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.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

Abstract 10100: Early Prediction of Neurological Outcome at 30 Days After Return of Spontaneous Circulation From Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Norihiro Nishioka ◽  
Daisuke Kobayashi ◽  
Takeyuki Kiguchi ◽  
Tetsuhisa Kitamura ◽  
Taku Iwami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Laboratory Data ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Calibration Plot ◽  
Early Prediction ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Validation Set ◽  
Hospital Cardiac Arrest

Aim: To develop and validate a model for early prediction of neurological outcomes in non-traumatic out-hospital cardiac arrest (OHCA) patients. Methods: We analyzed the data of adult non-traumatic cardiac arrest patients who experienced return of spontaneous circulation (ROSC) and were admitted to the intensive care unit between January 2013 and December 2017 from the database of a multicenter registry. We allocated 1329 patients who were admitted from 2013 to 2015 to the derivation set and 1025 patients admitted from 2016 to 2017 to the validation set. The primary outcome was the dichotomized Cerebral Performance Category at 30 days. We developed 2 models: model 1 including variables except for laboratory data and model 2 including all variables with laboratory data immediately available after ROSC. Logistic regression with least absolute shrinkage and selection operator regularization was used for model development. The C-statistics for discrimination, the prognostic ability, and calibration of the prediction model were assessed in the validation set. The reclassification of model 2 compared to model 1 was also evaluated by continuous net reclassification index (NRI). Results: The C-statistics [95% confidence intervals] of model 2 and 1 in validation set was 0.940 [0.921-0.959] and 0.935 [0.914-0.957], respectively (Figure 1). The calibration plot showed that both models were well-calibrated to observed neurological outcomes (Figure 2). The model 2 reclassified patients better than the model 1 (NRI: 0.663, p < 0.001). A web-based calculator based on these models was developed that allows clinicians to input the predictor variables needed for the probability of good or poor neurological outcomes (https://pcas-prediction.shinyapps.io/pcas_lasso/). Conclusion: The prediction tool including detailed in-hospital information showed good performance to predict neurological outcomes at 30 days in patients with ROSC after OHCA.

scholarly journals Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hyun-Jin Bae ◽  
Chang Hwan Sohn ◽  
Sung-Eun Cho ◽  
Jeongeun Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Rank Correlation ◽  
Spontaneous Circulation ◽  
Emergency Department Overcrowding ◽  
Neurologic Outcomes ◽  
Traumatic Cardiac Arrest ◽  
Occupancy Rates ◽  
Hospital Cardiac Arrest

Abstract Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

scholarly journals Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792095856
Author(s):  
Doo Youp Kim ◽  
Jin Sup Park ◽  
Sun Hak Lee ◽  
Jeong Cheon Choe ◽  
Jin Hee Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

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.

Abstract 111: Impact of Time to Return of Spontaneous Circulation on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest According to Age: Evidence From a Large-Scale Registry in Japan

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Hayato Tada ◽  
Masaya Shimojima ◽  
Hirofumi Okada ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Large Scale ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Performance Category ◽  
Return Of Spontaneous Circulation ◽  
The Impact ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Time to return of spontaneous circulation (ROSC) is a more important predictor of neurologically intact survival than the presence of ROSC in patients with out-of-hospital cardiac arrest (OHCA). However, the differences in the relationship between time to ROSC and neurologically intact survival in patients with OHCA based on age is unclear. Hypothesis: We hypothesized that the impact of time to ROSC on neurologically intact survival differs according to age. Methods: We analyzed the data of 34,905 patients with OHCA (age ≥18 years) who exhibited prehospital ROSC from the prospectively recorded all-Japan OHCA registry (2011-2014). The primary outcome was neurologically intact survival at 1 month after OHCA (cerebral performance category [CPC] 1 or 2). Time to ROSC was defined as the interval from the initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to the achievement of ROSC. We categorized time to ROSC by every 4-min interval (2 cycles of CPR) from 1 to 32 min and ≥33 min, and age into 4 groups: 18-64, 65-74, 75-89, and ≥90 years. Results: The overall CPC 1-2 rate was 21.1% (7,353/34,905). Increasing time to ROSC (per min) was negatively associated with CPC 1-2 (adjusted odds ratio, 0.91; 95% confidence interval, 0.90-0.91). The CPC 1-2 rates decreased as time to ROSC increased in each age group: from 58.8% (1,247/2,122) in 1-4 min to 2.8% (7/246) in ≥33 min for patients aged 18-64 years, from 51.1% (721/1,410) in 1-4 min to 1.6% (4/244) in ≥33 min for 65-74 years, from 37.3% (765/2,051) in 1-4 min to 0.7% (4/539) in 29-32 min for 75-89 years, and from 23.4% (92/393) in 1-4 min to 0.2% (1/481) in 17-20 min for ≥90 years (all p for trend <0.001). Conclusions: The CPC 1-2 rates of patients aged 18-64 and 65-74 years were above the 1% futility rate when prehospital ROSC was achieved after prolonged CPR, ≥33 min from initiation by EMS providers. However, the CPC 1-2 rates were below the 1% futility rate when prehospital ROSC was achieved ≥29 min and ≥17 min for patients aged 75-89 years and ≥90 years, respectively.

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