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Ćwiertnia M, Dutka M, Szlagor M, Stasicki A, Białoń P, Kudłacik B, Hajduga MB, Mikulska M, Majewski M, Nadolny K, Jaskiewicz F, Bobiński R, Kawecki M, Ilczak T. Methods of Using a Manual Defibrillator during Simultaneous Cardiac Arrest in Two Patients-Analysis of the Actions of Emergency Medical Response Teams during the Championships in Emergency Medicine. J Clin Med 2024; 13:5500. [PMID: 39336987 PMCID: PMC11432344 DOI: 10.3390/jcm13185500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/29/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Conducting advanced resuscitation requires medical personnel to carry out appropriately coordinated actions. Certain difficulties arise when it becomes necessary to conduct cardiopulmonary resuscitation (CPR) on two patients at the same time. The aim of this paper was to assess the actions of teams participating in emergency medicine championships in tasks related to simultaneous cardiac arrests in two patients. Methods: The study was conducted on the basis of an analysis of assessment cards for tasks carried out during the 'International Winter Championships in Emergency Medicine'. Three-person medical response teams (MRTs), with the support of two people, had the task of conducting advanced resuscitation on an adult and child simultaneously. The tasks were prepared and developed by European Resuscitation Council (ERC) instructors. Results: The study showed that teams used four methods of checking heart rhythm and performing defibrillation during CPR-using paddles only, using paddles and self-adhesive electrodes, using paddles and a three-lead ECG and using two pairs of self-adhesive electrodes. Teams performing cardiopulmonary resuscitation using paddles and a three-lead ECG performed significantly more actions incorrectly than other teams-in part due to the fact that they incorrectly interpreted which patient's heart rhythm was displayed on the defibrillator screen. The effectiveness of the remaining methods was similar for most of the actions. The CPR method using two pairs of electrodes enabled personal safety to be maintained to the significantly highest percentage during defibrillation. Conclusions: The study demonstrated that the need to conduct CPR on two patients at the same time, irrespective of the method used, caused MRT members considerable difficulties in correctly conducting some of the actions. The method of assessing heart rhythm using paddles and a three-lead ECG should not be used. The study showed that the optimal method of CPR in use appears to be the method using two pairs of adhesive electrodes-it provided, among other things, the significantly highest percentage of safely conducted defibrillation.
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Affiliation(s)
- Michał Ćwiertnia
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
| | - Mieczysław Dutka
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Michał Szlagor
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Arkadiusz Stasicki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Piotr Białoń
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Beata Kudłacik
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Maciej B Hajduga
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Monika Mikulska
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Mateusz Majewski
- Department of Emergency Medicine, Medical University of Silesia, Ziołowa 45, 40-635 Katowice, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Faculty of Medicine, Silesian Academy in Katowice, 40-555 Katowice, Poland
| | - Filip Jaskiewicz
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland
| | - Rafał Bobiński
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Marek Kawecki
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
| | - Tomasz Ilczak
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, Willowa 2, 43-309 Bielsko-Biała, Poland
- European Pre-Hospital Research Network, Nottingham NG11 8NS, UK
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Kono H, Takaishi K, Onuma M, Fukushima M, Takeuchi R. Bystanders' willingness to assist using automated external defibrillators during cardiac arrest. Heliyon 2024; 10:e37316. [PMID: 39296246 PMCID: PMC11407973 DOI: 10.1016/j.heliyon.2024.e37316] [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: 02/13/2024] [Revised: 08/19/2024] [Accepted: 08/30/2024] [Indexed: 09/21/2024] Open
Abstract
The "bystander effect," in which the presence of others inhibits rescue actions, has not been specifically examined in the context of cardiac arrest; understanding this effect in relation to rescue with automated external defibrillators (AEDs) is important. This study aims to identify the presence of others as a factor inhibiting rescue actions using an AED, from a social psychology perspective. We collected data through a web-based questionnaire involving registered residents in all 47 prefectures of Japan. The participants were presented with hypothetical scenarios of witnessing cardiac arrest events at train stations, under sparse or crowded conditions, and with or without the presence of competent parties (e.g., station staff or security guards). Their willingness to intervene was assessed across three levels of rescue behavior: (1) running and calling for help, (2) retrieving an AED, and (3) using an AED. This study found evidence of the bystander effect, indicating that the presence of competent others reduced behavioral interventions by bystanders during out-of-hospital cardiac arrest (OHCA) events. Moreover, the perceived presence of competent parties at the scene of a cardiac arrest reduced bystanders' willingness to initiate rescue under certain circumstances. While many bystanders were willing to initiate rescue efforts in response to calls for help, they resisted rescues involving an AED. This study observes that a bystander effect occurs among bystanders witnessing OHCA, explores the inhibiting effects of identifying competent parties on the initiation of rescue efforts, and suggests that there are significant invisible barriers to using AEDs in rescuing patients with OHCA.
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Affiliation(s)
- Hideko Kono
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
| | - Koichi Takaishi
- Faculty of Business Administration, Asia University, 5-8 Sakai, Musashino-shi, 180-8629, Japan
| | - Masaya Onuma
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
| | - Michi Fukushima
- Graduate School of Economics, Tohoku University, 27-1 Kawauchi, Aoba-ku, Sendai-shi, 980-8576, Japan
| | - Ryosuke Takeuchi
- Graduate School of International Social Sciences, Yokohama National University, 79-4 Tokiwadai, Hodogaya-ku, Yokohama-shi, 240-8501, Japan
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Ghassemi K, Reinier K, Chugh SS, Norby FL. Sex-specific health-related quality of life in survivors of cardiac arrest. Resusc Plus 2024; 19:100736. [PMID: 39185281 PMCID: PMC11343050 DOI: 10.1016/j.resplu.2024.100736] [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: 05/22/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Survival after out-of-hospital cardiac arrest (OHCA) remains low, although the number of survivors is increasing, and survivors are living longer. With increasing long-term survival, there is a need to understand health-related quality of life (HRQoL) measures. Although there are current recommendations for measuring HRQoL in OHCA survivors, there is significant heterogeneity in assessment timing and the measurement tools used to quantify HRQoL outcomes, making the interpretation and comparison of HRQoL difficult. Identifying groups of survivors of OHCA with poor HRQoL measures could be used for targeted intervention studies. Sex differences in OHCA resuscitation characteristics, post-cardiac arrest treatment, and short-term survival outcomes are well-documented, although variability in study methods and statistical adjustments appear to affect study results and conclusions. It is unclear whether sex differences exist in HRQoL among OHCA survivors and if study methods and statistical adjustment for patient characteristics or arrest circumstances impact the results. In this narrative review article, we provide an overview of the assessment of HRQoL and the main domains of HRQoL. We summarize the literature regarding sex differences in HRQoL in OHCA survivors. Few multivariable-adjusted studies reported HRQoL sex differences and there was significant heterogeneity in study size, timing of assessment, and domains measured and reported. What is reported suggests females have worse HRQoL than males, especially in the domains of physical function and mental health, but results should be interpreted with caution. Lastly, we discuss the challenges of a non-uniform approach to measurement and future directions for assessing and improving HRQoL in OHCA survivors.
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Affiliation(s)
- Kaitlyn Ghassemi
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific, United States
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Faye L Norby
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
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Quinn E, Murphy E, Du Pont D, Comber P, Blood M, Shah A, Kuc A, Hunter K, Carroll G. Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Received Naloxone in an Emergency Medical Services System With a High Prevalence Of Opioid Overdose. J Emerg Med 2024; 67:e249-e258. [PMID: 39034160 DOI: 10.1016/j.jemermed.2024.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/23/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Opioid-associated out-of-hospital cardiac arrest (OA-OHCA) is a subset of cardiac arrests that could benefit from measures outside of standard Advanced Cardiac Life Support (ACLS), such as naloxone. STUDY OBJECTIVES In this study, we sought to examine whether OHCA patients chosen for naloxone therapy by emergency medical services (EMS) clinicians in a system with high rates of opioid overdose would have increased rates of return of spontaneous circulation (ROSC) and survival to hospital discharge. METHODS The study took place in an urban EMS system with a high prevalence of opioid overdose. Paramedics could administer naloxone in cardiac arrest in addition to ACLS. It was often administered based on clinical gestalt for suspected OA-OHCA. The outcomes of OHCA patients who received naloxone were compared against those who received usual care in both an adjusted and unadjusted fashion. Lastly, we created a logistic regression model to test for an independent association of naloxone administration on ROSC and survival to hospital discharge. RESULTS A consecutive sample of 769 OHCA patients was obtained, of which 175 (23%) received naloxone. On average, patients who received naloxone had significantly fewer comorbidities and were younger. There was no difference in ROSC, survival to hospital discharge, or modified Rankin Scores. Using logistic regression modeling, there was no statistically significant effect of naloxone administration on these outcomes. CONCLUSION OHCA patients who received naloxone, despite being younger and having fewer comorbidities, had similar outcomes compared to those who received usual care. The difference in baseline characteristics suggests that paramedic gestalt reasonably selected for OA-OHCA.
