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Shehatta AL, Kaddoura R, Orabi B, Mohamed Ibrahim MI, El-Menyar A, Alyafei SA, Alkhulaifi A, Ibrahim AS, Hassan IF, Omar AS. Extracorporeal Membrane Oxygenation Pathway for Management of Refractory Cardiac Arrest: a Retrospective Study From a National Center of Extracorporeal Cardiopulmonary Resuscitation. Crit Pathw Cardiol 2024; 23:149-158. [PMID: 38381697 DOI: 10.1097/hpc.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiac arrest remains a critical condition with high mortality and catastrophic neurological impact. Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as an adjunct in cardiopulmonary resuscitation modalities. However, survival with good neurological outcomes remains a major concern. This study aims to explore our early experience with ECPR and identify the factors associated with survival in patients presenting with refractory cardiac arrest. METHODS This is a retrospective cohort study analyzing 6-year data from a tertiary center, the country reference for ECPR. This study was conducted at a national center of ECPR. Participants of this study were adult patients who experienced witnessed refractory cardiopulmonary arrest and were supported by ECPR. ECPR was performed for eligible patients as per the local service protocols. RESULTS Data from 87 patients were analyzed; of this cohort, 62/87 patients presented with in-hospital cardiac arrest (IHCA) and 25/87 presented with out-of-hospital cardiac arrest (OHCA). Overall survival to decannulation and hospital discharge rates were 26.4% and 25.3%, respectively. Among survivors (n = 22), 19 presented with IHCA (30.6%), while only 3 survivors presented with OHCA (12%). A total of 15/87 (17%) patients were alive at 6-month follow-up. All survivors had good neurological function assessed as Cerebral Performance Category 1 or 2. Multivariate logistic regression to predict survival to hospital discharge showed that IHCA was the only independent predictor (odds ratio: 5.8, P = 0.042); however, this positive association disappeared after adjusting for the first left ventricular ejection fraction after resuscitation. CONCLUSIONS In this study, the use of ECPR for IHCA was associated with a higher survival to discharge compared to OHCA. This study demonstrated a comparable survival rate to other established centers, particularly for IHCA. Neurological outcomes were comparable in both IHCA and OHCA survivors. However, large multicenter studies are warranted for better understanding and improving the outcomes.
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Affiliation(s)
- Ahmed Labib Shehatta
- From the Department of Medicine, Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rasha Kaddoura
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Qatar
| | - Bassant Orabi
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Qatar
| | | | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation
| | | | - Abdulaziz Alkhulaifi
- Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulsalam Saif Ibrahim
- From the Department of Medicine, Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ibrahim Fawzy Hassan
- From the Department of Medicine, Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Amr S Omar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Department of Cardiothoracic Surgery Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Critical Care Medicine, Beni Suef University, Egypt
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Nutma S, Roesink O, van Heugten CM, Hofmeijer J. Long term functioning with poor neurologic outcome after cardiac arrest. Resuscitation 2024:110375. [PMID: 39174000 DOI: 10.1016/j.resuscitation.2024.110375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
AIM Around six percent of comatose patients after cardiac arrest have a Cerebral Performance Categories score of three (CPC3) at six months after the arrest, classified as severe neurological disability. There is limited knowledge regarding the likelihood of further recovery in the cognitive, emotional, and quality of life domains. We aimed to estimate the probability of recovery towards independency. METHODS From a prospective Registry on comatose cardiac arrest patients admitted between 2013 and 2017 in two Dutch hospitals, we included patients with a CPC3 at six months after cardiac arrest. We followed patients up to November 2023. The primary outcome measure was the CPC score at time of follow up. Secondary outcomes were scores on questionnaires on cognition, mood, and quality of life according to the minimal dataset of acquired brain injury. RESULTS In our cohort of 667 patients, 29 (4.3%) had a CPC3 score at six months (median age 68 years, 83% male). At a median time of eight years after cardiac arrest, sixteen patients had died. Twelve of thirteen alive patients still had a CPC3 score (92%) and one a CPC2 (8%). Seven patients agreed with further interviewing, one showed independency in activities of daily living (14%). Six patients (86%) reported limitations due to physical and one (14%) due to emotional problems. All had severe cognitive impairment. Six (86%) missed cognitive rehabilitation. CONCLUSION Our study shows that while the probability of recovery towards independence for patients with severe neurological disability at six months after cardiac arrest is limited, most long-term survivors are satisfied with their quality of life.
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Affiliation(s)
- Sjoukje Nutma
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands.
| | - Ozzy Roesink
- Department of Health Sciences, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Critical Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
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Miyashita Y, Takei Y, Toyama G, Takahashi T, Adachi T, Omatsu K, Ozaki A. Neurological outcomes in traffic accidents: A propensity score matching analysis of medical and non-medical origin cases of out-of-hospital cardiac arrest. Am J Emerg Med 2024; 78:176-181. [PMID: 38290196 DOI: 10.1016/j.ajem.2024.01.028] [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: 08/14/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
AIM This study aimed to comprehensively compare the characteristics of out-of-hospital cardiac arrest (OHCA) with medical and non-medical origins attributed to traffic accidents and explore the potential association between the cases with a medical origin and neurologically favorable outcomes. METHODS In this retrospective nationwide population-based study, baseline data were collected between January 2018 and December 2020. We analyzed 5091 OHCA associated with traffic accidents on the road scene. Only those encounters involving treatment or transport by prehospital emergency medical technicians were included. The characteristics of OHCA incidents and their outcomes were analyzed by categorizing patients into "medical origin" and "non-medical origin" groups. RESULTS Medical-origin cases exhibited several distinct characteristics, including higher frequencies of occurrence during the daytime (79.3% [706/890] vs. 68.9% [2895/4201], p < 0.001), a higher prevalence among male (77.8% [692/890] vs. 68.3% [2871/4201], p < 0.001) and younger patients (median [25-75%]: 63 years [42-77] vs. 66 years [50-76], p = 0.003), a higher proportion of shockable initial rhythms(10.5% [93/890] vs. 1.1% [45/4201], p < 0.001), an increased number of cases requiring advanced airway management (33.8% [301/890] vs. 28.5% [1199/4201], p = 0.002) and adrenaline administration by emergency medical teams (26.9% [239/890] vs. 21.7% [910/4201], p < 0.001), and shorter transport times (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002) compared to non-medical-origin cases. However, medical-origin cases also had lower witness rates (42.8% [381/890] vs. 27.2% [1142/4201], p < 0.001) and were less likely to be transported to higher-level hospitals (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002). Propensity score matching analysis identified factors associated with favorable neurological outcomes in medical-origin traffic accidents. The adjusted odds ratios were as follows: 8.46 (3.47-20.61) for cases with shockable initial rhythms, 2.36 (1.01-5.52) for cases involving traffic accidents due to medical origin, and 0.09 (0.01-0.67) for cases where advanced airway management was provided. CONCLUSION In this retrospective study, the occurrence of OHCAs of medical origin involving traffic accidents were associated with favorable neurological outcomes. These cases more frequently demonstrated favorable factors for survival compared to those classified as of non-medical origin. The findings have important implications for public health and EMS professionals, they will guide future research aimed at optimizing prehospital care strategies and improving survival rates for similar cases.
