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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Kobata H, Kishimoto M, Kim SH, Ito Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Onoe A, Matsuyama T, Matsui S, Nishioka N, Okada Y, Makino Y, Kimata S, Kawai S, Zha L, Kiyohara K, Kitamura T, Iwami T. Intra-Aortic Balloon Pump among Shockable Out-of-Hospital Cardiac Arrest Patients: A Propensity-Weighted Analysis in a Multicenter, Nationwide Observational Study in Japan (The JAAM-OHCA Registry). J Clin Med 2023; 12:5945. [PMID: 37762886 PMCID: PMC10531972 DOI: 10.3390/jcm12185945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The effectiveness of IABP for shockable out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. This study aimed to investigate whether the use of an intra-aortic balloon pump (IABP) for non-traumatic shockable OHCA patients was associated with favorable neurological outcomes. METHODS From the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a nationwide multicenter prospective registry, we enrolled adult patients with non-traumatic and shockable OHCA for whom resuscitation was attempted, and who were transported to participating hospitals between 2014 and 2019. The primary outcome was 1-month survival with favorable neurological outcomes after OHCA. After adopting the propensity score (PS) inverse probability of weighting (IPW), we evaluated the association between IABP and favorable neurological outcomes. RESULTS Of 57,754 patients in the database, we included a total of 2738 adult non-traumatic shockable patients. In the original cohort, the primary outcome was lower in the IABP group (OR with 95% confidence intervals (CIs)), 0.57 (0.48-0.68), whereas, in the IPW cohort, it was not different between patients with and without IABP (OR, 1.18; 95% CI, 0.91-1.53). CONCLUSION In adult patients with non-traumatic shockable OHCA, IABP use was not associated with 1-month survival with favorable neurological outcomes.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka 558-8558, Japan;
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan;
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka 543-0035, Japan;
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University Takii Hospital, Moriguchi 570-8507, Japan;
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka 550-0025, Japan;
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan;
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama 589-8511, Japan;
| | - Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Center, Takatsuki 569-1124, Japan;
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka 578-0947, Japan;
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Center, Izumisano 598-8577, Japan;
| | - Yusuke Ito
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita 565-0862, Japan;
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan;
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka 534-0021, Japan;
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka 543-8555, Japan;
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Kishiwada 596-8522, Japan;
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata 573-1010, Japan;
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (S.M.); (L.Z.); (T.K.)
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (S.M.); (L.Z.); (T.K.)
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women’s University, Tokyo 102-8357, Japan;
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (S.M.); (L.Z.); (T.K.)
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto 606-8317, Japan; (S.Y.); (N.N.); (Y.O.); (Y.M.); (S.K.); (S.K.)
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Rykulski NS, Berger DA, Paxton JH, Klausner H, Smith G, Swor RA. The Effect of Missing Data on the Measurement of Cardiac Arrest Outcomes According to Race. PREHOSP EMERG CARE 2022; 27:1054-1057. [PMID: 36318902 DOI: 10.1080/10903127.2022.2137862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION High-quality data are important to understanding racial differences in outcome following out of hospital cardiac arrest (OHCA). Previous studies have shown differences in OHCA outcomes according to both race and socioeconomic status. EMS reporting of data on race is often incomplete. We aim to determine the effect of missing data on the determination of racial differences in outcomes for OHCA patients. METHODS We performed a secondary analysis of a data set developed by probabilistically linking the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) and the Michigan Inpatient Database (MIDB). Adult OHCA patients (age >18) who survived to hospital admission between 2014 and 2017 were included. Both datasets recorded patient race and ethnicity with CARES using a single race/ethnicity variable. Patients were categorized as White, Black, other, or missing and only a single choice was allowed. Due to the small number of Hispanic patients and the combined race/ethnicity variable, these patients were excluded. The outcomes of interest were survival to hospital discharge and survival to discharge with Cerebral Performance Category 1 or 2 (good outcome). Outcomes were stratified according to EMS- or hospital-documented race. RESULTS We included 3,756 matched patients, after excluding 34 Hispanic patients from analysis. Documentation of patient race was missing in 892 (22.1%) of CARES and 212 (5.6%) of MIDB patients. When both datasets documented Black or White race, agreement in race documentation was excellent (κ=0.83). White patients were more likely to have good outcomes than Black in both the CARES (27.3% vs 14.8%) and MIDB (26.9% vs 16.1%) databases (both p < 0.001), but were not more likely to survive (30.8% vs 27.3% p = 0.22; 30.3% vs 28.1%, p = 0.07). Moreover, we found no significant difference in outcome measures based on race documentation for White vs Black patients (good outcome [27.3 vs 26.9% (MIDB)] and [16.1% vs 14.8% (CARES)] respectively and survival [30.8% vs 30.3% (MIDB)] and [27.3 vs 28.1% (CARES)] respectively). CONCLUSION Despite higher rates of missing EMS documentation, we identified statistically similar rates in OHCA outcome measures between databases. Further work is needed to determine the true effect of missing documentation of race on OHCA outcome measures.
