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Eliakundu AL, Bloom JE, Ball J, Nehme E, Okyere D, Heritier S, Voskoboinik A, Dawson L, Cox S, Anderson D, Burrell A, Pilcher D, Chew DP, Kaye D, Nehme Z, Stub D. Prehospital factors predicting mortality in patients with shock: state-wide linkage study. Open Heart 2024; 11:e002799. [PMID: 39349049 DOI: 10.1136/openhrt-2024-002799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/26/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS. METHOD This is a retrospective cohort study of consecutive ambulance attendances for non-traumatic shock in Victoria, Australia (January 2015-June 2019) linked with government-held administrative data (emergency, admissions and mortality records). Predictors of 30-day mortality were assessed using Cox proportional regressions. The primary outcome was 30-day all-cause mortality. RESULTS Overall, 21 334 patients with non-traumatic shock (median age 69 years, 54.8% female) were successfully linked with state administrative records. Among this cohort, 9 149 (43%) patients died within 30-days. Compared with survivors, non-survivors had a longer median on-scene time: 60 (35-98) versus 30 (19-50), p <0.001. Non-survivors were more likely to be older (median age in years: 74 (61-84) vs 65 (47-78), p<0.001), had prehospital cardiac arrest requiring cardiopulmonary resuscitation (adjusted HR (aHR)=6.26, 95% CI 5.87, 6.69) and had prehospital intubation (aHR=1.07, CI 1.00, 1.14). Reduced 30-day mortality was associated with administration of epinephrine (aHR=0.66, CI 0.62, 0.71) and systolic blood pressures above 80 mm Hg in the prehospital setting. CONCLUSION The 30-day mortality from non-traumatic shock is high at 43%. Independent predictors of mortality included age, prehospital cardiac arrest and endotracheal intubation. Interventions that target reversible causes of short-term mortality in patients with non-traumatic shock are a high priority.
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Affiliation(s)
- Amminadab L Eliakundu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
| | - Jason E Bloom
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Emily Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Okyere
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Luke Dawson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
| | - David Anderson
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- ANZ Intensive Care Research Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- ANZ Intensive Care Research Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Derek P Chew
- Victorian Heart Institute, Monash University, Blackburn, Victoria, Australia
- Victorian Heart Hospital, Blackburn, Victoria, Australia
| | - David Kaye
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Soundararajan K, Adams DJ, Nathanson BH, Mader TJ, Godwin RC, Melvin RL, Coute RA. Use of machine learning models to predict neurologically intact survival for advanced age adults following out-of-hospital cardiac arrest. Acad Emerg Med 2024. [PMID: 39300690 DOI: 10.1111/acem.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Kameshwari Soundararajan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Dylana J Adams
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | | | - Timothy J Mader
- Department of Emergency Medicine, UMass Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Ryan C Godwin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Ryan L Melvin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Ryan A Coute
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Beekman R, Kim N, Nguyen C, McGinniss G, Deng Y, Kitlen E, Garcia G, Wira C, Khosla A, Johnson J, Miller PE, Perman SM, Sheth KN, Greer DM, Gilmore EJ. Temperature Control Parameters Are Important: Earlier Preinduction Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2024:S0196-0644(24)00340-8. [PMID: 39033449 DOI: 10.1016/j.annemergmed.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/20/2024] [Accepted: 06/07/2024] [Indexed: 07/23/2024]
Abstract
STUDY OBJECTIVE Temperature control trials in cardiac arrest patients have not reliably conferred neuroprotective benefit but have been limited by inconsistent treatment parameters. To evaluate the presence of a time dependent treatment effect, we assessed the association between preinduction time and clinical outcomes. METHODS In this retrospective, single academic center study between 2014 and 2022, consecutive out-of-hospital cardiac arrest (OHCA) patients treated with temperature control were identified. Preinduction was defined as the time from hospital arrival to initiation of a closed-loop temperature feedback device [door to temperature control initiation time], and early door to temperature control device time was defined a priori as <3 hours. We assessed the association between good neurologic outcome (cerebral performance category 1 to 2) and door to temperature control device time using logistic regression. The proportion of patients who survived to hospital discharge was evaluated as a secondary outcome. A sensitivity analysis using inverse probability treatment weighting, created using a propensity score, was performed to minimize measurable confounding. RESULTS Three hundred and forty-seven OHCA patients were included; the early door to temperature control device cohort included 75 (21.6%) patients with a median (interquartile range) door to temperature control device time of 2.50 (2.03 to 2.75) hours, whereas the late door to temperature control device cohort included 272 (78.4%) patients with a median (interquartile range) door to temperature control device time of 5.18 (4.19 to 6.41) hours. In the multivariable logistic regression model, early door to temperature control device time was associated with improved good neurologic outcome and survival before [adjusted odds ratio (OR) (95% confidence interval) 2.36 (1.16 to 4.81) and 3.02 (1.54 to 6.02)] and after [adjusted OR (95% confidence interval) 1.95 (1.19 to 3.79) and 2.14 (1.33 to 3.36)] inverse probability of treatment weighting, respectively. CONCLUSION In our study of OHCA patients, a shorter preinduction time for temperature control was associated with improved good neurologic outcome and survival. This finding may indicate that early initiation in the emergency department will confer benefit. Our findings are hypothesis generating and need to be validated in future prospective trials.
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Affiliation(s)
- Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT.
| | - Noah Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT; Geisel School of Medicine, Dartmouth College, Hanover, NH
| | | | - George McGinniss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Eva Kitlen
- Department of Neurology, Yale School of Medicine, New Haven, CT; UCSF School of Medicine, University of California San Francisco, San Francisco, CA
| | - Gabriella Garcia
- Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Akhil Khosla
- Department of Pulmonary Critical Care, Yale School of Medicine, New Haven, CT
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Sarah M Perman
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - David M Greer
- Department of Neurology, Boston University Medical Center, Boston, MA
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT
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Kramser N, Duse DA, Gröne M, Stücker B, Voß F, Tokhi U, Jung C, Horn P, Kelm M, Erkens R. Amiodarone Administration during Cardiopulmonary Resuscitation Is Not Associated with Changes in Short-Term Mortality or Neurological Outcomes in Cardiac Arrest Patients with Shockable Rhythms. J Clin Med 2024; 13:3931. [PMID: 38999496 PMCID: PMC11242294 DOI: 10.3390/jcm13133931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The search for the best therapeutic approach in cardiopulmonary resuscitations (CPR) remains open to question. In this study, we evaluated if Amiodarone administration during CPR was associated with short-term mortality or neurological development. Methods: A total of 232 patients with sudden cardiac arrest (CA) with shockable rhythms were included in our analysis. Propensity score matching based on age, gender, type of CA, and CPR duration was used to stratify between patients with and without Amiodarone during CPR. Primary endpoints were short-term mortality (30-day) and neurological outcomes assessed by the cerebral performance category. Secondary endpoints were plasma lactate, phosphate levels at hospital admission, and the peak Neuron-specific enolase. Results: Propensity score matching was successful with a caliper size used for matching of 0.089 and a sample size of n = 82 per group. The 30-day mortality rates were similar between both groups (p = 0.24). There were no significant differences in lactate levels at hospital admission and during the following five days between the groups. Patients receiving Amiodarone showed slightly higher phosphate levels at hospital admission, while the levels decreased to a similar value during the following days. Among CA survivors to hospital discharge, no differences between the proportion of good neurological outcomes were detected between the two groups (p = 0.58), despite slightly higher peak neuron-specific enolase levels in CA patients receiving Amiodarone (p = 0.03). Conclusions: Amiodarone administration is not associated with short-term mortality or neurological outcomes in CA patients with shockable rhythms receiving CPR.
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Affiliation(s)
- Nicolas Kramser
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Dragos Andrei Duse
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Michael Gröne
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Bernd Stücker
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Fabian Voß
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Ursala Tokhi
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), 40225 Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), 40225 Düsseldorf, Germany
| | - Ralf Erkens
- Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, 46397 Bocholt, Germany
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Blumer V, Kanwar MK, Barnett CF, Cowger JA, Damluji AA, Farr M, Goodlin SJ, Katz JN, McIlvennan CK, Sinha SS, Wang TY. Cardiogenic Shock in Older Adults: A Focus on Age-Associated Risks and Approach to Management: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1051-e1065. [PMID: 38406869 PMCID: PMC11067718 DOI: 10.1161/cir.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Cardiogenic shock continues to portend poor outcomes, conferring short-term mortality rates of 30% to 50% despite recent scientific advances. Age is a nonmodifiable risk factor for mortality in patients with cardiogenic shock and is often considered in the decision-making process for eligibility for various therapies. Older adults have been largely excluded from analyses of therapeutic options in patients with cardiogenic shock. As a result, despite the association of advanced age with worse outcomes, focused strategies in the assessment and management of cardiogenic shock in this high-risk and growing population are lacking. Individual programs oftentimes develop upper age limits for various interventional strategies for their patients, including heart transplantation and durable left ventricular assist devices. However, age as a lone parameter should not be used to guide individual patient management decisions in cardiogenic shock. In the assessment of risk in older adults with cardiogenic shock, a comprehensive, interdisciplinary approach is central to developing best practices. In this American Heart Association scientific statement, we aim to summarize our contemporary understanding of the epidemiology, risk assessment, and in-hospital approach to management of cardiogenic shock, with a unique focus on older adults.
