Initial Cardiac Rhythm Correlated to Emergency Department Survival

Background This study attempted to correlate the initial cardiac rhythm and survival from prehospital cardiac arrest, as a secondary end-point. Methods Prospective, randomized, double-blinded clinical intervention trial where bicarbonate was administered to 874 prehospital cardiopulmonary arrest patients in prehospital urban, suburban, and rural emergency medical service environments. Results This group's manifested an overall survival rate of 13.9% (110 of 793) of prehospital cardiac arrest patients. The most common presenting arrhythmia was ventricular fibrillation (VF) (45.0%), asystole (ASY) (34.4%), and pulseless electrical activity (PEA) (15.7%). Less commonly found were normal sinus rhythm (NSR) (1.8%), other (1.8%), ventricular tachycardia (VT) (0.6%), and atrioventricular block (AVB) (0.5%) as prearrest rhythms. The best survival was noted in those with a presenting rhythm of AVB (57.1%), VT (33.3%), VF (15.7%), NSR (14.3%), PEA (11.2%), and ASY (11.1%) (p = 0.02). However, there was no correlation between the final cardiac rhythm and outcome, other than an obvious end-of-life rhythm. Conclusion The most common presenting arrhythmia was VF (45%), while survival is greatest in those presenting with AVB (57.1%).

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Abstract 13743: A Tale of Syncope, Prolonged QT and ICD

Circulation ◽

10.1161/circ.142.suppl_3.13743 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Isma N Javed ◽

Nazir AHMAD ◽

Deborah J Lockwood ◽

Karen J J Beckman ◽

Stavros Stavrakis

Keyword(s):

Cardiac Arrest ◽

Family History ◽

Normal Sinus Rhythm ◽

Beta Blockers ◽

Strenuous Exercise ◽

Caucasian Woman ◽

Icd Implantation ◽

Her Family ◽

Normal Sinus ◽

The 1960S

Introduction: Long QT syndrome (LQTS) was first described in the 1960s. It manifests clinically as syncope, cardiac arrest or sudden cardiac death. LQTS can be caused by 15 different genes. These mutations lead to action potential prolongation by causing impaired repolarizing currents. Case Discussion: A 29-year-old previously healthy Caucasian woman was admitted after recurrent episodes of syncope that happened within 1-month prior to the presentation. She was hemodynamically stable with normal vitals. Her ECG showed normal sinus rhythm with corrected QT (QTc) of 598ms. In the ED, she suffered an episode of sustained monomorphic ventricular tachycardia (VT) and underwent cardioversion. She was started on amiodarone infusion. Serial ECGs showed prolonged QTc. She had another episode of pulseless VT that terminated without defibrillation. She was transferred to our facility for further care. Her family history was significant for paternal aunt who had died unexpectedly at the age of 39. All her lab work including electrolytes, thyroid panel, cardiac enzymes, inflammatory markers and extended drug screen was unrevealing. Transthoracic echocardiogram showed normal biventricular size and function. Decision making: She was started on propranolol for possible LQTS. Cardiac MR did not show any evidence of structural abnormalities. Genetic panel was sent. Since myocarditis or familial LQTS could not be ruled out, we proceeded with implantable cardioverter defibrillator (ICD) implantation for secondary prevention. She was discharged home on nadolol. Conclusion: In the absence of genetic information, LQTS can be diagnosed in symptomatic patients with QTc >480msec on serial ECGs after excluding secondary causes. Schwartz score comprising of ECG findings, symptoms, clinical & family history is diagnostic when greater than 3.5. Beta-blockers are indicated in all patients with a clinical diagnosis. Patients must avoid any QT prolonging agents and strenuous exercise. An ICD is indicated in patients who suffered cardiac arrest. ICD may also be considered for primary prevention in high risk patients.

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Case File: Cardiac amyloidosis using on routine hand-held ultrasound

POCUS Journal ◽

10.24908/pocus.v1i1.13217 ◽

2016 ◽

Vol 1 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Jeffrey Wilkinson, MD

Keyword(s):

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Sinus Rhythm ◽

General Hospital ◽

Cardiac Amyloidosis ◽

Normal Sinus Rhythm ◽

Case File ◽

Normal Sinus ◽

Kingston General Hospital

A 64 year-old man presented to the Kingston General Hospital with cardiac arrest. At the time of EMS arrival, the ECG showed ventricular tachycardia. The patient was intubated and ventilated. Multiple defibrillations were required to convert the patient back to normal sinus rhythm.