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Affiliation(s)
- Eric Quinn
- Maimonides Medical Center, Brooklyn, New York.
| | | | - Daniel Du Pont
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | | | | | - Aman Shah
- Cooper Medical School, Camden, New Jersey
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Chien CY, Tsai SL, Huang CH, Wang MF, Lin CC, Chen CB, Tsai LH, Tseng HJ, Huang YB, Ng CJ. Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study. JMIR MEDICAL EDUCATION 2024; 10:e52230. [PMID: 38683663 DOI: 10.2196/52230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/08/2023] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. OBJECTIVE This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. METHODS This study recruited participants aged ≥18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. RESULTS This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3% female), with 332 (28.5%), 270 (23.2%), 258 (22.2%), and 303 (26.1%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80%); however, a higher proportion (98/303, 32.3%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. CONCLUSIONS Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. TRIAL REGISTRATION IGOGO NCT05659108; https://www.cgmh-igogo.tw.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Senior Service Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei City Hospital, New Taipei City, Taiwan
| | - Ming-Fang Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, New Taipei, Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Hsiao-Jung Tseng
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Yan-Bo Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Wei J, Tan TC, Moa AM, MacIntyre CR. Cost-benefit of influenza vaccination in preventing sudden cardiac arrest amongst Australian adults. Vaccine 2024; 42:1593-1598. [PMID: 38341292 DOI: 10.1016/j.vaccine.2024.02.008] [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: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective of the study was to estimate the economic cost benefit of funding influenza vaccination to all Australian adults 50-64 years and predict its effect on sudden cardiac arrest (SCA) deaths and hospitalisation. METHODS We combined SCA hospitalisation data from the Australian Institute of Health and Welfare (AIHW) with survival, vaccination, and cost parameters from published literature to create a model estimating the cost benefit of universally funded influenza vaccinations to prevent SCA deaths and hospitalisation. Costs were considered from a government perspective and included cost of vaccines and GP consultations, whilst averted deaths were estimated through the age-adjusted value of a statistical life. RESULTS The target policy was estimated to prevent 278 SCA hospitalisations and 1269 SCA deaths. This would result in cost-savings of almost $4 billion annually, with an incremental benefit-cost ratio (BCR) of 59.94. The majority of savings were associate with averted deaths. When a sensitivity analysis was performed by altering statistical life year values and reducing life years left, the cost-saving remained significant with a minimum BCR of 29.97 derived. CONCLUSIONS Reducing SCA through extended vaccination including adults 50-64 years is likely to be a cost beneficial policy from a governmental perspective. SCA deaths account for a significant economic loss due to the high mortality rate, which was far greater than the costs saved through averted hospitalisations. More accurate parameters are needed to improve the reliability of these estimate; however, this model can be used as a basis for further research into the economic impact of SCA.
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Affiliation(s)
- Jenny Wei
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy C Tan
- School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Aye M Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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Tayal B, Rørth R, Kristensen SL, Wissenberg M, Dutta A, Gislason G, Køber L, Lippert F, Torp-Pedersen C, Søgaard P, Kragholm KH. Comparative outcomes in patients with preexisting heart failure to those without heart failure after out-of-hospital cardiac arrest: A nationwide registry study. Int J Cardiol 2024; 398:131595. [PMID: 37984715 DOI: 10.1016/j.ijcard.2023.131595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/08/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The knowledge of prognosis following out-of-hospital cardiac arrest (OHCA) in patients with heart failure heart failure (HF) is sparse. The objective of this study was to compare the outcome after OHCA among patients with and without HF. METHODS We studied 45,293 patients who were included for the Danish cardiac arrest registry between 2001 and 2014. Patients were stratified into two groups based on the presence of HF prior to cardiac arrest. The primary outcome was 30-day survival and secondary outcome was anoxic brain damage or permanent nursing home admission at 1-year among 30-day survivors. RESULTS Among the final 28,955 patients included, 6675 (23%) patients had prior HF and 22,280 (77%) patients had no prior HF. At 30 days, 616 (9.2%) patients survived among the patients with HF and 1916 (8.6%) among the patients without HF. There was a significant interaction between atrial fibrillation (AF) and HF for primary outcome and therefore it was assessed separately between the two study groups stratified based on AF. Among patients without AF a significantly higher odds of 30-day survival were observed among patients with HF (OR 2.69, 95% CI 2.34-3.08, P < 0.001), but no difference was observed among the patients from two study groups with no AF. No significant difference in risk for secondary outcome was observed among the two study groups. In multivariable average treatment effect modeling, all the results largely remain unchanged. CONCLUSIONS Outcome following OHCA among patients with and without HF is found to be similar in this large Danish OHCA registry.
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Affiliation(s)
- Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Mads Wissenberg
- Emergency Medical Services, Copenhagen, Copenhagen University, Denmark; Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Abhishek Dutta
- Trinity Health - Nazareth Hospital, Philadelphia, PA, USA
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Zealand University Hospital, Køge, Denmark; Faculty of Health and Medical Science, University of Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Freddy Lippert
- Emergency Medical Services, Copenhagen, Copenhagen University, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark
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Pourzand P, Moore J, Metzger A, Salverda B, Suresh M, Arango S, Rosenhagen H, Kaizer A, Duval S, Debaty G, Lurie K. Hemodynamics, survival and neurological function with early versus delayed automated head-up CPR in a porcine model of prolonged cardiac arrest. Resuscitation 2024; 194:110067. [PMID: 38043854 DOI: 10.1016/j.resuscitation.2023.110067] [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: 10/22/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
AIM To determine if controlled head and thorax elevation, active compression-decompression cardiopulmonary resuscitation (CPR), and an impedance threshold device combined, termed automated head-up positioning CPR (AHUP-CPR), should be initiated early, as a basic (BLS) intervention, or later, as an advanced (ALS) intervention, in a severe porcine model of cardiac arrest. METHODS Yorkshire pigs (n = 22) weighing ∼40 kg were anesthetized and ventilated. After 15 minutes of untreated ventricular fibrillation, pigs were randomized to AHUP-CPR for 25 minutes (BLS group) or conventional CPR for 10 minutes, followed by 15 minutes of AHUP-CPR (ALS group). Thereafter, epinephrine, amiodarone, and defibrillation were administered. Neurologic function, the primary endpoint, was assessed 24-hours later with a Neurological Deficit Score (NDS, 0 = normal and 260 = worst deficit score or death). Secondary outcomes included return of spontaneous circulation (ROSC), cumulative survival, hemodynamics and epinephrine responsivity. Data, expressed as mean ± standard deviation, were compared using Fisher's Exact, log-rank, Mann-Whitney U and unpaired t-tests. RESULTS ROSC was achieved in 10/11 pigs with early AHUP-CPR versus 6/11 with delayed AHUP-CPR (p = 0.14), and cumulative 24-hour survival was 45.5% versus 9.1%, respectively (p < 0.02). The NDS was 203 ± 80 with early AHUP-CPR versus 259 ± 3 with delayed AHUP-CPR (p = 0.035). ETCO2, rSO2, and responsiveness to epinephrine were significantly higher in the early versus delayed AHUP-CPR. CONCLUSION When delivered early rather than late, AHUP-CPR resulted in significantly increased hemodynamics, 24-hour survival, and improved neurological function in pigs after prolonged cardiac arrest. Based on these findings, AHUP-CPR should be considered a BLS intervention.
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Affiliation(s)
- Pouria Pourzand
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
| | - Johanna Moore
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Anja Metzger
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bayert Salverda
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Mithun Suresh
- Department of Medicine, CentraCare-St. Cloud Hospital St. Cloud, MN, USA
| | - Susana Arango
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Henry Rosenhagen
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alex Kaizer
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Sue Duval
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Guillaume Debaty
- Department of Emergency Medicine, University of Grenoble Alps/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | - Keith Lurie
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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Thiara S, Sekhon MS. Blood pressure augmentation after cardiac arrest: Time to move beyond manipulating vital signs. Resuscitation 2023; 190:109913. [PMID: 37516157 DOI: 10.1016/j.resuscitation.2023.109913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Sharanjit Thiara
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Collaborative Entity for REsearching Brain Ischemia (CEREBRI), University of British Columbia, Vancouver, BC, Canada
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Collaborative Entity for REsearching Brain Ischemia (CEREBRI), University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Kovoor JG, Marschner S, Amarasekera A, Nageswaran M, Page GJ, Chow CK, Thiagalingam A, Kovoor P. Public attitudes towards automated external defibrillators: results of a survey in the Australian general population. Front Cardiovasc Med 2023; 10:1178148. [PMID: 37332575 PMCID: PMC10272715 DOI: 10.3389/fcvm.2023.1178148] [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: 03/02/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Swift defibrillation by lay responders using automated external defibrillators (AEDs) increases survival in out-of-hospital cardiac arrest (OHCA). This study evaluated newly designed yellow-red vs. commonly used green-white signage for AEDs and cabinets and assessed public attitudes to using AEDs during OHCA. Methods New yellow-red signage was designed to enable easy identification of AEDs and cabinets. A prospective, cross-sectional study of the Australian public was conducted using an electronic, anonymised questionnaire between November 2021 and June 2022. The validated net promoter score investigated public engagement with the signage. Likert scales and binary comparisons evaluated preference, comfort and likelihood of using AEDs for OHCA. Results The yellow-red signage for AED and cabinet was preferred by 73.0% and 88%, respectively, over the green-white counterparts. Only 32% were uncomfortable with using AEDs, and only 19% indicated a low likelihood of using AEDs in OHCA. Conclusion The majority of the Australian public surveyed preferred yellow-red over green-white signage for AED and cabinet and indicated comfort and likelihood of using AEDs in OHCA. Steps are necessary to standardise yellow-red signage of AED and cabinet and enable widespread availability of AEDs for public access defibrillation.
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Affiliation(s)
- Joshua G. Kovoor
- The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
- Heart of the Nation, Sydney, NSW, Australia
- Health and Information, Adelaide, SA, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anjalee Amarasekera
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Meera Nageswaran
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia
- Health and Information, Adelaide, SA, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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11
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Ho AFW, Lim MJR, Earnest A, Blewer A, Graves N, Yeo JW, Pek PP, Tiah L, Ong MEH. Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 32:100672. [PMID: 36785853 PMCID: PMC9918801 DOI: 10.1016/j.lanwpc.2022.100672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
Background Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort. Methods We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan-Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up. Results We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5-17.8), decreasing to 1.2 (95% CI:0.7-1.8) at three years, and 0.4 (95% CI:0.2-0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02-1.04, p < 0.001), shockable presenting rhythm (HR:0.75, 95% CI:0.52-0.93, p = 0.015) and CPC category (HR:4.62, 95% CI:3.17-6.75, p < 0.001) were independently associated with mortality. Annual DALYs due to OHCA varied from 304.1 in 2010 to 849.7 in 2015, then 547.1 in 2018. Mean DALYs decreased from 12.162 in 2010 to 3.599 in 2018. Conclusions OHCA survivors had an increased mortality rate for the first three years which subsequently normalised compared to that of the general population. Annual OHCA disease burden in DALY trended downwards from 2010 to 2018. Improved surveillance and OHCA treatment strategies may improve long-term survivorship and decrease its global burden. Funding National Medical Research Council, Singapore, under the Clinician Scientist Award (NMRC/CSA-SI/0014/2017) and the Singapore Translational Research Investigator Award (MOH-000982-01).
