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Higgins S, Dlamini S, Hattingh M, Rambharose S, Theron E, Stassen W. Views and perceptions of advanced life support practitioners on initiating, withholding and terminating resuscitation in out-of-hospital cardiac arrest in the Emergency Medical Services of South Africa. Resusc Plus 2024; 19:100709. [PMID: 39104446 PMCID: PMC11298628 DOI: 10.1016/j.resplu.2024.100709] [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: 03/04/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction This study aimed to explore the views and perceptions of Advanced Life Support (ALS) practitioners in two South African provinces on initiating, withholding, and terminating resuscitation in OHCA. Methodology Semi-structured one-on-one interviews were conducted with operational ALS practitioners working within the prehospital setting in the Western Cape and Free State provinces. Recorded interviews were transcribed and subjected to inductive-dominant, manifest content analysis. After familiarisation with the data, meaning units were condensed, codes were applied and collated into categories that were then assessed, reviewed, and refined repeatedly. Results A total of 18 ALS providers were interviewed. Five main categories were developed from the data analysis: 1) assessment of prognosis, 2) internal factors affecting decision-making, 3) external factors affecting decision-making, 4) system challenges, and 5) ideas for improvement. Factors influencing the assessment of prognosis were history, clinical presentation, and response to resuscitation. Internal factors affecting decision-making were driven by emotion and contemplation. External factors affecting decision-making included family, safety, and disposition. System challenges relating to bystander response and resources were identified. Ideas for improvement in training and support were brought forward. Conclusion Many factors influence OHCA decision-making in the Western Cape and Free State provinces, and numerous system challenges have been identified. The findings of this study can be used as a frame of reference for prehospital emergency care personnel and contribute to the development of context-specific guidelines.
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Affiliation(s)
- S. Higgins
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - S. Dlamini
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - M. Hattingh
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - S. Rambharose
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - E. Theron
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - W. Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Bakhsh A, Binmahfooz S, Balubaid I, Aljedani H, Khared M, Alghamdi A, Alabdulwahab S, Alzahrani M, Abushosha A, Alharbi L, Baarma R, Babekir E. Comparing characteristics and outcomes of in-hospital cardiac arrest during the early and late COVID-19 pandemic at an academic institution in Saudi Arabia. Aust Crit Care 2024:S1036-7314(24)00118-8. [PMID: 38987124 DOI: 10.1016/j.aucc.2024.06.005] [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: 07/29/2023] [Revised: 05/06/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims. AIM We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021). METHODS This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021. RESULTS Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p < 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p < 0.01), and were intubated less often (23.0% vs. 59.3%; p < 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p < 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p < 0.01) were lower during the early COVID-19 pandemic period. CONCLUSIONS The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period.
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Affiliation(s)
- Abdullah Bakhsh
- Department of Emergency Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Saleh Binmahfooz
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Ibtihal Balubaid
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Hind Aljedani
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Mohsin Khared
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Abdulrahman Alghamdi
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Saleh Alabdulwahab
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Mohannad Alzahrani
- Department of Emergency Medicine, King Saud Medical City, P.O. Box 2897, Riyadh 11196, Saudi Arabia.
| | - Aziza Abushosha
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Layan Alharbi
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Reem Baarma
- Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Elmoiz Babekir
- Department of Emergency Medicine and Critical Care Medicine, Ibn Sina National College of Medical Sciences, P.O. Box 3817, Jeddah 22421, Saudi Arabia.
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Vahedian-Azimi A, Hassan IF, Rahimi-Bashar F, Elmelliti H, Akbar A, Shehata AL, Ibrahim AS, Ait Hssain A. What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study. Int J Emerg Med 2024; 17:56. [PMID: 38632515 PMCID: PMC11022486 DOI: 10.1186/s12245-024-00608-2] [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: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR. METHODS This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests. RESULTS The mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021-3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289-4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092-3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161-0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration. CONCLUSION These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Anzila Akbar
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ahmed Labib Shehata
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Abdulsalam Saif Ibrahim
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar.
- Medical Intensive Care Unit, ECMO team, Hamad General Hospital, Doha, Qatar.
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Vahedian-Azimi A, Hassan IF, Rahimi-Bashar F, Elmelliti H, Salesi M, Alqahwachi H, Albazoon F, Akbar A, Shehata AL, Ibrahim AS, Ait Hssain A. Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study. BMC Emerg Med 2024; 24:36. [PMID: 38438853 PMCID: PMC10913290 DOI: 10.1186/s12873-023-00905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/06/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). METHODS This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. RESULTS The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. CONCLUSIONS Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Fatima Albazoon
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Anzila Akbar
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ahmed Labib Shehata
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Abdulsalam Saif Ibrahim
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar.
