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Zhang Y, Yu Y, Qing P, Liu X, Ding Y, Wang J, Ao H. In-hospital cardiac arrest characteristics, causes and outcomes in patients with cardiovascular disease across different departments: a retrospective study. BMC Cardiovasc Disord 2024; 24:475. [PMID: 39243041 PMCID: PMC11378364 DOI: 10.1186/s12872-024-04152-y] [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: 05/27/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Cardiac etiologies arrest accounts for almost half of all in-hospital cardiac arrest (IHCA), and previous studies have shown that the location of IHCA is an important factor affecting patient outcomes. The aim was to compare the characteristics, causes and outcomes of cardiovascular disease in patients suffering IHCA from different departments of Fuwai hospital in Beijing, China. METHODS We included patients who were resuscitated after IHCA at Fuwai hospital between March 2017 and August 2022. We categorized the departments where cardiac arrest occurred as cardiac surgical or non-surgical units. Independent predictors of in-hospital survival were assessed by logistic regression. RESULTS A total of 119 patients with IHCA were analysed, 58 (48.7%) patients with cardiac arrest were in non-surgical units, and 61 (51.3%) were in cardiac surgical units. In non-surgical units, acute myocardial infarction/cardiogenic shock (48.3%) was the main cause of IHCA. Cardiac arrest in cardiac surgical units occurred mainly in patients who were planning or had undergone complex aortic replacement (32.8%). Shockable rhythms (ventricular fibrillation/ventricular tachycardia) were observed in approximately one-third of all initial rhythms in both units. Patients who suffered cardiac arrest in cardiac surgical units were more likely to return to spontaneous circulation (59.0% vs. 24.1%) and survive to hospital discharge (40.0% vs. 10.2%). On multivariable regression analysis, IHCA in cardiac surgical units (OR 5.39, 95% CI 1.90-15.26) and a shorter duration of resuscitation efforts (≤ 30 min) (OR 6.76, 95% CI 2.27-20.09) were associated with greater survival rate at discharge. CONCLUSION IHCA occurring in cardiac surgical units and a duration of resuscitation efforts less than 30 min were associated with potentially increased rates of survival to discharge.
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Affiliation(s)
- Ya Zhang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Ping Qing
- Department of Medical Intensive Care Units, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China.
| | - Xiaojie Liu
- Department of Anesthesiology, The Affliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong Province, China
| | - Yao Ding
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Jingcan Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China.
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Urteaga J, Elola A, Norvik A, Unneland E, Eftestøl TC, Bhardwaj A, Buckler D, Abella BS, Skogvoll E, Aramendi E. Machine learning model to predict evolution of pulseless electrical activity during in-hospital cardiac arrest. Resusc Plus 2024; 17:100598. [PMID: 38497047 PMCID: PMC10940985 DOI: 10.1016/j.resplu.2024.100598] [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: 11/28/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background During pulseless electrical activity (PEA) the cardiac mechanical and electrical functions are dissociated, a phenomenon occurring in 25-42% of in-hospital cardiac arrest (IHCA) cases. Accurate evaluation of the likelihood of a PEA patient transitioning to return of spontaneous circulation (ROSC) may be vital for the successful resuscitation. The aim We sought to develop a model to automatically discriminate between PEA rhythms with favorable and unfavorable evolution to ROSC. Methods A dataset of 190 patients, 120 with ROSC, were acquired with defibrillators from different vendors in three hospitals. The ECG and the transthoracic impedance (TTI) signal were processed to compute 16 waveform features. Logistic regression models where designed integrating both automated features and characteristics annotated in the QRS to identify PEAs with better prognosis leading to ROSC. Cross validation techniques were applied, both patient-specific and stratified, to evaluate the performance of the algorithm. Results The best model consisted in a three feature algorithm that exhibited median (interquartile range) Area Under the Curve/Balanced accuracy/Sensitivity/Specificity of 80.3(9.9)/75.6(8.0)/ 77.4(15.2)/72.3(16.4) %, respectively. Conclusions Information hidden in the waveforms of the ECG and TTI signals, along with QRS complex features, can predict the progression of PEA. Automated methods as the one proposed in this study, could contribute to assist in the targeted treatment of PEA in IHCA.
