Epidemiology, management, and survival rate of out-of-hospital cardiac arrest in Upper Silesia, Poland: an Utstein-style report

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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Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style

American Heart Journal ◽

10.1016/j.ahj.2007.02.032 ◽

2007 ◽

Vol 153 (5) ◽

pp. 792-799 ◽

Cited By ~ 33

Author(s):

Heidi L. Estner ◽

Christian Günzel ◽

Gjin Ndrepepa ◽

Frederic William ◽

Dirk Blaumeiser ◽

...

Keyword(s):

Cardiac Arrest ◽

Medical System ◽

Emergency Medical System ◽

Emergency Medical ◽

Utstein Style ◽

Hospital Cardiac Arrest

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Abstract P85: Out-of-hospital Cardiac Arrests With Extracorporeal Cardiopulmonary Resuscitation In Japan: Systematic Literature Review

Circulation ◽

10.1161/circ.118.suppl_18.s_1463-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tetsuya Sakamoto ◽

Yasufumi Asai ◽

Ken Nagao ◽

Yoshio Tahara ◽

Takahiro Atsumi ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Cardiopulmonary Resuscitation ◽

Literature Review ◽

Case Series ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Funnel Plot ◽

Case Series Study ◽

Series Study ◽

Hospital Cardiac Arrest

Background: In Japan, extracorporeal cardiopulmonary resuscitation (ECPR) became popular for cardiac arrest patients who resist conventional advanced life supports. Regardless of many clinical experiences, there has been no previous systematic literature review. Methods: Case series, reports and proceedings of scientific meeting about ECPR for out-of-hospital cardiac arrest written in Japanese between January 1, 1983 and July 31, 2007 were collected with Japana Centra Revuo Medicina (medical publication database in Japan) and review by experts. The outcome and characteristics of the patients were investigated, and the influence of publication bias of the case series study was also examined by the Funnel Plot method. Results: There were 951 out-of-hospital cardiac arrest patients who received ECPR in 92 reports (including 59 case series and 33 case reports) during the period. The average of age was 38.1 (4 – 88) years old and 76.1% was male. Three hundreds and eighty-one cases (40.1%) were arrests of cardiac etiology, and 212 were non-cardiac (22.3%). The cause of arrest was not described in other 37.6%. Excluding reports for only one case, weighted survival rate at discharge of 792 cases those were clearly described the outcome was 39.5±10.0%. When the relationship between the number of cases and the survival rate at discharge in each 59 case series study was shown in figure by the Funnel Plot method, the plotted data presented the reverse-funnel type that centered on the average of survival rate of all. Conclusions: The influence of publication bias of previous reports in Japan was relatively low. ECPR can greatly contribute to improve the outcome of out-of hospital cardiac arrests.

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Nineteen years’ experience of out-of-hospital cardiac arrest in Gothenburg—reported in Utstein style

Resuscitation ◽

10.1016/s0300-9572(03)00115-1 ◽

2003 ◽

Vol 58 (1) ◽

pp. 37-47 ◽

Cited By ~ 30

Author(s):

Martin Fredriksson ◽

Johan Herlitz ◽

J Engdahl

Keyword(s):

Cardiac Arrest ◽

Utstein Style ◽

Hospital Cardiac Arrest

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Utstein-style reporting of out-of-hospital cardiac arrest in the Bielsko-Biała county

Folia Cardiologica ◽

10.5603/fc.2016.0048 ◽

2016 ◽

Vol 11 (4) ◽

pp. 279-283

Author(s):

Dariusz Gach ◽

Jolanta U. Nowak ◽

Łukasz J. Krzych

Keyword(s):

Cardiac Arrest ◽

Utstein Style ◽

Hospital Cardiac Arrest

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Abstract 165: Hospital Variation in Time to Administration of Epinephrine After Cardiac Arrest With Initial Non-shockable Rhythm

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.165 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Rohan Khera ◽

Paul S Chan ◽

Michael W Donnino ◽

Saket Girotra ◽

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Inverse Correlation ◽

Poor Performance ◽

Patient Characteristics ◽

Hospital Performance ◽

Epinephrine Administration ◽

Shockable Rhythm ◽

Hospital Variation ◽

Hospital Cardiac Arrest

Background: For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods: Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (>18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge. Results: Among the 548 hospitals, there was substantial variation in rates of delayed epinephrine administration (median 13.5%, range: 0%- 53.8%). The odds of delay in epinephrine administration were 61% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.61; 95% C.I. 1.54 - 1.67). After adjusting for patient characteristics, the median risk-standardized survival rate for non-shockable in-hospital cardiac arrests was 12.1% and varied significantly across hospitals (range: 5.2% to 30.9%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized survival rate for cardiac arrests due to non-shockable rhythm (ρ= -0.23, P<0.0001). Compared to hospitals in the best quartile, risk-standardized survival was 17.4% lower at hospitals in the worst quartile of delayed epinephrine administration (13.8% vs. 11.4%, P<0.0001, Figure). Conclusions: Although delays in epinephrine administration following in-hospital cardiac arrest are common, there is substantial hospital variation in rates of delayed epinephrine administration. Hospitals with high rates of delayed epinephrine administration were found to have lower rates of risk-adjusted survival. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improvement in outcomes.

