1
|
da Silva Menezes Jr A, Braga AL, de Souza Cruvinel V. Prevalence, Outcomes, and Risk Factors for Cardiorespiratory Arrest in the Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2022; 26:704-709. [PMID: 35836636 PMCID: PMC9237152 DOI: 10.5005/jp-journals-10071-24201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cardiorespiratory arrest is defined as an abrupt halt in the cardiac mechanical activity that is accompanied by the loss of a detectable pulse, the cessation of breathing, and the loss of consciousness. The aim of this study is to create a clinical–epidemiological profile of patients who experienced cardiorespiratory arrest and were admitted to the intensive care unit to evaluate the associated factors and their impact on the prognosis of these patients. Patients and methods From January to December 2019, the medical records of 135 patients who received cardiopulmonary resuscitation were reviewed for this cross-sectional observational study. The information was collected according to the Utstein model. Results A low return of spontaneous circulation of 22.2% was observed, with a predominance of females (53.3%) and older patients (68.9%), multiple comorbidities at admission (68.4%), and asystole as the predominant rhythm. Female sex and age >60 years were statistically significant (p = 0.017), as was the association between sex and comorbidities (p = 0.036), with heart disease being the most prevalent in females (p = 0.036). Conclusion In this study, even though the resuscitation maneuver time (start of resuscitation following arrest) was very short and the defibrillation was performed promptly, there was a high prevalence of cardiac arrest and low survival rates after cardiopulmonary resuscitation. How to cite this article Menezes da Silva A, Braga AL, Cruvinel de Souza V. Prevalence, Outcomes, and Risk Factors for Cardiorespiratory Arrest in the Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2022;26(6):704–709.
Collapse
Affiliation(s)
- Antônio da Silva Menezes Jr
- Department of Medicine, Faculty of Medicine, Pontifical Catholic University of Goiás (PUC-GO), Goiânia, Goiás, Brazil
- Antônio da Silva Menezes Jr, Department of Medicine, Faculty of Medicine, Pontifical Catholic University of Goiás (PUC-GO), Goiânia, Goiás, Brazil, Phone: +(062) 982711177, e-mail:
| | - Angélica L Braga
- Department of Medicine, Faculty of Medicine, Pontifical Catholic University of Goiás (PUC-GO), Goiânia, Goiás, Brazil
| | - Viviane de Souza Cruvinel
- Department of Medicine, Faculty of Medicine, Pontifical Catholic University of Goiás (PUC-GO), Goiânia, Goiás, Brazil
| |
Collapse
|
2
|
Karasek J, Seiner J, Renza M, Salanda F, Moudry M, Strycek M, Lejsek J, Polasek R, Ostadal P. Bypassing out-of-hospital cardiac arrest patients to a regional cardiac center: Impact on hemodynamic parameters and outcomes. Am J Emerg Med 2021; 44:95-99. [PMID: 33582615 DOI: 10.1016/j.ajem.2021.01.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Current guidelines recommend systematic care for patients who experience out-of-hospital cardiac arrest (OHCA) and the development of cardiac arrest centers (CACs). However, data regarding prolonged transport time of these often hemodynamically unstable patients are limited. METHODS Data from a prospective OHCA registry of a regional CAC collected between 2013 and 2017, when all OHCA patients from the district were required to be transferred directly to the CAC, were analyzed. Patients were divided into two subgroups: CAC, when the CAC was the nearest hospital; and bypass, when OHCA occurred in a region of another local hospital but the subject was transferred directly to the CAC (7 hospitals in the district). Data included transport time, baseline characteristics, hemodynamic and laboratory parameters on admission (systolic blood pressure, lactate, pH, oxygen saturation, body temperature, and initial doses of vasopressors and inotropes), and final outcomes (30-day in-hospital mortality, intensive care unit stay, days on artificial ventilation, and cerebral performance capacity at 1 year). RESULTS A total of 258 subjects experienced OHCA in the study period; however, 27 were excluded due to insufficient data and 17 for secondary transfer to CAC. As such, 214 patients were analyzed, 111 in the CAC group and 103 in the bypass group. The median transport time was significantly longer for the bypass group than the CAC group (40.5 min [IQR 28.3-55.0 min] versus 20.0 min [IQR 13.0-34.0], respectively; p˂0.0001). There were no differences in 30-day in-hospital mortality, 1-year neurological outcome, or median length of mechanical ventilation. There were no differences in baseline characteristics, initial hemodynamic parameters on admission, catecholamine dosage(s). CONCLUSION Individuals who experienced OHCA and taken to a CAC incurred significantly prolonged transport times; however, hemodynamic parameters and/or outcomes were not affected. These findings shows the safety of bypassing local hospitals for a CAC.
