Prognostic factors for adults with cardiac arrest in the emergency department: a retrospective cohort study

Cardiac arrest in the emergency department is associated with the following three scenarios: out-of-hospital cardiac arrest, primary emergency department cardiac arrest (EDCA), and patients transferred from other hospitals after the return of spontaneous circulation from cardiac arrest. Among them, the primary cardiac arrest episode in the emergency department has been less studied. This aim of this study was to explore patient characteristics and the relationship between causes of EDCA and survival outcomes according to different patient management strategies. The main finding of this study was that EDCA with Cardiogenic etiology was associated with higher survival to discharge (OR: 2.31; 95% CI: 1.59–3.91) and discharged neurological outcome (OR: 2.84; 95% CI: 1.57–5.97). More favorable discharged neurological outcome were also found in EDCA patients with initial shockable rhythm (OR: 4.83; 95% CI: 2.33–10.01) and shorter resuscitation time (≤11.5 min, OR: 3.62; 95% CI: 1.57–8.32). EDCA patients under sedative medication (OR: 0.24; 95% CI: 0.10–0.59) and ventilator support by intubation before EDCA episode (OR: 0.26; 95% CI: 0.09–0.75) had poor neurological outcome. We conclude that EDCA patients with cardiogenic etiology have more favorable survival to discharge and discharged neurological outcomes. Prolonged CPR time during EDCA, post-intubation status and sedative medication use were prognostic factors of negative survival and neurological outcomes.

P6381Cardiac arrest patients presenting to hospitals at weekends are not subject to the weekend effect: insights from ACALM big data, United Kingdom

Introduction Patients presenting to hospital with a cardiac arrest are associated with significant mortality in the United Kingdom. The evidence for the weekend affect involving cardiac arrests is unclear and we investigated this further with ACALM big data. Methods Anonymous information on patients presenting to hospital with a cardiac arrest was obtained from several hospitals in UK between 2000–2014. ICD-10 and OPCS-4 codes were used to trace patients coded for primary cardiac arrest, co-morbidities and mortality data. Results Details of 4803 patients presenting with cardiac arrest is shown in Table1. Cox regression model including age, gender, ethnic group, Charlson score and the top ten causes of death in the UK showed that weekend presentation did not contribute to increased mortality (OR 1.01; 95%C.I 0.94–1.11; p=0.692) Table 1. Demographics and co-morbidities of cardiac arrest patients presenting on weekdays and weekends Weekday Weekend N (%) 3892 (81.0) 919 (19.0) Mean age ± S.D (years) 67.7±16.6 67.4±17.5 Male, % 55.4 54.1 Co-morbidities Mean Charlson Index 1.52 1.33 Heart Failure % 21.4 20.4 IHD % 38.4 37.1 Cancer (Lung, Breast or Colon) % 5.2 3.8 Cerebrovascular Disease % 6.4 6.3 COPD % 15.0 12.0 CKD % 9.4 7.7 Dementia % 4.7 2.6 Pneumonia % 14.7 14.4 Outcomes Crude 30 day mortality % 25.4* 32.8* Crude 1 year mortality % 41.0* 44.3* *Cox regression analyses showed no significant differences in mortality between weekend and weekday presentation. Conclusion We have demonstrated that the “weekend effect” is not present in patients admitted to hospital with cardiac arrest. Our findings can perhaps be explained by the presence of 24/7 cardiac arrest teams present in acute hospitals.

Usefulness of telemedicine for home ventilator-dependent children

Introduction Medical care for ventilator-dependent children must avoid hospital confinement, which is detrimental to the patient, their family and Paediatric Intensive Care Unit. Our objective was to assess the role of telemedicine in facilitating early and permanent discharge of such patients to home care. Methods This was a prospective clinical study (2007–2017) in tracheotomised ventilator-dependent children. We used a Big Data Telemedicine home system (Medlinecare 2.1) from the Paediatric Intensive Care Unit. Specialised home-nursing services were available. Clinical events were analysed using the Chi-square test (significance p < 0.05). Families subsequently completed a satisfaction survey. The Paediatric Intensive Care Unit management indicators were analysed. Results All of our ventilator-dependent children were included ( n=12). At time of discharge from the Paediatric Intensive Care Unit, they all required continuous mechanical ventilation and met the criteria of groups I–III of the OTA classification. In the first two years there were 141 events; the main cause was respiratory (69.5%, p < 0.001) and telemedicine was the main care approach (86.5%, p < 0.001). Eleven events required hospitalisation (7.8%) but 38 (27.0%) hospitalisations were avoided. The emergency readmission time accounted for 0.99% of the total time. Six patients were decannulated, and one patient died due to primary cardiac arrest. All the families considered that the telemedicine had helped to avoid hospital visits, was not an intrusion into their privacy, and improved the child’s safety and quality of life. An improvement in Paediatric Intensive Care Unit indicators was achieved. Discussion Telemedicine facilitated early and permanent discharge of our ventilator-dependent children to home care without affecting their quality of care.

Strenuous exercise induces a hyperreactive rebalanced haemostatic state that is more pronounced in men

SummaryPhysical exercise is recommended for a healthy lifestyle. Strenuous exercise, however, may trigger the haemostatic system, increasing the risk of vascular thrombotic events and the incidence of primary cardiac arrest. Our goal was to study the effects of strenuous exercise on risk factors of cardiovascular disease. Blood was collected from 92 healthy volunteers who participated in the amateur version of the protour Amstel Gold cycling race, before and directly after the race. Thrombin generation showed a shortening of the lag time and time to peak and an increase of the velocity index. Interestingly, the endogenous thrombin potential measured in plasma decreased due to reduced prothrombin conversion. Platelet reactivity increased and this effect was stronger in men than in women. Lower fibrinogen and higher D-dimer levels after exercise indicated higher fibrin formation. On the other hand, fibrinolysis was also elevated as indicated by a shortening of the clot lysis time. Exercise activated the endothelium (von Willebrand factor (VWF) and active VWF levels were elevated) and the immune system (concentrations IL-6, IL-8, MCP-1, RANTES and PDGF increased). Additionally, an increased cardiac troponin T level was measured post-exercise. Strenuous exercise induces a temporary hyperreactive state in the body with enhanced proand anticoagulant responses. As strenuous exercise has a more pronounced effect on platelet function in male subjects, this gives a possible explanation for the higher incidence of sudden cardiac death during exercise compared to women. This trial is registered at www.clinicaltrials.gov as NCT02048462.