1
|
Chung S, Wooten A, Hansen M, Neth M, Lupton J. The Evaluation of Online Medical Consultation Use in Pediatric Out-of-hospital Cardiac Arrest. PREHOSP EMERG CARE 2024:1-10. [PMID: 39356210 DOI: 10.1080/10903127.2024.2406029] [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: 04/20/2024] [Revised: 08/19/2024] [Accepted: 09/03/2024] [Indexed: 10/03/2024]
Abstract
OBJECTIVES Our study details Online medical consultation (OLMC) usage for Pediatric out-of-hospital cardiac arrest (P-OHCA), including proportion of P-OHCA utilizing OLMC, the characteristics of cases using OLMC, the types of information exchanged during OLMC calls, and the outcomes in patients where Emergency Medical Services (EMS) contacted OLMC. METHODS The study included P-OHCA patients treated by EMS agencies participating in the regional cardiac registry with total catchment population of approximately 1.5 million residents. We reviewed linked calls and EMS charts for P-OHCA cases treated from January 1st, 2018 through December 31st, 2022. RESULTS In total, 112 cases from January 2018 to December 2022 were included in the final analysis. Twenty-two out of 112 utilized OLMC with a mean time from 9-1-1 call to OLMC of 28.8 minutes. The no OLMC group had a significantly higher transport rate than OLMC group as well as higher percentages of ROSC at any time and ROSC upon arrival at the ED. Both survival to admission and survival to discharge were more prevalent in the no OLMC group, while there were no instances of survival to discharge in the OLMC group. During the calls, the discussion of crucial prognostic factors, including witness status, initial rhythm, ETCO2, and arrest duration, appears inconsistent. CONCLUSIONS Pediatric-OHCA cases with OLMC tend to contact OLMC late in the resuscitation, have poor prognostic factors, and have poor survival outcomes. The information exchanged during OLMC calls was highly variable, representing a clear opportunity for improvement. Future studies should explore the potential effect of early OLMC contact on patient outcomes and if a standardized template for OLMC data exchange improves consistency in recommendations for P-OHCA.
Collapse
Affiliation(s)
- SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Asia Wooten
- College of Medicine, Oregon Health and Science University, CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Matthew Neth
- Department of Emergency Medicine, Oregon Health and Science University, CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Joshua Lupton
- Department of Emergency Medicine, Oregon Health and Science University, CDW-EM 3181 SW Sam Jackson Park Road, Portland, OR 97239
| |
Collapse
|
2
|
Jang K, Hwang HM, Seo YH. Factors affecting neurological outcomes of patients with sudden cardiac arrest in the emergency department. BMC Emerg Med 2024; 24:167. [PMID: 39271981 PMCID: PMC11401323 DOI: 10.1186/s12873-024-01059-x] [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: 02/09/2024] [Accepted: 07/22/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Little is known about patients with sudden cardiac arrest in the emergency department (ED). This study aimed to identify factors affecting the prognosis of patients with cardiac arrest in the ED. METHODS This retrospective study analyzed patients with sudden cardiac arrest admitted to the ED of a general hospital between January 2016 and July 2020. A total of 153 patients with sudden cardiac arrest were identified, and 149 patients for whom all data could be confirmed were included in the statistical analysis of this study. A good neurological outcome was defined as a Cerebral Performance Category (CPC) scale score of 1 or 2, assessed 6 months after discharge. RESULTS In the univariate analysis, the characteristics of patients included in the good neurological outcomes group were younger (t = 3.553, p < .001), had shorter low flow time (t = 3.31, p = .019), and had more shockable initial rhythms (χ2 = 28.038, p = < .001). As a result of multivariate binary logistic regression analysis, among 43 patients alive 6 months after discharge, age 60 years or younger (odds ratio = 32.703, p = .005), low flow time 6 min or less (odds ratio = 38.418, p = .006), and initial shockable rhythm (odds ratio = 31.214, p < .001) were identified as predictors that had a significant impact on good neurological outcomes. CONCLUSIONS Young age, short low-flow-time, and initial shockable rhythm are predictors of good neurological outcomes in patients with acute cardiac arrest in the ED.
