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Leclercq F, Lonjon C, Marin G, Akodad M, Roubille F, Macia JC, Cornillet L, Gervasoni R, Schmutz L, Ledermann B, Colson P, Cayla G, Lattuca B. Post resuscitation electrocardiogram for coronary angiography indication after out-of-hospital cardiac arrest. Int J Cardiol 2020; 310:73-79. [PMID: 32295717 DOI: 10.1016/j.ijcard.2020.03.037] [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: 12/05/2019] [Revised: 02/22/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Coronary angiography is the standard of care after Out-of-Hospital Cardiac Arrest (OHCA), but its benefit for patients without persistent ST-segment elevation (STE) remains controversial. METHODS All patients admitted for coronary angiography after a resuscitated OHCA were consecutively included in this prospective study. Three patient groups were defined according to post-resuscitation ECG: STE or new left bundle branch block (LBBB) (group 1); other ST/T repolarization disorders (group 2) and no repolarisation disorders (group 3). The proportion and predictive factors of an acute coronary lesion, defined by acute coronary occlusion or thrombotic lesion or lesion associated with flow impairment, were evaluated according to different groups as well as thirty-day mortality. RESULTS Among 129 consecutive patients: 62 (48.1%), 30 (23.3%) and 30 (23.3%) patients were included in groups 1, 2 and 3 respectively. An acute coronary lesion was observed in 43% (n = 55) of patients, mainly in group 1 (n = 44, 70.9%). Initial coronary TIMI 0/1 flow was more frequently observed in group 1 than in group 2 (n = 25, 40.3% vs n = 1, 3.3%) and never in group 3. Chest pain and STE or new LBBB were independently associated with an acute coronary lesion (adj. OR = 7.14 [1.85-25.00]; p = 0.004 and adj. OR = 11.10 [3.70-33.33]; p < 0.001 respectively). In absence of any repolarization disorders, acute coronary lesion or occlusion were excluded with negative predictive values of 93.3% and 100% respectively. The one-month survival rate was 38.8% and was better in patients among the group 1 compared to those from the 2 other groups (n = 28, 45.2% vs n = 21, 35%, respectively; p = 0.014). CONCLUSION Considering the high negative predictive value of post-resuscitation ECG to exclude acute coronary lesion and occlusion after OHCA, a delayed coronary angiography appears a reliable alternative for patients without repolarization disorders.
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Affiliation(s)
- Florence Leclercq
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Clément Lonjon
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France
| | - Grégory Marin
- Department of Epidemiology, Medical Statistics and Public Health, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Mariama Akodad
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - François Roubille
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Jean-Christophe Macia
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Luc Cornillet
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Richard Gervasoni
- University of Montpellier, Cardiology department, Arnaud de Villeneuve University Hospital, Montpellier, France.
| | - Laurent Schmutz
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Bertrand Ledermann
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Montpellier, France..
| | - Guillaume Cayla
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
| | - Benoit Lattuca
- Cardiology Department, Caremeau University Hospital, Montpellier University, Nîmes, France.
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Choi JY, Jang JH, Lim YS, Jang JY, Lee G, Yang HJ, Cho JS, Hyun SY. Performance on the APACHE II, SAPS II, SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia. PLoS One 2018; 13:e0196197. [PMID: 29723201 PMCID: PMC5933749 DOI: 10.1371/journal.pone.0196197] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/09/2018] [Indexed: 01/31/2023] Open
Abstract
Objective This study assessed the ability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, and out-of-hospital cardiac arrest (OHCA) score to predict the outcome of OHCA patients who underwent therapeutic hypothermia (TH). Methods This study included OHCA patients treated with TH between January 2010 and December 2013. The APACHE II score, SAPS II, and SOFA score were calculated at the time of admission and 24 h and 48 h after intensive care unit admission. The OHCA score was calculated at the time of admission. The area under the curve (AUC) of the receiver operating characteristic curve and logistic regression analysis were used to evaluate outcome predictability. Results Data from a total of 173 patients were included in the analysis. The APACHE II score at 0 h and 48 h, SAPS II at 48 h, and OHCA score had moderate discrimination for mortality (AUC: 0.715, 0.750, 0.720, 0.740). For neurologic outcomes, the APACHE II score at 0 h and 48 h, SAPS II at 0 h and 48 h, and OHCA score showed moderate discrimination (AUC: 0.752, 0.738, 0.771, 0.771, 0.764). The APACHE II score, SAPS II and SOFA score at various time points, in addition to the OHCA score, were independent predictors of mortality and a poor neurologic outcome. Conclusions The APACHE II score, SAPS II, SOFA score, and OHCA score have different capabilities in discriminating and estimating hospital mortality and neurologic outcomes. The OHCA score, APACHE II score and SAPS II at time zero and 48 h offer moderate predictive accuracy. Other scores at 0 h and 48 h, except for the SOFA score, are independently associated with 30-day mortality and poor cerebral performance.
