scholarly journals Cerebellar Haemorrhage Leading to Sudden Cardiac Arrest

2020 ◽  
Vol 6 (1) ◽  
pp. 71-73 ◽  
Author(s):  
Ankit Agrawal ◽  
Maria Cardinale ◽  
Douglas Frenia ◽  
Aveek Mukherjee
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Acute Care Hospital ◽  
Pulseless Electrical Activity ◽  
Cerebrovascular Event ◽  
Care Hospital ◽  
Cerebellar Haemorrhage ◽  
Shockable Rhythm ◽  
Cardiac Stunning ◽  
Hospital Cardiac Arrest

AbstractIntroductionIntracranial haemorrhage (ICH) is a known, but a rare cause of out of hospital cardiac arrest (OHCA). It results in the development of non-shockable rhythms such as asystole or pulseless electrical activity (PEA).Case ReportA 77- years old male had an OHCA without any prodrome. An emergency medical services (EMS) team responded to an emergency call and intubated the patient at the site before transporting him to the Acute Care Hospital, New Brunswick, New Jersey, USA. On admission, a non-contrast computed tomography scan of the head revealed a large cerebellar haemorrhage. Non-traumatic ICH is a rare cause of OHCA. Although subarachnoid haemorrhage causing cardiac arrest has been described in the literature, cerebellar haemorrhage leading to cardiac arrest is rare. The mechanism by which ICH patients develop cardiac arrest is likely explained by a massive catecholamine surge leading to cardiac stunning.ConclusionA non-shockable rhythm in the seting of a sudden cardiac arrest should raise alarms for a primary non-cardiac ethology, especially a primary cerebrovascular event. The absence of brainstem reflexes increases the likelihood of an intracranial process.

scholarly journals In-hospital cardiac arrest resuscitation performed by the hospital emergency team: A 6-year retrospective register analysis at Danderyd University Hospital, Sweden

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1013 ◽  
Author(s):  
Hedwig Widestedt ◽  
Jasna Giesecke ◽  
Pernilla Karlsson ◽  
Jan G. Jakobsson
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Emergency Team ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Cardiac arrest requires rapid and effective handling. Huge efforts have been implemented to improve resuscitation of sudden cardiac arrest patients. Guidelines around the various parts of effective management, the chain of survival, are available. The aim of the present retrospective study was to study sudden in-hospital cardiac arrest (IHCA) and the outcomes of emergence team resuscitation in a university hospital in Sweden. Methods: The Swedish Cardiopulmonary Resuscitation Registry was used to access all reported cases of IHCA at Danderyd Hospital from 2012 through 2017. Return of spontaneous circulation (ROSC), discharge alive, 30-day mortality and Cerebral Performance Scales score (CPC) were analysed. Results: 574 patients with cardiac arrests were included in the study: 307 patients (54%) had ROSC; 195 patients (34%) were alive to be discharged from hospital; and 191 patients (33%) were still alive at day-30 after cardiac arrest. Witnessed cardiac arrests, VT/VF as initial rhythm and experiencing cardiac arrest in high monitored wards were factors associated with success. However, 53% of patients’ alive at day-30 had a none-shockable rhythm, 16% showed initially a pulseless electrical activity and 37% asystole. CPC score was available for 188 out of the 195 patients that were alive to be discharged: 96.5% of patients where data was available had a favourable neurological outcome, a CPC-score of 1 or 2 at discharge, and only 6 of these patients had a CPC-score of 3 or higher (3%). Conclusions: One third of patients with sudden IHCA were discharged from hospital and alive at day-30, a clear majority without cognitive deficit related to the cardiac arrest. High monitored care, witnessed cardiac arrest and shockable rhythm were factors associated with high success; however, more than half of surviving patients had initially a none-shockable rhythm.

Abstract 226: Sex Differences in Cardiac Catheterization Following Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bryn E Mumma ◽  
James F Holmes ◽  
Machelle D Wilson ◽  
Deborah B Diercks
Keyword(s):  
Cardiac Arrest ◽  
Sex Differences ◽  
Cardiac Catheterization ◽  
Health Planning ◽  
Acute Care Hospital ◽  
Coronary Intervention ◽  
Admission Diagnosis ◽  
Care Hospital ◽  
Hospital Data ◽  
Hospital Cardiac Arrest