Collapse
Affiliation(s)
- Kyeongmin Jang
- Department of Nursing, College of Health Sciences, Daejin University, 1007, Hoguk-ro, Pocheon-si, Gyeonggi-Do, Republic of Korea
| | - Hye-Min Hwang
- Department of Nursing, Bucheon University, 56, Sosa-Ro, Bucheon-Si, Gyeonggi-Do, Republic of Korea
| | - Yon Hee Seo
- Department of Nursing Science, Andong National University, 1375, Gyeongdong-Ro, Andong-Si, Gyeongsangbuk-Do, Republic of Korea.
| |
Collapse
|
3
|
Matta A, Philippe J, Nader V, Levai L, Moussallem N, Kazzi AA, Ohlmann P. Predictors and rate of survival after Out-of-Hospital Cardiac Arrest. Curr Probl Cardiol 2024; 49:102719. [PMID: 38908728 DOI: 10.1016/j.cpcardiol.2024.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major public health concern and encloses a wide spectrum of causes. The purpose of this study is to assess predictors and rate of survival at hospital discharge and long-term in the setting of OHCA. The secondary endpoint is to compare OHCA-survival outcomes of presumed ischemic versus non ischemic cause. METHODS A retrospective cohort was conducted on 318 consecutive patients admitted for OHCA at Civilian Hospitals of Colmar between 2010 and 2019. Data concerning baseline characteristics, EKG, biological parameters, and coronary angiograms were collected. We observed the living status (alive or dead) of each of study's participants by March 2023. RESULTS The observed survival rate was 34.3 % at hospital discharge and 26.7 % at 7.1-year follow up. The mean age of study population was 63 ± 16 years and 32.7 % were women. 65.7 % of OHCA-patients underwent coronary angiography that revealed a significant coronary artery disease (CAD) in half of study participants. Primary angioplasty was performed in 43.4 % of study population. The in-hospital mortality rate was significantly higher in those with RBBB (83.7 % vs. 62.5 %, p = 0.004), diabetes mellitus (84.2 % vs. 59.9 %, p < 0.001), arterial hypertension (72.2 % vs. 57.7 %, p = 0.007), peripheral arterial disease (79.2 % vs. 52.2 %, p = 0.031) whereas it was lower in case of anterior STEMI (43.9 % vs 71.4 %, p < 0.001), presence of obstructive CAD (52.2 % vs. 79.2 %, p < 0.001), primary angioplasty performance (48.6 % vs. 78.9 %, p < 0.001), initial shockable rhythm (43.8 % vs. 88.6 %, p < 0.001), initial chest pain (49.4 % vs. 71.5 %, p < 0.001). After adjusting on covariates, the Cox model only identified an initial shockable rhythm as independent predictor of survival at hospital discharge [HR = 0.185, 95 %CI (0.085-0.404), p < 0.001] and 7-year follow up [HR = 0.201, 95 %CI (0.082-0.492), p < 0.001]. The Kaplan-Meier and log Rank test showed a difference in survival outcomes between OHCA with versus without CAD (p < 0.001). CONCLUSION The proportion of OHCA-survivors is small despite the development of emergency health care system. Initial shockable rhythm is the strong predictor of survival. OHCA of presumed coronary cause is associated with a better long-term survival outcome.
Collapse
Affiliation(s)
- Anthony Matta
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France; School of medicine and medical sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon.
| | - John Philippe
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Vanessa Nader
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Laszlo Levai
- Department of cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Nicolas Moussallem
- School of medicine and medical sciences, Holy Spirit University of Kaslik, P.O.Box 446, Jounieh, Lebanon
| | - Amin A Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick Ohlmann
- Department of cardiology, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
4
|
Yan L, Wang L, Zhou L, Jin Q, Liao D, Su H, Lu G. Factors predicting the return of spontaneous circulation rate of cardiopulmonary resuscitation in China: Development and evaluation of predictive nomogram. Heliyon 2024; 10:e35903. [PMID: 39224381 PMCID: PMC11367279 DOI: 10.1016/j.heliyon.2024.e35903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Background This study aimed to construct and internally validate a probability of the return of spontaneous circulation (ROSC) rate nomogram in a Chinese population of patients with cardiac arrest (CA). Methods Patients with CA receiving standard cardiopulmonary resuscitation (CPR) were studied retrospectively. The minor absolute shrinkage and selection operator (LASSO) regression analysis and multivariable logistic regression evaluated various demographic and clinicopathological characteristics. A predictive nomogram was constructed and evaluated for accuracy and reliability using C-index, the area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA). Results A cohort of 508 patients who had experienced CA and received standard CPR was randomly divided into training (70 %, n = 356) and validation groups (30 %, n = 152) for the study. LASSO regression analysis and multivariable logistic regression revealed that thirteen variables, such as age, CPR start time, Electric defibrillation, Epinephrine, Sodium bicarbonate (NaHCO3), CPR Compression duration, The postoperative prothrombin (PT) time, Lactate (Lac), Cardiac troponin (cTn), Potassium (K+), D-dimer, Hypertension (HBP), and Diabetes mellitus (DM), were found to be independent predictors of the ROSC rate of CPR. The nomogram model showed exceptional discrimination, with a C-index of 0.933 (95 % confidence interval: 0.882-0.984). Even in the internal validation, a remarkable C-index value of 0.926 (95 % confidence interval: 0.875-0.977) was still obtained. The accuracy and reliability of the model were also verified by the AUC of 0.923 in the training group and 0.926 in the validation group. The calibration curve showed the model agreed with the actual results. DCA suggested that the predictive nomogram had clinical utility. Conclusions A predictive nomogram model was successfully established and proved to identify the influencing factors of the ROSC rate in patients with CA. During cardiopulmonary resuscitation, adjusting the emergency treatment based on the influence factors on ROSC rate is suggested to improve the treatment rate of patients with CA.
