1
|
Mueller M, Losert H, Sterz F, Gelbenegger G, Girsa M, Gatterbauer M, Zajicek A, Grassmann D, Krammel M, Holzer M, Uray T, Schnaubelt S. Prehospital emergency medicine research by additional teams on scene - Concepts and lessons learned. Resusc Plus 2023; 16:100494. [PMID: 38026141 PMCID: PMC10658399 DOI: 10.1016/j.resplu.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
While the initial minutes of acute emergencies significantly influence clinical outcomes, prehospital research often receives inadequate attention due to several challenges. Retrospective chart reviews carry the risk of incomplete and inaccurate data. Furthermore, prehospital intervention trials frequently encounter difficulties related to extensive training requirements, even during the planning phase. Consequently, we have implemented prospective research concepts involving additional paramedics and physicians directly at the scene during major emergency calls. Three concepts were used: (I) Paramedic field supervisor units, (II) a paramedic + physician field supervisor unit, (III) a special physician-based research car. This paper provides insights into our historical perspective, the current situation, and the lessons learned while overcoming certain barriers and using existing and novel facilitators. Our objective is to support other research groups with our experiences in their planning of upcoming prehospital trials.
Collapse
Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | | | | | - Daniel Grassmann
- Emergency Medical Service Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- Department of Cardiology, Clinic Floridsdorf, Vienna Healthcare Group, Austria
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| |
Collapse
|
2
|
Azcarate I, Urigüen JA, Leturiondo M, Sandoval CL, Redondo K, Gutiérrez JJ, Russell JK, Wallmüller P, Sterz F, Daya MR, Ruiz de Gauna S. The Role of Chest Compressions on Ventilation during Advanced Cardiopulmonary Resuscitation. J Clin Med 2023; 12:6918. [PMID: 37959385 PMCID: PMC10647836 DOI: 10.3390/jcm12216918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Background: There is growing interest in the quality of manual ventilation during cardiopulmonary resuscitation (CPR), but accurate assessment of ventilation parameters remains a challenge. Waveform capnography is currently the reference for monitoring ventilation rate in intubated patients, but fails to provide information on tidal volumes and inspiration-expiration timing. Moreover, the capnogram is often distorted when chest compressions (CCs) are performed during ventilation compromising its reliability during CPR. Our main purpose was to characterize manual ventilation during CPR and to assess how CCs may impact on ventilation quality. Methods: Retrospective analysis were performed of CPR recordings fromtwo databases of adult patients in cardiac arrest including capnogram, compression depth, and airway flow, pressure and volume signals. Using automated signal processing techniques followed by manual revision, individual ventilations were identified and ventilation parameters were measured. Oscillations on the capnogram plateau during CCs were characterized, and its correlation with compression depth and airway volume was assessed. Finally, we identified events of reversed airflow caused by CCs and their effect on volume and capnogram waveform. Results: Ventilation rates were higher than the recommended 10 breaths/min in 66.7% of the cases. Variability in ventilation rates correlated with the variability in tidal volumes and other ventilatory parameters. Oscillations caused by CCs on capnograms were of high amplitude (median above 74%) and were associated with low pseudo-volumes (median 26 mL). Correlation between the amplitude of those oscillations with either the CCs depth or the generated passive volumes was low, with correlation coefficients of -0.24 and 0.40, respectively. During inspiration and expiration, reversed airflow events caused opposed movement of gases in 80% of ventilations. Conclusions: Our study confirmed lack of adherence between measured ventilation rates and the guideline recommendations, and a substantial dispersion in manual ventilation parameters during CPR. Oscillations on the capnogram plateau caused by CCs did not correlate with compression depth or associated small tidal volumes. CCs caused reversed flow during inspiration, expiration and in the interval between ventilations, sufficient to generate volume changes and causing oscillations on capnogram. Further research is warranted to assess the impact of these findings on ventilation quality during CPR.
Collapse
Affiliation(s)
- Izaskun Azcarate
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
- Department of Applied Mathematics, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain
| | - Jose Antonio Urigüen
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
- Department of Applied Mathematics, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain
| | - Mikel Leturiondo
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | | | - Koldo Redondo
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | - José Julio Gutiérrez
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| | - James Knox Russell
- Center for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.K.R.); (M.R.D.)
| | - Pia Wallmüller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (F.S.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (F.S.)
| | - Mohamud Ramzan Daya
- Center for Policy and Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.K.R.); (M.R.D.)
| | - Sofía Ruiz de Gauna
- Group of Signal and Communications, Bilbao School of Engineering, University of the Basque Country UPV/EHU, Plaza Torres Quevedo 1, 48013 Bilbao, Spain; (J.A.U.); (M.L.); (K.R.); (J.J.G.); (S.R.d.G.)
| |
Collapse
|
3
|
Hennenberg J, Hecking M, Sterz F, Hassemer S, Kropiunigg U, Debus S, Stastka K, Löffler-Stastka H. Exploring the Synergy of Music and Medicine in Healthcare: Expert Insights into the Curative and Societal Role of the Relationship between Music and Medicine. Int J Environ Res Public Health 2023; 20:6386. [PMID: 37510618 PMCID: PMC10380075 DOI: 10.3390/ijerph20146386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Our study aimed to investigate the correlation between medicine, health perception, and music as well as the role of music in the healthcare setting. To gain insights into the dynamics between these two fields, we gathered opinions from attendees and presenters at an international conference on music medicine, musicians' health, and music therapy. A team of six interviewers conducted a total of 26 semi-structured interviews. The interview guide focused on four predetermined themes: (1) "music in medicine", (2) "performing arts medicine", (3) "music for the individual", and (4) "music for society". The responses were analyzed using grounded theory methods as well as thematic and content analysis. To enhance the analytical strength, investigator triangulation was employed. Within the predefined themes, we identified several subthemes. Theme 1 encompassed topics such as "listening and performing music for treating diseases and establishing non-verbal relationships", "the value of music in specific disorders, end-of-life care, and pain management", and "the design of sound spaces". Theme 2 explored aspects including the "denial and taboo surrounding physical and mental health issues among musicians", "the importance of prevention", and an antithesis: "pain and suffering driving creativity". Theme 3 addressed the "mental role of music in ordinary and extraordinary life" as well as "music's ability to enable self-conditioning". Lastly, Theme 4 examined the role of music in "cultural self-identification" and "development and education for children". Throughout the interviews, participants expressed a lack of knowledge and awareness regarding interdisciplinary research and the fields of music and medicine. Our findings affirm the significance of music therapy and performing arts medicine as well as the broader relationship between music and medicine. They highlight the potential benefits of perception and experiential pathways for individuals and, consequently, for human society.
Collapse
Affiliation(s)
- Juliane Hennenberg
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Wien, Austria
| | - Manfred Hecking
- Department of Internal Medicine III, Medical University of Vienna, 1090 Wien, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Wien, Austria
| | - Simeon Hassemer
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Wien, Austria
| | - Ulrich Kropiunigg
- Department of Medical Psychology, Medical University of Vienna, 1090 Wien, Austria
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University Medical Center of Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Kurt Stastka
- Department of Psychiatry, Klinik Favoriten Hospital of Vienna, 1100 Wien, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Wien, Austria
- Mental Health and Behavioural Medicine Program, Medical University of Vienna, 1090 Wien, Austria
| |
Collapse
|
4
|
von Amelunxen B, Kirk S, Hind J, Illibauer J, Krall C, Lessing S, Noyelle A, Murphy PMJ, Sterz F. A six-year teaching life supportive first aid program to eventually generate peer trainer pupils: a prospective case control study. BMC Med Educ 2023; 23:496. [PMID: 37407965 DOI: 10.1186/s12909-023-04476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Out of hospital cardiac arrest is a life-threatening condition. To improve the chances of survival, lay-person cardio-pulmonary-resuscitation (CPR) is a crucial factor. Many bystanders fail to react appropriately, even if life supporting first aid (LSFA) programs and campaigns including CPR tried to increase the handling of basic cardiac life support. To achieve an enhanced learning of CPR a pupil's grade after grade teaching program was established in a school with medical students. METHODS The learning of CPR was investigated in a prospective, case-controlled study at an international school. Pupils (12 ± 3 years old) joining our LSFA courses (n = 538, female: 243, attendance for evaluation: 476) were compared to a control group (n = 129, female: 52, attendance for evaluation: 102). Surveys and quality of CPR (QCPR%) through a computer linked "Resusci Anne" dummy were compared with Chi-squared tests, t-tests pair wisely, and by one-way ANOVA. RESULTS Knowledge and skills on the "Resusci Anne" were significantly better in trained grade 9 pupils compared to the control group (QCPR, 59 vs. 25%). The number of LSFA courses each grade 9 student had, correlated with improved practical performance (r2 = 0.21, p < 0.001). The willingness to deliver CPR to strangers increased with improved practical performance. Attitudes towards performing CPR were high in all participating grades. CONCLUSION Repetitive teaching LSFA to grade 5-9 pupil's grade after grade by medical students has been successfully established. Pupils who finish the program will eventually be able to teach LSFA to younger students. This is furthermore a good way of sharing a "learning by teaching" role and it enables to have more pupils as trainers who can provide instruction to a larger number of pupils with the purpose of having a better-trained population in LSFA.