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Corresponding author. Department of Emergency Medicine, Singapore General Hospital, Outram Rd, 169608, Singapore.
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Audrey Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
| | - Ling Tiah
- Accident & Emergency Department, Changi General Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
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12
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Held EP, Reinier K, Chugh H, Uy-Evanado A, Jui J, Chugh SS. Recurrent Out-of-Hospital Sudden Cardiac Arrest: Prevalence and Clinical Factors. Circ Arrhythm Electrophysiol 2022; 15:e011018. [PMID: 36383377 PMCID: PMC9938502 DOI: 10.1161/circep.122.011018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite improvements in management following survival from sudden cardiac arrest (SCA) and wide availability of implantable cardioverter defibrillators for secondary prevention, a subgroup of individuals will suffer multiple distinct episodes of SCA. The objective of this study was to characterize and evaluate the burden of recurrent out-of-hospital SCA among survivors of SCA in a single large US community. METHODS SCA cases were prospectively ascertained in the Oregon Sudden Unexpected Death Study. Individuals that experienced recurrent SCA were identified both prospectively and retrospectively. RESULTS We ascertained 6649 individuals with SCA (2002-2020) and 924 (14%) survived to hospital discharge. Of these, 88 survivors (10%) experienced recurrent SCA. Of the nonsurvivors (n=5725), 35 had suffered a recurrent SCA. Of the total 123 SCA cases with recurrent SCA, >60% occurred at least 1 year after the initial SCA (median 23 months, range: 6 days to 31 years). SCA occurred despite a secondary prevention implantable cardioverter defibrillator in 22% (n=26). Prevalence of coronary disease (36% versus 25%), hypertension (69% versus 43%), diabetes (44% versus 21%), and chronic kidney disease (35% versus 14%) was significantly higher in recurrent SCA versus single SCA survivors (n=80, P=0.01). Among individuals with no secondary prevention implantable cardioverter defibrillators before recurrent SCA, the majority had apparently reversible etiologies identified at initial SCA, with one-quarter undergoing coronary revascularization and over half diagnosed with noncoronary cardiac etiologies. CONCLUSIONS At least 10% of SCA survivors had recurrent SCA, and a large subgroup suffered their repeat SCA despite treatment for an apparently reversible etiology. A renewed focus on careful assessment of cardiac substrate as well as management of coronary disease, hypertension, diabetes, and chronic kidney disease in SCA survivors could reduce recurrent SCA.
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Affiliation(s)
- Elizabeth P. Held
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
| | - Sumeet S. Chugh
- Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
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13
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Chan PS, McNally B, Chang A, Girotra S, Al-Araji R, Mawani M, Ahn KO, Merritt R. Long-Term Outcomes for Out-of-Hospital Cardiac Arrest in Elderly Patients: An Analysis of Cardiac Arrest Registry to Enhance Survival Data Linked to Medicare Files. Circ Cardiovasc Qual Outcomes 2022; 15:e009042. [PMID: 36193751 PMCID: PMC9694664 DOI: 10.1161/circoutcomes.122.009042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most studies on out-of-hospital cardiac arrest have primarily focused on in-hospital or short-term survival. Little is known about long-term outcomes and resource use among survivors of out-of-hospital cardiac arrest. METHODS In this observationsl study, we describe overall long-term outcomes for patients from the national Cardiac Arrest Registry to Enhance Survival linked to Medicare files to create the Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors dataset. Cardiac Arrest Registry to Enhance Survival data between 2013 and 2019 were linked to Medicare data using probabilistic matching algorithms. Overall long-term mortality, readmissions, and index hospitalization costs are reported for the overall cohort. RESULTS Among 56 425 patients who were 65 years of age or older in Cardiac Arrest Registry to Enhance Survival who survived to hospital admission, 26 875 (47.6%) were successfully linked to Medicare files. Mean (+SD) cost of the index hospitalization was $23 262+$24 199 and the median cost was $14 636 (interquartile range, $9930-$30 033). Overall, 8676 (32.3%) survived to hospital discharge with 38.0% discharged home, 11.8% to hospice care, and the remaining 50.2% to other inpatient, skilled nursing care, or rehabilitation facilities. Mortality after discharge was initially high (27.0% at 3 months) and then increased gradually, with 1- and 3-year mortality of 37.1% and 50.1%, respectively. During the first year, 40.1% were readmitted at least once, with 19.7% readmitted on > 1 occasion. CONCLUSIONS The Cardiac Arrest Registry to Enhance Survival: Mortality, Events, and Costs for Cardiac Arrest survivors registry includes rich data on postdischarge outcomes and resource utilization. Use of this dataset will enable future investigations on the long-term effectiveness, costs, and cost-effectiveness of various interventions for out-of-hospital cardiac arrest in elderly patients.
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Affiliation(s)
- Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri and the University of Missouri-Kansas City (P.S.C.)
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, (B.M.)
- Rollins School of Public Health, Atlanta, GA (B.M., R.A.-A.)
| | | | - Saket Girotra
- University of Iowa Carver College of Medicine, Iowa City (S.G.)
| | - Rabab Al-Araji
- Rollins School of Public Health, Atlanta, GA (B.M., R.A.-A.)
| | - Minaz Mawani
- University of Georgia College of Public Health (M.M.)
| | - Ki Ok Ahn
- Hanyang University College of Medicine (K.O.A.)
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14
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Delbaere Q, Akodad M, Roubille F, Lattuca B, Cayla G, Leclercq F. One-Year Follow-Up of Patients Admitted for Emergency Coronary Angiography after Resuscitated Cardiac Arrest. J Clin Med 2022; 11:3738. [PMID: 35807020 PMCID: PMC9267145 DOI: 10.3390/jcm11133738] [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: 05/17/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Despite the improvement of the in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long-term outcome and quality of life of surviving patients. The aim of this study was to assess neurological outcomes at one year after resuscitated cardiac arrest; (2) Methods: This prospective, observational, and multicentre study included patients >18 yo admitted in the catheterisation laboratory for coronary angiography after aborted SCD between 1 May 2018 and 31 May 2020. Only patients who were discharged alive from hospital were evaluated. The primary endpoint was survival without neurological sequelae at one-year follow-up defined by a cerebral performance category (CPC) of one or two. Secondary end points included all-cause mortality, New York Heart Association (NYHA) functional class, neurologic evaluation at discharge, three-month and one-year follow-up using the CPC scale, and quality of life at 1 year using the Quality of Life after Brain Injury (QOLIBRI) questionnaire; (3) Results: Among 143 patients admitted for SCD within the study period, 61 (42.7%) were discharged alive from hospital, among whom 55 (90.1%) completed the one-year follow-up. No flow and low flow times were 1.9 ± 2.4 min and 16.5 ± 10.4 min, respectively. For 93.4% of the surviving patients, an initial shockable rhythm (n = 57) was observed and acute coronary syndrome was diagnosed in 75.4% of them (n = 46). At 1 year, survival rate without neurologic sequelae was 87.2% (n = 48). Patients with poor outcome were older (69.3 vs. 57.4 yo; p = 0.04) and had lower body mass index (22.4 vs. 26.7; p = 0.013) and a lower initial Left Ventricle Ejection Fraction (LVEF) (32.1% vs. 40.3%; p = 0.046). During follow-up, neurological status improved in 36.8% of patients presenting sequelae at discharge, and overall quality of life was satisfying for 66.7% of patients according to the QOLIBRI questionnaire; (4) Conclusions: Among patients admitted to the catheterisation laboratory for aborted SCD, mainly related to Acute Coronary Syndrom (ACS), less than a half of them were alive at discharge. However, the one-year survival rate without neurological sequelae was high and overall quality of life was good.
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Affiliation(s)
- Quentin Delbaere
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - Myriam Akodad
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - François Roubille
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
| | - Benoît Lattuca
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Guillaume Cayla
- Department of Cardiology, Caremeau University Hospital, 30900 Nîmes, France; (B.L.); (G.C.)
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, 34295 Montpellier, France; (M.A.); (F.R.); (F.L.)
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15
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Utilization of Non-Gated Chest Computed Tomography Scans in Predicting Acute Coronary Occlusion in Out-of-Hospital Cardiac Arrest. Curr Probl Cardiol 2022; 47:101276. [PMID: 35667497 DOI: 10.1016/j.cpcardiol.2022.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Coronary artery disease is thought to be responsible for up to 60-80% of out-of-hospital cardiac arrests. The utility of Computed Tomography (CT) chest when it comes to identifying acute coronary occlusion in patients following an arrest has not been studied. We aim to we evaluate whether myocardial perfusion on a contrast-enhanced chest CT performed for a non-cardiac cause can predict culprit coronary occlusion as the cause of cardiac arrest, and if the absence of a perfusion defect can exclude an ischemic etiology. METHODS A retrospective cohort of 53 consecutive patients presenting with VT or VF arrest and successful resuscitation who had contrast chest CT before angiography. CT scans were reviewed for myocardial perfusion defects by a cardiologist and radiologist blinded to angiogram findings. CT results were then compared with angiograms. RESULTS On coronary angiography, 22(42%) of the patients presenting with out-of-hospital arrest had critical stenosis. Sensitivity and specificity of perfusion defect on CT in identifying critical stenosis on catheterization was 0.45, 95% CI [0.24, 0.68] and 0.77, 95% CI [59%, 90%], respectively. The positive likelihood ratio being 2.01 (0.91,4.46) and the negative likelihood ratio being 0.70 (0.46,1.08). The diagnostic accuracy was 64.2%. CONCLUSIONS Our study did not show much utility for the use of myocardial perfusion defect on an incidental pre-angiography contrast chest CT to predict acute thrombotic occlusion in out-of-hospital cardiac arrest patients. However, this shouldn't discourage further studies evaluating the utility of contrast-enhanced CT-images in predicting acute coronary occlusion.
