (16.7% vs. 15.0%; p = 0 .69) during the first week as well as survival at 12 months (25.0% vs. 18.4%; p = 0.17) also did not show significant differences between the two periods. Conclusion: Awakening and neurological recovery were remarkable throughout the first week. In the current study, implementating the legislation allowing the cessation of life-sustaining treatments did not significantly affect the neurological and survival outcomes after IHCA. Trial registration: This study was registered in clinical-trial.gov (NCT03006484) in December 2016.

Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ross A Pollack ◽  
Siobhan P Brown ◽  
Thomas Rea ◽  
Peter J Kudenchuk ◽  
Myron L Weisfeldt
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Patient Characteristics ◽  
Neurological Status ◽  
Relative Safety ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Rhythm Analysis ◽  
In Transit ◽  
Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

Knowledge and Skills of Lay Participants Training with Basic Life Support Program in Case of Cardiac Arrest

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S44-S48
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Basic Life Support ◽  
Life Support ◽  
Training Session ◽  
Smartphone Application ◽  
Knowledge And Skills ◽  
Lay People ◽  
Before And After ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest is an important cause that leads to hospital admission and death. Improving lay people’s knowledge and skills in basic life support (BLS) may lead to reduced death associated with out-of-hospital cardiac arrest. “BLS NU KKU” is a BLS training program developed from up-to-date literature as a smartphone application used to train lay people in the community. Objective: To evaluate BLS-related knowledge and skills of participants before and after BLS training. Materials and Methods: A one group pretest-posttest design was used to implement the present study in Khon Kaen, Thailand. Participants were 350 individuals age 18 and older. An 8-hour BLS training session was offered to 10 groups of 35 participants over the period of 10 months between November 2018 and August 2019. Self-administered questionnaires were used to assess BLS knowledge and Cardiopulmonary resuscitation (CPR) skills. Results: The mean score for BLS-related knowledge significantly increased after the BLS training (mean = 15.05, SD = 2.51) compared to the scores before the training (mean = 10.47, SD = 3.43) (p<0.05). BLS skills improved from 0% to 100% (p<0.001) will all skills rated with mostly “excellent” and “good”. Satisfaction with the training program was also rated mostly with “excellent” and “good”. Conclusion: The BLS training program effectively improved participants’ knowledge and skills for basic life support. This program should be disseminated to train lay people in other settings. Keywords: Basic life support, Cardiac arrest, Mobile application

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tae Yun Kim ◽  
Sun Woo Lee ◽  
Kyuseok Kim ◽  
Joong Eui Rhee ◽  
Sung Koo Jung
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Controlled Clinical Trial ◽  
Emergency Medical Service System ◽  
Short Term ◽  
Combined Administration ◽  
Before And After ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

Abstract 17847: Gasping is a Valid Predictor Of ROSC and Hospital Discharge for In-hospital Cardiac Arrest Occurring on the Ward

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Luca Marengo ◽  
Wolfgang Ummenhofer ◽  
Gerster Pascal ◽  
Falko Harm ◽  
Marc Lüthy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Survival Data ◽  
Neurological Outcome ◽  
Rapid Response Team ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Data Set ◽  
Hospital Cardiac Arrest

Introduction: Agonal respiration has been shown to be commonly associated with witnessed events, ventricular fibrillation, and increased survival during out-of-hospital cardiac arrest. There is little information on incidence of gasping for in-hospital cardiac arrest (IHCA). Our “Rapid Response Team” (RRT) missions were monitored between December 2010 and March 2015, and the prevalence of gasping and survival data for IHCA were investigated. Methods: A standardized extended in-hospital Utstein data set of all RRT-interventions occurring at the University Hospital Basel, Switzerland, from December 13, 2010 until March 31, 2015 was consecutively collected and recorded in Microsoft Excel (Microsoft Corp., USA). Data were analyzed using IBM SPSS Statistics 22.0 (IBM Corp., USA), and are presented as descriptive statistics. Results: The RRT was activated for 636 patients, with 459 having a life-threatening status (72%; 33 missing). 270 patients (59%) suffered IHCA. Ventricular fibrillation or pulseless ventricular tachycardia occurred in 42 patients (16% of CA) and were associated with improved return of spontaneous circulation (ROSC) (36 (97%) vs. 143 (67%; p<0.001)), hospital discharge (25 (68%) vs. 48 (23%; p<0.001)), and discharge with good neurological outcome (Cerebral Performance Categories of 1 or 2 (CPC) (21 (55%) vs. 41 (19%; p<0.001)). Gasping was seen in 128 patients (57% of CA; 46 missing) and was associated with an overall improved ROSC (99 (78%) vs. 55 (59%; p=0.003)). In CAs occurring on the ward (154, 57% of all CAs), gasping was associated with a higher proportion of shockable rhythms (11 (16%) vs. 2 (3%; p=0.019)), improved ROSC (62 (90%) vs. 34 (55%; p<0.001)), and hospital discharge (21 (32%) vs. 7 (11%; p=0.006)). Gasping was not associated with neurological outcome. Conclusions: Gasping was frequently observed accompanying IHCA. The faster in-hospital patient access is probably the reason for the higher prevalence compared to the prehospital setting. For CA on the ward without continuous monitoring, gasping correlates with increased shockable rhythms, ROSC, and hospital discharge.

