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Gouveia e Melo R, Machado C, Caldeira D, Alves M, Lopes A, Serrano M, Fernandes e Fernandes R, Mendes Pedro L. Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies. IJC HEART & VASCULATURE 2022; 38:100934. [PMID: 35005212 PMCID: PMC8717414 DOI: 10.1016/j.ijcha.2021.100934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/28/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA. METHODS We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients. RESULTS Fourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30). CONCLUSION AAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.
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Affiliation(s)
- Ryan Gouveia e Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Carolina Machado
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniel Caldeira
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Mariana Alves
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Serviço de Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal
| | - Alice Lopes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Serrano
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Intensive Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Ruy Fernandes e Fernandes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Sin R, Vodehnalova I, Ralbovska DC, Struncova D, Cechurova L. Out-of-hospital cardiac arrest in the Pilsen Region in 2018. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:43-50. [PMID: 31974532 DOI: 10.5507/bp.2019.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS To acquire epidemiological data on pre-hospital cardiac arrest incidents occurring in the Pilsen Region of the Czech Republic in 2018, and the results of subsequent cardiopulmonary resuscitation Methods. A prospective observational study of the survival rate of out-of-hospital cardiac arrest (OHCA) in patients undergoing CPR carried out by emergency medical service personnel. The observed time period was from January 1st, 2018 until December 31st, 2018. The data were acquired from patients' records in paper and electronic forms. RESULTS In the monitored period 707 patients with signs of cardiac arrest were recorded in the Pilsen Region with an incidence rate of 128.9 per 100,000 inhabitants. Emergency medical units performed CPR in 484 cases. The incidence rate of pre-hospital CPR was 88.2 cases per 100,000 inhabitants. Spontaneous blood circulation was temporarily or permanently restored in 276 patients (57.0%), 203 (41.9%) patients were transferred to a hospital, and there were 61 (12.6%) cases of survival with Cerebral Performance Category (CPC) score of 1 or 2. The first monitored rhythm was a shockable in 134 (27.7%) cases. In this sub-group ROSC was achieved in 94 (70.1%) cases and 58 (43.3%) of those were subsequently transferred to a hospital. A good CPC result was achieved in 41 (30.6%) patients of this sub group. CONCLUSION The study has provided valuable epidemiological data on OHCA and prehospital CPR in the area of the Pilsen Region in 2018. The collected data, compared to international results, show a higher survival rate with good neurological score in 12.6% of cases.
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Affiliation(s)
- Robin Sin
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Department of Infectious Diseases and Travel Medicine, Faculty of Medicine in Pilsen, Charles University and University Hospital Pilsen, Czech Republic
| | - Ivana Vodehnalova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Denisa Charlotte Ralbovska
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Denisa Struncova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
| | - Lenka Cechurova
- Emergency Medical Service of the Pilsen Region, Pilsen, Czech Republic
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Luc G, Baert V, Escutnaire J, Genin M, Vilhelm C, Di Pompéo C, Khoury CE, Segal N, Wiel E, Adnet F, Tazarourte K, Gueugniaud PY, Hubert H. Epidemiology of out-of-hospital cardiac arrest: A French national incidence and mid-term survival rate study. Anaesth Crit Care Pain Med 2018; 38:131-135. [PMID: 29684654 DOI: 10.1016/j.accpm.2018.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is considered an important public health issue but its incidence has not been examined in France. The aim of this study is to define the incidence of OHCA in France and to compare this to other neighbouring countries. Data were extracted from the French OHCA registry. Only exhaustive centres during the period from January 1, 2013, to September 30, 2014 were included. All patients were included, regardless of their age and cause of OHCA. The participating centres covered about 10% of the French population. The study involved 6918 OHCA. The median age was 68 years, with 63% of males. Paediatric population (<15years) represented 1.8%. The global incidence of OHCA was 61.5 per 100,000 inhabitants per year in the total population corresponding to approximately 46,000 OHCA per year. In the adult population, we found an incidence of 75.3 cases per 100,000 inhabitants per year. In adults, the incidences were 100.3 and 52.7 in males and females, respectively. Most (75%) OHCA occurred at home and were due to medical causes (88%). Half of medical OHCA had cardiovascular causes. Survival rates at 30 days was 4.9% [4.4; 5.4] and increased to 10.4% [9.1; 11.7] when resuscitation was immediately performed by bystander at patient's collapse. The incidence and survival at 30 days of OHCA in France appeared similar to that reported in other European countries. Compared to other causes of deaths in France, OHCA is one of the most frequent causes, regardless of the initial pathology.
