In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team

Outcomes with intracoronary vs. intravenous epinephrine in cardiac arrest

BACKGROUND

Advanced Cardiovascular Life Support (ACLS) guidelines recommend intravenous (IV) and intraosseous (IO) epinephrine as a basic cornerstone in the resuscitation process. Data about the efficacy and safety of intracoronary (IC) epinephrine during cardiac arrest in the catheterization laboratory are lacking.

OBJECTIVE

To examine the efficacy and safety of IC vs. IV epinephrine for resuscitation during cardiac arrest in the catheterization laboratory.

METHODS AND RESULTS

This is a prospective observational study that included all patients who experienced cardiac arrest in the cath lab at two tertiary centres in Egypt from January 2015 to July 2022. Patients were divided into two groups according to the route of epinephrine given; IC vs. IV. The primary outcome was survival to hospital discharge. Secondary outcomes included rate of return of spontaneous circulation (ROSC), time-to-ROSC, and favourable neurological outcome at discharge defined as modified Rankin Scale (MRS) <3. A total of 162 patients met our inclusion criteria, mean age (60.69 ± 9.61), 34.6% women. Of them, 52 patients received IC epinephrine, and 110 patients received IV epinephrine as part of the resuscitation. Survival to hospital discharge was significantly higher in the IC epinephrine group (84.62% vs. 53.64%, P < 0.001) compared with the IV epinephrine group. The rate of ROSC was higher in the IC epinephrine group (94.23% vs. 70%, P < 0.001) and achieved in a shorter time (2.6 ± 1.97 min vs. 6.8 ± 2.11 min, P < 0.0001) compared with the IV group. Similarly, favourable neurological outcomes were more common in the IC epinephrine group (76.92% vs. 47.27%, P < 0.001) compared with the IV epinephrine group.

CONCLUSION

In this observational study, IC epinephrine during cardiac arrest in the cath lab appeared to be safe and may be associated with improved outcomes compared with the IV route. Larger randomized studies are encouraged to confirm these results.

Enabling Timely Medical Intervention by Exploring Health-Related Multivariate Time Series with a Hybrid Attentive Model

Modern healthcare practice, especially in intensive care units, produces a vast amount of multivariate time series of health-related data, e.g., multi-lead electrocardiogram (ECG), pulse waveform, blood pressure waveform and so on. As a result, timely and accurate prediction of medical intervention (e.g., intravenous injection) becomes possible, by exploring such semantic-rich time series. Existing works mainly focused on onset prediction at the granularity of hours that was not suitable for medication intervention in emergency medicine. This research proposes a Multi-Variable Hybrid Attentive Model (MVHA) to predict the impending need of medical intervention, by jointly mining multiple time series. Specifically, a two-level attention mechanism is designed to capture the pattern of fluctuations and trends of different time series. This work applied MVHA to the prediction of the impending intravenous injection need of critical patients at the intensive care units. Experiments on the MIMIC Waveform Database demonstrated that the proposed model achieves a prediction accuracy of 0.8475 and an ROC-AUC of 0.8318, which significantly outperforms baseline models.