Collapse
Affiliation(s)
- Leilei Yan
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingling Wang
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liangliang Zhou
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qianqian Jin
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dejun Liao
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongxia Su
- Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guangrong Lu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
5
|
Smits RLA, Sødergren STF, Folke F, Møller SG, Ersbøll AK, Torp-Pedersen C, van Valkengoed IGM, Tan HL. Long-term survival following out-of-hospital cardiac arrest in women and men: Influence of comorbidities, social characteristics, and resuscitation characteristics. Resuscitation 2024; 201:110265. [PMID: 38866232 DOI: 10.1016/j.resuscitation.2024.110265] [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: 03/12/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
AIM We aimed to study sex differences in long-term survival following out-of-hospital cardiac arrest (OHCA) compared to the general population, and determined associations for comorbidities, social characteristics, and resuscitation characteristics with survival in women and men separately. METHODS We followed 2,452 Danish (530 women and 1,922 men) and 1,255 Dutch (259 women and 996 men) individuals aged ≥25 years, who survived 30 days post-OHCA in 2009-2015, until 2019. Using Poisson regression analyses we assessed sex differences in long-term survival and sex-specific associations of characteristics mutually adjusted, and compared survival with an age- and sex-matched general population. The potential predictive value was assessed with the Concordance-index. RESULTS Post-OHCA survival was longer in women than men (adjusted incidence rate ratio (IRR) for mortality 0.74, 95%CI 0.61-0.89 in Denmark; 0.86, 95%CI 0.65-1.15 in the Netherlands). Both sexes had a shorter survival than the general population (e.g., IRR for mortality 3.07, 95%CI 2.55-3.70 and IRR 2.15, 95%CI 1.95-2.37 in Danish women and men). Higher age, glucose lowering medication, no dyslipidaemia medication, unemployment, and a non-shockable initial rhythm were associated with shorter survival in both sexes. Cardiovascular medication, depression/anxiety medication, living alone, low household income, and residential OHCA location were associated with shorter survival in men. Not living with children and bystander cardiopulmonary resuscitation provision were associated with shorter survival in women. The Concordance-indexes ranged from 0.51 to 0.63. CONCLUSIONS Women survived longer than men post-OHCA. Several characteristics were associated with long-term post-OHCA survival, with some sex-specific characteristics. In both sexes, these characteristics had low predictive potential.