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Affiliation(s)
- Gérald Luc
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Valentine Baert
- French national out-of-hospital cardiac arrest registry, RéAC, 59000 Lille, France
| | - Joséphine Escutnaire
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Michael Genin
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Christian Vilhelm
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Christophe Di Pompéo
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Carlos El Khoury
- RESCUE (Réseau Cardiologie Medecine d'Urgence) Network, Hussel Hospital, 38200 Vienne, France
| | - Nicolas Segal
- Department of Emergency Medicine, Assistance publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, 75010 Paris, France
| | - Eric Wiel
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France; Department of Emergency Medicine, SAMU 59, Lille University hospital, 59000 Lille, France
| | - Frédéric Adnet
- Inserm U942, Department of emergency medicine, hôpital Avicenne, AP-HP, Paris 13 University, 93000 Bobigny, France
| | - Karim Tazarourte
- SAMU 69, Lyon University Hospital, Claude Bernard University, 69003 Lyon, France
| | | | - Hervé Hubert
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France.
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- Research Group on the French national out-of-hospital cardiac arrest registry, RéAC, 59000 Lille, France
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Porzer M, Mrazkova E, Homza M, Janout V. Out-of-hospital cardiac arrest. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:348-353. [PMID: 29235577 DOI: 10.5507/bp.2017.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in developed industrial countries. The global worldwide average of OHCA incidence in adults is 95.9/100,000/year. European incidences vary according to source from 16 to 119/100,000/year. The aim of this study was to provide an overview of current information on OHCA. The incidences in various populations are discussed, along with the factors affecting the prognosis and outcome of these patients. The etiology and pathophysiological mechanisms are also described, especially in relation to the most common causes - acute and chronic forms of coronary artery disease and cardiomyopathies. Measures that could improve survival rates are discussed, with emphasis on the role of the general public and deployment of automatic external defibrillators.
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Affiliation(s)
- Martin Porzer
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Czech Republic.,Department of Cardiovascular Diseases, University Hospital Ostrava, Czech Republic
| | - Eva Mrazkova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Miroslav Homza
- Department of Cardiovascular Diseases, University Hospital Ostrava, Czech Republic
| | - Vladimir Janout
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Czech Republic
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Lukić A, Lulić I, Lulić D, Ognjanović Z, Cerovečki D, Telebar S, Mašić I. Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study. Croat Med J 2017; 57:591-600. [PMID: 28051284 PMCID: PMC5209925 DOI: 10.3325/cmj.2016.57.591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaľdin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management. METHODS We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaľdin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician's inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician's turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician's EMS experience. RESULTS Of 276 patients (median age 68 years, interquartile range [IQR] 16; 198 male; 37% ventricular fibrillation/ventricular tachycardia, bystander CPR rate 25%), 80 were transferred to hospital and 39 were discharged (median survival after discharge 23 months, IQR 46 months). During the 7-year study period, 29 newly graduated physicians inexperienced in EMS started to work in EMSVz (performing 77 resuscitations), while 48% of them stayed for less than one year. Airway management depended on physician's EMS experience (P=0.018): inexperienced physicians performed bag-valve-mask ventilation (BMV) more than the experienced, with no impact on survival rate. Physician's EMS experience did not influence adherence to resuscitation guidelines (P=0.668), survival to hospital discharge (P=0.791), or survival time (P=0.405). CONCLUSION OHCA survival rate of EMSVz resuscitations was higher than in Europe, but bystander CPR needs to be improved. Compared to experienced physicians, inexperienced physicians preferred BMV over intubation, but with similar adherence to resuscitation guidelines and survival after OHCA.
