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Shavelle DM, Bosson N, French WJ, Thomas JL, Niemann JT, Gausche-Hill M, Rollman JE, Rafique AM, Klomhaus AM, Kloner RA. Association of the COVID-19 Pandemic on Treatment Times for ST-Elevation Myocardial Infarction: Observations from the Los Angeles County Regional System. Am J Cardiol 2024; 213:93-98. [PMID: 38016494 DOI: 10.1016/j.amjcard.2023.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023]
Abstract
Previous studies have documented longer treatment times and worse outcomes for patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic. The objective of the present study was to evaluate the impact of the COVID-19 pandemic on treatment times and outcomes for patients with STEMI who underwent primary PCI within a regional system of care. This was a retrospective study using data from the Los Angeles County Emergency Medical Services Agency. Data on the emergency medical service activations were abstracted for patients with STEMI from March 19, 2020 to January 31, 2021, during the COVID-19 pandemic and for the same interval the previous year. All adult patients (≥18 years) with STEMI who underwent emergent coronary angiography were included. The primary end point was the first medical contact (FMC) to device time. The secondary end points included treatment time intervals, vascular complications, need for emergent coronary artery bypass surgery, length of hospital stay, and in-hospital mortality. During the study period, 3,017 patients underwent coronary angiography for STEMI, 1,893 patients pre-COVID-19 and 1,124 patients during COVID-19 (40% lower). A total of 2,334 patients (77%) underwent PCI. During the COVID-19 period, rates of PCI were significantly lower compared with the control period (75.1% vs 78.7%, p = 0.02). FMC to device time was shorter during the COVID-19 period compared with the control period (median 77.0 vs 81.0 minutes, p = 0.004). For patients with STEMI complicated by out-of-hospital cardiac arrest, FMC to device time was similar during the COVID-19 period compared with the control period (median 95.0 [33.0] vs 100.0 [40.0] minutes, p = 0.34). Vascular complications, the need for emergent bypass surgery, length of hospital stay, and in-hospital mortality were similar between the periods. In conclusion, in this large regional system of care, we found a relatively small but significant decrease in treatment times, yet overall, similar clinical outcomes for patients with STEMI who underwent primary PCI and were treated during the COVID-19 period compared with a control period. These findings suggest that mature cardiac systems of care were able to maintain efficient care despite the challenges of the COVID-19 pandemic.
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Affiliation(s)
- David M Shavelle
- Memorial Care Heart and Vascular Institute, Long Beach Medical Center, Long Beach, California.
| | - Nichole Bosson
- Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - William J French
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA
| | - Joseph L Thomas
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA
| | - James T Niemann
- David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - Marianne Gausche-Hill
- Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - Jeffrey Eric Rollman
- Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Asim M Rafique
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Department of Medicine, and
| | - Alexandra M Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Robert A Kloner
- Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institutes, Pasadena, California
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2
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Nasimi F, Yazdchi M. LDIAED: A lightweight deep learning algorithm implementable on automated external defibrillators. PLoS One 2022; 17:e0264405. [PMID: 35213628 PMCID: PMC8880955 DOI: 10.1371/journal.pone.0264405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022] Open
Abstract
Differentiating between shockable and non-shockable Electrocardiogram (ECG) signals would increase the success of resuscitation by the Automated External Defibrillators (AED). In this study, a Deep Neural Network (DNN) algorithm is used to distinguish 1.4-second segment shockable signals from non-shockable signals promptly. The proposed technique is frequency-independent and is trained with signals from diverse patients extracted from MIT-BIH, MIT-BIH Malignant Ventricular Ectopy Database (VFDB), and a database for ventricular tachyarrhythmia signals from Creighton University (CUDB) resulting, in an accuracy of 99.1%. Finally, the raspberry pi minicomputer is used to load the optimized version of the model on it. Testing the implemented model on the processor by unseen ECG signals resulted in an average latency of 0.845 seconds meeting the IEC 60601-2-4 requirements. According to the evaluated results, the proposed technique could be used by AED’s.
