Abstract 10276: Impact of Time-to-Compression on Out-of-Hospital Cardiac Arrest Survival Outcomes: A National Registry Study

Introduction: Time To first Compression (TTC) in out-of-hospital cardiac arrests (OHCA) is thought to be an important predictor of survival outcomes. Guidelines such as the Journal of American College of Cardiology Scientific Expert Panel recommend that extracorporeal membrane oxygenation (ECMO) should not be used on OHCA patients with TTC > 10 minutes. However, there is no literature validating this exclusion criterion on OHCA survival and neurological outcomes. This study aimed to evaluate the difference in neurological outcomes and survival to discharge of patients with CPR administered after 10 minutes, compared to within 10 minutes. Methodology: Data of OHCAs from 2012-2017 in Singapore were extracted from our national OHCA registry. We compared patients who received CPR within 10 minutes versus those who received CPR after 10 minutes. Primary outcomes were favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1 and 2), and secondary were survival to hospital discharge or 30-day-survival. Results: There were 12,771 OHCAs analyzed, with 5,704 patients with TTC </=10 minutes and 7,067 with TTC >10 minutes. Fewer patients survived to hospital discharge/30 th day with TTC > 10 minutes (aOR 0.43, 95%CI: 0.32-0.58) and survival with good neurological outcomes was lower (aOR 0.51; 95%CI: 0.41-0.62). Other significant predictors of good neurological outcomes included age (aOR 0.98, 95%CI: 0.98 - 0.99), witnessed arrest (aOR 2.39, 95%CI: 1.69-3.40), bystander AED (aOR 1.55, 95%CI: 1.12-2.26), and presence of shockable rhythm (aOR 8.76, 95%CI: 7.12-10.78). A cut-off of 17.5 minutes (aOR 0.43, 95%CI:0.28-0.65) resulted in <1% (127 out of 12,771) chance of survival with good neurological function based on the medical definition of Futility (specificity 0.84 sensitivity 0.84 ROC 0.91). Conclusion: Our study showed that there is a significant difference in survival and favourable neurological outcomes when TTC was >10 minutes. However, more data-driven cut-off timings/criteria should be considered instead of the arbitrary 10 minutes for eligibility of ECMO therapy.

Abstract 10611: Variation in Out-of-Hospital Cardiac Arrest Survival Across EMS Agencies

Background: Although some studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by neighborhood and geographic region, little is known about variation in OHCA survival at the level of EMS agencies—which, unlike neighborhoods and regions, may have modifiable resuscitation practices. Methods: Within the national Cardiac Arrest Registry to Enhance Survival, we identified 258,320 non-traumatic OHCAs from 764 EMS agencies with ≥10 OHCAs annually between 2015-2019. Using multivariable hierarchical logistic regression, we computed risk-adjusted rates of survival to hospital admission for each EMS agency. We quantified the extent of variation in survival with the median odds ratios (MOR) and assessed the extent to which variation in survival was explained by two EMS agency resuscitation practices: time from 911 call to EMS arrival and the proportion of OHCAs at each EMS agency with termination of resuscitation (TOR) without meeting TOR futility criteria. Results: Of 258,320 persons with OHCA, mean age was 62.2 ± 17.0 years and 36.1% were female. Overall, 85.0% were of presumed cardiac etiology, 82.3% occurred at home, 44.0% were witnessed by a bystander, and ~75% were due to a non-shockable initial rhythm. Across the 764 EMS agencies, the median risk-adjusted rate of survival to hospital admission was 27.4% (IQR, 24.5% - 30.2%). The adjusted MOR was 1.35 (95% CI: 1.32, 1.39), suggesting that the odds of survival to hospital admission after an OHCA varied by 35% in two identical patients in one randomly selected EMS agency vs. another. EMS agencies in the lowest quartile of risk-adjusted survival had a mean EMS response time of 12.0 ± 3.4 minutes, whereas those in the highest quartile had a mean EMS response time of 9.0 ± 2.6 minutes ( P <0.001). The mean proportion of OHCA cases where CPR was terminated in the field without meeting TOR futility criteria was 27.9% ±16.1% in quartile 1 and 18.9% ±11.4% in quartile 4 ( P <0.001). Adjustment for the EMS-level variation in both resuscitation practices attenuated the MOR to 1.30 (95% CI: 1.27, 1.33). Conclusions: Rates of survival to hospital admission for OHCA vary significantly by EMS agency, and some of this variation in survival is explained by differences in EMS arrival time and TOR practice patterns.