Collapse
Affiliation(s)
- Jiri Karasek
- Hospital Liberec, Cardiology, Liberec, Czech Republic; Third Medical Faculty, Charles University, Prague, Czech Republic.
| | - Jiri Seiner
- Hospital Liberec, Cardiology, Liberec, Czech Republic
| | - Metodej Renza
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Martin Moudry
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Matej Strycek
- Hospital Liberec, Cardiology, Liberec, Czech Republic
| | - Jan Lejsek
- EMS Region Liberec, Liberec, Czech Republic
| | | | - Petr Ostadal
- Hospital Na Homolce, Cardiology, Prague, Czech Republic
| |
Collapse
|
3
|
Association between Hospital volume of cardiopulmonary resuscitation for in-hospital cardiac arrest and survival to Hospital discharge. Resuscitation 2020; 148:25-31. [PMID: 31945429 DOI: 10.1016/j.resuscitation.2019.12.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/17/2019] [Accepted: 12/31/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prior studies have shown that hospital case volume is not associated with survival in patients with out-of-hospital cardiac arrest (OHCA). However, how case volume impact on survival for in-hospital cardiac arrest (IHCA) is unknown. METHODS We queried the National Inpatient Sample (NIS) in the U.S. 2005-2011 to identify cases in which in-hospital CPR was performed for IHCA. Restricted cubic spine was used to evaluate the association between hospital annual CPR volume and survival to hospital discharge. RESULTS Across more than 1000 hospitals in NIS, we identified 125,082 cases (mean age 67, 45% female) of IHCA for which CPR was performed over the study period. Median [Q1, Q3] case volume was 60 [34, 99]. Compared to those in the 1 st quartile of case volume, hospitals in the 4th quartile tends to have younger patients (mean = 66 vs 68 yrs), higher comorbidities (median Elixhauser score = 4 vs 3), and in low income areas (37 vs 30%). Overall, 23% of the patients survived to hospital discharge. There was a non-linear association between CPR volume and survival: a non-significant trend towards better survival was observed with increasing annual CPR volume that reached a plateau at 51-55 cases per year, after which survival began to drop and became significantly lower after 75 cases per year (p for non-linearity<0.001). Compared to those in first quartile of case volume, hospitals in 4th quartile had higher length of stay (median = 8 vs 10 days, respectively) and higher rate of non-routine home discharge (64% vs 67%) among those who survived. CONCLUSION Unlike OHCA, low CPR volume is an indicator of good performing hospitals and increasing CPR case volume does not translate to improve survival for IHCA.
Collapse
|
4
|
Koyama S, Gibo K, Yamaguchi Y, Okubo M. Variation in survival after out-of-hospital cardiac arrest between receiving hospitals in Japan: an observational study. BMJ Open 2019; 9:e033919. [PMID: 31767599 PMCID: PMC6887081 DOI: 10.1136/bmjopen-2019-033919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Patient outcomes after out-of-hospital cardiac arrest (OHCA) varies at multilevel (geographical regions, emergency medical service agencies and receiving hospitals) in the USA. However, it remains unclear whether there is a variation in patient outcomes after OHCA between relevant units of the healthcare system such as receiving hospitals in Japan. Therefore, we aimed to quantify the variation in patient outcomes after OHCA between receiving hospitals in Japan. DESIGN Secondary analysis of the prospective multicentre OHCA registry. SETTING The Japan Association for Acute Medicine OHCA Registry, a prospective multicentre OHCA registry, including 73 medical institutions in Japan. PARTICIPANTS 9303 adults (≥18 years old) with OHCA of medical origin, treated at 67 hospitals from June 2014 to December 2015. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 1-month survival after OHCA. The secondary outcome was favourable functional status at 1 month, defined as cerebral performance category scale 1 or 2. We constructed a series of multivariable hierarchical logistic regression models predicting outcomes, accounting for patient-level variables and clustering of patients within hospitals. We evaluated the adjusted 1-month survival and functional outcome for each hospital, ranked hospitals for each outcome and calculated median ORs (MORs) to quantify the between-hospital variation in outcomes. RESULTS The prevalence of 1-month survival after OHCA was 7.1% (663/9303) and that of favourable functional outcome was 3.6% (331/9303). After adjustment for patient-level factors, we observed variations in 1-month survival (range, 1.6%-13.8%; adjusted MOR 1.34; 95% CI 1.16 to 1.67) and favourable functional outcome (range, 0.7%-7.3%; adjusted MOR 1.53; 95% CI 1.10 to 2.24) between hospitals. CONCLUSIONS We found substantial variations in patient outcomes after OHCA within a large group of hospitals in Japan, despite adjustment for patient factors that are known to be associated with different outcomes.