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Shaker MS, Abrams EM, Oppenheimer J, Singer AG, Shaker M, Fleck D, Greenhawt M, Grove E. Estimation of Health and Economic Benefits of a Small Automatic External Defibrillator for Rapid Treatment of Sudden Cardiac Arrest (SMART): A Cost-Effectiveness Analysis. Front Cardiovasc Med 2022; 9:771679. [PMID: 35282380 PMCID: PMC8907482 DOI: 10.3389/fcvm.2022.771679] [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: 09/06/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. Early CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited. Methods Markov models were used to evaluate the cost-effectiveness of a portable SMART (SMall AED for Rapid Treatment of SCA) approach to early SCA management over a life-time horizon in at-risk and not at-risk populations. Simulated patients (n = 600,000) who had not received an implantable cardioverter defibrillator (ICD) were randomized to a SMART device with CPR prompts or non-SMART approaches. Annual SCA risk was varied from 0.2 to 3.5%. Analysis was performed in a US economy from both societal (SP) and healthcare (HP) perspectives to evaluate the number of SCA fatalities prevented by SMART, and SMART cost-effectiveness at a threshold of $100,000/Quality Adjusted Life Year (QALY). Results A SMART approach was cost-effective when annual SCA risk exceeded 1.51% (SP) and 1.62% (HP). The incremental cost-effectiveness ratios (ICER) were $95,251/QALY (SP) and $100,797/QALY (HP) at a 1.60% SCA annual risk. At a 3.5% annual SCA risk, SMART was highly cost-effective from both SP and HP [ICER: $53,925/QALY (SP), $59,672/QALY (HP)]. In microsimulation, SMART prevented 1,762 fatalities across risk strata (1.59% fatality relative risk reduction across groups). From a population perspective, SMART could prevent at least 109,839 SCA deaths in persons 45 years and older in the United States. Conclusions and Relevance A SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk. The availability of a smart-phone enabled pocket-sized AED with CPR prompts has the potential to greatly improve population health and economic outcomes.
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Affiliation(s)
- Marcus S. Shaker
- Dartmouth Geisel School of Medicine, Hanover, NH, United States
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Elissa M. Abrams
- Department of Pediatrics, University of Manitoba, Winnipeg, CA, United States
| | - John Oppenheimer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Alexander G. Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, CA, United States
| | | | - Daniel Fleck
- Altrix Medical, Centreville, VA, United States
- Department of Computer Science, George Mason University, Fairfax, VA, United States
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Evan Grove
- Dartmouth Geisel School of Medicine, Hanover, NH, United States
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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17
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Kjaergaard J, Schmidt H, Møller JE, Hassager C. The “Blood pressure and oxygenation targets in post resuscitation care, a randomized clinical trial”: design and statistical analysis plan. Trials 2022; 23:177. [PMID: 35209951 PMCID: PMC8867659 DOI: 10.1186/s13063-022-06101-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 12/27/2022] Open
Abstract
Background Comatose patients admitted after resuscitation from cardiac arrest have a significant risk of poor outcome due to hypoxic brain injury. While numerous studies have investigated and challenged the target temperature as the efficacious part of the guideline endorsed Targeted Temperature Management (TTM) protocols, our knowledge and how the remaining parts of the TTM are optimized remain sparse. The present randomized trial investigated two aspects of the TTM protocol: target blood pressure during the ICU stay and oxygenation during mechanical ventilation. Furthermore, the efficacy of device-based post-TTM fever management is addressed. Methods Investigator-initiated, dual-center, randomized clinical trial in comatose OHCA patients admitted to an intensive cardiac care unit. Patients are eligible for inclusion if unconscious, older than 18 years of age, and have return of spontaneous circulation for more than 20 min. Intervention: allocation 1:1:1:1 into a group defined by (a) blood pressure targets in double-blind intervention targeting a mean arterial blood pressure of 63 or 77 mmHg and (b) restrictive (9–10 kPa) or liberal (13–14 kPa) of arterial oxygen concentration during mechanical ventilation. As a subordinate intervention, device-based active fever management is discontinued after 36 h or 72. Patients will otherwise receive protocolized standard of care according to international guidelines, including targeted temperature management at 36 °C for 24 h, sedation with fentanyl and propofol, and multimodal neuro-prognostication. Primary endpoint: Discharge from hospital in poor neurological status (Cerebral Performance category 3 or 4) or death, whichever comes first. Secondary outcomes: Time to initiation of renal replacement therapy or death, neuron-specific enolase (NSE) level at 48 h, MOCA score at day 90, Modified Ranking Scale (mRS) and CPC at 3 months, NT-pro-BNP at 90 days, eGFR and LVEF at 90 days, daily cumulated vasopressor requirement during ICU stay, and need for a combination of vasopressors and inotropic agents or mechanical circulatory support. Discussion We hypothesize that low or high target blood pressure and restrictive and liberal oxygen administration will have an impact on mortality by reducing the risk and degree of hypoxic brain injury. This will be assessment neurological outcome and biochemical and neuropsychological testing after 90 days. Trial registration ClinicalTrials.gov NCT03141099. Registered on May 2017 (retrospectively registered)
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18
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Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, Gale CP, Maggioni AP, Petersen SE, Huculeci R, Kazakiewicz D, de Benito Rubio V, Ignatiuk B, Raisi-Estabragh Z, Pawlak A, Karagiannidis E, Treskes R, Gaita D, Beltrame JF, McConnachie A, Bardinet I, Graham I, Flather M, Elliott P, Mossialos EA, Weidinger F, Achenbach S. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022; 43:716-799. [PMID: 35016208 DOI: 10.1093/eurheartj/ehab892] [Citation(s) in RCA: 390] [Impact Index Per Article: 195.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. METHODS AND RESULTS Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. CONCLUSION Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.
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Affiliation(s)
- Adam Timmis
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Panos Vardas
- Hygeia Hospitals Group, HHG, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Hugo Katus
- Department of Internal Medicine and Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aldo P Maggioni
- Research Center of Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Radu Huculeci
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Barbara Ignatiuk
- Division of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | | | - Agnieszka Pawlak
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roderick Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Timisoara, Romania
| | - John F Beltrame
- University of Adelaide, Central Adelaide Local Health Network, Basil Hetzel Institute, Adelaide, Australia
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Ian Graham
- Tallaght University Hospital, Dublin, Ireland
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Franz Weidinger
- Department of Internal Medicine and Cardiology, Klinik Landstrasse, Vienna, Austria
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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19
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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.
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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
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20
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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.
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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.
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21
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Manzo-Silberman S, Nix C, Goetzenich A, Demondion P, Kang C, Bonneau M, Cohen-Solal A, Leprince P, Lebreton G. Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices. J Clin Med 2021; 10:jcm10163623. [PMID: 34441919 PMCID: PMC8396996 DOI: 10.3390/jcm10163623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France;
- Correspondence: ; Tel.: +33-661135334 or +33-149958224
| | - Christoph Nix
- Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany; (C.N.); (A.G.)
| | - Andreas Goetzenich
- Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany; (C.N.); (A.G.)
| | - Pierre Demondion
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
| | - Chantal Kang
- XP-MED, 78100 Saint Germain en Laye, France; (C.K.); (M.B.)
| | - Michel Bonneau
- XP-MED, 78100 Saint Germain en Laye, France; (C.K.); (M.B.)
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France;
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
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22
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Otaki Y, Watanabe T, Goto J, Wanezaki M, Kato S, Tamura H, Nishiyama S, Arimoto T, Takahashi H, Watanabe M. Association between thrombolysis in myocardial infarction grade and clinical outcome after emergent percutaneous coronary intervention in patients with acute myocardial infarction who have suffered out-of-hospital cardiac arrest: the Yamagata AMI registry. Heart Vessels 2021; 37:40-49. [PMID: 34228158 DOI: 10.1007/s00380-021-01903-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Despite improvements in the survival rate of acute myocardial infarction (AMI), out-of-hospital cardiac arrest (OHCA) due to AMI is still a devastating condition. Thrombolysis in myocardial infarction (TIMI) grade is used to classify coronary reperfusion after percutaneous coronary intervention (PCI), but it remains unclear whether TIMI grade after emergent PCI is associated with short-term mortality in patients with AMI who have suffered OHCA. We analyzed data collected from 2012 to 2017 and recorded in the Yamagata AMI registry, which is a multicenter surveillance conducted in all institutions in Yamagata prefecture. Among 3332 patients with AMI, 254 had suffered OHCA. There were 564 deaths during the 30 days after the onset of AMI. The survival rate was lower in patients who had suffered OHCA than in those who had not (40% vs. 87%; P < 0.0001). Patients with AMI who had suffered OHCA were divided into three groups based on TIMI grade (TIMI III group, n = 70; TIMI ≤ II group, n = 21; and no coronary angiography [non-CAG] group, n = 163). The survival rates in the TIMI III, TIMI ≤ II, and non-CAG groups were 87%, 38%, and 5%, respectively. Kaplan-Meier analysis demonstrated that the survival rate was highest in the TIMI III group. Multivariate Cox proportional hazard regression analysis demonstrated that TIMI III was closely associated with survival after adjustment for confounding factors. Achieving TIMI grade III during emergent PCI is crucial to improve survival in patients with AMI who have suffered OHCA.