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Affiliation(s)
- Yumiko Miyashita
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
| | - Yutaka Takei
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan.
| | - Gen Toyama
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
| | - Tsukasa Takahashi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
| | - Tetsuhiro Adachi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
| | - Kentaro Omatsu
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
| | - Akane Ozaki
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata-shi, 950-3198 Niigata, Japan
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Tosi DM, Fernandez MC, Oomrigar S, Burton LP, Hammel IS, Quartin A, Ruiz JG. Association of Frailty and Cardiopulmonary Resuscitation Outcomes in Older U.S. Veterans. Am J Hosp Palliat Care 2024; 41:398-404. [PMID: 37078363 DOI: 10.1177/10499091231171389] [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] [Indexed: 04/21/2023] Open
Abstract
Objectives: Determine the association between frailty and immediate survival of cardiopulmonary resuscitation (CPR) in older Veterans. Secondary outcomes: compare in-hospital mortality, duration of resuscitation efforts, hospital and intensive care unit (ICU) length of stay, neurologic outcomes, and discharge disposition between frail and non-frail Veterans. Methods: Retrospective cohort study including Veterans 50 years and older, who were "Full Code" and had in-hospital cardiac arrest between 7/1/2017 and 6/30/2020, at the Miami VAMC. Frailty Index for the VA (VA-FI) was used to determine frailty status. Immediate Survival was determined by return of spontaneous circulation (ROSC) and in-hospital mortality was determined by all-cause mortality. We compared outcomes between frail and non-frail Veterans using chi-square test. After adjusting for age, gender, race, and previous hospitalizations, we used multivariate binomial logistic regression with 95% confidence intervals to analyze the relationship between immediate survival and frailty, and in-hospital mortality and frailty. Results: 91% Veterans were non-Hispanic, 49% Caucasian, 96% male, mean age 70.7 ± 8.5 years, 73% frail and 27% non-frail. Seventy-six (65.5%) Veterans had ROSC, without difference by frailty status (P = .891). There was no difference based on frailty status of in-hospital mortality, discharge disposition, or neurologic outcomes. Frail and non-frail Veterans had resuscitation efforts lasting the same amount of time. Conclusions and Implications: CPR outcomes were not different depending on frailty status in our Veteran population. With these results, we cannot use frailty - as measured by the VA-FI - as a prognosticator of CPR outcomes in Veterans.
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Affiliation(s)
- Dominique M Tosi
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marlena C Fernandez
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
| | - Shivaan Oomrigar
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
| | - Lorena P Burton
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
| | - Iriana S Hammel
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew Quartin
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
- University of Miami/Jackson Health System, Miami, FL, USA
| | - Jorge G Ruiz
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Bruce W. Carter Miami VAMC, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Takei Y, Toyama G, Takahashi T, Omatsu K. Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest. Sci Rep 2024; 14:6071. [PMID: 38480805 PMCID: PMC10937976 DOI: 10.1038/s41598-024-56487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
To elucidate the relationship between the interval from cardiopulmonary resuscitation initiation to return of spontaneous circulation (ROSC) and neurologically favourable 1-month survival in order to determine the appropriate duration of basic life support (BLS) without advanced interventions. This population-based cohort study included patients aged ≥ 18 years with 9132 out-of-hospital cardiac arrest of presumed cardiac origin who were bystander-witnessed and had achieved ROSC between 2018 and 2020. Patients were classified into two groups based on the resuscitation methods as the "BLS-only" and the "BLS with administered epinephrine (BLS-AE)" groups. Receiver operating characteristic (ROC) curve analysis indicated that administering BLS for 9 min yielded the best neurologically outcome for patients with a shockable rhythm [sensitivity, 0.42; specificity, 0.27; area under the ROC curve (AUC), 0.60] in the BLS-only group. Contrastingly, for patients with a non-shockable rhythm, performing BLS for 6 min yielded the best neurologically outcome (sensitivity, 0.65; specificity, 0.43; AUC, 0.63). After propensity score matching, multivariate analysis revealed that BLS-only resuscitation [6.44 (5.34-7.77)] was associated with neurologically favourable 1-month survival. This retrospective study revealed that BLS-only intervention had a significant impact in the initial minutes following CPR initiation. Nevertheless, its effectiveness markedly declined thereafter. The optimal duration for effective BLS-only intervention varied depending on the patient's initial rhythm. Consequently, advanced interventions should be administered within the first few minutes to counteract the diminishing effectiveness of BLS-only intervention.
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Affiliation(s)
- Yutaka Takei
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan.
| | - Gen Toyama
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Tsukasa Takahashi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Kentaro Omatsu
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
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Fischer D, Edlow BL. Coma Prognostication After Acute Brain Injury: A Review. JAMA Neurol 2024:2815829. [PMID: 38436946 DOI: 10.1001/jamaneurol.2023.5634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Among the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute brain injury. Across a range of brain injury etiologies, these determinations often dictate whether life-sustaining treatment is continued or withdrawn; thus, they have major implications for morbidity, mortality, and health care costs. Neuroprognostication relies on a diverse array of tests, including behavioral, radiologic, physiological, and serologic markers, that evaluate the brain's functional and structural integrity. Observations Prognostic markers, such as the neurologic examination, electroencephalography, and conventional computed tomography and magnetic resonance imaging (MRI), have been foundational in assessing a patient's current level of consciousness and capacity for recovery. Emerging techniques, such as functional MRI, diffusion MRI, and advanced forms of electroencephalography, provide new ways of evaluating the brain, leading to evolving schemes for characterizing neurologic function and novel methods for predicting recovery. Conclusions and Relevance Neuroprognostic markers are rapidly evolving as new ways of assessing the brain's structural and functional integrity after brain injury are discovered. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. However, even as such efforts are underway, a series of promising findings coupled with the imperfect predictive value of conventional prognostic markers and the high stakes of these assessments have prompted clinical guidelines to endorse emerging techniques for neuroprognostication. Thus, clinicians have been thrust into an uncertain predicament in which emerging techniques are not yet perfected but too promising to ignore. This review illustrates the current, and likely future, landscapes of prognostic markers. No matter how much prognostic markers evolve and improve, these assessments must be approached with humility and individualized to reflect each patient's values.
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Affiliation(s)
- David Fischer
- Division of Neurocritical Care, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown
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Kuppelin M, Goetsch A, Choisel R, Isner-Horobeti ME, Goetsch T, Krasny-Pacini A. An exploratory study of dialectical behaviour therapy for emotional dysregulation and challenging behaviours after acquired brain injury. NeuroRehabilitation 2024; 55:77-94. [PMID: 39031392 PMCID: PMC11380244 DOI: 10.3233/nre-230383] [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] [Indexed: 07/22/2024]
Abstract
BACKGROUND Challenging behaviours and emotional dysregulation are common sequelae of acquired brain injury (ABI), but treatment remain underdeveloped. Dialectical behaviour therapy is an evidence-based therapy for emotional dysregulation. OBJECTIVE To explore the feasibility and preliminary efficacy of dialectical behaviour therapy for ABI. METHODS An exploratory longitudinal study that compared thirty adults with brain injury presenting persistent emotion dysregulation or challenging behaviours. Control group received a personalized multidisciplinary program only (n = 13). The dialectical behaviour therapy group received five months of emotion regulation skills learning as an add-on (n = 17). Preliminary efficacy was measured on Difficulties in Emotion Regulation Scale-16 and Quality of Life after Brain Injury total score and emotion subscore. RESULTS Fourteen participants completed the dialectical behaviour therapy. This study provided preliminary evidence for the feasibility and acceptability of dialectical behaviour therapy. Repeated measures revealed improvement on the Difficulties in Emotion Regulation Scale-16 (-7.6 [-17.3; 1.7]; Pr = 0.95) and on the Quality Of Life emotion subscore (13.5 [-3.8; 30.9]; Pr = 0.94). CONCLUSION This study raises important questions regarding the type of patients who can benefit from this intervention, necessary adaptations of dialectical behaviour therapy and the way it can help post-traumatic growth and identity reconstruction after ABI.