Collapse
Affiliation(s)
- Satoshi Koyama
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan
- Department of Clinical Research and Education, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan
| | - Yutaka Yamaguchi
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan
- Department of Clinical Research and Education, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
5
|
Lipe D, Giwa A, Caputo ND, Gupta N, Addison J, Cournoyer A. Do Out-of-Hospital Cardiac Arrest Patients Have Increased Chances of Survival When Transported to a Cardiac Resuscitation Center? J Am Heart Assoc 2019; 7:e011079. [PMID: 30482128 PMCID: PMC6405559 DOI: 10.1161/jaha.118.011079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Patients suffering from an out‐of‐hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta‐analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out‐of‐hospital cardiac arrest was performed. Methods and Results PubMed, EMBASE, and the Cochrane Library databases were first searched using a specifically designed search strategy. Both original randomized controlled trials and observational studies were considered for inclusion. Cardiac resuscitation centers were defined as having on‐site percutaneous coronary intervention and targeted temperature management capability at all times. The primary outcome measure was survival. Twelve nonrandomized observational studies were retained in this review. A total of 61 240 patients were included in the 10 studies that could be included in the meta‐analysis regarding the survival outcome. Being transported to a cardiac resuscitation center was associated with an increase in survival (odds ratio=1.95 [95% confidence interval 1.47‐2.59], P<0.001). Conclusions Adult patients suffering from an out‐of‐hospital cardiac arrest transported to cardiac resuscitation centers have better outcomes than their counterparts. When possible, it is reasonable to transport these patients directly to cardiac resuscitation centers (class IIa, level of evidence B, nonrandomized). Clinical Trial Registration URL: http://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42018086608.
Collapse
Affiliation(s)
- Demis Lipe
- 1 Department of Emergency Medicine MD Anderson Cancer Center Houston TX
| | - Al Giwa
- 2 Icahn School of Medicine at Mount Sinai New York NY.,3 Department of Emergency Medicine Mount Sinai Hospital New York NY
| | - Nicholas D Caputo
- 4 Department of Emergency Medicine Lincoln Medical Center New York NY
| | - Nachiketa Gupta
- 2 Icahn School of Medicine at Mount Sinai New York NY.,3 Department of Emergency Medicine Mount Sinai Hospital New York NY
| | | | - Alexis Cournoyer
- 6 Université de Montréal Montréal Québec Canada.,7 Department of Emergency Medicine Hôpital du Sacré-Cœur de Montréal Montréal Québec Canada.,8 Institut de Cardiologie de Montréal Montréal Québec Canada
| |
Collapse
|
6
|
Dicker B, Todd VF, Tunnage B, Swain A, Smith T, Howie G. Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes. Resuscitation 2019; 142:111-116. [DOI: 10.1016/j.resuscitation.2019.06.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
|
7
|
Matsuoka Y, Ikenoue T, Hata N, Taguri M, Itaya T, Ariyoshi K, Fukuhara S, Yamamoto Y. Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study. Resuscitation 2019; 136:85-92. [DOI: 10.1016/j.resuscitation.2019.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 01/05/2023]
|
8
|
Elmer J, Callaway CW, Chang CCH, Madaras J, Martin-Gill C, Nawrocki P, Seaman KAC, Sequeira D, Traynor OT, Venkat A, Walker H, Wallace DJ, Guyette FX. Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers. Ann Emerg Med 2018; 73:29-39. [PMID: 30060961 DOI: 10.1016/j.annemergmed.2018.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE It is unknown whether regionalization of postarrest care by interfacility transfer to cardiac arrest receiving centers reduces mortality. We seek to evaluate whether treatment at a cardiac arrest receiving center, whether by direct transport or early interfacility transfer, is independently associated with long-term outcome. METHODS We performed a retrospective cohort study including adults resuscitated from out-of-hospital cardiac arrest in southwestern Pennsylvania and neighboring Ohio, West Virginia, and Maryland, which includes approximately 5.7 million residents in urban, suburban, and rural counties. Patients were treated by 1 of 78 ground emergency medical services agencies or 2 air medical transport agencies between January 1, 2010, and November 30, 2014. Our primary exposures of interest were interfacility transfer to a cardiac arrest receiving center within 24 hours of arrest or any treatment at a cardiac arrest receiving center regardless of transfer status. Our primary outcome was