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Affiliation(s)
- Yoichiro Otaki
- Department of Advanced Cardiovascular Therapeutics, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Jun Goto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Masahiro Wanezaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hiroki Takahashi
- Department of Advanced Cardiovascular Therapeutics, Yamagata University School of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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23
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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24
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Feng D, Li C, Yang X, Wang L. Gender differences and survival after an out-of-hospital cardiac arrest: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:765-775. [PMID: 33174152 DOI: 10.1007/s11739-020-02552-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
Patients who experience out-of-hospital cardiac arrest (OHCA) have unacceptably high mortality rates. It remains unclear whether gender has an association with survival in this regard. Hence, we aimed to investigate the association between gender and survival by conducting a systematic review and meta-analysis. The databases of PubMed, Embase, and Cochrane Database of Systematic Reviews were searched from inception to 17 March, 2020. Studies assessing the association between gender and survival to discharge or 30-day survival after OHCA were included. Two reviewers independently assessed the eligibility of the identified studies. The random-effects model was used to pool data, and the outcome was reported as odds ratios (ORs) and 95% confidence intervals, as the relative measure of association. Twenty-three eligible studies enrolling 897,805 patients were included in this systematic review. Overall, women were older and less likely to experience arrest in public places. When arrest occurred, women had less initial shockable rhythm, were less likely to be witnessed by bystanders, and were less likely provided with CPR compared with men. After admission, women underwent less coronary angiography, percutaneous coronary angiography, and targeted temperature management therapy. Eleven studies with ORs were pooled, showing a significant survival benefit in women (OR = 1.08, p < 0.05, I2 = 52.3%). In the subgroup analysis, both premenopausal women (< 50 years) (OR = 1.42, p < 0.001, I2 = 0%) and postmenopausal women (≥ 50 years) (OR = 1.07, p < 0.05, I2 = 16.4%) had higher odds of survival compared with age-matched men. Despite the unfavorable factors, the pooled results showed a significant survival benefit in women after OHCA, especially in premenopausal women.
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Affiliation(s)
- Dejing Feng
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong-Ti South Road, Beijing, 10020, China.
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25
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Revisiting the Ten Commandments of Emergency Medicine: A Resident's Perspective. Ann Emerg Med 2021; 77:367-370. [PMID: 33618812 DOI: 10.1016/j.annemergmed.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 11/21/2022]
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26
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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27
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Li J, Zhang Y, Long M, Liu M, Zhang W, Gu L, Su C, Xiong Y, Wang L, Idris A. Out-of-hospital cardiac arrest patients with implantable cardioverter-defibrillators: What are their outcomes? Resuscitation 2020; 157:141-148. [PMID: 33191208 DOI: 10.1016/j.resuscitation.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
THE AIM OF THE STUDY To identify the prognostic factors and effects of implantable cardioverter-defibrillators (ICDs) in out-of-hospital cardiac arrest (OHCA) patients with ICDs because the clinical characteristics and outcomes of OHCA patients with ICDs are unknown. METHODS The North American Resuscitation Outcomes Consortium (ROC) Cardiac Epistry Version 3 dataset was analyzed. Eligible patients were divided into OHCA patients with and without ICDs. Multivariable regressions were employed to analyze. RESULTS Of 51,634 eligible OHCA patients, 581 (1.13%) had implanted ICDs. Among them, 53 (9.1%) patients survived to hospital discharge, and 40 (6.9%) patients had favorable neurological outcome at hospital discharge. Multivariable regression showed ICDs were not associated with OHCA outcomes in the total OHCA patients. In the OHCA patients with ICDs, shockable initial emergency medical services (EMS)-recorded rhythms and the ICD-shock-only defibrillation pattern were independent favorable factors for survival to hospital discharge(OR = 3.3, 95%CI 1.7-6.2, P < 0.001; OR = 2.4, 95%CI 1.1-5.5, P = 0.035, respectively) and neurological outcome at hospital discharge (OR = 6.5, 95%CI 2.9-14.4, P < 0.001; OR = 3.6, 95%CI 1.4-9.1, P = 0.006, respectively). During field resuscitation in OHCA patients with ICDs, at least 34.9% of total patients and 64.6% of patients with initial EMS-recorded VT/VF rhythms needed additional external shocks. CONCLUSIONS Shockable initial EMS-recorded rhythms and ICD-shock-only defibrillation pattern were independent factors for the favorable outcomes of OHCA patients with ICDs. ICDs were not associated with the outcomes of OHCA, and additional external shocks were needed in a substantial number of OHCA patients with ICDs during field resuscitation.
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Affiliation(s)
- Jie Li
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China; Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yongshu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Ming Long
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Wanwan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Liwen Gu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Chen Su
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China
| | - Yan Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China.
| | - Ahamed Idris
- University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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28
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Majewski D, Ball S, Bailey P, Bray J, Finn J. Relative long-term survival in out-of-hospital cardiac arrest: Is it really improving? Resuscitation 2020; 157:108-111. [PMID: 33164882 DOI: 10.1016/j.resuscitation.2020.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
AIM To describe the long-term survival of out-of-hospital cardiac arrest (OHCA) patients and to determine whether survival is improving in comparison to the general age- and sex-matched population. METHODS We utilised the St John Western Australia (WA) OHCA database to retrospectively identify patients aged ≥16 years who experienced an OHCA within the Perth metropolitan area between 1998 and 2017 and survived for at least 30-days post arrest. Patients were excluded if their primary residence was not WA, they did not have an emergency medical services attempted resuscitation (or bystander defibrillation) or did not have an arrest of medical aetiology. Relative survival ratios stratified by decade of arrest were calculated by dividing observed survival of the study cohort by the expected survival of an age- and sex-matched cohort estimated from the Australian Bureau of Statistics life tables for WA. RESULTS The OHCA patients who initially survived to 30-days experienced a modest reduction in long-term survival, with 84% (95% CI, 78-90) of patients surviving to 10-years relative to the age- and sex-matched general population. The 10-year relative survival increased from 76% (95% CI, 67-85) to 92% (95% CI, 84-100) between the first (1998-2007) and second (2008-2017) decade of our study. CONCLUSION Relative long-term survival prospects for initial OHCA survivors are moderately lower than that of the general population, however these differences have reduced over time and may be approaching those of the general population.
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Affiliation(s)
- David Majewski
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery, and Paramedicine, Curtin University, Bentley, WA, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery, and Paramedicine, Curtin University, Bentley, WA, Australia; St John WA, Belmont, WA, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery, and Paramedicine, Curtin University, Bentley, WA, Australia; St John WA, Belmont, WA, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery, and Paramedicine, Curtin University, Bentley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery, and Paramedicine, Curtin University, Bentley, WA, Australia; Medical School (Emergency Medicine), The University of Western Australia, Crawley, WA, Australia; St John WA, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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29
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Haag MB, Hersh AR, Toffey DE, Sargent JA, Stecker EC, Heitner SB, Caughey AB, Balaji S. Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Children with Cardiac Conditions Associated with Risk for Sudden Cardiac Death. Pediatr Cardiol 2020; 41:1484-1491. [PMID: 32623612 DOI: 10.1007/s00246-020-02395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
Children at high risk for sudden cardiac death (SCD) receive implantable cardioverter-defibrillators (ICD) for prevention, but the cost effectiveness of ICDs in children at intermediate risk is unclear. Our objective was to create a cost-effectiveness model to compare costs and outcomes in children at risk of SCD, with and without ICD. Utilizing hypertrophic cardiomyopathy as the proxy disease, a theoretical cohort of 8150 children was followed for 69 years. Model inputs were derived from the literature, with an incremental cost-effectiveness ratio (ICER) willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY) used to delineate cost effectiveness. Outcomes included prevalence of severe neurological morbidity (SNM), SCD, cost, and QALYs. In children at intermediate risk of SCD (4-6% over 5 years), ICD resulted in 56 fewer cases of SNM, 2686 fewer deaths. In children at high risk (> 6% over 5 years), ICD placement resulted in 74 fewer cases of SNM and 3663 fewer deaths from cardiac causes. The costs of ICD were higher, but placement was cost effective with an ICER of $3009 per QALY in intermediate risk children, but ICD therapy was a dominant strategy in high-risk children. Sensitivity analysis demonstrated ICD placement was cost-effective until the annual probability of SCD was < 0.22%. The model was robust over a wide range of values. For children at risk of SCD, prophylactic ICD implantation is cost effective, resulting in improved outcomes and increased QALYs, despite increased costs. These findings highlight the economic benefits of ICD utilization in this population.
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Affiliation(s)
- Meredith B Haag
- Division of Pediatric Cardiology, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR, USA
| | - Alyssa R Hersh
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - David E Toffey
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Eric C Stecker
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Stephen B Heitner
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Seshadri Balaji
- Division of Pediatric Cardiology, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR, USA. .,Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA.