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Affiliation(s)
- Jon Urteaga
- Communications Engineering Department, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
| | - Andoni Elola
- Department of Electronic Technology, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
| | - Anders Norvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Eirik Unneland
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Trygve C. Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger (UiS), Kjell Arholms gate 41, 4021 Stavanger, Norway
| | - Abhishek Bhardwaj
- University of California, 900 University Ave, Riverside, CA 92521, United State
| | - David Buckler
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | | | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Elisabete Aramendi
- Communications Engineering Department, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903 Barakaldo, Spain
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3
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Unneland E, Norvik A, Bergum D, Buckler DG, Bhardwaj A, Christian Eftestøl T, Aramendi E, Nordseth T, Abella BS, Terje Kvaløy J, Skogvoll E. Non-shockable rhythms: A parametric model for the immediate probability of return of spontaneous circulation. Resuscitation 2023; 191:109895. [PMID: 37406761 DOI: 10.1016/j.resuscitation.2023.109895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Cardiac arrest can present with asystole, Pulseless Electrical Activity (PEA), or Ventricular Fibrillation/Tachycardia (VF/VT). We investigated the transition intensity of Return of spontaneous circulation (ROSC) from PEA and asystole during in-hospital resuscitation. MATERIALS AND METHODS We included 770 episodes of cardiac arrest. PEA was defined as ECG with >12 QRS complexes per min, asystole by an isoelectric signal >5 seconds. The observed times of PEA to ROSC transitions were fitted to five different parametric time-to-event models. At values ≤0.1, transition intensities roughly represent next-minute probabilities allowing for direct interpretation. Different entities of PEA and asystole, dependent on whether it was the primary or a secondary rhythm, were included as covariates. RESULTS The transition intensities to ROSC from primary PEA and PEA after asystole were unimodal with peaks of 0.12 at 3 min and 0.09 at 6 min, respectively. Transition intensities to ROSC from PEA after VF/VT, or following transient ROSC, exhibited high initial values of 0.32 and 0.26 at 3 minutes, respectively, but decreased. The transition intensity to ROSC from initial asystole and asystole after PEA were both about 0.01 and 0.02; while asystole after VF/VT had an intensity to ROSC of 0.15 initially which decreased. The transition intensity from asystole after temporary ROSC was constant at 0.08. CONCLUSION The immediate probability of ROSC develops differently in PEA and asystole depending on the preceding rhythm and the duration of the resuscitation attempt. This knowledge may aid simple bedside prognostication and electronic resuscitation algorithms for monitors/defibrillators.
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Affiliation(s)
- Eirik Unneland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anders Norvik
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - Daniel Bergum
- Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - David G Buckler
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Trygve Christian Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Elisabete Aramendi
- University of the Basque Country, Engineering School of Bilbao, BioRes Group, Bilbao, Spain
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital. Oslo, Norway
| | - Benjamin S Abella
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
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4
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Noordergraaf GJ, van Rijbroek LS. When your patient has a non-shockable rhythm: Which rhythm might be next and is it better? Resuscitation 2023; 191:109919. [PMID: 37541610 DOI: 10.1016/j.resuscitation.2023.109919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Affiliation(s)
- G J Noordergraaf
- Department of Anesthesiology, Resuscitation and Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.
| | - L S van Rijbroek
- Department of Anesthesiology, Resuscitation and Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
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Sanson G, Antonaglia V, Buttignon G, Caggegi GD, Pegani C, Peratoner A. Dynamic Course of Clinical State Transitions in Patients Undergoing Advanced Life Support after Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2023; 28:461-469. [PMID: 37695947 DOI: 10.1080/10903127.2023.2258192] [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: 06/12/2023] [Revised: 08/10/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Studies of out-of-hospital cardiac arrest generally document the presenting (pulseless electrical activity [PEA], ventricular fibrillation/tachycardia (VF/VT), asystole), and the final states (resuming stable spontaneous circulation [s-ROSC], being declared dead). Only a few studies described the transitions between clinical states during advanced life support (ALS). The aim of this study was to describe and analyze the dynamics of state transitions during ALS. METHODS A retrospective analysis of 464 OHCA events was conducted. Any observed state and its corresponding changing time were documented through continuous electrocardiographic and trans-thoracic impedance recording. RESULTS When achieved, most s-ROSCs were obtained by 30 min, regardless of the presenting state. After this time point, the persistence of any transient state was associated with a great probability of being declared dead. The most probable change for VF/VT or PEA at any time was the transition to asystole (36.4% and 34.4%, respectively); patients in asystole at any time had a 70% probability of death. Patients achieving s-ROSC mostly came from a VF/VT state.In most cases, the presenting rhythm tended to persist over time during ALS. Asystole was the most stable state; a higher degree of instability was observed when the presenting rhythms were VF/VT or PEA. Transient ROSC episodes occurred mainly as the first transition after the presenting state, especially for initial PEA. CONCLUSIONS An understanding of the dynamic course of clinical state transitions during ALS may allow treatment strategies to be tailored in patients affected by OHCA.
