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Uehara K, Tagami T, Hyodo H, Takagi G, Ohara T, Yasutake M. The ABC (Age, Bystander, and Cardiogram) score for predicting neurological outcomes of cardiac arrests without pre-hospital return of spontaneous circulation: A nationwide population-based study. Resusc Plus 2024; 19:100673. [PMID: 38881598 PMCID: PMC11177075 DOI: 10.1016/j.resplu.2024.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/18/2024] Open
Abstract
Aim We previously proposed the ABC score to predict the neurological outcomes of cardiac arrest without prehospital return of spontaneous circulation (ROSC). Using nationwide population-based data, this study aimed to validate the ABC score through various resuscitation guideline periods. Methods We analysed cases with cardiac arrest due to internal causes and failure to achieve prehospital ROSC in the All-Japan Utstein Registry. Patients from the 2007-2009, 2012-2014, and 2017-2019 periods were classified into the 2005, 2010, and 2015 guideline groups, respectively. Neurological outcomes were assessed using cerebral performance categories (CPCs) one month after the cardiac arrest. We defined CPC 1-2 as a favourable outcome. We evaluated the test characteristics of the ABC score, which could range from 0 to 3. Results Among the 162,710, 186,228, and 190,794 patients in the 2005, 2010, and 2015 guideline groups, 0.7%, 0.8%, and 0.9% of the patients had CPC 1-2, respectively. The proportions of CPC 1-2 were 2.9%, 3.6%, and 4.6% in patients with ABC scores of 2 and were 9.5%, 13.3%, and 16.8% in patients with ABC scores of 3, respectively. Among patients with ABC scores of 0, 0.2%, 0.1%, and 0.2%, all had CPC 1-2, respectively. The areas under the receiver operating characteristic curves for the ABC score were 0.798, 0.822, and 0.828, respectively. Conclusions The ABC score had acceptable discrimination for neurological outcomes in patients without prehospital ROSC in the three guideline periods.
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Affiliation(s)
- Kazuyuki Uehara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Hideya Hyodo
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Gen Takagi
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Toshihiko Ohara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Masahiro Yasutake
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
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Omatsu K, Yamashita A, Inaba H. Impact of pandemic-related movement restriction on public access defibrillation in Japan: a retrospective cohort study. BMJ Open 2024; 14:e083692. [PMID: 38589259 PMCID: PMC11015190 DOI: 10.1136/bmjopen-2023-083692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES To analyse monthly changes in public access defibrillation (PAD) incidence and outcomes of out-of-hospital cardiac arrest (OHCA) during the 2020-2021 COVID-19 pandemic compared with those during the 2016-2019 prepandemic period with consideration of pandemic-related movement restriction. DESIGN Retrospective cohort study. SETTING An extended database was created by combining and reconciling the nationwide Utstein-style OHCA and the emergency medical service (EMS) transportation databases in Japan. PARTICIPANTS We analysed 226 182 EMS-witnessed, non-newborn and out-of-home OHCA cases in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were the PAD incidence and neurologically favourable 1-month survival rate. The secondary outcomes were bystander cardiopulmonary resuscitation (CPR) provision and dispatcher-assisted CPR attempts. RESULTS The proportion of out-of-home OHCA cases slightly decreased during the pandemic (from 33.7% to 31.9%). Although the pandemic was associated with a decreased PAD incidence, 2-year trend analyses by an interaction test showed that the PAD incidence was lower during the first nationwide declaration of a state of emergency (p<0.001) and in the pandemic's second year (p<0.01). Regardless of location, delays in basic life support (BLS) actions and EMS contact with patients were more common and the rate of PAD-induced return of spontaneous circulation was lower during the pandemic. PAD incidence reduction was significant only in locations with a recommendation of automated external defibrillator placement (p<0.001). In other locations, a pronounced delay in BLS was found during the pandemic. The neurologically favourable survival rate was reduced in parallel with the reduced PAD incidence during the pandemic (r=0.612, p=0.002). CONCLUSIONS Prolonged and repeated movement restrictions during the COVID-19 pandemic worsened the OHCA outcomes concurrently with disturbed BLS actions, including the reduced PAD incidence in out-of-home settings. Maintaining BLS training, re-arranging automated external defibrillator placement and establishing a local alert system for recruiting well-trained citizens to the scene are essential.