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Suh GJ, Kim T, Kim KS, Kwon WY, Kim H, Park H, Wang G, Park J, Hur S, Sim J, Kim K, Lee JC, Shin DA, Cho WS, Kim BJ, Kwon S, Lee YJ. A remote-controlled automatic chest compression device capable of moving compression position during CPR: A pilot study in a mannequin and a swine model of cardiac arrest. PLoS One 2024; 19:e0297057. [PMID: 38241416 PMCID: PMC10798619 DOI: 10.1371/journal.pone.0297057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/24/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Recently, we developed a chest compression device that can move the chest compression position without interruption during CPR and be remotely controlled to minimize rescuer exposure to infectious diseases. The purpose of this study was to compare its performance with conventional mechanical CPR device in a mannequin and a swine model of cardiac arrest. MATERIALS AND METHODS A prototype of a remote-controlled automatic chest compression device (ROSCER) that can change the chest compression position without interruption during CPR was developed, and its performance was compared with LUCAS 3 in a mannequin and a swine model of cardiac arrest. In a swine model of cardiac arrest, 16 male pigs were randomly assigned into the two groups, ROSCER CPR (n = 8) and LUCAS 3 CPR (n = 8), respectively. During 5 minutes of CPR, hemodynamic parameters including aortic pressure, right atrial pressure, coronary perfusion pressure, common carotid blood flow, and end-tidal carbon dioxide partial pressure were measured. RESULTS In the compression performance test using a mannequin, compression depth, compression time, decompression time, and plateau time were almost equal between ROSCER and LUCAS 3. In a swine model of cardiac arrest, coronary perfusion pressure showed no difference between the two groups (p = 0.409). Systolic aortic pressure and carotid blood flow were higher in the LUCAS 3 group than in the ROSCER group during 5 minutes of CPR (p < 0.001, p = 0.008, respectively). End-tidal CO2 level of the ROSCER group was initially lower than that of the LUCAS 3 group, but was higher over time (p = 0.022). A Kaplan-Meier survival analysis for ROSC also showed no difference between the two groups (p = 0.46). CONCLUSION The prototype of a remote-controlled automated chest compression device can move the chest compression position without interruption during CPR. In a mannequin and a swine model of cardiac arrest, the device showed no inferior performance to a conventional mechanical CPR device.
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Affiliation(s)
- Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Taegyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hayoung Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesu Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gaonsorae Wang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeheung Park
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Sungmoon Hur
- Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Jaehoon Sim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | | | - Jung Chan Lee
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering and Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Ah Shin
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Woo Sang Cho
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Byung Jun Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Soyoon Kwon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Ye Ji Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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7
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George N, Stephens K, Ball E, Crandall C, Ouchi K, Unruh M, Kamdar N, Myaskovsky L. Extracorporeal Membrane Oxygenation for Cardiac Arrest: Does Age Matter? Crit Care Med 2024; 52:20-30. [PMID: 37782526 PMCID: PMC11267242 DOI: 10.1097/ccm.0000000000006039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVES The impact of age on hospital survival for patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest (CA) is unknown. We sought to characterize the association between older age and hospital survival after ECPR, using a large international database. DESIGN Retrospective analysis of the Extracorporeal Life Support Organization registry. PATIENTS Patients 18 years old or older who underwent ECPR for CA between December 1, 2016, and October 31, 2020. MEASUREMENTS AND MAIN RESULTS The primary outcome was adjusted odds ratio (aOR) of death after ECPR, analyzed by age group (18-49, 50-64, 65-74, and > 75 yr). A total of 5,120 patients met inclusion criteria. The median age was 57 years (interquartile range, 46-66 yr). There was a significantly lower aOR of survival for those 65-74 (0.68l 95% CI, 0.57-0.81) or those greater than 75 (0.54; 95% CI, 0.41-0.69), compared with 18-49. Patients 50-64 had a significantly higher aOR of survival compared with those 65-74 and greater than 75; however, there was no difference in survival between the two youngest groups (aOR, 0.91; 95% CI, 0.79-1.05). A sensitivity analysis using alternative age categories (18-64, 65-69, 70-74, and ≥ 75) demonstrated decreased odds of survival for age greater than or equal to 65 compared with patients younger than 65 (for age 65-69: odds ratio [OR], 0.71; 95% CI, 0.59-0.86; for age 70-74: OR, 0.84; 95% CI, 0.67-1.04; and for age ≥ 75: OR, 0.64; 95% CI, 0.50-0.81). CONCLUSIONS This investigation represents the largest analysis of the relationship of older age on ECPR outcomes. We found that the odds of hospital survival for patients with CA treated with ECPR diminishes with increasing age, with significantly decreased odds of survival after age 65, despite controlling for illness severity and comorbidities. However, findings from this observational data have significant limitations and further studies are needed to evaluate these findings prospectively.
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Affiliation(s)
- Naomi George
- Department of Emergency Medicine, Division of Critical Care, University of New Mexico School of Medicine, Albuquerque, NM
| | - Krista Stephens
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Emily Ball
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Kei Ouchi
- Department of Emergency Medicine, Division of Critical Care, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Emergecy Medicine, Harvard Medical School, Boston, MA
- Serious Illness Care Program, Ariadne Labs, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Cancer Institute, Boston, MA
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
- Department of Population Health Sciences, Stanford University, Stanford, CA
- Department of Emergency Medicine, Department of Family Medicine, Department of Surgery, Department of Obstetrics and Gynecology, Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
- Center for Healthcare Equity in Kidney Disease, University of New Mexico School of Medicine, Albuquerque, NM
| | - Mark Unruh
- Department of Psychosocial Oncology and Palliative Care, Cancer Institute, Boston, MA
| | - Neil Kamdar
- Department of Emergency Medicine, Division of Critical Care, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Emergecy Medicine, Harvard Medical School, Boston, MA
- Serious Illness Care Program, Ariadne Labs, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Cancer Institute, Boston, MA
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
- Department of Population Health Sciences, Stanford University, Stanford, CA
- Department of Emergency Medicine, Department of Family Medicine, Department of Surgery, Department of Obstetrics and Gynecology, Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
- Center for Healthcare Equity in Kidney Disease, University of New Mexico School of Medicine, Albuquerque, NM
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
- Center for Healthcare Equity in Kidney Disease, University of New Mexico School of Medicine, Albuquerque, NM
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8
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Adams D, Nathanson BH, White CN, Jackson EA, Mader TJ, Coute RA. Predicting Neurologically Intact Survival for Advanced Age Adults After Successful Resuscitation of Out-of-Hospital Cardiac Arrest. Am J Cardiol 2023; 207:222-228. [PMID: 37757519 DOI: 10.1016/j.amjcard.2023.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023]
Abstract
We sought to predict survival to hospital discharge with favorable neurologic outcome for advanced age adults (≥65 years) after successful resuscitation of non-traumatic out-of-hospital cardiac arrest (OHCA). A retrospective observational cohort analysis was performed using the national Cardiac Arrest Registry to Enhance Survival database from January 1, 2013 to December 31, 2021. All nontraumatic OHCA occurring in advanced age adults who survived to hospital admission were included. The primary outcome was survival with favorable neurologic outcome defined as a cerebral performance category score of 1 or 2 at hospital discharge. Multivariable logistic regression including patient variables (age category, gender, co-morbidities) and OHCA characteristics (location, rhythm category, witnessed status, and who initiated cardiopulmonary resuscitation) were used to predict hospital outcome. 83,574 patients met study inclusion criteria with 19,298 (23.1%) surviving with favorable neurologic outcome. The median age was 75 years (interquartile range 69 to 82 years), 58.9% were male, and a majority of events occurred at home (67.3%). Age was found to have a linear, negative association with outcome. Survival with cerebral performance category 1 or 2 ranged from 28.8% in those between the age of 65 to 69 years (n = 23,161) and 13.7% for those age >90 years (n = 4,666). The regression model produced outcome probabilities ranging from 2.6% to 80.8% with a cross-validated AUROC of 0.742 (95% confidence interval 0.738 to 0.746) and a Brier score of 0.151. In conclusion, a simple model with basic patient and OHCA characteristics can predict hospital outcomes in advanced age adults with good discrimination and calibration.
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Affiliation(s)
- Dylana Adams
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | | | - Christopher N White
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Timothy J Mader
- Department of Emergency Medicine, UMass Chan Medical School-Baystate, Springfield, Massachusetts; Department of Healthcare Delivery and Population Science, UMass Chan Medical School-Baystate, Springfield, Massachusetts
| | - Ryan A Coute
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
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Goodarzi A, Abdi A, Ghasemi H, Darvishi N, Jalali R. The outcomes of cardiopulmonary resuscitation and their predictors during the coronavirus 2019 pandemic in Iran. BMC Emerg Med 2023; 23:94. [PMID: 37605176 PMCID: PMC10441697 DOI: 10.1186/s12873-023-00860-4] [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: 02/10/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can negatively affect different healthcare-related outcomes. Nonetheless, there is limited information about its effects on different healthcare-related outcomes. This study aimed at evaluating the outcomes of cardiopulmonary resuscitation (CPR) and their predictors during the COVID-19 pandemic in Iran. METHODS This cross-sectional study was conducted on 1253 patients who had undergone CPR in the emergency wards of teaching hospitals in the west of Iran from the beginning of the first wave to the end of the third epidemic wave of COVID-19 in Iran, between February 20, 2020, and January 20, 2021. Data were collected using the National CPR Documentation Forms developed based on the Utstein Style and routinely used for all patients with cardiac arrest (CA). The SPSS (v. 20.0) program was used to analyze the data through the Chi-square, Fisher's exact, and Mann-Whitney U tests and logistic regression analysis. RESULTS Participants' age mean was 64.62 ± 17.54 years. Age mean among participants with COVID-19 was eight years more than other participants. Most participants were male (64.09%) and had at least one underlying disease (64.99%). The total rates of the return of spontaneous circulation (ROSC) and CPR-discharge survival were respectively 15.3% and 3.8% among all participants, 20.25% and 5.17% among participants without COVID-19, and 8.96% and 2.04% among participants with COVID-19. The significant predictors of ROSC were age, affliction by COVID-19, affliction by underlying diseases, baseline rhythm, delay in epinephrine administration, and epinephrine administration time interval, while the significant predictors of CPR-discharge survival were age and baseline rhythm. CONCLUSIONS The total rates of ROSC and CPR-discharge survival were respectively 15.3% and 3.8% among all participants. The rates of ROSC and CPR to discharge survival among patients without COVID-19 are respectively 2.26 and 2.53 times more than the rates among patients with COVID-19.