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Some effects of breath holding and apneic underwater diving on cardiac rhythm in man

Journal of Applied Physiology ◽

10.1152/jappl.1962.17.3.461 ◽

1962 ◽

Vol 17 (3) ◽

pp. 461-466 ◽

Cited By ~ 47

Author(s):

C. Robert Olsen ◽

Darrell D. Fanestil ◽

Per F. Scholander

Keyword(s):

Cardiac Arrhythmias ◽

Cardiac Rhythm ◽

Sinus Tachycardia ◽

Normal Sinus Rhythm ◽

Sinus Bradycardia ◽

Breath Holding ◽

Sinus Arrest ◽

Sinus Arrhythmia ◽

Normal Sinus ◽

Idioventricular Rhythm

Man's bradycardic response to simple breath holding was augmented by submersion in water of 27 C and was not prevented by muscular exercise. Cardiac arrhythmias occurred with 45 of 64 periods of apnea in 16 subjects and were more frequent during the dives than during breath holding. These arrhythmias, with the exception of atrial, nodal, and ventricular premature contractions, were inhibitory in type and included sinus bradycardia and arrhythmia, sinus arrest followed by either nodal escape or ventricular escape, A-V block, A-V nodal rhythm, and idioventricular rhythm. T waves frequently became tall and peaked during both breath holding and dives. Prompt return to normal sinus rhythm was the rule with the first breath after surfacing. Sinus tachycardia, sinus arrhythmia, and atrial, nodal, or ventricular premature contractions were seen during recovery. Submitted on October 9, 1961

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A Case report of hemodynamic instability, cardiac arrest, and acute severe dyspnea subsequent to inhalation of crystal methamphetamine

Pharmaceutical and Biomedical Research ◽

10.18502/pbr.v5i2.1585 ◽

2019 ◽

Cited By ~ 1

Author(s):

Farhad Gholami ◽

Seyed Hamzeh Hosseini ◽

Amirhossein Ahmadi ◽

Maryam Nabati

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Normal Sinus Rhythm ◽

Hemodynamic Instability ◽

Acute Dyspnea ◽

Crystal Methamphetamine ◽

Electrical Shock ◽

Mechanically Ventilated ◽

Normal Sinus ◽

History Of

Misuse of stimulants similar to amphetamine is a universal problem. These stimulants cause many complications in their abusers. However, myocardial infarction is rarely reported as a complication of amphetamine abuse. Herein, we report a man aged 42 years presented at the Emergency Department with the chief complaint of acute dyspnea following ice inhalation without history of dyspnea. Within the first hour and a half of admission, the patient was treated by nasal oxygen and bronchodilator aminophylline. However, he did not respond to the initial treatment and lost his consciousness; showed ventricular fibrillation, cardiac arrest, and hemodynamic instability. So, cardiopulmonary resuscitation was immediately initiated for him. The patient was intubated, mechanically ventilated. Also, the synchronized electrical shock was delivered 5 times (200-360 J) along with amiodarone (300 mg intravenously [IV] stat, then 1 mg/min IV infusion for 6 hours and next 0.5 mg/min for 18 hours) to treat the ventricular fibrillation. The arrhythmia was subsequently controlled, and his normal sinus rhythm was resumed. Two hours later, condition of the patient improved, and he was extubated. After two days, when the patient got stable, the echocardiography was performed, which was completely normal.

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Metoclopramide-induced cardiac arrest

Clinics and Practice ◽

10.4081/cp.2011.e83 ◽

2011 ◽

Vol 1 (4) ◽

pp. 83 ◽

Cited By ~ 6

Author(s):

Martha M. Rumore ◽

Spencer Evan Lee ◽

Steven Wang ◽

Brenna Farmer

Keyword(s):

Cardiac Arrest ◽

Myocardial Injury ◽

Normal Sinus Rhythm ◽

Morbidly Obese ◽

St Depression ◽

Normal Sinus ◽

Obese Female ◽

Artery Disease ◽

Electrocardiogram Ecg ◽

Prescribing Information

The authors report a case of cardiac arrest in a patient receiving intravenous (IV) metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV) injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG) revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT) associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs) related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s) underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and reporting of bradydysrrhythmias and cardiac arrest in patients receiving metoclopramide.

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Abstract 254: High Shock Efficacy and Algorithm Performance for a 150J Biphasic Waveform AED Used by Lay and BLS Responders During Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.254 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Stacy Gehman ◽

Edward Kompare ◽

Barbara Fink ◽

Tim Johnson ◽

Walter Hufford ◽

...

