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Bougouin W, Lascarrou JB, Chelly J, Benghanem S, Geri G, Maizel J, Fage N, Sboui G, Pichon N, Daubin C, Sauneuf B, Mongardon N, Taccone F, Hermann B, Colin G, Lesieur O, Deye N, Chudeau N, Cour M, Bourenne J, Klouche K, Klein T, Raphalen JH, Muller G, Galbois A, Bruel C, Jacquier S, Paul M, Sandroni C, Cariou A. Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: Insights from a prospective multicenter cohort. Resuscitation 2024; 202:110362. [PMID: 39151721 DOI: 10.1016/j.resuscitation.2024.110362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 08/19/2024]
Abstract
AIM To investigate the performance of the 2021 ERC/ESICM-recommended algorithm for predicting poor outcome after cardiac arrest (CA) and potential tools for predicting neurological recovery in patients with indeterminate outcome. METHODS Prospective, multicenter study on out-of-hospital CA survivors from 28 ICUs of the AfterROSC network. In patients comatose with a Glasgow Coma Scale motor score ≤3 at ≥72 h after resuscitation, we measured: (1) the accuracy of neurological examination, biomarkers (neuron-specific enolase, NSE), electrophysiology (EEG and SSEP) and neuroimaging (brain CT and MRI) for predicting poor outcome (modified Rankin scale score ≥4 at 90 days), and (2) the ability of low or decreasing NSE levels and benign EEG to predict good outcome in patients whose prognosis remained indeterminate. RESULTS Among 337 included patients, the ERC-ESICM algorithm predicted poor neurological outcome in 175 patients, and the positive predictive value for an unfavourable outcome was 100% [98-100]%. The specificity of individual predictors ranged from 90% for EEG to 100% for clinical examination and SSEP. Among the remaining 162 patients with indeterminate outcome, a combination of 2 favourable signs predicted good outcome with 99[96-100]% specificity and 23[11-38]% sensitivity. CONCLUSION All comatose resuscitated patients who fulfilled the ERC-ESICM criteria for poor outcome after CA had poor outcome at three months, even if a self-fulfilling prophecy cannot be completely excluded. In patients with indeterminate outcome (half of the population), favourable signs predicted neurological recovery, reducing prognostic uncertainty.
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Affiliation(s)
- Wulfran Bougouin
- AfterROSC Network Group, Paris, France; Université de Paris Cité, Inserm, Paris Cardiovascular Research Center, Paris, France; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France.
| | - Jean-Baptiste Lascarrou
- AfterROSC Network Group, Paris, France; Université de Paris Cité, Inserm, Paris Cardiovascular Research Center, Paris, France; Service de Médecine Intensive Réanimation, University Hospital Center, Nantes, France
| | - Jonathan Chelly
- AfterROSC Network Group, Paris, France; Réanimation Polyvalente, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Toulon, France
| | - Sarah Benghanem
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, APHP, CHU Cochin, Université Paris Cité, Paris, France
| | - Guillaume Geri
- AfterROSC Network Group, Paris, France; Réanimation Polyvalente, Groupe Hospitalier Privé Ambroise Paré Hartmann, Neuilly-sur-Seine, France
| | - Julien Maizel
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CHU Amiens, Amiens, France
| | - Nicolas Fage
- AfterROSC Network Group, Paris, France; Département de médecine intensive réanimation et médecine hyperbare, CHU Angers, Angers, France
| | - Ghada Sboui
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CH Béthune, Béthune, France
| | - Nicolas Pichon
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CH Brive‑La‑Gaillarde, Brive, France
| | - Cédric Daubin
- AfterROSC Network Group, Paris, France; CHU de Caen Normandie, Médecine Intensive Réanimation, 14000 CAEN, France
| | - Bertrand Sauneuf
- AfterROSC Network Group, Paris, France; Réanimation Médecine Intensive, Centre Hospitalier Public du Cotentin, 50100 Cherbourg-en-Cotentin, France
| | - Nicolas Mongardon
- AfterROSC Network Group, Paris, France; Service d'Anesthésie‑Réanimation et Médecine Péri-Opératoire, APHP, CHU Henri Mondor, Créteil, France
| | - Fabio Taccone
- AfterROSC Network Group, Paris, France; Réanimation, ERASME, Brussels, Belgium
| | - Bertrand Hermann
- AfterROSC Network Group, Paris, France; Médecine Intensive-Réanimation, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, France
| | - Gwenhaël Colin
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CHD Vendée, La Roche‑Sur‑Yon, France
| | - Olivier Lesieur
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, APHP, CHU Lariboisière, Paris, France
| | - Nicolas Chudeau
