1
|
Tabata R, Tagami T, Suzuki K, Amano T, Takahashi H, Numata H, Kitano S, Kitamura N, Ogawa S. Effect of cardiopulmonary resuscitation training for layperson bystanders on outcomes of out-of-hospital cardiac arrest: A prospective multicenter observational study. Resuscitation 2024; 201:110314. [PMID: 38992559 DOI: 10.1016/j.resuscitation.2024.110314] [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: 05/15/2024] [Revised: 07/02/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Effective bystander cardiopulmonary resuscitation (CPR) improves outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, the effect of CPR training on the rate of return of spontaneous circulation (ROSC) among laypersons has yet to be thoroughly evaluated. METHODS This prospective, multicenter observational study was conducted across 42 centers in Japan. We assessed OHCA patients who received bystander CPR from a layperson, excluding those performed by healthcare staff. The primary outcome was the ROSC rate. Secondary outcomes included pre-hospital ROSC, ROSC after hospital arrival, favorable neurological outcomes, and 30-day survival. Propensity score with inverse probability treatment weighting (IPTW) was used to adjust for confounders, including age, sex, presence or absence of witnesses, and past medical history. RESULTS A total of 969 OHCA patients were included, divided into CPR-trained (n = 322) and control (n = 647). Before adjustment, the ROSC rate was higher in the trained group than the control (40.1% vs. 30.1%, P < 0.01). After IPTW adjustment, the trained group showed a significantly higher ROSC rate (36.7% vs. 30.6%; P = 0.02). All secondary outcomes in the trained group were significantly improved before adjustment. After IPTW adjustment, the trained group showed improved rates of pre-hospital ROSC and ROSC after hospital arrival (30.7% vs. 24.0%; P < 0.01, 23.9% vs. 20.7%; P = 0.04). There were no differences in neurological outcomes and 30-day survival. CONCLUSION This study demonstrated that CPR training for laypersons was associated with increased ROSC rates in OHCA patients, indicating potential advantages of CPR training for non-healthcare professionals.
Collapse
Affiliation(s)
- Ryusei Tabata
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Japan.
| | - Kensuke Suzuki
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Tomohito Amano
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Haruka Takahashi
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Hiroto Numata
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Shinnosuke Kitano
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Japan
| | - Satoo Ogawa
- The Graduate School of Health and Sport Science, Nippon Sport Science University, Japan
| |
Collapse
|
2
|
Amacher SA, Gross S, Becker C, Arpagaus A, Urben T, Gaab J, Emsden C, Tisljar K, Sutter R, Pargger H, Marsch S, Hunziker S. Misconceptions and do-not-resuscitate preferences of healthcare professionals commonly involved in cardiopulmonary resuscitations: A national survey. Resusc Plus 2024; 17:100575. [PMID: 38375442 PMCID: PMC10875294 DOI: 10.1016/j.resplu.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Aims To assess the DNR preferences of critical care-, anesthesia- and emergency medicine practitioners, to identify factors influencing decision-making, and to raise awareness for misconceptions concerning CPR outcomes. Methods A nationwide multicenter survey was conducted in Switzerland confronting healthcare professionals with a case vignette of an adult patient with an out-of-hospital cardiac arrest (OHCA). The primary outcome was the rate of DNR Code Status vs. CPR Code Status when taking the perspective from a clinical case vignette of a 70-year-old patient. Secondary outcomes were participants' personal preferences for DNR and estimates of survival with good neurological outcome after in- and out-of-hospital cardiac arrest. Results Within 1803 healthcare professionals, DNR code status was preferred in 85% (n = 1532) in the personal perspective of the case vignette and 53.2% (n = 932) when making a decision for themselves. Main predictors for a DNR Code Status regarding the case vignette included preferences for DNR Code Status for themselves (n [%] 896 [58.5] vs. 87 [32.1]; adjusted odds ratio [OR] 2.97, 95% confidence interval [CI] 2.25-3.92; p < 0.001) and lower estimated OHCA survival (mean [±SD] 12.3% [±11.8] vs. 14.7%[±12.8]; adjusted OR 0.98, 95% CI 0.97-0.99; p = 0.001). Physicians chose a DNR order more often when compared to nurses and paramedics. Conclusions The estimation of outcomes following cardiac arrest and personal living conditions are pivotal factors influencing code status preferences in healthcare professionals. Healthcare professionals should be aware of cardiac arrest prognosis and potential implications of personal preferences when engaging in code status- and end-of-life discussions with patients and their relatives.