Introduction: Cardiac catheterization is recommended for patients resuscitated from out-of-hospital cardiac arrest (OHCA) with a suspected cardiac etiology. Women are less likely than men to receive cardiac catheterization in other presentations of cardiovascular disease, but it remains unknown whether this disparity extends to OHCA. Objective: To determine whether patient sex is associated with undergoing cardiac catheterization after OHCA. Methods: We included all adult cases in the 2011 California Office of Statewide Health Planning and Development (OSHPD) database with a present-on-admission diagnosis of cardiac arrest (ICD-9-CM 427.5) or sudden cardiac death (ICD-9-CM 798) who were admitted from the emergency department to an acute care hospital. Data extracted from the OSHPD database included patient demographics, diagnoses, and procedures. ICD-9-CM procedure codes from the OSHPD database were used to identify patients who received cardiac catheterization. To determine factors associated with undergoing cardiac catheterization, we used a hierarchical logistic regression model that included age, sex, race, ethnicity, insurance type, ventricular arrest rhythm, and treatment at a hospital with 24/7 percutaneous coronary intervention capability. Results: We studied 4493 men and 3287 women admitted following OHCA. Women were older (median age 70 vs 64 years; p<0.001), had had fewer ventricular arrest rhythms (21.8% vs 31.7%; p<0.001), and received fewer cardiac catheterization procedures [12.5% vs 21.4%; p<0.0001]. This sex difference in cardiac catheterization persisted in the multivariable hierarchical model (adjusted OR 0.65; 95% CI 0.57-0.76; p<0.0001) and in a subgroup analysis including only patients with ventricular arrest rhythms (adjusted OR 0.63; 95% CI 0.51-0.78; p<0.0001) Conclusion: Sex differences exist in cardiac catheterization following resuscitation from OHCA. Future efforts should focus on understanding and resolving these differences.

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Markus Keferböck ◽  
Philip Datler ◽  
Mario Krammel ◽  
Elisabeth Lobmeyer ◽  
Alexander Nürnberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Sudden Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Medical Personnel ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

scholarly journals Association of beta-blockers and first-registered heart rhythm in out-of-hospital cardiac arrest: real-world data from population-based cohorts across two European countries

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1206-1215
Author(s):  
Carlo A Barcella ◽  
Talip E Eroglu ◽  
Michiel Hulleman ◽  
Asger Granfeldt ◽  
Patrick C Souverein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
The Netherlands ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Pulseless Electrical Activity ◽  
Heart Rhythm ◽  
Real World Data ◽  
Shockable Rhythm ◽  
Receptor Blockers ◽  
Hospital Cardiac Arrest

Abstract Aims Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA. Methods and results We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands. Beta-blocker use was defined as exposure to either non-selective beta-blockers, β1-selective beta-blockers, or α-β-dual-receptor blockers within 90 days prior to OHCA. We calculated odds ratios (ORs) for the association of beta-blockers with first-registered heart rhythm using multivariable logistic regression. We identified 23 834 OHCA-patients in Denmark and 1584 in the Netherlands: 7022 (29.5%) and 519 (32.8%) were treated with beta-blockers, respectively. Use of non-selective beta-blockers, but not β1-selective blockers, was more often associated with non-shockable rhythm than no use of beta-blockers [Denmark: OR 1.93, 95% confidence interval (CI) 1.48–2.52; the Netherlands: OR 2.52, 95% CI 1.15–5.49]. Non-selective beta-blocker use was associated with higher proportion of pulseless electrical activity (PEA) than of shockable rhythm (OR 2.38, 95% CI 1.01–5.65); the association with asystole was of similar magnitude, although not statistically significant compared with shockable rhythm (OR 2.34, 95% CI 0.89–6.18; data on PEA and asystole were only available in the Netherlands). Use of α-β-dual-receptor blockers was significantly associated with non-shockable rhythm in Denmark (OR 1.21; 95% CI 1.03–1.42) and not significantly in the Netherlands (OR 1.37; 95% CI 0.61–3.07). Conclusion Non-selective beta-blockers, but not β1-selective beta-blockers, are associated with non-shockable rhythm in OHCA.

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.

P4167Non-shockable rhythm related sudden cardiac arrest in the community

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sharifzadehgan ◽  
J Rischard ◽  
W Bougouin ◽  
F Dumas ◽  
V Waldmann ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Heart Disease ◽  
Sudden Cardiac Arrest ◽  
Pulseless Electrical Activity ◽  
Structural Heart Disease ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Coronary Syndrome ◽  
Shockable Rhythm ◽  
Initial Rhythm

Abstract Introduction A significant increase in the prevalence of sudden cardiac arrest (SCA) with non-shockable rhythm has been reported, related to asystole and pulseless electrical activity (PEA). Factors associated with non-shockable rhythm and the mode to the return of spontaneous circulation (ROSC) may help for a better understanding. Purpose We aimed to describe the frequency, characteristics and outcome of SCA related to non-shockable versus shockable rhythm in the community. Methods In this prospective ongoing, multicentre population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed. Initial rhythm was obtained from the EMS report and the initial recorded rhythm strip when available. Medical records for each SCA were reviewed by cardiologists to identify underlying aetiology and associated conditions. Results Among the 3,028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 2,904 patients had available information regarding initial rhythm at the time of EMS arrival. Among them, 1,314 patients (45.3%) presented with non-shockable rhythm: 1,109 (38.2%) cases with asystole, 197 (6.8%) with PEA and 8 (0.3%) with high degree atrioventricular block. Cases with non-shockable rhythm were older (60.6 vs. 57.4 years, P<0.001), with greater proportion of females (34.9 vs. 19.2%, P<0.001) and less proportion of family history of coronary artery disease or SCA. Proportion of warning symptoms prior to the SCA was higher among patients with non-shockable rhythm (74.3 vs. 64.9%, P<0.001) but the proportion of chest pain was lower (24.0 vs. 43.3%, P<0.001). Survival rate was much lower in non-shockable rhythm cases (7.2 vs. 42.3%, P<0.001). Among the 1,314 non-shockable cases eventually admitted alive to hospital, 1,022 (77.8%) did not require external defibrillation prior to ROSC, and a majority (91.7%) received adrenaline during resuscitation. In this subgroup, the main identified cardiac cause was acute coronary syndrome (45.3%), followed by chronic CAD (27.1%), structural non-ischemic heart disease (22.4%), and non-structural heart disease (5.2%). Conclusions Initial non-shockable rhythm is encountered in almost half of SCA cases admitted alive; mostly occurs in older patients with higher proportion of females. Over three quarters of these cases did not require external defibrillation prior to ROSC.