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Affiliation(s)
- Fahimeh Nasimi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Mohammadreza Yazdchi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
- * E-mail:
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3
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Hammad M, Kandala RN, Abdelatey A, Abdar M, Zomorodi‐Moghadam M, Tan RS, Acharya UR, Pławiak J, Tadeusiewicz R, Makarenkov V, Sarrafzadegan N, Khosravi A, Nahavandi S, EL-Latif AAA, Pławiak P. Automated detection of shockable ECG signals: A review. Inf Sci (N Y) 2021. [DOI: 10.1016/j.ins.2021.05.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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4
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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5
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Braumann S, Nettersheim FS, Hohmann C, Tichelbäcker T, Hellmich M, Sabashnikov A, Djordjevic I, Adler J, Nies RJ, Mehrkens D, Lee S, Stangl R, Reuter H, Baldus S, Adler C. How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study. Clin Res Cardiol 2020; 109:1402-1410. [DOI: 10.1007/s00392-020-01640-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
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6
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May TL, Lary CW, Riker RR, Friberg H, Patel N, Søreide E, McPherson JA, Undén J, Hand R, Sunde K, Stammet P, Rubertsson S, Belohlvaek J, Dupont A, Hirsch KG, Valsson F, Kern K, Sadaka F, Israelsson J, Dankiewicz J, Nielsen N, Seder DB, Agarwal S. Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive Care Med 2019; 45:637-646. [PMID: 30848327 PMCID: PMC6486427 DOI: 10.1007/s00134-019-05580-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/22/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. METHODS Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. RESULTS A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. CONCLUSIONS Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
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Affiliation(s)
- Teresa L May
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA. .,Clinical and Translational Science Institute, Tufts University, Boston, ME, 02111, USA.
| | - Christine W Lary
- Center for Outcomes Research, Maine Medical Center, Portland, ME, USA
| | - Richard R Riker
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Hans Friberg
- Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden
| | - Nainesh Patel
- Division of Cardiovascular Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA
| | - Eldar Søreide
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Department Clinical Medicine, University of Bergen, Bergen, Norway
| | - John A McPherson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Johan Undén
- Department of Clinical Sciences, Lund University, Getingevägen, 22185, Lund, Sweden.,Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | - Robert Hand
- Department of Critical Care, Eastern Maine Medical Center, Bangor, ME, USA
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pascal Stammet
- Medical Department National Rescue Services, Luxembourg, 14, rue Stümper, 2557, Luxembourg, Luxembourg
| | - Stein Rubertsson
- Department of Surgical Sciences/Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Jan Belohlvaek
- Department of Internal Medicine II, Cardiovascular Medicine, General Teaching Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic
| | - Allison Dupont
- Department of Cardiology, Northeast Georgia Medical Center, Gainesville, Georgia, USA
| | - Karen G Hirsch
- Stanford Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Felix Valsson
- Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykyavik, Iceland
| | - Karl Kern
- Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, USA
| | - Farid Sadaka
- Mercy Hospital St Louis, St Louis University, St. Louis, MO, USA
| | - Johan Israelsson
- Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden
| | - Josef Dankiewicz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Sachin Agarwal
- Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY, USA
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7
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Li H, Wu TT, Liu PC, Liu XS, Mu Y, Guo YS, Chen Y, Xiao LP, Huang JF. Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China. Am J Emerg Med 2018; 37:1301-1306. [PMID: 30401593 DOI: 10.1016/j.ajem.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS This retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest. METHODS ACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes. RESULTS The total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16-30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16-30 min), Killip ≤ II, and CCI ≤ 2. CONCLUSION Younger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.
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Affiliation(s)
- Hong Li
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China.
| | - Ting Ting Wu
- Department of Nursing, Fujian Health College, Fujian, China
| | - Pei Chang Liu
- Department of Anesthesiology, Fujian Union Hospital Clinical Medical College, Fujian, China
| | - Xue Song Liu
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yan Mu
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China
| | - Yang Song Guo
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yuan Chen
- Department of Nursing, Xiamen Cardiovascular Disease Hospital, Xiamen University Medical School, Xiamen, China
| | - Li Ping Xiao
- Department of Nursing, First Hospital of Longyan, Fujian Medical University, Longyan, China
| | - Jiang Feng Huang
- School of Public Health, Fujian Medical University, Fujian, China
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8
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McCarthy JJ, Carr B, Sasson C, Bobrow BJ, Callaway CW, Neumar RW, Ferrer JME, Garvey JL, Ornato JP, Gonzales L, Granger CB, Kleinman ME, Bjerke C, Nichol G. Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e645-e660. [DOI: 10.1161/cir.0000000000000557] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010).