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Affiliation(s)
- Marie Kuppelin
- INSERM UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, University of Strasbourg, Strasbourg, France
- EMOI-TC Service, Clémenceau University Institute of Rehabilitation, UGECAM Alsace, Strasbourg, France
| | - Antoine Goetsch
- EMOI-TC Service, Clémenceau University Institute of Rehabilitation, UGECAM Alsace, Strasbourg, France
- Service of Physical Medicine and Rehabilitation, Clémenceau University Institute of Rehabilitation, UF 4372, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Régine Choisel
- EMOI-TC Service, Clémenceau University Institute of Rehabilitation, UGECAM Alsace, Strasbourg, France
| | - Marie-Eve Isner-Horobeti
- Service of Physical Medicine and Rehabilitation, Clémenceau University Institute of Rehabilitation, UF 4372, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA3072 Mitochondria, Oxidative Stress and Muscle Protection, Strasbourg University, Strasbourg, France
| | - Thibaut Goetsch
- Department of Public Health, Strasbourg University Hospital, GMRC, Strasbourg, France
| | - Agata Krasny-Pacini
- INSERM UMR-S 1329, Strasbourg Translational Neuroscience and Psychiatry, University of Strasbourg, Strasbourg, France
- EMOI-TC Service, Clémenceau University Institute of Rehabilitation, UGECAM Alsace, Strasbourg, France
- Service of Physical Medicine and Rehabilitation, Clémenceau University Institute of Rehabilitation, UF 4372, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Reichenbach A, Alteheld L, Henriksen J, Nakstad ER, Andersen GØ, Sunde K, Šaltytė Benth J, Lundqvist C. Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes. Front Neurol 2023; 14:1222401. [PMID: 37859655 PMCID: PMC10582351 DOI: 10.3389/fneur.2023.1222401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Background Early prediction of outcomes in comatose patients after out-of-hospital cardiac arrest is challenging. Prognostication tools include clinical examination, biomarkers, and neuroradiological and neurophysiological tests. We studied the association between transcranial Doppler (TCD) and the outcome. Methods This was a pre-defined sub-study of the prospective observational Norwegian Cardiorespiratory Arrest Study. Patients underwent standardized post-resuscitation care, including target temperature management (TTM) to 33°C for 24 h. TCD was performed at days 1, 3, and 5-7. The primary endpoint was cerebral performance category (CPC) at 6 months, dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. We used linear mixed modeling time-series analysis. Results Of 139 TCD-examined patients, 81 (58%) had good outcomes. Peak systolic velocity in the middle cerebral artery (PSV) was low during TTM (Day 1) and elevated after rewarming (Day 3). Thereafter, it continued to rise in patients with poor, but normalized in patients with good, outcomes. At days 5-7, PSV was 1.0 m/s (95% CI 0.9; 1.0) in patients with good outcomes and 1.3 m/s (95% CI 1.1; 1.4) in patients with poor outcomes (p < 0.001). Conclusion Elevated PSV at days 5-7 indicated poor outcomes. Our findings suggest that serial TCD examinations during the first week after cardiorespiratory arrest may improve our understanding of serious brain injury.
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Affiliation(s)
- Antje Reichenbach
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Lars Alteheld
- Department of Neurology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Julia Henriksen
- Department of Neurology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Espen Rostrup Nakstad
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Oslo, Norway
- Norwegian National Unit for Chemical, Biological, Radioactive, Nuclear, and Explosive Medicine, Oslo University Hospital Ullevaal, Oslo, Norway
| | | | - Kjetil Sunde
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
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Mandigers L, den Uil CA, Belliato M, Raemen H, Rossi E, van Rosmalen J, Rietdijk WJR, Melis JR, Gommers D, van Thiel RJ, Dos Reis Miranda D. Higher mean cerebral oxygen saturation shortly after extracorporeal cardiopulmonary resuscitation in patients who regain consciousness. Artif Organs 2023; 47:1479-1489. [PMID: 37042484 DOI: 10.1111/aor.14548] [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: 02/05/2022] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes. METHODS This prospective observational study was conducted in three European hospitals. We included adult ECPR patients between October 2018 and March 2020, in whom cerebral regional oxygen saturation (rSO2 ) measurements were started minutes before ECPR initiation until 3 h after. The primary outcome was regain of consciousness, defined as following commands, analyzed using binary logistic regression. RESULTS The sample consisted of 26 ECPR patients (23% women, Agemean 46 years). We found no significant differences in rSO2 values at baseline (49.1% versus 49.3% for regain versus no regain of consciousness). Mean cerebral rSO2 values in the first 30 min after ECPR initiation were higher in patients who regained consciousness (38%) than in patients who did not regain consciousness (62%, odds ratio 1.23, 95% confidence interval 1.01-1.50). CONCLUSION Higher mean cerebral rSO2 values in the first 30 min after initiation of ECPR were found in patients who regained consciousness.
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Affiliation(s)
- Loes Mandigers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands
| | - Mirko Belliato
- UOC Anestesia e Rianimazione 2, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hannelore Raemen
- Emergency Department, University Hospital Antwerp, Antwerp, Belgium
| | - Eleonora Rossi
- UOC Anestesia e Rianimazione 1, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joo-Ree Melis
- Department of Traumatology, University Hospital Antwerp, Antwerp, Belgium
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert J van Thiel
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Mølstrøm S, Nielsen TH, Nordstrøm CH, Forsse A, Møller S, Venø S, Mamaev D, Tencer T, Theódórsdóttir Á, Krøigård T, Møller J, Hassager C, Kjærgaard J, Schmidt H, Toft P. A randomized, double-blind trial comparing the effect of two blood pressure targets on global brain metabolism after out-of-hospital cardiac arrest. Crit Care 2023; 27:73. [PMID: 36823636 PMCID: PMC9951410 DOI: 10.1186/s13054-023-04376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE This study aimed to assess the effect of different blood pressure levels on global cerebral metabolism in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). METHODS In a double-blinded trial, we randomly assigned 60 comatose patients following OHCA to low (63 mmHg) or high (77 mmHg) mean arterial blood pressure (MAP). The trial was a sub-study in the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX). Global cerebral metabolism utilizing jugular bulb microdialysis (JBM) and cerebral oxygenation (rSO2) was monitored continuously for 96 h. The lactate-to-pyruvate (LP) ratio is a marker of cellular redox status and increases during deficient oxygen delivery (ischemia, hypoxia) and mitochondrial dysfunction. The primary outcome was to compare time-averaged means of cerebral energy metabolites between MAP groups during post-resuscitation care. Secondary outcomes included metabolic patterns of cerebral ischemia, rSO2, plasma neuron-specific enolase level at 48 h and neurological outcome at hospital discharge (cerebral performance category). RESULTS We found a clear separation in MAP between the groups (15 mmHg, p < 0.001). Cerebral biochemical variables were not significantly different between MAP groups (LPR low MAP 19 (16-31) vs. high MAP 23 (16-33), p = 0.64). However, the LP ratio remained high (> 16) in both groups during the first 30 h. During the first 24 h, cerebral lactate > 2.5 mM, pyruvate levels > 110 µM, LP ratio > 30, and glycerol > 260 µM were highly predictive for poor neurological outcome and death with AUC 0.80. The median (IQR) rSO2 during the first 48 h was 69.5% (62.0-75.0%) in the low MAP group and 69.0% (61.3-75.5%) in the high MAP group, p = 0.16. CONCLUSIONS Among comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. Patients with a poor clinical outcome exhibited significantly worse biochemical patterns, probably illustrating that insufficient tissue oxygenation and recirculation during the initial hours after ROSC were essential factors determining neurological outcome.
