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Yin RT, Berve PO, Skaalhegg T, Elola A, Taylor TG, Walker RG, Aramendi E, Chapman FW, Wik L. Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest. Resuscitation 2024; 201:110311. [PMID: 38992561 DOI: 10.1016/j.resuscitation.2024.110311] [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: 05/24/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND AIMS Chest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest. METHODS We analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015-2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression. RESULTS We included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R2: 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively). CONCLUSIONS ABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration.
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Affiliation(s)
- Rose T Yin
- Stryker Emergency Care, Redmond, WA 98052, USA
| | - Per Olav Berve
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Doctor Car 119, Air Ambulance Department, Division of Prehospital Care, Oslo University Hospital, Oslo, Norway
| | - Tore Skaalhegg
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Andoni Elola
- BioRes Group, Department of Electronic Technology, University of the Basque Country (UPV/EHU), Eibar, Spain
| | | | | | - Elisabete Aramendi
- BioRes Group, Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | | | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Doctor Car 119, Air Ambulance Department, Division of Prehospital Care, Oslo University Hospital, Oslo, Norway.
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Koller AC, Salcido DD, Genbrugge C, Menegazzi JJ. Sudden Electrocardiogram Rhythm Changes after Return of Spontaneous Circulation in Porcine Models of Out-of-Hospital Cardiac Arrest: A Phenomenological Report. PREHOSP EMERG CARE 2022; 28:87-91. [PMID: 36193987 PMCID: PMC10123171 DOI: 10.1080/10903127.2022.2132333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Observation of the electrocardiogram (ECG) immediately following return of spontaneous circulation (ROSC) in resuscitated swine has revealed the interesting phenomenon of sudden ECG rhythm changes (SERC) that occur in the absence of pharmacological, surgical, or other medical interventions. OBJECTIVE We sought to identify, quantify, and characterize post-ROSC SERC in successfully resuscitated swine. METHODS We reviewed all LabChart data from resuscitated approximately 4- to 6-month-old swine used for various experimental protocols from 2006 to 2019. We identified those that achieved sustained ROSC and analyzed their entire post-ROSC periods for evidence of SERC in the ECG, and arterial and venous pressure tracings. Presence or absence of SERC was confirmed independently by two reviewers (ACK, DDS). We measured the interval from ROSC to first SERC, analyzed the following metrics, and calculated the change from 60 sec pre-SERC (or from ROSC if less than 60 sec) to 60 sec post-SERC: heart rate, central arterial pressure (CAP), and central venous pressure (CVP). RESULTS A total of 52 pigs achieved and sustained ROSC. Of these, we confirmed at least one SERC in 25 (48.1%). Two pigs (8%) each had two unique SERC events. Median interval from ROSC to first SERC was 3.8 min (inter-quartile range 1.0-6.9 min; range 16 sec to 67.5 min). We observed two distinct types of SERC: type 1) the post-SERC heart rate and arterial pressure increased (72% of cases); and type 2) the post-SERC heart rate and arterial pressure decreased (28% of cases). For type 1 cases, the mean (standard deviation [SD]) heart rate increased by 33.6 (45.7) beats per minute (bpm). The mean (SD) CAP increased by 20.6 (19.2) mmHg. For type 2 cases, the mean (SD) heart rate decreased by 39.7 (62.3) bpm. The mean (SD) CAP decreased by 21.9 (15.6) mmHg. CONCLUSIONS SERC occurred in nearly half of all cases with sustained ROSC and can occur multiple times per case. First SERC most often occurred within the first 4 minutes following ROSC. Heart rate, CAP, and CVP changed at the moment of SERC. We are proceeding to examine whether this phenomenon occurs in humans post-cardiac arrest and ROSC.
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Affiliation(s)
- Allison C. Koller
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
| | - David D. Salcido
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
| | | | - James J. Menegazzi
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
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Khan UR, Khudadad U, Baig N, Ahmed F, Raheem A, Hisam B, Khan NU, Hock MOE, Razzak JA. Out of hospital cardiac arrest: experience of a bystander CPR training program in Karachi, Pakistan. BMC Emerg Med 2022; 22:93. [PMID: 35659187 PMCID: PMC9164717 DOI: 10.1186/s12873-022-00652-2] [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: 03/08/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan.
Methods
Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR.
Results
The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p < 0.001) from pre-test [47.8/100, Standard Deviation (SD) ±13.4] to post-test (70.2/100, SD ±12.1). Mean CPR knowledge after 6 months (retention) reduced slightly from (70.2/100, ±12.1) to (66.5/100, ±10.8). CPR skill retention for various components (check for scene safety, check for response, check for breathing and correct placement of the heel of hands) deteriorated significantly (p < 0.001) from 77.9% in the post-test to 72.8% in re-test. Participants performed slightly better on achieving an adequate rate of chest compressions from 73.1% in post-test to 76.7% in re-test (p 0.27).
Conclusion
Community members with non-health backgrounds can learn and retain CPR skills, allowing them to be effective bystander CPR providers in OHCA situations. We recommend mass population training in Pakistan for CPR to increase survival from OHCA.
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4
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Hagberg G, Ihle-Hansen H, Sandset EC, Jacobsen D, Wimmer H, Ihle-Hansen H. Long Term Cognitive Function After Cardiac Arrest: A Mini-Review. Front Aging Neurosci 2022; 14:885226. [PMID: 35721022 PMCID: PMC9204346 DOI: 10.3389/fnagi.2022.885226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide. With better pre- and inhospital treatment, including cardiopulmonary resuscitation (CPR) as an integrated part of public education and more public-access defibrillators available, OHCA survival has increased over the last decade. There are concerns, after successful resuscitation, of cerebral hypoxia and degrees of potential acquired brain injury with resulting poor cognitive functioning. Cognitive function is not routinely assessed in OHCA survivors, and there is a lack of consensus on screening methods for cognitive changes. This narrative mini-review, explores available evidence on hypoxic brain injury and long-term cognitive function in cardiac arrest survivors and highlights remaining knowledge deficits.
