scholarly journals Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (16) ◽  
pp. 8389
Author(s):  
Heekyung Lee ◽  
Hyungoo Shin ◽  
Jaehoon Oh ◽  
Tae Ho Lim ◽  
Bo-Seung Kang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Spontaneous Circulation ◽  
Normal Weight ◽  
Risk Of Bias ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Underweight Patients ◽  
Hospital Cardiac Arrest

Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07–1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14–1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12–1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.

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.

Abstract 346: Targeted Temperature Management is Associated with Improved Neurological Outcomes in Witnessed Out-of-hospital Cardiac Arrest Patients Who Achieve Early Return of Spontaneous Circulation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nobuyuki Enzan ◽  
Ken-ichi Hiasa ◽  
Kenzo Ichimura ◽  
Masaaki Nishihara ◽  
Takeshi Iyonaga ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Odds Ratio ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Propensity Score Matching Analysis ◽  
Hospital Cardiac Arrest

Background: Previous randomized controlled trials demonstrated the efficacy of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) patients with both shockable and non-shockable rhythm. Real-world evidence for TTM using large OHCA database are scarce, and no study has investigated the relationship between TTM and time-to-return of spontaneous circulation (ROSC). Methods: The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients with witnessed non-traumatic OHCA who had been resuscitated and were in a coma were included. Eligible patients were divided into two groups according to the use of TTM. The primary outcome was defined as a Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The propensity score matching analysis was used. The cubic spline analysis of the odds ratio of CPC 1-2 for TTM use by time-to-ROSC was performed. Results: Out of 34,754 patients with OHCA, 5,261 patients were included. The mean age was 70.3 years, and 3,417 (65.0%) were male. CPC 1-2 was more frequently observed in the TTM group in propensity score matching analysis (15.1% vs. 8.5%; odds ratio 1.92; 95% confidence interval 1.04-3.53; P=0.037). The cubic spline analysis showed that TTM was associated with CPC 1-2 in witnessed OHCA patients, which did not reach statistical significance in patients with time-to-ROSC longer than 50 min. Conclusions: TTM was associated with better neurological outcomes in witnessed OHCA patients, especially when patients were resuscitated within 50 min after collapse.

P1700Atrial fibrillation with CRBBB highly predict hospital mortality in the AMI patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y.-H Liu ◽  
Y.-C Wu ◽  
J.-L Lin
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrest ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Spontaneous Circulation ◽  
Bundle Branch Block ◽  
Return Of Spontaneous Circulation ◽  
Qrs Duration ◽  
Hospital Cardiac Arrest

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. The use of ECG to predict mortality and neurological outcomes in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA has not been well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was mortality in hospital. The hospital mortality rate was 44.4%. Wide QRS duration (>120ms; 48.1%), complete right bundle branch block (33.3%) and atrial fibrillation (59.3%) occurred frequently in the first ECG of post-rescuscitation patients. Patient with wide QRS duration (correlation coefficient, CC: 0.350; p=0.074) and atrial fibrillation (CC: 0.287; p=0.147) had a trend towards higher mortality rate. Complete right bundle branch block (CRBBB) on the first ECG post resuscitation (CC: 0.632; p<0.001) and ST depression on first ECG post resuscitation (CC: 0.481; p=0.011) were associated with worse outcome (Mortality). Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (CC: −0.635; p<0.001), and sinus rhythm on first ECG (CC: −0.474; p=0.012) were associated better outcome (survival and neurological recovery). The combination two ECG characteristics of atrial fibrillation and CRBBB on the first ECG post resuscitation was highly associated with in-hospital mortality (CC: 0.725; p<0.001). It had a 66.7% sensitivity, 93.3% specificity, 88.9% positive predictive value, and 78.9% negative predictive value for predicting mortality. In conclusion, atrial fibrillation with CRBBB on the first ECG post resuscitation is the best predictors for unfavorable neurological outcome and mortality.

scholarly journals Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohammed S. Alshahrani ◽  
Hassan W. Aldandan
Keyword(s):  
Cardiac Arrest ◽  
Sodium Bicarbonate ◽  
Observational Studies ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Current Evidence ◽  
Cochrane Library ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a common cause of death worldwide (Neumar et al., Circulation 122:S729–S767, 2010), affecting about 300,000 persons in the USA on an annual basis; 92% of them die (Roger et al., Circulation 123:e18–e209, 2011). The existing evidence about the use of sodium bicarbonate (SB) for the treatment of cardiac arrest is controversial. We performed this study to summarize the evidence about the use of SB in patients with out-of-hospital cardiac arrest (OHCA). Methods We searched PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library, until June 2019, for randomized controlled trials (RCTs) and observational studies that used SB in patients with OHCA. Outcomes of interest were the rate of survival to discharge, return of spontaneous circulation (ROSC), sustained ROSC, and good neurological outcomes at discharge. Odds ratio (OR) with their 95% confidence interval (CI) were pooled in a random or fixed meta-analysis model. Results A total of 14 studies (four RCTs and 10 observational studies) enrolling 28,412 patients were included; of them, eight studies were included in the meta-analysis. The overall pooled estimate did not favor SB or control in terms of survival rate at discharge (OR= 0.66, 95% CI [0.18, 2.44], p=0.53) and ROSC rate (OR= 1.54, 95% CI [0.38, 6.27], p=0.54), while the pooled estimate of two studies showed that SB was associated with less sustained ROSC (OR= 0.27, 95% CI [0.07, 0.98], p=0.045) and good neurological outcomes at discharge (OR= 0.12, 95% CI [0.09, 0.15], p<0.01). Conclusion The current evidence demonstrated that SB was not superior to the control group in terms of survival to discharge and return of spontaneous circulation. Further, SB was associated with lower rates of sustained ROSC and good neurological outcomes.

Abstract WP477: Neuro-Cognitive Outcomes After Transitioning to Pit Crew Model for Out of Hospital Cardiac Arrest

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Shravani Vindhyal ◽  
Paul Nduna ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Cognitive Outcomes ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: Survival and neurological outcomes from the out of hospital cardiac arrest (OHCA) varies from one region to another depending on the different practices followed by the emergency personnel. Our study looked into neuro-cognitive outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected by the emergency medical services (EMS) before transitioning (from 2010 - 2012) and after transitioning (from 2013-2016) to the pit crew approach. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcomes were the average number of pauses >10 seconds and the cerebral performance post return of spontaneous circulation (ROSC) Results: The average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 56% vs 47% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Conclusion: This focused model of high-quality CPR performance with the individualized assigned task has shown a declining trend in the rates of cerebral disability especially with moderate and severe cerebral performance including the patients in coma or vegetative state. More studies with better neuro-cognitive follow-up care after ROSC is needed to further establish the superiority of pit crew model approach.

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