vital status, assessed through December 31, 2014, with National Death Index records. We used unadjusted and adjusted survival analyses to test the independent association of cardiac arrest receiving center care, whether through direct or interfacility transport, on mortality. RESULTS Overall, 5,217 cases were observed for 3,629 person-years, with 3,865 total deaths. Most patients (82%) were treated at 42 non-cardiac arrest receiving centers with median annual volume of 17 cases (interquartile range 1 to 53 cases per center annually), whereas 18% were cared for at cardiac arrest receiving centers receiving at least 1 interfacility transfer per month. In adjusted models, treatment at a cardiac arrest receiving center was independently associated with reduced hazard of death compared with treatment at a non-cardiac arrest receiving center (adjusted hazard ratio 0.84; 95% confidence interval 0.74 to 0.94). These effects were unchanged when analysis was restricted to patients brought from the scene to the treating hospital. No other hospital characteristic, including total out-of-hospital cardiac arrest patient volume and cardiac catheterization capabilities, independently predicted outcome. CONCLUSION Both early interfacility transfer to a cardiac arrest receiving center and direct transport to a cardiac arrest receiving center from the scene are independently associated with reduced mortality.
Collapse
Affiliation(s)
- Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan Madaras
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Philip Nawrocki
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | | | - Denisse Sequeira
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Owen T Traynor
- Department of Emergency Medicine, St. Clair Hospital, Pittsburgh, PA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Heather Walker
- Department of Emergency Medicine, Excela Health, Greensburg, PA
| | - David J Wallace
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
9
|
Tsai SL, Chaou CH, Huang CH, Tzeng IS, Kuo CW, Weng YM, Chien CY. Features of hospital and emergency medical service in out-of-hospital cardiac arrest patients with shockable rhythm. Am J Emerg Med 2017; 35:1222-1227. [PMID: 28341188 DOI: 10.1016/j.ajem.2017.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Predicting the outcome of out-of-hospital cardiac arrest (OHCA) patients is crucial. We examined hospital characteristics and parameters of emergency medical service (including scene time interval and direct ambulance delivery to intensive heart hospitals) as survival or outcome predictors. STUDY DESIGN Data from 546 consecutive OHCA shockable patients treated between January 2012 and December 2015 in Taoyuan City (Taiwan, ROC) were collected. In addition to demographic data, location of arrest, initial rhythm, availability of a hospital with or without 24/7 percutaneous coronary intervention (PCI), emergency medical service (EMS) time, provision of cardiopulmonary resuscitation by a bystander, presence of a witness at collapse, and level of life support were analysed. RESULTS Multivariate analysis showed that hospitalisation with immediate PCI availability was an independent predictor (OR: 4.32; 95% CI: 1.27-14.70) solely for the outcome of survival until discharge. The presence of a witness while collapsing (OR: 3.52; 95% CI: 1.03-11.98), EMS response time (OR: 0.83; 95% CI: 0.70-0.98), and scene time interval (STI; OR: 0.89; 95% CI: 0.81-0.99) were valuable for predicting the neurological outcome. CONCLUSIONS Direct ambulance delivery to intensive heart hospitals that had 24/7 PCI availability was associated with a higher probability of surviving until discharge in OHCA patients with shockable rhythms. Similarly, a witnessed collapse was correlated with being discharged alive from hospital and recovering with good cerebral performance. In addition, longer response time and scene time interval indicated poorer survival and neurological outcome.
Collapse
Affiliation(s)
- Shang-Li Tsai
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Chung-Hsien Chaou
- Chang Gung University College of Medicine, 259 Wen-Hwa 1st Road, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine and Medical Education, Taipei Chang Gung Memorial Hospital, 199 Tunghwa Road, Taipei 105, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan
| | - I-Shiang Tzeng
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 501, 17 Xu-Zhou Road, Taipei 100, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan.
| |
Collapse
|
10
|
Blood lactate concentration after cardiac arrest resulting from myocardial infarction and outcome. Am J Emerg Med 2016; 34:1311-3. [DOI: 10.1016/j.ajem.2016.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022] Open
|