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Affiliation(s)
- Afshin Goodarzi
- Department of Prehospital Emergency, School of paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Boshen Y, Yuankang Z, Xinjie Z, Taixi L, Kaifan N, Zhixiang W, Juan S, Junli D, Suiji L, Xia L, Chengxing S. Triglyceride-glucose index is associated with the occurrence and prognosis of cardiac arrest: a multicenter retrospective observational study. Cardiovasc Diabetol 2023; 22:190. [PMID: 37501144 PMCID: PMC10375765 DOI: 10.1186/s12933-023-01918-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA. METHODS In this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed. RESULTS Overall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72-9.69) vs. 8.89 (8.45-9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03-1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02-1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA. CONCLUSION Elevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.
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Affiliation(s)
- Yang Boshen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yuankang
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Xinjie
- Department of Respiratory Medicine, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Li Taixi
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niu Kaifan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Zhixiang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Juan
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Duan Junli
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Suiji
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China.
| | - Lu Xia
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shen Chengxing
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Liu CH, Tsai MJ, Hsu CF, Tsai CH, Su YS, Cai DC. The Influence of the COVID-19 Pandemic on Emergency Medical Services to Out-of-Hospital Cardiac Arrests in a Low-Incidence Urban City: An Observational Epidemiological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2713. [PMID: 36768079 PMCID: PMC9915115 DOI: 10.3390/ijerph20032713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
The Emergency Medical Services (EMS) system faced overwhelming challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, further information is required to determine how the pandemic affected the EMS response and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) patients in COVID-19 low-incidence cities. A retrospective study was conducted in Chiayi, Taiwan, a COVID-19 low-incidence urban city. We compared the outcomes and rescue records before (2018-2019) and during (2020-2021) the COVID-19 pandemic. A total of 567 patients before and 497 during the pandemic were enrolled. Multivariate analysis revealed that the COVID-19 pandemic had no significant influence on the achievement of return of spontaneous circulation (ROSC) and sustained ROSC but was associated with lower probabilities of survival to discharge (aOR = 0.43, 95% CI: 0.21-0.89, p = 0.002) and discharge with favorable neurologic outcome among OHCA patients (aOR = 0.35, 95% CI: 0.16-0.77, p = 0.009). Patients' ages and OHCA locations were also discovered to be independently related to survival results. The overall impact of longer EMS rescue times on survival outcomes during the pandemic was not significant, with an exception of the specific group that experienced prolonged rescue times (total EMS time > 21 min).
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Affiliation(s)
- Chung-Hsien Liu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
- Graduate School of Design, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Chi-Feng Hsu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Cheng-Han Tsai
- Department of Emergency Medicine, Taichung Veteran’s General Hospital, Chia-Yi Branch, Chiayi City 600, Taiwan
| | - Yao-Sing Su
- Fire Bureau, Chiayi City Government, Chiayi City 600, Taiwan
| | - Deng-Chuan Cai
- Graduate School of Design, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
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Goodarzi A, Khodaveisi M, Abdi A, Salimi R, Oshvandi K. Healthcare providers' experiences in hospital resuscitation of patients with COVID-19: a qualitative study. BMC Nurs 2022; 21:238. [PMID: 36008836 PMCID: PMC9406244 DOI: 10.1186/s12912-022-01020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP’s experiences of CPR in patients with COVID-19. Methods A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method. Results The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor’s degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. “Human aspects of Care”, “Perceived Psychological Effects of Resuscitation in COVID-19”, “HCP’s perceptions of factors affecting the resuscitation process in COVID-19”, and “Perceived differences in COVID-19 resuscitation compared to non-COVID patients” were super-ordinate themes. Conclusions The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants’ fatigue or lack of oxygen due to the use of personal protective equipment (PPE).
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Affiliation(s)
- Afshin Goodarzi
- Department of medical emergency, Faculty of Paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Home Care) Research Center, Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Salimi
- Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran.
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Sans Roselló J, Vidal-Burdeus M, Loma-Osorio P, Pons Riverola A, Bonet Pineda G, El Ouaddi N, Aboal J, Ariza Solé A, Scardino C, García-García C, Fernández-Peregrina E, Sionis A. “Impact of age on management and prognosis of resuscitated sudden cardiac death patients”. IJC HEART & VASCULATURE 2022; 40:101036. [PMID: 35514873 PMCID: PMC9062668 DOI: 10.1016/j.ijcha.2022.101036] [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: 01/20/2022] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Background Sudden cardiac death (SCD) has a great impact on healthcare due to cardiologic and neurological complications. Admissions of elderly people in Cardiology Intensive Care Units have increased. We assessed the impact of age in presentation, therapeutic management and in vital and neurological prognosis of SCD patients. Methods We carried out a retrospective, observational, multicenter registry of patients who were admitted with a SCD in 5 tertiary hospitals from January 2013 to December 2020. We divided our cohort into two groups (patients < 80 years and ≥ 80 years). Clinical, analytical and hemodynamic variables as well as in-hospital management were registered and compared between groups. The degree of neurological dysfunction, vital status at discharge and the influence of age on them were also reviewed. Results We reviewed 1160 patients admitted with a SCD. 11.3% were ≥ 80 years. Use of new antiplatelet agents, performance of a coronary angiography, use of pulmonary artery catheter and temperature control were less carried out in the elderly. Age, non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min, time to ROSC > 20 min and lactate > 2 mmol/L were independent predictors for in-hospital mortality. Non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min and time to ROSC > 20 min but not age were independent predictors for poor neurological outcomes. Conclusions Age determined a less aggressive management and it was associated with a worse vital prognosis in patients admitted with a SCD. Nevertheless, age was not associated with worse neurological outcomes.
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Affiliation(s)
- Jordi Sans Roselló
- Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
| | - Maria Vidal-Burdeus
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitari Vall d’Hebrón. Barcelona, Spain
| | - Pablo Loma-Osorio
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Alexandra Pons Riverola
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Gil Bonet Pineda
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Nabil El Ouaddi
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jaime Aboal
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Albert Ariza Solé
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Cosme García-García
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Alessandro Sionis
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
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Salcido DD, Koller AC, Genbrugge C, Fink EL, Berg RA, Menegazzi JJ. Injury characteristics and hemodynamics associated with guideline-compliant CPR in a pediatric porcine cardiac arrest model. Am J Emerg Med 2022; 51:176-183. [PMID: 34763236 PMCID: PMC8982633 DOI: 10.1016/j.ajem.2021.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Guidelines for depth of chest compressions in pediatric cardiopulmonary resuscitation (CPR) are based on sparse evidence. OBJECTIVE We sought to evaluate the performance of the two most widely recommended chest compression depth levels for pediatric CPR (1.5 in. and 1/3 the anterior-posterior diameter- APd) in a controlled swine model of asphyxial cardiac arrest. METHODS We executed a 2-group, randomized laboratory study with an adaptive design allowing early termination for overwhelming injury or benefit. Forty mixed-breed domestic swine (mean weight = 26 kg) were sedated, anesthetized and paralyzed along with endotracheal intubation and mechanical ventilation. Asphyxial cardiac arrest was induced with fentanyl overdose. Animals were untreated for 9 min followed by mechanical CPR with a target depth of 1.5 in. or 1/3 the APd. Advanced life support drugs were administered IV after 4 min of basic resuscitation followed by defibrillation at 14 min. The primary outcomes were return of spontaneous circulation (ROSC), hemodynamics and CPR-related injury severity. RESULTS Enrollment in the 1/3 APd group was stopped early due to overwhelming differences in injury. Twenty-three animals were assigned to the 1.5 in. group and 15 assigned to the 1/3 APd group, per an adaptive group design. The 1/3 APd group had increased frequency of rib fracture (6.7 vs 1.7, p < 0.001) and higher proportions of several anatomic injury markers than the 1.5 in. group, including sternal fracture, hemothorax and blood in the endotracheal tube (p < 0.001). ROSC and hemodynamic measures were similar between groups. CONCLUSION In this pediatric model of cardiac arrest, chest compressions to 1/3APd were more harmful without a concurrent benefit for resuscitation outcomes compared to the 1.5 in. compression group.
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Affiliation(s)
- David D. Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Allison C. Koller
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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15
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Screening for neurocognitive impairment following out-of-hospital cardiac arrest: anyone for a MoCA? Resuscitation 2022; 172:137-138. [DOI: 10.1016/j.resuscitation.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
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Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111020. [PMID: 34769541 PMCID: PMC8582961 DOI: 10.3390/ijerph182111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.
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Henson T, Rawanduzy C, Salazar M, Sebastian A, Weber H, Al-Mufti F, Mayer SA. Outcome and prognostication after cardiac arrest. Ann N Y Acad Sci 2021; 1508:23-34. [PMID: 34580886 DOI: 10.1111/nyas.14699] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/17/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
The outcome after out-of-hospital cardiac arrest has historically been grim at best. The current overall survival rate of patients admitted to a hospital is approximately 10%, making cardiac arrest one of the leading causes of death in the United States. The situation is improving with the incorporation of therapeutic temperature modulation, aggressive prevention of secondary brain injury, and improved access to advanced cardiovascular support, all of which have decreased mortality and allowed for better outcomes. Mortality after cardiac arrest is often the direct result of active withdrawal of life-sustaining therapy based on the perception that neurological recovery is not possible. This reality highlights the importance of providing accurate estimates of neurological prognosis to decision makers when discussing goals of care. The current standard of care for assessing neurological status in patients with hypoxic-ischemic encephalopathy emphasizes a multimodal approach that includes five elements: (1) neurological examination off sedation, (2) continuous electroencephalography, (3) serum neuron-specific enolase levels, (4) magnetic resonance brain imaging, and (5) somatosensory-evoked potential testing. Sophisticated decision support systems that can integrate these clinical, imaging, and biomarker and neurophysiologic data and translate it into meaningful projections of neurological outcome are urgently needed.