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Affiliation(s)
- Kentaro Omatsu
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Akira Yamashita
- Department of Cardiology, Noto General Hospital, Nanao, Japan
| | - Hideo Inaba
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- Department of Emergency Medicine, Kanazawa Medical University, Kahoku-gun, Japan
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Hambelton C, Wu L, Smith J, Thompson K, Neth MR, Daya MR, Jui J, Lupton JR. Utility of end-tidal carbon dioxide to guide resuscitation termination in prolonged out-of-hospital cardiac arrest. Am J Emerg Med 2024; 77:77-80. [PMID: 38104387 DOI: 10.1016/j.ajem.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023] Open
Abstract
STUDY OBJECTIVE To evaluate if the change in end-tidal carbon dioxide (ETCO2) over time has improved discriminatory value for determining resuscitation futility compared to a single ETCO2 value in prolonged, refractory non-shockable out-of-hospital cardiac arrest (OHCA). METHODS This is a retrospective analysis of adult refractory non-shockable, non-traumatic OHCA patients in the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry) from 2018 to 2021. We defined refractory non-shockable OHCA cases as patients with lack of a shockable rhythm at any time or return of spontaneous circulation at any time prior to 30-min of on-scene resuscitation. We abstracted ETCO2 values first recorded after advanced airway placement and nearest to the 30-min mark of on-scene resuscitation (30 min-ETCO2) from EMS charts. The primary outcome was survival to hospital discharge. We compared 30 min-ETCO2 cutoffs of 10 mmHg and 20 mmHg to the trend (increasing or not) from initial to 30 min-ETCO2 (delta-ETCO2) using sensitivity, specificity, and area under the receiver operating curves (AUROC). RESULTS Of 3837 adult OHCA, 2850 were initially non-shockable, and there were 617 (16.1%) cases of refractory non-shockable OHCA at 30-min. We excluded 320 cases without at least two ETCO2 recordings in the EMS chart, leaving 297 cases that met inclusion criteria. Of these, 176 (59.3%) were transported and 2 (0.7%) survived to discharge. Using absolute 30 min-ETCO2 cutoffs, both survivors were in the >10 mmHg group (sensitivity 100.0%, specificity 12.5%), whereas only one survivor was identified in the >20 mmHg group (sensitivity 50.0%, specificity 32.5%). Using delta-ETCO2, both survivors were in the increasing ETCO2 group (sensitivity 100.0%, specificity 60.7%). In comparing the two tests that did not misclassify survivors, the AUROC [95% CI] was higher when using delta-ETCO2 (0.803 [0.775-0.831]) compared to an absolute cutoff of 10 mmHg (0.563 [0.544-0.582]). CONCLUSIONS Nearly one-sixth of EMS-treated adult OHCA patients had refractory non-shockable arrests after at least 30 min of ongoing resuscitation. In this group, the ETCO2 trend following advanced airway placement may be more accurate in guiding termination of resuscitation than an absolute ETCO2 cutoff of 10 or 20 mmHg.
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Affiliation(s)
- Connor Hambelton
- Department of Emergency Medicine at Oregon Health and Science University, United States of America.
| | - Lucy Wu
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Jeffrey Smith
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Kathryn Thompson
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Matthew R Neth
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Mohamud R Daya
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Jonathan Jui
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
| | - Joshua R Lupton
- Department of Emergency Medicine at Oregon Health and Science University, United States of America
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Cheng P, Yang P, Zhang H, Wang H. Prediction Models for Return of Spontaneous Circulation in Patients with Cardiac Arrest: A Systematic Review and Critical Appraisal. Emerg Med Int 2023; 2023:6780941. [PMID: 38035124 PMCID: PMC10684323 DOI: 10.1155/2023/6780941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Prediction models for the return of spontaneous circulation (ROSC) in patients with cardiac arrest play an important role in helping physicians evaluate the survival probability and providing medical decision-making reference. Although relevant models have been developed, their methodological rigor and model applicability are still unclear. Therefore, this study aims to summarize the evidence for ROSC prediction models and provide a reference for the development, validation, and application of ROSC prediction models. Methods PubMed, Cochrane Library, Embase, Elsevier, Web of Science, SpringerLink, Ovid, CNKI, Wanfang, and SinoMed were systematically searched for studies on ROSC prediction models. The search time limit was from the establishment of the database to August 30, 2022. Two reviewers independently screened the literature and extracted the data. The PROBAST was used to evaluate the quality of the included literature. Results A total of 8 relevant prediction models were included, and 6 models reported the AUC of 0.662-0.830 in the modeling population, which showed good overall applicability but high risk of bias. The main reasons were improper handling of missing values and variable screening, lack of external validation of the model, and insufficient information of overfitting. Age, gender, etiology, initial heart rhythm, EMS arrival time/BLS intervention time, location, bystander CPR, witnessed during sudden arrest, and ACLS duration/compression duration were the most commonly included predictors. Obvious chest injury, body temperature below 33°C, and possible etiologies were predictive factors for ROSC failure in patients with TOHCA. Age, gender, initial heart rhythm, reason for the hospital visit, length of hospital stay, and the location of occurrence in hospital were the predictors of ROSC in IHCA patients. Conclusion The performance of current ROSC prediction models varies greatly and has a high risk of bias, which should be selected with caution. Future studies can further optimize and externally validate the existing models.
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Affiliation(s)
- Pengfei Cheng
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | - Pengyu Yang
- School of International Nursing, Hainan Medical University, Haikou 571199, China
| | - Hua Zhang
- School of International Nursing, Hainan Medical University, Haikou 571199, China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou 571199, China
| | - Haizhen Wang
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
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Omatsu K, Uchiyama M, Shimizu U, Ling Y, Okuda S, Koyama Y. Impact of Heavy Snowfall on Emergency Transport and Prognosis of Out-of-Hospital Cardiac Arrest Patients: A Nation-Wide Cohort Study. Prehosp Disaster Med 2023; 38:436-443. [PMID: 37448197 PMCID: PMC10445114 DOI: 10.1017/s1049023x23006040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. METHODS A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. RESULTS A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. CONCLUSIONS This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.
