scholarly journals Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan

2021 ◽  
Vol 18 (21) ◽  
pp. 11020
Author(s):  
Han-Chun Huang ◽  
Tsung-Yu Lee ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
Yi-Rong Chen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Retrospective Study ◽  
Clinical Outcomes ◽  
Response Times ◽  
Spontaneous Circulation ◽  
Temporal Difference ◽  
Physiological Factors ◽  
Temporal Differences ◽  
Urban City ◽  
Hospital Cardiac Arrest

Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95%CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95%CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

A five-year retrospective study of out-of-hospital cardiac arrest in a north-east Italian urban area

2018 ◽  
Vol 18 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Matteo Danielis ◽  
Martina Chittaro ◽  
Amato De Monte ◽  
Giulio Trillò ◽  
Davide Durì
Keyword(s):  
Cardiac Arrest ◽  
Retrospective Study ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Odds Ratio ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Background: The reporting and analysing of data of out-of-hospital cardiac arrests encourages the quality improvement of the emergency medical services. For this reason, the establishment of a sufficiently large patient database is intended to allow analysis of resuscitation treatments for out-of-hospital cardiac arrests and performances of different emergency medical services. Aims: The aim of this study was to describe the demographics, characteristics, outcomes and determinant factors of survival for patients who suffered an out-of-hospital cardiac arrest. Methods: this was a retrospective study including all out-of-hospital cardiac arrest cases treated by the emergency medical service in the district of Udine (Italy) from 1 January 2010–31 December 2014. Results: A total of 1105 out-of-hospital cardiac arrest patients were attended by the emergency medical service. Of these, 489 (44.2%) underwent cardiopulmonary resuscitation, and return of spontaneous circulation was achieved in 142 patients (29%). There was a male predominance overall, and the main age was 72.6 years (standard deviation 17.9). Cardiopulmonary resuscitation before emergency medical service arrival was performed on 62 cases (44%) in the return of spontaneous circulation group, and on 115 cases (33%) in the no return of spontaneous circulation group ( p<0.024). Among the 142 cases of return of spontaneous circulation, 29 (5.9%) survived to hospital discharge. There was a smaller likelihood of return of spontaneous circulation when patients were female (odds ratio 0.61, 0.40–0.93). Patients who had an out-of-hospital cardiac arrest with an initial shockable rhythm (odds ratio 6.33, 3.86–10.39) or an age <60 years (odds ratio 2.91, 1.86–4.57) had a greater likelihood of return of spontaneous circulation. In addition, bystander cardiopulmonary resuscitation (odds ratio 1.56, 1.04–2.33) was associated with an increased chance of return of spontaneous circulation. Conclusion: The incidence of out-of-hospital cardiac arrest and survival rate lies within the known range. A wider database is necessary to achieve a better knowledge of out-of-hospital cardiac arrest and to drive future investments in the healthcare system.

scholarly journals Effect of the COVID-19 pandemic on cardiac arrest resuscitation practices and outcomes in non-COVID-19 patients

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sau Ki Tong ◽  
Lowell Ling ◽  
Jack Zhenhe Zhang ◽  
Florence H. Y. Yap ◽  
Kam Leung Law ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Retrospective Study ◽  
Cardiopulmonary Resuscitation ◽  
Median Time ◽  
Spontaneous Circulation ◽  
First Responder ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Team

AbstractThe effect of changes to cardiopulmonary resuscitation (CPR) procedures in response to Coronavirus disease 2019 (COVID-19) on in-hospital cardiac arrest (IHCA) management and outcomes are unreported. In this multicenter retrospective study, we showed that median time to arrival of resuscitation team has increased and proportion of patients receiving first-responder CPR has lowered during this pandemic. IHCA during the pandemic was independently associated with lower return of spontaneous circulation OR 0.63 (95% CI 0.43–0.91), despite adjustment for lowered patient comorbidity and increased time to resuscitation team arrival. Changes to resuscitation practice in this pandemic had effects on IHCA outcomes, even in patients without COVID-19.

scholarly journals A SARS-CoV-2-járvány hatása a kórházon kívüli és belüli szívmegállásra

2021 ◽  
Vol 162 (46) ◽  
pp. 1831-1841
Author(s):  
Alexandra Fekete-Győr ◽  
Enikő Kovács ◽  
Boldizsár Kiss ◽  
Endre Zima
Keyword(s):  
Public Health ◽  
Cardiac Arrest ◽  
Response Times ◽  
Healthcare Services ◽  
Spontaneous Circulation ◽  
Published Data ◽  
Health Measures ◽  
New Public Health ◽  
The Impact ◽  
Hospital Cardiac Arrest