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Affiliation(s)
- Nicholas S Rykulski
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - David A Berger
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - James H Paxton
- Department of Emergency Medicine, Detroit Receiving Hospital & Sinai-Grace Hospital, Wayne State University School of Medicine, Detroit, Michigan
| | - Howard Klausner
- Department of Emergency Medicine, Henry Ford Health System, Wayne State University School of Medicine, Detroit, Michigan
| | - Graham Smith
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
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Mørk SR, Bøtker MT, Christensen S, Tang M, Terkelsen CJ. Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support. Resusc Plus 2022; 10:100230. [PMID: 35434669 PMCID: PMC9010695 DOI: 10.1016/j.resplu.2022.100230] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. Results Among 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. Conclusions Short-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- Corresponding author at: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Morten Thingemann Bøtker
- Aarhus University, Aarhus, Denmark
- Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | - Steffen Christensen
- Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Mariann Tang
- Aarhus University, Aarhus, Denmark
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- The Danish Heart Foundation, Denmark
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Swor RA, Chen NW, Song J, Paxton JH, Berger DA, Miller JB, Pribble J, Reynolds JC. Hospital length of stay, do not resuscitate orders, and survival for post-cardiac arrest patients in Michigan: A study for the CARES Surveillance Group. Resuscitation 2021; 165:119-126. [PMID: 34166745 DOI: 10.1016/j.resuscitation.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Current guidelines recommend deferring prognostic decisions for at least 72 h following admission after Out of Hospital cardiac arrest (OHCA). Most non-survivors experience withdrawal of life sustaining therapy (WLST), and early WLST may adversely impact survival. We sought to characterize the hospital length of stay (LOS) and timing of Do Not Resuscitate (DNR) orders (as surrogates for WLST), to assess their relationship to survival following cardiac arrest. DESIGN We performed a retrospective cohort study of probabilistically linked cardiac arrest registries (Cardiac Arrest Registry to Enhance Survival (CARES) and Michigan Inpatient Database (MIDB) from 2014 to 2017. PATIENTS Adult (≥18 years) patients admitted following OHCA were included. We considered LOS ≤ 3 days (short LOS) and written DNR order with LOS ≤ 3 days (Early DNR) as indicators of early WLST. Our primary outcome was survival to hospital discharge. We utilized multilevel logistic regression clustered by hospital to examine associations of these variables, patient characteristics and survival to hospital discharge. MEASUREMENT AND MAIN RESULTS We included 3644 patients from 38 hospitals with >30 patients. Patients mean age was 62.4 years and were predominately male (59.3%). LOS ≤ 3 days (ORadj = 0.11) and early DNR (ORadj = 0.02) were inversely associated with survival to discharge. There was a non-significant inverse association between hospital rates of LOS ≤ 3 days and survival (p = 0.11), and Early DNR and survival (p = 0.83). In the multilevel model, using median odd ratios to assess variation in LOS ≤ 3 days and survival, patient characteristics contributed more to variability in surviival than between-hospital variation. However, between-hospital variation contributed more to variability than patient characteristics in the provision of early DNR orders. CONCLUSIONS We observed that LOS ≤ 3 days for post-arrest patients was negatively-associated with survival, with both patient characteristics and between-hospital variation associated with outcomes. However, between-hospital variation appears to be more highly-associated with provision of early DNR orders than patient characteristics. Further work is needed to assess variation in early DNR orders and their impact on patient survival.
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Affiliation(s)
- Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, United States.
| | - Nai-Wei Chen
- Division of Informatics and Biostatistics, Beaumont Research Institute Beaumont Health, United States
| | - Jaemin Song
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, United States
| | - James H Paxton
- Department of Emergency Medicine, Detroit Receiving Hospital & Sinai-Grace Hospital, Wayne State University School of Medicine, United States
| | - David A Berger
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, United States
| | - Joseph B Miller
- Department of Emergency Medicine, Henry Ford Health System, Wayne State University School of Medicine, United States
| | - Jim Pribble
- Department of Emergency Medicine, Michigan Medicine University of Michigan, United States
| | - Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, United States
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