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Kawakami S, Tahara Y, Noguchi T, Yasuda S, Koga H, Nishi JI, Yonemoto N, Nonogi H, Ikeda T. Association between defibrillation-to-adrenaline interval and short-term outcomes in patients with out-of-hospital cardiac arrest and an initial shockable rhythm. Resusc Plus 2024; 18:100651. [PMID: 38711911 PMCID: PMC11070920 DOI: 10.1016/j.resplu.2024.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Aim The optimal timing of adrenaline administration after defibrillation in patients with out-of-hospital cardiac arrest (OHCA) and an initial shockable rhythm is unknown. We investigated the association between the defibrillation-to-adrenaline interval and clinical outcomes. Methods Between 2011 and 2020, we enrolled 1,259,960 patients with OHCA into a nationwide prospective population-based registry in Japan. After applying exclusion criteria, 20,905 patients with an initial shockable rhythm documented at emergency medical services (EMS) arrival who received adrenaline after defibrillation were eligible for this study. Multivariable logistic regression analysis was used to predict favourable short-term outcomes: prehospital return of spontaneous circulation (ROSC), 30-day survival, or a favourable neurological outcome (Cerebral Performance Category 1 or 2) at 30 days. Patients were categorised into 2-minute defibrillation-to-adrenaline intervals up to 18 min, or more than 18 min. Results At 30 days, 1,618 patients (8%) had a favourable neurological outcome. The defibrillation-to-adrenaline interval in these patients was significantly shorter than in patients with an unfavourable neurological outcome [8 (5-12) vs 11 (7-16) minutes; P < 0.001]. The proportion of patients with prehospital ROSC, 30-day survival, or a favourable neurological outcome at 30 days decreased as the defibrillation-to-adrenaline interval increased (P < 0.001 for trend). Multivariable analysis revealed that a defibrillation-to-adrenaline interval of > 6 min was an independent predictor of worse prehospital ROSC, 30-day survival, or neurological outcome at 30 days when compared with an interval of 4-6 min. Conclusion A longer defibrillation-to-adrenaline interval was significantly associated with worse short-term outcomes in patients with OHCA and an initial shockable rhythm.
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Affiliation(s)
- Shoji Kawakami
- Department of Cardiology, Aso Iizuka Hospital, Fukuoka, Japan
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenobu Koga
- Clinical Research Support Office, Aso Iizuka Hospital, Fukuoka, Japan
| | | | - Naohiro Yonemoto
- Department of Public Health, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Nonogi
- Faculty of Health Science, Osaka Aoyama University, Minoo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression. Pediatr Res 2023:10.1038/s41390-022-02462-5. [PMID: 36646884 DOI: 10.1038/s41390-022-02462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.
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Influence of advanced life support response time on out-of-hospital cardiac arrest patient outcomes in Taipei. PLoS One 2022; 17:e0266969. [PMID: 35421162 PMCID: PMC9009650 DOI: 10.1371/journal.pone.0266969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background The association between out-of-hospital cardiac arrest patient survival and advanced life support response time remained controversial. We aimed to test the hypothesis that for adult, non-traumatic, out-of-hospital cardiac arrest patients, a shorter advanced life support response time is associated with a better chance of survival. We analyzed Utstein-based registry data on adult, non-traumatic, out-of-hospital cardiac arrest patients in Taipei from 2011 to 2015. Methods Patients without complete data, witnessed by emergency medical technicians, or with response times of ≥ 15 minutes, were excluded. We used logistic regression with an exposure of advanced life support response time. Primary and secondary outcomes were survival to hospital discharge and favorable neurological outcomes (cerebral performance category ≤ 2), respectively. Subgroup analyses were based on presenting rhythms of out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation, and witness status. Results A total of 4,278 cases were included in the final analysis. The median advanced life support response time was 9 minutes. For every minute delayed in advanced life support response time, the chance of survival to hospital discharge would reduce by 7% and chance of favorable neurological outcome by 9%. Subgroup analysis showed that a longer advanced life support response time was negatively associated with the chance of survival to hospital discharge among out-of-hospital cardiac arrest patients with shockable rhythm and pulse electrical activity groups. Conclusions In non-traumatic, adult, out-of-hospital cardiac arrest patients in Taipei, a longer advanced life support response time was associated with declining odds of survival to hospital discharge and favorable neurologic outcomes, especially in patients presenting with shockable rhythm and pulse electrical activity.