Összefoglaló. A koronavírus-betegség (COVID–19) okozta közvetlen mortalitáson túl, a járvány közvetett úton is hatással lehet a hirtelen szívhalálra. Egyre növekvő számú közlemény foglalkozik a járványnak a hirtelen szívhalálra kifejtett közvetett hatásával. A kijárási korlátozások és az egészségügyi rendszerek átszervezése hozzájárulhatott ahhoz, hogy a járvány alatt mind a kórházon kívüli, mind a kórházon belüli szívhalál előfordulása megemelkedett. Közegészségügyi intézkedések, mint a korlátozások és a kórházak átszervezése, megváltoztathatják az egészségügyi szolgáltatásokhoz való hozzáférést, ezért hozzájárulhattak az elmúlt évben tapasztalt emelkedett számú szívmegálláshoz. Közleményünk célja a SARS-CoV-2-járvány hirtelen szívhalálra kifejtett hatására vonatkozó, a nemzetközi irodalomban jelenleg megtalálható tanulmányok összefoglalása, melyek a kórházon kívüli szívmegállás előfordulásának háromszoros emelkedéséről számoltak be a járványt megelőző évhez képest. Általánosságban elmondható, hogy a kórházon kívüli szívmegállás a járvány ideje alatt nagyobb gyakorisággal járt nem sokkolandó ritmussal, hosszabb idő telt el a mentők kiérkezéséig, alacsonyabb volt a szemtanú által megkezdett újraélesztés, a spontán keringés visszatérésének, valamint a kórházi elbocsátásnak a gyakorisága. A járványnak a kórházon belüli szívmegállásra kifejtett hatása kevésbé vizsgált az irodalomban. Míg a hirtelen szívhalált követő mortalitás néhány kutatásban jelentős emelkedést mutatott, addig máshol nem volt különbség a járványt megelőző időszakhoz képest. A COVID–19-pandémia ideje alatt jelentősen megnövekedett kórházon kívüli és belüli szívmegállás hátterében a járványnak közvetett úton is szerepe lehet, a fertőzés közvetlen hatása mellett. A túlélési lánc megbomlását számos helyen tapasztalták, ami hozzájárulhatott a kedvezőtlen kimenetelhez. Mind a prehospitális, mind pedig a hospitális ellátás gyakorlatában bekövetkező jelentős változások magyarázhatják a világ különböző pontjain megfigyelt eltéréseket. Orv Hetil. 2021; 162(46): 1831–1841. Summary. The direct effect of COVID-19 on mortality through acute respiratory failure is well-established. However, there are a growing number of publications suggesting that the prevalence and outcome of sudden cardiac death may also be indirectly affected by the pandemic. Public health measures, such as lockdowns and reorganisation of hospitals, can alter the access to healthcare services and therefore might have contributed to the excess number of cardiac arrests which were seen over the last year. Our aim was to review the currently available publications regarding the impact of the COVID-19 pandemic on out-of-hospital and in-hospital cardiac arrests. A recent study reported a 3-fold growth in the incidence of out-of-hospital cardiac arrests during the 2020 COVID-19 period compared to the year before. In general, the number of non-shockable rhythms increased, bystander-witnessed cases and bystander-initiated cardiopulmonary resuscitation were reduced and ambulance response times were significantly delayed during the pandemic. Return of spontaneous circulation and survival to discharge substantially decreased compared to the time before the pandemic. The difference between the rate of mortality following in-hospital cardiac arrest during and before the pandemic is controversial according to published data. The incidence of out-of-hospital and in-hospital cardiac arrests significantly increased during the pandemic compared to previous years suggesting direct effects of COVID-19 infection and indirect effects from new public health measures. The disruption of the chain of survival could have contributed to the increased mortality following out-of-hospital cardiac arrest. Orv Hetil. 2021; 162(46): 1831–1841.

scholarly journals P115: Outcomes of out of hospital cardiac arrest in First Nations vs. non-First Nations patients in Saskatoon

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S105-S106
Author(s):  
O. Scheirer ◽  
A. Leach ◽  
S. Netherton ◽  
P. Mondal ◽  
T. Hillier ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Arrest ◽  
First Nations ◽  
Hospital Discharge ◽  
Response Times ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
First Nations People ◽  
Hospital Cardiac Arrest

Introduction: One in nine (11.7%) people in Saskatchewan identifies as First Nations. In Canada, First Nations people experience a higher burden of cardiovascular disease when compared to the general population, but it is unknown whether they have different outcomes in out of hospital cardiac arrest (OHCA). Methods: We reviewed pre-hospital and inpatient records of patients sustaining an OHCA between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with OHCA of presumed cardiac origin occurring in the catchment area of Saskatoon's EMS service. Variables of interest included, age, gender, First Nations status (as identified by treaty number), EMS response times, bystander CPR, and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. Results: In all, 372 patients sustained OHCA, of which 27 were identified as First Nations. First Nations patients with OHCA tended to be significantly younger (mean age 46 years vs. 65 years, p &lt; 0.0001) and had shorter EMS response times (median times 5.3 minutes vs. 6.2 minutes, p = 0.01). There were no differences between First Nations and non-First Nations patients in terms of incidence of shockable rhythms (24% vs. 26%, p = 0.80), ROSC (42% vs. 41%, p = 0.87), survival to admission (27% vs 33%, p = 0.53), and survival to hospital discharge (15% vs. 12%, p = 0.54). Conclusion: In Saskatoon, First Nations patients sustaining OHCA appear to have similar survival rates when compared with non-First Nations patients, suggesting similar baseline care. Interestingly, First Nations patients sustaining OHCA were significantly younger than their non-First Nations counterparts. This may reflect a higher burden of cardiovascular disease, suggesting a need improved prevention strategies.

scholarly journals Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 314-321 ◽  
Author(s):  
Jason E. Buick ◽  
Steve Lin ◽  
Valeria E. Rac ◽  
Steven C. Brooks ◽  
Gérald Kierzek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Response Times ◽  
Spontaneous Circulation ◽  
Public Access ◽  
Health Concern ◽  
Bivariate Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

ABSTRACT Introduction: Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology. Methods: A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies. Results: A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge. Conclusions: Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.

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