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Affiliation(s)
- Anita Lukić
- Anita Lukic, V. Sokola 19, Varazdin, HR42000, Croatia,
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6
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Hasan OF, Al Suwaidi J, Omer AA, Ghadban W, Alkilani H, Gehani A, Salam AM. The influence of female gender on cardiac arrest outcomes: a systematic review of the literature. Curr Med Res Opin 2014; 30:2169-78. [PMID: 24940826 DOI: 10.1185/03007995.2014.936552] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sudden cardiac arrest is an important cause of cardiovascular mortality. The impact of gender on the outcome of cardiac arrest is not clear and data about that is limited. OBJECTIVE Understanding the influence of gender on cardiac arrest through a systematic review of the published literature. METHODS A search of all published studies in English between January 1970 and May 2013 was performed using the electronic databases PubMed and MEDLINE, using the key words 'cardiac arrest', 'outcome', and 'gender'. RESULTS Eleven studies were included in this review, all of which were observational studies conducted using national-based database registries of cardiac arrest. A total of 548,440 patients were enrolled in these studies with 220,646 (40.3%) of them being female patients. In general, there was a lower percentage of women in the reported studies compared to men. Women were older in age and more likely to have non-shockable rhythms as the initial rhythm. Women also had a lower rate of witnessed arrest, a lower rate of bystander resuscitation, a higher rate of survival until hospital admission and a lower rate of in-hospital survival compared to men. Women also had a more favorable one month survival and neurological outcome. CONCLUSION In the reported literature female gender seems to offer survival and outcome advantages following out-of-hospital cardiac arrest over male gender. This is in contrast to most other aspects of heart disease in which women tend to have a worse prognosis.
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Affiliation(s)
- Omar F Hasan
- Cardiology Section, Al-Khor Hospital, Hamad Medical City , Doha , Qatar
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Savastano S, Klersy C, Raimondi M, Langord K, Vanni V, Rordorf R, Vicentini A, Petracci B, Landolina M, Visconti LO. Positive trend in survival to hospital discharge after out-of-hospital cardiac arrest. J Cardiovasc Med (Hagerstown) 2014; 17:227. [DOI: 10.2459/jcm.0000000000000040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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BUANES EA, HELTNE JK. Comparison of in-hospital and out-of-hospital cardiac arrest outcomes in a Scandinavian community. Acta Anaesthesiol Scand 2014; 58:316-22. [PMID: 24404789 DOI: 10.1111/aas.12258] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reported incidence and survival from in-hospital and out-of-hospital cardiac arrest show great variability, making it difficult to compare the groups. In order to eliminate effects of time and culture, we investigated out-of-hospital cardiac arrest compared with in-hospital cardiac arrest in our community over a 1-year period. METHODS We conducted a cohort study including patients with in-hospital and out-of-hospital cardiac arrest. Multiple data sources were screened in order to identify all cardiac arrest patients. Utstein style data were collected prospectively from 1 December 2008 to 30 November 2009 with subsequent analysis. RESULTS A total of 380 resuscitations because of cardiac arrest were included, 154 (40.6%) in-hospital and 226 (59.4%) out-of-hospital. The in-hospital cardiac arrest group was older, had higher proportions of witnessed cardiac arrest, bystander cardiopulmonary resuscitation, bystander direct current (DC) shock and professional first rescuer. Survival to hospital discharge was 16.2% for in-hospital cardiac arrest vs. 16.8% for out-of-hospital cardiac arrest. CONCLUSION Survival from in-hospital and out-of-hospital cardiac arrest in this cohort is similar.