Collapse
Affiliation(s)
- Simon A. Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Armon Arpagaus
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christian Emsden
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Kishihara Y, Kashiura M, Yasuda H, Kitamura N, Nomura T, Tagami T, Yasunaga H, Aso S, Takeda M, Moriya T. Association between institutional volume of out-of-hospital cardiac arrest cases and short term outcomes. Am J Emerg Med 2024; 75:65-71. [PMID: 37922832 DOI: 10.1016/j.ajem.2023.10.025] [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: 06/15/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a serious condition. The volume-outcome relationship and various post-cardiac arrest care elements are believed to be associated with improved neurological outcomes. Although previous studies have investigated the volume-outcome relationship, adjusting for post-cardiac arrest care, intra-class correlation for each institution, and other covariates may have been insufficient. OBJECTIVE To investigate the volume-outcome relationships and favorable neurological outcomes among OHCA cases in each institution. METHODS We conducted a prospective observational study of adult patients with non-traumatic OHCA using the OHCA registry in Japan. The primary outcome was 30-day favorable neurological outcomes, and the secondary outcome was 30-day survival. We set the cutoff values to trisect the number of patients as equally as possible and classified institutions into high-, middle-, and low-volume. Generalized estimating equations (GEE) were performed to adjust for covariates and within-hospital clustering. RESULTS Among the 9909 registry patients, 7857 were included. These patients were transported to either low- (2679), middle- (2657), or high- (2521) volume institutions. The median number of eligible patients per institution in 19 months of study periods was 82 (range, 1-207), 252 (range, 210-353), and 463 (range, 390-701), respectively. After multivariable GEE using the low-volume institution as a reference, no significant difference in odds ratios and 95% confidence intervals were noted for 30-day favorable neurological outcomes for middle volume [1.22 (0.69-2.17)] and high volume [0.80 (0.47-1.37)] institutions. Moreover, there was no significant difference for 30-day survival for middle volume [1.02 (0.51-2.02)] and high volume [1.09 (0.53-2.23)] institutions. CONCLUSION The patient volume of each institution was not associated with 30-day favorable neurological outcomes. Although this result needs to be evaluated more comprehensively, there may be no need to set strict requirements for the type of institution when selecting a destination for OHCA cases.
Collapse
Affiliation(s)
- Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan.
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan; Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, 35 Shinanomachi, Sinzyuku-ku, Tokyo 160-0016, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-shi, Chiba 292-0822, Japan.
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa 211-8533, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Shotaro Aso
- Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinzyuku-ku, Tokyo 162-8666, Japan.
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan.
| |
Collapse
|
4
|
Gross S, Amacher SA, Rochowski A, Reiser S, Becker C, Beck K, Blatter R, Emsden C, Nkoulou C, Sutter R, Tisljar K, Pargger H, Marsch S, Hunziker S. “Do-not-resuscitate” preferences of the general Swiss population: Results from a national survey. Resusc Plus 2023; 14:100383. [PMID: 37056958 PMCID: PMC10085778 DOI: 10.1016/j.resplu.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023] Open
Abstract
AIMS To assess the do-not-resuscitate preferences of the general Swiss population and to identify predictors influencing decision-making. Methods A nationwide web-based survey was conducted in Switzerland on a representative sample of the adult population. The primary endpoint was the preference for a "Do Not Resuscitate" order (DNR Code Status) vs. cardiopulmonary resuscitation (CPR Code Status) in a clinical case vignette of an out-of-hospital cardiac arrest. Secondary endpoint were participants' own personal preferences for DNR. Results 1138 subjects participated in the web-based survey, 1044 were included in the final analysis. Preference for DNR code status was found in 40.5% (n = 423) in the case vignette and in 20.3% (n = 209) when making a personal decision for themselves. Independent predictors for DNR Code Status for the case vignette were: Personal preferences for their own DNR Code Status (adjusted OR 2.44, 95%CI 1.67 to 3.55; p < 0.001), intubation following respiratory failure (adjusted OR 1.95, 95%CI 1.20 to 3.18; p = 0.007), time-period after which resuscitation should not be attempted (adjusted OR 0.91, 95%CI 0.89 to 0.93); p < 0.001), and estimated chance of survival in case of a cardiac arrest (adjusted OR per decile 0.91, 95%CI 0.84 to 0.99, p = 0.02; which was overestimated by all participants. Conclusions Main predictors for a DNR Code Status were personal preferences and the overestimation of good neurological outcome after cardiac arrest. Overestimation of positive outcomes after cardiac arrest seems to influence patient opinion and should thus be addressed during code status discussions.