Collapse
Affiliation(s)
- R L A Smits
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - S T F Sødergren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - F Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - S G Møller
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - A K Ersbøll
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, North Zealand Hospital Hilleroed, Hilleroed, Denmark
| | - I G M van Valkengoed
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - H L Tan
- Amsterdam UMC location University of Amsterdam, Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
| |
Collapse
|
6
|
Troger F, Klug G, Poskaite P, Tiller C, Lechner I, Reindl M, Holzknecht M, Fink P, Brunnauer EM, Gizewski ER, Metzler B, Reinstadler S, Mayr A. Mitral annular disjunction in out-of-hospital cardiac arrest patients-a retrospective cardiac MRI study. Clin Res Cardiol 2024; 113:770-780. [PMID: 38602567 PMCID: PMC11026248 DOI: 10.1007/s00392-024-02440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Mitral annular disjunction (MAD), defined as defective attachment of the mitral annulus to the ventricular myocardium, has recently been linked to malignant arrhythmias. However, its role and prognostic significance in patients requiring cardiopulmonary resuscitation (CPR) remain unknown. This retrospective analysis aimed to describe the prevalence and significance of MAD by cardiac magnetic resonance (CMR) imaging in out-of-hospital cardiac arrest (OHCA) patients. METHODS Eighty-six patients with OHCA and a CMR scan 5 days after CPR (interquartile range (IQR): 49 days before - 9 days after) were included. MAD was defined as disjunction-extent ≥ 1 mm in CMR long-axis cine-images. Medical records were screened for laboratory parameters, comorbidities, and a history of arrhythmia. RESULTS In 34 patients (40%), no underlying cause for OHCA was found during hospitalization despite profound diagnostics. Unknown-cause OHCA patients showed a higher prevalence of MAD compared to definite-cause patients (56% vs. 10%, p < 0.001) and had a MAD-extent of 6.3 mm (IQR: 4.4-10.3); moreover, these patients were significantly younger (43 years vs. 61 years, p < 0.001), more often female (74% vs. 21%, p < 0.001) and had fewer comorbidities (hypertension, hypercholesterolemia, coronary artery disease, all p < 0.005). By logistic regression analysis, the presence of MAD remained significantly associated with OHCA of unknown cause (odds ratio: 8.49, 95% confidence interval: 2.37-30.41, p = 0.001) after adjustment for age, presence of hypertension, and hypercholesterolemia. CONCLUSIONS MAD is rather common in OHCA patients without definitive aetiology undergoing CMR. The presence of MAD was independently associated to OHCA without an identifiable trigger. Further research is needed to understand the exact role of MAD in OHCA patients.
Collapse
Affiliation(s)
- Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Paulina Poskaite
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Eva-Maria Brunnauer
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elke R Gizewski
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
7
|
Gentile FR, Wik L, Isasi I, Baldi E, Aramendi E, Steen-Hansen JE, Fasolino A, Compagnoni S, Contri E, Palo A, Primi R, Bendotti S, Currao A, Quilico F, Vicini Scajola L, Lopiano C, Savastano S. Amplitude spectral area of ventricular fibrillation can discriminate survival of patients with out-of-hospital cardiac arrest. Front Cardiovasc Med 2024; 11:1336291. [PMID: 38380178 PMCID: PMC10876863 DOI: 10.3389/fcvm.2024.1336291] [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: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
Background Evidence of the association between AMplitude Spectral Area (AMSA) of ventricular fibrillation and outcome after out-of-hospital cardiac arrest (OHCA) is limited to short-term follow-up. In this study, we assess whether AMSA can stratify the risk of death or poor neurological outcome at 30 days and 1 year after OHCA in patients with an initial shockable rhythm or with an initial non-shockable rhythm converted to a shockable one. Methods This is a multicentre retrospective study of prospectively collected data in two European Utstein-based OHCA registries. We included all cases of OHCAs with at least one manual defibrillation. AMSA values were calculated after data extraction from the monitors/defibrillators used in the field by using a 2-s pre-shock electrocardiogram interval. The first detected AMSA value, the maximum value, the average value, and the minimum value were computed, and their outcome prediction accuracy was compared. Multivariable Cox regression models were run for both 30-day and 1-year deaths or poor neurological outcomes. Neurological cerebral performance category 1-2 was considered a good neurological outcome. Results Out of the 578 patients included, 494 (85%) died and 10 (2%) had a poor neurological outcome at 30 days. All the AMSA values considered (first value, maximum, average, and minimum) were significantly higher in survivors with good neurological outcome at 30 days. The average AMSA showed the highest area under the receiver operating characteristic curve (0.778, 95% CI: 0.7-0.8, p < 0.001). After correction for confounders, the highest tertiles of average AMSA (T3 and T2) were significantly associated with a lower risk of death or poor neurological outcome compared with T1 both at 30 days (T2: HR 0.6, 95% CI: 0.4-0.9, p = 0.01; T3: HR 0.6, 95% CI: 0.4-0.9, p = 0.02) and at 1 year (T2: HR 0.6, 95% CI: 0.4-0.9, p = 0.01; T3: HR 0.6, 95% CI: 0.4-0.9, p = 0.01). Among survivors at 30 days, a higher AMSA was associated with a lower risk of mortality or poor neurological outcome at 1 year (T3: HR 0.03, 95% CI: 0-0.3, p = 0.02). Discussion Lower AMSA values were significantly and independently associated with the risk of death or poor neurological outcome at 30 days and at 1 year in OHCA patients with either an initial shockable rhythm or a conversion rhythm from non-shockable to shockable. The average AMSA value had the strongest association with prognosis.