Collapse
Affiliation(s)
| | - Samantha Kirk
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Julian Hind
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Jennifer Illibauer
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Christoph Krall
- Center of Medical Statistics, Medical University of Vienna, Wien, Austria
| | | | | | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria.
- Allgemeines Krankenhaus Wien Medizinische Universität Wien, Universitätsklinik für Notfallmedizin, Währinger Gürtel 18-20/6D, Wien, 1090, Austria.
| |
Collapse
|
5
|
Gauna SRD, Leturiondo M, Azcarate I, Redondo K, Russell J, Wallmüller P, Sterz F. P081 Qualitative analysis of capnogram oscillations caused by manual chest compressions: the role of reversed airflow. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00491-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Schriefl C, Schwameis M, Ettl F, Poppe M, Clodi C, Mueller M, Grafeneder J, Eskandary F, Reindl-Schwaighofer R, Warenits AM, Kupis A, Holzer M, Sterz F, Schoergenhofer C. Blood urea nitrogen kinetics in the early postcardiac arrest phase are associated with clinical outcome: A retrospective cohort study. Eur J Anaesthesiol 2022; 39:405-407. [PMID: 34261100 PMCID: PMC8900999 DOI: 10.1097/eja.0000000000001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christoph Schriefl
- From the Department of Emergency Medicine (CSchr, MS, FE, MP, CC, MM, JG, AMW, MH, FS), Department of Medicine III (FE, RRS) and Department of Clinical Pharmacology (AK, CScho), Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Schnaubelt S, Mayr FB, Losert H, Domanovits H, Sulzgruber P, Holzer M, Sterz F, Uray T. Very long-term survivors of in-hospital and out-of-hospital cardiac arrest show considerable impairment of daily life. Resuscitation 2022; 173:192-200. [DOI: 10.1016/j.resuscitation.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 01/27/2023]
|
8
|
Schriefl C, Steininger P, Clodi C, Mueller M, Poppe M, Ettl F, Nuernberger A, Grafeneder J, Losert H, Schwameis M, Holzer M, Sterz F, Schoergenhofer C. The association of early diarrhea after successful resuscitation following out-of-hospital cardiac arrest with neurological outcome: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28164. [PMID: 34889287 PMCID: PMC8663854 DOI: 10.1097/md.0000000000028164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal ischemia with reperfusion tissue injury contributes to post-cardiac arrest syndrome. We hypothesized that diarrhea is a symptom of intestinal ischemia/reperfusion injury and investigated whether the occurrence of early diarrhea (≤12 hours) after successful cardiopulmonary resuscitation is associated with an unfavorable neurological outcome.We analyzed data from the Vienna Clinical Cardiac Arrest Registry. Inclusion criteria comprised ≥18 years of age, a witnessed, non-traumatic out-of-hospital cardiac arrest, return of spontaneous circulation (ROSC), initial shockable rhythm, and ST-segment elevation in electrocardiogram after ROSC with consecutive coronary angiography. Patients with diarrhea caused by other factors (e.g., infections, antibiotic treatment, or chronic diseases) were excluded. The primary endpoint was neurological function between patients with or without "early diarrhea" (≤12 hours after ROSC) according to cerebral performance categories.We included 156 patients between 2005 and 2012. The rate of unfavorable neurologic outcome was higher in patients with early diarrhea (67% vs 37%). In univariate analysis, the crude odds ratio for unfavorable neurologic outcome was 3.42 (95% confidence interval, 1.11-10.56, P = .03) for early diarrhea. After multivariate adjustment for traditional prognostication markers the odds ratio of early diarrhea was 5.90 (95% confidence interval, 1.28-27.06, P = .02).In conclusion, early diarrhea within 12 hours after successful cardiopulmonary resuscitation was associated with an unfavorable neurological outcome.
Collapse
Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Steininger
- Emergency Department, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
9
|
Mueller M, Beitzke D, Scherz T, Loewe C, Mangold A, Marculescu R, Poppe M, Sterz F, Herkner H, Lang I, Testori C, Weiser C. Copeptin Levels Are Independent from Mild Therapeutic Hypothermia but Do Not Predict Infarct Size in Patients Presenting with ST-Segment Elevation Myocardial Infarction. J Cardiovasc Dev Dis 2021; 8:jcdd8100131. [PMID: 34677200 PMCID: PMC8539262 DOI: 10.3390/jcdd8100131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Mild therapeutic hypothermia (MTH) is a treatment adjunct in ST-segment elevation myocardial infarction (STEMI) that deserves investigation. Copeptin―a surrogate marker for vasopressin―is an early biomarker in STEMI. Data from cardiac arrest patients suggest a reduction of copeptin levels through MTH; however, copeptin levels have not been investigated in MTH during STEMI. Methods: We analyzed patients treated with MTH during STEMI in a sub-study of the STATIM trial (Testori, Heart 2019). Patients were randomized to normothermia or MTH with out-of-hospital initiation. Seven copeptin samples were collected from each patient. Primary endpoint was the difference in copeptin levels between the groups. As secondary endpoints, we defined differences in the kinetics between the sampling timepoints and the correlation between copeptin and the infarct size in relation to left ventricular myocardium. Results: We included 99 patients (MTH n = 47, control n = 52) in our intention to treat analysis. No differences in copeptin values at first medical contact between the MTH and normothermia groups were found. MTH showed no effect on copeptin levels, neither during cooling phase nor through the course. Copeptin peaked at first medical contact and hospital admission in both groups. No differences in kinetics between the timepoints were found. Copeptin showed no correlation with infarct size, neither at first medical contact nor hospital admission. Conclusions: Copeptin levels were not influenced by MTH in STEMI, suggesting the use of this biomarker also during temperature management. Furthermore, copeptin levels were not usable as a surrogate marker for infarct size at any timepoint.
Collapse
Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Thomas Scherz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (D.B.); (C.L.)
| | - Andreas Mangold
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (T.S.); (A.M.); (I.L.)
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
- Correspondence: ; Tel.: +43-40-400-19640; Fax: +43-40-400-19650
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.P.); (F.S.); (H.H.); (C.W.)
| |
Collapse
|
10
|
Mueller M, Grafeneder J, Schoergenhofer C, Schwameis M, Schriefl C, Poppe M, Clodi C, Koch M, Sterz F, Holzer M, Ettl F. Initial Blood pH, Lactate and Base Deficit Add No Value to Peri-Arrest Factors in Prognostication of Neurological Outcome After Out-of-Hospital Cardiac Arrest. Front Med (Lausanne) 2021; 8:697906. [PMID: 34604252 PMCID: PMC8483260 DOI: 10.3389/fmed.2021.697906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear. Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed. Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA. Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.
Collapse
Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Moritz Koch
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
11
|
Schriefl C, Schoergenhofer C, Poppe M, Clodi C, Mueller M, Ettl F, Jilma B, Grafeneder J, Schwameis M, Losert H, Holzer M, Sterz F, Zeiner-Schatzl A. Author Correction: Admission C-reactive protein concentrations are associated with unfavourable neurological outcome after out-of-hospital cardiac arrest. Sci Rep 2021; 11:18912. [PMID: 34535712 PMCID: PMC8448892 DOI: 10.1038/s41598-021-98687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
12
|
Früh A, Bileck A, Muqaku B, Wurm R, Neuditschko B, Arfsten H, Galli L, Kriechbaumer L, Hubner P, Goliasch G, Heinz G, Holzer M, Sterz F, Adlbrecht C, Gerner C, Distelmaier K. Catalase Predicts In-Hospital Mortality after Out-of-Hospital Cardiac Arrest. J Clin Med 2021; 10:jcm10173906. [PMID: 34501367 PMCID: PMC8432041 DOI: 10.3390/jcm10173906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022] Open
Abstract
The generation of harmful reactive oxygen species (ROS), including hydrogen peroxide, in out-of-hospital cardiac arrest (OHCA) survivors causes systemic ischemia/reperfusion injury that may lead to multiple organ dysfunction and mortality. We hypothesized that the antioxidant enzyme catalase may attenuate these pathophysiological processes after cardiac arrest. Therefore, we aimed to analyze the predictive value of catalase levels for mortality in OHCA survivors. In a prospective, single-center study, catalase levels were determined in OHCA survivors 48 h after the return of spontaneous circulation. Thirty-day mortality was defined as the study end point. A total of 96 OHCA survivors were enrolled, of whom 26% (n = 25) died within the first 30 days after OHCA. The median plasma intensity levels (log2) of catalase were 8.25 (IQR 7.64–8.81). Plasma levels of catalase were found to be associated with mortality, with an adjusted HR of 2.13 (95% CI 1.07–4.23, p = 0.032). A Kaplan–Meier analysis showed a significant increase in 30-day mortality in patients with high catalase plasma levels compared to patients with low catalase levels (p = 0.012). High plasma levels of catalase are a strong and independent predictor for 30-day mortality in OHCA survivors. This indicates that ROS-dependent tissue damage is playing a crucial role in fatal outcomes of post-cardiac syndrome patients.