Abstract 2003: More Chest Compressions and Fewer Shocks Are Given During Out-of-Hospital Cardiac Arrest Resuscitation With the 2005 AHA Guidelines

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynn J White ◽  
Sarah A Cantrell ◽  
Robert Cronin ◽  
Shawn Koser ◽  
David Keseg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Survival Rates ◽  
Automated Analysis ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Convenience Sample ◽  
Care Protocol ◽  
Before And After ◽  
Hospital Cardiac Arrest

Introduction Long pauses without chest compressions (CC) have been identified in CPR provided by EMS professionals for out-of-hospital cardiac arrest (OOHCA). The 2005 AHA ECC CPR guidelines emphasize CC. The 2005 AHA Basic Life Support (BLS) for Healthcare Professionals (HCP) course introduced a training method with more CPR skills practice during the DVD based course. The purpose of this before/after study was to determine whether CC rates increased after introduction of the 2005 course. Methods This urban EMS system has 400 cardiac etiology OOHCA events annually. A convenience sample of 49 continuous electronic ECG recordings of VF patients was analyzed with the impedance channel of the LIFEPAK 12 (Physio-Control, Redmond WA) and proprietary software. A trained researcher verified the automated analysis. Each CC during the resuscitation attempt and pauses in CC before and after the first defibrillation shock were noted. The time of return of spontaneous circulation (ROSC) was determined by medical record review and onset of regular electrical activity without CC. Medical records were reviewed for outcome to hospital discharge. The EMS patient care protocol for VF was changed on July 1, 2006 to comply with the 2005 AHA ECC guidelines. Cases were grouped by the OOHCA date: 9/2004 to 12/31/2006 (pre) and 7/1/2006 to 4/21/2007 (post). EMS personnel began taking the 2005 BLS for HCP course during spring 2006. Monthly courses over 3 years will recertify 1500 personnel. Results 29 cases were analyzed from the pre group and 20 from the post group. Compressions per minute increased from a mean (±SD) of 47 ± 16 pre to 75 ± 33 post (P < 0.01). The mean count of shocks given per victim decreased from 4.5 ± 4.0 pre to 2.8 ± 1.8 post (P < 0.04). The CC pause before the first shock was unchanged (23.6 ± 18.4 seconds to 22.1 ± 17.9). but the CC pause following that shock decreased significantly from 48.7 ± 63.2 to 11.8 ± 22.5 (p=0.008). Rates of ROSC (55% pre, 50% post) and survival to discharge (15% pre, 13% post) were similar. Conclusion Following introduction of the 2005 BLS for HCP course and the EMS protocol change, the quality of CPR delivered to victims of OOHCA improved significantly compared with pre-2006 CPR. The sample size was too small to detect differences in survival rates.

scholarly journals Reduced frequency of cardiopulmonary arrests by rapid response teams

2012 ◽  
Vol 10 (4) ◽  
pp. 442-448 ◽  
Author(s):  
Paulo David Scatena Gonçales ◽  
Joyce Assis Polessi ◽  
Lital Moro Bass ◽  
Gisele de Paula Dias Santos ◽  
Paula Kiyomi Onaga Yokota ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Rapid Response Team ◽  
Rapid Response ◽  
High Complexity ◽  
Rapid Response Teams ◽  
Cardiorespiratory Arrest ◽  
Reduced Frequency ◽  
Before And After ◽  
Response Team ◽  
The Impact

OBJECTIVE: To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS: A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS: During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p<0.001) and 14.34 deaths/1,000 discharges (p=0.029). CONCLUSION: The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

Sign in / Sign up

Export Citation Format

Share Document