scholarly journals In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients

2020 ◽  
Vol 15 (2) ◽  
pp. 219-227 ◽  
Author(s):  
Monique Anderson Starks ◽  
Jingjing Wu ◽  
Eric D. Peterson ◽  
Judith A. Stafford ◽  
Roland A. Matsouaka ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Dialysis Patients ◽  
Logistic Regression Models ◽  
Initial Rhythm ◽  
Maintenance Dialysis ◽  
Poor Outcomes ◽  
Composite Scores ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background and objectivesPatients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Using the Get With The Guidelines-Resuscitation (GWTG-R) registry, we examined processes of care and outcomes of in-hospital cardiac arrest for patients on maintenance dialysis compared with nondialysis patients.Design, setting, participants, & measurementsWe used GWTG-R data linked to Centers for Medicare and Medicaid data to identify patients with ESKD receiving maintenance dialysis from 2000 to 2012. We then case-matched adult patients on maintenance dialysis to nondialysis patients in a 1:3 ratio on the basis of age, sex, race, hospital, and year of arrest. Logistic regression models with generalized estimating equations were used to assess the association of in-hospital cardiac arrest and outcomes by dialysis status.ResultsAfter matching, there were a total of 31,144 GWTG-R patients from 372 sites, of which 8498 (27%) were on maintenance dialysis. Patients on maintenance dialysis were less likely to have a shockable initial rhythm (20% versus 21%) and less likely to be within the intensive care unit at the time of arrest (46% versus 47%) compared with nondialysis patients; they also had lower composite scores for resuscitation quality (89% versus 90%) and were less likely to have defibrillation within 2 minutes (54% versus 58%). After adjustment, patients on maintenance dialysis had similar adjusted odds of survival to discharge (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 0.97 to 1.13), better acute survival (OR, 1.33; 95% CI, 1.26 to 1.40), and were more likely to have favorable neurologic status (OR, 1.12; 95% CI, 1.04 to 1.22) compared with nondialysis patients.ConclusionsAlthough there appears to be opportunities to improve the quality of in-hospital cardiac arrest care for among those on maintenance dialysis, survival to discharge was similar for these patients compared with nondialysis patients.

Out-of-hospital cardiac arrest

2021 ◽  
pp. 76-87
Author(s):  
Jerry P Nolan ◽  
Christian Hassager
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Hospital Cardiac Arrest

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

The association of Duration of participation in get with the guidelines-resuscitation with quality of Care for in-Hospital Cardiac Arrest

2018 ◽  
Vol 204 ◽  
pp. 156-162 ◽  
Author(s):  
Monique A. Starks ◽  
David Dai ◽  
Graham Nichol ◽  
Sana M. Al-Khatib ◽  
Paul Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Of Care ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Abstract 264: Timing of In-Hospital Cardiac Arrest and Association with Survival to Discharge and Subsequent Length of Stay

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Kevin Kennedy ◽  
Paul Chan
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Regression Models ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models ◽  
Hierarchical Logistic Regression ◽  
The Mean ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: In-hospital cardiac arrest (IHCA) is common and often fatal. To date, the time from admission to IHCA has not been described, and the association between timing of cardiac arrest and likelihood of survival to discharge and subsequent hospital length of stay (LOS) is unknown. Methods: Within the national Get with the Guidelines Resuscitation registry, we identified 175,904 patients admitted between 2000 and 2013 with an IHCA. For each patient, the time from admission to IHCA was determined and categorized as early (7 days). Multivariable hierarchical logistic regression models examined the association between timing of IHCA and both survival to discharge and, among survivors, subsequent LOS from date of IHCA. Results: Overall, the mean and median times from admission to IHCA were 5.3 ± 6.3 days and 3 days (IQR: 1-8), respectively. Nearly half (83,811 [47.6%]) of patients had their IHCA 7 days from admission, respectively. After adjustment for patient and and cardiac arrest factors, cardiac arrests occurring later during the hospitalization were associated with modestly lower survival (reference: 7 days: adjusted OR 0.89 [0.86-0.92]; P<.01). However, this association pertained only to patients with a shockable IHCA (P for interaction between shockable and non-shockable rhythms: <0.001). Lastly, among those surviving to discharge, later timing of IHCA was associated with much longer subsequent LOS (reference: 7 days: 6.8 additional days [6.3-7.3]; P<0.001). Conclusion: Most IHCA occur after the first 72 hours of admission. Patients with IHCA >3 days from admission had significantly lower hospital survival and longer hospitalizations from the time of cardiac arrest.