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5
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Roh SY, Choi JI, Park SH, Kim YG, Shim J, Kim JS, Han KD, Kim YH. The 10-Year Trend of Out-of-hospital Cardiac Arrests: a Korean Nationwide Population-Based Study. Korean Circ J 2021; 51:866-874. [PMID: 34595855 PMCID: PMC8484994 DOI: 10.4070/kcj.2021.0127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 01/31/2023] Open
Abstract
We aimed to evaluate the epidemiologic features and outcomes of non-traumatic out-of-hospital cardiac arrest (OHCA) on the basis of nationwide population-based data from Korean National Health Insurance System. This study showed the incidence of OHCA in Korea had increased during the last decade (48.2 per 100,000 person-years in 2008 to 66.7 in 2017). Coronary artery disease was the main cause (59.8%). The 1-year mortality rate tended to decline steadily. Despite the advances in medical care system, the incidence of OHCA has increased and mortality rate was still high. Background and Objectives It is crucial to understand the exact public health burden of out-of-hospital cardiac arrest (OHCA) cases; this is presently unknown since sufficient episodes are not reported in registry studies. We aimed to evaluate the epidemiologic features and outcomes of non-traumatic OHCA. Methods During January 2008 to December 2017, we enrolled 387,665 patients who had been assigned a code for sudden cardiac arrest or had undergone cardiopulmonary resuscitation in the emergency room using the Korean National Health Insurance Service database. Those whose arrest was of non-cardiac origin were excluded. Results The incidence of OHCA per 100,000 patients increased steadily from 48.2 in 2008 to, 53.8 in 2011, 60.1 in 2014, and 66.7 in 2017, with a 1-year survival rate of 8.2%. Age and sex-adjusted mortality rates showed a decreasing trend. The hazard ratio was 1.0015 in 2009, 0.9865 in 2012, 0.9769 in 2015, and 0.9629 in 2017 (p for trend <0.0001), with coronary artery disease-related OHCA accounting for 59.8% of the total. Subgroups with coronary artery disease-related OHCA were more likely to be older and have a higher prevalence of all related comorbidities, excluding malignancy, than those with non-coronary artery disease-related OHCA. Conclusions This nationwide population-based study showed that the incidence of OHCA in Korea had increased during the last decade. The post OHCA 1-year mortality rate showed a poor outcome but improved gradually.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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7
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Wimmer H, Lundqvist C, Šaltytė Benth J, Stavem K, Andersen GØ, Henriksen J, Drægni T, Sunde K, Nakstad ER. Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up study. Resuscitation 2021; 162:372-380. [PMID: 33571604 DOI: 10.1016/j.resuscitation.2021.01.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/14/2020] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but data several years after the arrest are lacking. We assessed long-term HRQoL in OHCA survivors and how known outcome predictors impact HRQoL. METHODS In adult OHCA survivors, HRQoL was assessed five years post arrest using Short-form 36 (SF-36), EQ-5D-3 L (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) among others. Results were compared to the next of kins' estimates and to a Norwegian reference population. RESULTS Altogether 96 survivors were included mean 5.3 (range 3.6-7.2) years after OHCA. HRQoL compared well to the reference population, except for lower score for general health with 67.2 (95%CI (62.1; 72.3) vs. 72.9 (71.9; 74.0)), p = 0.03. Younger (≤58 years) vs. older survivors scored lower for general health with mean (SD) of 62.1 (27.5) vs. 73.0 (19.5), p = 0.03, vitality (55.2 (20.5) vs. 64.6 (17.3), p = 0.02, social functioning (75.3 (28.7) vs. 94.1 (13.5), p < 0.001 and mental component summary (49.0 (9.9) vs. 55.8 (6.7), p < 0.001. They scored higher for HADS-anxiety (4.8 (3.6 vs. 2.7 (2.5), p = 0.001, and had lower EQ-5D index (0.72 (0.34) vs. 0.84 (0.19), p = 0.04. Early vs. late awakeners had higher EQ-5D index (0.82 (0.23) vs. 0.71 (0.35), p = 0.04 and lower HADS-depression scores (2.5 (2.9) vs. 3.8 (2.3), p = 0.04. Next of kin estimated HRQoL similar to the survivors' own estimates. CONCLUSIONS HRQoL five years after OHCA was good and mainly comparable to a matched reference population. Stratified analyses revealed impaired HRQoL among younger survivors and those awakening late, mainly for mental domains.
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Affiliation(s)
- Henning Wimmer
- Department of Acute Medicine, Oslo University Hospital, Ullevål, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Norway; Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Norway
| | - Geir Ø Andersen
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Julia Henriksen
- Department of Neurology, Oslo University Hospital, Ullevål, Norway
| | - Tomas Drægni
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Research and Development, Oslo University Hospital, Ullevål, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Ullevål, Norway
| | - Espen R Nakstad
- Department of Acute Medicine, Oslo University Hospital, Ullevål, Norway
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Yoshimura S, Hirayama A, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Inoue T, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Okada Y, Nishioka N, Kobayashi D, Matsui S, Kimata S, Shimazu T, Kitamura T, Iwami T. Trends in In-Hospital Advanced Management and Survival of Out-of-Hospital Cardiac Arrest Among Adults From 2013 to 2017 - A Multicenter, Prospective Registry in Osaka, Japan. Circ J 2021; 85:1851-1859. [PMID: 33536400 DOI: 10.1253/circj.cj-20-1022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of our study was to investigate in detail the temporal trends in in-hospital characteristics, actual management, and survival, including neurological status, among adult out-of-hospital cardiac arrest (OHCA) patients in recent years.Methods and Results:From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all OHCA patients aged ≥18 years for whom resuscitation was attempted, and who were transported to participating hospitals between the years 2013 and 2017. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. Temporal trends in in-hospital management and favorable neurological outcome among adult OHCA patients were assessed. Of the 11,924 patients in the database, we included a total of 10,228 adult patients from 16 hospitals. As for in-hospital advanced treatments, extracorporeal cardiopulmonary resuscitation (ECPR) use increased from 2.4% in 2013 to 4.3% in 2017 (P for trend <0.001). However, the proportion of adult OHCA patients with favorable neurological outcome did not change during the study period (from 5.7% in 2013 to 4.4% in 2017, adjusted odds ratio (OR) for 1-year increment: 0.98 (95% confidence interval: 0.94-1.23)). CONCLUSIONS In this target population, in-hospital management such as ECPR increased slightly between 2013 and 2017, but 1-month survival with favorable neurological outcome after adult OHCA did not improve significantly.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Takeyuki Kiguchi
- Department of Preventive Services, Kyoto University School of Public Health.,Critical Care and Trauma Center, Osaka General Medical Center
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital
| | | | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine
| | | | | | | | | | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health
| | | | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health
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9
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Rhee BY, Kim B, Lee YH. Effects of Prehospital Factors on Survival of Out-Of-Hospital Cardiac Arrest Patients: Age-Dependent Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155481. [PMID: 32751367 PMCID: PMC7432520 DOI: 10.3390/ijerph17155481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Many prehospital factors that are known to influence survival rates after out-of-hospital cardiac arrest (OHCA) have been rarely studied as to how their influence varies depending on the age. In this study, we tried to find out what prehospital factors affect the survival rate after OHCA by age groups and how large the effect size of those factors is in each age group. We used the South Korean OHCA registry, which includes information on various prehospital factors relating OHCA and final survival status. The association between prehospital factors and survival was explored through logistic regression analyses for each age group. The effects of prehospital factors vary depending on the patient’s age. Being witnessed was relatively more influential in younger patients and the presence of first responders became more important as patients became older. While bystander cardiopulmonary resuscitation (CPR) did not appear to significantly affect survival in younger people, use of an automated external defibrillator (AED) showed the largest effect size on the survival in all age groups. Since the pathophysiology and etiologies of OHCA vary according to age, more detailed information on life support by age is needed for the development and application of more specialized protocols for each age.