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30
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Wollborn J, Steiger C, Ruetten E, Benk C, Kari FA, Wunder C, Meinel L, Buerkle H, Schick MA, Goebel U. Carbon monoxide improves haemodynamics during extracorporeal resuscitation in pigs. Cardiovasc Res 2020; 116:158-170. [PMID: 30873524 DOI: 10.1093/cvr/cvz075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 01/26/2023] Open
Abstract
AIMS Heart disease of different aetiology remains the leading cause of cardiac arrest (CA). Despite efforts to improve the quality of cardiopulmonary resuscitation (CPR), subsequent myocardial and systemic damage after CA still present a major long-term burden. Low-dose carbon monoxide (CO) is known to exert protective effects in cardiovascular pathophysiology but clinical applications are challenged by unfavourable delivery modes. We tested the hypothesis that extracorporeal resuscitation (E-CPR) in combination with controlled fast onset CO delivery results in improved cardiac physiology and haemodynamics. Damage-associated molecular pattern (DAMP) signalling may be part of the molecular mechanism. METHODS AND RESULTS In an established porcine model, E-CPR was performed. While E-CPR leads to similar results as compared to a conventional CPR strategy, CO delivery in combination with E-CPR demonstrated significant cardioprotection. Cardiac performance analysis using echocardiography and thermodilution techniques showed a CO-dependent improved cardiac function compared to severe myocardial dysfunction in CPR and E-CPR (left ventricular ejection fraction: Sham 49 ± 5; CPR 26 ± 2; E-CPR 25 ± 2; CO-E-CPR 31 ± 4; P < 0.05). While sublingual microcirculation was significantly compromised in CPR and E-CPR, CO delivery demonstrated a significant improvement in microvascular function (microvascular flow index: Sham 2.9 ± 0.1; CPR 2.2 ± 0.1; E-CPR 1.8 ± 0.1; CO-E-CPR 2.7 ± 0.1; P < 0.01). Histological and serological myocardial damage markers were significantly reduced (hsTroponin-T Sham 0.01 ± 0.001; CPR 1.9 ± 0.2; E-CPR 3.5 ± 1.2; CO-E-CPR 0.5 ± 0.2 ng/mL; P < 0.05). DAMP signalling was decreased ipse facto leading to influence of cardioprotective heat shock and cyclooxygenase response. CONCLUSIONS CO treatment restores myocardial function and improves systemic macro- and microhaemodynamics in E-CPR through a reduction in DAMPs.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Germany
| | - Eva Ruetten
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christoph Benk
- Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Department of Cardiothoracic Surgery, Heart Center - University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Department of Cardiothoracic Surgery, Heart Center - University of Freiburg, Freiburg, Germany
| | - Christian Wunder
- Department of Anesthesiology and Critical Care, Robert-Bosch-Krankenhaus Stuttgart, Germany
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Martin A Schick
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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31
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Haag MB, Hersh AR, Toffey DE, Sargent JA, Stecker EC, Heitner SB, Caughey AB, Balaji S. Cost-effectiveness of in-home automated external defibrillators for children with cardiac conditions associated with risk of sudden cardiac death. Heart Rhythm 2020; 17:1328-1334. [PMID: 32234558 DOI: 10.1016/j.hrthm.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children at high risk for sudden cardiac death (SCD) (>6% over 5 years) receive an implantable cardioverter-defibrillator (ICD), but no guidelines are available for those at lower risk. For children at intermediate risk for SCD (4%-6% over 5 years), the utility and cost-effectiveness of in-home automated external defibrillators (AEDs) are unclear. OBJECTIVE The purpose of this study was to assess the cost-effectiveness of in-home AED for children at intermediate risk for SCD. METHODS Using hypertrophic cardiomyopathy (HCM) as the proxy disease, a theoretical cohort of 1550 ten-year-old children with HCM was followed for 69 years. Baseline annual risk of SCD was 0.8%. Outcomes were SCD, severe neurologic morbidity (SNM), cost, and quality-adjusted life-years (QALYs). Model inputs were derived from the literature, with a willingness-to-pay threshold of $100,000 per QALY. RESULTS Among children at intermediate risk for SCD, in-home AED resulted in 31 fewer cases of SCD but 3 more cases of SNM. There were 319 QALYs gained. Although costs were higher by $28 million, the incremental cost-effectiveness ratio was $86,458, which is below the willingness-to-pay threshold. CONCLUSION For children at intermediate risk for SCD and HCM, in-home AED is cost-effective, resulting in fewer deaths and increased QALYS for a cost below the willingness-to-pay threshold. These findings highlight the economic benefits of in-home AED use in this population.
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Affiliation(s)
- Meredith B Haag
- Oregon Health and Science University, School of Medicine, Portland, Oregon
| | - Alyssa R Hersh
- Oregon Health and Science University, School of Medicine, Portland, Oregon
| | - David E Toffey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - James A Sargent
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Stephen B Heitner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Seshadri Balaji
- Doernbecher Children's Hospital, Division of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon.
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32
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Predicting factors for long-term survival in patients with out-of-hospital cardiac arrest - A propensity score-matched analysis. PLoS One 2020; 15:e0218634. [PMID: 31940337 PMCID: PMC6961829 DOI: 10.1371/journal.pone.0218634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death worldwide, with acute coronary syndromes accounting for most of the cases. While the benefit of early revascularization has been clearly demonstrated in patients with ST-segment-elevation myocardial infarction (STEMI), diagnostic pathways remain unclear in the absence of STEMI. We aimed to characterize OHCA patients presenting to 2 tertiary cardiology centers and identify predicting factors associated with survival. Methods We retrospectively analyzed 519 patients after OHCA from February 2003 to December 2017 at 2 centers in Munich, Germany. Patients undergoing immediate coronary angiography (CAG) were compared to those without. Multivariate regression analysis and inverse probability treatment weighting (IPTW) were performed to identify predictors for improved outcome in a matched population. Results Immediate CAG was performed in 385 (74.1%) patients after OHCA with presumed cardiac cause of arrest. As a result of multivariate analysis after propensity score matching, we found that immediate CAG, return of spontaneous circulation (ROSC) at admission, witnessed arrest and former smoking were associated with improved 30-days-survival [(OR, 0.46; 95% CI, 0.26–0.84), (OR, 0.21; 95% CI, 0.10–0.45), (OR, 0.50; 95% CI, 0.26–0.97), (OR, 0.43; 95% CI, 0.23–0.81)], and 1-year-survival [(OR, 0.39; 95% CI, 0.19–0.82), (OR, 0.29; 95% CI, 0.12–0.7), (OR, 0.43; 95% CI, 0.2–1.00), (OR, 0.3; 95% CI, 0.14–0.63)]. Conclusions In our study, immediate CAG, ROSC at admission, witnessed arrest and former smoking were independent predictors of survival in cardiac arrest survivors. Improvement in prehospital management including bystander CPR and best practice post-resuscitation care with optimized triage of patients to an early invasive strategy may help ameliorate overall outcome of this critically-ill patient population.
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33
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Mandigers L, Termorshuizen F, de Keizer NF, Gommers D, Dos Reis Miranda D, Rietdijk WJR, den Uil CA. A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in the Netherlands between 2010 and 2016. Resuscitation 2020; 147:88-94. [PMID: 31926259 DOI: 10.1016/j.resuscitation.2019.12.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
AIM Worldwide, cardiac arrest (CA) remains a major cause of death. Most post-CA patients are admitted to the intensive care unit (ICU). The aim of this study is to describe mortality rates and possible changes in mortality rates in patients with CA admitted to the ICU in the Netherlands between 2010 and 2016. METHODS In this study, we included all adult CA patients registered in the National Intensive Care Evaluation (NICE) registry who were admitted to ICUs in the Netherlands between 2010 and 2016. The primary outcome was 1-year mortality which was analysed by Cox regression. The secondary outcomes were ICU mortality and hospital mortality. Hospital mortality was analysed by binary logistic regression analysis. Patients were stratified by whether they experienced in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Finally, the outcome over calendar time was assessed for both groups. RESULTS We included 26,056 CA patients: 10,618 (40.8%) IHCA patients and 14,482 (55.6%) OHCA patients. The 1-year mortality rate was 57.5%: 59% for IHCA and 56.4% for OHCA, p < 0.01. This mortality rate remained stable between 2010 and 2016 for IHCA (p = 0.31) and declined for OHCA patients (p = 0.01). The hospital mortality rate was 50.3%: 50.5% for IHCA and 50.2% for OHCA, p = 0.66. This mortality rate remained stable between 2010-2016 for IHCA (p = 0.21) and decreased for OHCA patients (p < 0.01). An additional analysis with calendar year as a continuous variable showed a mortality decline of 1.56% per calendar year for 1-year mortality. CONCLUSION This nationwide registry cohort study reported a 57.5% 1-year mortality rate for CA patients admitted to the ICU between 2010 and 2016. We reported a decline in 1-year mortality for OHCA patients in these years.
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Affiliation(s)
- Loes Mandigers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Fabian Termorshuizen
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Kimmoun A, Cariou A, Gayat E, Feliot E, Takagi K, Megarbane B, Mebazaa A, Deye N. One-year outcome of patients admitted after cardiac arrest compared to other causes of ICU admission. An ancillary analysis of the observational prospective and multicentric FROG-ICU study. Resuscitation 2019; 146:237-246. [PMID: 31678408 DOI: 10.1016/j.resuscitation.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE While cardiac arrest (CA) patients discharged alive from intensive care unit (ICU) are considered to have good one-year survival but potential neurological impairment, comparisons with other ICU sub-populations non-admitted for CA purpose are still lacking. This study aimed to compare long-term outcome and health-related quality of life (HRQOL) between CA patients and patients admitted to ICU for all other causes. METHODS In 1635 patients discharged alive from 21 European ICUs in an ancillary analysis of a prospective multicentric cohort, we compared CA causes of ICU admission to all other causes of ICU admissions (named non-CAs). The primary endpoint was one-year survival rate after ICU discharge. Secondary endpoints included HRQOL at 3, 6 and 12 months after ICU discharge using the outcome survey short form-36 (SF36). Propensity score matching was used to consider the probability of having CA. RESULTS Of the 1635 patients, 1561 were included in this study comprised of 1447 non-CAs and 114 CAs. At one-year in the non-matched population, survival rate was greater in the CA group 89% versus the non-CA group 78% (log rank p = 0.0056). In the matched population, this difference persisted between CAs and non-CAs (log rank p = 0.049). The physical component summary of the SF36 scale was higher in the CA group than in the non-CA group at all time points in both non-matched and matched populations. CONCLUSIONS CA patients discharged alive from ICU have a better one-year survival and a better HRQOL specifically on physical functions than patients admitted to ICU for other causes. TRIAL REGISTRATION ClinicalTrials.gov NCT01367093; registered on June 6, 2011.