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.

Mobile versus fixed automated external defibrillators (AED deployment in a geographically dispersed population: analysis of the girona territori cardioprotegit project

Introduction/Aim Public defibrillation doubles out-of-hospital cardiac arrest survival. However, the best way to provide public defibrillation coverage to geographically dispersed populations remains unknown. The aim of this study is to compare usage rates and effectivity between mobile versus fixed Automated External Defibrillators (AED). Methods This project is a prospective registry of the usage rate of public AED (542 fixed AED, 241 mobile AED) and the analysis of the electrocardiographic traces, from June 2011 until December 2019. We compared the usage rate, the proportion of shockable rhythms and defibrillation success between fixed versus mobile AED. Results Of 566 registered usages, we obtained 494 electrocardiographic traces, of which 108 (21%) were from fixed AED. The usage rate of fixed and mobile AED were 0.022use/AED-year and 0.177use/AED-year respectively. In Fixed AED group we observed a higher proportion of shockable rhythms (34.2% vs. 20.3%, p=0,01) and higher defibrillation success (79% vs. 63%, p=0,02). The proportion of patients with shockable rhythms who were transferred to a hospital were 62.1% and 50% in Fixed AED and Mobile AED group respectively (p=0,306). Conclusions In Fixed AED group we observed more shockable rhythms and higher defibrillation success rates. Mobile AED were 8 times more used. FUNDunding Acknowledgement Type of funding sources: None.

Using Literature Based Discovery to Gain Insights Into the Metabolomic Processes of Cardiac Arrest

In this paper, we describe how we applied LBD techniques to discover lecithin cholesterol acyltransferase (LCAT) as a druggable target for cardiac arrest. We fully describe our process which includes the use of high-throughput metabolomic analysis to identify metabolites significantly related to cardiac arrest, and how we used LBD to gain insights into how these metabolites relate to cardiac arrest. These insights lead to our proposal (for the first time) of LCAT as a druggable target; the effects of which are supported by in vivo studies which were brought forth by this work. Metabolites are the end product of many biochemical pathways within the human body. Observed changes in metabolite levels are indicative of changes in these pathways, and provide valuable insights toward the cause, progression, and treatment of diseases. Following cardiac arrest, we observed changes in metabolite levels pre- and post-resuscitation. We used LBD to help discover diseases implicitly linked via these metabolites of interest. Results of LBD indicated a strong link between Fish Eye disease and cardiac arrest. Since fish eye disease is characterized by an LCAT deficiency, it began an investigation into the effects of LCAT and cardiac arrest survival. In the investigation, we found that decreased LCAT activity may increase cardiac arrest survival rates by increasing ω-3 polyunsaturated fatty acid availability in circulation. We verified the effects of ω-3 polyunsaturated fatty acids on increasing survival rate following cardiac arrest via in vivo with rat models.

Cardiac Arrest Survival Post-Electrocution – Management in a Low-Resource Emergency Department in Ghana: A Case Series

Introduction The potential dangers of electrical injuries continue to increase since the commercial availability of electricity. Degrees of electrical injuries range from minor burns to cardiac arrest. Electrocution is cardiac arrest resulting from an electric shock. In Ghana, many electrocution cases are declared dead with little or no resuscitative measures. With the establishment of the emergency department (ED) at Komfo Anokye Teaching Hospital (KATH), such cases within the catchment area are being managed. We sought to describe the management of three (3) cases of electrocution admitted which were resuscitated at the KATH ED. Case Series We present three retrospective cases of electrocution involving two adults and one child presenting to the ED of KATH. None of them had any form of cardiopulmonary resuscitation (CPR) at the scene, or en route to the hospital, however, all cases received resuscitative measures of CPR, defibrillation, intubation and other supportive management, and were successfully discharged home in a few days with no major complications. Discussion Electrical injuries do occur; however, continuous education and caution should be taken especially whilst using electricity and electrical appliances. Workers with high exposure to electricity should emphasize maximum safety precautions and use of appropriate protective equipment. Home appliances should be well hidden and insulated to protect children. Early recognition of cardiac arrest, immediate initiation of CPR, availability of defibrillators improves outcomes in cardiac arrest post-electrocution.