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Affiliation(s)
- Kentaro Omatsu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mieko Uchiyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Utako Shimizu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Yiwei Ling
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shujiro Okuda
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yu Koyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
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Karatsu S, Hirano Y, Kondo Y, Okamoto K, Tanaka H. A Machine Learning Prediction Model for Non-cardiogenic Out-of-hospital Cardiac Arrest with Initial Non-shockable Rhythm. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:222-230. [PMID: 38855432 PMCID: PMC11153060 DOI: 10.14789/jmj.jmj22-0035-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/23/2023] [Indexed: 06/11/2024]
Abstract
Objectives The purpose of this study was to develop and validate a machine learning prediction model for the prognosis of non-cardiogenic out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm. Design Data were obtained from a nationwide OHCA registry in Japan. Overall, 222,056 patients with OHCA and an initial non-shockable rhythm were identified from the registry in 2016 and 2017. Patients aged <18 years and OHCA caused by cardiogenic origin, cancer, and external factors were excluded. Finally, 58,854 participants were included. Methods Patients were classified into the training dataset (n=29,304, data from 2016) and the test dataset (n=29,550, data from 2017). The training dataset was used to train and develop the machine learning model, and the test dataset was used for internal validation. We selected XGBoost as the machine learning classifier. The primary outcome was the poor prognosis defined as cerebral performance category of 3-5 at 1 month. Eleven prehospital variables were selected as outcome predictors. Results In validation, the machine learning model predicted the primary outcome with an accuracy of 90.8% [95% confidence interval (CI): 90.5-91.2], a sensitivity of 91.4% [CI: 90.7-91.4], a specificity of 74.1% [CI: 69.2-78.6], and an area under the receiver operating characteristic value of 0.89 [0.87-0.92]. The important features for model development were the prehospital return of spontaneous circulation, prehospital adrenaline administration, and initial electrical rhythm. Conclusions We developed a favorable machine learning model to predict the prognosis of non-cardiogenic OHCA with an initial non-shockable rhythm in the early stage of resuscitation.
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Goto Y. No association of CPR duration with long-term survival. Resuscitation 2023; 182:109677. [PMID: 36581181 DOI: 10.1016/j.resuscitation.2022.109677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan.
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Tsai MF, Yu SH, Sie JS, Huang FW, Shih HM. Prognostic value of early and late spontaneous conversion into a shockable rhythm for patients with out-of-hospital cardiac arrest. Am J Emerg Med 2022; 61:192-198. [PMID: 36179648 DOI: 10.1016/j.ajem.2022.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prognostic significance of conversion into a shockable rhythm in patients who experienced out-of-hospital cardiac arrest (OHCA) with an initially nonshockable rhythm is controversial, perhaps due to the timing of rhythm conversion not being considered previously. We aimed to compare the different prognoses of patients with OHCA and early and late conversion of their rhythm into a shockable rhythm. METHODS This was a single-centre retrospective cohort study. We enrolled patients with OHCA who were sent to a medical centre in central Taiwan from 2016 to 2020. Patients <18 years old, those with cardiac arrest due to trauma or a circumstantial cause, and those for whom resuscitation was not attempted were excluded. Patients were divided into two groups in accordance with presentation with an initially shockable rhythm. Those with an initially nonshockable rhythm were divided into three subgroups: early-conversion, late-conversion, and nonconversion groups. The primary outcome was the neurological functional status upon discharge from hospital. RESULTS A total of 1645 patients with OHCA were included: initially shockable rhythm group, 339; early conversion group, 68; late-conversion group, 166; and nonconversion group, 1072. After adjustment, multivariate logistic regression revealed that a favourable neurological outcome was more common in the early conversion group than the nonconversion group (odds ratio [OR] 2.4; 95% confidence interval [CI], 1.1-5.3; p = 0.035), whereas the late-conversion group did not significantly differ from the nonconversion group (OR 0.5; 95% CI, 0.1-1.5; p = 0.211). The proportions of sustained return of spontaneous circulation and survival to discharge were also higher in the early conversion group than the late-conversion group (OR 2.9 95% CI 1.6-5.5, p = 0.001 and OR 4.5, 1.8-11.0, p = 0.001, respectively). CONCLUSION In patients who experience OHCA and have an initially nonshockable rhythm, early conversion into a shockable rhythm resulted in a better prognosis, whereas late conversion was not significantly different from nonconversion.
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Affiliation(s)
- Meng-Feng Tsai
- School of Medicine, College of Medicine, China Medical University, Taiwan; Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Hua Yu
- School of Medicine, College of Medicine, China Medical University, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ji-Syuan Sie
- School of Medicine, College of Medicine, China Medical University, Taiwan
| | - Fen-Wei Huang
- School of Medicine, College of Medicine, China Medical University, Taiwan
| | - Hong-Mo Shih
- School of Medicine, College of Medicine, China Medical University, Taiwan; Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Public Health, China Medical University, Taichung, Taiwan.
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