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Affiliation(s)
| | | | | | | | - Harli Weber
- New York Medical College, Valhalla, New York
| | - Fawaz Al-Mufti
- Westchester Medical Center, Valhalla, New York.,New York Medical College, Valhalla, New York
| | - Stephan A Mayer
- Westchester Medical Center, Valhalla, New York.,New York Medical College, Valhalla, New York
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18
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Lee S, Lee SW, Han KS, Ki M, Ko YH, Kim SJ. Analysis of Characteristics and Mortality in Cardiac Arrest Patients by Hospital Level: a Nationwide Population-based Study. J Korean Med Sci 2021; 36:e173. [PMID: 34184437 PMCID: PMC8239426 DOI: 10.3346/jkms.2021.36.e173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/31/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Survival and post-cardiac arrest care vary considerably by hospital, region, and country. In the current study, we aimed to analyze mortality in patients who underwent cardiac arrest by hospital level, and to reveal differences in patient characteristics and hospital factors, including post-cardiac arrest care, hospital costs, and adherence to changes in resuscitation guidelines. METHODS We enrolled adult patients (≥ 20 years) who suffered non-traumatic cardiac arrest from 2006 to 2015. Patient demographics, insurance type, admission route, comorbidities, treatments, and hospital costs were extracted from the National Health Insurance Service database. We categorized patients into tertiary hospital, general hospital, and hospital groups according to the level of the hospital where they were treated. We analyzed the patients' characteristics, hospital factors, and mortalities among the three groups. We also analyzed post-cardiac arrest care before and after the 2010 guideline changes. The primary end-point was 30 days and 1 year mortality rates. RESULTS The tertiary hospital, general hospital, and hospital groups represented 32.6%, 49.6%, and 17.8% of 337,042 patients, respectively. The tertiary and general hospital groups were younger, had a lower proportion of medical aid coverage, and fewer comorbidities, compared to the hospital group. Post-cardiac arrest care, such as percutaneous coronary intervention, targeted temperature management, and extracorporeal membrane oxygenation, were provided more frequently in the tertiary and general hospital groups. After adjusting for age, sex, insurance type, urbanization level, admission route, comorbidities, defibrillation, resuscitation medications, angiography, and guideline changes, the tertiary and general hospital groups showed lower 1-year mortality (tertiary hospital vs. general hospital vs. hospital, adjusted odds ratios, 0.538 vs. 0.604 vs. 1; P < 0.001). After 2010 guideline changes, a marked decline in atropine use and an increase in post-cardiac arrest care were observed in the tertiary and general hospital groups. CONCLUSION The tertiary and general hospital groups showed lower 30 days and 1 year mortality rates than the hospital group, after adjusting for patient characteristics and hospital factors. Higher-level hospitals provided more post-cardiac arrest care, which led to high hospital costs, and showed good adherence to the guideline change after 2010.
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Affiliation(s)
- Sijin Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kap Su Han
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University Hospital, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea.
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Schriefl C, Schoergenhofer C, Ettl F, Poppe M, Clodi C, Mueller M, Grafeneder J, Jilma B, Magnet IAM, Buchtele N, Boegl MS, Holzer M, Sterz F, Schwameis M. Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome. Front Med (Lausanne) 2021; 8:639803. [PMID: 34179033 PMCID: PMC8219926 DOI: 10.3389/fmed.2021.639803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA. Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression. Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014). Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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20
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The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073636. [PMID: 33807385 PMCID: PMC8036320 DOI: 10.3390/ijerph18073636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/02/2023]
Abstract
High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.
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21
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Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med 2021; 12:695-723. [PMID: 33683679 PMCID: PMC7938035 DOI: 10.1007/s41999-021-00454-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Aim We aimed to collect the available evidence on outcome regarding survival and quality of life after CPR following both IHCA and OHCA in the older population. Findings Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Message Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y. Purpose We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population. Methods A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL). Results The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0–11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7–25.0% and 0–10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1–2 was found in 11.5–23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1–2 among patients surviving until hospital discharge was 82–93% (IHCA) and 77–91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies. Conclusions Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y.
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Affiliation(s)
- Rina Zanders
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
| | - Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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22
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Marcus EL, Chigrinskiy P, Deutsch L, Einav S. Age, pre-arrest neurological condition, and functional status as outcome predictors in out-of-hospital cardiac arrest: Secondary analysis of the Jerusalem Cohort Study data. Arch Gerontol Geriatr 2021; 93:104317. [PMID: 33310659 DOI: 10.1016/j.archger.2020.104317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Investigate the relation between age, baseline neurological and functional status, and survival after out-of-hospital cardiac arrest (OHCA). METHODS Data analysis from the Jerusalem District Resuscitation Study. Patients >80 years and those 18-80 years with OHCA from 4/2005-12/2010 were compared. PRIMARY OUTCOME survival at four time points; secondary outcomes: neurological and functional status at hospital discharge, and relationship between survival, age and pre-arrest activities of daily living (ADL) and Cerebral Performance Category (CPC) scores (higher scores indicate worse function in both). RESULTS 3,211 patients (1,259 >80 years, 1952 aged 18-80) with median follow-up 5.9 years (range 0.1-11.1 years) were included. Survival was better for younger patients at all four time points, including 7.8% versus 2.5% at hospital discharge, 4.6% versus 0.2% at late follow-up. Functional status at discharge was also better, 4.8 ± 5.4 versus 9.0 ± 4.7, p<0.001, and more young patients had CPC1/2, 60.7% versus 32.2%, p = 0.004. Older patients who survived to emergency department admission had increased mortality per year of age (2.6%, hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.006-1.048 versus 1.7%, HR 1.017, 95% CI 1.010-1.025), per point in pre-arrest ADL (3.0%, HR 1.030, 95% CI 1.007-1.054 versus 5.8%, HR 1.058, 95% CI 1.036-1.080), and per point in pre-arrest CPC (24%, HR 1.242, 95% CI 1.097-1.406 versus 37%, HR 1.370 95% CI 1.232-1.524). CONCLUSION Patient independence before arrest may be a more crucial determinant of resuscitation outcome than older age alone. Discussion of end-of-life preferences is particularly important for older individuals with functional and cognitive decline.
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Affiliation(s)
- Esther-Lee Marcus
- Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, Israel; School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Pavel Chigrinskiy
- Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, Israel; School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd., Modiin, Israel.
| | - Sharon Einav
- School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel; Intensive Care Unit, Shaare-Zedek Medical Center, Jerusalem, Israel.
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Pyo SY, Park GJ, Kim SC, Kim H, Lee SW, Lee JH. Impact of the modified SESAME ultrasound protocol implementation on patients with cardiac arrest in the emergency department. Am J Emerg Med 2021; 43:62-68. [PMID: 33529851 DOI: 10.1016/j.ajem.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Point-of-care (POC) ultrasound protocols are commonly used for the initial management of patients with cardiac arrest in the emergency department (ED). However, there is little published evidence regarding any mortality benefit. We compared and studied the effect of implementation of the modified SESAME protocol in terms of clinical outcomes and resuscitation management. METHODS This was a single-center retrospective observational study. We conducted a pre- and post-intervention study to evaluate changes in patient outcomes and management after educating emergency medicine residents and the faculty about the modified SESAME protocol. The pre-intervention period lasted from March 2018 to February 2019, and the post-intervention period lasted from May 2019 to April 2020. The modified SESAME protocol education was initiated in March 2019. Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes. RESULTS A total of 334 patients were included in this study during a 24-month period. We found no significant differences between the two groups for the primary outcome of survival to hospital admission (pre-intervention group 28.9% versus post-intervention group 28.6%; P = 0.751), survival to hospital discharge (12.1% vs. 12.4%; P = 0.806), and good neurologic outcome at discharge (6.0% vs. 8.1%; P = 0.509). The proportion of resuscitation procedures of thrombolysis, emergency transfusion, tube thoracotomy, and pericardiocentesis during resuscitation increased from 0.6% in the pre-intervention period to 4.9% in the post-intervention period (P = 0.016). CONCLUSION We did not discover any significant survival benefits associated with the implementation of the modified SESAME protocol; however, early diagnosis of specific pathologies (pericardial effusion, possible pulmonary embolism, tension pneumothorax, and hypovolemia) and accordingly a direct increase in the resuscitation management were seen in this study. Future studies with larger sample sizes are required to examine the clinical outcomes as well as to identify the most effective POC ultrasonography protocols for non-traumatic cardiac arrests.
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Affiliation(s)
- Su Yeong Pyo
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungbuk National University, 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Ji Han Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea.
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Lee BK, Callaway CW, Coppler PJ, Rittenberger JC. The prognostic performance of brain ventricular characteristic differ according to sex, age, and time after cardiac arrest in comatose out-of-hospital cardiac arrest survivors. Resuscitation 2020; 154:69-76. [DOI: 10.1016/j.resuscitation.2020.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022]
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25
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Embong H, Md Isa SA, Harunarashid H, Abd Samat AH. Factors associated with prolonged cardiopulmonary resuscitation attempts in out-of-hospital cardiac arrest patients presenting to the emergency department. Australas Emerg Care 2020; 24:84-88. [PMID: 32847734 DOI: 10.1016/j.auec.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is high variability among clinicians' decision of appropriate cardiopulmonary resuscitation (CPR) duration before deciding for termination of resuscitation. This study attempted to investigate factors associated with the decision to prolong resuscitation attempts in cardiac arrest patients treated in an emergencydepartment (ED). METHODS A retrospective study that evaluated two years of mortality registry starting in 2015 was conducted in the ED of University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Adult out-hospital cardiac arrest (OHCA) patients treated in the ED were included. Multivariate logistic regression analysis was utilized for the exploration of factors associated with prolonged CPR attempts (> 30min). RESULTS The median CPR duration was 24min (range 2-68min). Four variables were independently associated with prolonged CPR attempts: younger age (OR, 0.97; 95% CI, 0.95-0.99; p<0.001), pre-existing heart disease (OR, 1.97; 95% CI, 1.07-3.65; p=0.031), occurrence of transient return of spontaneous circulation (ROSC) (OR, 2.38; 95% CI, 1.05-5.36; p=0.037), and access to the ED by nonemergency medical services (EMS) transport (OR, 1.92; 95% CI, 1.09-3.37; p=0.024). CONCLUSION Patient-related and access-related factors were associated with prolonged CPR attempts among OHCA patients resuscitated in the ED.