Collapse
Affiliation(s)
- Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Lars Wik
- Oslo University Hospital, Division of Prehospital Emergency Medicine, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway
- Prehospital Clinic, Doctor Car, Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway
| | - Iraia Isasi
- BioRes Group, University of the Basque Country, Bilbao, Spain
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Enrico Contri
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
8
|
Schultz BV, Rolley A, Doan TN, Bodnar D, Isoardi K. Epidemiology and survival outcomes of out-of-hospital cardiac arrest following volatile substance use in Queensland, Australia. Clin Toxicol (Phila) 2023; 61:649-655. [PMID: 37988117 DOI: 10.1080/15563650.2023.2267172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The deliberate inhalation of volatile substances for their psychotropic properties is a recognised public health issue that can precipitate sudden death. This study aimed to describe the epidemiological characteristics and survival outcomes of patients with out-of-hospital cardiac arrests following volatile substance use. METHODS We conducted a retrospective cohort analysis of all out-of-hospital cardiac arrest attended by the Queensland Ambulance Service over a ten-year period (2012-2021). Incidents were extracted from the Queensland Ambulance Service cardiac arrest registry, which collects clinical information using the Utstein-style guidelines and linked hospital data. RESULTS During the study period, 52,102 out-of-hospital cardiac arrests were attended, with 22 (0.04%) occurring following volatile substance use. The incidence rate was 0.04 per 100,000 population, with no temporal trends identified. The most commonly used product was deodorant cans (19/22), followed by butane canisters (2/22), and nitrous oxide canisters (1/22). The median age of patients was 15 years (interquartile range 13-23), with 14/22 male and 8/22 Indigenous Australians. Overall, 16/22 patients received a resuscitation attempt by paramedics. Of these, 12/16 were bystander witnessed, 10/16 presented in an initial shockable rhythm, and 9/16 received bystander chest compressions. The rates of event survival, survival to hospital discharge, and survival with good neurological outcome (Cerebral Performance Category 1-2) were 69% (11/16, 95% CI 41-89%), 38% (6/16, 95% CI 15-65%) and 31% (5/16, 11-59%), respectively. Eight patients in the paramedic-treated cohort that used hydrocarbon-based products were administered epinephrine during resuscitation. Of these, none subsequently survived to hospital discharge. In contrast, all six patients that did not receive epinephrine survived to hospital discharge, with 5/6 having a good neurological outcome. CONCLUSION Out-of-hospital cardiac arrest following volatile substance use is rare and associated with relatively favourable survival rates. Patients were predominately aged in their adolescence with Indigenous Australians disproportionately represented.
Collapse
Affiliation(s)
- Brendan V Schultz
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Adam Rolley
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tan N Doan
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Bodnar
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Katherine Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Zhang X, Zheng X, Dai Z, Zheng H. The development and validation of a nomogram to determine neurological outcomes in cardiac arrest patients. BMC Anesthesiol 2023; 23:289. [PMID: 37620773 PMCID: PMC10463846 DOI: 10.1186/s12871-023-02251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the variables that influence neurological functional restoration in cardiac arrest patients and construct a nomogram to predict neurofunctional prognosis. PATIENTS AND METHODS We extracted the data from the Dryad database. Associations between patient variables and neurological outcomes were examined by logistic regression models. On the basis of these predictors, a prognostic nomogram was constructed. The identification and calibration of the prognostic nomogram were evaluated through the receiver operating characteristic (ROC) curve, the calibration curve, and the concordance index (C-index). RESULTS A total of 374 cardiac arrest individuals were recruited in the research. Sixty percent of the participants had an adverse neurological result. The multivariable logistic regression analysis for poor neurological recovery, which showed patient age ≥ 65 years, previous neurological disease, witnessed arrest, bystander cardio-pulmonary resuscitation(CPR), cardiac arrest presenting with a non-shockable rhythm, total epinephrine dose ≥ 2.5 mg at the time of resuscitation and acute kidney injury(AKI) remained independent predictors for neurological outcomes. CONCLUSIONS The novel nomogram based on clinical characteristics is an efficient tool to predict neurological outcomes in cardiac arrest patients, which may help clinicians identifying high-risk patients and tailoring personalized treatment regimens.