Collapse
|
5
|
Clinical outcomes following out-of-hospital cardiac arrest: The minute-by-minute impact of bystander cardiopulmonary resuscitation. Resuscitation 2023; 185:109693. [PMID: 36646371 DOI: 10.1016/j.resuscitation.2023.109693] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIMS The time-dependent prognostic role of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients has not been described with great precision, especially for neurologic outcomes. Our objective was to assess the association between bystander CPR, emergency medical service (EMS) response time, and OHCA patients' outcomes. METHODS This cohort study used the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registries. Bystander-witnessed adult OHCA treated by EMS were included. The primary outcome was survival to hospital discharge and secondary outcome was survival with a good neurologic outcome (modified Rankin scale 0-2). Multivariable logistic regression models were used to assess the associations and interactions between bystander CPR, EMS response time and clinical outcomes. RESULTS Out of 229,637 patients, 41,012 were included (18,867 [46.0%] without bystander CPR and 22,145 [54.0%] with bystander CPR). Bystander CPR was independently associated with higher survival (adjusted odds ratio [AOR] = 1.70 [95%CI 1.61-1.80]) and survival with a good neurologic outcome (AOR = 1.87 [95%CI 1.70-2.06]), while longer EMS response times were independently associated with lower survival to hospital discharge (each additional minute of EMS response time: AOR = 0.92 [95%CI 0.91-0.93], p < 0.001) and lower survival with a good neurologic outcome (AOR = 0.88 [95%CI 0.86-0.89], p < 0.001). There was no interaction between bystander CPR and EMS response time's association with survival (p = 0.12) and neurologic outcomes (p = 0.65). CONCLUSIONS Although bystander CPR is associated with an immediate increase in odds of survival and of good neurologic outcome for OHCA patients, it does not influence the negative association between longer EMS response time and survival and good neurologic outcome.
Collapse
|
6
|
Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, Loretz N, Gross S, Tisljar K, Sutter R, Appenzeller-Herzog C, Marsch S, Hunziker S. Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Cardiol 2022; 7:633-643. [PMID: 35507352 PMCID: PMC9069345 DOI: 10.1001/jamacardio.2022.0795] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. Objective To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. Data Sources A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021. Study Selection Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol. Data Extraction and Synthesis Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. Main Outcomes and Measures The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. Results The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. Conclusions and Relevance In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.
Collapse
Affiliation(s)
- Simon A Amacher
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Chantal Bohren
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - René Blatter
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jonas Mueller
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Nina Loretz
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Appenzeller-Herzog
- Medical Faculty, University of Basel, Basel, Switzerland.,University Medical Library, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Han Chin Y, Yu Leon Yaow C, En Teoh S, Zhi Qi Foo M, Luo N, Graves N, Eng Hock Ong M, Fu Wah Ho A. Long-term outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2021; 171:15-29. [PMID: 34971720 DOI: 10.1016/j.resuscitation.2021.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022]
Abstract
AIMS Long term outcomes after out-of-hospital cardiac arrest (OHCA) are not well understood. This study aimed to evaluate the long-term (1-year and beyond) survival outcomes, including overall survival and survival with favorable neurological status and the quality-of-life (QOL) outcomes, among patients who survived the initial OHCA event (30 days or till hospital discharge). METHODS Embase, Medline and PubMed were searched for primary studies (randomized controlled trials, cohort and cross-sectional studies) which reported the long-term survival outcomes of OHCA patients. Data abstraction and quality assessment was conducted, and survival at predetermined timepoints were assessed via single-arm meta-analyses of proportions, using generalized linear mixed models. Comparative meta-analyses were conducted using the Mantel-Haenszel Risk Ratio (RR) estimates, using the DerSimonian and Laird model. RESULTS 67 studies were included, and among patients that survived to hospital discharge or 30-days, 77.3% (CI=71.2-82.4), 69.6% (CI=54.5-70.3), 62.7% (CI=54.5-70.3), 46.5% (CI=32.0-61.6), and 20.8% (CI=7.8-44.9) survived to 1-, 3-, 5-, 10- and 15-years respectively. Compared to Asia, the probability of 1-year survival was greater in Europe (RR=2.1, CI=1.8-2.3), North America (RR=2.0, CI=1.7-2.2) and Oceania (RR=1.9,CI=1.6-2.1). Males had a higher 1-year survival (RR:1.41, CI=1.25-1.59), and patients with initial shockable rhythm had improved 1-year (RR=3.07, CI=1.78-5.30) and 3-year survival (RR=1.45, CI=1.19-1.77). OHCA occurring in residential locations had worse 1-year survival (RR=0.42, CI=0.25-0.73). CONCLUSION Our study found that up to 20.8% of OHCA patients survived to 15-years, and survival was lower in Asia compared to the other regions. Further analysis on the differences in survival between the regions are needed to direct future long-term treatment of OHCA patients.