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Affiliation(s)
- E. A. BUANES
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
| | - J. K. HELTNE
- Department of Anaesthesia and Intensive Care; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
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Moriwaki Y, Tahara Y, Kosuge T, Suzuki N. Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography. J Emerg Trauma Shock 2013; 6:87-94. [PMID: 23723616 PMCID: PMC3665077 DOI: 10.4103/0974-2700.110752] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/17/2012] [Indexed: 11/04/2022] Open
Abstract
CONTEXT The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA) has not been established. We have performed perimortem computed tomography (CT) during cardiopulmonary resuscitation. AIMS To clarify the incidence of non-cardiac etiology (NCE), actual distribution of the causes of OHCPA via perimortem CT and its usefulness. SETTINGS AND DESIGN Population-based observational case series study. MATERIALS AND METHODS We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding) and others. RESULTS Of a total OHCPA, perimortem CT was performed in 57.5% and 62.5% were finally diagnosed as NCE: Acute aortic dissection (AAD) 8.07%, pulmonary thrombo-embolization (PTE) 1.46%, hypoxia due to pneumonia 5.25%, asthma and acute worsening of chronic obstructive pulmonary disease 2.06%, cerebrovascular disorder (CVD) 4.48%, airway obstruction 7.64%, and submersion 5.63%. The rates of patients who survived to hospital discharge were 6-14% in patients with NCE. Out of the 1476 cases excluding obvious NCE of OHCPA, 66.3% underwent perimortem CT, 14.6% of cases without obvious NCE and 22.1% of cases with perimortem CT were confirmed as having some NCE. CONCLUSIONS Of the total OHCPA the incidences of NCE was 62.5%; the leading etiologies were AAD, airway obstruction, submersion, hypoxia and CVD. The rates of cases converted from cardiac etiology to NCE using perimortem CT were 14.6% of cases without an obvious NCE.
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Affiliation(s)
- Yoshihiro Moriwaki
- Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
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Pleskot M, Hazukova R, Stritecka H, Cermakova E. Five-year survival of patients after out-of-hospital cardiac arrest depending on age. Arch Gerontol Geriatr 2011; 53:e88-92. [DOI: 10.1016/j.archger.2010.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/23/2010] [Accepted: 06/25/2010] [Indexed: 11/28/2022]
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Yeeheng U. Factors Associated With Successful Resuscitation of Out-of-Hospital Cardiac Arrest at Rajavithi Hospital’s Narenthorn Emergency Medical Service Center, Thailand. Asia Pac J Public Health 2011; 23:601-7. [DOI: 10.1177/1010539511411902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study is to determine factors associated with successful resuscitation of out-of-hospital cardiac arrest (OHCA) patients by Narenthorn Emergency Medical Service Center (EMS), Thailand. A retrospective observational study was conducted with 73 OHCA patients who were resuscitated from December 2004 to January 2007. Inferential statistics, univariate (χ2) and multivariate analyses (logistic regression) were applied for data analysis. A total of 73 OHCA patients were included. The mean age was 58.3 years; 86.3% were ≥40 years, 72.6% were male. The causes of arrest were cardiac problem 53.4%. In all, 46.6% were witnessed arrest; 53.4% had response time (RT) ≥10 minutes, and 27.4% had bystander cardiopulmonary resuscitation (CPR). Overall, 79.5% were found in the residence. Initial electrocardiogram showed that 74% were nonshockable rhythm. A total of 34.2% were resuscitated by an EMS team with <4 members, and 53.4% had return of spontaneous circulation, survival to admission was 61.5% and survival to discharge was 7.7%. Witnessed arrest (odds ratio [OR] = 7.403; 95% confidence interval [CI] = 2.169-24.683) and bystander CPR (OR = 5.619; 95% CI = 1.014-36.170) had correlation with successful resuscitation of OHCA patients. RT showed a trend toward statistical significance (OR = 1.051; 95% CI = 0.765-16.083). This study found that witnessed arrest and bystander CPR were major factors associated with successful resuscitation of OHCA patients. Our findings will be useful for the development of community programs to decrease the mortality from OHCA.