Collapse
Affiliation(s)
- Xuru Zhang
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou City, 350014, China, No 420 Fuma Road, Jinan District, Fujian Province
| | - Xiaowei Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Zhisen Dai
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou City, 350014, China, No 420 Fuma Road, Jinan District, Fujian Province
| | - Huizhe Zheng
- Department of Anesthesiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou City, 350014, China, No 420 Fuma Road, Jinan District, Fujian Province.
| |
Collapse
|
10
|
Analysis of factors influencing cardiopulmonary resuscitation and survival outcome in adults after in-hospital cardiac arrest: a retrospective observational study. Chin Med J (Engl) 2022; 135:2875-2877. [PMID: 36728511 PMCID: PMC9945559 DOI: 10.1097/cm9.0000000000002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Indexed: 02/03/2023] Open
|
11
|
The Impact of Prehospital and Hospital Care on Clinical Outcomes in Out-of-Hospital Cardiac Arrest. J Clin Med 2022; 11:jcm11226851. [PMID: 36431328 PMCID: PMC9698546 DOI: 10.3390/jcm11226851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: In recent years, several actions have been made to shorten the chain of survival in out-of-hospital cardiac arrest (OHCA). These include placing defibrillators in public places, training first responders, and providing dispatcher-assisted CPR (DA-CPR). In this work, we aimed to evaluate the impact of these changes on patients' outcomes, including achieving return of spontaneous circulation (ROSC), survival to discharge, and survival with favorable neurological function. Methods: We retrospectively retrieved data of all calls to the national emergency medical service in Ashdod city, Israel, of individuals who underwent OHCA at the age of 18 and older between the years 2018 and 2021. Data was collected on prehospital and hospital interventions. The association between pre-hospital and hospital interventions to ROSC, survival to discharge, and neurological outcomes was evaluated. Logistic regression was used for multivariable analysis. Results: During the years 2018-2021, there were 1253 OHCA cases in the city of Ashdod. ROSC was achieved in 207 cases (32%), survival to discharge was attained in 48 cases (7.4%), and survival with favorable neurological function was obtained in 26 cases (4%). Factors significantly associated with good prognosis were shockable rhythm, witnessed arrest, DA-CPR, use of AED, and treatment for STEMI. All patients that failed to achieve ROSC outside of the hospital setting had a poor prognosis. Conclusions: This study demonstrates the prognostic role of the initial rhythm and the use of AED in OHCA. Hospital management, including STEMI documentation and catheterization, was also an important prognostication factors. Additionally, when ROSC is not achieved in the field, hospital transfer should be considered.
Collapse
|
12
|
Freund A, van Royen N, Kern KB, Jobs A, Thiele H, Lemkes JS, Desch S. Early coronary angiography in patients after out-of-hospital cardiac arrest without ST-segment elevation: Meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2022; 100:330-337. [PMID: 35900214 DOI: 10.1002/ccd.30355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/30/2022] [Accepted: 06/26/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare early coronary angiography to a delayed or selective approach in out-of-hospital cardiac arrest (OHCA) without ST-segment elevation of possible cardiac cause by means of meta-analysis of available randomized controlled trials (RCTs). METHODS We searched MEDLINE and the Cochrane Central Register of Controlled Trials for RCTs comparing early with delayed or selective coronary angiography in OHCA patients of possible cardiac origin without ST-segment elevation. The primary endpoint was all-cause short-term mortality (PROSPERO CRD42021271484). RESULTS The search strategy identified three RCTs enrolling a total of 1167 patients. An early invasive approach was not associated with improved short-term mortality (odds ratio 1.19, 95% confidence interval 0.94-1.52; p = 0.15). Further, no significant differences were shown with respect to the risk of severe neurological deficit, the composite of all-cause mortality or severe neurological deficit, need for renal replacement therapy due to acute renal failure, and significant bleeding at short-term follow-up. CONCLUSION Early coronary angiography in OHCA without ST-segment elevation is not superior compared to a delayed/selective approach.
Collapse
Affiliation(s)
- Anne Freund
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karl B Kern
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, USA
| | - Alexander Jobs
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | |
Collapse
|
13
|
Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, Loretz N, Gross S, Tisljar K, Sutter R, Appenzeller-Herzog C, Marsch S, Hunziker S. Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Cardiol 2022; 7:633-643. [PMID: 35507352 PMCID: PMC9069345 DOI: 10.1001/jamacardio.2022.0795] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce. Objective To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA. Data Sources A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021. Study Selection Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol. Data Extraction and Synthesis Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. Main Outcomes and Measures The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. Results The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. Conclusions and Relevance In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.