Collapse
Affiliation(s)
- Yip Han Chin
- School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Seth En Teoh
- School of Medicine, National University Singapore, Singapore, Singapore
| | - Mabel Zhi Qi Foo
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Nicholas Graves
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore.
| |
Collapse
|
8
|
Mckenzie N, Ball S, Bailey P, Finn L, Arendts G, Celenza A, Fatovich D, Jenkins I, Mukherjee A, Smedley B, Ghedina N, Bray J, Ho KM, Dobb G, Finn J. Neurological outcome in adult out-of-hospital cardiac arrest - Not all doom and gloom! Resuscitation 2021; 167:227-232. [PMID: 34480975 DOI: 10.1016/j.resuscitation.2021.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
AIMS To describe neurological and functional outcomes among out-of-hospital cardiac arrest (OHCA) patients who survived to hospital discharge; to determine the association between neurological outcome at hospital discharge and 12-month survival. METHODS Our cohort comprised adult OHCA patients (≥18 years) attended by St John WA (SJWA) paramedics in Perth, Western Australia (WA), who survived to hospital discharge, between 1st January 2004 and 31st December 2019. Neurological and functional status at hospital discharge (and before the arrest) was determined by medical record review using the five-point 'Cerebral Performance Category (CPC)' and 'Overall Performance Category (OPC)' scores. Adjusted multivariable logistic regression analysis was used to estimate the association of CPC score at hospital discharge with 12-month survival, adjusted for prognostic variables. RESULTS Over the study period, SJWA attended 23,712 OHCAs. Resuscitation was attempted in 43.4% of cases (n = 10,299) with 2171 subsequent admissions, 99.4% (n = 2158) of these were admitted to a study hospital. Of the 1062 hospital survivors, 71.3% (n = 757) were CPC1 (highest category of neurological performance), 21.4% (n = 227) CPC2, 6.3% (n = 67) CPC3 and 1.0% (n = 11) CPC4. OPC scores followed a similar distribution. Of the 1,011 WA residents who survived to hospital discharge, 92.3% (n = 933) survived to 12-months. A CPC1-2 at hospital discharge was significantly associated with 12-month survival (adjusted odds ratio 3.28, 95% confidence interval 1.69-6.39). CONCLUSION Whilst overall survival is low, most survivors of OHCA have a good neurological outcome at hospital discharge and are alive at 12-months.
Collapse
Affiliation(s)
- Nicole Mckenzie
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia
| | - Lyndall Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia
| | - Glenn Arendts
- Medical School, University of Western Australia, Crawley, WA, Australia; Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Antonio Celenza
- Medical School, University of Western Australia, Crawley, WA, Australia; Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Daniel Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
| | - Ian Jenkins
- Fremantle Hospital, Fremantle, WA, Australia
| | | | - Ben Smedley
- Rockingham General Hospital, Rockingham WA, Australia
| | | | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kwok M Ho
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; St John of God Hospital Subiaco, Subiaco, WA, Australia; School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | - Geoffrey Dobb
- Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
9
|
Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest. Resuscitation 2021; 164:30-37. [PMID: 33965475 DOI: 10.1016/j.resuscitation.2021.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) causes brain injury. Functional status of survivors at hospital discharge is a core resuscitation measure, frequently using the Cerebral Performance Category (CPC) or modified Rankin Scale (mRS). Which scale better predicts long-term survival following OHCA is not known. METHODS We evaluated long-term survival after hospital discharge in a retrospective cohort of persons resuscitated from OHCA in King County, WA from 2007 to 2015. Patients were independently assessed at discharge using both scales, leveraging the regional quality improvement registry, which records the 5-level CPC, and concurrent research studies involving the Resuscitation Outcomes Consortium, which used the 7-level mRS, taken from information in the hospital record. The risk of mortality associated with CPC and mRS categories was estimated using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS Among 878 eligible patients discharged alive, there were 358 deaths during 9118.5 person-years of follow-up. Overall 1, 5 and 10-year survival was 84.4%, 68.5%, and 53.7% and varied according to CPC and mRS (p < 0.01 per Kaplan-Meier). Compared to CPC-1, hazard ratio (HR) increased incrementally for CPC-2 = 1.33 (1.03-1.73), CPC-3 = 1.90 (1.37-2.65), and CPC-4 = 8.25 (5.63-12.10). Compared to mRS = 0, HR for mRS-1 = 1.02 (0.66-1.58), mRS-2 = 1.52 (1.00-2.32), mRS-3 = 1.41 (0.92-2.14), mRS-4 = 2.00 (1.37-2.97), and mRS-5 = 4.90 (3.23-7.44). CONCLUSION In OHCA survivors, CPC and mRS scales both predicted long-term survival. However mRS 0-1 and 2-3 groups did not have distinct prognoses, suggesting that a consolidated mRS score may simplify capture of relevant prognostic information for survival predictions.