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Affiliation(s)
- Simon Mølstrøm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | - Troels Halfeld Nielsen
- grid.7143.10000 0004 0512 5013Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Carl-Henrik Nordstrøm
- grid.7143.10000 0004 0512 5013Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Axel Forsse
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Møller
- grid.7143.10000 0004 0512 5013OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Venø
- grid.7143.10000 0004 0512 5013Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Dmitry Mamaev
- grid.7143.10000 0004 0512 5013Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Tomas Tencer
- grid.7143.10000 0004 0512 5013Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Ásta Theódórsdóttir
- grid.7143.10000 0004 0512 5013Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Thomas Krøigård
- grid.7143.10000 0004 0512 5013Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Jacob Møller
- grid.4973.90000 0004 0646 7373The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark ,grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Medicine, University of Southern, Odense, Denmark
| | - Christian Hassager
- grid.4973.90000 0004 0646 7373The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjærgaard
- grid.4973.90000 0004 0646 7373The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Schmidt
- grid.7143.10000 0004 0512 5013Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Palle Toft
- grid.7143.10000 0004 0512 5013Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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11
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Park SY, Lim D, Ryu JH, Kim YH, Choi B, Kim SH. Modification of termination of resuscitation rule with compression time interval in South Korea. Sci Rep 2023; 13:1403. [PMID: 36697453 PMCID: PMC9876889 DOI: 10.1038/s41598-023-28789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
This study aimed to validate the predictive performance of the termination of resuscitation (TOR) rule and examine the compression time interval (CTI) as a criterion for modifying the rule. This retrospective observational study analyzed adult out-of-hospital cardiac arrest (OHCA) patients attended by emergency medical service (EMS) providers in mixed urban-rural areas in Korea in 2020 and 2021. We evaluated the predictive performance of basic life support (BLS) and the Korean Cardiac Arrest Research Consortium (KoCARC) TOR rule using the false-positive rate (FPR) and positive predictive value (PPV). We modified the age cutoff criterion and examined the CTI as a new criterion. According to the TOR rule, 1827 OHCA patients were classified into two groups. The predictive performance of the BLS TOR rule had an FPR of 11.7% (95% confidence interval (CI): 5.9-17.5) and PPV of 98.4% (97.6-99.2) for mortality, and an FPR of 3.6% (0.0-7.8) and PPV of 78.6% (75.9-81.3) for poor neurological outcomes at hospital discharge. The predictive performance of the KoCARC TOR rule had an FPR of 5.0% (1.1-8.9) and PPV of 98.9% (98.0-99.8) for mortality, and an FPR of 3.7% (0.0-7.8) and PPV of 50.0% (45.7-54.3) for poor neurological outcomes at hospital discharge. The modified cutoff value for age was 68 years, with an area under the receiver operating characteristic curve over 0.7. In the group that met the BLS TOR rule, the cutoff of the CTI for death was not determined and was 21 min for poor neurological outcomes. In the group that met the KoCARC TOR rule, the cutoff of the CTI for death and poor neurological outcomes at the time of hospital discharge was 25 min and 21 min, respectively. The BLS TOR and KoCARC TOR rules showed inappropriate predictive performance for mortality and poor neurological outcomes. However, the predictive performance of the TOR rule could be supplemented by modifying the age criterion and adding the CTI criterion of the KoCARC.
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Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, 49201, South Korea
| | - Daesung Lim
- Department of Emergency Medicine, Seoul Medical Center, Seoul, 02053, South Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan, 50612, South Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, 51353, South Korea
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, 44033, South Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, 44033, South Korea.
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12
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Hagberg G, Ihle-Hansen H, Sandset EC, Jacobsen D, Wimmer H, Ihle-Hansen H. Long Term Cognitive Function After Cardiac Arrest: A Mini-Review. Front Aging Neurosci 2022; 14:885226. [PMID: 35721022 PMCID: PMC9204346 DOI: 10.3389/fnagi.2022.885226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide. With better pre- and inhospital treatment, including cardiopulmonary resuscitation (CPR) as an integrated part of public education and more public-access defibrillators available, OHCA survival has increased over the last decade. There are concerns, after successful resuscitation, of cerebral hypoxia and degrees of potential acquired brain injury with resulting poor cognitive functioning. Cognitive function is not routinely assessed in OHCA survivors, and there is a lack of consensus on screening methods for cognitive changes. This narrative mini-review, explores available evidence on hypoxic brain injury and long-term cognitive function in cardiac arrest survivors and highlights remaining knowledge deficits.
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13
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Blennow Nordström E, Lilja G, Ullén S, Blennow K, Friberg H, Hassager C, Kjærgaard J, Mattsson-Carlgren N, Moseby-Knappe M, Nielsen N, Vestberg S, Zetterberg H, Cronberg T. Serum neurofilament light levels are correlated to long-term neurocognitive outcome measures after cardiac arrest. Brain Inj 2022; 36:800-809. [DOI: 10.1080/02699052.2022.2048693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Erik Blennow Nordström
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden – Forum South, Skane University Hospital, Lund, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Hans Friberg
- Department of Clinical Sciences Lund, Intensive and Perioperative Care, Lund University, Skane University Hospital, Malmö, Sweden
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Marion Moseby-Knappe
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Helsingborg Hospital, Lund, Sweden
| | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
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Zhou P, Xu H, Li B, Yang C, Zhou Z, Shi J, Li Z. Neurological outcomes in adult drowning patients in China. Ann Saudi Med 2022; 42:127-138. [PMID: 35380055 PMCID: PMC8982001 DOI: 10.5144/0256-4947.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drowning is the third leading cause of unintentional death worldwide. The epidemiological characteristics of adult drownings are rarely reported. OBJECTIVE Investigate factors associated with neurological prognosis in adult drowning inpatients. DESIGN Multicenter medical record review. SETTING Tertiary health care institutions. PATIENTS AND METHODS We collected demographic and clinical data on patients who drowned but survived between September 2006 and January 2020. Neurological prognosis was compared in patients with and without cardiac arrest. MAIN OUTCOME MEASURES Neurological outcomes. SAMPLE SIZE AND CHARACTERISTICS 142 patients with mean age of 50.6 (19.8) years, male/female ratio of 1.54:1. RESULT Forty-five patients (31.7%) received CPR, 90 patients (63.4%) experienced unconsciousness, and 59 patients (41.5%) received endotracheal intubation and mechanical ventilation. Multivariate logistic regression analysis showed that the initial blood lactic acid level (OR: 7.67, 95%CI: 1.23-47.82, P=.029) was associated with a poor neurological prognosis in patients without cardiac arrest. The incidence of ICU admission (OR: 16.604, 95%CI: 1.15-239.49, P=.039) was associated with a poor neurologic prognosis in patients with cardiac arrest. CONCLUSIONS For the drowning patients with cardiac arrest, ICU admission was associated with neurological function prognosis in these patients. Among the patients without cardiac arrest, the initial lactate value was associated with neurological function prognosis of these patients. LIMITATIONS Retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
- Peisen Zhou
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Huaqing Xu
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Bingccan Li
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Chenbing Yang
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zhiliang Zhou
- From the Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jincun Shi
- From the Department of Emergency Medicine, Wenzhou Central Hospital, Zhejiang, China
| | - Zhangping Li
- From the The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Zhejiang, China
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Park SY, Lim D, Kim SC, Ryu JH, Kim YH, Choi B, Kim SH. Effect of Prehospital Epinephrine Use on Survival from Out-of-Hospital Cardiac Arrest and on Emergency Medical Services. J Clin Med 2021; 11:jcm11010190. [PMID: 35011931 PMCID: PMC8745563 DOI: 10.3390/jcm11010190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
This study was to identify the effect of epinephrine on the survival of out-of-hospital cardiac arrest (OHCA) patients and changes in prehospital emergency medical services (EMSs) after the introduction of prehospital epinephrine use by EMS providers. This was a retrospective observational study comparing two groups (epinephrine group and norepinephrine group). We used propensity score matching of the two groups and identified the association between outcome variables regarding survival and epinephrine use, controlling for confounding factors. The epinephrine group was 339 patients of a total 1943 study population. The survival-to-discharge rate and OR (95% CI) of the epinephrine group were 5.0% (p = 0.215) and 0.72 (0.43–1.21) in the total patient population and 4.7% (p = 0.699) and 1.15 (0.55–2.43) in the 1:1 propensity-matched population. The epinephrine group received more mechanical chest compression and had longer EMS response times and scene times than the norepinephrine group. Mechanical chest compression was a negative prognostic factor for survival to discharge and favorable neurological outcomes in the epinephrine group. The introduction of prehospital epinephrine use in OHCA patients yielded no evidence of improvement in survival to discharge and favorable neurological outcomes and adversely affected the practice of EMS providers, exacerbating the factors negatively associated with survival from OHCA.