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Abstract 252: The Association of Award Recognition From Get With the Guidelines-Resuscitation with Improved Survival Rates in In-Hospital Cardiac Arrest Events

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.252 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Kathie Thomas ◽

Art Miller ◽

Greg Poe

Keyword(s):

Cardiac Arrest ◽

Quality Improvement ◽

Survival Rate ◽

Discharge Rate ◽

Survival Rates ◽

Improvement Program ◽

Award Winning ◽

National Survival ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background and Objectives: It is estimated that over 200,000 adults experience in-hospital cardiac arrest each year. Overall survival to discharge has remained relatively unchanged for decades and survival rates remain at about 20% (Elenbach et al., 2009). Get With The Guidelines-Resuscitation (GWTG-R) is an in-hospital quality improvement program designed to improve adherence to evidence-based care of patients who experience an in-hospital resuscitation event. GWTG-R focuses on four achievement measures. The measures for adult patients include time to first chest compression of less than or equal to one minute, device confirmation of correct endotracheal tube placement, patients with pulseless VF/VT as the initial documented rhythm with a time to first shock of less than or equal to two minutes, and events in which patients were monitored or witnessed at the time of cardiac arrest. The objective of this abstract is to examine the association between hospital adherence to GWTG-R and in-hospital cardiac arrest survival rates. Methods: A retrospective review of adult in-hospital cardiopulmonary arrest (CPA) patients (n=1849) from 21 Michigan, Illinois, and Indiana hospitals using the GWTG-R database was conducted from January 2014 through December 2014. This study included adult CPA patients that did and did not survive to discharge. Results: The review found that hospitals that had attained 84.6% or higher thresholds in all four achievement measures for at least one year, which is award recognition status, had a significantly improved in-hospital CPA survival to discharge rate of 29.6%. Hospitals that did not obtain award status had a CPA survival to discharge rate of 24.3%. The national survival rate for in-hospital adult CPA survival to discharge is 20%. Hospitals that did not achieve award recognition status still demonstrated improvement in survival rate when compared to the national survival rate, indicating the importance of a quality improvement program such as GWTG-R. No significant difference was found between in-hospital adult CPA survival rate and race between GWTG-R award winning and non-award winning hospitals. Hospitals that earned award recognition from GWTG-R had a survival to discharge rate of 30.2% for African Americans and 29.6% for whites. Hospitals that were did not earn award recognition from GWTG-R had a survival to discharge rate of 20.0% for African Americans and 20.1% for whites. Conclusions: Survival of in-hospital adult CPA patients improved significantly when GWTG-R measures are adhered to. Survival of in-hospital adult CPA patients also improves with implementation of GWTG-R. It is crucial that hospitals collect and analyze data regarding resuscitation processes and outcomes. Quality improvement measures can then be implemented in order to assist with improving in-hospital CPA survival rates.

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Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary's Hospital

Resuscitation ◽

10.1016/j.resuscitation.2009.04.007 ◽

2009 ◽

Vol 80 (7) ◽

pp. 778-783 ◽

Cited By ~ 38

Author(s):

Chun Song Youn ◽

Seung Pill Choi ◽

Hyeon Woo Yim ◽

Kyu Nam Park

Keyword(s):

Cardiac Arrest ◽

Years Of Experience ◽

Utstein Style ◽

Hospital Cardiac Arrest

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P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest

EP Europace ◽

10.1093/europace/euaa162.103 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Goto ◽

A Funada ◽

T Maeda ◽

F Okada ◽

Y Goto

Keyword(s):

Cardiac Arrest ◽

Cerebral Performance Category ◽

Flow Duration ◽

Shockable Rhythm ◽

Number Of Patients ◽

Initial Rhythm ◽

The Relationship ◽

Neurologically Intact ◽

Utstein Style ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA. Purpose The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA. Methods We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site. Results The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to <10%, <5%, and <1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to <10%, <5%, and <1%, were 10, 11, and 15 minutes, respectively. Conclusions In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be <17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.

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