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Affiliation(s)
- Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jae Ho Jang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
- * E-mail:
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jee Yong Jang
- Department of Emergency Medicine, Mokpo Hankook Hospital, Mokpo, Jeollanam-do, South Korea
| | - Gun Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jin Seong Cho
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Sung Youl Hyun
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, South Korea
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Swor R, Qu L, Putman K, Sawyer KN, Domeier R, Fowler J, Fales W. Challenges of Using Probabilistic Linkage Methodology to Characterize Post-Cardiac Arrest Care in Michigan. PREHOSP EMERG CARE 2017; 22:208-213. [PMID: 28910207 DOI: 10.1080/10903127.2017.1362086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To improve survival of patients resuscitated from out of hospital cardiac arrest (OCHA), data is needed to assess and improve inpatient post-resuscitation care. Our objective was to apply probabilistic linkage methodology to link EMS and inpatient databases and evaluate whether it may be used to describe post-arrest care in Michigan. METHODS We performed a retrospective study to describe post-cardiac arrest care in adult OHCA patients who were transported to Michigan hospitals from July 1, 2010, to June 30, 2013. Using probabilistic linkage methodology we linked two databases, the Michigan EMS Information System (MI_EMSIS) and the Michigan Inpatient Database (MIDB), which describes inpatient care and outcome of all admissions. Rates of case incidence and survival were compared to published literature. We compared the linked dataset to existing cardiac arrest databases from three counties to evaluate the quality of this linkage. RESULTS Multiple iterations of match strategies were used to create a linked EMS-inpatient dataset. There were 12,838 MI_EMSIS cardiac arrest records of which 1,977 were matched with MIDB records, identifying them as surviving to hospital admission. Of these 590 (30.0%) survived to hospital discharge. The annual survival incidence/100,000 population to admission was 6.93/100,000 and survival incidence to discharge was 2.1/100,000. The matched dataset was compared to county databases identified a limited sensitivity [48.2%, 95% CI 42.1%-55.3%)] and positive predictive value [64.4%, 95% CI 56.8%-71.3%)]. CONCLUSION Use of the MI_EMSISEMS database and the Michigan Inpatient database was feasible and produced rates of cardiac arrest admission and survival rates similar to published literature. This process yielded a limited match compared to existing county cardiac arrest databases. We conclude that such a linked dataset is useful for descriptive purposes but not as a population based dataset to evaluate statewide post-cardiac arrest care.
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Grossestreuer AV, Gaieski DF, Donnino MW, Nelson JIM, Mutter EL, Carr BG, Abella BS, Wiebe DJ. Cardiac arrest risk standardization using administrative data compared to registry data. PLoS One 2017; 12:e0182864. [PMID: 28783754 PMCID: PMC5544239 DOI: 10.1371/journal.pone.0182864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data. METHODS AND RESULTS Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death at hospital discharge. The registry model was considered the "gold standard" with which to compare the administrative model, using metrics including comparing areas under the curve, calibration curves, and Bland-Altman plots. The administrative risk standardization model had a c-statistic of 0.891 (95% CI: 0.876-0.905) compared to a registry c-statistic of 0.907 (95% CI: 0.895-0.919). When limited to only non-modifiable factors, the administrative model had a c-statistic of 0.818 (95% CI: 0.799-0.838) compared to a registry c-statistic of 0.810 (95% CI: 0.788-0.831). All models were well-calibrated. There was no significant difference between c-statistics of the models, providing evidence that valid risk standardization can be performed using administrative data. CONCLUSIONS Risk standardization using administrative data performs comparably to standardization using registry data. This methodology represents a new tool that can enable opportunities to compare hospital performance in specific hospital systems or across the entire US in terms of survival after CA.