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Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan 48114, Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Seong Chun Kim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan 50612, Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan 44033, Korea
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16
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Thomas AM, Chaban V, Pischke SE, Orrem HL, Bosnes V, Sunde K, Seljeflot I, Lundqvist C, Nakstad ER, Andersen GØ, Schjalm C, Mollnes TE, Barratt-Due A. Complement ratios C3bc/C3 and sC5b-9/C5 do not increase the sensitivity of detecting acute complement activation systemically. Mol Immunol 2021; 141:273-279. [PMID: 34906905 DOI: 10.1016/j.molimm.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Complement activation plays an important pathogenic role in numerous diseases. The ratio between an activation product and its parent protein is suggested to be more sensitive to detect complement activation than the activation product itself. In the present study we explored whether the ratio between the activation product and the parent protein for C3 (C3bc/C3) and for C5 (sC5b-9/C5) increased the sensitivity to detect complement activation in acute clinical settings compared to the activation product alone. MATERIALS AND METHODS Samples from patients with acute heart failure following ST-elevated myocardial infarction (STEMI) and from patients with out-of-hospital cardiac arrest (OHCA) were used. C3, C3bc and C5, sC5b-9 were analysed in 629 and 672 patient samples, respectively. Healthy controls (n = 20) served to determine reference cut-off values for activation products and ratios, defined as two SD above the mean. RESULTS Increased C3bc/C3- and sC5b-9/C5 ratios were vastly dependent on C3bc and sC5b-9. Thus, 99.5 % and 98.1 % of the increased C3bc/C3- and sC5b-9/C5 ratios were solely dependent on increased C3bc and sC5b-9, respectively. Significantly decreased C3 and C5 caused increased ratios in only 3/600 (0.5 %) and 4/319 (1.3 %) samples, respectively. Strong correlations between C3bc and C3bc/C3-ratio and between sC5b-9 and sC5b-9/C5-ratio were found in the STEMI- (r = 0.926 and r = 0.786, respectively) and the OHCA-population (r = 0.908 and r = 0.843, respectively; p < 0.0001 for all). Importantly, sC5b-9 identified worse outcome groups better than sC5b-9/C5-ratio. CONCLUSION C3bc and sC5b-9 were sensitive markers of complement activation. The ratios of C3bc/C3 and sC5b-9/C5 did not improve detection of complement activation systemically.
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Affiliation(s)
- Anub Mathew Thomas
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway; Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Norway
| | - Viktoriia Chaban
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway
| | - Søren E Pischke
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Hilde Lang Orrem
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - Vidar Bosnes
- Department of Immunology, Section of Medical Immunology, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, University of Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Norway; Department of Cardiology, Oslo University Hospital, Norway
| | - Christofer Lundqvist
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Neurology, Akershus University Hospital, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Oslo, Norway
| | - Espen Rostrup Nakstad
- Norwegian National Unit for CBRNE Medicine, Division of Medicine, Oslo University Hospital, Norway
| | | | - Camilla Schjalm
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway; Research Laboratory, Nordland Hospital, Bodø, Norway; K.G. Jebsen TREC, University of Tromsø, Norway; Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Barratt-Due
- Department of Immunology, Oslo University Hospital and University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
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Müller J, Bissmann B, Becker C, Beck K, Loretz N, Gross S, Amacher SA, Bohren C, Pargger H, Tisljar K, Sutter R, Marsch S, Hunziker S. Neuron-Specific Enolase (NSE) Predicts Long-Term Mortality in Adult Patients after Cardiac Arrest: Results from a Prospective Trial. MEDICINES 2021; 8:medicines8110072. [PMID: 34822369 PMCID: PMC8624292 DOI: 10.3390/medicines8110072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
Background: We investigated whether Neuron-specific enolase (NSE) serum concentration predicts long-term mortality and poor neurological outcome in adult cardiac arrest patients. Methods: Within this prospective observational study, we included consecutive adult patients admitted to the intensive care unit (ICU) after cardiac arrest. NSE was measured upon ICU admission and on days 1, 2, 3, 5 and 7. Results: Of 403 patients, 176 (43.7%) survived. Median follow-up duration was 43.7 months (IQR 14.3 to 63.0 months). NSE levels on day 3 were increased more than threefold in non-survivors compared to survivors (median NSE (ng/mL) 19.8 (IQR 15.7 to 27.8) vs. 72.6 (IQR 26 to 194)) and showed the highest prognostic performance for mortality compared to other days of measurement, with an AUC of 0.81 and an adjusted hazard ratio of 1.55 (95% CI 1.41 to 1.71, p < 0.001). Subgroup analysis showed an excellent sensitivity and negative predictive value of 100% of NSE in patients <54 years of age. Conclusion: NSE measured three days after cardiac arrest is associated with long-term mortality and neurological outcome and may provide prognostic information that improves clinical decision making. Particularly in the subgroup of younger patients (<54 years), NSE showed excellent negative predictive value.
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Affiliation(s)
- Jonas Müller
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Benjamin Bissmann
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Christoph Becker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
| | - Katharina Beck
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Nina Loretz
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Sebastian Gross
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Simon A. Amacher
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland
| | - Chantal Bohren
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
| | - Hans Pargger
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland
| | - Kai Tisljar
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland
| | - Raoul Sutter
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland
| | - Stephan Marsch
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
- Intensive Care Unit, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (B.B.); (C.B.); (K.B.); (N.L.); (S.G.); (S.A.A.); (C.B.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland; (H.P.); (K.T.); (R.S.); (S.M.)
- Correspondence: ; Tel.: +41-61-265-25-25
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Lim D, Park SY, Choi B, Kim SH, Ryu JH, Kim YH, Sung AJ, Bae BK, Kim HB. The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea. J Korean Med Sci 2021; 36:e255. [PMID: 34519188 PMCID: PMC8438185 DOI: 10.3346/jkms.2021.36.e255] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea. METHODS This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients. RESULTS A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00-24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5-10] vs. 8 [6-11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592-0.995) for survival at admission and 0.693 (95% CI, 0.446-1.077) for survival to discharge were found. CONCLUSION During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.
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Affiliation(s)
- Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Korea.
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan, Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ae Jin Sung
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Byung Kwan Bae
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Hospital, Busan, Korea
| | - Han Byeol Kim
- Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Otomune K, Hifumi T, Jinno K, Nakamura K, Okazaki T, Inoue A, Kawakita K, Kuroda Y. Neurological outcomes associated with prehospital advanced airway management in patients with out-of-hospital cardiac arrest due to foreign body airway obstruction. Resusc Plus 2021; 7:100140. [PMID: 34223396 PMCID: PMC8244501 DOI: 10.1016/j.resplu.2021.100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Several studies have examined the association between advanced airway management (AAM) and survival for arrest that is non-shockable, noncardiac in origin, or due to suffocation; however, the efficacy of prehospital AAM compared with no AAM following foreign body removal by emergency medical services (EMS) has not been examined. We aimed to compare neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA) due to foreign body airway obstruction (FBAO) managed with and without AAM after foreign body removal. METHODS This retrospective observational cohort study used all emergency transportation data of Japan and the All-Japan Utstein Registry. We included patients with OHCA aged ≥18 years undergoing resuscitation and removal of airway foreign bodies by EMS from January 2015 to December 2017. The exposure of interest was prehospital AAM by EMS after foreign body removal, and the primary outcome was a favorable neurological outcome at hospital discharge (i.e., a cerebral performance category of 1-2). RESULTS Overall, 329,098 adults had OHCAs and 23,060 had foreign bodies removed from their airways; 3681 adult patients met our eligibility criteria and were divided as: AAM (2045) and non-AAM (1636) groups. Propensity score matching resulted in 1210 matched pairs with balanced baseline characteristics between the groups. The rate of favorable neurological outcome was significantly lower in the AAM group than in the non-AAM group (OR 0.34, 95% CI 0.19-0.62). However, survival was not significantly different between the two groups (OR 1.08, 95% CI 0.84-1.37). CONCLUSIONS We have not demonstrated the benefit of AAM for patients with OHCA due to FBAO. Further study will be required to confirm the efficacy of AAM for those patients.