- AfterROSC Network Group, Paris, France; Réanimation médico-chirurgicale, CH Le Mans, Le Mans, France
| | - Martin Cour
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, Hospices Civils Lyon, Lyon, France
| | - Jeremy Bourenne
- AfterROSC Network Group, Paris, France; Réanimation des Urgences et Déchocage, CHU La Timone, APHM, Marseille, France
| | - Kada Klouche
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France
| | - Thomas Klein
- AfterROSC Network Group, Paris, France; Service de Médecine Intensive Réanimation Brabois, CHRU, Nancy, France
| | - Jean-Herlé Raphalen
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, APHP, CHU Necker, Paris, France
| | - Grégoire Muller
- AfterROSC Network Group, Paris, France; Centre Hospitalier Universitaire (CHU) d'Orléans, Médecine Intensive Réanimation, Université de Tours, MR INSERM 1327 ISCHEMIA, F37000 Tours, France; Clinical Research in Intensive Care and Sepsis-Trial Group for Global Evaluation and Research in Sepsis (CRICS_TRIGGERSep) French Clinical Research Infrastructure Network (F-CRIN) Research Network, France
| | - Arnaud Galbois
- AfterROSC Network Group, Paris, France; Service de Réanimation Polyvalente, Ramsay-Santé, Hôpital Privé Claude Galien, Quincy‑Sous‑Sénart, France
| | - Cédric Bruel
- AfterROSC Network Group, Paris, France; Service de Réanimation Polyvalente, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Sophie Jacquier
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CHU Tours, Tours, France
| | - Marine Paul
- AfterROSC Network Group, Paris, France; Médecine Intensive Réanimation, CH Versailles, Le Chesnay, France
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alain Cariou
- AfterROSC Network Group, Paris, France; Université de Paris Cité, Inserm, Paris Cardiovascular Research Center, Paris, France; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
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Ghanbari V, Khatony A, Janatolmakan M, Rezaeian S, Rostamnia L. Emergency care utilization and patients' outcome before and after COVID-19 national lockdown in Iran: a cross-sectional study. BMC Emerg Med 2023; 23:114. [PMID: 37775730 PMCID: PMC10542682 DOI: 10.1186/s12873-023-00887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients' outcome in the emergency department (ED). METHOD Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period. RESULT The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly. CONCLUSION Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.
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Affiliation(s)
- Vahid Ghanbari
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leili Rostamnia
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Stone RM, Kaufman BT, Burns TA, Delbridge TR. COVID-19 Testing Among Out-of-Hospital Cardiac Arrest Patients: Implications for Public Health. PREHOSP EMERG CARE 2023; 28:448-452. [PMID: 37494661 DOI: 10.1080/10903127.2023.2241893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE The objective of this study was to compare COVID-19 test positivity among out-of-hospital cardiac arrest patients whose resuscitative efforts were terminated in the field with the surrounding community. METHODS This was a retrospective cohort study of out-of-hospital cardiac arrest patients for whom unsuccessful resuscitative efforts were terminated in the field. Emergency medical services (EMS) personnel obtained postmortem COVID-19 nasal swab specimens from these patients between July 1, 2020 and February 28, 2022 to facilitate patient contact tracing and awareness of potential occupational exposure. A chi-square (n-1) was used to compare test result proportions between cardiac arrest patients and the community at large. A Pearson correlation was used to correlate test positivity among the two groups. RESULTS EMS personnel obtained postmortem specimens from 648 cardiac arrest patients; 20 (3.1%) were inconclusive. Of the 628 specimens successfully tested, 69 (11.0%) were positive, and 559 (89.0%) were negative. Monthly positivity ranged from 0.0% to 34.0%. For the community at large, overall test positivity during the same period was 5.1%, with a monthly range from 0.4% to 15.2%. Overall, expired and tested cardiac arrest patients had 5.9% (95%CI 3.68 - 8.59) greater COVID-19 test positivity than the general community. There was significant correlation in monthly positivity rates between the groups (r = 0.778, p < .001, 95%CI0.51 - 0.91). CONCLUSIONS Compared to the general population, COVID-19 was over-represented among EMS cardiac arrest patients who died in the field. Postmortem testing by EMS personnel, not typical practice, identified infectious disease cases that would have otherwise gone undetected, indicating potential for future surveillance applications.