Collapse
Affiliation(s)
- Anton Früh
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Besnik Muqaku
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Benjamin Neuditschko
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Department of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Galli
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Kriechbaumer
- University Clinic of Orthopedics, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | | | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| |
Collapse
|
13
|
Wurm R, Arfsten H, Muqaku B, Ponleitner M, Bileck A, Altmann P, Rommer P, Seidel S, Hubner P, Sterz F, Heinz G, Gerner C, Adlbrecht C, Distelmaier K. Prediction of Neurological Recovery After Cardiac Arrest Using Neurofilament Light Chain is Improved by a Proteomics-Based Multimarker Panel. Neurocrit Care 2021; 36:434-440. [PMID: 34342833 DOI: 10.1007/s12028-021-01321-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/19/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Continuous advances in resuscitation care have increased survival, but the rate of favorable neurological outcome remains low. We have shown the usefulness of proteomics in identifying novel biomarkers to predict neurological outcome. Neurofilament light chain (NfL), a marker of axonal damage, has since emerged as a promising single marker. The aim of this study was to assess the predictive value of NfL in comparison with and in addition to our established model. METHODS NfL was measured in plasma samples drawn at 48 h after cardiac arrest using single-molecule assays. Neurological function was recorded on the cerebral performance category (CPC) scale at discharge from the intensive care unit and after 6 months. The ability to predict a dichotomized outcome (CPC 1-2 vs. 3-5) was assessed with receiver operating characteristic (ROC) curves. RESULTS Seventy patients were included in this analysis, of whom 21 (30%) showed a favorable outcome (CPC 1-2), compared with 49 (70%) with an unfavorable outcome (CPC 3-5) at discharge. NfL increased from CPC 1 to 5 (16.5 pg/ml to 641 pg/ml, p < 0.001). The addition of NfL to the existing model improved it significantly (Wald test, p < 0.001), and the combination of NfL with a multimarker model showed high areas under the ROC curve (89.7% [95% confidence interval 81.7-97.7] at discharge and 93.7% [88.2-99.2] at 6 months) that were significantly greater than each model alone. CONCLUSIONS The combination of NfL with other plasma and clinical markers is superior to that of either model alone and achieves high areas under the ROC curve in this relatively small sample.
Collapse
Affiliation(s)
- Raphael Wurm
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Henrike Arfsten
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Besnik Muqaku
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | | | - Klaus Distelmaier
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
Scherz T, Hofbauer TM, Ondracek AS, Simon D, Sterz F, Testori C, Lang IM, Mangold A. Mild Therapeutic Hypothermia Alters Hemostasis in ST Elevation Myocardial Infarction Patients. Front Cardiovasc Med 2021; 8:707367. [PMID: 34295929 PMCID: PMC8290912 DOI: 10.3389/fcvm.2021.707367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Rationale: Mild therapeutic hypothermia (MTH) is a concept to reduce infarct size and improve outcome after ST-segment elevation myocardial infarction (STEMI). In the STATIM trial, we investigated MTH as an additional therapy for STEMI patients. In the intention-to-treat set, 101 patients were included. No difference in primary and secondary endpoints measured by cardiac magnetic resonance imaging was found. Platelet activation and plasmatic coagulation are key in the pathophysiology of STEMI. In the present study, we investigated the effect of MTH on primary and secondary hemostasis in STEMI patients. Methods and Results: Platelet function and morphology were assessed by routine blood count, aggregometry testing, and flow cytometry. Soluble platelet markers were determined by enzyme-linked immunosorbent assay (ELISA) testing. Plasmatic coagulation was measured throughout the study. Platelet count remained unchanged, irrespective of treatment, whereas platelet size decreased in both patient groups. Platelet aggregometry indicated increased platelet reactivity in the MTH group. Furthermore, higher adenosine diphosphate (ADP) plasma levels were found in MTH patients. Expression of glycoprotein IIb/IIIa was increased on platelets of STEMI patients treated with MTH. Lower patient temperatures correlated with longer clotting times and resulted in reduced pH. Lower pH values were positively correlated with longer clotting times. Conclusion: Present data indicate longer clotting times and higher platelet reactivity in STEMI patients treated with MTH. These changes did not correspond to clinical bleeding events or larger infarct size.
Collapse
Affiliation(s)
- Thomas Scherz
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Thomas M Hofbauer
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Anna S Ondracek
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Daniel Simon
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Cardiology, Klinikum Bamberg, Bamberg, Germany
| | - Fritz Sterz
- Department of Emergency Medicine, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Irene M Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas Mangold
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
15
|
Schriefl C, Schoergenhofer C, Ettl F, Poppe M, Clodi C, Mueller M, Grafeneder J, Jilma B, Magnet IAM, Buchtele N, Boegl MS, Holzer M, Sterz F, Schwameis M. Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome. Front Med (Lausanne) 2021; 8:639803. [PMID: 34179033 PMCID: PMC8219926 DOI: 10.3389/fmed.2021.639803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA. Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression. Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014). Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period.
Collapse
Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Früh A, Goliasch G, Wurm R, Arfsten H, Seidel S, Galli L, Kriechbaumer L, Hubner P, Heinz G, Sterz F, Adlbrecht C, Distelmaier K. Gastric regurgitation predicts neurological outcome in out-of-hospital cardiac arrest survivors. Eur J Intern Med 2021; 83:54-57. [PMID: 32839077 DOI: 10.1016/j.ejim.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 12/19/2022]
Abstract
Hypoxic-ischemic brain injury can affect and disturb the autonomous nervous system (ANS), which regulates various visceral systems including the gastro-intestinal and emetic system. The present study aimed to analyze the predictive value of gastric regurgitation (GReg) for neurological outcome in out-of-hospital cardiac arrest (OHCA) survivors. In this prospective, single-center study, 79 OHCA survivors treated at a university-affiliated tertiary care centre were included and GReg was measured at the first day after successful cardiopulmonary resuscitation. Neurological outcome was assessed by the Cerebral Performance Categories score at discharge. Seventy-six percent of the study population had a poor neurological outcome. GReg was found to be associated with poor neurological outcome with an adjusted OR of 5.37 (95% CI 1.41-20.46; p = 0.01). The area under the ROC curve for GReg was 0.69 (95% CI, 0.56-0.81) for poor neurological outcome. GReg on the first day after OHCA is an early, strong and independent predictor for poor neurological outcome in comatose OHCA survivors. These results are particularly compelling because measurement of GReg is inexpensive and routinely performed in critical care units.
Collapse
Affiliation(s)
- Anton Früh
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Austria
| | - Lukas Galli
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Lukas Kriechbaumer
- University Clinic of Orthopedics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Gottfried Heinz
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christopher Adlbrecht
- Department of Cardiology, Vienna North Hospital - Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research Vienna, Brünner Straße 68, 1210 Vienna, Austria.
| | - Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, Austria
| |
Collapse
|
17
|
Schriefl C, Schoergenhofer C, Grafeneder J, Poppe M, Clodi C, Mueller M, Ettl F, Jilma B, Wallmueller P, Buchtele N, Weikert C, Losert H, Holzer M, Sterz F, Schwameis M. Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome. Thromb Haemost 2020; 121:477-483. [PMID: 33186992 DOI: 10.1055/s-0040-1719029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults ≥18 years of age who suffered a nontraumatic cardiac arrest and had achieved return of spontaneous circulation between January 2013 and December 2018. Patients receiving anticoagulants or thrombolytic therapy and those subjected to extracorporeal membrane oxygenation support were excluded. Routine blood sampling was performed on admission as soon as a vascular access was available. The primary outcome was 30-day neurologic function, assessed by the Cerebral Performance Category scale (3-5 = unfavorable neurologic function). Multivariable regression was used to assess associations between normal (≤41 seconds) and prolonged (>41 seconds) aPTT on admission (exposure) and the primary outcome. Results are given as odds ratio (OR) with 95% confidence intervals (95% CIs). Out of 1,591 cardiac arrest patients treated between 2013 and 2018, 360 patients (32% female; median age: 60 years [interquartile range: 48-70]) were eligible for analysis. A total of 263 patients (73%) had unfavorable neurologic function at day 30. aPTT prolongation >41 seconds was associated with a 190% increase in crude OR of unfavorable neurologic function (crude OR: 2.89; 95% CI: 1.78-4.68, p < 0.001) and with more than double the odds after adjustment for traditional risk factors (adjusted OR: 2.01; 95% CI: 1.13-3.60, p = 0.018). In conclusion, aPTT prolongation on admission is associated with unfavorable neurologic outcome after successful resuscitation from cardiac arrest.