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Affiliation(s)
- Ubon Yeeheng
- Rajavithi Hospital’s Narenthorn Emergency Medical Service Center, Bangkok, Thailand
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Koster RW, Sayre MR, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2011; 81 Suppl 1:e48-70. [PMID: 20956035 DOI: 10.1016/j.resuscitation.2010.08.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
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Sayre MR, Koster RW, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S298-324. [PMID: 20956253 DOI: 10.1161/circulationaha.110.970996] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010; 81:1479-87. [DOI: 10.1016/j.resuscitation.2010.08.006] [Citation(s) in RCA: 1221] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/16/2010] [Accepted: 08/09/2010] [Indexed: 11/20/2022]
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Redpath C, Sambell C, Stiell I, Johansen H, Williams K, Samie R, Green M, Gollob M, Lemery R, Birnie D. In-hospital mortality in 13,263 survivors of out-of-hospital cardiac arrest in Canada. Am Heart J 2010; 159:577-583.e1. [PMID: 20362715 DOI: 10.1016/j.ahj.2009.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 12/14/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a substantial mortality rate in patients admitted alive after out-of-hospital cardiac arrest. The primary objective of our study was to examine trends in in-hospital survival in out-of-hospital cardiac arrest survivors in Canada between 1994 and 2004. The secondary objective was to examine predictors of in-hospital survival in these patients. METHODS Data on hospital admissions from April 1, 1994, to March 31, 2004, were obtained from the Health Person-oriented Information Database, maintained by Statistics Canada. We included all patients with a primary diagnosis of cardiac arrest who survived to hospital admission. We assessed survival to hospital discharge in all patients admitted alive. RESULTS In Canada, 13,263 patients survived community arrest between 1994 and 2004. The annual incidence of hospital admission after out-of-hospital cardiac arrest decreased by 33%, from 5.37 per 100,000 in 1994 to 3.63 per 100,000 in 2004 (P < .0001 for trend). Subsequently, 5,045 patients (38.03%) survived to hospital discharge. The survival rate did not change during the duration of the study. Invasive coronary artery disease management was associated with a greatly increased chance of survival (odds ratio 21.98, 95% CI 17.62-27.42). Also male gender, heart failure, and acute myocardial ischemia were independent positive predictors of survival to hospital discharge; greater age and comorbidities were negative predictors of survival. Finally, there were significant interprovincial variations in survival rates. CONCLUSIONS Our study, the largest of its kind, has 4 main findings. Firstly, between 1993 and 2004, there was a significant and steady decline in admission rates after community cardiac arrest. Second, there was no change in the in-hospital survival rates. Thirdly, invasive management of coronary artery disease was associated with a greatly improved chance of survival, and finally, there were important regional variations in survival rates.
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Affiliation(s)
- Calum Redpath
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2009; 3:63-81. [PMID: 20123673 DOI: 10.1161/circoutcomes.109.889576] [Citation(s) in RCA: 1471] [Impact Index Per Article: 98.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have identified key predictors of out-of-hospital cardiac arrest (OHCA), but differences exist in the magnitude of these findings. In this meta-analysis, we evaluated the strength of associations between OHCA and key factors (event witnessed by a bystander or emergency medical services [EMS], provision of bystander cardiopulmonary resuscitation [CPR], initial cardiac rhythm, or the return of spontaneous circulation). We also examined trends in OHCA survival over time. METHODS AND RESULTS An electronic search of PubMed, EMBASE, Web of Science, CINAHL, Cochrane DSR, DARE, ACP Journal Club, and CCTR was conducted (January 1, 1950 to August 21, 2008) for studies reporting OHCA of presumed cardiac etiology in adults. Data were extracted from 79 studies involving 142 740 patients. The pooled survival rate to hospital admission was 23.8% (95% CI, 21.1 to 26.6) and to hospital discharge was 7.6% (95% CI, 6.7 to 8.4). Stratified by baseline rates, survival to hospital discharge was more likely among those: witnessed by a bystander (6.4% to 13.5%), witnessed by EMS (4.9% to 18.2%), who received bystander CPR (3.9% to 16.1%), were found in ventricular fibrillation/ventricular tachycardia (14.8% to 23.0%), or achieved return of spontaneous circulation (15.5% to 33.6%). Although 53% (95% CI, 45.0% to 59.9%) of events were witnessed by a bystander, only 32% (95% CI, 26.7% to 37.8%) received bystander CPR. The number needed to treat to save 1 life ranged from 16 to 23 for EMS-witnessed arrests, 17 to 71 for bystander-witnessed, and 24 to 36 for those receiving bystander CPR, depending on baseline survival rates. The aggregate survival rate of OHCA (7.6%) has not significantly changed in almost 3 decades. CONCLUSIONS Overall survival from OHCA has been stable for almost 30 years, as have the strong associations between key predictors and survival. Because most OHCA events are witnessed, efforts to improve survival should focus on prompt delivery of interventions of known effectiveness by those who witness the event.