scholarly journals Survival after out-of-hospital cardiac arrest is associated with area-level socioeconomic status

Heart ◽  
2018 ◽  
pp. heartjnl-2018-313838 ◽  
Author(s):  
Martin Jonsson ◽  
Juho Härkönen ◽  
Petter Ljungman ◽  
Araz Rawshani ◽  
Per Nordberg ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cardiac Arrest ◽  
Western World ◽  
Positive Trend ◽  
Logistic Regression Models ◽  
Initial Rhythm ◽  
The Relationship ◽  
Sex Positive ◽  
Hospital Cardiac Arrest ◽  
Average Educational Level

ObjectiveOut-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world. In this study we aimed to investigate the relationship between area-level socioeconomic status (SES) and 30-day survival after OHCA. We hypothesised that high SES at an area level is associated with an improved chance of 30-day survival.MethodsPatients with OHCA in Stockholm County between 1 January 2006 and 31 December 2015 were analysed retrospectively. To quantify area-level SES, we linked the patient’s home address to 250 × 250/1000 × 1000 meter grids with aggregated information about income and education. We constructed multivariable logistic regression models in which area-level SES measures were adjusted for age, sex, emergency medical services response time, witnessed status, initial rhythm, aetiology, location and year of cardiac arrest.ResultsWe included 7431 OHCAs. There was significantly greater 30-day survival (p=0.003) in areas with a high proportion of university-educated people. No statistically significant association was seen between median disposable income and 30-day survival. The adjusted OR for 30-day survival among patients in the highest educational quintile was 1.70 (95% CI 1.15 to 2.51) compared with patients in the lowest educational quintile. We found no significant interaction for sex. Positive trend with increasing area-level education was seen in both men and women but the trend was only statistically significant among men (p=0.012)ConclusionsSurvival to 30 days after OHCA is positively associated with the average educational level of the residential area. Area-level income does not independently predict 30-day survival after OHCA.

Abstract 18923: Trends in Long-term Survival After In-hospital Cardiac Arrest: Insights From Get With the Guidelines-Resuscitation®

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Lauren E Thompson ◽  
Paul S Chan ◽  
Fengmeng Tang ◽  
Brahmajee K Nallamothu ◽  
Saket Girotra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Temporal Trends ◽  
Pulseless Electrical Activity ◽  
Term Survival ◽  
Initial Rhythm ◽  
Adjusted Rate ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Although survival to hospital discharge after in-hospital cardiac arrest (IHCA) has improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. Accordingly, we evaluated temporal trends in 1-year survival after IHCA. Methods: We linked data from Get With The Guidelines-Resuscitation (a national IHCA registry) with Medicare files and evaluated temporal trends in 1-year survival after IHCA between 2000 and 2011, using multivariable Poisson regression models to account for patient factors, clinical factors, cardiac arrest characteristics (e.g. initial rhythm, location of arrest), and hospital site. We examined 1-year survival trends overall, and separately for shockable (ventricular fibrillation [VF] and pulseless ventricular tachycardia [VT]) and non-shockable rhythms (asystole and pulseless electrical activity [PEA]). Results: Of 45,567 patients with IHCA, the majority had a presenting rhythm of PEA (43.5%) or asystole (42.2%), and half (53.6%) occurred in an ICU. Overall 1-year survival was 9.4%, with higher survival each successive year (FIGURE). Risk-adjusted 1-year survival increased over time for all IHCA (adjusted rate ratio [RR] per year, 1.05; 95% confidence interval [CI], 1.04 to 1.06; P<0.001 for trend) and separately for VT/VF and PEA/asystole arrests (all p for trend <0.001). Compared with 2000-01, 1-year survival after IHCA in 2011 increased by 62% (adjusted RR, 1.62 [95% CI: 1.44-1.81]) (TABLE). Conclusions: Over the past decade, 1-year survival after IHCA has significantly improved each year.

scholarly journals Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up studyJūratė Šaltytė Benth

Resuscitation ◽  
2021 ◽  
Author(s):  
Henning Wimmer ◽  
Christofer Lundqvist ◽  
Jūratė Šaltytė Benth ◽  
Knut Stavem ◽  
Geir Ø. Andersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Hospital Cardiac Arrest

Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden

Heart ◽  
2010 ◽  
Vol 96 (22) ◽  
pp. 1826-1830 ◽  
Author(s):  
C. Holmgren ◽  
L. Bergfeldt ◽  
N. Edvardsson ◽  
T. Karlsson ◽  
J. Lindqvist ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

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.

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