Collapse
Affiliation(s)
| | | | - Juergen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Pia Wallmueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Austria
| |
Collapse
|
18
|
Gauna SRD, Gutiérrez JJ, Ruiz JM, Azkarate I, Leturiondo M, Sandoval CL, Russell JK, Wallmüller P, Sterz F. Characterization of manual ventilations during in-hospital CPR. Resuscitation 2020. [DOI: 10.1016/j.resuscitation.2020.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Gutiérrez JJ, Leturiondo M, Gauna SRD, Ruiz JM, Azkarate I, Sandoval CL, Russell JK, Wallmüller P, Sterz F. Relationship between ventilation volumes caused by chest compressions and the artefact on capnograms during in-hospital CPR. Resuscitation 2020. [DOI: 10.1016/j.resuscitation.2020.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Warenits AM, Hatami J, Müllebner A, Ettl F, Teubenbacher U, Magnet IAM, Bauder B, Janata A, Miller I, Moldzio R, Kramer AM, Sterz F, Holzer M, Högler S, Weihs W, Duvigneau JC. Motor Cortex and Hippocampus Display Decreased Heme Oxygenase Activity 2 Weeks After Ventricular Fibrillation Cardiac Arrest in Rats. Front Med (Lausanne) 2020; 7:513. [PMID: 33015090 PMCID: PMC7511667 DOI: 10.3389/fmed.2020.00513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023] Open
Abstract
Heme oxygenase (HO) and biliverdin reductase (BVR) activities are important for neuronal function and redox homeostasis. Resuscitation from cardiac arrest (CA) frequently results in neuronal injury and delayed neurodegeneration that typically affect vulnerable brain regions, primarily hippocampus (Hc) and motor cortex (mC), but occasionally also striatum and cerebellum. We questioned whether these delayed effects are associated with changes of the HO/BVR system. We therefore analyzed the activities of HO and BVR in the brain regions Hc, mC, striatum and cerebellum of rats subjected to ventricular fibrillation CA (6 min or 8 min) after 2 weeks following resuscitation, or sham operation. From all investigated regions, only Hc and mC showed significantly decreased HO activities, while BVR activity was not affected. In order to find an explanation for the changed HO activity, we analyzed protein abundance and mRNA expression levels of HO-1, the inducible, and HO-2, the constitutively expressed isoform, in the affected regions. In both regions we found a tendency for a decreased immunoreactivity of HO-2 using immunoblots and immunohistochemistry. Additionally, we investigated the histological appearance and the expression of markers indicative for activation of microglia [tumor necrosis factor receptor type I (TNFR1) mRNA and immunoreactivity for ionized calcium-binding adapter molecule 1 (Iba1])], and activation of astrocytes [immunoreactivity for glial fibrillary acidic protein (GFAP)] in Hc and mC. Morphological changes were detected only in Hc displaying loss of neurons in the cornu ammonis 1 (CA1) region, which was most pronounced in the 8 min CA group. In this region also markers indicating inflammation and activation of pro-death pathways (expression of HO-1 and TNFR1 mRNA, as well as Iba1 and GFAP immunoreactivity) were upregulated. Since HO products are relevant for maintaining neuronal function, our data suggest that neurodegenerative processes following CA may be associated with a decreased capacity to convert heme into HO products in particularly vulnerable brain regions.
Collapse
Affiliation(s)
| | - Jasmin Hatami
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Andrea Müllebner
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria.,Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Ursula Teubenbacher
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | - Barbara Bauder
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Andreas Janata
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Miller
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Rudolf Moldzio
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Högler
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weihs
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
21
|
Ondracek AS, Hofbauer TM, Wurm R, Arfsten H, Seidl V, Früh A, Seidel S, Hubner P, Mangold A, Goliasch G, Heinz G, Lang IM, Sterz F, Adlbrecht C, Distelmaier K. Imbalance between plasma double-stranded DNA and deoxyribonuclease activity predicts mortality after out-of-hospital cardiac arrest. Resuscitation 2020; 151:26-32. [PMID: 32251701 DOI: 10.1016/j.resuscitation.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/24/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
AIM Despite an increased rate of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients, almost half of patients do not survive up to hospital discharge. Understanding pathophysiological mechanisms of post-cardiac arrest syndrome is essential for developing novel therapeutic strategies. During systemic inflammatory responses and concomitant cell death, double-stranded (ds) DNA is released into circulation, exerting pro-inflammatory effects. Deoxyribonuclease (DNase) degrades dsDNA. The role of DNase activity in OHCA survivors and impact on clinical outcome has not been analyzed yet. METHODS In a prospective, single-center study, dsDNA and DNase activity were determined at hospital admission (acute phase) and 24 h (subacute phase) after ROSC. The ratio between dsDNA levels and DNase activity was calculated to determine the extent of dsDNA release in relation to the patients' capacity of degradation. Thirty-day mortality was defined as study end point. RESULTS We enrolled 64 OHCA survivors, of whom 26.6% (n = 17) died within 30 days. A peak of circulating dsDNA was observed at admission which decreased within 24 h. DNase activity did not differ between acute and subacute phase, while dsDNA load per DNase activity significantly decreased. The ratio between dsDNA levels and DNase activity in the subacute phase was the strongest predictor of 30-day mortality with an adjusted HR per 1 SD of 3.59 (95% CI, 1.80-7.18, p < 0.001). CONCLUSION Disproportionally increased dsDNA levels uncompensated by DNase activity are a strong predictor of mortality in OHCA survivors. This pilot study points to a potentially protective effect of DNase activity in patients undergoing cardiac arrest.
Collapse
Affiliation(s)
- A S Ondracek
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - T M Hofbauer
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - R Wurm
- Department of Neurology, Medical University of Vienna, Austria
| | - H Arfsten
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - V Seidl
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - A Früh
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - S Seidel
- Department of Neurology, Medical University of Vienna, Austria
| | - P Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - A Mangold
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - G Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - G Heinz
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - I M Lang
- Department of Internal Medicine II, Medical University of Vienna, Austria
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - C Adlbrecht
- Department of Cardiology, Vienna North Hospital - Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria.
| | - K Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, Austria
| |
Collapse
|
22
|
Schnaubelt S, Mayr F, Sterz F, Zajicek A, Uray T. Feasibility of continuous NIRS monitoring during out-of hospital cardiac arrest until 72 hours post-ROSC. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Schnaubelt S, Mayr F, Sterz F, Sulzgruber P, Uray T. Quality of life in long-term survivors of cardiac arrest. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Schriefl C, Mayr F, Poppe M, Zajicek A, Nürnberger A, Clodi C, Herkner H, Sulzgruber P, Lobmeyr E, Schober A, Holzer M, Sterz F, Uray T. Time of out-of-hospital cardiac arrest is not associated with outcome in a metropolitan area: A multicenter cohort study. Resuscitation 2019; 142:61-68. [DOI: 10.1016/j.resuscitation.2019.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/21/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022]
|
25
|
Hubner P, Wijshoff RWCGR, Muehlsteff J, Wallmüller C, Warenits AM, Magnet IAM, Nammi K, Russell JK, Sterz F. On detection of spontaneous pulse by photoplethysmography in cardiopulmonary resuscitation. Am J Emerg Med 2019; 38:526-533. [PMID: 31138516 DOI: 10.1016/j.ajem.2019.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/20/2019] [Accepted: 05/22/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This work investigates the potential of photoplethysmography (PPG) to detect a spontaneous pulse from the finger, nose or ear in order to support pulse checks during cardiopulmonary resuscitation (CPR). METHODS In a prospective single-center cross-sectional study, PPG signals were acquired from cardiac arrest victims who underwent CPR. The PPG signals were analyzed and compared to arterial blood pressure (ABP) signals as a reference during three distranaisco; Date: 2/2/2020; Time:18:44:23inct phases of CPR: compression pauses, on-going compressions and at very low arterial blood pressure. Data analysis was based on a qualitative subjective visual description of similarities of the frequency content of PPG and ABP waveform. RESULTS In 9 patients PPG waveforms corresponded to ABP waveforms during normal blood pressures. During ABP in the clinically challenging range of 60 to 90 mmHg and during chest compressions and pauses, PPG continued to resemble ABP, as both signals showed similar frequency components as a result of chest compressions as well as cardiac activity. Altogether 1199 s of PPG data in compression pauses were expected to show a spontaneous pulse, of which 732 s (61%) of data were artifact-free and showed the spontaneous pulse as visible in the ABP. CONCLUSIONS PPG signals at all investigated sites can indicate pulse presence at the moment the heart resumes beating as verified via the ABP signal. Therefore, PPG may provide decision support during CPR, especially related to preventing and shortening interruptions for unnecessary pulse checks. This could have impact on CPR outcome and should further be investigated.
Collapse
Affiliation(s)
- Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | | | - Jens Muehlsteff
- Oregon Health and Science University, Department of Emergency Medicine, Portland, OR, USA.
| | | | | | | | - Krishnakant Nammi
- Oregon Health and Science University, Department of Emergency Medicine, Portland, OR, USA.
| | - James K Russell
- Oregon Health and Science University, Department of Emergency Medicine, Portland, OR, USA
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| |
Collapse
|
26
|
Dyson K, Brown SP, May S, Smith K, Koster RW, Beesems SG, Kuisma M, Salo A, Finn J, Sterz F, Nürnberger A, Morrison LJ, Olasveengen TM, Callaway CW, Shin SD, Gräsner JT, Daya M, Ma MHM, Herlitz J, Strömsöe A, Aufderheide TP, Masterson S, Wang H, Christenson J, Stiell I, Vilke GM, Idris A, Nishiyama C, Iwami T, Nichol G. International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template. Resuscitation 2019; 138:168-181. [PMID: 30898569 DOI: 10.1016/j.resuscitation.2019.03.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/11/2019] [Accepted: 03/10/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. METHODS We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232). RESULTS Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. CONCLUSIONS The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.