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Jaeger D, Lafrance M, Canon V, Kosmopoulos M, Gaisendrees C, Debaty G, Yannopoulos D, Hubert H, Chouihed T. Association between cardiopulmonary resuscitation duration and survival after out-of-hospital cardiac arrest according: a first nationwide study in France. Intern Emerg Med 2024; 19:547-556. [PMID: 37898966 DOI: 10.1007/s11739-023-03449-8] [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: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Determining whether to pursue or terminate resuscitation efforts remains one of the biggest challenges of cardiopulmonary resuscitation (CPR). No ideal cut-off duration has been recommended and the association between CPR duration and survival is still unclear for out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the association between CPR duration and 30-day survival after OHCA with favorable neurological outcomes according to initial rhythm. METHODS This was an observational, retrospective analysis of the French national multicentric registry on cardiac arrest, RéAC. The primary endpoint was neurologically intact 30-day survival according to initial rhythm. RESULTS 20,628 patients were included. For non-shockable rhythms, the dynamic probability of 30-day survival with a Cerebral Performance Category (CPC) of 1 or 2 was less than 1% after 25 min of CPR. CPR duration over 10 min was not associated with 30-day survival with CPC of 1 or 2 (adjusted OR: 1.67; CI 95% 0.95-2.94). For shockable rhythms, the dynamic probability of 30-day survival with a CPC score of 1 or 2, was less than 1% after 54 min of CPR. CPR duration of 21-25 min was still associated with 30-day survival and 30-day survival with a CPC of 1 or 2 (adjusted OR: 2.77; CI 95% 2.16-3.57 and adjusted OR: 1.82; CI 95% 1.06-3.13, respectively). CONCLUSIONS Survival decreased rapidly with increasing CPR duration, especially for non-shockable rhythms. Pursuing CPR after 25 min may be futile for patients presenting a non-shockable rhythm. On the other hand, shockable rhythms might benefit from prolonged CPR.
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Affiliation(s)
- Deborah Jaeger
- Emergency Department, University Hospital of Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France.
- INSERM U1116, University of Lorraine, 54500, Vandoeuvre-Les-Nancy, France.
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Martin Lafrance
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Electronique des Arrêts Cardiaques-RéAC), 59000, Lille, France
| | - Valentine Canon
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Electronique des Arrêts Cardiaques-RéAC), 59000, Lille, France
| | - Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
- Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany
| | - Guillaume Debaty
- Department of Emergency Medicine, University Hospital of Grenoble Alps, SAMU 38, Grenoble, France
| | - Demetri Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Hervé Hubert
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
- French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Electronique des Arrêts Cardiaques-RéAC), 59000, Lille, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
- INSERM U1116, University of Lorraine, 54500, Vandoeuvre-Les-Nancy, France
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Ayyıldız A, Ayyıldız FA, Yıldırım ÖT, Yıldız G. Investigation of mortality rates and the factors affecting survival in out-of-hospital cardiac arrest patients. Aging Male 2023; 26:2255013. [PMID: 37724359 DOI: 10.1080/13685538.2023.2255013] [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: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND It is known that even if spontaneous circulation returns after cardiopulmonary resuscitation(CPR) in geriatric out-of-hospital cardiac arrests(OHCA), the overall one-year survival rate of these patients is very low. In our study, we aimed to investigate the factors affecting survival in OHCA cases. METHODS OHCA patients over 18 years of age were examined in two different groups as 18-64 years old and over 65 years old. Demographic data, comorbidities, cardiac arrest rhythms and minutes, and the number of days they were hospitalized in the intensive care unit were recorded. RESULTS The mean age was 65.9 ± 15.8 years and 39.9% (n = 110) of the patients were female. The number of intensive care unit stays was significantly higher in the over-65 age group (p = 0.011). The mortality rate and one-year survival rate were significantly lower in the over-65 age group (p < 0.001). Median CPR time was 21 min (IQR:14-32) in the entire patient population. The duration of CPR was 22 min (IQR:14-35) in patients with in-hospital mortality, and 15 min (IQR:13-25) in patients discharged from the hospital. In this comparison, the difference is statistically significant (p = 0.008). CONCLUSION In our study, it was determined that especially over 65 years of age, coronary artery disease, and post-arrest CPR duration were determinant and predictive factors in in-hospital and long-term survival.