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Affiliation(s)
- Bo Yoon Rhee
- Korea Centers for Disease Control and Prevention, Cheongju 28160, Korea; (B.Y.R.); (B.K.)
| | - Boram Kim
- Korea Centers for Disease Control and Prevention, Cheongju 28160, Korea; (B.Y.R.); (B.K.)
| | - Yo Han Lee
- Graduate School of Public Health, Ajou University, Suwon 16499, Korea
- Correspondence:
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Chien CY, Tsai SL, Tsai LH, Chen CB, Seak CJ, Weng YM, Lin CC, Ng CJ, Chien WC, Huang CH, Lin CY, Chaou CH, Liu PH, Tseng HJ, Fang CT. Impact of Transport Time and Cardiac Arrest Centers on the Neurological Outcome After Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study. J Am Heart Assoc 2020; 9:e015544. [PMID: 32458720 PMCID: PMC7429006 DOI: 10.1161/jaha.119.015544] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Should all out‐of‐hospital cardiac arrest (OHCA) patients be directly transported to cardiac arrest centers (CACs) remains under debate. Our study evaluated the impacts of different transport time and destination hospital on the outcomes of OHCA patients. Methods and Results Data were collected from 6655 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City, Taiwan, between January 2012 and December 2016. Patients were matched on propensity score, which left 5156 patients, 2578 each in the CAC and non‐CAC groups. Transport time was dichotomized into <8 and ≥8 minutes. The relations between the transport time to CACs and good neurological outcome at discharge and survival to discharge were investigated. Of the 5156 patients, 4215 (81.7%) presented with nonshockable rhythms and 941 (18.3%) presented with shockable rhythms. Regardless of transport time, transportation to a CAC increased the likelihoods of survival to discharge (<8 minutes: adjusted odds ratio [aOR], 1.95; 95% CI, 1.11–3.41; ≥8 minutes: aOR, 1.92; 95% CI, 1.25–2.94) and good neurological outcome at discharge (<8 minutes: aOR, 2.70; 95% CI, 1.40–5.22; ≥8 minutes: aOR, 2.20; 95% CI, 1.29–3.75) in OHCA patients with shockable rhythms but not in patients with nonshockable rhythms. Conclusions OHCA patients with shockable rhythms transported to CACs demonstrated higher probabilities of survival to discharge and a good neurological outcome at discharge. Direct ambulance delivery to CACs should thus be considered, particularly when OHCA patients present with shockable rhythms.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Taoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Wei-Che Chien
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Taoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
| | - Cheng-Yu Lin
- Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics Unit Clinical Trial Center Chang Gung Memorial Hospital Linkou Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
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Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST). Resuscitation 2020; 149:170-179. [DOI: 10.1016/j.resuscitation.2019.12.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
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13
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Anderson NE, Slark J, Gott M. When resuscitation doesn’t work: A qualitative study examining ambulance personnel preparation and support for termination of resuscitation and patient death. Int Emerg Nurs 2020; 49:100827. [DOI: 10.1016/j.ienj.2019.100827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022]
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Postresuscitation Care after Out-of-hospital Cardiac Arrest: Clinical Update and Focus on Targeted Temperature Management. Anesthesiology 2020; 131:186-208. [PMID: 31021845 DOI: 10.1097/aln.0000000000002700] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post-cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.
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Trepa M, Bastos S, Fontes-Oliveira M, Costa R, Dias-Frias A, Luz A, Dias V, Santos M, Torres S. Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study. J Crit Care Med (Targu Mures) 2020; 6:41-51. [PMID: 32104730 PMCID: PMC7029411 DOI: 10.2478/jccm-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/29/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Recovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality. METHODS Retrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included. RESULTS 60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH<7.25mmol/L and lactates >4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH<7.35 at 24h, lactates>2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn't significantly correlate to the outcome. CONCLUSION Classic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients's subset.
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Affiliation(s)
- Maria Trepa
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Samuel Bastos
- Universidade do Porto Instituto de Ciencias Biomedicas Abel Salazar, Porto, Portugal
| | | | - Ricardo Costa
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | | | - André Luz
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Vasco Dias
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Mário Santos
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
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Noel L, Jaeger D, Baert V, Debaty G, Genin M, Sadoune S, Bassand A, Tazarourte K, Gueugniaud PY, El Khoury C, Hubert H, Chouihed T. Effect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: Adjusted results from the French National Cardiac Arrest Registry. Resuscitation 2019; 144:91-98. [PMID: 31499101 DOI: 10.1016/j.resuscitation.2019.08.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022]
Abstract
AIM Cardiac arrest (CA) was considered irreversible until 1960, when basic cardiopulmonary resuscitation (CPR) was defined. CPR guidelines include early recognition of CA, rapid and effective CPR, effective defibrillation strategies and organized post-resuscitation to ensure a strengthening of the survival chain. Bystanders are the key to extremely early management, which is associated with the early medical care provided by EMS. This study aims to assess the prognosis of a bystander's cardiac CPR when it is initiated by the Dispatch Centre (DC). METHODS We included patients in 3 groups according to who initiated the CPR. The groups were matched according to multiple propensity partition methods. We presented our results in terms of 30-day survival and neurological prognosis. RESULTS 85,634 patients were included. Statistical study focused on 18,185 patients once the exclusion criteria were applied. 12,743 (70.1%) are men and the average age is 70.1 years. Survival at D30 was 5.11% in the absence of CPR, 8.86% with bystander initiation and 7.35% with DC initiation (p < 0.001). Survival at D30 with favourable neurologic prognosis (CPC 1-2) was 76.30%, 83.69% and 82.82%, respectively. Our results show a 3.75% increase in the chance of survival at D30 if CPR was initiated by bystanders compared to patients for whom CPR was not initiated, a 2.25% increase in survival in the group that received from CPR initiated by the DC compared to the group that did not receive CPR. CONCLUSIONS Bystander CPR initiated by the DC represents a suitable option following out-of-hospital cardiac arrest.
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Affiliation(s)
- Lucile Noel
- Emergency Department, University Hospital of Nancy, France
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, France; INSERM, Clinical Investigation Center - Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France
| | - Valentine Baert
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Guillaume Debaty
- University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France
| | - Michael Genin
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Sonia Sadoune
- Emergency Department, University Hospital of Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, France
| | - Karim Tazarourte
- Emergency "URMARS" Pole, Edouard Herriot Hospital Group, HCL, Lyon, France; Health Services and Performance Research, HESPER, EA7425, Claude Bernard University, Lyon 1, France
| | - Pierre-Yves Gueugniaud
- French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France; Emergency "URMARS" Pole, Edouard Herriot Hospital Group, HCL, Lyon, France
| | - Carlos El Khoury
- Health Services and Performance Research, HESPER, EA7425, Claude Bernard University, Lyon 1, France; Emergency Department and RESCUe Network, Lucien Hussel Hospital, France
| | - Hervé Hubert
- Univ. Lille, CHU Lille, EA2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, France; INSERM, Clinical Investigation Center - Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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17
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Rakun A, Allen J, Shahidah N, Ng YY, Leong BSH, Gan HN, Mao D, Chia MYC, Cheah SO, Tham LP, Ong MEH. Ethnic and Neighborhood Socioeconomic Differences In Incidence and Survival From Out-Of-Hospital Cardiac Arrest In Singapore. PREHOSP EMERG CARE 2019; 23:619-630. [PMID: 30582395 DOI: 10.1080/10903127.2018.1558317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: We aimed to examine the association of ethnicity and socioeconomic status (SES) with Out-of-Hospital Cardiac Arrest (OHCA) incidence and 30-day survival in Singapore. Methods: We analyzed the Singapore cohort of Pan-Asia Resuscitation Outcome Study (PAROS), a multi-center, prospective OHCA registry between 2010 and 2015. The Singapore Socioeconomic Disadvantage Index (SEDI) score, obtained according to zip code, was used as surrogate for neighborhood SES. Age-adjusted OHCA incidence and Utstein survival were calculated by ethnicity and SES. Utstein survival was defined as the number of cardiac OHCA cases with initial rhythm of ventricular fibrillation witnessed by a bystander who survived 30-days or until hospital discharge. Logistic regression was used to investigate association of ethnicity with 30-day and Utstein survivals. Results: Our study population comprised 8,900 patients: 6,453 Chinese, 1,472 Malays, and 975 Indians. The overall age-adjusted incidence ratios (95% CI) for Malay/Chinese and Indian/Chinese were 1.93 (1.83-2.04) and 1.95 (1.83-2.08), respectively. The overall age-adjusted incidence ratios (95% CI) for average/low and high/low SEDI group were 1.12 (0.95-1.33) and 1.29 (1.08-1.53), respectively. Malay showed lesser Utstein survival of 8.1% compared to Chinese (14.6%) and Indian (20.4%) [p = 0.018]. Ethnicity did not reach statistical significance (p = 0.072) in forward selection model of Utstein survival, while SEDI score and category were not significant (p > 0.2 and p = 0.349). Conclusions: We found Malay and Indian communities to be at higher risks of OHCA compared to Chinese, and additionally, the Malay community is at higher risk of subsequent mortality than the Chinese and Indian communities. These disparities were not explained by neighborhood SES.