Collapse
Affiliation(s)
- Kylie Dyson
- Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia.
| | - Siobhan P Brown
- University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Susanne May
- University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Markku Kuisma
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Ari Salo
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Judith Finn
- School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia, WA, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria
| | - Alexander Nürnberger
- Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna, Austria
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sang Do Shin
- Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jan-Thorsten Gräsner
- Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel, Kiel, Germany
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States
| | | | - Johan Herlitz
- Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden
| | - Anneli Strömsöe
- School of Health and Social Sciences, University of Dalarna, Falun, Sweden
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Siobhán Masterson
- On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Henry Wang
- Department of Emergency Medicine, University of Texas Health Science Center, Houston, TX, United States
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ian Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwester, Dallas, TX, United States
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Graham Nichol
- University of Washington - Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
27
|
Roedl K, Spiel AO, Nürnberger A, Horvatits T, Drolz A, Hubner P, Warenits AM, Sterz F, Herkner H, Fuhrmann V. Hypoxic liver injury after in- and out-of-hospital cardiac arrest: Risk factors and neurological outcome. Resuscitation 2019; 137:175-182. [PMID: 30831218 DOI: 10.1016/j.resuscitation.2019.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypoxic liver injury (HLI) is a frequent and life-threatening complication in critically ill patients that occurs in up to ten percent of critically ill patients. However, there is a lack of data on HLI following cardiac arrest and its clinical implications on outcome. Aim of this study was to investigate incidence, outcome and functional outcome of patients with HLI after in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). METHODS We conducted an analysis of a cardiac arrest registry data over a 7-year period. All patients with non-traumatic OHCA and IHCA with return of spontaneous circulation (ROSC) treated at the emergency department of a tertiary care hospital were included in the study. HLI was defined according to established criteria. Predictors of HLI, occurrence, clinical and neurological outcome were assessed using multivariable regression. RESULTS Out of 1068 patients after IHCA and OHCA with ROSC, 219 (21%) patients developed HLI. Rate of HLI did not differ significantly in IHCA and OHCA patients. Multivariate regression analysis identified time-to-ROSC [OR 1.18, 95% CI (1.01-1.38); p < 0.05], presence of cardiac failure [OR 2.57, 95% CI (1.65-4.01); p < 0.001] and Charlson comorbidity index [OR 0.83, 95% CI (0.72-0.95); p < 0.01] as independent predictors for occurrence of HLI. Good functional outcome was significantly lower in patients suffering from HLI after 28-days (35% vs. 48%, p < 0.001) and 1-year (34% vs. 44%, p < 0.001). Occurrence of HLI was associated with unfavourable neurological outcome [OR 1.74, 95% CI (1.16-2.61); p < 0.01] in multivariate regression analysis. CONCLUSION New onset of HLI is a frequent finding after IHCA and OHCA. HLI is associated with increased mortality, unfavourable neurological and overall outcome.
Collapse
Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
| | - Alexander O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Alexander Nürnberger
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Thomas Horvatits
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
| | - Andreas Drolz
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
28
|
Olsen JA, Brunborg C, Steinberg M, Persse D, Sterz F, Lozano M, Westfall M, van Grunsven PM, Lerner EB, Wik L. Survival to hospital discharge with biphasic fixed 360 joules versus 200 escalating to 360 joules defibrillation strategies in out-of-hospital cardiac arrest of presumed cardiac etiology. Resuscitation 2019; 136:112-118. [PMID: 30708074 DOI: 10.1016/j.resuscitation.2019.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Guidelines recommend constant or escalating energy levels for shocks after the initial defibrillation attempt. Studies comparing survival to hospital discharge with escalating vs fixed high energy level shocks are lacking. We compared survival to hospital discharge for 200 J escalating to 360 J vs fixed 360 J in patients with initial ventricular fibrillation/pulseless ventricular tachycardia in a post-hoc analysis of the Circulation Improving Resuscitation Care trial database. METHODS AND RESULTS Pre-shock rhythm, rhythm 5 s after shock, shock energy levels, termination of ventricular fibrillation/pulseless ventricular tachycardia (TOF), and survival to hospital discharge were recorded. Association between defibrillation strategy and survival to hospital discharge was investigated with multivariable logistic regression. The escalating energy group included 260 patients and 883 shocks vs 478 patients and 1736 shocks in the fixed-high energy group. There was no difference in survival to hospital discharge between escalating (70/255 patients, 28%) and fixed energy group (132/478 patients, 28%) (unadjusted OR 1.00, 95% CI 0.72-1.42 and adjusted OR 0.81, 95% CI 0.54-1.22, p = 0.32). First shock TOF was 86% in the escalating group compared to 83% in the fixed-high group, p = 0.27. CONCLUSION There was no difference in survival to hospital discharge or the frequency of TOF between escalating energy and fixed-high energy group. ClinicalTrials.gov Identifier: NCT00597207.
Collapse
Affiliation(s)
- Jan-Aage Olsen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mikkel Steinberg
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Persse
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, United States
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Lozano
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Mark Westfall
- Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, WI, United States; Theda Clark Regional Medical Center, Neenah, WI, United States
| | | | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
29
|
Wallmüller C, Spiel A, Sterz F, Schober A, Hubner P, Stratil P, Testori C. Age-dependent effect of targeted temperature management on outcome after cardiac arrest. Eur J Clin Invest 2018; 48:e13026. [PMID: 30215851 PMCID: PMC6586035 DOI: 10.1111/eci.13026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In elder patients after out-of-hospital cardiac arrest, diminished neurologic function as well as reduced neuronal plasticity may cause a low response to targeted temperature management (TTM). Therefore, we investigated the association between TTM (32-34°C) and neurologic outcome in cardiac arrest survivors with respect to age. MATERIAL AND METHODS This retrospective cohort study included patients 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest with presumed cardiac cause, which remained comatose after return of spontaneous circulation. Patients were a priori split by age into four groups (<50 years (n = 496); 50-64 years (n = 714); 65-74 years (n = 395); >75 years (n = 280)). Subsequently, within these groups, patients receiving TTM were compared to those not treated with TTM. RESULTS Out of 1885 patients, 921 received TTM for 24 hours. TTM was significantly associated with good neurologic outcome in patients <65 years of age whereas showing no effect in elders (65-74 years: OR: 1.49 (95% CI: 0.90-2.47); > 75 years: OR 1.44 (95% CI 0.79-2.34)). CONCLUSION In our cohort, it seems that TTM might not be able to achieve the same benefit for neurologic outcome in all age groups. Although the results of this study should be interpreted with caution, TTM was associated with improved neurologic outcome only in younger individuals, patients with 65 years of age or older did not benefit from this treatment.
Collapse
Affiliation(s)
| | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Andreas Schober
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Peter Stratil
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| |
Collapse
|
30
|
Buchtele N, Schober A, Schoergenhofer C, Spiel AO, Mauracher L, Weiser C, Sterz F, Jilma B, Schwameis M. Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest. Eur J Intern Med 2018; 57:44-48. [PMID: 29958747 DOI: 10.1016/j.ejim.2018.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/28/2018] [Accepted: 06/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent Korean data suggest a high prevalence of overt disseminated intravascular coagulation (DIC) and a good predictive performance of the ISTH DIC score in successfully resuscitated out-of-hospital cardiac arrest. OBJECTIVES We hypothesised that in a European cohort of resuscitated out-of-hospital cardiac arrest patients the prevalence of DIC is substantially lower. Furthermore, the determination of D-dimer levels at admission, but not the DIC score, could improve mortality prediction above traditional predictors. PATIENTS/METHODS Data were extracted from a prospective cardiac arrest registry including patients admitted between 2006 and 2015, who achieved return of spontaneous circulation and had parameters for DIC score calculation available. The primary outcome was the prevalence of overt DIC at admission. Secondary outcomes included the association of overt DIC with 30-day mortality and the contribution of the DIC score and D-dimer levels to 30-day mortality prediction using logistic regression. Three stepwise models were evaluated by receiver-operating-characteristic analysis. RESULTS Out of 1179 patients 388 were included in the study. Overt DIC was present in 8% of patients and associated with substantial 30-day mortality (83% vs. 39%). The AUC for model 1, including traditional mortality predictors, was 0.83. The inclusion of D-dimer levels significantly improved prognostication above traditional predictors (model 3, AUC 0.89), whereas the inclusion of the DIC Score had no effect on mortality prediction (model 2, AUC 0.83). CONCLUSION Overt DIC was rare in a European cohort of out-of-hospital cardiac arrest patients. D-dimer levels improved 30-day mortality prediction and provided added value to assess early mortality risk after successful resuscitation.