Collapse
Affiliation(s)
- Simon A Amacher
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Chantal Bohren
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - René Blatter
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jonas Mueller
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Nina Loretz
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Appenzeller-Herzog
- Medical Faculty, University of Basel, Basel, Switzerland.,University Medical Library, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
14
|
Trends in out-of-hospital cardiac arrest incidence, patient characteristics and survival over 18 years in Perth, Western Australia. Resusc Plus 2022; 9:100201. [PMID: 35098176 PMCID: PMC8783140 DOI: 10.1016/j.resplu.2022.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To investigate trends in the incidence, characteristics, and survival of out-of-hospital cardiac arrests (OHCA) in the Perth metropolitan area between 2001 and 2018. Methods We calculated the crude incidence rate, age-standardised incidence rate (ASIR) and age- and sex-specific incidence rates (per 100,000 population) for OHCA of presumed cardiac aetiology. ASIRs were calculated using the direct method of standardisation using the 2001 Australian Population standard. Survival was assessed at return of spontaneous circulation at emergency department arrival and at 30 days. Temporal trends in patient and arrest characteristics were assessed with logistic regression, while trends in incidence were assessed using Joinpoint regression. Survival trends were assessed using binary logistic regression. Results A total of 18,417 OHCAs of presumed cardiac aetiology were attended by emergency medical services in Perth between 2001 and 2018. Overall, there were no significant changes in the crude or ASIR of OHCA over the study period, although OHCA incidence in 15–39 year-old males increased by 12.5% annually between 2011 and 2018. Both bystander cardiopulmonary resuscitation and bystander defibrillation increased over the study period, while the proportion of shockable arrests declined. Thirty-day OHCA survival improved significantly over time, with the odds of survival (in bystander-witnessed, initial shockable rhythm arrests) improving 12% (95% CI, 9.0% to 14.0%) annually, from 8.4% in 2001 to 44.0% in 2018. Conclusion Overall, there were no significant trends in OHCA incidence over the study period, although arrests in 15–39 year-old males increased significantly after 2011. There were significant improvements in 30-day survival between 2001 and 2018.
Collapse
|
15
|
Baldi E, Compagnoni S, Buratti S, Primi R, Bendotti S, Currao A, Gentile FR, Sechi GM, Mare C, Bertona R, Raimondi Cominesi I, Taravelli E, Fava C, Danzi GB, Oltrona Visconti L, Savastano S. Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis. Front Cardiovasc Med 2022; 8:764043. [PMID: 34977181 PMCID: PMC8715950 DOI: 10.3389/fcvm.2021.764043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories. Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient. Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the “all-EMS treated” group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8–30.2), 6.8 (95%CI, 3.8–10.7), 3.8 (95%CI, 1.7–6.7), 4.05 (95%CI, 1.9–6.9), and 2.6 (95%CI, 1.03–4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories “shockable bystander witnessed” and “shockable bystander CPR”: SMRs of 19.4 (95%CI, 11.3–29.8) and 19.4 (95%CI, 10.8–30.6) for the first year and of 6.8 (95%CI, 6.6–13) and 8.1 (95%CI, 3.1–15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1–2. Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.