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McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI, Lotfipour S, Chakravarthy B. Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation. West J Emerg Med 2019; 20:15-22. [PMID: 30643596 PMCID: PMC6324716 DOI: 10.5811/westjem.2018.11.39040] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Most medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR. METHODS This was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual. RESULTS Students in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30-4.82]) for SIM and 3.89 cm (95% CI [3.50-4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699-0.751]) for SIM group and 0.679 (95% CI [0.655-0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7-40.8]) for SIM group and 79.5 s (95% CI [44.8-119.6]) for STD group, p=0.007. CONCLUSION High-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.
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Affiliation(s)
- C Eric McCoy
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Asif Rahman
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Juan C Rendon
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Craig L Anderson
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Mark I Langdorf
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Shahram Lotfipour
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Bharath Chakravarthy
- University of California Irvine School of Medicine, Department of Emergency Medicine, Irvine, California
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Cho KH, Park JH, Moon SW, Yun SK, Kim JY. Effect of a multi-tiered dispatch system on out-of-hospital cardiac arrest patients: preliminary report from the Gyeonggi province, South Korea. Clin Exp Emerg Med 2018; 5:144-149. [PMID: 30269450 PMCID: PMC6166042 DOI: 10.15441/ceem.17.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/16/2017] [Indexed: 12/02/2022] Open
Abstract
Objective In South Korea, the Gyeonggi Fire Services introduced a multi-tiered dispatch system for out-of-hospital cardiac arrest (OHCA) cases in July 2015. In this study, we investigated whether the multi-tiered dispatch system improved the pre-hospital return of the spontaneous circulation (ROSC) rate. Methods All non-traumatic adult OHCAs treated and transported by the 119 emergency medical system from July 2015 to December 2015 were included in the study. Demographic and pre-hospital Utstein element-data were collected from the emergency medical system OHCA database. The primary outcome was pre-hospital ROSC as measured at the scene. Results Of the included OHCAs, 1,436 (89.0%) were categorized to the single-tiered dispatch group and 162 (10.1%) to the multi-tiered dispatch group. The rate of administration of advanced airway ventilation (61.1% vs. 48.0%, P=0.002) and intravenous access (18.5% vs. 12.5%, P=0.037) was higher in the multi-tiered group compared to that in the single-tiered group. The use of epinephrine was higher in the multi-tiered group (4.9% vs. 1.5%, P=0.002). The pre-hospital ROSC rates in the multi-tiered group were higher when compared with the single-tiered group, but the difference was not significant (10.5% vs. 7.5%, P=0.218). The adjusted odds ratio for pre-hospital ROSC rates in the multi-tiered group was 1.29 (95% confidence interval, 0.69 to 2.40). Conclusion The multi-tiered dispatch system was not associated with a significant increase in the pre-hospital ROSC rate during the early phase of its implementation, even though advanced maneuvers were performed more frequently.
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Affiliation(s)
- Kyung Hune Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sung Woo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong-Keun Yun
- Gyeonggi Provincial Fire and Disaster Headquarters, Suwon, Korea
| | - Jin-Young Kim
- Gyeonggi Provincial Fire and Disaster Headquarters, Suwon, Korea
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Lin Y, Tsai SH, Yang CS, Wu CH, Huang CH, Lin FH, Ku CH, Chung CH, Chien WC, Lai CY, Chu CM. Improved survival of hospitalized patients with cardiac arrest due to coronary heart disease after implementation of post-cardiac arrest care: A population-based study. Medicine (Baltimore) 2018; 97:e12382. [PMID: 30213003 PMCID: PMC6155939 DOI: 10.1097/md.0000000000012382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Post-cardiac arrest care was implemented in 2010 and has been shown to improve the survival of patients with coronary heart disease (CHD). However, the findings varied for different survival conditions.We conducted a retrospective longitudinal study of records from 2007 to 2013 in the National Health Insurance Research Database. We evaluated the differences in short-term (2-day and 7-day) and long-term (30-day and survival to discharge) survival after the implementation of post-cardiac arrest care and among age subgroups. We reviewed inpatient datasets in accordance with the International Classification of Disease Clinical Modification, 9th revision codes (ICD-9-CM). Eligible participants were identified as those with simultaneous diagnoses of cardiac arrest (ICD-9-CM codes: 427.41 or 427.5) and CHD (ICD-9-CM codes: 410-414). Multiple logistic regression was applied to establish the relationship between calendar year and survival outcomes.The odds of 2-day survival from 2011 to 2013 were higher than those from 2007 to 2010 (adjusted odds ratio [aOR]: 1.15; 95% confidence interval [CI]: 1.03-1.29). Similarly, the odds of 7-day survival from 2011 to 2013 were higher than those from 2007 to 2010 (aOR: 1.11; 95% CI: 1.01-1.22). Improvements in the odds of 2-day and 7-day survival were discovered only in patients <65 years old. Our data reinforce that short-term survival improved after implementation of post-cardiac arrest care. However, older age seemed to nullify the influence of post-cardiac arrest care on survival.