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Affiliation(s)
- Ayşe Ayyıldız
- Department of Intensive Care, Eskişehir City Hospital, Eskişehir, Turkey
| | | | | | - Göknur Yıldız
- Department of Emergency Medicine, Eskişehir City Hospital, Eskişehir, Turkey
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Wengenmayer T, Tigges E, Staudacher DL. Extracorporeal cardiopulmonary resuscitation in 2023. Intensive Care Med Exp 2023; 11:74. [PMID: 37902904 PMCID: PMC10616028 DOI: 10.1186/s40635-023-00558-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023] Open
Affiliation(s)
- Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Eike Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Dawid L Staudacher
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
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Wang JJ, Zhou Q, Huang ZH, Han Y, Qin CZ, Chen ZQ, Xiao XY, Deng Z. Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest. World J Cardiol 2023; 15:508-517. [PMID: 37900904 PMCID: PMC10600787 DOI: 10.4330/wjc.v15.i10.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. AIM To explore factors influencing prehospital return of spontaneous circulation (P-ROSC) in patients with OHCA and develop a nomogram prediction model. METHODS Clinical data of patients with OHCA in Shenzhen, China, from January 2012 to December 2019 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were applied to select the optimal factors predicting P-ROSC in patients with OHCA. A nomogram prediction model was established based on these influencing factors. Discrimination and calibration were assessed using receiver operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was used to evaluate the model's clinical utility. RESULTS Among the included 2685 patients with OHCA, the P-ROSC incidence was 5.8%. LASSO and multivariate logistic regression analyses showed that age, bystander cardiopulmonary resuscitation (CPR), initial rhythm, CPR duration, ventilation mode, and pathogenesis were independent factors influencing P-ROSC in these patients. The area under the ROC was 0.963. The calibration plot demonstrated that the predicted P-ROSC model was concordant with the actual P-ROSC. The good clinical usability of the prediction model was confirmed using DCA. CONCLUSION The nomogram prediction model could effectively predict the probability of P-ROSC in patients with OHCA.
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Affiliation(s)
- Jing-Jing Wang
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Qiang Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Zhen-Hua Huang
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Yong Han
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Chong-Zhen Qin
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Zhong-Qing Chen
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Xiao-Yong Xiao
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China
| | - Zhe Deng
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center , shenzhen 518035, Guangdong Province, China.
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Schultz BV, Rolley A, Doan TN, Bodnar D, Isoardi K. Epidemiology and survival outcomes of out-of-hospital cardiac arrest following volatile substance use in Queensland, Australia. Clin Toxicol (Phila) 2023; 61:649-655. [PMID: 37988117 DOI: 10.1080/15563650.2023.2267172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The deliberate inhalation of volatile substances for their psychotropic properties is a recognised public health issue that can precipitate sudden death. This study aimed to describe the epidemiological characteristics and survival outcomes of patients with out-of-hospital cardiac arrests following volatile substance use. METHODS We conducted a retrospective cohort analysis of all out-of-hospital cardiac arrest attended by the Queensland Ambulance Service over a ten-year period (2012-2021). Incidents were extracted from the Queensland Ambulance Service cardiac arrest registry, which collects clinical information using the Utstein-style guidelines and linked hospital data. RESULTS During the study period, 52,102 out-of-hospital cardiac arrests were attended, with 22 (0.04%) occurring following volatile substance use. The incidence rate was 0.04 per 100,000 population, with no temporal trends identified. The most commonly used product was deodorant cans (19/22), followed by butane canisters (2/22), and nitrous oxide canisters (1/22). The median age of patients was 15 years (interquartile range 13-23), with 14/22 male and 8/22 Indigenous Australians. Overall, 16/22 patients received a resuscitation attempt by paramedics. Of these, 12/16 were bystander witnessed, 10/16 presented in an initial shockable rhythm, and 9/16 received bystander chest compressions. The rates of event survival, survival to hospital discharge, and survival with good neurological outcome (Cerebral Performance Category 1-2) were 69% (11/16, 95% CI 41-89%), 38% (6/16, 95% CI 15-65%) and 31% (5/16, 11-59%), respectively. Eight patients in the paramedic-treated cohort that used hydrocarbon-based products were administered epinephrine during resuscitation. Of these, none subsequently survived to hospital discharge. In contrast, all six patients that did not receive epinephrine survived to hospital discharge, with 5/6 having a good neurological outcome. CONCLUSION Out-of-hospital cardiac arrest following volatile substance use is rare and associated with relatively favourable survival rates. Patients were predominately aged in their adolescence with Indigenous Australians disproportionately represented.