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Affiliation(s)
- Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Vittorio Antonaglia
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Buttignon
- Emergency Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Gorizia, Italy
| | - Giuseppe Davide Caggegi
- Emergency Medical Service, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Carlo Pegani
- Emergency Medical Service, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Alberto Peratoner
- Emergency Medical Service, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
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6
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Faldaas BO, Nielsen EW, Storm BS, Lappegård KT, How OJ, Nilsen BA, Kiss G, Skogvoll E, Torp H, Ingul C. Hands-free continuous carotid Doppler ultrasound for detection of the pulse during cardiac arrest in a porcine model. Resusc Plus 2023; 15:100412. [PMID: 37448689 PMCID: PMC10336194 DOI: 10.1016/j.resplu.2023.100412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 07/15/2023] Open
Abstract
Background/Purpose Pulse palpation is an unreliable method for diagnosing cardiac arrest. To address this limitation, continuous hemodynamic monitoring may be a viable solution. Therefore, we developed a novel, hands-free Doppler system, RescueDoppler, to detect the pulse continuously in the carotid artery. Methods In twelve pigs, we evaluated RescueDoppleŕs potential to measure blood flow velocity in three situations where pulse palpation of the carotid artery was insufficient: (1) systolic blood pressure below 60 mmHg, (2) ventricular fibrillation (VF) and (3) pulseless electrical activity (PEA). (1) Low blood pressure was induced using a Fogarty balloon catheter to occlude the inferior vena cava. (2) An implantable cardioverter-defibrillator induced VF. (3) Myocardial infarction after microembolization of the left coronary artery caused True-PEA. Invasive blood pressure was measured in the contralateral carotid artery. Time-averaged blood flow velocity (TAV) in the carotid artery was related to mean arterial pressure (MAP) in a linear mixed model. Results RescueDoppler identified pulsatile blood flow in 41/41 events with systolic blood pressure below 60 mmHg, with lowest blood pressure of 19 mmHg. In addition the absence of spontaneous circulation was identified in 21/21 VF events and true PEA in 2/2 events. The intraclass correlation coefficient within animals for TAV and MAP was 0.94 (95% CI. 0.85-0.98). Conclusions In a porcine model, RescueDoppler reliably identified pulsative blood flow with blood pressures below 60 mmHg. During VF and PEA, circulatory arrest was rapidly and accurately demonstrated. RescueDoppler could potentially replace unreliable pulse palpation during cardiac arrest and cardiopulmonary resuscitation.
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Affiliation(s)
- Bjørn Ove Faldaas
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Erik Waage Nielsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Anesthesia, Surgical Clinic, Nordland Hospital Trust, Bodø, Norway
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Benjamin Stage Storm
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Anesthesia, Surgical Clinic, Nordland Hospital Trust, Bodø, Norway
- Research Laboratory, Nordland Hospital Trust, Bodø, Norway
| | - Knut Tore Lappegård
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Ole-Jakob How
- Department of Medical Biology, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bent Aksel Nilsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Anesthesia, Surgical Clinic, Nordland Hospital Trust, Bodø, Norway
| | - Gabriel Kiss
- Department of Computer Science (IDI), Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Charlotte Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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7
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Barros AJ, Enfield KB. In-Hospital Cardiac Arrest. Emerg Med Clin North Am 2023; 41:455-464. [PMID: 37391244 PMCID: PMC10549775 DOI: 10.1016/j.emc.2023.03.003] [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] [Indexed: 07/02/2023]
Abstract
This article reviews the epidemiology and management of in-hospital cardiac arrest.
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Affiliation(s)
- Andrew Julio Barros
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA.