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Affiliation(s)
- Yu Lin
- Graduate Institute of Life Sciences
- Department of Nursing, University of Kang Ning
| | | | - Chen-Shu Yang
- Physical Examination Center, Kaohsiung Armed Forces General Hospital Gangshan Branch
| | | | | | | | - Chih-Hung Ku
- School of Public Health
- Department of Health Industry Management, Kainan University, Taoyuan City
| | - Chi-Hsiang Chung
- School of Public Health
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City
| | - Chung-Yu Lai
- Physical Examination Center, Kaohsiung Armed Forces General Hospital Gangshan Branch
| | - Chi-Ming Chu
- Graduate Institute of Life Sciences
- School of Public Health
- Department of Healthcare Administration and Medical Informatics College of Health Sciences, Kaohsiung Medical University
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Srinivasan NT, Schilling RJ. Sudden Cardiac Death and Arrhythmias. Arrhythm Electrophysiol Rev 2018; 7:111-117. [PMID: 29967683 PMCID: PMC6020177 DOI: 10.15420/aer.2018:15:2] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 01/01/2023] Open
Abstract
Sudden cardiac death (SCD) and arrhythmia represent a major worldwide public health problem, accounting for 15-20 % of all deaths. Early resuscitation and defibrillation remains the key to survival, yet its implementation and the access to public defibrillators remains poor, resulting in overall poor survival to patients discharged from hospital. Novel approaches employing smart technology may provide the solution to this dilemma. Though the majority of cases are attributable to coronary artery disease, a thorough search for an underlying cause in cases where the diagnosis is unclear is necessary. This enables better management of arrhythmia recurrence and screening of family members. The majority of cases of SCD occur in patients who do not have traditional risk factors for arrhythmia. New and improved large scale screening tools are required to better predict risk in the wider population who represent the majority of cases of SCD.
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Salam I, Thomsen JH, Kjaergaard J, Bro-Jeppesen J, Frydland M, Winther-Jensen M, Køber L, Wanscher M, Hassager C, Søholm H. Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. SCAND CARDIOVASC J 2018; 52:133-140. [PMID: 29553891 DOI: 10.1080/14017431.2018.1450991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). DESIGN Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI). RESULTS A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. CONCLUSION A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.
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Affiliation(s)
- Idrees Salam
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.,b Department of Anaesthesiology , Central Denmark Regional Hospital Horsens , Horsens , Denmark
| | - Jakob Hartvig Thomsen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Jesper Kjaergaard
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - John Bro-Jeppesen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Martin Frydland
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Matilde Winther-Jensen
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lars Køber
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Michael Wanscher
- c Department of Thoracic Anaesthesiology, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Christian Hassager
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Helle Søholm
- a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.,d Department of Cardiology , Zealand University Hospital , Roskilde , Denmark
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Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. Additionally, we describe how investigators and key stakeholders in resuscitation science have formulated specific Utstein data element domains in an attempt to standardise the definitions and outcomes reported in OHCA research so that management pathways can be improved. Finally, we identify the predictors of survival after OHCA and what primary and secondary prevention strategies can be instigated to mitigate the devastating sequelae of this growing public health issue.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.
| | - Kyoung-Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Thomas Rea
- Division of General Internal Medicine, Harborview Medical Centre, University of Washington, Seattle, WA, USA
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Chang BL, Mercer MP, Bosson N, Sporer KA. Variations in Cardiac Arrest Regionalization in California. West J Emerg Med 2018; 19:259-265. [PMID: 29560052 PMCID: PMC5851497 DOI: 10.5811/westjem.2017.10.34869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/14/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction The development of cardiac arrest centers and regionalization of systems of care may improve survival of patients with out-of-hospital cardiac arrest (OHCA). This survey of the local EMS agencies (LEMSA) in California was intended to determine current practices regarding the treatment and routing of OHCA patients and the extent to which EMS systems have regionalized OHCA care across California. Methods We surveyed all of the 33 LEMSA in California regarding the treatment and routing of OHCA patients according to the current recommendations for OHCA management. Results Two counties, representing 29% of the California population, have formally regionalized cardiac arrest care. Twenty of the remaining LEMSA have specific regionalization protocols to direct all OHCA patients with return of spontaneous circulation to designated percutaneous coronary intervention (PCI)-capable hospitals, representing another 36% of the population. There is large variation in LEMSA ability to influence inhospital care. Only 14 agencies (36%), representing 44% of the population, have access to hospital outcome data, including survival to hospital discharge and cerebral performance category scores. Conclusion Regionalized care of OHCA is established in two of 33 California LEMSA, providing access to approximately one-third of California residents. Many other LEMSA direct OHCA patients to PCI-capable hospitals for primary PCI and targeted temperature management, but there is limited regional coordination and system quality improvement. Only one-third of LEMSA have access to hospital data for patient outcomes.
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Affiliation(s)
- Brian L Chang
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Mary P Mercer
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California
| | - Nichole Bosson
- Los Angeles County Emergency Medical Service Agency, Los Angeles, California.,Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute, Carson, California
| | - Karl A Sporer
- University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California.,Alameda County Emergency Medical Service Agency, Alameda, California
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Aloush S, Tubaishat A, ALBashtawy M, Suliman M, Alrimawi I, Al Sabah A, Banikhaled Y. Effectiveness of Basic Life Support Training for Middle School Students. J Sch Nurs 2018; 35:262-267. [DOI: 10.1177/1059840517753879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bystander cardiopulmonary resuscitation improves survival after out-of-hospital cardiac arrest. This study aimed to assess the effectiveness of a basic life support (BLS) educational course given to 110 middle school children, using a pretest posttest design. In the pretest, students were asked to demonstrate BLS on a manikin to simulate a real-life scenario. After the pretest, a BLS training course of two sessions was provided, followed by posttest on the same manikin. Students were assessed using an observational sheet based on the American Heart Association’s BLS guidelines. In the pretest, students showed significant weakness in the majority of guidelines. In the posttest, they demonstrated significant improvement in their BLS skills. BLS training in the middle school was effective, considering the lack of previous skills. It is recommended that BLS education be compulsory in the school setting.
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Affiliation(s)
- Sami Aloush
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Ahmad Tubaishat
- Faculty of Nursing, Adult Health Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammed ALBashtawy
- Community and Mental Health Department, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammad Suliman
- Community and Mental Health Department, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Ashraf Al Sabah
- Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Kvakkestad KM, Sandvik L, Andersen GØ, Sunde K, Halvorsen S. Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: A prospective cohort study. Resuscitation 2017; 122:41-47. [PMID: 29155294 DOI: 10.1016/j.resuscitation.2017.11.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/04/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022]
Abstract
AIM To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA). METHODS Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons. RESULTS We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n=4522) or non-STEMI (NSTEMI, n=4903). Mean age was 63.6±standard deviation (SD) 12.5, 63.8±13.1 and 69.7±13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR)OHCAvsSTEMI 1.15 [95% CI 0.82-1.60], aHROHCAvsNSTEMI 0.89 [95% CI 0.64-1.24]). CONCLUSIONS Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30days had similar long-term risk as AMI patients without OHCA.
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Affiliation(s)
- Kristin M Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, P.O. Box 1122 Blindern, 0317 Oslo, Norway
| | - Geir Øystein Andersen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway
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Setälä P, Hoppu S, Virkkunen I, Yli-Hankala A, Kämäräinen A. Assessment of futility in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2017; 61:1334-1344. [PMID: 28905989 DOI: 10.1111/aas.12966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out-of-hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility. METHODS We conducted this study using the Utstein template during a 12-month study period. We compared the event characteristics between full and partial resuscitation attempts and determined the incidence, survival and neurological outcome. RESULTS Emergency Medical Services (EMS) attended a total of 314 OHCA cases. In 34 cases, resuscitation was not attempted due to futility. Seventy-four cases were partial resuscitation attempts where resuscitation was soon discontinued due to dismal prognostic factors. Partial attempts were associated with an unwitnessed OHCA, prolonged downtime, end-stage malignant disease, multiple trauma, asystole or pulseless electrical activity as the initial rhythm, and a first responding unit being the first unit on the scene (P < 0.05, respectively). The calculation of survival to hospital discharge rate was 14% and increased 5% when partial resuscitation attempts were excluded from the analysis. Seventy-four percentage had a Cerebral Performance Category 1-2 at hospital discharge. Shockable initial rhythm, public location and bystander CPR had a positive impact on survival. CONCLUSIONS Resuscitative efforts were considered futile in 11% of cases and resuscitation was discontinued due to evidence of futility in additional 24% cases based on additional information. Terminating resuscitation should be identified as a separate subgroup of OHCA cases to better reflect the outcome.