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9
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Taglieri N, Saia F, Bacchi Reggiani ML, Ghetti G, Bruno AG, Rosetti C, Bruno M, Corsini A, Battistini P, Lanati G, Di Dio MT, Della Riva D, Compagnone M, Marrozzini C, Rapezzi C. Prognostic significance of shockable and non-shockable cardiac arrest in ST-segment elevation myocardial infarction patients undergoing primary angioplasty. Resuscitation 2018; 123:8-14. [DOI: 10.1016/j.resuscitation.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
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10
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Shavelle DM, Bosson N, Thomas JL, Kaji AH, Sung G, French WJ, Niemann JT. Outcomes of ST Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest (from the Los Angeles County Regional System). Am J Cardiol 2017; 120:729-733. [PMID: 28728743 DOI: 10.1016/j.amjcard.2017.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/16/2017] [Accepted: 06/01/2017] [Indexed: 01/01/2023]
Abstract
The objective of this study was to evaluate the time to primary percutaneous coronary intervention (PCI) and the outcome for patients with ST elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). In this regional system, all patients with STEMI and/or OHCA with return of spontaneous circulation were transported to STEMI Receiving Centers. The outcomes registry was queried for patients with STEMI with underwent primary PCI from April 2011 to December 2014. Patients with STEMI complicated by OHCA were compared with a reference group of STEMI without OHCA. The primary end point was the first medical contact-to-device time. Of 4,729 patients with STEMI who underwent primary PCI, 422 patients (9%) suffered OHCA. Patients with OHCA were on average 2 years (95% confidence interval 0.7 to 3.0) older and had a slightly higher male predominance. The first medical contact-to-device time was longer in STEMI with OHCA compared with STEMI alone (94 ± 37 vs. 86 ± 34 minutes, p < 0.0001). In-hospital mortality was higher after OHCA, 38% versus 6% in STEMI alone, odds ratio 6.3 (95% confidence interval 5.3 to 7.4). Among OHCA survivors, 193 (73%) were discharged with a cerebral performance category score of 1 or 2. In conclusion, despite longer treatment intervals, neurologic outcome was good in nearly half of the surviving patients with STEMI complicated by OHCA, suggesting that these patients can be effectively treated with primary PCI in a regionalized system of care.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California; Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph L Thomas
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gene Sung
- Department of Neurology, University of Southern California, Los Angeles, California
| | - William J French
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - James T Niemann
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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11
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Lam DH, Glassmoyer LM, Strom JB, Davis RB, McCabe JM, Cutlip DE, Donnino MW, Cocchi MN, Pinto DS. Factors associated with performing urgent coronary angiography in out-of-hospital cardiac arrest patients. Catheter Cardiovasc Interv 2017; 91:832-839. [PMID: 28766924 DOI: 10.1002/ccd.27199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Factors associated with performing urgent coronary angiography (UCA) in patients with out-of-hospital cardiac arrest (OHCA) were identified. BACKGROUND Current guidelines for resuscitated OHCA patients recommend UCA if there is ST-elevation on post-arrest electrocardiogram or high suspicion of acute myocardial infarction. Some have advocated for UCA in all OHCA regardless of suspected etiology. The reasons for variations in performing UCA are not well understood. METHODS A retrospective analysis of subjects presenting with resuscitated OHCA to a single academic medical center from 12/15/2007 to 8/31/2014 was conducted. Demographic and clinical characteristics of patients undergoing UCA, defined as angiography within 6 hr of presentation, were compared with those not undergoing UCA. Logistic regression was used to determine predictors of UCA. RESULTS A total of 323 resuscitated OHCA patients (mean age, 64 years; women, 35%) were included in the analysis; 107 (33.1%) underwent coronary angiography during their hospitalization and 66 (20.4%) underwent UCA. Multivariable adjusted factors associated with UCA were ST-elevation [odds ratio (OR) 14.66, 95% confidence interval (CI) 6.28-34.24, P < 0.001], initial shockable rhythm (OR 3.69, 95% CI 1.52-8.97, P = 0.004), and history of coronary artery disease (CAD) (OR 3.37, 95% CI 1.43-7.95, P = 0.005). Higher age (OR 0.71 per decade, 95% CI 0.55-0.92, P = 0.01) and obvious non-cardiac cause of arrest (OR 0.08, 95% CI 0.02-0.38, P = 0.001) were negatively associated with UCA. CONCLUSIONS In resuscitated out-of-hospital cardiac arrest patients, ST-elevation, shockable rhythm, and history of CAD were associated with performing urgent coronary angiography; older patients and those with obvious non-cardiac causes of arrest were negatively associated.
