Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest

Background: This study was conducted to identify the predictive factors for survival and favorable neurological outcome in patients with emergency department cardiac arrest (EDCA). Methods: ED patients who suffered from in-hospital cardiac arrest (IHCA) from July 2014 to June 2019 were enrolled. The electronic medical records were retrieved and data were extracted according to the IHCA Utstein-style guidelines. Results: The cardiac arrest survival post-resuscitation in-hospital (CASPRI) score was associated with survival, and the CASPRI scores were lower in the survival group. Three components of the CASPRI score were associated with favorable neurological survival, and the CASPRI scores were lower in the favorable neurological survival group of patients who were successfully resuscitated. The independent predictors of survival were presence of hypotension/shock, metabolic illnesses, short resuscitation time, receiving coronary angiography, and TTM. Receiving coronary angiography and low CASPRI score independently predicted favorable neurological survival in resuscitated patients. The performance of a low CASPRI score for predicting favorable neurological survival was fair, with an AUROCC of 0.77. Conclusions: The CASPRI score can be used to predict survival and neurological status of patients with EDCA. Post-cardiac arrest care may be beneficial for IHCA, especially in patients with EDCA.

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Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.186 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Pavitra Kotini-Shah ◽

Oksana Pugach ◽

Ruizhe Chen ◽

Marina Del Rios ◽

Kimberly Vellano ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

Sex Differences ◽

Coronary Angiography ◽

Neurological Outcome ◽

The United States ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

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Abstract 207: The Association of Academia With Neurological Outcome Among Out-Of-Cardiac Arrest Patients Who Undergo Extracorporeal Cardio-Pulmonary Resuscitation

Circulation ◽

10.1161/circ.140.suppl_2.207 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Yohei Okada ◽

Takeyuki Kiguchi ◽

Tetsuhisa Kitamura ◽

Takashi Kawamura ◽

Taku Iwami

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Critical Study ◽

Hospital Arrival ◽

Cardio Pulmonary Resuscitation ◽

Poor Neurological Outcome ◽

Favorable Neurological Outcome ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

Background: Our study aim was to identify the association of acidemia with neurological outcome among the out-of-hospital cardiac arrest patients who undergo extracorporeal cardio-pulmonary resuscitation (E-CPR). Method: We analyzed the data from multi-institutional prospective cohort study (CRITICAL study: Comprehensive Registry of Intensive Cares for out-of-hospital cardiac arrest Survival) including 14 emergency departments in Osaka, Japan. We included adult out-of-hospital cardiac arrest patients aged ≥18 years who undergo E-CPR. The exposure of interest was serum pH measured before start to E-CPR on admission, and it was divided to tertiles. The primary outcome was 30-days favorable neurological outcome defined as cerebral performance category 1 or 2. We calculated the adjusted odds ratio (OR) with 95% confidence intervals (CI) using logistic regression model, adjusted by age, sex, witness of collapse, by-stander CPR, cardiac rhythm on hospital arrival, and time to hospital arrival. Results: Among 9,822 patients in Critical study database, 303 patients were included in the analysis. The median (interquartile range) of the age was 62 (48-71) years-old. The range of serum pH in each tertile was as below; Tertile 1[ pH≥7.02, (n=101)], Tertile 2 [pH 6.87-7.02, (n=100)], Tertile 3 [pH <6.87, (n=102)]. The adjusted OR with 95%CI of tertile2, and 3 for favorable neurological outcome were 0.23 (0.09 to 0.58), and 0.18 (0.06 to 0.52) referred to Tertile 1, respectively. Conclusion: Among the out-of-hospital cardiac arrest patients who undergo E-CPR, severe acidemia (pH < 7.02) on arrival was associated with 30-days poor neurological outcome. Serum pH measurement might be useful to consider the indication of E-CPR.

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Evaluation of prognostic prediction models for out-of-hospital cardiac arrest

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920966912 ◽

2020 ◽

pp. 102490792096691

Author(s):

Yat Hei Lo ◽

Yuet Chung Axel Siu

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Prediction Models ◽

Model Development ◽

Spontaneous Circulation ◽

Emergency Team ◽

Survival Score ◽

Prognostic Prediction ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

Introduction: Accurate prognostic prediction of out-of-hospital cardiac arrest is challenging but important for the emergency team and patient’s family members. A number of prognostic prediction models specifically designed for out-of-hospital cardiac arrest are developed and validated worldwide. Objective: This narrative review provides an overview of the prognostic prediction models out-of-hospital cardiac arrest patients for use in the emergency department. Discussion: Out-of-hospital cardiac arrest prognostic prediction models are potentially useful in clinical, administrative and research settings. Development and validation of such models require prehospital and hospital predictor and outcome variables which are best in the standardised Utstein Style. Logistic regression analysis is traditionally employed for model development but machine learning is emerging as the new tool. Examples of such models available for use in the emergency department include ROSC After Cardiac Arrest, CaRdiac Arrest Survival Score, Utstein-Based Return of Spontaneous Circulation, Out-of-Hospital Cardiac Arrest, Cardiac Arrest Hospital Prognosis and Cardiac Arrest Survival Score. The usefulness of these models awaits future studies.