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Affiliation(s)
- Antoine Kimmoun
- Medical Intensive Care Unit, Nancy University Hospital, University of Lorraine, Nancy, France; UMR-S 942, INSERM, Paris, France; U1116, INSERM, Nancy, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris Sudden Death Expertise Center, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Elodie Feliot
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Koji Takagi
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Bruno Megarbane
- Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, INSERM UMRS-1144, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité,UMR-S 942, INSERM, Paris, France.
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35
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Lee JC, Tae HJ, Cho JH, Kim IS, Lee TK, Park CW, Park YE, Ahn JH, Park JH, Yan BC, Lee HA, Hong S, Won MH. Therapeutic hypothermia attenuates paraplegia and neuronal damage in the lumbar spinal cord in a rat model of asphyxial cardiac arrest. J Therm Biol 2019; 83:1-7. [PMID: 31331507 DOI: 10.1016/j.jtherbio.2019.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 01/27/2023]
Abstract
Spinal cord ischemia can result from cardiac arrest. It is an important cause of severe spinal cord injury that can lead to serious spinal cord disorders such as paraplegia. Hypothermia is widely acknowledged as an effective neuroprotective intervention following cardiac arrest injury. However, studies on effects of hypothermia on spinal cord injury following asphyxial cardiac arrest and cardiopulmonary resuscitation (CA/CPR) are insufficient. The objective of this study was to examine effects of hypothermia on motor deficit of hind limbs of rats and vulnerability of their spinal cords following asphyxial CA/CPR. Experimental groups included a sham group, a group subjected to CA/CPR, and a therapeutic hypothermia group. Severe motor deficit of hind limbs was observed in the control group at 1 day after asphyxial CA/CPR. In the hypothermia group, motor deficit of hind limbs was significantly attenuated compared to that in the control group. Damage/death of motor neurons in the lumbar spinal cord was detected in the ventral horn at 1 day after asphyxial CA/CPR. Neuronal damage was significantly attenuated in the hypothermia group compared to that in the control group. These results indicated that therapeutic hypothermia after asphyxial CA/CPR significantly reduced hind limb motor dysfunction and motoneuronal damage/death in the ventral horn of the lumbar spinal cord following asphyxial CA/CPR. Thus, hypothermia might be a therapeutic strategy to decrease motor dysfunction by attenuating damage/death of spinal motor neurons following asphyxial CA/CPR.
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Affiliation(s)
- Jae-Chul Lee
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea
| | - Hyun-Jin Tae
- Bio-Safety Research Institute, College of Veterinary Medicine, Chonbuk National University, Chonbuk, Iksan, 54596, Republic of Korea
| | - Jeong Hwi Cho
- Bio-Safety Research Institute, College of Veterinary Medicine, Chonbuk National University, Chonbuk, Iksan, 54596, Republic of Korea
| | - In-Shik Kim
- Bio-Safety Research Institute, College of Veterinary Medicine, Chonbuk National University, Chonbuk, Iksan, 54596, Republic of Korea
| | - Tae-Kyeong Lee
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea
| | - Cheol Woo Park
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea
| | - Young Eun Park
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea
| | - Ji Hyeon Ahn
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon, Gangwon, 24252, Republic of Korea
| | - Joon Ha Park
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon, Gangwon, 24252, Republic of Korea
| | - Bing Chun Yan
- Institute of Integrative Traditional and Western Medicine, Medical College, Yangzhou University, Yangzhou, Jiangsu, 225001, PR China
| | - Hyang-Ah Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea
| | - Seongkweon Hong
- Department of Surgery, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea.
| | - Moo-Ho Won
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon, 24341, Republic of Korea.
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36
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
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Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Tze-Fan Chao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Health, Hollywood, FL, USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health, Framingham Heart Study, Boston, MA, USA
| | | | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography, Instituto Nacional De Cardiologia, Mexico City, Mexico
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Atul Verma
- Southlake Regional Health Centre, Ontario, Canada
| | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, People's Republic of China
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37
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Abstract
Ventricular fibrillation (VF) is the most commonly encountered arrhythmia following out-of-hospital cardiac arrest. Previous studies have demonstrated early defibrillation and bystander cardiopulmonary resuscitation as essential in reducing patient mortality. What remains a clinical concern, however, is the treatment of patients experiencing VF refractory to defibrillation. Although current guidelines advocate pharmacotherapy for the management of shock-refractory VF, double sequential defibrillation has become a popular topic of discussion. This article provides a discourse regarding refractory VF, and a review of double sequential defibrillation literature. Further study is required before the recommendation for widespread implementation of this defibrillation technique.
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Affiliation(s)
- Erica M Simon
- Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - Kaori Tanaka
- Department of Emergency Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7736, San Antonio, TX 78229, USA.
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38
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Bohm M, Lilja G, Finnbogadóttir H, Cronberg T, Undén J, Friberg H, Kjærgaard J, Nielsen N, Wise MP, Åkerman E. Detailed analysis of health-related quality of life after out-of-hospital cardiac arrest. Resuscitation 2018; 135:197-204. [PMID: 30385386 DOI: 10.1016/j.resuscitation.2018.10.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
AIM To describe the detailed health-related quality of life (HRQoL) in survivors from the TTM-trial and to investigate potential differences related to sex and age. METHODS This is a cross-sectional study originating from a large prospective international, multicentre trial, including 442 respondents who answered the Short Form-36 item Questionnaire Health Survey version 2® (SF-36v2®) at a structured follow-up 6 months after out-of-hospital cardiac arrest (OHCA). Statistical analysis between independent groups were performed with Mann-Whitney U or Chi-square. Age was analysed primarily as a dichotomised variable. RESULTS Although overall physical and mental health were within the normal range, a substantial proportion of respondents had impaired function at domain-specific levels, particularly in Role-Physical (50%) and Role-Emotional (35%). Females scored significantly lower than males in; Physical Functioning (41.7 vs. 47.9, p < 0.001), Role-Physical (40.4 vs. 44.3, p = 0.02), General Health (47.0 vs. 50.5, p = 0.02), Vitality (47.2 vs. 52.7, p < 0.001), and Role-Emotional (41.5 vs. 46.2, p = 0.009). Those ≤65 years scored significantly better in Physical Functioning (47.9 vs. 44.1 p < 0.001), while those >65 years scored significantly better in Vitality (50.8 vs. 53.7, p = 0.006) and Mental Health (50.3 vs. 52.6, p = 0.04). CONCLUSIONS Many OHCA survivors demonstrated impaired function in HRQoL at a domain level, despite most patients reporting an acceptable general HRQoL. Females reported worse HRQoL than males. Older age was associated with a worse Physical Functioning but better Vitality and Mental Health. Role-Physical and Role-Emotional aspects of health were especially affected, even when effects of age and sex where accounted for.
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Affiliation(s)
- Mattias Bohm
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
| | - Gisela Lilja
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Hafrún Finnbogadóttir
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Tobias Cronberg
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Johan Undén
- Lund University, Hallands Hospital Halmstad, Department of Operation and Intensive Care, Halmstad, Sweden
| | - Hans Friberg
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Department of Intensive and Perioperative Care, Malmö, Sweden
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Anesthesiology and Intensive Care, Helsingborg, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Eva Åkerman
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
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39
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Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of safety and adverse effects in the practice of therapeutic hypothermia. Am J Emerg Med 2018; 36:1886-1894. [PMID: 30017685 DOI: 10.1016/j.ajem.2018.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022] Open
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40
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Suryanarayana P, Garza HHK, Klewer J, Hutchinson MD. Electrophysiologic Considerations After Sudden Cardiac Arrest. Curr Cardiol Rev 2018; 14:102-108. [PMID: 29737257 PMCID: PMC6088441 DOI: 10.2174/1573403x14666180507164443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/31/2018] [Accepted: 04/25/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Sudden Cardiac Death (SCD) remains a major public health concern, accounting for more than 50% of cardiac deaths. The majority of these deaths are related to ischemic heart disease, however increasingly recognized are non-ischemic causes such as cardiac channelopathies. Bradyarrhythmias and pulseless electrical activity comprise a larger proportion of out-of-hospital arrests than previously realized, particularly in patients with more advanced heart failure or noncardiac triggers such as pulmonary embolism. Patients surviving Sudden Cardiac Arrest (SCA) have a substantial risk of recurrence, particularly within 18 months post event. The timing of tachyarrhythmias complicating acute infarction has important implications regarding the likelihood of recurrence, with those occurring within 48 hours having a more favorable long-term outcome. In the absence of a clear reversible cause, implantable cardioverter defibrillators remain the mainstay in the secondary prevention of SCD. Post defibrillation electromechanical dissociation is common in patients with cardiomyopathy and can lead to SCD despite successful defibrillation of the primary tachyarrhythmia. Antiarrhythmic agents are highly effective in preventing recurrent arrhythmias in specific diseases such as the congenital long QT syndrome. Conclusion: Catheter ablation is used most commonly to prevent recurrent ICD therapies in patients with structural heart disease-related ventricular arrhythmias, however recent publications have shown substantial benefit in other entities such as idiopathic ventricular fibrillation.