| | - Kyle B Enfield
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA. https://twitter.com/KBEnfieldMD
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8
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Fuchs A, Franzmeier L, Cheseaux-Carrupt M, Kaempfer M, Disma N, Pietsch U, Huber M, Riva T, Greif R. Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study. Front Med (Lausanne) 2023; 10:1198078. [PMID: 37396914 PMCID: PMC10309035 DOI: 10.3389/fmed.2023.1198078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Little is known about intraoperative cardiac arrest during anesthesia care. In particular, data on characteristics of cardiac arrest and neurological survival are scarce. Methods We conducted a single-center retrospective observational study evaluating anesthetic procedures from January 2015 until December 2021. We included patients with an intraoperative cardiac arrest and excluded cardiac arrest outside of the operating room. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes were sustained ROSC over 20 min, 30-day survival, and favorable neurological outcome according to Clinical Performance Category (CPC) 1 and 2. Results We screened 228,712 anesthetic procedures, 195 of which met inclusion criteria and were analyzed. The incidence of intraoperative cardiac arrest was 90 (CI 95% 78-103) in 100,000 procedures. The median age was 70.5 [60.0; 79.4] years, and two-thirds of patients (n = 135; 69.2%) were male. Most of these patients with cardiac arrest had ASA physical status IV (n = 83; 42.6%) or V (n = 47; 24.1%). Cardiac arrest occurred more frequently (n = 104; 53.1%) during emergency procedures than elective ones (n = 92; 46.9%). Initial rhythm was pre-dominantly non-shockable with pulseless electrical activity mostly. Most patients (n = 163/195, 83.6%; CI 95 77.6-88.5%) had at least one instance of ROSC. Sustained ROSC over 20 min was achieved in most patients with ROSC (n = 147/163; 90.2%). Of the 163 patients with ROSC, 111 (68.1%, CI 95 60.4-75.2%) remained alive after 30 days, and most (n = 90/111; 84.9%) had favorable neurological survival (CPC 1 and 2). Conclusion Intraoperative cardiac arrest is rare but is more likely in older patients, patients with ASA physical status ≥IV, cardiac and vascular surgery, and emergency procedures. Patients often present with pulseless electrical activity as the initial rhythm. ROSC can be achieved in most patients. Over half of the patients are alive after 30 days, most with favorable neurological outcomes, if treated immediately.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lea Franzmeier
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marie Cheseaux-Carrupt
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Martina Kaempfer
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicola Disma
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Urs Pietsch
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- ERC Research Net, Niel, Belgium
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9
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Norvik A, Kvaløy JT, Skjeflo GW, Bergum D, Nordseth T, Loennechen JP, Unneland E, Buckler DG, Bhardwaj A, Eftestøl T, Aramendi E, Abella BS, Skogvoll E. Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity. Resuscitation 2023; 185:109739. [PMID: 36806651 DOI: 10.1016/j.resuscitation.2023.109739] [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: 11/16/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Pulseless electrical activity (PEA) is commonly observed in in-hospital cardiac arrest (IHCA). Universally available ECG characteristics such as QRS duration (QRSd) and heart rate (HR) may develop differently in patients who obtain ROSC or not. The aim of this study was to assess prospectively how QRSd and HR as biomarkers predict the immediate outcome of patients with PEA. METHOD We investigated 327 episodes of IHCA in 298 patients at two US and one Norwegian hospital. We assessed the ECG in 559 segments of PEA nested within episodes, measuring QRSd and HR during pauses of compressions, and noted the clinical state that immediately followed PEA. We investigated the development of HR, QRSd, and transitions to ROSC or no-ROSC (VF/VT, asystole or death) in a joint longitudinal and competing risks statistical model. RESULTS Higher HR, and a rising HR, reflect a higher transition intensity ("hazard") to ROSC (p < 0.001), but HR was not associated with the transition intensity to no-ROSC. A lower QRSd and a shrinking QRSd reflect an increased transition intensity to ROSC (p = 0.023) and a reduced transition intensity to no-ROSC (p = 0.002). CONCLUSION HR and QRSd convey information of the immediateoutcome during resuscitation from PEA. These universally available and promising biomarkers may guide the emergency team in tailoring individual treatment.
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Affiliation(s)
- A Norvik
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - J T Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - G W Skjeflo
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Surgery, Section for Anesthesiology, Nordland Hospital, Bodø, Norway
| | - D Bergum
- Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - T Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - J P Loennechen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Cardiology, St. Olav University Hospital, Trondheim, Norway
| | - E Unneland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - D G Buckler
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, USA
| | - A Bhardwaj
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - T Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - E Aramendi
- University of the Basque Country, Engineering School of Bilbao, Bilbao, Spain
| | - B S Abella
- Center for Resuscitation Science, University of Pennsylvania, Philadelphia, USA
| | - E Skogvoll
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
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10
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Noordergraaf GJ, Venema A. Way to go: PEA in the in-hospital setting, a step to return of spontaneous circulation. Resuscitation 2022; 176:64-65. [PMID: 35644306 DOI: 10.1016/j.resuscitation.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Gerrit J Noordergraaf
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - Alyssa Venema
- Department of Anesthesiology, Resuscitation & Pain Management, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
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