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Affiliation(s)
- P. Setälä
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- FinnHEMS Research and Development Unit; FinnHEMS Ltd; Vantaa Finland
| | - S. Hoppu
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- Department of Intensive Care; Tampere University Hospital; Tampere Finland
| | - I. Virkkunen
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
- FinnHEMS Research and Development Unit; FinnHEMS Ltd; Vantaa Finland
| | - A. Yli-Hankala
- Medical School; University of Tampere; Tampere Finland
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - A. Kämäräinen
- Emergency Medical Service; Tampere University Hospital; Tampere Finland
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Grossestreuer AV, Gaieski DF, Donnino MW, Nelson JIM, Mutter EL, Carr BG, Abella BS, Wiebe DJ. Cardiac arrest risk standardization using administrative data compared to registry data. PLoS One 2017; 12:e0182864. [PMID: 28783754 PMCID: PMC5544239 DOI: 10.1371/journal.pone.0182864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data. METHODS AND RESULTS Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death at hospital discharge. The registry model was considered the "gold standard" with which to compare the administrative model, using metrics including comparing areas under the curve, calibration curves, and Bland-Altman plots. The administrative risk standardization model had a c-statistic of 0.891 (95% CI: 0.876-0.905) compared to a registry c-statistic of 0.907 (95% CI: 0.895-0.919). When limited to only non-modifiable factors, the administrative model had a c-statistic of 0.818 (95% CI: 0.799-0.838) compared to a registry c-statistic of 0.810 (95% CI: 0.788-0.831). All models were well-calibrated. There was no significant difference between c-statistics of the models, providing evidence that valid risk standardization can be performed using administrative data. CONCLUSIONS Risk standardization using administrative data performs comparably to standardization using registry data. This methodology represents a new tool that can enable opportunities to compare hospital performance in specific hospital systems or across the entire US in terms of survival after CA.
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Affiliation(s)
- Anne V. Grossestreuer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - David F. Gaieski
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Joshua I. M. Nelson
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Eric L. Mutter
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Brendan G. Carr
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Benjamin S. Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas J. Wiebe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Impact of in or out of office hours at admission time on outcome in out-of-hospital cardiac arrest patients. Eur J Emerg Med 2017; 24:249-254. [DOI: 10.1097/mej.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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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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Bundgaard K, Hansen SM, Mortensen RN, Wissenberg M, Hansen M, Lippert F, Gislason G, Køber L, Nielsen J, Torp-Pedersen C, Rasmussen BS, Kragholm K. Association between bystander cardiopulmonary resuscitation and redeemed prescriptions for antidepressants and anxiolytics in out-of-hospital cardiac arrest survivors. Resuscitation 2017; 115:32-38. [DOI: 10.1016/j.resuscitation.2017.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/22/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
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Sunde K, Callaway CW. Extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest - to whom and when, that's the difficult question! Acta Anaesthesiol Scand 2017; 61:369-371. [PMID: 28251604 DOI: 10.1111/aas.12873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- K. Sunde
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - C. W. Callaway
- Department of Emergency Medicine; University of Pittsburgh; Pittsburgh PA USA
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35
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Ošťádal P, Rokyta R, Balík M, Bělohlávek J, Cvachovec K, Černý V, Dostál P, Janota T, Kala P, Matějovič M, Pařenica J, Šeblová J, Škulec R, Šrámek V, Truhlář A. Cardiac Arrest Centers. Joint Statement of Czech Professional Societies: Czech Acute Cardiac Care Association of the Czech Society of Cardiology, Czech Resuscitation Council, Czech Society of Intensive Care Medicine ČLS JEP, Czech Society of Anesthesiology, Resuscitation and Intensive Care Medicine ČLS JEP, and Society for Emergency and Disaster Medicine ČLS JEP. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bakke HK, Steinvik T, Angell J, Wisborg T. A nationwide survey of first aid training and encounters in Norway. BMC Emerg Med 2017; 17:6. [PMID: 28228110 PMCID: PMC5322636 DOI: 10.1186/s12873-017-0116-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Bystander first aid can improve survival following out-of-hospital cardiac arrest or trauma. Thus, providing first aid education to laypersons may lead to better outcomes. In this study, we aimed to establish the prevalence and distribution of first aid training in the populace, how often first aid skills are needed, and self-reported helping behaviour. Methods We conducted a telephone survey of 1000 respondents who were representative of the Norwegian population. Respondents were asked where and when they had first aid training, if they had ever encountered situations where first aid was necessary, and stratified by occupation. First aid included cardio-pulmonary resuscitation (CPR) and basic life support (BLS). To test theoretical first aid knowledge, respondents were subjected to two hypothetical first aid scenarios. Results Among the respondents, 90% had received first aid training, and 54% had undergone first aid training within the last 5 years. The workplace was the most common source of first aid training. Of the 43% who had been in a situation requiring first aid, 89% had provided first aid in that situation. There were considerable variations among different occupations in first aid training, and exposure to situations requiring first aid. Theoretical first aid knowledge was not as good as expected in light of the high share who had first aid training. In the presented scenarios 42% of respondent would initiate CPR in an unconscious patient not breathing normally, and 46% would provide an open airway to an unconscious road traffic victim. First aid training was correlated with better theoretical knowledge, but time since first aid training was not. Conclusions A high proportion of the Norwegian population had first aid training, and interviewees reported high willingness to provide first aid. Theoretical first aid knowledge was worse than expected. While first aid is part of national school curriculum, few have listed school as the source for their first aid training. Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0116-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Håkon Kvåle Bakke
- Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. .,Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway. .,Department of Anaesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway.