Collapse
Affiliation(s)
- N Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - A Schober
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - C Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - A O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - L Mauracher
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - C Weiser
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - B Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - M Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
31
|
Testori C, Beitzke D, Mangold A, Sterz F, Loewe C, Weiser C, Scherz T, Herkner H, Lang I. Out-of-hospital initiation of hypothermia in ST-segment elevation myocardial infarction: a randomised trial. Heart 2018; 105:531-537. [PMID: 30361270 PMCID: PMC6580740 DOI: 10.1136/heartjnl-2018-313705] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 01/29/2023] Open
Abstract
Objective To evaluate the effect of prereperfusion hypothermia initiated in the out-of-hospital setting in awake patients with ST-segment elevation myocardial infarction (STEMI) on myocardial salvage measured by cardiac MRI (CMR). Methods Hypothermia was initiated within 6 hours of symptom onset by the emergency medical service with surface cooling pads and cold saline, and continued in the cath lab with endovascular cooling (target temperature: ≤35°C at time of reperfusion). Myocardial salvage index (using CMR) was compared in a randomised, controlled, open-label, endpoint blinded trial to a not-cooled group of patients at day 4±2 after the event. Results After postrandomisation exclusion of 19 patients a total of 101 patients were included in the intention-to-treat analysis (control group: n=54; hypothermia group: n=47). Target temperature was reached in 38/47 patients (81%) in the intervention group. Study-related interventions resulted in a delay in time from first medical contact to reperfusion of 14 min (control group 89±24 min; hypothermia group 103±21 min; p<0.01). Myocardial salvage index was 0.37 (±0.26) in the control group and 0.43 (±0.27) in the hypothermia group (p=0.27). No differences in cardiac biomarkers or clinical outcomes were found. In a CMR follow-up 6 months after the initial event no significant differences were detected. Conclusion Out-of-hospital induced therapeutic hypothermia as an adjunct to primary percutaneous coronary intervention did not improve myocardial salvage in patients with STEMI. Trial registration number NCT01777750
Collapse
Affiliation(s)
- Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Mangold
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Scherz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
32
|
Poppe M, Clodi C, Schriefl C, Warenits A, Nürnberger A, Sterz F, Lobmeyr E, Weiser C. Short EMS Scene Time Interval in out-of-hospital-cardiac arrest results in higher rates of favorable outcome and is imperative for eCPR. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
Dyson K, Brown S, May S, Koster R, Beesems S, Kuisma M, Salo A, Finn J, Sterz F, Nürnberger A, Karen S, Morrison L, Olasveengen T, Callaway C, Shin SD, Gräsner JT, Daya M, Ma MHM, Herlitz J, Anneli S, Aufderheide T, Masterson S, Wang H, Christenson J, Stiell I, Vilke G, Nishiyama C, Iwami T, Nichol G. International variation in survival after out-of-hospital cardiac arrest: a validation study of the Utstein template. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Weidenauer D, Hamp T, Schriefl C, Holaubek C, Gattinger M, Krammel M, Winnisch M, Weidenauer A, Mundigler G, Lang I, Schreiber W, Sterz F, Herkner H, Domanovits H. The impact of cardiopulmonary resuscitation (CPR) manikin chest stiffness on motivation and CPR performance measures in children undergoing CPR training-A prospective, randomized, single-blind, controlled trial. PLoS One 2018; 13:e0202430. [PMID: 30114240 PMCID: PMC6095555 DOI: 10.1371/journal.pone.0202430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardio-pulmonary-resuscitation (CPR) training starting at the age of 12 years is recommended internationally. Training younger children is not recommended because young children lack the physical ability to perform adequate CPR and discouragement to perform CPR later is apprehended. The aim of this study was to answer the following questions: Are younger children discouraged after CPR training? Is discouragement caused by their lack in physical ability to perform adequate chest compressions on a standard manikin and would the use of manikins with a reduced resistance affect their motivation or performance? METHODS We investigated the motivation and CPR performance of children aged 8-13 years after CPR training on manikins of different chest stiffness in a prospective, randomized, single-blind, controlled trial. 322 children underwent randomization and received 30 minutes CPR training in small groups at school. We used two optically identical resuscitation manikins with different compression resistances of 45kg and 30kg. Motivation was assessed with a self-administered questionnaire. Performance was measured with the Resusci®Anne SkillReporter™. FINDINGS Motivation after the training was generally high and there was no difference between the two groups in any of the questionnaire items on motivation: Children had fun (98 vs. 99%; P = 0.32), were interested in the training (99 vs. 98%; P = 0.65), and were glad to train resuscitation again in the future (89 vs. 91%; P = 0.89). CPR performance was generally poor (median compression score (8, IQR 1-45 and 29, IQR 11-54; P<0.001) and the mean compression depth was lower in the 45kg-resistance than in the 30kg-resistance group (33±10mm vs. 41±9; P<0.001). CONCLUSIONS Compression resistances of manikins, though influencing CPR performance, did not discourage 8 to 13 year old children after CPR training. The findings refute the view that young children are discouraged when receiving CPR training even though they are physically not able to perform adequate CPR.
Collapse
Affiliation(s)
- David Weidenauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Hamp
- Department of General Anesthesia and Intensive Care, Prehospital Emergency Medicine Research Group, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Caroline Holaubek
- Department of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna, Austria
| | | | - Mario Krammel
- Municipal Ambulance Service of Vienna, Vienna, Austria
| | - Markus Winnisch
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerald Mundigler
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
35
|
Scherz T, Hofbauer T, Ondracek A, Simon D, Testori CH, Sterz F, Mangold A, Lang IM. P184High platelet activity in hypothermic patients with acute ST-elevation myocardial infarction. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Scherz
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - T Hofbauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - A Ondracek
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Simon
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C H Testori
- Medical University of Vienna, Emergency Medicine, Vienna, Austria
| | - F Sterz
- Medical University of Vienna, Emergency Medicine, Vienna, Austria
| | - A Mangold
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - I M Lang
- Medical University of Vienna, Cardiology, Vienna, Austria
| |
Collapse
|
36
|
Mangold A, Scherz T, Hofbauer T, Ondracek A, Simon D, Testori C, Sterz F, Lang IM. P572Neutrophil activation and neutrophil extracellular traps in STEMI patients treated with therapeutic hypothermia. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Mangold
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - T Scherz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - T Hofbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Ondracek
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - D Simon
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Testori
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - F Sterz
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - I M Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| |
Collapse
|
37
|
Weiser C, Poppe M, Sterz F, Herkner H, Clodi C, Schriefl C, Warenits A, Vossen M, Schwameis M, Nürnberger A, Spiel A. Initial electrical frequency predicts survival and neurological outcome in out of hospital cardiac arrest patients with pulseless electrical activity. Resuscitation 2018; 125:34-38. [PMID: 29408228 DOI: 10.1016/j.resuscitation.2018.01.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/11/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Outcome is generally poor in out of hospital cardiac arrests (OHCA) with initial non-shockable rhythms. Termination of resuscitation rules facilitate early prognostication at the scene to cease resuscitation attempts in futile situations and to proceed advanced life support in promising conditions. As pulseless electrical activity (PEA) is present as first rhythm in every 4th OHCA we were interested if the initial electrical frequency in PEA predicts survival. METHODS All patients >18 years of age with non-traumatic OHCA and PEA as first rhythm between August 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Defibrillator and epidemiological data from the emergency medical system as survival data were processed considering the initial electrical activity in PEA and 30 days survival. RESULTS Out of 2149 OHCA patients, a total of 504 PEA patients were eligible for analyses. These patients were stratified into 4 groups according the initial electrical frequency in PEA: 10-24/min, 25-39/min, 40-59/min, >60/min. Compared to a frequency >60/min all other subgroups were associated with higher mortality especially those with an initial electrical frequency 10-24 (adjusted OR 0.56 (0.39-0.79) p = .001 for each category chance). QRS duration in PEA did not influence outcome. Patients in the >60/min group showed a 30-days-survival rate of 22% and a good neurological outcome in 15% of all patients - comparable to shockable cardiac arrest rhythms. CONCLUSION Regardless of other resuscitation factors, higher initial electrical frequency in PEA is associated with increased odds of survival and good neurological outcome.
Collapse
Affiliation(s)
- Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | - Mathias Vossen
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna, Austria
| |
Collapse
|
38
|
Schnaubelt S, Sulzgruber P, Menger J, Skhirtladze-Dworschak K, Sterz F, Dworschak M. Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favourable neurological outcome - A review of the current literature. Resuscitation 2018; 125:39-47. [PMID: 29410191 DOI: 10.1016/j.resuscitation.2018.01.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Regional cerebral oxygen saturation (rSO2) can be measured non-invasively even at no- or low-flow states. It thus allows assessment of brain oxygenation during CPR. Certain rSO2 values had been associated with return of spontaneous circulation (ROSC) and neurological outcome in the past. Clear-cut thresholds for the prediction of beneficial outcome, however, are still lacking. METHODS We conducted a database search to extract all available investigations on rSO2 measurement during CPR. Mean, median, and ΔrSO2 values were either taken from the studies or calculated. Thresholds for the outcome "ROSC" and "neurological outcome" were sought. RESULTS We retrieved 26 publications for the final review. The averaged mean rSO2 for patients achieving ROSC was 41 ± 12% vs. 30 ± 12% for non-ROSC (p = .009). ROSC was not observed when mean rSO2 remained <26%. In ROSC patients, ΔrSO2 was 22 ± 16% vs. 7 ± 10% in non-ROSC patients (p = .009). A rSO2 threshold of 36% predicted ROSC with a sensitivity of 67% and specificity of 69% while ΔrSO2 of 7% showed a sensitivity of 100% and a specificity of 86% (AUC = 0.733 and 0.893, respectively). Mean rSO2 of 47 ± 11% was associated with favourable and 38 ± 12% with poor neurological outcome. There was, however, a great overlap between groups due to scarce data. CONCLUSION Higher rSO2 consistently correlated with increased rates of ROSC. The discriminatory power of rSO2 to prognosticate favourable neurological outcome remains unclear. Measuring rSO2 during CPR could potentially facilitate clinical decision-making.