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Affiliation(s)
- Kanako Otomune
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Keisuke Jinno
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Kentaro Nakamura
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Akihiko Inoue
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
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20
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Mölström S, Nielsen TH, Nordström CH, Forsse A, Möller S, Venö S, Mamaev D, Tencer T, Schmidt H, Toft P. Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest. Sci Rep 2021; 11:15871. [PMID: 34354178 PMCID: PMC8342553 DOI: 10.1038/s41598-021-95405-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Bedside detection and early treatment of lasting cerebral ischemia may improve outcome after out-of-hospital cardiac arrest (OHCA). This feasibility study explores the possibilities to use microdialysis (MD) for continuous monitoring of cerebral energy metabolism by analyzing the draining cerebral venous blood. Eighteen comatose patients were continuously monitored with jugular bulb and radial artery (reference) MD following resuscitation. Median time from cardiac arrest to MD was 300 min (IQR 230–390) with median monitoring time 60 h (IQR 40–81). The lactate/pyruvate ratio in cerebral venous blood was increased during the first 20 h after OHCA, and significant differences in time-averaged mean MD metabolites between jugular venous and artery measurements, were documented (p < 0.02). In patients with unfavorable outcome (72%), cerebral venous lactate and pyruvate levels remained elevated during the study period. In conclusion, the study indicates that jugular bulb microdialysis (JBM) is feasible and safe. Biochemical signs of lasting ischemia and mitochondrial dysfunction are frequent and associated with unfavorable outcome. The technique may be used in comatose OHCA patients to monitor biochemical variables reflecting ongoing brain damage and support individualized treatment early after resuscitation.
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Affiliation(s)
- Simon Mölström
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | | | - Carl H Nordström
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Axel Forsse
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Venö
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Dmitry Mamaev
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Tomas Tencer
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
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Abstract
PURPOSE OF REVIEW Recovery after severe brain injury is variable and challenging to accurately predict at the individual patient level. This review highlights new developments in clinical prognostication with a special focus on the prediction of consciousness and increasing reliance on methods from data science. RECENT FINDINGS Recent research has leveraged serum biomarkers, quantitative electroencephalography, MRI, and physiological time-series to build models for recovery prediction. The analysis of high-resolution data and the integration of features from different modalities can be approached with efficient computational techniques. SUMMARY Advances in neurophysiology and neuroimaging, in combination with computational methods, represent a novel paradigm for prediction of consciousness and functional recovery after severe brain injury. Research is needed to produce reliable, patient-level predictions that could meaningfully impact clinical decision making.
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Rossetti AO, Schindler K, Sutter R, Rüegg S, Zubler F, Novy J, Oddo M, Warpelin-Decrausaz L, Alvarez V. Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure: A Multicenter Randomized Clinical Trial. JAMA Neurol 2021; 77:1225-1232. [PMID: 32716479 PMCID: PMC7385681 DOI: 10.1001/jamaneurol.2020.2264] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question In patients with acute consciousness impairment and no recent seizures, does continuous electroencephalogram (cEEG) correlate with reduced mortality compared with repeated routine EEG (rEEG)? Findings In this pragmatic, multicenter randomized clinical trial analyzing 364 adults, cEEG translated into a higher rate of seizures/status epilepticus detection and antiseizure treatment modifications but did not improve mortality compared with rEEG. Meaning Pending larger studies, rEEG may represent a valid alternative to cEEG in centers with limited resources. Importance In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection, but is resource-consuming compared with routine EEG (rEEG). It is also uncertain whether cEEG has an effect on outcome. Objective To assess whether cEEG is associated with reduced mortality compared with rEEG. Design, Setting, and Participants The pragmatic multicenter Continuous EEG Randomized Trial in Adults (CERTA) was conducted between 2017 and 2018, with follow-up of 6 months. Outcomes were assessed by interviewers blinded to interventions.The study took place at 4 tertiary hospitals in Switzerland (intensive and intermediate care units). Depending on investigators’ availability, we pragmatically recruited critically ill adults having Glasgow Coma Scale scores of 11 or less or Full Outline of Responsiveness score of 12 or less, without recent seizures or status epilepticus. They had cerebral (eg, brain trauma, cardiac arrest, hemorrhage, or stroke) or noncerebral conditions (eg, toxic-metabolic or unknown etiology), and EEG was requested as part of standard care. An independent physician provided emergency informed consent. Interventions Participants were randomized 1:1 to cEEG for 30 to 48 hours vs 2 rEEGs (20 minutes each), interpreted according to standardized American Clinical Neurophysiology Society guidelines. Main Outcomes and Measures Mortality at 6 months represented the primary outcome. Secondary outcomes included interictal and ictal features detection and change in therapy. Results We analyzed 364 patients (33% women; mean [SD] age, 63 [15] years). At 6 months, mortality was 89 of 182 in those with cEEG and 88 of 182 in those with rEEG (adjusted relative risk [RR], 1.02; 95% CI, 0.83-1.26; P = .85). Exploratory comparisons within subgroups stratifying patients according to age, premorbid disability, comorbidities on admission, deeper consciousness reduction, and underlying diagnoses revealed no significant effect modification. Continuous EEG was associated with increased detection of interictal features and seizures (adjusted RR, 1.26; 95% CI, 1.08-1.15; P = .004 and 3.37; 95% CI, 1.63-7.00; P = .001, respectively) and more frequent adaptations in antiseizure therapy (RR, 1.84; 95% CI, 1.12-3.00; P = .01). Conclusions and Relevance This pragmatic trial shows that in critically ill adults with impaired consciousness and no recent seizure, cEEG leads to increased seizure detection and modification of antiseizure treatment but is not related to improved outcome compared with repeated rEEG. Pending larger studies, rEEG may represent a valid alternative to cEEG in centers with limited resources. Trial Registration ClinicalTrials.gov Identifier: NCT03129438
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Affiliation(s)
- Andrea O Rossetti
- Department of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Kaspar Schindler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Frédéric Zubler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan Novy
- Department of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mauro Oddo
- Department of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Loane Warpelin-Decrausaz
- Clinical Trial Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Alvarez
- Department of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Department of Neurology, Hôpital du Valais, Sion, Switzerland
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Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST). Resuscitation 2020; 149:170-179. [DOI: 10.1016/j.resuscitation.2019.12.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
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24
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An international, consensus-derived Core Outcome Set for Cardiac Arrest effectiveness trials: the COSCA initiative. Curr Opin Crit Care 2020; 25:226-233. [PMID: 30925524 DOI: 10.1097/mcc.0000000000000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials - the COSCA initiative. RECENT FINDINGS The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described. Working collaboratively with international stakeholders - including survivors, family members and advocates - as research partners and participants ensured that a range of perspectives were considered throughout all stages of COSCA development. Three core domains and methods of assessment were recommended: survival - at 30 days or hospital discharge; neurological function assessed at 30 days or hospital discharge with the modified Rankin Scale; and health-related quality of life assessed at 90 days (as a minimum) with one of three generic measures. SUMMARY The COSCA recommendation describes a small group of outcomes that should be reported as a minimum across large, randomized clinical effectiveness trials for cardiac arrest.
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25
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Meyer AS, Johansson PI, Kjaergaard J, Frydland M, Meyer MA, Henriksen HH, Thomsen JH, Wiberg SC, Hassager C, Ostrowski SR. "Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA): Safety and efficacy of low-dose Iloprost, a prostacyclin analogue, in addition to standard therapy, as compared to standard therapy alone, in post-cardiac-arrest-syndrome patients.". Am Heart J 2020; 219:9-20. [PMID: 31710844 DOI: 10.1016/j.ahj.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE An increasingly recognized prognostic factor for out-of-hospital-cardiac-arrest (OHCA) patients is the ischemia-reperfusion injury after restored blood circulation. Endothelial injury is common in patients resuscitated from cardiac arrest and is associated with poor outcome. This study was designed to investigate if iloprost infusion, a prostacyclin analogue, reduces endothelial damage in OHCA patients. METHODS 50 patients were randomized in a placebo controlled double-blinded trial and allocated 1:2 to 48-hours iloprost infusion, (1 ng/kg/min) or placebo (saline infusion). Endothelial biomarkers (soluble thrombomodulin (sTM), sE-selectin, syndecan-1, soluble vascular endothelial growth factor (sVEGF), vascular endothelial cadherine (VEcad), nucleosomes) and sympathoadrenal activation (epinephrine/norepinephrine) from baseline to 48 and 96-hours were evaluated. RESULTS Iloprost infusion did not influence endothelial biomarkers by the 48-hour endpoint. A rebound effect was observed with higher biomarker plasma values in the iloprost group (sTM p=0.02; Syndecan p=0.004; nucleosomes p<0.001; VEcad p<0.03) after 96-hours. There was a significant difference in 180-day mortality in favor of placebo. There was no difference regarding total adverse events between groups (p=0.73). Two patients were withdrawn in the iloprost group due to hypotension. CONCLUSIONS The administration of low-dose iloprost (1ng/kg/min) to OHCA patients did not significantly influence endothelial biomarkers as measured by the 48- hour endpoint. A rebound effect was however observed in the 96-hour statistical model, with increasing endothelial biomarker levels after cessation of the iloprost-infusion.