Keyword(s):

Cardiac Arrest ◽

Normal Sinus Rhythm ◽

Convenience Sample ◽

Shock Delivery ◽

Shockable Rhythm ◽

Normal Sinus ◽

High Shock ◽

Biphasic Waveform ◽

Post Shock ◽

Hospital Cardiac Arrest

Introduction: Effective AED defibrillation of out of hospital cardiac arrest (OHCA) depends on the safe and effective identification of shockable rhythms, and on delivery of effective defibrillation energy. This report summarizes rhythm detection performance and shock efficacy during OHCA uses of Philips HeartStart Home and OnSite AEDs using non-escalating 150 J therapy. Methods: A convenience sample of 185 OHCA AED patient uses were reviewed by clinical experts. All analysis periods that resulted in AED rhythm advisories (Shock Advised or No Shock Advised) were annotated. Shockable rhythm categories include VF and polymorphic VT/flutter. Non-Shockable rhythm categories include normal sinus rhythm, other rhythms (e.g., atrial fibrillation/flutter, bradycardia, SVT, idioventricular, bundle branch block), and asystole. Intermediate rhythms (benefits of defibrillation are limited or uncertain) were not included. Post-shock rhythm was categorized as shockable, non-shockable, or undeterminable (rhythms corrupted by CPR artifact or pads removal within 5-s of shock delivery). Shock success was defined as conversion to a non-shockable rhythm within 5-s post-shock. Results: A total of 487 analysis periods resulted in AED rhythm advisories, with 175 annotated as Shockable and 312 Non-shockable. Sensitivity and specificity (n/N, Exact 95% CI) were 97.7% (171/175, 94.3%, 99.4%) and 100% (312/312, 98.8%, 100.0%) respectively. A total of 165 shocks were delivered to 100 patients with 5 undeterminable post-shock rhythms. The remaining 160 shocks were delivered to 156 Shockable rhythm episodes. All shock efficacy was 96.9% (155/160, 92.9%, 99.0%): 150 episodes converted to non-shockable rhythms after one shock (96.2% (150/156, 91.8%, 98.6%)); 154 after two shocks (98.7% (154/156, 95.4%, 99.8%)); and 155 after three shocks, the first two of which were undeterminable (99.4% (155/156, 96.5%, 100.0%)). The remaining episode had a failed first shock, followed by an undeterminable second shock, which was the last shock of the use. Conclusion: For these 150J fixed-energy AEDs, OHCA defibrillation is safe (100% specificity), and effective (97.7% sensitivity; 96.2% single shock effectiveness; 98.7% after two shocks; 99.4% after three shocks).

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P003: Which factors predict resuscitation outcomes in patients arriving to the emergency department in cardiac arrest? A SHoC series study

CJEM ◽

10.1017/cem.2018.201 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S57-S58

Author(s):

P. Atkinson ◽

N. Beckett ◽

D. Lewis ◽

J. Fraser ◽

A. Banerjee ◽

...

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Electrical Activity ◽

Odds Ratio ◽

Cardiac Rhythm ◽

Point Of Care ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Point Of Care Ultrasound ◽

Successful Resuscitation

Introduction: The decision as to whether to end resuscitation for pre-hospital cardiac arrest (CA) patients in the field or in the emergency department (ED) is commonly made based upon standard criteria. We studied the reliability of several easily determined criteria as predictors of resuscitation outcomes in a population of adults in CA transported to the ED. Methods: A retrospective database and chart analysis was completed for patients arriving to a tertiary ED in cardiac arrest, between 2010 and 2014. Patients were excluded if aged under 19. Multiple data were abstracted from charts using a standardized form. Regression analysis was used to compare criteria that predicted return of spontaneous circulation (ROSC) and survival to hospital admission (SHA). Results: 264 patients met the study inclusion criteria. Logistic regression was used to identify predictors of ROSC and SHA. The criteria that emerged as significant predictors for ROSC included; longer ED resuscitation time (Odds ratio 1.11 (1.06- 1.18)), witnessed arrest (Odds ratio 9.43 (2.58- 53.0)) and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 3.23 (1.07-9.811)) over Asystole. Receiving point of care ultrasound (PoCUS; Odds ratio 0.22 (0.07-0.69)); and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 4.10 (1.43-11.88)) were the significant predictors for SHA. Longer times for ED resuscitation was close to reaching significance for predicting SHA Conclusion: Our results suggest that both fixed and adaptable factors, including increasing resuscitation time, and PoCUS use in the ED were important independent predictors of successful resuscitation. Several commonly used criteria were unreliable predictors.

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