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Affiliation(s)
- Comilla Sasson
- Departments of Emergency Medicine and Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Pleskot M, Hazukova R, Stritecka H, Cermakova E, Pudil R. Long-term prognosis after out-of-hospital cardiac arrest with/without ST elevation myocardial infarction. Resuscitation 2009; 80:795-804. [PMID: 19411128 DOI: 10.1016/j.resuscitation.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 12/23/2008] [Accepted: 04/02/2009] [Indexed: 11/26/2022]
Abstract
AIM To describe the 3-year survival of patients after out-of-hospital cardiac arrest (OHCA) taking into account the presence of ST-segment elevation myocardial infarction (STEMI) and evaluating prognostic factors associated with pre-hospital and hospital care. PATIENT GROUP Over a period of 29 months and with the aid of a questionnaire supplied to 24 rescue stations, we prospectively included 560 individuals (415 men; aged 16-97 years, median 68) for whom cardio-pulmonary resuscitation (CPR) for OHCA of confirmed cardiac etiology was attempted. RESULTS Of 149 hospitalized individuals, 28.2% survived 1 year and 25.5% survived 3 years after OHCA. In the subgroup of patients with STEMI (26 individuals; 17.5%), 57.7% survived 1 year and 53.9% survived 3 years. In the subgroup of patients without STEMI (n=123), 22% survived 1 year and 19.5% survived 3 years. The strongest predictors for long-term survival by logistic regression analysis were: age under 70 years, ventricular fibrillation as initial rhythm, CPR without atropine, and STEMI. OHCA occurrence at a public place was an indicator of better survival in the subgroup with STEMI. In the subgroup of patients without STEMI, long-term angiotensin-converting enzyme inhibitor treatment, CPR without atropine, a Glasgow Coma Scale upon hospital admission over 3, no presence of cardiogenic shock, and no manifestations of postanoxic encephalopathy (Fisher's exact test, chi(2) test) were indicators of better survival. CONCLUSION Among 560 individuals with "primary cardiac" etiology OHCA and initiation of professional CPR, 8% survived 1 year and 7% survived 3 years. A higher survival rate among patients with STEMI was documented.
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Affiliation(s)
- Miloslav Pleskot
- First Department of Internal Medicine, University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic.
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Utstein style study of cardiopulmonary bypass after cardiac arrest. Am J Emerg Med 2008; 26:649-54. [PMID: 18606315 DOI: 10.1016/j.ajem.2007.09.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 09/27/2007] [Accepted: 09/29/2007] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe the effect emergency cardiopulmonary bypass (CPB) for resuscitation on the survival rate of patients. METHODS The study population was composed of persons 16 years or older who had out-of-hospital cardiac arrest and were transferred to the Sapporo Medical University Hospital from the scene between January 1, 2000, and September 30, 2004. Children younger than 16 years and persons who were dead were excluded. Data were collected according to the Utstein style. Survival rates and cerebral performance category were analyzed using chi(2) analysis for the patients with presumed cardiac etiology. Cardiopulmonary bypass was applied to patients who showed no response with standard advanced cardiac life support. The interval from collapse and other noncardiac etiologies were considered criteria for exclusion. RESULTS Of the 919 patient medical records reviewed, CPB was performed in 92 patients. Of the 919 patients, 398 were of presumed cardiac etiology (n = 66 for CPB), 48 patients survived, and 24 patients (n = 7 for CPB) had a good cerebral outcome (cerebral performance category score 1). With CPB, the rate of survival at 3 months increased significantly (22.7% vs 9.9%, P < .05), but the rate of good cerebral outcome (10.6% vs 5.1%, P = .087) showed a positive trend. CONCLUSION The use of CPB for arrest patients was associated with reduced mortality. It did not increase good neurologic outcome significantly. Still, 7 cases with intact central nervous system would have been lost without CPB.
