Factors Associated with Survival from  In-Hospital Cardiac Arrest in the Service Wards  and Intensive Care Units of a Tertiary Hospital

Background. Despite the recent advances in advanced cardiac life support (ACLS), there has been no significant improvement in survival among patients who undergo cardiac arrest. To date, there are no local guidelines on the requirements or standards of in-hospital cardiac arrest teams in the Philippines. In addition, there are still no studies on the outcomes of cardiac arrests among adult patients in a tertiary hospital in the Philippines. Objectives. The objective of this study is to investigate patient-, event-, and hospital-related factors associated with survival among adult patients who underwent in-hospital cardiac arrest in the service wards and intensive care units of a tertiary hospital. Methods. This is a prospective cross-sectional study conducted over three months in 2018. Patient-, event- and hospital-related data were collected from each patient with a cardiac arrest event who was referred to the cardiac arrest teams based on the modified Utstein form of reporting cardiac arrests. Survival to discharge from cardiac arrest was the main outcome. Results. The study included 119 patients, 47.9% male, with a mean age of 50.1 years (SD 16.7). Survival rate was 6.7%. The mean response time did not differ between survival group (1.46 minutes) and mortality group (1.82 minutes) (p value = 0.26). The presence of a shockable initial rhythm (3.6% vs 3/8; p value = 0.01), shorter lag time to initiation of electrical therapy (6.0 vs 9.3 ± 5.6 min; p value = 0.02), shorter time to establishment of an airway (2.75 ± 1.6 vs. 6.98 ± 5.2 min; p value = 0.01), and shorter duration of resuscitation (7 ± 4.6 vs. 13.0 ± 7.9 min; p value = 0.01) were significantly associated with survival. The presence of underlying illnesses is associated with higher mortality. The most common hospital-related problems identified were the need to cover long distances, delay in the call, and the lack of elevators. Conclusion. The survival rate of patients who underwent cardiac arrest and resuscitation by a cardiac arrest team is low. The initial presenting rhythm, lag time to initiation of electrical therapy, time to establishment of airway, duration of resuscitation, as well as the underlying disease can significantly affect survival. Streamlining the resources of the hospital to address these matters can have an impact on survival.

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Factors Associated with Successful Resuscitation after In-Hospital Cardiac Arrest: an prospective observational study performed in a tertiary hospital in south west of China

Resuscitation ◽

10.1016/j.resuscitation.2019.06.059 ◽

2019 ◽

Vol 142 ◽

pp. e22

Author(s):

Yarong He ◽

Peng Yao ◽

Tianyong Han ◽

Qin Li ◽

Yu Cao

Keyword(s):

Cardiac Arrest ◽

Observational Study ◽

Prospective Observational Study ◽

Tertiary Hospital ◽

Successful Resuscitation ◽

Factors Associated ◽

South West ◽

Hospital Cardiac Arrest

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Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽

10.1186/s13054-021-03606-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Sivagowry Rasalingam Mørk ◽

Carsten Stengaard ◽

Louise Linde ◽

Jacob Eifer Møller ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Neurological Outcome ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Good Neurological Outcome ◽

Factors Associated ◽

National Consensus ◽

Hospital Cardiac Arrest

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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Factors associated with shockable versus non-shockable rhythms in patients with in-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2020.11.022 ◽

2021 ◽

Vol 158 ◽

pp. 166-174

Author(s):

Nikola Stankovic ◽

Maria Høybye ◽

Mathias J. Holmberg ◽

Kasper G. Lauridsen ◽

Lars W. Andersen ◽

...

Keyword(s):

Cardiac Arrest ◽

Factors Associated ◽

Hospital Cardiac Arrest

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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Neurological prognostication tools in out‐of‐hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13177 ◽

2018 ◽

Vol 62 (10) ◽

pp. 1412-1420 ◽

Cited By ~ 1

Author(s):

M. Winther‐Jensen ◽

C. Hassager ◽

J. F. Lassen ◽

L. Køber ◽

C. Torp‐Pedersen ◽

...

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Units ◽

Hospital Cardiac Arrest

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Abstract 267: Injuries Associated With Mechanical Chest Compressions in Patients With Out-Of-Hospital Cardiac Arrest: A Comparison of LUCAS 2 and LUCAS 2 Active Decompression

Circulation ◽

10.1161/circ.140.suppl_2.267 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Polina Petrovich ◽

Per-Olav Berve ◽

Gitta Erika Turowski ◽

Arne Stray-Pedersen ◽

Jo Kramer-Johansen ◽

...

Keyword(s):

Cardiac Arrest ◽

Injury Pattern ◽

Rib Fractures ◽

P Value ◽

Injury Patterns ◽

Chest Compressions ◽

Internal Organs ◽

Alpha Level ◽

Hospital Cardiac Arrest ◽

Sternal Fractures

Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopulmonary resuscitation (CPR). Visceral injuries are also reported. During manual chest compressions, incidence of rib fractures is reported to be 13-97% and sternal fractures 1-43%. Studies on active compression decompression (AD) devices report incidence on rib fractures ranging from 4-87% and sternal fractures 0-93%. The aim of the present study is to describe and compare injury patterns caused by two mechanical, piston-based chest compression devices; LUCAS 2 and LUCAS 2AD in patients with out-of-hospital cardiac arrest. Method: In the randomized clinical trial comparing standard LUCAS 2 with LUCAS 2AD, patients who died were eligible for medical or forensic autopsy. The pathologists described injury pattern in each patient focusing on CPR-related injuries, but was blinded for the device used. We used Pearson X 2 test with an alpha level of 0.05 to evaluate our findings. Results: Of the 221 patients included between April 2015 and April 2017, 204 patients died of whom 115 were autopsied, LUCAS 2 n=62 and LUCAS 2 AD n=53. Median age was 63 (range: 19-91) and men represented 70%. CPR related rib fractures occurred in 70%, and sternal fractures in 45% of all patients. When comparing LUCAS 2 to LUCAS 2AD we found no difference in incidence of rib fractures (69% vs. 70%; p-value: 0.9) or in sternal fractures (44% vs. 47%; p-value: 0.7). Most frequent non-skeletal complication was bleeding in pleura (25), pericardium (13), mediastinum (7), abdomen (5), and ventricle (3). Many patients had bleedings reported from more than one location, but the amount of blood was mostly small and considered to not contribute to the cause of death. A total of 10 patients had injuries on internal organs such as lungs (6), liver (2), spleen (1), and diaphragm (1). Conclusion: Comparing LUCAS 2 with LUCAS 2AD we found no difference in rib- or sternal fractures. CPR related injuries on internal organs were rare. We conclude that LUCAS 2AD do not cause more skeletal or non-skeletal injuries compared to LUCAS 2.

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Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919830896 ◽

2019 ◽

Vol 27 (3) ◽

pp. 155-161 ◽

Cited By ~ 1

Author(s):

Veerapong Vattanavanit ◽

Supattra Uppanisakorn ◽

Thanapon Nilmoje

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

American Heart Association ◽

American Heart ◽

Medical Intensive Care Unit ◽

Heart Association ◽

Temperature Management ◽

Medical Intensive Care ◽

Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

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