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Affiliation(s)
- Hashim Embong
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Syakirah Anisa Md Isa
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Husyairi Harunarashid
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Azlan Helmy Abd Samat
- Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
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Kovács E, Pilecky D, Szakál-Tóth Z, Fekete-Győr A, Gyarmathy VA, Gellér L, Hauser B, Gál J, Merkely B, Zima E. The role of age in post-cardiac arrest therapy in an elderly patient population. Physiol Int 2020; 107:319-336. [PMID: 32692712 DOI: 10.1556/2060.2020.00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
Aim We investigated the effect of age on post-cardiac arrest treatment outcomes in an elderly population, based on a local database and a systemic review of the literature. Methods Data were collected retrospectively from medical charts and reports. Sixty-one comatose patients, cooled to 32-34 °C for 24 h, were categorized into three groups: younger group (≤65 years), older group (66-75 years), and very old group (>75 years). Circumstances of cardiopulmonary resuscitation (CPR), patients' characteristics, post-resuscitation treatment, hemodynamic monitoring, neurologic outcome and survival were compared across age groups. Kruskal-Wallis test, Chi-square test and binary logistic regression (BLR) were applied. In addition, a literature search of PubMed/Medline database was performed to provide a background. Results Age was significantly associated with having a cardiac arrest on a monitor and a history of hypertension. No association was found between age and survival or neurologic outcome. Age did not affect hemodynamic parameter changes during target temperature management (TTM), except mean arterial pressure (MAP). Need of catecholamine administration was the highest among very old patients. During the literature review, seven papers were identified. Most studies had a retrospective design and investigated interventions and outcome, but lacked unified age categorization. All studies reported worse survival in the elderly, although old survivors showed a favorable neurologic outcome in most of the cases. Conclusion There is no evidence to support the limitation of post-cardiac arrest therapy in the aging population. Furthermore, additional prospective studies are needed to investigate the characteristics and outcome of post-cardiac arrest therapy in this patient group.
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Affiliation(s)
- E Kovács
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | | | - Z Szakál-Tóth
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - A Fekete-Győr
- 4St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - L Gellér
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - B Hauser
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - J Gál
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - B Merkely
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - E Zima
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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27
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Koen 'J, Nathanaël T, Philippe D. A systematic review of current ECPR protocols. A step towards standardisation. Resusc Plus 2020; 3:100018. [PMID: 34223301 PMCID: PMC8244348 DOI: 10.1016/j.resplu.2020.100018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Aim Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Our goal was to identify the best protocol for survival with good neurological outcome through the evaluation of current inclusion criteria, exclusion criteria, cannulation strategies and additional therapeutic measures. Methods A systematic literature search was used to identify eligible publications from PubMed, Embase, Web of Science and Cochrane for articles published from 29 June 2009 until 29 June 2019. Results The selection process led to a total of 24 eligible articles, considering 1723 patients in total. A good neurological outcome at hospital discharge was found in 21.3% of all patients. The most consistent criterion for inclusion was refractory cardiac arrest (RCA), used in 21/25 (84%) of the protocols. The preferred cannulation method was the percutaneous Seldinger technique (44%). Conclusion ECPR is a feasible option for cardiac arrest and should already be considered in an early stage of CPR. One of the key findings is that time-to-ECPR seems to be correlated with good neurological survival. An important contributing factor is the definition of RCA. Protocols defining RCA as >10 min had a mean good neurological survival of 26.7%. Protocols with a higher cut-off, between 15 and 30 min, had a mean good neurological survival of 14.5%. Another factor contributing to the time-to-ECPR is the preferred access technique. A percutaneous Seldinger technique combined with ultrasonography and fluoroscopic guidance leads to a reduced cannulation time and complication rate. Conclusive research around prehospital cannulation still needs to be conducted.
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Affiliation(s)
- 't Joncke Koen
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium.,KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Thelinge Nathanaël
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium.,KULeuven, Faculty of Medicine, Leuven, Belgium
| | - Dewolf Philippe
- Department of Emergency Medicine, University Hospitals of Leuven, Leuven, Belgium.,KULeuven, Department of Public Health and Primary Care, Leuven, Belgium.,KULeuven, Faculty of Medicine, Leuven, Belgium
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28
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Harrogate S, Stretch B, Seatter R, Finney S, Singer B. A retrospective analysis of inpatient cardiac arrests over one year at a tertiary heart attack and cardiothoracic centre identifying potential candidates for an inpatient extracorporeal cardiopulmonary resuscitation service. J Intensive Care Soc 2020; 21:105-110. [PMID: 32489405 DOI: 10.1177/1751143719848660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is an internationally recognised treatment for refractory cardiac arrest, with evidence of improved outcomes in selected patient groups from cohort studies and case series. In order to establish the clinical need for an in-hospital extracorporeal cardiopulmonary resuscitation service at a tertiary cardiac centre, we analysed the inpatient cardiac arrest database for the previous 12 months. Methods Evidence-based inclusion criteria were used to retrospectively identify the number of patients potentially eligible for extracorporeal cardiopulmonary resuscitation over a 12-month period. Results A total of 261 inpatient cardiac arrests were analysed with 21 potential extracorporeal cardiopulmonary resuscitation candidates meeting the inclusion criteria (1.75 patients per month, or 8% of inpatient cardiac arrests (21/261)). The majority (71%) of these cardiac arrests occurred outside of normal working hours. Survival-to-discharge within this sub-group with conventional cardiopulmonary resuscitation was 19% (4/21). Conclusion Sufficient numbers of refractory inpatient cardiac arrests occur to justify an extracorporeal cardiopulmonary resuscitation service, but a 24-h on-site extracorporeal membrane oxygenation team presents a significant financial and logistical challenge.
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Affiliation(s)
| | - Benjamin Stretch
- ACCS Anaesthetics CT1 Barts and the London School of Anaesthesia, London, UK
| | | | - Simon Finney
- St Bartholomew's Hospital, London, UK.,William Harvey Resarch Institute, Queen Mary University, London, UK
| | - Ben Singer
- St Bartholomew's Hospital, London, UK.,William Harvey Resarch Institute, Queen Mary University, London, UK.,Barts Health, NHS Trust, London, UK
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29
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Siman-Tov M, Strugo R, Podolsky T, Rosenblat I, Blushtein O. Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study. Am J Emerg Med 2020; 44:333-338. [PMID: 32336582 DOI: 10.1016/j.ajem.2020.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018. METHODS All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768). RESULTS DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC. CONCLUSIONS OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.
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Affiliation(s)
- Maya Siman-Tov
- Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | | | - Oren Blushtein
- Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel
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30
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Wiberg S, Holmberg MJ, Donnino MW, Kjaergaard J, Hassager C, Witten L, Berg KM, Moskowitz A, Andersen LW. Age-dependent trends in survival after adult in-hospital cardiac arrest. Resuscitation 2020; 151:189-196. [PMID: 32246986 DOI: 10.1016/j.resuscitation.2020.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. METHODS This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between 2000 and 2016. The primary outcome was survival to hospital discharge. Patients were stratified into five age groups: <50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. RESULTS A total of 234,767 IHCA patients were included. The absolute increase in survival per calendar year was 0.8% (95% CI 0.7-1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95% CI 0.4-0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients older than 80 years. We observed a significant interaction between calendar year and age group (p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. CONCLUSIONS For patients with IHCA, rates of survival to discharge have improved significantly from 2000 to 2016 across all age groups.
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Affiliation(s)
- Sebastian Wiberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Mathias J Holmberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lise Witten
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Katherine M Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lars W Andersen
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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The CAHP (cardiac arrest hospital prognosis) score: A tool for risk stratification after out-of-hospital cardiac arrest in elderly patients. Resuscitation 2020; 148:200-206. [DOI: 10.1016/j.resuscitation.2020.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 01/23/2023]
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Pätz T, Stelzig K, Pfeifer R, Pittl U, Thiele H, Busch HJ, Reinhard I, Wolfrum S. Age-associated outcomes after survived out-of-hospital cardiac arrest and subsequent target temperature management. Acta Anaesthesiol Scand 2019; 63:1079-1088. [PMID: 31206587 DOI: 10.1111/aas.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The registry of the German Society of Intensive Care and Emergency Medicine was founded to analyze outcome of modern post-resuscitation care. METHODS A total of 902 patients were analyzed in this retrospective, multicenter, and population-based observational trial on individuals suffering from out-of-hospital cardiac arrest. All patients had return of spontaneous circulation (ROSC) and received TTM after admitted to an intensive care unit. Outcome was focused on age and analyzed by creating 4 subgroups (<65, 65-74, 75-84, ≥85 years). Twenty-eight day and 180-day survival and a favorable neurological outcome according to the Cerebral Performance Category scale were evaluated as clinical endpoints. RESULTS At 28-day and 180-day follow-up, 44.8% and 53.4% of all patients had died, respectively. The evaluation of survival rate by age category revealed a higher mortality, but not an unfavorable neurological prognosis with increasing age. In multiple stepwise regressions, age, time to ROSC, bystander resuscitation, and cardiac cause of cardiac arrest were associated with increased chance of 180-day survival and, in addition, bystander resuscitation, time of hypoxia, and a defibrillation performed by emergency medical service were associated with a favorable neurological outcome at 180-day follow-up. CONCLUSION Increasing age was associated with a higher mortality, but not with an unfavorable neurological outcome. The majority of survivors had a favorable neurologic outcome 6 months after cardiac arrest.