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The Importance of the Time that Elapses Before Spontaneous Circulation is Established Following an Out-of-Hospital Cardiac Arrest

Open Medicine Journal ◽

10.2174/1874220301805010033 ◽

2018 ◽

Vol 5 (1) ◽

pp. 33-38

Author(s):

Atsushi Sakurai ◽

Kosaku Kinoshita ◽

Akira Utagawa ◽

Junko Yamaguchi ◽

Makoto Furukawa ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

Emergency Call ◽

Elapsed Time ◽

Outcome Group ◽

Favorable Neurological Outcome ◽

Utstein Style ◽

Hospital Cardiac Arrest

Objective: In order to clarify indications for therapeutic hypothermia, we retrospectively examined patients resuscitated after Out-of-Hospital Cardiac Arrest (OHCA) who recorded an Auditory Brainstem Response (ABR) wave V according to the Utstein-style guidelines. Methods: Patients who recorded an ABR wave V immediately after resuscitation from OHCA were kept at 34 °C for 48 hours. The cohort was divided into two groups: A favorable neurological outcome group (F group: N=12) and an unfavorable neurological outcome group (U group: N=14). Favorable neurological outcome was defined as Pittsburgh Cerebral-Performance Scale (CPC) 1 or 2 and unfavorable as CPC 3-5. Data used to compare the groups included whether CA was witnessed, if a bystander initiated cardiopulmonary resuscitation, presence of cardiac etiology, initial cardiac rhythm and elapsed time from emergency call receipt until Return of Spontaneous Circulation (ROSC). Results: Elapsed time from receipt of the emergency call until ROSC was significantly shorter in the F group than in the U group. ROC curve analysis indicated that the cut-off duration was 28 minutes for a favorable neurological outcome. Conclusion: For OHCA patients with an ABR wave V, elapsed time from receipt of emergency call until ROSC may be an important parameter within the Utstein-style guidelines to determine the usefulness of therapeutic hypothermia.

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The Utstein style reporting in cardiac arrest for resuscitated patients in the emergency department between January 2001 and June 2005

Resuscitation ◽

10.1016/j.resuscitation.2006.06.065 ◽

2006 ◽

Vol 70 (2) ◽

pp. 307-308

Author(s):

Valentin Georgescu ◽

A. Manoleli ◽

I. Dimitriu ◽

L. Dinu ◽

V. Strambu

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Resuscitated Patients ◽

Utstein Style

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Abstract 25: Early Coronary Angiography and Survival After Out-Of-Hospital Cardiac Arrest

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.25 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Ankur Vyas ◽

Paul Chan ◽

Bryan McNally ◽

Saket Girotra

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Propensity Score Analysis ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

C Statistic ◽

Using Data ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are common rhythms seen in out-of-hospital cardiac arrest (OHCA). Although acute myocardial infarction is a frequent cause of VF and pulseless VT, it is unknown whether a strategy of early coronary angiography is associated with improved survival in patients with OHCA. Methods: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 1810 adult patients who had an OHCA due to VF, pulseless VT, or an unknown but shockable rhythm and were successfully resuscitated and admitted to a hospital. Using a matched propensity score analysis, we examined the association between a strategy of early coronary angiography within the first day of cardiac arrest and survival to discharge. Results: Early coronary angiography was performed in 874 (48.3%) patients, of whom 523 (59.8%) received coronary stents. Compared to those without early angiography, patients undergoing early coronary angiography were younger (59.9 vs. 62.5 years); more likely to be men (77.9% vs. 64.5%), have a witnessed arrest (86.3% vs. 76.7%), have a diagnosis of ST-elevation myocardial infarction (STEMI) (68.5% vs. 20.3%); and less likely to have known cardiovascular disease (37.3% vs. 54.3%), diabetes (15.4% vs. 26.6%), and renal disease (3.7% vs. 8.3%) (P <0.01 for all comparisons). A total of 565 patients without early angiography were successfully matched to 565 patients with early coronary angiography (c-statistic of 0.77). A strategy of early coronary angiography was associated with higher rates of in-hospital survival (adjusted OR: 1.22, [1.02- 1.45], P=0.025). There were no differences in favorable neurological outcome between the two groups (adjusted OR: 1.10, [0.98-1.23], P=0.12). Conclusion: Among patients with an OHCA due to VF or pulseless VT who were successfully resuscitated and admitted to a hospital, a strategy of early coronary angiography was associated with better survival, which was not compromised by worse neurological outcomes. Given that many patients with an OHCA due to VF or pulseless VT do not currently undergo early coronary angiography, randomized trials are needed to confirm whether a strategy of early coronary angiography can improve outcomes in patients with OHCA.