Collapse
Affiliation(s)
- Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Stefano Buratti
- Division of Cardiology, Ospedale Civile di Voghera, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Voghera, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Francesca Romana Gentile
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | - Roberta Bertona
- Division of Cardiology, Ospedale Civile di Vigevano, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Vigevano, Italy
| | - Irene Raimondi Cominesi
- Division of Cardiology, Ospedale Maggiore di Lodi, Azienda Socio-Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
| | - Erika Taravelli
- Division of Cardiology, Ospedale Maggiore di Crema, Azienda Socio-Sanitaria Territoriale (ASST) di Crema, Crema, Italy
| | - Cristian Fava
- Division of Cardiology, Ospedale Carlo Poma, Azienda Socio-Sanitaria Territoriale (ASST) di Mantova, Mantova, Italy
| | - Gian Battista Danzi
- Division of Cardiology, Ospedale di Cremona, Azienda Socio-Sanitaria Territoriale (ASST) di Cremona, Cremona, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | |
Collapse
|
16
|
Han Chin Y, Yu Leon Yaow C, En Teoh S, Zhi Qi Foo M, Luo N, Graves N, Eng Hock Ong M, Fu Wah Ho A. Long-term outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2021; 171:15-29. [PMID: 34971720 DOI: 10.1016/j.resuscitation.2021.12.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022]
Abstract
AIMS Long term outcomes after out-of-hospital cardiac arrest (OHCA) are not well understood. This study aimed to evaluate the long-term (1-year and beyond) survival outcomes, including overall survival and survival with favorable neurological status and the quality-of-life (QOL) outcomes, among patients who survived the initial OHCA event (30 days or till hospital discharge). METHODS Embase, Medline and PubMed were searched for primary studies (randomized controlled trials, cohort and cross-sectional studies) which reported the long-term survival outcomes of OHCA patients. Data abstraction and quality assessment was conducted, and survival at predetermined timepoints were assessed via single-arm meta-analyses of proportions, using generalized linear mixed models. Comparative meta-analyses were conducted using the Mantel-Haenszel Risk Ratio (RR) estimates, using the DerSimonian and Laird model. RESULTS 67 studies were included, and among patients that survived to hospital discharge or 30-days, 77.3% (CI=71.2-82.4), 69.6% (CI=54.5-70.3), 62.7% (CI=54.5-70.3), 46.5% (CI=32.0-61.6), and 20.8% (CI=7.8-44.9) survived to 1-, 3-, 5-, 10- and 15-years respectively. Compared to Asia, the probability of 1-year survival was greater in Europe (RR=2.1, CI=1.8-2.3), North America (RR=2.0, CI=1.7-2.2) and Oceania (RR=1.9,CI=1.6-2.1). Males had a higher 1-year survival (RR:1.41, CI=1.25-1.59), and patients with initial shockable rhythm had improved 1-year (RR=3.07, CI=1.78-5.30) and 3-year survival (RR=1.45, CI=1.19-1.77). OHCA occurring in residential locations had worse 1-year survival (RR=0.42, CI=0.25-0.73). CONCLUSION Our study found that up to 20.8% of OHCA patients survived to 15-years, and survival was lower in Asia compared to the other regions. Further analysis on the differences in survival between the regions are needed to direct future long-term treatment of OHCA patients.
Collapse
Affiliation(s)
- Yip Han Chin
- School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Seth En Teoh
- School of Medicine, National University Singapore, Singapore, Singapore
| | - Mabel Zhi Qi Foo
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Nicholas Graves
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore.
| |
Collapse
|
17
|
Yaow CYL, Teoh SE, Lim WS, Wang RSQ, Han MX, Pek PP, Tan BYQ, Ong MEH, Ng QX, Ho AFW. Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: A systematic review and meta-analysis. Resuscitation 2021; 170:82-91. [PMID: 34826580 DOI: 10.1016/j.resuscitation.2021.11.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022]
Abstract
AIM Quality of life after surviving out-of-hospital cardiac arrest (OHCA) is poorly understood, and the risk to mental health is not well understood. We aimed to estimate the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) following OHCA. METHODS In this systematic review and meta-analysis, databases (MEDLINE, EMBASE, and PsycINFO) were searched from inception to July 3, 2021, for studies reporting the prevalence of depression, anxiety, and PTSD among OHCA survivors. Data abstraction and quality assessment were conducted by two authors independently, and a third resolved discrepancies. A single-arm meta-analysis of proportions was conducted to pool the proportion of patients with these conditions at the earliest follow-up time point in each study and at predefined time points. Meta-regression was performed to identify significant moderators that contributed to between-study heterogeneity. RESULTS The search yielded 15,366 articles. 13 articles were included for analysis, which comprised 186,160 patients. The pooled overall prevalence at the earliest time point of follow-up was 19.0% (11 studies; 95% confidence interval [CI] = 11.0-30.0%) for depression, 26.0% (nine studies; 95% CI = 16.0-39.0%) for anxiety, and 20.0% (three studies; 95% CI = 3.0-65.0%) for PTSD. Meta-regression showed that the age of patients and proportion of female sex were non-significant moderators. CONCLUSION The burden of mental health disorders is high among survivors of OHCA. There is an urgent need to understand the predisposing risk factors and develop preventive strategies.
Collapse
Affiliation(s)
- Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Seth En Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Wei Shyann Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Renaeta Shi Qi Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ming Xuan Han
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia, Building H McMahons Road, Frankston, Vic 3199, Australia
| | - Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, 8 College Rd, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Singapore, 1 Outram Rd, Singapore 169608, Singapore; Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore, 91 Ubi Ave 4, Singapore 408827, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, 1 Outram Rd, Singapore 169608, Singapore; Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
| |
Collapse
|