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Affiliation(s)
- Brendan V Schultz
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Adam Rolley
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tan N Doan
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Bodnar
- Department of Health, Queensland Ambulance Service, Brisbane, Queensland, Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Katherine Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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10
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Huabbangyang T, Silakoon A, Papukdee P, Klaiangthong R, Thongpean C, Pralomcharoensuk W, Khaokaen W, Bumrongchai S, Chaisorn R, Saumok C. Sustained Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest; Developing a Predictive Model Based on Multivariate Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e33. [PMID: 37215240 PMCID: PMC10197907 DOI: 10.22037/aaem.v11i1.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction Identifying the predictive factors of sustained return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) will be helpful in management of these patients. This study aimed to develop a predictive model in this regard. Methods In a retrospective observational study, data of adult patients with OHCA, were collected from Vajira emergency medical services patient care report. Multiple logistic regression analysis with a regression coefficient was used to develop a predictive score for a sustained ROSC at the scene. Area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the accuracy of the predictive score for a sustained ROSC. Results Independent factors associated with a sustained ROSC included cardiopulmonary resuscitation (CPR) duration < 30 min (adjusted odds ratio (AOR)= 5.05, 95% confidence interval (CI): 3.34-7.65; p < 0.001); advanced airway management with an endotracheal tube (AOR= 3.06, 95% CI: 1.77-5.31; p < 0.001); advanced airway management with laryngeal mask airway (AOR= 3.42, 95% CI: 1.02-11.46; p = 0.046); defibrillation (AOR = 2.05, 95% CI: 1.31-3.2; p = 0.002); Capillary blood glucose (CBG) level < 150 mg% (AOR= 1.95, 95% CI: 1.05-3.65; p = 0.035); CBG at least 150 mg% (AOR= 2.87, 95% CI: 1.56-5.29; p = 0.001); pupil reflex (AOR = 2.96, 95% CI: 1.1-7.96; p = 0.032); and response time at most 8 min (AOR= 1.66, 95% CI: 1.07-2.57; p = 0.023). These were developed into the pupil reflex, response time, advanced airway management, defibrillation, CBG, and CPR duration (PRAD-CCPR) score. The most accurate cutoff point of score using Youden's index was ≥ 6 with AUC of 0.759 (95% CI: 0.715-0.802; p < 0.001), sensitivity of 62.0% (95% CI: 51.2-71.9%), specificity of 75.7% (95% CI: 69.4-81.2%), positive predictive value of 51.8% (95% CI: 40.9-62.3%), and negative predictive value of 79.5% (95% CI: 73.5-84.6%). Conclusion An optimal PRAD-CCPR score of ≥ 6 provides an acceptable accuracy of 0.759 with sensitivity of 62.0% and specificity of 75.7% in prediction of sustained ROSC following OHCA. This predictive score might help CPR commanders to prognosticate the outcome of patients with OHCA at the scene.
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Affiliation(s)
- Thongpitak Huabbangyang
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Agasak Silakoon
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Pramote Papukdee
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Rossakorn Klaiangthong
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Chaleamlap Thongpean
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Weerawan Khaokaen
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sunisa Bumrongchai
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Ratree Chaisorn
- Division of Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chomkamol Saumok
- Division of Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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11
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Sanz-García A, Martín-Rodríguez F, López-Izquierdo R. Reply to ms AJEM32267 "Comment on: Association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest". Am J Emerg Med 2023; 68:199-200. [PMID: 37085407 DOI: 10.1016/j.ajem.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023] Open
Affiliation(s)
- Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain.
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain.
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, C/ Sinesio Delgado, 4, 28029 Madrid, Spain.