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Affiliation(s)
- Toni Pätz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care MedicineLübeck Germany
| | - Katharina Stelzig
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
| | - Rüdiger Pfeifer
- Clinic for Internal Medicine University of Jena Jena Germany
| | - Undine Pittl
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Hans-Jörg Busch
- University Emergency Center University of Freiburg Freiburg Germany
| | - Iris Reinhard
- Department of Biostatistics Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University Mannheim Germany
| | - Sebastian Wolfrum
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
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Wang TH, Lin HA, Kao WF, Chao CC. Locational effect on automated external defibrillator use and association of age with on-site return of spontaneous circulation. Am J Emerg Med 2019; 37:1446-1449. [DOI: 10.1016/j.ajem.2018.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022] Open
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Management and outcomes of cardiac arrests at nursing homes: A French nationwide cohort study. Resuscitation 2019; 140:86-92. [DOI: 10.1016/j.resuscitation.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022]
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Affiliation(s)
- George F Glass
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville
| | - William J Brady
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville
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36
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Hiemstra B, Bergman R, Absalom AR, van der Naalt J, van der Harst P, de Vos R, Nieuwland W, Nijsten MW, van der Horst ICC. Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis 2018; 12:341-349. [PMID: 30231773 PMCID: PMC6266245 DOI: 10.1177/1753944718792420] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population. METHODS: Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (⩾75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population. RESULTS: Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 ± 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% ( p < 0.001). A CPC of 1 was present in 73% of the elderly patients versus 86% of the younger patients ( p = 0.031). In 7.3% of the elderly patients, a CPC >2 was observed versus 2.5% of their younger counterparts ( p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population ( p = 0.019). CONCLUSIONS: The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population.
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Affiliation(s)
- Bart Hiemstra
- Department of Critical Care, University of
Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001,
Groningen, 9700 RB, The Netherlands
| | - Remco Bergman
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Anthony R. Absalom
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Ronald de Vos
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Wybe Nieuwland
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Maarten W. Nijsten
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
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Kangasniemi H, Setälä P, Huhtala H, Kämäräinen A, Virkkunen I, Jämsen E, Yli-Hankala A, Hoppu S. Out-of-hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland. Acta Anaesthesiol Scand 2018; 62:1297-1303. [PMID: 29845604 DOI: 10.1111/aas.13152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dispatching Emergency Medical Services to treat patients with deteriorating health in nursing homes and primary care facilities is common in Finland. We examined the cardiac arrest patients to describe this phenomenon. We had a special interest in patients for whom cardiopulmonary resuscitation was considered futile. METHODS We conducted an observational study between 1 June 2013 and 31 May 2014 in the Pirkanmaa area. We included cases in which Emergency Medical Services participated in the treatment of cardiac arrest patients in nursing homes and primary care facilities. RESULTS Emergency Medical Services attended to a total of 355 cardiac arrest patients, and 65 patients (18%) met the inclusion criteria. The included patients were generally older than 65 years, but otherwise heterogeneous. Nineteen patients (29%) had a valid do-not-attempt-resuscitation order, but paramedics were not informed about it in 10 (53%) of those cases. Eight (12%) of the 65 patients survived to hospital admission and 3 (5%) survived to hospital discharge with a neurologically favourable outcome. Two patients were alive 90 days after the cardiac arrest; both were younger than 70 years of age and had ventricular fibrillation as primary rhythm. There were no survivors in nursing homes. CONCLUSIONS The do-not-attempt-resuscitation orders were often unavailable during a cardiopulmonary resuscitation attempt. Although resuscitation attempts were futile for patients in nursing homes, some patients in primary care facilities demonstrated a favourable outcome after cardiac arrest. Emergency Medical Services seem to be able to recognise potential survivors and focus resources on their treatment.
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Affiliation(s)
- H. Kangasniemi
- Research and Development Unit; FinnHEMS Ltd; WTC Helsinki Airport; Vantaa Finland
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - P. Setälä
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - H. Huhtala
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - A. Kämäräinen
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - I. Virkkunen
- Research and Development Unit; FinnHEMS Ltd; WTC Helsinki Airport; Vantaa Finland
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - E. Jämsen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - A. Yli-Hankala
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - S. Hoppu
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
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Lee DH, Lee BK, Jeung KW, Jung YH, Cho YS, Cho IS, Youn CS, Kim JW, Park JS, Min YI. Relationship between ventricular characteristics on brain computed tomography and 6-month neurologic outcome in cardiac arrest survivors who underwent targeted temperature management. Resuscitation 2018; 129:37-42. [PMID: 29902493 DOI: 10.1016/j.resuscitation.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 01/31/2023]
Abstract
AIM OF THE STUDY Brain swelling after cardiac arrest may affect the ventricles. We aimed to investigate the prognostic performance of ventricular characteristics on brain computed tomography (CT) in cardiac arrest survivors who underwent targeted temperature management (TTM). METHODS This retrospective cohort study included adult comatose cardiac arrest survivors who underwent brain CT scan within 24 h after resuscitation and underwent TTM from 2014 to 2016. The ventricular areas (lateral, third, and fourth ventricle), distances between the anterior horns of the lateral ventricle (LV) and the posterior horns of the LV, and maximal internal diameter of the skull were measured. Grey-to-white matter ratio (GWR), Evans' index, and relative LV area were calculated. The primary outcome was a 6-month neurologic outcome. RESULTS Of 258 patients, 176 (68.2%) had an unfavourable neurologic outcome. GWR, LV area, third ventricle area, distance between the anterior horns of the LV, distance between the posterior horns of the LV, Evans' index, and relative LV area were different between neurologic outcome groups. Evans' index (0.683; 95% confidence interval [CI], 0.623-0.739) and relative LV area (0.670; 95% CI, 0.609-0.727) had higher value of area under the curve than the other ventricular characteristics and showed prognostic performance comparable with GWR (0.600; 95% CI, 0.538-0.661). All ventricular characteristics and GWR were not independently associated with neurologic outcome after adjusting for covariates. CONCLUSION Ventricular characteristics on brain CT were associated with 6 months neurologic outcome in cardiac arrest survivors. Ventricular characteristics were objective measures that had comparable prognostic performance with GWR.
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Affiliation(s)
- Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea.
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea
| | - Yong Soo Cho
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea
| | - In Soo Cho
- Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul, Republic of Korea
| | - Chun Song Youn
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yong Il Min
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea
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Suh GJ, Park J, Lee JC, Na SH, Kwon WY, Kim KS, Kim T, Jung YS, Ko JI, Shin SM, You KM. End-tidal CO 2-guided automated robot CPR system in the pig. Preliminary communication. Resuscitation 2018; 127:119-124. [PMID: 29665427 DOI: 10.1016/j.resuscitation.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our aim was to compare the efficacy of the end-tidal CO2-guided automated robot CPR (robot CPR) system with manual CPR and mechanical device CPR. METHODS We developed the algorithm of the robot CPR system which automatically finds the optimal compression position under the guidance of end-tidal CO2 feedback in swine models of cardiac arrest. Then, 18 pigs after 11 min of cardiac arrest were randomly assigned to one of three groups, robot CPR, LUCAS CPR, and manual CPR groups (n = 6 each group). Return of spontaneous circulation (ROSC) and Neurological Deficit Score 48 h after ROSC were compared. RESULTS A ROSC was achieved in 5 pigs, 4 pigs, and 3 pigs in the robot CPR, LUCAS CPR, and manual CPR groups, respectively (p = 0.47). Robot CPR showed a significant difference in Neurological Deficit Score 48 h after ROSC compared to manual CPR, whereas LUCAS CPR showed no significant difference over manual CPR. (p = 0.01; Robot versus Manual adjusted p = 0.04, Robot versus LUCAS adjusted p = 0.07, Manual versus LUCAS adjusted p = 1.00). CONCLUSIONS The end-tidal CO2-guided automated robot CPR system did not significantly improve ROSC rate in a swine model of cardiac arrest. However, robot CPR showed significant improvement of Neurological Deficit Score 48 h after ROSC compared to Manual CPR while LUCAS CPR showed no significant improvement compared to Manual CPR.
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Affiliation(s)
- Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jaeheung Park
- Graduate School of Convergence Science and Technology, Seoul National University and the Advanced Institutes of Convergence Technology, 145 Gwanggyo-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Department of Biomedical Engineering, Seoul National University Hospital and the Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Sang Hoon Na
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Division of Cardiology, Department of Internal medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Taegyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yoon Sun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jung-In Ko
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - So Mi Shin
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kyoung Min You
- Department of Emergency Medicine, Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea
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Ahn S, Lee BK, Youn CS, Kim YJ, Sohn CH, Seo DW, Kim WY. Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia. Intern Emerg Med 2018; 13:413-419. [PMID: 28389857 DOI: 10.1007/s11739-017-1662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/03/2017] [Indexed: 01/21/2023]
Abstract
Neurologically intact survival after cardiac arrest is possible even after prolonged resuscitation efforts. However, the factors associated with good neurologic outcome in these patients remain unknown. This study identifies predictors associated with good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). This multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between 2007 and 2012 includes adult (≥18 years) non-traumatic OHCA patients with prolonged (>30 min) downtime who underwent TTM treatment. Good neurologic outcomes were defined as cerebral performance category scores of ≤2. Of the 930 comatose adult cardiac arrest patients treated with TTM, 423 patients with prolonged downtime were included. A total of 76 (18.0%) had good neurologic outcome. Multivariable analysis reveal that age <65 years (OR 7.91, 95% CI 3.18-19.68), initial shockable rhythm (OR 6.31, 95% CI 3.40-11.74), and witnessed arrest (OR 3.81, 95% CI 1.73-8.45) are associated with good neurologic outcome. The sensitivity and specificity for good neurologic outcome in patients with age <65 years, shockable rhythm, and witnessed arrest are 90.8% and 41.2, 67.6 and 79.5%, and 81.6 and 41.2%, respectively. In prolonged cardiac arrest patients, initial shockable rhythm, age <65 years, or witnessed arrest are predictors for neurologic intact survival.