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Predictive Model of Good Clinical Outcomes in Patients Undergoing Coronary Angiography after Out-of-Hospital Cardiac Arrest: A Prospective, Multicenter Observational Study Conducted by the Korean Cardiac Arrest Research Consortium

Journal of Clinical Medicine ◽

10.3390/jcm10163695 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3695

Author(s):

Jin Beom ◽

Incheol Park ◽

Je You ◽

Yun Roh ◽

Min Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Observational Study ◽

External Validation ◽

Patient Age ◽

Multicenter Observational Study ◽

Neurologic Outcomes ◽

Patient Âgé ◽

Resuscitated Patients ◽

Hospital Cardiac Arrest

This observational study aimed to develop novel nomograms that predict the benefits of coronary angiography (CAG) after resuscitating patients with out-of-hospital cardiac arrest (OHCA) regardless of the electrocardiography findings and to perform an external validation of these models. Data were extracted from a prospective, multicenter registry of resuscitated patients with OHCA (October 2015–June 2018). New nomograms were developed based on variables associated with survival discharge and neurologic outcomes; their analysis included 723 and 709 patients, respectively. Patient age (p < 0.001), prehospital defibrillation by emergency medical technicians (EMTs) (p = 0.003), prehospital return of spontaneous circulation (ROSC) (p = 0.02), and time from collapse to ROSC (p < 0.001) were associated with survival discharge. Patient age (p < 0.001), prehospital defibrillation by EMTs (p < 0.001), and time from collapse to ROSC (p < 0.001) were associated with neurologic outcomes. The new nomogram had a good predictive performance, with an area under the curve (AUC) of 0.8832 (95% confidence interval (CI): 0.8358–0.9305) for survival discharge and an AUC of 0.9048 (95% CI: 0.8627–0.9469) for neurologic outcomes. Novel nomograms that predict survival discharge and good neurological outcomes after CAG in patients with OHCA were developed and validated; they can be quickly and easily applied to identify patients who will benefit from CAG.

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Admission biomarkers among patients with acute myocardial-infarction related cardiogenic shock with or without out-of-hospital cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.090 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Thoegersen ◽

M Frydland ◽

O Helgestad ◽

LO Jensen ◽

J Josiassen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Cardiogenic Shock ◽

Plasma Concentrations ◽

Endothelial Damage ◽

Soluble Thrombomodulin ◽

Catheterization Laboratory ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Lundbeck Foundation OnBehalf Critical Cardiac Care Research Group Background Approximately half of all patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) present with out-of-hospital cardiac arrest (OHCA). Cardiogenic shock due to OHCA is caused by abrupt cessation of circulation, whereas AMICS without OHCA is due to cardiac failure with low cardiac output. Thus, there may also be differences between the two conditions in terms of blood borne biomarkers. Purpose To explore the potential differences in the admission plasma concentrations of biomarkers reflecting tissue perfusion (lactate), neuroendocrine response (mid-regional proadrenomedullin [MRproADM], Copeptin, pro-atrial natriuretic peptide [proANP]), endothelial damage (Syndecan-1, soluble thrombomodulin [sTM]), inflammation (soluble suppression of tumorigenicity 2 [sST2]) and kidney injury (neutrophil gelatinase-associated lipocalin [NGAL]), in patients with AMICS presenting with or without OHCA. Method Consecutive patients admitted for acute coronary angiography due to suspected ST-elevation myocardial infarction (STEMI) were enrolled during a 1-year period. A total of 2,713 patients were screened. In the present study 86 patients with confirmed STEMI and CS at admission were included. Results Patients with OHCA (had significantly higher median admission concentrations of Lactate (6,9 mmol/L vs. 3.4 mmol/L p <0.001), NGAL (220 ng/ml vs 150 ng/ml p = 0.046), sTM (10 ng/ml vs. 8.0 ng/ml p = 0.026) and Syndecan-1 (160 ng/ml vs. 120 ng/ml p= 0.015) and significantly lower concentrations of MR-proADM (0.85 nmol/L vs. 1.6 nmol/L p <0.001) and sST2 (39 ng/ml vs. 62 ng/ml p < 0.001). After adjusting for age, sex, and time from symptom onset to coronary angiography, lactate (p = 0.008), NGAL (p = 0.03) and sTM (p = 0.011) were still significantly higher in patients presenting with OHCA while sST2 was still significantly lower (p = 0.029). There was very little difference in 30-day mortality between the OHCA and non-OHCA groups (OHCA 37% vs. non-OHCA 38%). Conclusion Patients with STEMI and CS at admission with or without concomitant OHCA had similar 30-day mortality but differed in terms of Lactate, NGAL, sTM and sST2 levels at the time of admission to catheterization laboratory. These findings propose that non-OHCA and OHCA patients with CS could be considered as two individual clinical entities. Abstract Figure. Level of biomarkers OHCA vs. non-OHCA

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