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12
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Djarv T. What is harmless but can kill you? Resuscitation 2022; 179:274-276. [PMID: 36099981 DOI: 10.1016/j.resuscitation.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Therese Djarv
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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13
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Monlezun DJ, Sinyavskiy O, Peters N, Steigner L, Aksamit T, Girault MI, Garcia A, Gallagher C, Iliescu C. Artificial Intelligence-Augmented Propensity Score, Cost Effectiveness and Computational Ethical Analysis of Cardiac Arrest and Active Cancer with Novel Mortality Predictive Score. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081039. [PMID: 36013506 PMCID: PMC9412828 DOI: 10.3390/medicina58081039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022]
Abstract
Background and objectives: Little is known about outcome improvements and disparities in cardiac arrest and active cancer. We performed the first known AI and propensity score (PS)-augmented clinical, cost-effectiveness, and computational ethical analysis of cardio-oncology cardiac arrests including left heart catheterization (LHC)-related mortality reduction and related disparities. Materials and methods: A nationally representative cohort analysis was performed for mortality and cost by active cancer using the largest United States all-payer inpatient dataset, the National Inpatient Sample, from 2016 to 2018, using deep learning and machine learning augmented propensity score-adjusted (ML-PS) multivariable regression which informed cost-effectiveness and ethical analyses. The Cardiac Arrest Cardio-Oncology Score (CACOS) was then created for the above population and validated. The results informed the computational ethical analysis to determine ethical and related policy recommendations. Results: Of the 101,521,656 hospitalizations, 6,656,883 (6.56%) suffered cardiac arrest of whom 61,300 (0.92%) had active cancer. Patients with versus without active cancer were significantly less likely to receive an inpatient LHC (7.42% versus 20.79%, p < 0.001). In ML-PS regression in active cancer, post-arrest LHC significantly reduced mortality (OR 0.18, 95%CI 0.14−0.24, p < 0.001) which PS matching confirmed by up to 42.87% (95%CI 35.56−50.18, p < 0.001). The CACOS model included the predictors of no inpatient LHC, PEA initial rhythm, metastatic malignancy, and high-risk malignancy (leukemia, pancreas, liver, biliary, and lung). Cost-benefit analysis indicated 292 racial minorities and $2.16 billion could be saved annually by reducing racial disparities in LHC. Ethical analysis indicated the convergent consensus across diverse belief systems that such disparities should be eliminated to optimize just and equitable outcomes. Conclusions: This AI-guided empirical and ethical analysis provides a novel demonstration of LHC mortality reductions in cardio-oncology cardiac arrest and related disparities, along with an innovative predictive model that can be integrated within the digital ecosystem of modern healthcare systems to improve equitable clinical and public health outcomes.
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Affiliation(s)
- Dominique J. Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- UNESCO Chair in Bioethics & Human Rights, 00163 Rome, Italy; (A.G.); (C.G.)
- School of Bioethics, Universidad Anahuac México, Mexico City 52786, Mexico;
- Center for Artificial Intelligence and Health Equities, Global System Analytics & Structures, New Orleans, LA 70112, USA; (N.P.); (L.S.)
- Correspondence: or or
| | - Oleg Sinyavskiy
- Department of Public Health, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan;
| | - Nathaniel Peters
- Center for Artificial Intelligence and Health Equities, Global System Analytics & Structures, New Orleans, LA 70112, USA; (N.P.); (L.S.)
| | - Lorraine Steigner
- Center for Artificial Intelligence and Health Equities, Global System Analytics & Structures, New Orleans, LA 70112, USA; (N.P.); (L.S.)
| | - Timothy Aksamit
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Maria Ines Girault
- School of Bioethics, Universidad Anahuac México, Mexico City 52786, Mexico;
| | - Alberto Garcia
- UNESCO Chair in Bioethics & Human Rights, 00163 Rome, Italy; (A.G.); (C.G.)
- School of Bioethics, Universidad Anahuac México, Mexico City 52786, Mexico;
| | - Colleen Gallagher
- UNESCO Chair in Bioethics & Human Rights, 00163 Rome, Italy; (A.G.); (C.G.)
- Pontifical Academy for Life, 00193 Rome, Italy
- Section of Integrated Ethics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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14
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Yılmaz C, Gülen B, Sönmez E, Akbay D, Söğüt Ö, Özdemir S, Özer ÖF. Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients. Avicenna J Med 2022; 12:148-153. [PMID: 36092384 PMCID: PMC9458353 DOI: 10.1055/s-0042-1755389] [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] [Indexed: 11/21/2022] Open
Abstract
Background
SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE−1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR).
Methods
Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE−1 and other routine biochemical parameters were studied in blood samples taken at the time of admission.
Results
There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE−1 value of the ROSC group was significantly higher than that of the non-survivor group (
p
˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE−1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC.
Conclusions
The SCUBE−1 values were found to be significantly higher in the ROSC group compared with the non-survivor group.
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Affiliation(s)
- Cahit Yılmaz
- Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bedia Gülen
- Department of Emergency Medicine, İstanbul Medipol University, Istanbul, Turkey
| | - Ertan Sönmez
- Department of Emergency Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Dursun Akbay
- Private Practice, Bezmialem Foundation University, Istanbul, Turkey
| | - Özgür Söğüt
- Department of Emergency Medicine, University of Health Sciences Haseki Training and Research Hospital, Istanbul, Turkey
| | - Serdar Özdemir
- Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ömer Faruk Özer
- Department of Biochemistry, Bezmialem Foundation University, Istanbul, Turkey
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