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Affiliation(s)
- Anne V. Grossestreuer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - David F. Gaieski
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Joshua I. M. Nelson
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Eric L. Mutter
- Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Brendan G. Carr
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Benjamin S. Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas J. Wiebe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Pineton de Chambrun M, Bréchot N, Lebreton G, Schmidt M, Hekimian G, Demondion P, Trouillet JL, Leprince P, Chastre J, Combes A, Luyt CE. Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest. Intensive Care Med 2016; 42:1999-2007. [PMID: 27681706 DOI: 10.1007/s00134-016-4541-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest. METHODS We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included. Refractory cardiac arrest patients, given VA-ECMO under cardiopulmonary resuscitation, were excluded. RESULTS Ninety-four patients received VA-ECMO for refractory shock post-cardiac arrest. Their hospital and 12-month survival rates were 28 and 27 %, respectively. All 1-year survivors were cerebral performance category 1. Multivariable analysis retained INR >2.4 (OR 4.9; 95 % CI 1.4-17.2), admission SOFA score >14 (OR 5.3; 95 % CI 1.7-16.5), and shockable rhythm (OR 0.3; 95 % CI 0.1-0.9) as independent predictors of hospital mortality, but not SAPS II, out-of-hospital cardiac arrest score, or other cardiac arrest variables. Only 10 % of patients with an admission SOFA score >14 survived, whereas 50 % of those with scores ≤14 were alive at 1 year. Restricting the analysis to the 67 patients with out-of-hospital cardiac arrest of coronary cause yielded similar results. CONCLUSION Among 94 patients implanted with VA-ECMO for refractory cardiogenic shock post-cardiac arrest resuscitation, the 24 (27 %) 1-year survivors had good neurological outcomes, but survival was significantly better for patients with admission SOFA scores <14, shockable rhythm, and INR ≤2.4. VA-ECMO might be considered a rescue therapy for patients with refractory cardiogenic shock post-cardiac arrest resuscitation.
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Affiliation(s)
- Marc Pineton de Chambrun
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Nicolas Bréchot
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Schmidt
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Hekimian
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Pierre Demondion
- Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Louis Trouillet
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Pascal Leprince
- Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean Chastre
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alain Combes
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Service de Réanimation Médicale, iCAN, Groupe Hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
- Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
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Sauneuf B, Bouffard C, Cornet E, Daubin C, Brunet J, Seguin A, Valette X, Chapuis N, du Cheyron D, Parienti JJ, Terzi N. Immature/total granulocyte ratio improves early prediction of neurological outcome after out-of-hospital cardiac arrest: the MyeloScore study. Ann Intensive Care 2016; 6:65. [PMID: 27422256 PMCID: PMC4947062 DOI: 10.1186/s13613-016-0170-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA. Methods This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012–2014) after successfully resuscitated OHCA. The I/T-G ratio was determined in blood samples collected at admission. Results We studied 204 patients (77 % male, median age, 58 [48–67] years), of whom 64 % had a suspected cardiac cause of OHCA, 62 % died in the unit, and 31.5 % survived with good cerebral function. Independent outcome predictors by multivariate analysis were age, first shockable rhythm, bystander-initiated resuscitation, and I/T-G ratio. Compared to the model computed without the I/T-G ratio, the model with the ratio performed significantly better [areas under the ROC curves (AUCs), 0.78 vs. 0.83, respectively; P = 0.04]. These items were used to develop the MyeloScore equation: ([0.47 × I/T-G ratio] + [0.023 × age in years]) − 1.26 if initial VF/VT − 1.1 if bystander-initiated CPR. The MyeloScore predicted neurological outcomes with similar accuracy to the previously reported OHCA score (0.83 and 0.85, respectively; P = 0.6). The ROC–AUC was 0.84, providing external validation of the MyeloScore. Conclusions The I/T-G ratio independently predicts neurological outcome after OHCA and, when added to other known risk factors, improves neurological outcome prediction. The clinical performance of the MyeloScore requires evaluation in a prospective study.
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Affiliation(s)
- Bertrand Sauneuf
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France.
| | - Claire Bouffard
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Edouard Cornet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4652 - MILPAT, Université de Caen Basse-Normandie, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Cedric Daubin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Jennifer Brunet
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Amélie Seguin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Xavier Valette
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hôpital Cochin, AP-HP, Paris, France.,Institut Cochin, CNRS (UMR8104), INSERM, U1016, Université Paris Descartes, Paris, France
| | - Damien du Cheyron
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Inserm U 1075 COMETE, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.,HP2, Inserm U1042, Université Grenoble-Alpes, 38000, Grenoble, France.,Service de réanimation médicale, CHU Grenoble Alpes, 38000, Grenoble, France.,Faculté de Médecine, Université Grenoble-Alpes, 38000, Grenoble, France
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Andersen LW, Kurth T, Chase M, Berg KM, Cocchi MN, Callaway C, Donnino MW. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. BMJ 2016; 353:i1577. [PMID: 27053638 PMCID: PMC4823528 DOI: 10.1136/bmj.i1577] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. DESIGN Prospective observational cohort study. SETTING Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. PARTICIPANTS Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. INTERVENTION Epinephrine given within two minutes after the first defibrillation. MAIN OUTCOME MEASURES Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. RESULTS 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation (0.71, 0.60 to 0.83; P<0.001) and good functional outcome (0.69, 0.58 to 0.83; P<0.001). CONCLUSION Half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines. The receipt of epinephrine within two minutes after the first defibrillation was associated with decreased odds of survival to hospital discharge as well as decreased odds of return of spontaneous circulation and survival to hospital discharge with a good functional outcome.