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Affiliation(s)
- Roger M Stone
- Montgomery County (MD) Fire and Rescue Service, Gaithersburg, Maryland
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Timothy A Burns
- Montgomery County (MD) Fire and Rescue Service, Gaithersburg, Maryland
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Hussain A, Okobi OE, Obi CB, Chukwuedozie VC, Sike CG, Etomi EH, Akinyemi FB. Association Between Self-Rated Health and Medical Care Disruption Due to COVID-19 Among Individuals With Atherosclerotic Cardiovascular Disease. Cureus 2023; 15:e40697. [PMID: 37485099 PMCID: PMC10359049 DOI: 10.7759/cureus.40697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted medical care across diverse populations with varying outcomes. In this study, we evaluated the relationship between health rating and disruption in medical care due to COVID-19 among individuals with atherosclerotic cardiovascular disease (ASCVD). METHODS Data from the 2020 National Health Interview Survey was used for this study. ASCVD sample included those with self-reported coronary heart disease, stroke, and heart attack. Health rating was represented as fair to poor, good, and very good to excellent. The outcome variable was a disruption of medical care due to COVID-19 (delay in medical care or did not get care). The chi-square test was used for the descriptive analysis and multiple logistic regression was used to evaluate the relationship between health rating and disruption in medical care with demographic factors, comorbidities, and cumulative social risk adjusted for. RESULTS Among the 31,568 adults, 1,707/31,568 representing 9,385,855 adults 18 years and above with ASCVD reported experiencing or not experiencing a disruption in medical care. After adjusting for cumulative risk, the odds of not getting medical care due to COVID-19 were high for those who rated their health as fair/poor as compared to excellent (adjusted odds ratio (AOR) = 1.95, 95% CI = 1.24-3.08, p = 0.004). These odds remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.84, 95% CI = 1.11-3.06, p = 0.018). After adjusting for cumulative risk, medical care utilization (received, delayed, did not receive) was rated. Those who rated their health as fair to poor as compared to excellent were more likely to report a delay in health care due to COVID-19 (AOR = 1.85, 95% CI = 1.28-2.68, p = 0.001) and remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.86, 95% CI = 1.22-2.82, p = 0.004). Female respondents with ASCVD who rated their health as fair/poor were more likely to experience a delay in medical care due to COVID-19 (AOR = 2.06, 95% CI = 1.06-4.01, p = 0.033) or not get medical care due to COVID-19 (AOR = 2.86, 95% CI = 1.42-5.76, p = 0.003) as compared to those who rated their health as excellent. With regards to men with ASCVD, health rating was not related to their reported disruption of medical care due to COVID-19. CONCLUSIONS A poor to fair health rating is associated with a delay in getting or not getting medical care among individuals with ASCVD. Further studies are needed to evaluate this relationship further.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Health, Harlan, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | - Cherechi G Sike
- General Practice, Windsor University School of Medicine, Cayon, KNA
| | - Eghogho H Etomi
- Cardiology, Kharkiv National Medical University, Kharkiv, UKR
- Research, Texas Southern University, Houston, USA
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Stirparo G, Fagoni N, Bellini L, Oradini‐Alacreu A, Migliari M, Villa GF, Botteri M, Signorelli C, Sechi GM, Zoli A. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand 2022; 66:1124-1129. [PMID: 35894939 PMCID: PMC9349817 DOI: 10.1111/aas.14117] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/17/2022] [Accepted: 06/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year. METHODS Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD). RESULTS During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CI95% ) 0.882-0.993], p = .029) and in the return of spontaneous circulation (ROSC) (OR = 0.621 [CI95% 0.563-0.685], p < .0001), while there was no significant reduction in the use of PAD. Analysing only March, the period of the first wave in Lombardy, the comparison shows a reduction in bystanders CPRs (OR = 0.727 [CI95% 0.602-0.877], p = .0008), use of PAD (OR = 0.441 [CI95% 0.272-0.716], p = .0009) and in ROSC (OR = 0.179 [CI95% 0.124-0.257], p < .0001). These phenomena could be influenced by the different settings in which the OHCAs occurred; in fact, those that occurred in public places with a mandatory PAD were strongly reduced (OR = 0.49 [CI95% , 0.44-0.55], p < .0001). CONCLUSIONS COVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.