Collapse
Affiliation(s)
- S Schnaubelt
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria; Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - P Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Austria
| | - J Menger
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - K Skhirtladze-Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - M Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria.
| |
Collapse
|
39
|
Warenits AM, Sterz F, Schober A, Ettl F, Magnet IAM, Högler S, Teubenbacher U, Grassmann D, Wagner M, Janata A, Weihs W. Reduction of Serious Adverse Events Demanding Study Exclusion in Model Development: Extracorporeal Life Support Resuscitation of Ventricular Fibrillation Cardiac Arrest in Rats. Shock 2018; 46:704-712. [PMID: 27392153 DOI: 10.1097/shk.0000000000000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Extracorporeal life support is a promising concept for selected patients in refractory cardiogenic shock and for advanced life support of persistent ventricular fibrillation cardiac arrest. Animal models of ventricular fibrillation cardiac arrest could help to investigate new treatment strategies for successful resuscitation. Associated procedural pitfalls in establishing a rat model of extracorporeal life support resuscitation need to be replaced, refined, reduced, and reported.Anesthetized male Sprague-Dawley rats (350-600 g) (n = 126) underwent cardiac arrest induced with a pacing catheter placed into the right ventricle via a jugular cannula. Rats were resuscitated with extracorporeal life support, mechanical ventilation, defibrillation, and medication. Catheter and cannula explantation was performed if restoration of spontaneous circulation was achieved. All observed serious adverse events (SAEs) occurring in each of the experimental phases were analyzed.Restoration of spontaneous circulation could be achieved in 68 of 126 rats (54%); SAEs were observed in 76 (60%) experiments. Experimental procedures related SAEs were 62 (82%) and avoidable human errors were 14 (18%). The most common serious adverse events were caused by insertion or explantation of the venous bypass cannula and resulted in lethal bleeding, cannula dislocation, or air embolism.Establishing an extracorporeal life support model in rats has confronted us with technical challenges. Even advancements in small animal critical care management over the years delivered by an experienced team and technical modifications were not able to totally avoid such serious adverse events. Replacement, refinement, and reduction reports of serious adverse events demanding study exclusions to avoid animal resources are missing and are presented hereby.
Collapse
Affiliation(s)
- Alexandra-Maria Warenits
- *Department of Emergency Medicine, Medical University of Vienna, Wien, Austria †Department of Biomedical Research, Medical University of Vienna, Wien, Austria ‡Department of Pathobiology, University of Veterinary Medicine Vienna, Wien, Austria §II. Med. Department Cardiology, Hanusch Hospital, Wien, Austria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Roedl K, Wallmüller C, Drolz A, Horvatits T, Rutter K, Spiel A, Ortbauer J, Stratil P, Hubner P, Weiser C, Motaabbed JK, Jarczak D, Herkner H, Sterz F, Fuhrmann V. Outcome of in- and out-of-hospital cardiac arrest survivors with liver cirrhosis. Ann Intensive Care 2017; 7:103. [PMID: 28986855 PMCID: PMC5630568 DOI: 10.1186/s13613-017-0322-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/19/2017] [Indexed: 12/16/2022] Open
Abstract
Background Organ failure increases mortality in patients with liver cirrhosis. Data about resuscitated cardiac arrest patients with liver cirrhosis are missing. This study aims to assess aetiology, survival and functional outcome in patients after successful cardiopulmonary resuscitation (CPR) with and without liver cirrhosis. Methods Analysis of prospectively collected cardiac arrest registry data of consecutively hospital-admitted patients following successful CPR was performed. Patient’s characteristics, admission diagnosis, severity of disease, course of disease, short- and long-term mortality as well as functional outcome were assessed and compared between patients with and without cirrhosis. Results Out of 1068 patients with successful CPR, 47 (4%) had liver cirrhosis. Acute-on-chronic liver failure (ACLF) was present in 33 (70%) of these patients on admission, and four patients developed ACLF during follow-up. Mortality at 1 year was more than threefold increased in patients with liver cirrhosis (OR 3.25; 95% CI 1.33–7.96). Liver cirrhosis was associated with impaired neurological outcome (OR for a favourable cerebral performance category: 0.13; 95% CI 0.04–0.36). None of the patients with Child–Turcotte–Pugh (CTP) C cirrhosis survived 28 days with good neurological outcome. Overall nine (19%) patients with cirrhosis survived 28 days with good neurological outcome. All patients with ACLF grade 3 died within 28 days. Conclusion Cardiac arrest survivors with cirrhosis have worse outcome than those without. Although one quarter of patients with liver cirrhosis survived longer than 28 days after successful CPR, patients with CTP C as well as advanced ACLF did not survive 28 days with good neurological outcome. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0322-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | | | - Andreas Drolz
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Thomas Horvatits
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Karoline Rutter
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Alexander Spiel
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Ortbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Peter Stratil
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jasmin Katrin Motaabbed
- Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. .,Division of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
41
|
Sulzgruber P, Datler P, Sterz F, Poppe M, Lobmeyr E, Keferböck M, Zeiner S, Nürnberger A, Schober A, Hubner P, Stratil P, Wallmueller C, Weiser C, Warenits AM, Zajicek A, Ettl F, Magnet I, Uray T, Testori C, van Tulder R. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis. Eur Heart J Acute Cardiovasc Care 2017; 7:423-431. [PMID: 28948850 DOI: 10.1177/2048872617731894] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive. METHODS To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed. Patients were matched in four groups with a 1:1:1:1 ratio ( n=210/group) according to bag-mask-valve, laryngeal tube, endotracheal intubation and secondary endotracheal intubation after primary laryngeal tube ventilation. RESULTS The laryngeal tube subgroup showed the lowest 30-day survival rate among all tested devices ( p<0.001). However, in the case of endotracheal intubation after primary laryngeal tube ventilation, survival rates were comparable to the primary endotracheal tube subgroup. The use of a laryngeal tube was independently and directly associated with mortality with an adjusted odds ratio of 1.97 (confidence interval: 1.14-3.39; p=0.015). Additionally, patients receiving laryngeal tube ventilation showed the lowest rate of good neurological performance (6.7%; p<0.001) among subgroups. However, if patients received endotracheal intubation after initial laryngeal tube ventilation, the outcome proved to be significantly better (9.5%; p<0.001). CONCLUSION We found that the use of a laryngeal tube for airway management in cardiac arrest was significantly associated with poor 30-day survival rates and unfavourable neurological outcome. A primary endotracheal airway management needs to be considered at the scene, or an earliest possible secondary endotracheal intubation during both pre-hospital and in-hospital post-return of spontaneous circulation critical care seems crucial and most beneficial for the patient outcome.
Collapse
Affiliation(s)
- Patrick Sulzgruber
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria.,2 Ludwig Boltzman Institute, Cluster for Cardiovascular Research, Austria
| | - Philip Datler
- 3 Department of Anaesthesia, Medical University of Vienna, Austria
| | - Fritz Sterz
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Poppe
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Elisabeth Lobmeyr
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Markus Keferböck
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Sebastian Zeiner
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Andreas Schober
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Pia Hubner
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Peter Stratil
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Christoph Weiser
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | - Florian Ettl
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Ingrid Magnet
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christoph Testori
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Raphael van Tulder
- 1 Department of Emergency Medicine, Medical University of Vienna, Austria
| |
Collapse
|
42
|
Schnaubelt S, Wallmueller C, Mayr F, Losert H, Testori C, Ruzicka G, Graf N, Sterz F, Uray T. Comprehensive pre- and in-hospital near-infrared-spectroscopy can predict outcome parameters in patients after out-of-hospital cardiac arrest – A feasibility study. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Weiser C, Weihs W, Holzer M, Testori C, Kramer AM, Kment C, Stoiber M, Poppe M, Wallmüller C, Stratil P, Hoschitz M, Laggner A, Sterz F. Feasibility of profound hypothermia as part of extracorporeal life support in a pig model. J Thorac Cardiovasc Surg 2017; 154:867-874. [DOI: 10.1016/j.jtcvs.2017.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
|
44
|
Schriefl C, Mayr FB, Poppe M, Nürnberger A, Clodi C, Wallmueller C, Testori C, Sterz F, Uray T. Time of day does not influence outcome after out-of-hospital cardiac arrest in an urban area. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
45
|
Hubner P, Lobmeyr E, Wallmüller C, Poppe M, Datler P, Keferböck M, Zeiner S, Nürnberger A, Zajicek A, Laggner A, Sterz F, Sulzgruber P. Improvements in the quality of advanced life support and patient outcome after implementation of a standardized real-life post-resuscitation feedback system. Resuscitation 2017; 120:38-44. [PMID: 28864072 DOI: 10.1016/j.resuscitation.2017.08.235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/12/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Educational aspects in the training of advanced life support (ALS) represent a key role in critical care management of patients with out-of-hospital cardiac arrest (OHCA) and received special attention in guidelines of various international societies. While a positive association of feedback on ALS performance in training conditions is well established, data on the impact of a real-life post-resuscitation feedback on both ALS quality and outcome remain scarce and inconclusive. We aimed to elucidate the impact of a standardized post-resuscitation feedback on quality of ALS and improvements in patient outcome, in a real-life out-of-hospital setting. METHODS We prospectively enrolled and analyzed 2209 patients presenting with OHCA receiving resuscitation attempts by the municipal emergency medical service (EMS) of Vienna over a two-year period. A standardized post-resuscitation feedback protocol was delivered to the respective EMS-team to elucidate its impact on the quality of ALS. RESULTS We observed that both chest compression rates and ratios were in accordance to recommendations of recent guidelines. While interruptions of chest compressions longer than 30s declined during the observation period (-6.5%) rates of the recommended chest compressions during defibrillator-charging periods increased (+8.9%). Since the percentage of ROSC and 30-day survival remained balanced, the frequencies of both survival until hospital discharge (+6.3%) and favorable neurological outcome (+16%) in survivors significantly increased during the observation period. CONCLUSION Improvements in the quality of advanced life support as well the patient outcome were observed after the implementation of a standardized post-resuscitation feedback protocol.