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26
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Barakat AF, Thalappillil A, Qin D, Ladejobi A, Bhonsale A, Kancharla K, Wang NC, Adelstein E, Jain S, Estes NM, Saba S. Implications of Neurological Status on Defibrillator Therapy and Long-Term Mortality of Sudden Cardiac Arrest Survivors. JACC Clin Electrophysiol 2019; 5:843-850. [DOI: 10.1016/j.jacep.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
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27
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Fukui S, Kawakami M, Otaka Y, Ishikawa A, Yashima F, Hayashida K, Muraoka K, Liu M. Activities of daily living among elderly persons with severe aortic stenosis. Disabil Rehabil 2019; 43:338-344. [PMID: 31204521 DOI: 10.1080/09638288.2019.1624838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the level of limitations in activities of daily living (ADL) and instrumental ADL, and identify related factors to instrumental ADL among elderly persons with severe aortic stenosis (AS). MATERIALS AND METHODS We prospectively enrolled 112 consecutive elderly persons (mean age, 84.6 ± 4.4 y) with severe AS. We assessed ADL and instrumental ADL using the Barthel index (BI) and the Frenchay activities index (FAI), respectively. Cardiac, physical, cognitive and kidney functions, nutritional status, medical histories, and comorbidities were assessed. A multiple logistic analysis was developed to explore related factors to the FAI. RESULTS The medians (ranges) of BI and FAI were 100 (15-100) and 21 (0-38), respectively. The multiple logistic analysis revealed that a history of heart failure (sβ = -0.189), a history of cerebrovascular disease (sβ = -0.233), the short physical performance battery score ≤ 8 (sβ = -0.272), the mini-mental state examination score ≤ 23 (sβ = -0.168) were significantly related to the FAI (p < 0.05). CONCLUSIONS Physical frailty, a history of heart failure, cerebrovascular disease, and cognitive decline were independently related to declined instrumental ADL. IMPLICATIONS FOR REHABILIATION Activities of daily living was well-preserved among elderly persons with severe aortic stenosis. Instrumental activities of daily living varied among patients with aortic stenosis and was sometimes impaired. Physical frailty, a history of heart failure, and a history of cerebrovascular disease were independently associated with instrumental activities of daily living in elderly persons with severe aortic stenosis.
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Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Mölström S, Nielsen TH, Nordström CH, Hassager C, Møller JE, Kjærgaard J, Möller S, Schmidt H, Toft P. Design paper of the "Blood pressure targets in post-resuscitation care and bedside monitoring of cerebral energy state: a randomized clinical trial". Trials 2019; 20:344. [PMID: 31182135 PMCID: PMC6558732 DOI: 10.1186/s13063-019-3397-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurological injuries remain the leading cause of death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Adequate blood pressure is of paramount importance to optimize cerebral perfusion and to minimize secondary brain injury. Markers measuring global cerebral ischemia caused by cardiac arrest and consecutive resuscitation and reflecting the metabolic variations after successful resuscitation are needed to assist a more individualized post-resuscitation care. Currently, no technique is available for bedside evaluation of global cerebral energy state, and until now blood pressure targets have been based on limited clinical evidence. Recent experimental and clinical studies indicate that it might be possible to evaluate cerebral oxidative metabolism from measuring the lactate-to-pyruvate (LP) ratio of the draining venous blood. In this study, jugular bulb microdialysis and immediate bedside biochemical analysis are introduced as new diagnostic tools to evaluate the effect of higher mean arterial blood pressure on global cerebral metabolism and the degree of cellular damage after OHCA. METHODS/DESIGN This is a single-center, randomized, double-blinded, superiority trial. Sixty unconscious patients with sustained return of spontaneous circulation after OHCA will be randomly assigned in a one-to-one fashion to low (63 mm Hg) or high (77 mm Hg) mean arterial blood pressure target. The primary end-point will be a difference in mean LP ratio within 48 h between blood pressure groups. Secondary end-points are (1) association between LP ratio and all-cause intensive care unit (ICU) mortality and (2) association between LP ratio and survival to hospital discharge with poor neurological function. DISCUSSION Markers measuring cerebral ischemia caused by cardiac arrest and consecutive resuscitation and reflecting the metabolic changes after successful resuscitation are urgently needed to enable a more personalized post-resuscitation care and prognostication. Jugular bulb microdialysis may provide a reliable global estimate of cerebral metabolic state and can be implemented as an entirely new and less invasive diagnostic tool for ICU patients after OHCA and has implications for early prognosis and treatment. TRIAL REGISTRATION ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03095742 ). Registered March 30, 2017.
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Affiliation(s)
- Simon Mölström
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Troels Halfeld Nielsen
- Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Carl H Nordström
- Department of Neurosurgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christian Hassager
- The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Jesper Kjærgaard
- The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Sören Möller
- OPEN - Odense Patient data Explorative Network, University of Southern Denmark, Odense University Hospital and Department of Clinical Research, J. B. Winsløws Vej 9, Odense, 5000, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
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Survival and neurological outcome with extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest caused by massive pulmonary embolism: A two center observational study. Resuscitation 2019; 136:8-13. [DOI: 10.1016/j.resuscitation.2018.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/22/2022]
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30
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Welbourn C, Efstathiou N. How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review. Scand J Trauma Resusc Emerg Med 2018; 26:77. [PMID: 30201018 PMCID: PMC6131783 DOI: 10.1186/s13049-018-0476-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain injury can occur after cardiac arrest due to the effects of ischaemia and reperfusion. In serious cases this can lead to permanent disability. This risk must be considered when making decisions about terminating resuscitation. There are very specific rules for termination of resuscitation in the prehospital setting however a similar rule for resuscitation in hospital does not exist. The aim of this review was to explore the effects of duration of cardiopulmonary resuscitation on neurological outcome in survivors of both in-hospital and out-of-hospital cardiac arrest achieving return of spontaneous circulation in hospital. METHODS A systematic review was conducted. Five databases were searched in addition to hand searching the journals Resuscitation and Circulation and reference lists, quality of the selected studies was assessed and a narrative summary of the data presented. Studies reporting relevant outcomes were included if the participants were adults achieving return of spontaneous circulation in the hospital setting. Studies looking at additional interventions such as extracorporeal resuscitation and therapeutic hypothermia were not included. Case studies were excluded. The study period was from January 2010 to March 2016. RESULTS Seven cohort studies were included for review. Quality scores ranged from eight to 11 out of 12. Five of the studies found a significant association between shorter duration of resuscitation and favourable neurological outcome. CONCLUSIONS There is generally a better neurological outcome with a shorter duration of CPR in survivors of cardiac arrest however a cut-off beyond which resuscitation is likely to lead to unfavourable outcome could not be determined and is unlikely to exist. The findings of this review could be considered by clinicians making decisions about terminating resuscitation. This review has highlighted many gaps in the knowledge where future research is needed; a validated and reliable measure of neurological outcome following cardiac arrest, more focused research on the effects of duration on neurological outcome and further research into the factors leading to brain damage in cardiac arrest.