Collapse
|
10
|
Kranc H, Novack V, Shtein A, Sherman R, Novack L. Extreme temperature and out-of-hospital-cardiac-arrest. Nationwide study in a hot climate country. Environ Health 2021; 20:38. [PMID: 33820550 PMCID: PMC8022396 DOI: 10.1186/s12940-021-00722-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/17/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Out-of-hospital-cardiac arrest (OHCA) is frequently linked to environmental exposures. Climate change and global warming phenomenon have been found related to cardiovascular morbidity, however there is no agreement on their impact on OHCA occurrence. In this nationwide analysis, we aimed to assess the incidence of the OHCA events attended by emergency medical services (EMS), in relation to meteorological conditions: temperature, humidity, heat index and solar radiation. METHODS We analyzed all adult cases of OHCA in Israel attended by EMS during 2016-2017. In the case-crossover design, we compared ambient exposure within 72 h prior to the OHCA event with exposure prior to the four control times using conditional logistic regression in a lag-distributed non-linear model. RESULTS There were 12,401 OHCA cases (68.3% were pronounced dead-on-scene). The patients were on average 75.5 ± 16.2 years old and 55.8% of them were males. Exposure to 90th and 10th percentile of temperature adjusted to humidity were positively associated with the OHCA with borderline significance (Odds Ratio (OR) =1.20, 95%CI 0.97; 1.49 and OR 1.16, 95%CI 0.95; 1.41, respectively). Relative humidity below the 10th percentile was a risk factor for OHCA, independent of temperature, with borderline significance (OR = 1.16, 95%CI 0.96; 1.38). Analysis stratified by seasons revealed an adverse effect of exposure to 90th percentile of temperature when estimated in summer (OR = 3.34, 95%CI 1.90; 3.5.86) and exposure to temperatures below 10th percentile in winter (OR = 1.75, 95%CI 1.23; 2.49). Low temperatures during a warm season and high temperatures during a cold season had a protective effect on OHCA. The heat index followed a similar pattern, where an adverse effect was demonstrated for extreme levels of exposure. CONCLUSIONS Evolving climate conditions characterized by excessive heat and low humidity represent risk factors for OHCA. As these conditions are easily avoided, by air conditioning and behavioral restrictions, necessary prevention measures are warranted.
Collapse
Affiliation(s)
- Hannan Kranc
- Department of Public Health, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Department of Internal Medicine, Soroka University Medical Center, Beer Sheva, Israel
| | - Alexandra Shtein
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Lena Novack
- Negev Environmental Health Research Institute, Soroka University Medical Center, 84101 Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
11
|
Kashiura M, Amagasa S, Moriya T, Sakurai A, Kitamura N, Tagami T, Takeda M, Miyake Y. Relationship Between Institutional Volume of Out-of-Hospital Cardiac Arrest Cases and 1-Month Neurologic Outcomes: A Post Hoc Analysis of a Prospective Observational Study. J Emerg Med 2020; 59:227-237. [PMID: 32466859 DOI: 10.1016/j.jemermed.2020.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The influence of institutional volume of out-of-hospital cardiac arrest (OHCA) cases on outcomes remains unclear. OBJECTIVES This study evaluated the relationship between institutional volume of adult, nontraumatic OHCA cases and 1-month favorable neurologic outcomes. METHODS This study retrospectively analyzed data between January 2012 and March 2013 from a prospective observational study in the Kanto area of Japan. We analyzed adult patients with nontraumatic OHCA who underwent cardiopulmonary resuscitation by emergency medical service personnel and in whom spontaneous circulation was restored. Based on the institutional volume of OHCA cases, we divided institutions into low-, middle-, or high-volume groups. The primary and secondary outcomes were 1-month favorable neurologic outcomes and 1-month survival, respectively. A multivariate logistic regression analysis adjusted for propensity score and in-hospital variables was performed. RESULTS Of 2699 eligible patients, 889, 898, and 912 patients were transported to low-volume (40 institutions), middle-volume (14 institutions), and high-volume (9 institutions) centers, respectively. Using low-volume centers as the reference, transport to a middle- or high-volume center was not significantly associated with a favorable 1-month neurologic outcome (adjusted odds ratio [OR] 1.21 [95% confidence interval {CI} 0.84-1.75] and adjusted OR 0.77 [95% CI 0.53-1.12], respectively) or 1-month survival (adjusted OR 1.10 [95% CI 0.82-1.47] and adjusted OR 0.76 [95% CI 0.56-1.02], respectively). CONCLUSIONS Institutional volume was not significantly associated with favorable 1-month neurologic outcomes or 1-month survival in OHCA. Further investigation is needed to determine the association between hospital characteristics and outcomes in patients with OHCA.