| | - Tine Steinvik
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway
| | - Johan Angell
- Lawyers Leiros & Olsen AS, Tromsø, Norway.,Faculty of Law, University of Tromsø, Tromsø, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, 9037, Tromsø, Norway.,Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Salciccioli JD, Marshall DC, Sykes M, Wood AD, Joppa SA, Sinha M, Lim PB. Basic life support education in secondary schools: a cross-sectional survey in London, UK. BMJ Open 2017; 7:e011436. [PMID: 28062467 PMCID: PMC5223627 DOI: 10.1136/bmjopen-2016-011436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Basic life support (BLS) training in schools is associated with improved outcomes from cardiac arrest. International consensus statements have recommended universal BLS training for school-aged children. The current practice of BLS training in London schools is unknown. The aim of this study was to assess current practices of BLS training in London secondary schools. SETTING, POPULATION AND OUTCOMES A prospective audit of BLS training in London secondary schools was conducted. Schools were contacted by email, and a subsequent telephone interview was conducted with staff familiar with local training practices. Response data were anonymised and captured electronically. Universal training was defined as any programme which delivers BLS training to all students in the school. Descriptive statistics were used to summarise the results. RESULTS A total of 65 schools completed the survey covering an estimated student population of 65 396 across 19 of 32 London boroughs. There were 5 (8%) schools that provide universal training programmes for students and an additional 31 (48%) offering training as part of an extracurricular programme or chosen module. An automated external defibrillator (AED) was available in 18 (28%) schools, unavailable in 40 (61%) and 7 (11%) reported their AED provision as unknown. The most common reasons for not having a universal BLS training programme are the requirement for additional class time (28%) and that funding is unavailable for such a programme (28%). There were 5 students who died from sudden cardiac arrest over the period of the past 10 years. CONCLUSIONS BLS training rates in London secondary schools are low, and the majority of schools do not have an AED available in case of emergency. These data highlight an opportunity to improve BLS training and AEDs provision. Future studies should assess programmes which are cost-effective and do not require significant amounts of additional class time.
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Affiliation(s)
| | | | | | | | | | | | - P Boon Lim
- Department of Cardiology, Hammersmith Hospital, LondonUK
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Bae J, Oh J, Lee S, Lim TH, Kang H, Lee J. Analysis of the Performance for Bystanders’ Cardiopulmonary Resuscitation in Geriatric and Out-of-Hospital Cardiac Arrested Patients. Ann Geriatr Med Res 2016. [DOI: 10.4235/agmr.2016.20.3.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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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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Mawani M, Kadir MM, Azam I, Mehmood A, McNally B, Stevens K, Nuruddin R, Ishaq M, Razzak JA. Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study. BMC Emerg Med 2016; 16:28. [PMID: 27465304 PMCID: PMC4963996 DOI: 10.1186/s12873-016-0093-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 07/21/2016] [Indexed: 12/04/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country. Methods We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a structured questionnaire. All patients ≥18 years of age, presenting with OHCA of cardiac origin, were included. Patients with do-not-resuscitate status or referred from other hospitals were excluded. Our primary outcome was survival of OHCA patients at the end of ED stay. Results During the three month period, data was obtained from 310 OHCA patients. The overall survival to ED discharge was 1.6 % which decreased to 0 % at 2-months after discharge. More than half (58.3 %) of these OHCA patients were brought to the hospital in a non-EMS (emergency medical service) vehicle i.e. public or private transportation. Patients utilizing non-EMS transportation reached the hospital earlier with a median time of 23 min compared to patients utilizing any type of ambulances which had a delay of 7 min hospital reaching time (median time 30 min). However, patients utilizing ambulances with life-support facilities, as compared to all other types of pre-hospital transportation, had the shortest time to first life-support intervention (15 min). Most of the patients (92.9 %) had a witnessed cardiac arrest out of which only a small percentage (2.3 %) received bystander CPR (cardio pulmonary resuscitation). Median time from arrest to receiving first CPR was 20 min. Only 1 % of patients were found to have a shockable rhythm on first assessment. Conclusion This study showed that the overall survival of OHCA is null in this population. Lack of bystander CPR and weaker emergency medical services (EMS) leading to a delay in receiving life-support interventions were some of the important observations. Poor survival emphasizes the need to standardize EMS systems, initiate public awareness programs and strengthen links in the chain of survival. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0093-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minaz Mawani
- Department of Medicine, Aga Khan University, First floor, Faculty Offices Building, Stadium road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | | | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Amber Mehmood
- International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan McNally
- Emory University School of Medicine & Rollins School of Public Health, Atlanta, GA, USA
| | - Kent Stevens
- Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rozina Nuruddin
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mohammad Ishaq
- Department of Medicine, Aga Khan University, First floor, Faculty Offices Building, Stadium road, P.O. Box 3500, Karachi, 74800, Pakistan.,Karachi Institute of Heart Diseases, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University & Aman Health, Aman Foundation, Karachi, Pakistan
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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-Hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest: A Nationwide Database Study. Crit Care Med 2016; 44:488-95. [PMID: 26496447 DOI: 10.1097/ccm.0000000000001401] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the change in provision of therapeutic hypothermia and coronary intervention (postresuscitation care) over time and to clarify the association between these provisions and in-hospital mortality in patients with out-of-hospital cardiac arrest. DESIGN A nationwide retrospective cohort study using multiple propensity score analyses. SETTING Japanese Diagnosis Procedure Combination inpatient database. PATIENTS Adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation were identified from July to December in 2008-2012 (385 hospitals; n = 3,413). MEASUREMENTS AND MAIN RESULTS We evaluated the proportion of patients receiving postresuscitation care and all-cause mortality at 30 days after out-of-hospital cardiac arrest. The proportion of postresuscitation care provision increased significantly over the study period (Mantel-Haenszel trend test, p < 0.001). The overall 30-day mortality was 52.0% (1,774/3,413), and the crude 30-day mortality decreased significantly during the study period (p = 0.006). Logistic regression analysis showed significant associations between the fiscal years 2011 and 2012 and 30-day mortality (2011: odds ratio, 0.75; 95% CI, 0.57-0.98 and 2012: odds ratio, 0.61; 95% CI, 0.47-0.81). Multiple propensity score analysis incorporating postresuscitation care showed that 30-day mortality was significantly associated with postresuscitation care, and the significant associations between 30-day mortality and the years 2011 and 2012 were no longer observed (2011: odds ratio, 1.05; 95% CI, 0.82-1.3 and 2012: odds ratio, 0.95; 95% CI, 0.74-1.2). CONCLUSIONS The 30-day survival rate of adult patients with cardiogenic out-of-hospital cardiac arrest related to ventricular fibrillation improved significantly after 2010 in Japan. This improvement may be associated with an increase in postresuscitation care provision.
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Stær-Jensen H, Nakstad ER, Fossum E, Mangschau A, Eritsland J, Drægni T, Jacobsen D, Sunde K, Andersen GØ. Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.115.002784. [PMID: 26453688 DOI: 10.1161/circinterventions.115.002784] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA. METHODS AND RESULTS All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62±12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a ≥90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow. CONCLUSIONS Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization. CLINICAL TRIAL REGISTRATIONURL: http://www.clinicaltrials.gov. Unique identifier: NCT01239420.