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Affiliation(s)
- Lars W Andersen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, One Deaconess Road, Boston, MA 02215, USA Department of Anesthesiology, Aarhus University Hospital, Nørrebrogade 44, Bygn. 21, 1 Aarhus 8000, Denmark Research Center for Emergency Medicine, Aarhus University Hospital, Trøjborgvej 72-74, Bygn. 30, Aarhus 8200, Denmark
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Seestrasse 73, Berlin D-13347, Germany
| | - Maureen Chase
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, One Deaconess Road, Boston, MA 02215, USA
| | - Katherine M Berg
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Michael N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, One Deaconess Road, Boston, MA 02215, USA Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Clifton Callaway
- Department of Emergency Medicine, 400A Iroquois, 3600 Forbes Avenue, Pittsburgh, PA 15260, USA
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, One Deaconess Road, Boston, MA 02215, USA Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:82. [PMID: 27038920 PMCID: PMC4818959 DOI: 10.1186/s13054-016-1257-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/26/2016] [Indexed: 12/17/2022]
Abstract
Background The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock. Methods We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a minimum of 1 hour. Patients were randomized to intravenous hydrocortisone 100 mg or placebo every 8 hours for 7 days or until shock reversal. The primary endpoint was time to shock reversal. Results Fifty patients were included with 25 in each group. There was no difference in time to shock reversal between groups (hazard ratio: 0.83 [95 % CI: 0.40–1.75], p = 0.63). We found no difference in secondary outcomes including shock reversal (52 % vs. 60 %, p = 0.57), good neurological outcome (24 % vs. 32 %, p = 0.53) or survival to discharge (28 % vs. 36 %, p = 0.54) between the hydrocortisone and placebo groups. Of the patients with a baseline cortisol < 15 ug/dL, 100 % (6/6) in the hydrocortisone group achieved shock reversal compared to 33 % (1/3) in the placebo group (p = 0.08). All patients in the placebo group died (100 %; 3/3) whereas 50 % (3/6) died in the hydrocortisone group (p = 0.43). Conclusions In a population of cardiac arrest patients with vasopressor-dependent shock, treatment with hydrocortisone did not improve time to shock reversal, rate of shock reversal, or clinical outcomes when compared to placebo. Clinical trial registration Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.
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Andersen LW, Bivens MJ, Giberson T, Giberson B, Mottley JL, Gautam S, Salciccioli JD, Cocchi MN, McNally B, Donnino MW. The relationship between age and outcome in out-of-hospital cardiac arrest patients. Resuscitation 2015; 94:49-54. [PMID: 26044753 DOI: 10.1016/j.resuscitation.2015.05.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/21/2015] [Accepted: 05/18/2015] [Indexed: 01/07/2023]
Abstract
AIM To determine the association between age and outcome in a large multicenter cohort of out-of-hospital cardiac arrest patients. METHODS Retrospective, observational, cohort study of out-of-hospital cardiac arrest from the CARES registry between 2006 and 2013. Age was categorized into 5-year intervals and the association between age group and outcomes (return of spontaneous circulation (ROSC), survival and good neurological outcome) was assessed in univariable and multivariable analysis. We performed a subgroup analysis in patients who had return of spontaneous circulation. RESULTS A total of 101,968 people were included. The median age was 66 years (quartiles: 54, 78) and 39% were female. 31,236 (30.6%) of the included patients had sustained ROSC, 9761 (9.6%) survived to hospital discharge and 8058 (7.9%) survived with a good neurological outcome. The proportion of patients with ROSC was highest in those with age <20 years (34.1%) and lowest in those with age 95-99 years (23.5%). Patients with age <20 years had the highest proportion of survival (16.7%) and good neurological outcome (14.8%) whereas those with age 95-99 years had the lowest proportion of survival (1.7%) and good neurological outcome (1.2%). In the full cohort and in the patients with ROSC there appeared to be a progressive decline in survival and good neurological outcome after the age of approximately 45-64 years. Age alone was not a good predictor of outcome. CONCLUSIONS Advanced age is associated with outcomes in out-of-hospital cardiac arrest. We did not identify a specific age threshold beyond which the chance of a meaningful recovery was excluded.