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Affiliation(s)
- David H Lam
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Lauren M Glassmoyer
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California
| | - Jordan B Strom
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Donald E Cutlip
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of Pulmonary Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Divison of Critical Care, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Duane S Pinto
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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12
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Postreanimationsbehandlung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Wah W, Wai KL, Pek PP, Ho AFW, Alsakaf O, Chia MYC, Noor JM, Kajino K, De Souza NNA, Ong MEH. Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest. Am J Emerg Med 2016; 35:206-213. [PMID: 27810251 DOI: 10.1016/j.ajem.2016.10.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA. METHODOLOGY This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models. RESULTS 40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR=6.10, 95% confidence interval/CI=5.06-7.34) and subsequent conversion to shockable rhythm (OR=2.00,95%CI=1.10-3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses. CONCLUSION Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy.
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Affiliation(s)
- Win Wah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Khin Lay Wai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Emergency Medicine Residency Program, SingHealth Services, Singapore
| | - Omer Alsakaf
- Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates
| | | | - Julina Md Noor
- Department of Emergency and Trauma, Hospital Sungai Buloh, Selangor, Malaysia
| | - Kentaro Kajino
- Critical Care Medical Center, Osaka National Hospital, Osaka, Japan
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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14
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Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VRM, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2016; 95:202-22. [PMID: 26477702 DOI: 10.1016/j.resuscitation.2015.07.018] [Citation(s) in RCA: 734] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK.
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Véronique R M Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK
| | - Bernd W Bottiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans Friberg
- Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
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15
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Kitamura T, Kiyohara K, Matsuyama T, Hatakeyama T, Shimamoto T, Izawa J, Nishiyama C, Iwami T. Is Survival After Out-of-Hospital Cardiac Arrests Worse During Days of National Academic Meetings in Japan? A Population-Based Study. J Epidemiol 2015; 26:155-62. [PMID: 26639754 PMCID: PMC4773492 DOI: 10.2188/jea.je20150100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Outcomes after out-of-hospital cardiac arrests (OHCAs) might be worse during academic meetings because many medical professionals attend them. METHODS This nationwide population-based observation of all consecutively enrolled Japanese adult OHCA patients with resuscitation attempts from 2005 to 2012. The primary outcome was 1-month survival with a neurologically favorable outcome. Calendar days at three national meetings (Japanese Society of Intensive Care Medicine, Japanese Association for Acute Medicine, and Japanese Circulation Society) were obtained for each year during the study period, because medical professionals who belong to these academic societies play an important role in treating OHCA patients after hospital admission, and we identified two groups: the exposure group included OHCAs that occurred on meeting days, and the control group included OHCAs that occurred on the same days of the week 1 week before and after meetings. Multiple logistic regression analysis was used to adjust for confounding variables. RESULTS A total of 20 143 OHCAs that occurred during meeting days and 38 860 OHCAs that occurred during non-meeting days were eligible for our analyses. The proportion of patients with favorable neurologic outcomes after whole arrests did not differ during meeting and non-meeting days (1.6% [324/20 143] vs 1.5% [596/38 855]; adjusted odds ratio 1.02; 95% confidence interval, 0.88-1.19). Regarding bystander-witnessed ventricular fibrillation arrests of cardiac origin, the proportion of patients with favorable neurologic outcomes also did not differ between the groups. CONCLUSIONS In this population, there were no significant differences in outcomes after OHCAs that occurred during national meetings of professional organizations related to OHCA care and those that occurred during non-meeting days.
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Affiliation(s)
- Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
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Kim MJ, Ro YS, Shin SD, Song KJ, Ahn KO, Hong SO, Kim YT. Association of emergent and elective percutaneous coronary intervention with neurological outcome and survival after out-of-hospital cardiac arrest in patients with and without a history of heart disease. Resuscitation 2015; 97:115-21. [DOI: 10.1016/j.resuscitation.2015.08.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/19/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022]
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Gundersen DC. The Legalization of Marijuana: Implications for Regulation and Practice. JOURNAL OF NURSING REGULATION 2015. [DOI: 10.1016/s2155-8256(15)30782-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Rab T, Kern KB, Tamis-Holland JE, Henry TD, McDaniel M, Dickert NW, Cigarroa JE, Keadey M, Ramee S. Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient. J Am Coll Cardiol 2015; 66:62-73. [PMID: 26139060 DOI: 10.1016/j.jacc.2015.05.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
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Affiliation(s)
- Tanveer Rab
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, Tucson, Arizona
| | | | - Timothy D Henry
- Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Michael McDaniel
- Division of Cardiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Matthew Keadey
- Division of Emergency Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen Ramee
- Structural and Valvular Heart Disease Program, Ochsner Medical Center, New Orleans, Louisiana
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