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Affiliation(s)
- Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Chun Song Youn
- Department of Emergency Medicine, College of Medicine, Seoul Saint Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
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Singer B, Reynolds JC, Lockey DJ, O'Brien B. Pre-hospital extra-corporeal cardiopulmonary resuscitation. Scand J Trauma Resusc Emerg Med 2018; 26:21. [PMID: 29587810 PMCID: PMC5870373 DOI: 10.1186/s13049-018-0489-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Survival from out-of-hospital cardiac arrest (OHCA) has remained low despite advances in resuscitation science. Hospital-based extra-corporeal cardiopulmonary resuscitation (ECPR) is a novel use of an established technology that provides greater blood flow and oxygen delivery during cardiac arrest than closed chest compressions. Hospital-based ECPR is currently offered to selected OHCA patients in specialized centres. The interval between collapse and restoration of circulation is inversely associated with good clinical outcomes after ECPR. Pre-hospital delivery of ECPR concurrent with conventional resuscitation is one approach to shortening this interval and improving outcomes after OHCA. This article examines the background and rationale for pre-hospital ECPR; summarises the findings of a literature search for published evidence; and considers candidate selection, logistics, and complications for this complex intervention.
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Affiliation(s)
- Ben Singer
- St Bartholomew's Hospital and Barts Heart Centre, Barts Health NHS Trust, London, UK. .,The Blizard Institute, Queen Mary University, London, UK. .,William Harvey Research Institute, Queen Mary University, London, UK.
| | - Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - David J Lockey
- The Blizard Institute, Queen Mary University, London, UK
| | - Ben O'Brien
- St Bartholomew's Hospital and Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University, London, UK.,Outcomes Research Consortium, Cleveland, OH, USA
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Andrew E, Mercier E, Nehme Z, Bernard S, Smith K. Long-term functional recovery and health-related quality of life of elderly out-of-hospital cardiac arrest survivors. Resuscitation 2018; 126:118-124. [PMID: 29545136 DOI: 10.1016/j.resuscitation.2018.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Understanding the prognosis of elderly out-of-hospital cardiac arrest (OHCA) patients is vital to informing resuscitation and advanced care planning decisions. However, short-term outcomes such as survival to hospital discharge do not account for post-arrest quality of life. We describe the 12-month functional recovery and health-related quality of life (HR-QOL) of elderly OHCA survivors, including those arresting in aged care facilities. METHODS We conducted a retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data for all OHCA survivors to hospital discharge aged ≥65 years between 1 January 2010 and 30 June 2016. The influence of age on functional recovery and independent living was assessed using multivariable logistic regression. RESULTS During the study period, 20,103 elderly OHCAs were attended, 9016 (44.9%) of whom received a resuscitation attempt. In total, 876 (9.7%) patients survived to hospital discharge and 777 were alive 12 months post-arrest. Of these, 651 participated in 12-month follow-up (response rate 83.8%). Most (60.6%) resided at home without additional care and 66.6% reported a good functional recovery, however both measures decreased with increasing age (p < 0.001). Mental HR-QOL increased with increasing age and was significantly better than the age- and sex-matched Australian population. Each 10-year increase in age was associated with a 40.8% (95%CI 25.6-53.0%) reduction in the odds of good functional recovery, and a 65.8% (95%CI 55.8-73.5%) reduction in the odds of living independently. Of the 2575 OHCAs in an aged care facility, 2.2% survived to hospital discharge, however no patient reported a good 12-month functional recovery. CONCLUSIONS Most elderly OHCA survivors resided independently with good functionality 12 months post-arrest. However, increasing age was associated with less favourable outcomes. New strategies are needed with regard to resuscitation in aged care facilities.
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Affiliation(s)
- Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre de recherche du CHU de Québec, Québec, Canada; The Alfred Hospital, Melbourne, Australia.
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia.
| | - Stephen Bernard
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia.
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia.
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Abstract
The objective of this retrospective cohort study was to assess mortality and morbidity after cardiac arrest in hospital inpatients aged 80 years or older, in an Australian tertiary hospital. We studied patients aged 80 years or older who suffered an in-hospital cardiac arrest from 1 January 2000 to 31 December 2016. The main outcome measures were one-year survival and narrative morbidity. Two hundred and eighty-five patients were identified. Absolute one-year survival after cardiac arrest was, at best, 12.6%. Narrative descriptions of morbidity demonstrate high healthcare utilisation, dependency or residential care, and significant impairments of physical and social function. In conclusion, one-year survival after cardiac arrest in the very elderly is poor. In those who survive, significant morbidity is present.
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Andersen LW, Holmberg MJ, Granfeldt A, Løfgren B, Vellano K, McNally BF, Siegerink B, Kurth T, Donnino MW. Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest. Resuscitation 2018; 126:72-79. [PMID: 29477731 DOI: 10.1016/j.resuscitation.2018.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Automated external defibrillators (AEDs) can be used by bystanders to provide rapid defibrillation for patients with out-of-hospital cardiac arrest (OHCA). Whether neighborhood characteristics are associated with AED use is unknown. Furthermore, the association between AED use and outcomes has not been well characterized for all (i.e. shockable and non-shockable) public OHCAs. METHODS We included public, non-911-responder witnessed OHCAs registered in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2016. The primary patient outcome was survival to hospital discharge with a favorable functional outcome. We first assessed the association between neighborhood characteristics and bystander AED use using logistic regression and then assessed the association between bystander AED use and patient outcomes in a propensity score matched cohort. RESULTS 25,182 OHCAs were included. Several neighborhood characteristics, including the proportion of people living alone, the proportion of white people, and the proportion with a high-school degree or higher, were associated with bystander AED use. 5132 OHCAs were included in the propensity score-matched cohort. Bystander AED use was associated with an increased risk of a favorable functional outcome (35% vs. 25%, risk difference: 9.7% [95% confidence interval: 7.2%, 12.2%], risk ratio: 1.38 [95% confidence interval: 1.27, 1.50]). This was driven by increased favorable functional outcomes with AED use in patients with shockable rhythms (58% vs. 39%) but not in patients with non-shockable rhythms (10% vs. 10%). CONCLUSIONS Specific neighborhood characteristics were associated with bystander AED use in OHCA. Bystander AED use was associated with an increase in favorable functional outcome.
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Affiliation(s)
- Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA.
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA
| | - Asger Granfeldt
- Department of Anesthesiology, Aarhus University Hospital, 8000, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital of Randers, 8900, Randers, Denmark
| | - Kimberly Vellano
- Department of Emergency Medicine, Emory University, 30322, Atlanta, Georgia, USA
| | - Bryan F McNally
- Department of Emergency Medicine, Emory University, 30322, Atlanta, Georgia, USA
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA
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Funada A, Goto Y, Tada H, Teramoto R, Shimojima M, Hayashi K, Kawashiri MA, Yamagishi M. Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis. Resuscitation 2018; 124:69-75. [PMID: 29317350 DOI: 10.1016/j.resuscitation.2018.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/11/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between duration of cardiopulmonary resuscitation (CPR) and post-arrest outcomes based on severity stratification in out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC) remains unclear. METHODS We analysed 420,959 adult patients without prehospital ROSC in the All-Japan OHCA registry for 4 years. Prehospital CPR duration was defined as the time from CPR initiation by emergency medical service (EMS) providers to hospital arrival. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2, CPC 1-2). RESULTS The rate of overall 1-month CPC 1-2 was 0.45% (1899/420,959). Using recursive partitioning analysis to predict 1-month CPC 1-2, we stratified patients into 4 groups with 3 predictors: patients aged <75 years with initial shockable rhythm (1-month CPC 1-2 rate, 6.15%), those aged ≥75 years with initial shockable rhythm (1.32%), those with EMS-witnessed arrest and initial non-shockable rhythm (1.62%), and those with EMS-unwitnessed arrest and initial non-shockable rhythm (0.15%). Prehospital CPR duration was negatively associated with 1-month CPC 1-2 (adjusted odds ratio 0.94 per 1-min increment; 95% confidence interval 0.94-0.95). Prehospital CPR durations beyond which the dynamic probability of 1-month CPC 1-2 decreased to <1% were 26 min, 10 min, 7 min, and at all times in above-mentioned stratification, respectively. CONCLUSIONS In OHCA patients without prehospital ROSC, those aged <75 years with initial shockable rhythm had acceptable 1-month CPC 1-2 rate. However, CPR efforts lasting 26 min or over before hospital arrival could be futile.
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Affiliation(s)
- Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan.
| | - Hayato Tada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Ryota Teramoto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Masaya Shimojima
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
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Segal N, di Pompéo C, Escutnaire J, Wiel E, Dumont C, Castra L, Tazarourte K, El Khoury C, Gueugniaud PY, Hubert H. Evolution of Survival in Cardiac Arrest with Age in Elderly Patients: Is Resuscitation a Dead End? J Emerg Med 2017; 54:295-301. [PMID: 29273461 DOI: 10.1016/j.jemermed.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Even if age is not considered the key prognostic factor for survival in cardiac arrest (CA), some studies question whether cardiopulmonary resuscitation (CPR) in the elderly could be futile. OBJECTIVE The aim of this study was to describe differences in out-of-hospital CA survival rates according to age stratification based on the French National CA registry (RéAC). The second objective was to analyze the differences in resuscitation interventions according to age. METHODS We performed a retrospective cohort study based on data extracted from the RéAC. All 18,249 elderly patients (>65 years old) with non-traumatic CA recorded between July 2011 and March 2015 were included. Patients' ages were stratified into 5-year increments. RESULTS Cardiopulmonary resuscitation (CPR) was started significantly more often in younger patients (p = 0.019). Ventilation and automated external defibrillation by bystanders were started without any difference between age subgroups (p = 0.147 and p = 0.123, respectively). No difference in terms of rate of external chest compressions or ventilation initiation was found between the subgroups (p = 0.357 and p = 0.131, respectively). Advanced cardiac life support was started significantly more often in younger patients (p = 0.023). Total CPR duration, return of spontaneous circulation, and survival at hospital admission and at 30 days or hospital discharge decreased significantly with age (p < 10-3). The survival decrease was linear, with a loss of 3% survival chances each 5-year interval. CONCLUSIONS This study found that survival in older persons decreased linearly by 3% every 5 years. However, this diminished rate of survival could be the consequence of a shorter duration and less advanced life support.