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Affiliation(s)
- Giuseppe Stirparo
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly,Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Nazzareno Fagoni
- AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly,Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Lorenzo Bellini
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Aurea Oradini‐Alacreu
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Maurizio Migliari
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Guido Francesco Villa
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Marco Botteri
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly,AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly
| | - Carlo Signorelli
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Giuseppe Maria Sechi
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Alberto Zoli
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
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Fazel MF, Mohamad MHN, Sahar MA, Juliana N, Abu IF, Das S. Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10968. [PMID: 36078684 PMCID: PMC9518324 DOI: 10.3390/ijerph191710968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Early cardiopulmonary resuscitation (CPR) is a strong link in the of survival for sudden cardiac arrest. Hence, bystander CPR (BPCR) plays an important role in curbing mortality and morbidity from out-of-hospital sudden cardiac arrest. However, the recent global Coronavirus disease 2019 (COVID-19) pandemic has impacted both public training and confidence in performing out-of-hospital CPR. This paper reviews detailed information from databases including Google Scholar, Scopus, PubMed and Web of Science on the readiness of BCPR during the pandemic. We also discussed the challenges bystanders encountered during the COVID-19 pandemic and the precautions to follow. Finally, we also highlighted the limitations which would benefit future endeavours in establishing well-planned and sustainable CPR training programs for the public. Therefore, regardless of the existing COVID-19 pandemic, BCPR must be emphasised to curb out-of-hospital cardiac arrest (OHCA) mortality.
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Affiliation(s)
- Muhammad Fattah Fazel
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | | | - Mohd Azmani Sahar
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | - Srijit Das
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Alkoudh, Muscat 123, Oman
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Roasio A, Costanzo E, Bergesio G, Bosso S, Longu S, Zapparoli F, Bertocchini S, Forno G, Fogliati A, Novelli MT. Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center. Cureus 2022; 14:e24432. [PMID: 35637817 PMCID: PMC9128792 DOI: 10.7759/cureus.24432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/05/2022] Open
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Brady WJ, Chavez S, Gottlieb M, Liang SY, Carius B, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings. Am J Emerg Med 2022; 57:114-123. [PMID: 35561501 PMCID: PMC9045864 DOI: 10.1016/j.ajem.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. Objective This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. Discussion COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. Conclusion This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
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Incidence, characteristics and predictors of mortality following cardiac arrest in ICUs of a German university hospital: A retrospective cohort study. Eur J Anaesthesiol 2022; 39:452-462. [PMID: 35200202 DOI: 10.1097/eja.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac arrest in intensive care is a rarely studied type of in-hospital cardiac arrest. OBJECTIVE This study examines the incidence, characteristics, risk factors for mortality as well as long-term prognosis following cardiac arrest in intensive care. DESIGN Retrospective cohort study. SETTING Five noncardiac surgical ICUs (41 surgical and 37 medical beds) at a German university hospital between 2016 and 2019. PATIENTS Adults experiencing cardiac arrest defined as the need for chest compressions and/or defibrillation occurring for the first time on the ICU. MAIN OUTCOME MEASURES Primary endpoint: occurrence of cardiac-arrest in the ICU. Secondary endpoints: diagnostic and therapeutic measures; risk factors and marginal probabilities of no-return of spontaneous circulation; rates of return of spontaneous circulation, hospital discharge, 1-year-survival and 1-year-neurological outcome. RESULTS A total of 114 cardiac arrests were observed out of 14 264 ICU admissions; incidence 0.8%; 95% confidence interval (CI) 0.7 to 1.0; 45.6% received at least one additional diagnostic test, such as blood gas analysis (36%), echocardiography (19.3%) or chest x-ray (9.9%) with a resulting change in therapy in 52%, (more frequently in those with a return of spontaneous circulation vs none, P = 0.023). Risk factors for no-return of spontaneous circulation were cardiac comorbidities (OR 5.4; 95% CI, 1.4 to 20.7) and continuous renal replacement therapy (OR 5.9; 95% CI, 1.7 to 20.8). Bicarbonate levels greater than 21 mmol l-1 were associated with a higher mortality risk in combination either with cardiac comorbidities (bicarbonate <21 mmol l-1: 13%; 21 to 26 mmol l-1: 45%; >26 mmol l-1: 42%) or with a SOFA at least 2 (bicarbonate <21 mmol l-1: 8%; 21 to 26 mmol l-1: 40%; >26 mmol l-1: 37%). In-hospital mortality was 78.1% (n=89); 1-year-survival-rate was 10.5% (95% CI, 5.5 to 17.7) and survival with a good neurological outcome was 6.1% (95% CI, 2.5 to 12.2). CONCLUSION Cardiac arrest in ICU is a rare complication with a high mortality and low rate of good neurological outcome. The development of a structured approach to resuscitation should include all available resources of an ICU and adequately consider the complete diagnostic and therapeutic spectra as our results indicate that these are still underused. The development of prediction models of death should take into account cardiac and hepatic comorbidities, continuous renal replacement therapy, SOFA at least 2 before cardiac arrest and bicarbonate level. Further research should concentrate on identifying early predictors and on the prevention of cardiac arrest in ICU.
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