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Affiliation(s)
- Prakash Suryanarayana
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Hyon-He K Garza
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Jacob Klewer
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Mathew D Hutchinson
- Division of Cardiovascular Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
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41
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK, Bautista-Vargas WF, Chiang CE, Cuesta A, Dan GA, Frankel DS, Guo Y, Hatala R, Lee YS, Murakawa Y, Pellegrini CN, Pinho C, Milan DJ, Morin DP, Nadalin E, Ntaios G, Prabhu MA, Proietti M, Rivard L, Valentino M, Shantsila A. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice? J Arrhythm 2018; 34:99-123. [PMID: 29657586 PMCID: PMC5891416 DOI: 10.1002/joa3.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany
| | | | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute Memorial Health Hollywood FL USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA
| | | | - Lin Yee Chen
- Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany
| | - Jonathan Kalman
- Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia
| | | | | | - Deirdre A Lane
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico
| | - Tatjana Potpara
- School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK
| | | | - Hung-Fat Tse
- Department of Medicine The University of Hong Kong Hong Kong China
| | - Atul Verma
- Southlake Regional Health Centre Newmarket ON Canada
| | - Shu Zhang
- Beijing Fuwai Hospital Beijing China
| | | | - William-Fernando Bautista-Vargas
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Chern-En Chiang
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alejandro Cuesta
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Gheorghe-Andrei Dan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David S Frankel
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yutao Guo
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Robert Hatala
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Young Soo Lee
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yuji Murakawa
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Cara N Pellegrini
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Claudio Pinho
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David J Milan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Daniel P Morin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Elenir Nadalin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - George Ntaios
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mukund A Prabhu
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Marco Proietti
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Lena Rivard
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mariana Valentino
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alena Shantsila
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
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European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Heart Rhythm 2018; 15:e37-e60. [PMID: 29563045 DOI: 10.1016/j.hrthm.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/18/2022]
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Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. Additionally, we describe how investigators and key stakeholders in resuscitation science have formulated specific Utstein data element domains in an attempt to standardise the definitions and outcomes reported in OHCA research so that management pathways can be improved. Finally, we identify the predictors of survival after OHCA and what primary and secondary prevention strategies can be instigated to mitigate the devastating sequelae of this growing public health issue.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.
| | - Kyoung-Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Thomas Rea
- Division of General Internal Medicine, Harborview Medical Centre, University of Washington, Seattle, WA, USA
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44
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Sarak B, Goodman SG, Brieger D, Gale CP, Tan NS, Budaj A, Wong GC, Huynh T, Tan MK, Udell JA, Bagai A, Fox KA, Yan AT. Electrocardiographic Findings in Patients With Acute Coronary Syndrome Presenting With Out-of-Hospital Cardiac Arrest. Am J Cardiol 2018; 121:294-300. [PMID: 29197473 DOI: 10.1016/j.amjcard.2017.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022]
Abstract
We sought to characterize presenting electrocardiographic findings in patients with acute coronary syndromes (ACSs) and out-of-hospital cardiac arrest (OHCA). In the Global Registry of Acute Coronary Events and Canadian ACS Registry I, we examined presenting and 24- to 48-hour follow-up ECGs (electrocardiogram) of ACS patients who survived to hospital admission, stratified by presentation with OHCA. We assessed the prevalence of ST-segment deviation and bundle branch blocks (assessed by an independent ECG core laboratory) and their association with in-hospital and 6-month mortality among those with OHCA. Of the 12,040 ACS patients, 215 (1.8%) survived to hospital admission after OHCA. Those with OHCA had higher presenting rates of ST-segment elevation, ST-segment depression, T-wave inversion, precordial Q-waves, left bundle branch block (LBBB), and right bundle branch block (RBBB) than those without. Among patients with OHCA, those with ST-segment elevation had significantly lower in-hospital mortality (20.9% vs 33.0%, p = 0.044) and a trend toward lower 6-month mortality (27% vs 39%, p = 0.060) compared with those without ST-segment elevation. Conversely, among OCHA patients, LBBB was associated with significantly higher in-hospital and 6-month mortality rates (58% vs 22%, p <0.001, and 65% vs 28%, p <0.001, respectively). ST-segment depression and RBBB were not associated with either outcome. Sixty-three percent of bundle branch blocks (RBBB or LBBB) on the presenting ECG resolved by 24 to 48 hours. In conclusion, compared with ACS patients without cardiac arrest, those with OHCA had higher rates of ST-segment elevation, LBBB, and RBBB on admission. Among OHCA patients, ST-segment elevation was associated with lower in-hospital mortality, whereas LBBB was associated with higher in-hospital and 6-month mortality.
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45
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Ladny JR, Smereka J, Rodríguez-Núñez A, Leung S, Ruetzler K, Szarpak L. Is there any alternative to standard chest compression techniques in infants? A randomized manikin trial of the new "2-thumb-fist" option. Medicine (Baltimore) 2018; 97:e9386. [PMID: 29384839 PMCID: PMC5805411 DOI: 10.1097/md.0000000000009386] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pediatric cardiac arrest is a fatal emergent condition that is associated with high mortality, permanent neurological injury, and is a socioeconomic burden at both the individual and national levels. The aim of this study was to test in an infant manikin a new chest compression (CC) technique ("2 thumbs-fist" or nTTT) in comparison with standard 2-finger (TFT) and 2-thumb-encircling hands techniques (TTEHT). METHODS This was prospective, randomized, crossover manikin study. Sixty-three nurses who performed a randomized sequence of 2-minute continuous CC with the 3 techniques in random order. Simulated systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressures (PP, SBP-DBP) in mm Hg were measured. RESULTS The nTTT resulted in a higher median SBP value (69 [IQR, 63-74] mm Hg) than TTEHT (41.5 [IQR, 39-42] mm Hg), (P < .001) and TFT (26.5 [IQR, 25.5-29] mm Hg), (P <.001). The simulated median value of DBP was 20 (IQR, 19-20) mm Hg with nTTT, 18 (IQR, 17-19) mm Hg with TTEHT and 23.5 (IQR, 22-25.5) mm Hg with TFT. DBP was significantly higher with TFT than with TTEHT (P <.001), as well as with TTEHT than nTTT (P <.001). Median values of simulated MAP were 37 (IQR, 34.5-38) mm Hg with nTTT, 26 (IQR, 25-26) mm Hg with TTEHT and 24.5 (IQR,23.5-26.5) mm Hg with TFT. A statistically significant difference was noticed between nTTT and TFT (P <.001), nTTT and TTEHT (P <.001), and between TTEHT and TFT (P <.001). Sixty-one subjects (96.8%) preferred the nTTT over the 2 standard methods. CONCLUSIONS The new nTTT technique achieved higher SBP and MAP compared to the standard CC techniques in our infant manikin model. nTTT appears to be a suitable alternative or complementary to the TFT and TTEHT.
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Affiliation(s)
- Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Antonio Rodríguez-Núñez
- Clinursid Research Group, School of Nursing, University of Santiago de Compostela
- Institute of Research of Santiago (IDIS)
- Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela
- SAMID-II Network, Madrid, Spain
| | - Steve Leung
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
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46
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Nehme Z, Andrew E, Nair R, Bernard S, Smith K. Recurrent out-of-hospital cardiac arrest. Resuscitation 2017; 121:158-165. [DOI: 10.1016/j.resuscitation.2017.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/19/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
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47
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Prognostische Bedeutung der Laienreanimation bei extrahospitalem Herz-Kreislauf-Stillstand. Med Klin Intensivmed Notfmed 2017; 112:737-740. [DOI: 10.1007/s00063-017-0327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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48
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Pruitt CM. What happens to the "good saves"? Resuscitation 2017; 121:A4-A5. [PMID: 28943124 DOI: 10.1016/j.resuscitation.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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Zhou L, Lin Q, Wang P, Yao L, Leong K, Tan Z, Huang Z. Enhanced neuroprotective efficacy of bone marrow mesenchymal stem cells co-overexpressing BDNF and VEGF in a rat model of cardiac arrest-induced global cerebral ischemia. Cell Death Dis 2017; 8:e2774. [PMID: 28492549 PMCID: PMC5520708 DOI: 10.1038/cddis.2017.184] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 02/07/2023]
Abstract
Cardiac arrest-induced global cerebral ischemia injury (CA-GCII) usually leads to a poor neurological outcome without an effective treatment. Bone marrow-derived mesenchymal stem cells (BMMSCs) may provide a potential cell-based therapy against neurologic disorders through induction of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF). To optimize the neuroprotective efficacy of BMMSCs further, in this study we have derived BMMSCs, which co-overexpress both BDNF and VEGF, and tested them for the treatment of CA-GCII in a rat model. Lentiviruses that express rat BDNF exon IV or VEGF-A were created using the bicistronic shuttle vectors of pLVX-IRES-ZsGreen1 and pLVX-IRES-tdTomato, respectively. BMMSCs that were co-transduced with the engineered lentiviruses with co-overexpression of both BDNF and VEGF along with corresponding fluorescent protein reporters were injected via jugular vein of rats that just recovered from a cardiac arrest. Animals were then scored for neurofunctional deficits and examined for brain pathology and gene expression relevant to the engraftment seven days after the treatments. We demonstrate that anchorage of lentiviral vector-transduced BMMSCs, which co-overexpressed both BDNF and VEGF in the hippocampus and temporal cortex along with significantly ameliorated brain pathology and improved neurofunctional performance in CA-GCII rats after transplantation. These findings provide a proof of concept for the further validation of engineered BMMSCs for the treatment of CA-GCII patients in clinical practice in the future.
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Affiliation(s)
- Lili Zhou
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Emergency Medicine, Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China
| | - Qingming Lin
- Department of Emergency Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Peng Wang
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Emergency Medicine, Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China
| | - Lan Yao
- Department of Emergency Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Kahong Leong
- Department of Emergency Medicine, Hospital Conde S. Januario, Macau, China
| | - Zhiqun Tan
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA 92697, USA.,Institute of Precision Medicine, Jining Medical University, Jining 272067, China
| | - Zitong Huang
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Emergency Medicine, Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China
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Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, Rajan S, Lippert F, Folke F, Gislason G, Køber L, Fonager K, Jensen SE, Gerds TA, Torp-Pedersen C, Rasmussen BS. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017; 376:1737-1747. [PMID: 28467879 DOI: 10.1056/nejmoa1601891] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.).
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Affiliation(s)
- Kristian Kragholm
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Mads Wissenberg
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Rikke N Mortensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Steen M Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Carolina Malta Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kristinn Thorsteinsson
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Shahzleen Rajan
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Freddy Lippert
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Fredrik Folke
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Gunnar Gislason
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Lars Køber
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kirsten Fonager
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Svend E Jensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Thomas A Gerds
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Christian Torp-Pedersen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Bodil S Rasmussen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
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