Abstract 120: Outcomes of Out-of-Hospital Cardiac Arrest in Children

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Natalie Jayaram ◽  
Bryan McNally ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Temporal Trends ◽  
Pulseless Electrical Activity ◽  
Patient Characteristics ◽  
National Registry ◽  
Older Children ◽  
Shockable Rhythm ◽  
Study Population ◽  
Hospital Cardiac Arrest

Background: As pediatric out-of-hospital cardiac arrest (OHCA) occurs infrequently, little is known about survival outcomes in children. We examined whether OHCA survival in children differed by patients’ age, sex, and race, as well as recent survival trends. Methods: Within the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective U.S. OHCA registry encompassing 64 million residents, we identified patients less than 18 years of age with an OHCA from October, 2005 to December, 2012. We examined whether survival differed by patients’ age (≤1 year, 1-8 years, >8 years), sex, race, and initial cardiac arrest rhythm, using modified Poisson regression, adjusted for patient characteristics. Similarly, we examined trends in survival, with years 2005-7 as the reference. Results: A total of 1,412 patients with an OHCA were identified, of which 67 (4.7%) were infants, 918 (65.0%) were younger children, and 427 (30.2%) older children. Sixty percent of the study population was male and 33.4% were black. The vast majority of arrests involved a non-shockable rhythm, with only 9.2% of patients having a first documented rhythm of ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 103 (7.3%) patients survived to hospital discharge. Of those with non-shockable rhythms (asystole, pulseless electrical activity, and unknown, non-shockable rhythms), 4.4% survived to discharge compared with a survival of 36.2% in those with VT or VF (P<0.001). After adjustment for patient characteristics, children 1-8 years of age were less likely to survive to hospital discharge compared with children >8 years of age (rate ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34, 0.82). In addition, OHCAs due to VT or VF were associated with improved survival (RR 6.67; 95% CI 4.35, 10.23). In contrast, there were no differences in survival by sex or race. Additionally, no temporal trends in survival were observed (p=0.47). Conclusion: In a large, national registry of pediatric OHCA, we found no disparities in survival by patients’ sex, race, or year of arrest, although survival was lower in young children and those with non-shockable cardiac arrest rhythms.

Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Faiza Ahmed ◽  
Lubna Abbasi ◽  
Nida Ghouri ◽  
Muhammad Junaid Patel
Keyword(s):  
Gender Differences ◽  
Cardiac Arrest ◽  
Tertiary Care Hospital ◽  
Small Sample Size ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Cross Sectional ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic. Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period. Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%. Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 How to cite this:Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022;38(2):387-392. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract 144: Good Neurological Survival After Cardiac Arrest with Initial Shockable Rhythm Increased Year by Year but with Unshockable Rhythm Did Not in Japan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroyuki Hanada ◽  
Hiroshi Nonogi ◽  
Ken Nagao
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Population Based ◽  
Performance Category ◽  
Shockable Rhythm ◽  
Rate Of Increase ◽  
New Strategy ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Backgrounds: Early good cardiopulmonary resuscitation (CPR) and early defibrillation are essential for good neurological survival (GNS) in out-of-hospital cardiac arrest (OHCA). Both automated external defibrillator (AED) equipped in public place and CPR educated people in Japan have been increased. We hypothesized that GNS in patients resuscitated from initial shockable rhythm have been increasing in Japan and that GNS from initial unshockable rhythm might not. Methods and Results: From January 2005 through December 2012, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 925,288). We identified 73,751 witnessed cardiogenic cardiac arrest with the age >18 years old and transported to hospitals within 60 minutes from the witness. Among them, 18,436 cases had the initial shockable rhythm of ventricular fibrillation (VF) or pulsless ventricular tachycardia (VT) and 55,315 cases had the initial unshockable rhythm of pulseless electrical activity (PEA) or asystole (Asys). GNS was defined as cerebral performance category scale 1 or 2 one month after the arrest. Results were shown in the figure. Although the rate of increase in number of OHCA with unshockable arrest over the year was greater than that with shockable arrest, GNS ratio was increasing only in OHCA with shockable arrest. Conclusion: Good neurological survival resuscitated from initial arrest rhythm with VF/VT had been increasing year by year, but that with PEA/Asys was very low and not changed these 8 years in Japan. We need new strategy for those OHCA patients with initial unshockable rhythm.

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