Collapse
Affiliation(s)
- Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Lobmeyr
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philip Datler
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus Keferböck
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Zeiner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Anton Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Patrick Sulzgruber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute, Cluster for Cardiovascular Research, Vienna, Austria
| |
Collapse
|
46
|
Stöckl M, Testori C, Sterz F, Holzer M, Weiser C, Schober A, Nichol G, Frossard M, Herkner H, Kechvar J, Losert H. Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest-A randomized, double blinded, double dummy, clinical trial. Resuscitation 2017; 120:14-19. [PMID: 28860012 DOI: 10.1016/j.resuscitation.2017.08.238] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 01/19/2023]
Abstract
AIM OF THE STUDY Current guidelines recommend targeted temperature management to improve neurological outcome after cardiac arrest. Evidence regarding an ideal sedative/analgesic regimen including skeletal muscle paralysis is limited. METHODS Patients were randomized to either a continuous administration of rocuronium (continuous-NMB-group) or to a continuous administration of saline supplemented by rocuronium bolus administration if demanded (bolus-NMB-group). The primary outcome was the number of shivering episodes. Secondary outcomes included survival and neurological status one year after cardiac arrest, time to awakening, length of stay as well as required cumulative dose of rocuronium, midazolam and fentanyl. RESULTS Sixty-three patients (32 continuous-NMB-group; 31 bolus-NMB-group) were enrolled. Differences in baseline characteristics were not significant. Shivering episodes were detected in 94% of the patients in the bolus-NMB-group compared to 25% of the patients receiving continuous rocuronium infusion (p<0.01). The continuous-NMB-group received significant lower doses of midazolam (4.3±0.8mg/kg vs. 5.1±0.9mg/kg, p<0.01) and fentanyl (62±14μg/kg vs. 71±7μg/kg, p<0.01), but higher cumulative doses of rocuronium (7.8±1.8mg/kg vs. 2.3±1.6mg/kg, p<0.01). Earlier awakening (2 [IQR 2;3] vs. 4 [IQR 2;7.5] days, p=0.04) and decreased length of stay at the ICU (6 [IQR 3;5.9] vs. 10 [IQR 5;15] days, p=0.03) were observed in the continuous-NMB-group. There were no significant differences in survival and quality of life 12 months after cardiac arrest. CONCLUSIONS Continuous neuromuscular blockade during the first day after resuscitation reduced shivering, midazolam and fentanyl requirement, time to awakening and discharge from intensive care unit. There were no differences in overall survival, cooling rate and time to target temperature.
Collapse
Affiliation(s)
- Mathias Stöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I, Brothers of Saint John of God Hospital, Eisenstadt, Austria
| | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Schober
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Graham Nichol
- Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA, USA
| | - Martin Frossard
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jasmin Kechvar
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
47
|
Sulzgruber P, Hubner P, Lobmeyr E, Wallmueller C, Poppe M, Datler P, Keferboeck M, Zeiner S, Nuernberger A, Laggner A, Sterz F. P3021A standardized real-life post-resuscitation feedback-system improves the quality of advanced life support in out-of-hospital cardiac arrest. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Nürnberger A, Herkner H, Sterz F, Olsen JA, Lozano M, van Grunsven PM, Lerner EB, Persse D, Malzer R, Brouwer MA, Westfall M, Souders CM, Travis DT, Herken UR, Wik L. Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial. Eur J Clin Invest 2017; 47:439-446. [PMID: 28407232 PMCID: PMC5488218 DOI: 10.1111/eci.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/10/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest. MATERIALS AND METHODS Retrospective analysis of Circulation Improving Resuscitation Care (CIRC) trial data to assess if therapeutic cooling to 33 ± 1 °C core temperature had an association with survival. Of 4231 adult, out-of-hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1812. Logistic regression was undertaken in a stepwise fashion to account for the impact on outcome of each significant difference and for the variable of interest between the groups. RESULTS Out-of- and in-hospital cooled were 263 (15%), only after admission cooled were 230 (13%) and not cooled were 357 (20%) patients. The group cooled out of- and in hospital had 98 (37%) survivors as compared to the groups cooled in hospital only [80 (35%)] and of those not cooled [68 (19%)]. After adjusting for known covariates (sex, age, witnessed cardiac arrest, no- and low-flow time, shockable initial rhythm, random allocation, bystander cardiopulmonary resuscitation and percutaneous coronary intervention), the odds ratio for survival comparing no cooling to out-of- plus in-hospital cooling was 0·53 [95% confidence interval (CI): 0·46-0·61, P < 0·001], and comparing to in-hospital cooling only was 0·67 (95% CI: 0·50-0·89, P = 0·006). CONCLUSION Mild therapeutic hypothermia initiated out of hospital and/or in hospital was associated with improved survival within this secondary analysis of the CIRC cohort compared to no therapeutic hypothermia.
Collapse
Affiliation(s)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Wien, Austria
| | - Jan-Aage Olsen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Michael Lozano
- Hillsborough County Fire Rescue, Hillsborough County Government, Tampa, FL, USA.,Department of Emergency Medicine, Lake Erie College, Bradenton, FL, USA
| | | | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Persse
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, USA
| | - Reinhard Malzer
- Wiener Rettung, Municipal Ambulance Service of Vienna, Wien, Austria
| | - Marc A Brouwer
- Department of Cardiology, Heart Lung Center, GA Nijmegen, the Netherlands
| | - Mark Westfall
- Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, Grand Chute, WI, USA.,Theda Clark Regional Medical Center, Neenah, WI, USA
| | - Chris M Souders
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, USA
| | - David T Travis
- Hillsborough County Fire Rescue, Hillsborough County Government, Tampa, FL, USA
| | | | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
49
|
Weiser C, Schwameis M, Sterz F, Herkner H, Lang IM, Schwarzinger I, Spiel AO. Mortality in patients resuscitated from out-of-hospital cardiac arrest based on automated blood cell count and neutrophil lymphocyte ratio at admission. Resuscitation 2017; 116:49-55. [PMID: 28476480 DOI: 10.1016/j.resuscitation.2017.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/05/2017] [Accepted: 05/02/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The neutrophil lymphocyte ratio(NLR) is a marker of systemic inflammation. We hypothesized that admission NLR is related to mortality and that epinephrine application during resuscitation influences NLR in patients after successful resuscitation from out of hospital cardiac arrest (OHCA). METHODS This retrospective cohort study is based on a registry including all OHCA patients who had a presumed cardiac cause of cardiac arrest and achieved sustained ROSC prior to admission between 2005 and 2014. Patients were categorized into three groups according to the calculated NLR at admission (NLR <6, ≥6, and 'abnormal differential' indicating no differential blood cell count on patients report due to exceedance of machine predefined parameter limits). The primary outcome measure was long-term mortality after OHCA. Cox proportional hazards models were used for multivariable analysis. RESULTS Out of 2273 OHCA patients during the study period a total of 1188(52%) patients were eligible for analysis, of those 274(23%) were female and mean age was 64 (25-75 IQR:52-72). Compared to a NLR<6 (n=442), adjusted hazard ratio for long-term mortality was significantly higher in patients with a NLR≥6 (n=447; 1.52 (95%CI 1.03-2.24)) and in patients with abnormal differential (n=299; 3.16 (95%CI 2.02-4.97)). Epinephrine application during resuscitation did not explain the effect of NLR on mortality. CONCLUSION In this large retrospective cohort study of altogether >1000 OHCA patients, hospital admission NLR<6 compared to abnormal differential or NLR≥6 was associated with mortality independently from epinephrine application.
Collapse
Affiliation(s)
- Christoph Weiser
- Departments of Emergency Medicine, Medical University of Vienna, Austria.
| | - Michael Schwameis
- Departments of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Departments of Emergency Medicine, Medical University of Vienna, Austria
| | - Harald Herkner
- Departments of Emergency Medicine, Medical University of Vienna, Austria
| | - Irene M Lang
- Departments of Cardiology, Medical University of Vienna, Austria
| | - Ilse Schwarzinger
- Departments of Laboratory Medicine, Medical University of Vienna, Austria
| | - Alexander O Spiel
- Departments of Emergency Medicine, Medical University of Vienna, Austria
| |
Collapse
|
50
|
Dellimore K, Wijshoff R, Haarburger C, Aarts V, Derkx R, van de Laar J, Nammi K, Russell JK, Hubner P, Sterz F, Muehlsteff J. Towards an algorithm for automatic accelerometer-based pulse presence detection during cardiopulmonary resuscitation. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:3531-3534. [PMID: 28269060 DOI: 10.1109/embc.2016.7591490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Manual palpation is still the gold standard for assessment of pulse presence during cardiopulmonary resuscitation (CPR) for professional rescuers. However, this method is unreliable, time-consuming and subjective. Therefore, reliable, quick and objectified assessment of pulse presence in cardiac arrest situations to assist professional rescuers is still an unmet need. Accelerometers may present a promising sensor modality as pulse palpation technology for which pulse detection at the carotid artery has been demonstrated to be feasible. This study extends previous work by presenting an algorithm for automatic, accelerometer-based pulse presence detection at the carotid site during CPR. We show that accelerometers might be helpful in automated detection of pulse presence during CPR.
Collapse
|