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Affiliation(s)
- Henrik Stær-Jensen
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway.
| | - Espen Rostrup Nakstad
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Eigil Fossum
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Arild Mangschau
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Jan Eritsland
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Tomas Drægni
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Dag Jacobsen
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Kjetil Sunde
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
| | - Geir Øystein Andersen
- From the Department of Anesthesiology (H.S.-J., K.S.), Institute for Experimental Medical Research (H.S.-J.), Department of Acute Medicine (E.R.N., D.J.), Department of Cardiology (E.F., A.M., J.E., G.Ø.A.), and Department of Research and Development (T.D.), Oslo University Hospital Ulleval, Oslo, Norway; and Center for Heart Failure Research (A.M., J.E., G.Ø.A.), and Insititute of Clinical Medicine (D.J., K.S.), University of Oslo, Norway
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Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics. Emerg Med Int 2016; 2016:6983750. [PMID: 27379186 PMCID: PMC4917693 DOI: 10.1155/2016/6983750] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (p = 0.05), with a stronger disparity between low- and high-income neighborhoods (p = 0.01 and p = 0.03, resp.). Survival with bystander CPR was statistically greater in white- versus black-predominant neighborhoods (p = 0.04). Increased survival, overall and with bystander CPR, was seen with high- versus low-education neighborhoods (p = 0.03). Neighborhoods with more high school age persons displayed the lowest survival. We discovered a significant disparity in OHCA survival within neighborhoods of low-income, black-predominance, and low-education. Reduced survival was seen in neighborhoods with larger populations of high school students. This group is a potential target for training, and instruction can conceivably change survival outcomes in these neighborhoods, closing the gap, thus improving survival for all.
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Nestaas S, Stensæth KH, Rosseland V, Kramer-Johansen J. Radiological assessment of chest compression point and achievable compression depth in cardiac patients. Scand J Trauma Resusc Emerg Med 2016; 24:54. [PMID: 27103035 PMCID: PMC4840890 DOI: 10.1186/s13049-016-0245-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Using magnetic resonance imaging (MRI) to relate cardiovascular structures to surface anatomy in a population relevant to cardiac arrest victims, relate the external thoracic anterior-posterior (AP) diameter (APEXTERNAL) and blood-filled structures to recommended chest compression depths, and define an optimal compression point (OCP). Methods MRI axial scans of referred patients were analysed. We defined origo as the skin surface of the centre of sternum in the internipple line. The blood-filled structures beneath origo were identified and the sum of their inner diameters (APBLOOD) and APEXTERNAL were measured. We defined OCP based on the image with maximum compressible left and right ventricle and where LVOT was not present. We measured the distance from origo to OCP. Results Consecutive patients, mean (SD), age 52 (17) years, 110 (76 %) males, were categorized: cardiac disease (n = 74), aortic disease (n = 13), no findings/study patient (included in another study) (n = 57). The structure LVOT/aortic valve (AV)/aortic root was present in 46 % of patients with cardiac disease vs. 19 % of patients with no findings. APEXTERNAL for males and females was 25 (2) cm and 22 (2) cm, and APBLOOD 6.5 cm (2) and 4.7 cm (2), respectively. Distance from origo to OCP was 32 (11) mm to the left and 16 (21) mm caudally. Discussion LVOT/AV/aortic root was present beneath the origo in almost half the patients with cardiac disease. Recommended chest compression depths exceeded the anterior-posterior diameter of blood-filled structures in more than half of the females. OCP was found 3 cm left of the origo. Conclusions Based on our study, individualized compression point and depth could be further studied in a prospective, clinical study. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0245-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sverre Nestaas
- Department of Anaesthesiology, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway.
| | - Knut Haakon Stensæth
- Department of Radiology and Nuclear Medicine and Institute of Circulation and Imaging, St Olavs University Hospital and Norwegian University of Science and Technology, Po Box 3250, Sluppen, N-7006, Trondheim, Norway
| | - Vigdis Rosseland
- Intervention- and Sonography Unit, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway
| | - Jo Kramer-Johansen
- Department of Anaesthesiology, Oslo University Hospital, Po Box 4956, Nydalen, N-0424, Oslo, Norway.,Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital and University of Oslo, Po Box 4956, Nydalen, N-0424, Oslo, Norway
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Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry). Cardiol Res Pract 2016; 2016:8798261. [PMID: 26885436 PMCID: PMC4739452 DOI: 10.1155/2016/8798261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 02/03/2023] Open
Abstract
Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.
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Rogers KC, Oliphant CS, Finks SW. Clinical efficacy and safety of cilostazol: a critical review of the literature. Drugs 2016; 75:377-95. [PMID: 25758742 DOI: 10.1007/s40265-015-0364-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cilostazol is a unique antiplatelet agent that has been commercially available for over two decades. As a phosphodiesterase III inhibitor, it reversibly inhibits platelet aggregation yet also possesses vasodilatory and antiproliferative properties. It has been widely studied in a variety of disease states, including peripheral arterial disease, cerebrovascular disease, and coronary artery disease with percutaneous coronary intervention. Overall, cilostazol appears to be a promising agent in the management of these disease states with a bleeding profile comparable to placebo; even when combined with other antiplatelet agents, cilostazol does not appear to increase the rate of bleeding. Despite the possible benefit of cilostazol, its use is limited by tolerability as some patients often report drug discontinuation due to headache, diarrhea, dizziness, or increased heart rate. To date, it has been predominantly studied in the Asian population, making it difficult to extrapolate these results to a more diverse patient population. This paper discusses the evolving role of cilostazol in the treatment of vascular diseases.
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Affiliation(s)
- Kelly C Rogers
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, 881 Madison Ave, Rm 457, Memphis, TN, 38163, USA,
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Beck B, Tohira H, Bray JE, Straney L, Brown E, Inoue M, Williams TA, McKenzie N, Celenza A, Bailey P, Finn J. Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014. Resuscitation 2015; 98:79-84. [PMID: 26620392 DOI: 10.1016/j.resuscitation.2015.10.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/25/2015] [Accepted: 10/25/2015] [Indexed: 11/19/2022]
Abstract
AIM This study aims to describe and compare traumatic and medical out-of-hospital cardiac arrest (OHCA) occurring in Perth, Western Australia, between 1997 and 2014. METHODS The St John Ambulance Western Australia (SJA-WA) OHCA Database was used to identify all adult (≥ 16 years) cases. We calculated annual crude and age-sex standardised incidence rates (ASIRs) for traumatic and medical OHCA and investigated trends over time. RESULTS Over the study period, SJA-WA attended 1,354 traumatic OHCA and 16,076 medical OHCA cases. The mean annual crude incidence rate of traumatic OHCA in adults attended by SJA-WA was 6.0 per 100,000 (73.9 per 100,000 for medical cases), with the majority resulting from motor vehicle collisions (56.7%). We noted no change to either incidence or mechanism of injury over the study period (p>0.05). Compared to medical OHCA, traumatic OHCA cases were less likely to receive bystander cardiopulmonary resuscitation (CPR) (20.4% vs. 24.5%, p=0.001) or have resuscitation commenced by paramedics (38.9% vs. 44.8%, p<0.001). However, rates of bystander CPR and resuscitation commenced by paramedics increased significantly over time in traumatic OHCA (p<0.001). In cases where resuscitation was commenced by paramedics there was no difference in the proportion who died at the scene (37.2% traumatic vs. 34.3% medical, p=0.17), however, fewer traumatic OHCAs survived to hospital discharge (1.7% vs. 8.7%, p<0.001). CONCLUSIONS Despite temporal increases in rates of bystander CPR and paramedic resuscitation, traumatic OHCA survival remains poor with only nine patients surviving from traumatic OHCA over the 18-year period.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth Brown
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
| | - Nicole McKenzie
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Antonio Celenza
- Discipline of Emergency Medicine, The University of Western Australia, Crawley, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
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Greif R, Lockey A, Conaghan P, Lippert A, De Vries W, Monsieurs K. Ausbildung und Implementierung der Reanimation. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0092-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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