Collapse
Affiliation(s)
- Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shunsuke Amagasa
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Klapheke AK, Keegan THM, Ruskin R, Cress RD. Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer. Support Care Cancer 2020; 28:4901-4909. [DOI: 10.1007/s00520-020-05324-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/23/2020] [Indexed: 01/06/2023]
|
13
|
Post-resuscitation EQ-5D-3L scoring by the patient or caregiver/legal guardian versus the medical professional: a sub-study of the Jerusalem District Resuscitation Study. Intensive Care Med 2019; 45:1163-1164. [DOI: 10.1007/s00134-019-05611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
|
14
|
Barakat AF, Thalappillil A, Qin D, Ladejobi A, Bhonsale A, Kancharla K, Wang NC, Adelstein E, Jain S, Estes NM, Saba S. Implications of Neurological Status on Defibrillator Therapy and Long-Term Mortality of Sudden Cardiac Arrest Survivors. JACC Clin Electrophysiol 2019; 5:843-850. [DOI: 10.1016/j.jacep.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
|
15
|
Cronberg T, Nolan JP. Reliable neurological prediction after cardiac arrest — Are we willing to pay the price? Resuscitation 2019; 139:365-366. [DOI: 10.1016/j.resuscitation.2019.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
|
16
|
Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score. Cardiol J 2019; 28:95-100. [PMID: 30994183 DOI: 10.5603/cj.a2019.0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt reperfusion and post-resuscitation care, including targeted temperature management (TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions. METHODS Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariate logistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy. RESULTS The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74. CONCLUSIONS PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM.
Collapse
|
17
|
Gupta A, Ladejobi A, Munir MB, Pasupula DK, Bhonsale A, Kancharla K, Wang NC, Jain S, Saba S. Derivation and validation of a new score to predict long-term survival after sudden cardiac arrest. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1585-1590. [DOI: 10.1111/pace.13528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Aman Gupta
- Department of Internal Medicine; UPMC; University of Pittsburgh; Pittsburgh PA USA
| | - Adetola Ladejobi
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Mohammad Bilal Munir
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | | | - Aditya Bhonsale
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Krishna Kancharla
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Norman C. Wang
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Sandeep Jain
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Samir Saba
- Division of Cardiovascular Diseases, Department of Internal Medicine, UPMC, Heart & Vascular Institute; University of Pittsburgh; Pittsburgh PA USA
| |
Collapse
|
18
|
Barry T, Headon M, Glynn R, Conroy N, Tobin H, Egan M, Bury G. Ten years of cardiac arrest resuscitation in Irish general practice. Resuscitation 2018; 126:43-48. [PMID: 29510194 DOI: 10.1016/j.resuscitation.2018.02.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/06/2018] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. METHODS A ten year prospective observational study involving a cohort of Irish general practices. SETTING 521 general practice settings distributed throughout the Republic of Ireland, representing approximately one quarter of all practices and a third of Irish GPs. PARTICIPANTS 534 patients suffering cardiac arrest in the community for whom resuscitation was attempted. INTERVENTIONS Cardiac arrest with resuscitation attempted (CARA) in which a GP played a role. RESULTS Over a ten year period almost half of participating practices reported one or more CARAs. A total of 534 CARAs were reported at a variety of locations; 161 (30%) had ROSC (return of spontaneous circulation) at some point, with outcome data available for 147/161; 90 patients survived to hospital discharge. Most survivors for whom follow up data are available were discharged home and were completely independent. The highest rate of survival was achieved when CARAs occurred at a GP practice premises (47.4%). CONCLUSIONS Resuscitation following OHCA is a key task in general practice. Over time a significant number of GPs encounter OHCA, attempt resuscitation and achieve higher survival to hospital discharge rates than occur nationally among OHCAs in Ireland. We conclude that a defibrillator should be routinely available at all general practices and staff should have appropriate resuscitation skills.
Collapse
Affiliation(s)
- Tomas Barry
- School of Medicine, University College Dublin, Ireland.
| | - Mary Headon
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | - Ronan Glynn
- Public Health Medicine, Health Service Executive, Ireland
| | - Niall Conroy
- School of Medicine, University College Dublin, Ireland
| | - Helen Tobin
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | - Mairead Egan
- Centre for Emergency Medical Science, University College Dublin, Ireland
| | - Gerard Bury
- School of Medicine, University College Dublin, Ireland; University College Dublin, Ireland
| |
Collapse
|
19
|
Agarwal S, Presciutti A, Roth W, Matthews E, Rodriguez A, Roh DJ, Park S, Claassen J, Lazar RM. Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors. Crit Care Med 2018; 46:e141-e150. [PMID: 29135522 PMCID: PMC5771814 DOI: 10.1097/ccm.0000000000002846] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest. DESIGN Observational, retrospective review of a prospectively collected cohort. SETTING Medical or surgical ICUs in a single tertiary care center. PATIENTS Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3-4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1-15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2-13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03-0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06-0.9; p = 0.04). CONCLUSIONS Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest.