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Affiliation(s)
- Lars W Andersen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthew J Bivens
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tyler Giberson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brandon Giberson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - J Lawrence Mottley
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shiva Gautam
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Justin D Salciccioli
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bryan McNally
- Department of Emergency Medicine, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Takahashi K, Sasanuma N, Itani Y, Tanaka T, Domen K, Masuyama T, Ohyanagi M, Suzuki K. Impact of early interventions by a cardiac rehabilitation team on the social rehabilitation of patients resuscitated from cardiogenic out-of-hospital cardiopulmonary arrest. Intern Med 2015; 54:133-9. [PMID: 25743003 DOI: 10.2169/internalmedicine.54.2825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We examined the effects of intervention performed by a multidisciplinary cardiac rehabilitation (CR) team on the social rehabilitation of patients with cardiogenic out-of-hospital cardiopulmonary arrest (OHCA) in the acute phase. METHODS This study included 122 patients who were resuscitated after cardiogenic OHCA during a 10-year period. They were divided into two groups: including a non-CR group of patients (n=58) who were admitted before the CR team started performing systematic intervention and a CR group (n=64) who were admitted after the intervention was initiated. The following items were examined for each group: treatment condition at onset, contents of treatment, primary disease, presence or absence of underlying disease, presence or absence of complications, general physical and neurological outcome, duration of hospital stay, and status of social rehabilitation. RESULTS Although the number of patients with cardiogenic OHCA did not markedly change, the number of bystanders participating in cardiopulmonary resuscitation (CPR) was significantly higher in the CR group versus the non-CR group (p<0.01). The effect of bystanders participating in CPR also significantly reduced the mortality outcome (p<0.05 versus the group without CPR), and patients in the CR group were more likely to achieve social rehabilitation (p<0.05 versus the group without CPR). Moreover, the number of patients who returned to society one year later was increased in the CR group versus the non-CR group (p<0.05). The incidence of respiratory complications was also significantly lower in the CR group versus the non-CR group (p<0.05). CONCLUSION Along with the usefulness of rapid pre-hospital aid, our results suggest that systemic intervention performed by the CR team administered while the patient was in the acute phase may have promoted social rehabilitation of patients resuscitated after cardiogenic OHCA.
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Affiliation(s)
- Keiko Takahashi
- Medical Education Center, Hyogo College of Medicine; Cardiovascular Division, Department of Internal Medicine Hyogo College of Medicine, Japan
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Post cardiac arrest syndrome. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Post cardiac arrest syndrome☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442020-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Szymanski FM, Karpinski G, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Kotkowski M, Opolski G. Usefulness of the D-dimer concentration as a predictor of mortality in patients with out-of-hospital cardiac arrest. Am J Cardiol 2013; 112:467-71. [PMID: 23683952 DOI: 10.1016/j.amjcard.2013.03.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 11/26/2022]
Abstract
During cardiac arrest and after cardiopulmonary resuscitation, activation of blood coagulation occurs, with a lack of adequate endogenous fibrinolysis. The aim of the present study was to determine whether the serum D-dimer concentration on admission is an independent predictor of all-cause mortality in patients with out-of-hospital cardiac arrest. We enrolled 182 consecutive patients (122 men, mean age 64.3 ± 15 years), who had presented to the emergency department from January 2007 to July 2012 because of out-of-hospital cardiac arrest. Information about the initial arrest rhythm, biochemical parameters, including the D-dimer concentration on admission, neurologic outcomes, and 30-day all-cause mortality were retrospectively collected. Of the 182 patients, 79 (43.4%) had died. The patients who died had had lower systolic (100 ± 39.6 vs 120.5 ± 26.9 mm Hg; p = 0.0004) and diastolic (58.3 ± 24.1 vs 74 ± 16.3 mm Hg; p <0.0001) blood pressure on admission. The deceased patients more often had had a history of myocardial infarction (32.9% vs 25.2%; p = 0.04) and less often had had an initial shockable rhythm (41.8% vs 60.2%; p = 0.02). The patients who died had had a significantly higher mean D-dimer concentration (9,113.6 ± 5,979.2 vs 6,121.6 ± 4,597.5 μg/L; p = 0.005) compared with patients who stayed alive. On multivariate logistic regression analysis, an on-admission D-dimer concentration >5,205 μg/L (odds ratio 5.7, 95% confidence interval 1.22 to 26.69) and hemoglobin concentration (odds ratio 1.66, 95% confidence interval 1.13 to 2.43) were strong and independent predictors of all-cause mortality. In conclusion, patients with a higher D-dimer concentration on admission had a poorer prognosis. The D-dimer concentration was an independent predictor of all-cause mortality.
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