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Affiliation(s)
- Nicolas Segal
- Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, Paris, France
| | - Christophe di Pompéo
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Joséphine Escutnaire
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Eric Wiel
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France; SAMU 59 and Emergency Department, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Cyrielle Dumont
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Laurent Castra
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Karim Tazarourte
- SAMU 69, Lyon University Hospital, University of Claude Bernard-Lyon 1, Edouard Herriot Hospital, Lyon, France
| | - Carlos El Khoury
- Réseau Cardiologie Médecine d'Urgence Network, Hussel Hospital, Vienne, France
| | - Pierre-Yves Gueugniaud
- SAMU 69, Lyon University Hospital, University of Claude Bernard-Lyon 1, Edouard Herriot Hospital, Lyon, France
| | - Hervé Hubert
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
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- Research Group on the French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
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Gaspari R, Weekes A, Adhikari S, Noble V, Nomura JT, Theodoro D, Woo M, Atkinson P, Blehar D, Brown S, Caffery T, Douglass E, Fraser J, Haines C, Lam S, Lanspa M, Lewis M, Liebmann O, Limkakeng A, Lopez F, Platz E, Mendoza M, Minnigan H, Moore C, Novik J, Rang L, Scruggs W, Raio C. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation 2017; 120:103-107. [PMID: 28916478 DOI: 10.1016/j.resuscitation.2017.09.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. METHODS This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks. Only cases with visible cardiac activity on ultrasound were included in the present analysis. Cardiac activity was categorized as disorganized (agonal twitching) or organized (contractions with changes in ventricular dimensions). Patients were categorized as receiving either standard bolus ACLS medications or alternative medications during the resuscitation (continuous adrenergic agents, thrombolytics, others). The primary outcome was survival to hospital admission. The secondary outcome was return of spontaneous circulation (ROSC). Multivariate modeling was performed to assess association between survival to hospital admission in patients with intravenous adrenergic agents and cardiac activity. RESULTS In our cohort of 225 patients in PEA cardiac arrest with cardiac activity on ultrasound, the overall survival rate was higher in patients with organized cardiac activity than with disorganized cardiac activity. PEA cardiac arrest patients with organized cardiac activity treated with standard ACLS interventions demonstrated improved survival to hospital admission compared to those with disorganized activity (37.7% (95%CI 24.8-50.2%) versus 17.9% (95%CI 10.9-28%). PEA cardiac arrest patients with organized cardiac activity who received continuous adrenergic agents during the resuscitation and prior to ROSC demonstrated higher survival to hospital admission 45.5% (95%CI 26.9-65.4%) and ROSC 90.9% (95%CI 71.0-98.7%) compared to those with disorganized cardiac activity who received continuous adrenergic agents during the resuscitation 0% (95%CI 0-23.0%) and 47.1% (95%CI 26-69%). Regression analysis demonstrates an association between increased survival in patients receiving intravenous adrenergic agents and organized cardiac activity. CONCLUSION Survival in patients following PEA arrest is higher in patients with organized cardiac activity. The initiation of continuous adrenergic agents during PEA was associated with improved survival to hospital admission in patients with organized cardiac activity on bedside ultrasound, but this improvement was not seen in patients in PEA with disorganized cardiac activity. Bedside ultrasound may identify a subset of patients that respond differently to ACLS interventions.
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Affiliation(s)
- Romolo Gaspari
- University of Massachusetts Medical School, Worcester, MA, United States.
| | | | | | - Vicki Noble
- Massachusetts General Hospital, Boston, MA, United States
| | - Jason T Nomura
- Christiana Care Health Systems, Newark, DE, United States
| | - Daniel Theodoro
- Washington University School of Medicine, St Louis, MO, United States
| | | | | | - David Blehar
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Samuel Brown
- University of Utah, Salt Lake City, UT, United States
| | | | - Emily Douglass
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Samuel Lam
- Advocate Christ Medical Center, Chicago, IL, United States
| | | | | | | | | | - Fernando Lopez
- Duke University School of Medicine, Durham, NC, United States
| | - Elke Platz
- Brigham and Women's Hospital, Boston, MA, United States
| | - Michelle Mendoza
- University of Massachusetts Medical School, Worcester, MA, United States
| | | | | | - Joseph Novik
- NYU Bellevue Hospital, New York, NY, United States
| | - Louise Rang
- Kingston General Hospital, Kingston, ON, Canada
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Nongchang P, Wong WL, Pitaksanurat S, Amchai PB. Intravenous Fluid Administration and the Survival of Pre hospital Resuscitated out of Hospital Cardiac Arrest Patients in Thailand. J Clin Diagn Res 2017; 11:OC29-OC32. [PMID: 29207756 DOI: 10.7860/jcdr/2017/29603.10656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
Introduction Out of Hospital Cardiac Arrest (OHCA) is a leading cause of death worldwide. The Emergency Medical Service (EMS) provides early care to critical OHCA patients. Pre hospital intervention has been improving OHCA survival rate, however it is still unclear for the recommendation of routine infusion of Intravenous (IV) fluids during cardiac arrest resuscitation. Aim This study aimed to determine whether IV fluid administration was associated with increasing survival of resuscitated OHCA patients and to assess the survival rate of resuscitated OHCA patients. Materials and Methods This cross-sectional analytical study was conducted among 33,006 resuscitated OHCA patients who received emergency medical service in Thailand. Data set from the EMS Registry of the OHCA patients who received Advanced Life Support (ALS) and Cardiopulmonary Resuscitation (CPR) during January 2011 to December 2015 was enrolled as per inclusion criteria. Data were analysed by using both descriptive statistic and multiple logistic regression. Results The result indicated that 27,270 OHCA patients (82.62%:95%CI=82.121-83.030%) survived until they reached hospital. In addition, after adjusting for effect modifiers and covariates, it was found that adult (≥18 years) with IV fluid administration were more likely to survive (adjusted OR=4.389; 95% CI: 3.911-4.744) when compared to children (<18 years) with IV fluid administration (adjusted OR =2.952; 95% CI: 2.040-4.273). Other factors associated with OHCA patients' survival were female gender (adjusted OR =1.151; 95% CI: 1.067-1.241), response time per minutes (adjusted OR =0.993; 95% CI: 0.989-0.997), scene time per minutes (adjusted OR=0.948; 95% CI: 0.944-0.952) and transport time per minutes (adjusted OR=0.973, 95%CI: 0.968-0.978). Conclusion This study revealed that IV fluid administration was significantly associated with survival of OHCA patients while controlled other covariates including female gender, response time, scene time and transport time. Therefore, it is recommended that the IV fluid administration should be medicated for resuscitated OHCA patients.
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Affiliation(s)
- Phichet Nongchang
- PhD Scholar, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Wongsa Laohasiri Wong
- Associate Professor, Faculty of Public Health and Research and Training Center for Enhancing Quality of Life for Working Age People, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Pitaksanurat
- Assistant Professor, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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Kim YT, Shin SD, Hong SO, Ahn KO, Ro YS, Song KJ, Hong KJ. Effect of national implementation of utstein recommendation from the global resuscitation alliance on ten steps to improve outcomes from Out-of-Hospital cardiac arrest: a ten-year observational study in Korea. BMJ Open 2017; 7:e016925. [PMID: 28827263 PMCID: PMC5724141 DOI: 10.1136/bmjopen-2017-016925] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The Utstein ten-step implementation strategy (UTIS) proposed by the Global Resuscitation Alliance, a bundle of community cardiopulmonary resuscitation (CPR) programs to improve outcomes after out-of-hospital cardiac arrests (OHCAs), has been developed. However, it is not documented whether UTIS programs are associated with better outcomes or not. The study aimed to test the association between the UTIS programme and better outcomes after OHCA. METHODS The study was a before- and after-intervention study. Adults OHCAs treated by emergency medical service (EMS) from 2006 to 2015 in Korea were collected, excluding patients witnessed by ambulance personnel and without outcomes. Phase 1 (2009-2011) after implementing three programs (national OHCA registry, obligatory CPR education, and public report of OHCA outcomes), and phase 2 (2012-2015) after implementing two programs (telephone-assisted CPR and EMS quality assurance programme) were compared with the control period (2006-2008) when no UTIS programme were implemented. The primary outcome was good neurological recovery (cerebral performance scale 1 or 2). We tested the association between the phases and outcomes, adjusting for confounders using a multivariate logistic regression model to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS A total of 1 28 888 eligible patients were analysed. The control, phase 1, and phase two study groups were 19.4%, 30.5%, and 50.0% of the whole, respectively. There were significant changes in pre-hospital ROSC (0.8% in 2006 and 7.1% in 2015), survival to discharge (3.0% in 2006 and 6.1% in 2015), and good neurological recovery (1.2% in 2006 and 4.1% in 2015). The AORs (95% CIs) for good neurological recovery were 1.82 (1.53-2.15) or phase 1 and 2.21 (1.78-2.75) for phase two compared with control phase. CONCLUSION The national implementation of the five UTIS programs was significantly associated with better OHCA outcomes in Korea.
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Affiliation(s)
- Young Taek Kim
- Division of Chronic Disease Management, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ok Hong
- Division of Chronic Disease Management, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Reynolds JC, Grunau BE, Elmer J, Rittenberger JC, Sawyer KN, Kurz MC, Singer B, Proudfoot A, Callaway CW. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. Resuscitation 2017; 117:24-31. [DOI: 10.1016/j.resuscitation.2017.05.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/15/2022]
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