Collapse
Affiliation(s)
- Sachin Agarwal
- All authors: Department of Neurology, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Einav S, Wacht O, Kaufman N, Alkalay E. Cardiopulmonary arrest in primary care clinics: more holes than cheese: a survey of the knowledge and attitudes of primary care physicians regarding resuscitation. Isr J Health Policy Res 2017; 6:22. [PMID: 28616160 PMCID: PMC5466743 DOI: 10.1186/s13584-017-0148-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients experiencing pre-arrest symptoms may first refer to their primary care physician. The study's aim was to determine the likelihood that a patient undergoing out-of-hospital cardiac arrest will receive appropriate resuscitation efforts in a primary care clinic in a country with a directive that clinics maintain resuscitation equipment and physicians undergo periodic resuscitation training. METHODS An anonymous, 23-question online cross-sectional survey was created and administered to primary care physicians working in community clinics (10/1/2015-5/3/2015). Recruitment was accomplished by posting a link to the survey to all physicians listed as registered Society of Family Medicine members and in other online forums dedicated to residents and board-certified specialists in family medicine in Israel. The primary outcome measure was the proportion of respondents whose responses indicate that they fulfill all conditions for performing resuscitation. RESULTS Of approximately 2400 potential respondents, 185 replied to the survey; the study's findings should be viewed as preliminary. Respondents' characteristics were generally similar to those of the study population, but respondents had a higher rate of family medicine specialists. Respondents were mostly female (n = 108, 58%) Israeli graduates who have practiced medicine for > 10 years (72%, n = 134). 55% (n = 101) had undergone basic life support (BLS) training within < 2 years. Although just 5% (n = 10) estimated call-to-Emergency Medical Service (EMS) arrival time to their clinic to be <5 min, only 64% (n = 119) knew the telephone number for summoning EMS. Most confirmed the existence of a resuscitation cart in their clinic (85%, n = 157); 68% confirmed the presence of a defibrillator (n = 126). Most respondents were aware of the location of the defibrillator in their clinic (67%, n = 123), stated its accessibility during working hours (63%, n = 116), and 56% (n = 103) knew how to use it. Only 28% of the questionnaires indicated that all requirements for mounting an effective BLS response had been fulfilled. CONCLUSIONS The study suggests that many primary care clinics are under-equipped and their physicians are under-prepared to initiate life-saving services. Steps must be taken to rectify this situation. In addition, to develop more reliable estimates of the phenomena reported in this preliminary study, these issues should be re-examined in the context of a high response rate physician survey.
Collapse
Affiliation(s)
- Sharon Einav
- Surgical Intensive Care, Shaare Zedek Medical Center, and Anesthesia and Intensive Care Medicine, Hebrew University-Hadassah Faculty of Medicine, POB 3235, Beyt 12, Jerusalem, 91031 Israel
| | - Oren Wacht
- Department of Emergency Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Nechama Kaufman
- Departments of Emergency Medicine and Intensive Care Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Eliezer Alkalay
- Herut-Mishmeret Family Medicine Clinic, Sharon-Shomron section of the Clalit Healthcare Services, associated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| |
Collapse
|
21
|
Andrew E, Nehme Z, Wolfe R, Bernard S, Smith K. Long-term survival following out-of-hospital cardiac arrest. Heart 2017; 103:1104-1110. [DOI: 10.1136/heartjnl-2016-310485] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 11/03/2022] Open
|
22
|
Perez CA, Samudra N, Aiyagari V. Cognitive and Functional Consequence of Cardiac Arrest. Curr Neurol Neurosci Rep 2016; 16:70. [DOI: 10.1007/s11910-016-0669-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
23
|
Angiographic findings and survival in patients undergoing coronary angiography due to sudden cardiac arrest in Western Sweden. Resuscitation 2015; 90:13-20. [DOI: 10.1016/j.resuscitation.2014.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/15/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
|
24
|
Moran PS, Teljeur C, Masterson S, O'Neill M, Harrington P, Ryan M. Cost-effectiveness of a national public access defibrillation programme. Resuscitation 2015; 91:48-55. [PMID: 25828922 DOI: 10.1016/j.resuscitation.2015.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
AIM Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement. METHODS We used a cost-utility analysis to estimate the costs and consequences of public access defibrillation (PAD) programmes from a societal perspective, based on AED deployment by building type. Comparator programmes ranged from those that only included building types with the highest incidence of OHCA, to the comprehensive programme outline in the proposed legislation. Data on OHCA incidence and outcomes were obtained from the Irish Out-of-Hospital-Cardiac-Arrest Register (OHCAR). Costs were obtained from the Irish health service, device suppliers and training providers. RESULTS The incremental cost effectiveness ratio (ICER) for the most comprehensive PAD scheme was €928,450/QALY. The ICER for the most scaled-back programme involving AED placement in transport stations, medical practices, entertainment venues, schools (excluding primary) and fitness facilities was €95,640/QALY. A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective. CONCLUSION National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.