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Pleskot M, Hazukova R, Stritecka IH, Cermakova E. The Highest Incidence of Out-of-Hospital Cardiac Arrest During a Circadian Period in Survivors. Int Heart J 2008; 49:183-92. [DOI: 10.1536/ihj.49.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Miloslav Pleskot
- 1st Department of Internal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, University Hospital
| | - Radka Hazukova
- 1st Department of Internal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, University Hospital
| | - Ing. Hana Stritecka
- Faculty of Military Health Sciences, University of Defence in Hradec Kralove
| | - Eva Cermakova
- Computer Technology Center, Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University in Prague
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Pleskot M, Babu A, Hazukova R, Stritecky J, Bis J, Matejka J, Cermakova E. Out-of-hospital cardiac arrests in patients with acute ST elevation myocardial infarctions in the East Bohemian region over the period 2002-2004. Cardiology 2007; 109:41-51. [PMID: 17627108 DOI: 10.1159/000105325] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 11/05/2006] [Indexed: 01/19/2023]
Abstract
BACKGROUND Early reperfusion by direct percutaneous coronary intervention (PCI) in patients with ST segment elevation acute myocardial infarctions (STEMI) with an out-of-hospital cardiac arrest (OHCA) reduces hospital and longterm mortality. AIMS Evaluating the significance of direct PCI for the short-term (discharge from acute hospitalization) and 1-year survival in patients with acute STEMI after OHCA. METHODS In this prospective study, from April 1, 2002 up to August 31, 2004, a total of 26 hospitalized individuals (22 men, 4 women, aged 35-79 years, median 58.5) from the East Bohemian region with OHCA (primary group of 718 individuals) with acute STEMI were included. Urgent coronary angiography was performed in 20 individuals, and direct PCI was done in 19 of them. The remaining 6 patients did not undergo angiography. RESULTS Fifteen patients (57.7%) survived acute hospitalization, of whom 11 were without neurological deficits. In the subgroup with urgent coronary angiography 14 patients (70%) survived hospitalization, and in the subgroup without coronarography only 1 patient survived hospitalization (16.7%). In the subgroup with PCIs, 13 out of the 19 patients survived (68.4%). None of the patients died during the 1-year follow-up after being discharged from acute hospitalization. According to the urgent coronarography the artery most commonly responsible for the infarction was the left anterior descending artery (50%). Initial TIMI flow grade 0-I was found in 17 patients and grade II-III in 3 individuals. After PCI, irrespective of stent implantation, an optimal angiographic success (TIMI flow grade II-III) was obtained in 17 cases. CONCLUSION Short-term survival of patients after OHCA with STEMI treated with direct PCI was found to be 68.4%. Out of 6 patients not receiving reperfusion therapy 1 survived (16.7%). Over the course of the 1-year follow-up none of the patients died.
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Affiliation(s)
- Miloslav Pleskot
- 1st Department of Internal Medicine, University Hospital, Hradec Kralove, Czech Republic
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Pleskot M, Hazukova R, Stritecka H. Survival of patients with left bundle-branch block after out-of-hospital cardiac arrest. Resuscitation 2006; 71:396-8. [PMID: 17069950 DOI: 10.1016/j.resuscitation.2006.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 08/01/2006] [Accepted: 08/01/2006] [Indexed: 11/23/2022]
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In this issue. Resuscitation 2006. [DOI: 10.1016/j.resuscitation.2006.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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