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Affiliation(s)
- Clare Welbourn
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Nikolaos Efstathiou
- College of Medical and Dental Sciences, Institute of Clinical Sciences, School of Nursing, Medical School, University of Birmingham, Room EF15, Vincent Drive, Birmingham, B15 2TT UK
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Does Continuous Video-EEG in Patients With Altered Consciousness Improve Patient Outcome? Current Evidence and Randomized Controlled Trial Design. J Clin Neurophysiol 2018. [DOI: 10.1097/wnp.0000000000000467] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Palacios-Rubio J, Marina-Breysse M, Quintanilla JG, Gil-Perdomo JM, Juárez-Fernández M, Garcia-Gonzalez I, Rial-Bastón V, Corcobado MC, Espinosa MC, Ruiz F, Gómez-Mascaraque Pérez F, Bringas-Bollada M, Lillo-Castellano JM, Pérez-Castellano N, Martínez-Sellés M, López de Sá E, Martín-Benítez JC, Perez-Villacastín J, Filgueiras-Rama D. Early prognostic value of an Algorithm based on spectral Variables of Ventricular fibrillAtion from the EKG of patients with suddEn cardiac death: A multicentre observational study (AWAKE). ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:460-467. [PMID: 29885765 DOI: 10.1016/j.acmx.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/09/2018] [Accepted: 05/01/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Ventricular fibrillation (VF)-related sudden cardiac death (SCD) is a leading cause of mortality and morbidity. Current biological and imaging parameters show significant limitations on predicting cerebral performance at hospital admission. The AWAKE study (NCT03248557) is a multicentre observational study to validate a model based on spectral ECG analysis to early predict cerebral performance and survival in resuscitated comatose survivors. METHODS Data from VF ECG tracings of patients resuscitated from SCD will be collected using an electronic Case Report Form. Patients can be either comatose (Glasgow Coma Scale - GCS - ≤8) survivors undergoing temperature control after return of spontaneous circulation (RoSC), or those who regain consciousness (GCS=15) after RoSC; all admitted to Intensive Cardiac Care Units in 4 major university hospitals. VF tracings prior to the first direct current shock will be digitized and analyzed to derive spectral data and feed a predictive model to estimate favorable neurological performance (FNP). The results of the model will be compared to the actual prognosis. RESULTS The primary clinical outcome is FNP during hospitalization. Patients will be categorized into 4 subsets of neurological prognosis according to the risk score obtained from the predictive model. The secondary clinical outcomes are survival to hospital discharge, and FNP and survival after 6 months of follow-up. The model-derived categorisation will be also compared with clinical variables to assess model sensitivity, specificity, and accuracy. CONCLUSIONS A model based on spectral analysis of VF tracings is a promising tool to obtain early prognostic data after SCD.
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Affiliation(s)
| | - Manuel Marina-Breysse
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain
| | - Jorge G Quintanilla
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Miriam Juárez-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital Universitario Gregorio Marañón, Department of Cardiology, Madrid, Spain
| | | | | | - María Carmen Corcobado
- Unidad de Cuidados Intensivos, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - María Carmen Espinosa
- Unidad de Cuidados Intensivos, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Francisco Ruiz
- Unidad de Cuidados Intensivos, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - José María Lillo-Castellano
- Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain; Fundación interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital Universitario Gregorio Marañón, Department of Cardiology, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Esteban López de Sá
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital Universitario La Paz, Department of Cardiology, Madrid, Spain
| | | | - Julián Perez-Villacastín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Fundación interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - David Filgueiras-Rama
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2018; 127:147-163. [DOI: 10.1016/j.resuscitation.2018.03.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2018; 137:e783-e801. [PMID: 29700122 DOI: 10.1161/cir.0000000000000562] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.
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How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors. Crit Care Med 2018; 46:e286-e293. [DOI: 10.1097/ccm.0000000000002946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Haywood KL, Pearson N, Morrison LJ, Castrén M, Lilja G, Perkins GD. Assessing health-related quality of life (HRQoL) in survivors of out-of-hospital cardiac arrest: A systematic review of patient-reported outcome measures. Resuscitation 2018; 123:22-37. [DOI: 10.1016/j.resuscitation.2017.11.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/03/2017] [Accepted: 11/26/2017] [Indexed: 12/14/2022]
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Dostálová V, Sedláček K, Bělohlávek J, Turek R, Pretl M, Bezdíček O. Psychosocial sequelae following cardiac arrest. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kim J, Kim K, Callaway CW, Doh K, Choi J, Park J, Jo YH, Lee JH. Dynamic prediction of patient outcomes during ongoing cardiopulmonary resuscitation. Resuscitation 2016; 111:127-133. [PMID: 27658653 DOI: 10.1016/j.resuscitation.2016.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The probability of the return of spontaneous circulation (ROSC) and subsequent favourable outcomes changes dynamically during advanced cardiac life support (ACLS). We sought to model these changes using time-to-event analysis in out-of-hospital cardiac arrest (OHCA) patients. METHODS Adult (≥18 years old), non-traumatic OHCA patients without prehospital ROSC were included. Utstein variables and initial arterial blood gas measurements were used as predictors. The incidence rate of ROSC during the first 30min of ACLS in the emergency department (ED) was modelled using spline-based parametric survival analysis. Conditional probabilities of subsequent outcomes after ROSC (1-week and 1-month survival and 6-month neurologic recovery) were modelled using multivariable logistic regression. The ROSC and conditional probability models were then combined to estimate the likelihood of achieving ROSC and subsequent outcomes by providing k additional minutes of effort. RESULTS A total of 727 patients were analyzed. The incidence rate of ROSC increased rapidly until the 10th minute of ED ACLS, and it subsequently decreased. The conditional probabilities of subsequent outcomes after ROSC were also dependent on the duration of resuscitation with odds ratios for 1-week and 1-month survival and neurologic recovery of 0.93 (95% CI: 0.90-0.96, p<0.001), 0.93 (0.88-0.97, p=0.001) and 0.93 (0.87-0.99, p=0.031) per 1-min increase, respectively. Calibration testing of the combined models showed good correlation between mean predicted probability and actual prevalence. CONCLUSIONS The probability of ROSC and favourable subsequent outcomes changed according to a multiphasic pattern over the first 30min of ACLS, and modelling of the dynamic changes was feasible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400 A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States
| | - Kibbeum Doh
- Medical Device Research and Development Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jungho Choi
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jongdae Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
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Grossestreuer AV, Abella BS, Sheak KR, Cinousis MJ, Perman SM, Leary M, Wiebe DJ, Gaieski DF. Inter-rater reliability of post-arrest cerebral performance category (CPC) scores. Resuscitation 2016; 109:21-24. [PMID: 27650863 DOI: 10.1016/j.resuscitation.2016.09.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/29/2016] [Accepted: 09/05/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Cerebral Performance Category (CPC) scores are often an outcome measure for post-arrest neurologic function, collected worldwide to compare performance, evaluate therapies, and formulate recommendations. At most institutions, no formal training is offered in their determination, potentially leading to misclassification. MATERIALS AND METHODS We identified 171 patients at 2 hospitals between 5/10/2005 and 8/31/2012 with two CPC scores at hospital discharge recorded independently - in an in-house quality improvement database and as part of a national registry. Scores were abstracted retrospectively from the same electronic medical record by two separate non-clinical researchers. These scores were compared to assess inter-rater reliability and stratified based on whether the score was concordant or discordant among reviewers to determine factors related to discordance. RESULTS Thirty-nine CPC scores (22.8%) were discordant (kappa: 0.66), indicating substantial agreement. When dichotomized into "favorable" neurologic outcome (CPC 1-2)/"unfavorable" neurologic outcome (CPC 3-5), 20 (11.7%) scores were discordant (kappa: 0.70), also indicating substantial agreement. Patients discharged home (as opposed to nursing/other care facility) and patients with suspected cardiac etiology of arrest were statistically more likely to have concordant scores. For the quality improvement database, patients with discordant scores had a statistically higher median CPC score than those with concordant scores. The registry had statistically lower median CPC score (CPC 1) than the quality improvement database (CPC 2); p<0.01 for statistical significance. CONCLUSIONS CPC scores have substantial inter-rater reliability, which is reduced in patients who have worse outcomes, have a non-cardiac etiology of arrest, and are discharged to a location other than home.
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Affiliation(s)
- Anne V Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Healthcare Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Benjamin S Abella
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kelsey R Sheak
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marisa J Cinousis
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Marion Leary
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Douglas J Wiebe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - David F Gaieski
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
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