Collapse
Affiliation(s)
- Patrick S Moran
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland; Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
| | - Conor Teljeur
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Siobhán Masterson
- Discipline of General Practice, National University of Ireland Galway, Ireland; Department of Public Health Medicine, Health Service Executive, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland
| | - Michelle O'Neill
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Patricia Harrington
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Máirín Ryan
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| |
Collapse
|
25
|
Cone DC, Middleton PM. Are out-of-hospital cardiac arrest survival rates improving? Resuscitation 2015; 91:A7-8. [PMID: 25796993 DOI: 10.1016/j.resuscitation.2015.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
- David C Cone
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Paul M Middleton
- Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Coppler PJ, Elmer J, Calderon L, Sabedra A, Doshi AA, Callaway CW, Rittenberger JC, Dezfulian C. Validation of the Pittsburgh Cardiac Arrest Category illness severity score. Resuscitation 2015; 89:86-92. [PMID: 25636896 DOI: 10.1016/j.resuscitation.2015.01.020] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The purpose of this study was to validate the ability of an early post-cardiac arrest illness severity classification to predict patient outcomes. METHODS The Pittsburgh Cardiac Arrest Category (PCAC) is a 4-level illness severity score that was found to be strongly predictive of outcomes in the initial derivation study. We assigned PCAC scores to consecutive in and out-of-hospital cardiac arrest subjects treated at two tertiary care centers between January 2011 and September 2013. We made assignments prospectively at Site 1 and retrospectively at Site 2. Our primary outcome was survival to hospital discharge. Inter-rater reliability of retrospective PCAC assessments was assessed. Secondary outcomes were favorable discharge disposition (home or acute rehabilitation), Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) at hospital discharge. We tested the association of PCAC with each outcome using unadjusted and multivariable logistic regression. RESULTS We included 607 cardiac arrest patients during the study (393 at Site 1 and 214 at Site 2). Site populations differed in age, arrest location, rhythm, use of hypothermia and distribution of PCAC. Inter-rater reliability of retrospective PCAC assignments was excellent (κ=0.81). PCAC was associated with survival (unadjusted odds ratio (OR) for Site 1: 0.33 (95% confidence interval (CI) 0.27-0.41)) Site 2: 0.32 (95% CI 0.24-0.43) even after adjustment for other clinical variables (adjusted OR Site 1: 0.32 (95% CI 0.25-0.41) Site 2: 0.31 (95% CI 0.22-0.44)). PCAC was predictive of secondary outcomes. CONCLUSIONS Our results confirm that PCAC is strongly predictive of survival and good functional outcome after cardiac arrest.
Collapse
Affiliation(s)
- Patrick J Coppler
- Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States
| | - Luis Calderon
- Department of Emergency Medicine, University of Pittsburgh, United States
| | - Alexa Sabedra
- Department of Emergency Medicine, University of Pittsburgh, United States
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh, United States
| | - Clifton W Callaway
- Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Emergency Medicine, University of Pittsburgh, United States; Department of Pharmacology and Chemical Biology, University of Pittsburgh, United States
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh, United States
| | - Cameron Dezfulian
- Safar Center for Resuscitation Research, University of Pittsburgh, United States; Department of Critical Care Medicine, University of Pittsburgh, United States; Vascular Medicine Institute, University of Pittsburgh, United States.
| |
Collapse
|
27
|
|
28
|
Life after cardiac arrest: A very long term follow up. Resuscitation 2015; 91:99-103. [PMID: 25613361 DOI: 10.1016/j.resuscitation.2015.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/14/2014] [Accepted: 01/07/2015] [Indexed: 11/22/2022]
Abstract
AIM To describe survival and causes of death after cardiac arrest (CA) and the life situation of very long term survivors. METHODS Individuals with successful resuscitation treated at the Sahlgrenska university hospital during 1995-1999 and presented in former CA publications were studied. Survival time and causes of death data were extracted from the individuals who had died's records. Very long term survivors were offered a follow up visit at home. Mini Mental State Examination (MMSE) used to describe cognitive abilities and EQ-5D to assess quality of life. The life situation was also explored. RESULTS 14 out of 104 possible participants had survived to follow up. The median time to follow up among the 8 who agreed to participation was 17 years. Out of the 8 participants, 4 failed to reach the cut off score of normal cognitive abilities in the MMSE and 7/8 participants did not reach the cut off score for normal cognitive function in the MoCA. Overall the participants were content with their life situation and QoL. However, a tendency towards lower scores on the cognitive testing and a lower self-reported QoL was observed. No depression, post-traumatic stress disorder or anxiety disorder were found. CONCLUSIONS A CA may lead to permanent cognitive impairments and the risk of dementia may be higher because of the injuries sustained during the collapse. However, further studies with more participants are needed to fully determine the risk of cognitive impairment after a CA. Regarding life situation, there was a tendency of lower QoL with lower scores on the cognitive testing. With a new treatment paradigm, there is a need for long term studies regarding this new population.
Collapse
|
29
|
Ginsberg GM, Kark JD, Einav S. Cost–utility analysis of treating out of hospital cardiac arrests in Jerusalem. Resuscitation 2015; 86:54-61. [DOI: 10.1016/j.resuscitation.2014.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/02/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
|