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Jaeger D, Baert V, Javaudin F, Debaty G, Duhem H, Koger J, Gueugniaud PY, Tazarourte K, El Khoury C, Hubert H, Chouihed T. Effect of adrenaline dose on neurological outcome in out-of-hospital cardiac arrest: a nationwide propensity score analysis. Eur J Emerg Med 2022; 29:63-69. [PMID: 34908000 DOI: 10.1097/mej.0000000000000891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adrenaline is recommended during cardio-pulmonary resuscitation. The optimal dose remains debated, and the effect of lower than recommended dose is unknown. OBJECTIVE To compare the outcome of patients treated with the recommended, lower or higher cumulative doses of adrenaline. DESIGN, SETTINGS, PARTICIPANTS Patients were included from the French National Cardiac Arrest Registry and were grouped based on the received dose of adrenaline: recommended, higher and lower dose. OUTCOME MEASURES AND ANALYSIS The primary endpoint was good neurologic outcome at 30 days post-OHCA, defined by a cerebral performance category (CPC) of less than 3. Secondary endpoints included return of spontaneous circulation and survival to hospital discharge. A multiple propensity score adjustment approach was performed. MAIN RESULTS 27 309 patients included from July 1st 2011 to January 1st 2019 were analysed, mean age was 68 (57-78) years and 11.2% had ventricular fibrillation. 588 (2.2%) patients survived with a good CPC score. After adjustment, patients in the high dose group had a significant lower rate of good neurologic outcome (OR, 0.6; 95% CI, 0.5-0.7). There was no significant difference for the primary endpoint in the lower dose group (OR, 0.8; 95% CI, 0.7-1.1). There was a lower rate of survival to hospital discharge in the high-dose group vs. standard group (OR, 0.5; 95% CI, 0.5-0.6). CONCLUSION The use of lower doses of adrenaline was not associated with a significant difference on survival good neurologic outcomes at D30. But a higher dose of adrenaline was associated with a lower rate of survival with good neurological outcomes and poorer survival at D30.
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Affiliation(s)
- Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy
- INSERM U1116, University of Lorraine, Nancy
| | | | | | - Guillaume Debaty
- University Grenoble Alps/CNRS/University Hospital of Grenoble, Grenoble
| | - Helene Duhem
- University Grenoble Alps/CNRS/University Hospital of Grenoble, Grenoble
| | - Jonathan Koger
- Emergency Department, University Hospital of Nancy, Nancy
| | - Pierre-Yves Gueugniaud
- French National Out-of-Hospital Cardiac Arrest Registry, ReAC, Lille
- Emergency Department, GH Edouard Herriot, Hospices Civils de Lyon, Lyon
| | - Karim Tazarourte
- Emergency Department, GH Edouard Herriot, Hospices Civils de Lyon, Lyon
- University of Claude, Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - Carlos El Khoury
- Emergency Department and Clinical Research Unit, Médipôle, Hôpital Mutualiste, Villeurbanne
| | - Herve Hubert
- University of Lille, CHU Lille, EA2694, Lille
- French National Out-of-Hospital Cardiac Arrest Registry, ReAC, Lille
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Nancy
- INSERM U1116, University of Lorraine, Nancy
- Clinical Investigation Center Unit 1433, INSERM University Hospital of Nancy, Vandoeuvre les, Nancy, France
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Okada Y, Komukai S, Kitamura T, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Inoue T, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Nishioka N, Kobayashi D, Matsui S, Hirayama A, Yoshimura S, Kimata S, Shimazu T, Ohtsuru S, Iwami T. Clustering out‐of‐hospital cardiac arrest patients with non‐shockable rhythm by machine learning latent class analysis. Acute Med Surg 2022; 9:e760. [PMID: 35664809 PMCID: PMC9136939 DOI: 10.1002/ams2.760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Aim We aimed to identify subphenotypes among patients with out‐of‐hospital cardiac arrest (OHCA) with initial non‐shockable rhythm by applying machine learning latent class analysis and examining the associations between subphenotypes and neurological outcomes. Methods This study was a retrospective analysis within a multi‐institutional prospective observational cohort study of OHCA patients in Osaka, Japan (the CRITICAL study). The data of adult OHCA patients with medical causes and initial non‐shockable rhythm presenting with OHCA between 2012 and 2016 were included in machine learning latent class analysis models, which identified subphenotypes, and patients who presented in 2017 were included in a dataset validating the subphenotypes. We investigated associations between subphenotypes and 30‐day neurological outcomes. Results Among the 12,594 patients in the CRITICAL study database, 4,849 were included in the dataset used to classify subphenotypes (median age: 75 years, 60.2% male), and 1,465 were included in the validation dataset (median age: 76 years, 59.0% male). Latent class analysis identified four subphenotypes. Odds ratios and 95% confidence intervals for a favorable 30‐day neurological outcome among patients with these subphenotypes, using group 4 for comparison, were as follows; group 1, 0.01 (0.001–0.046); group 2, 0.097 (0.051–0.171); and group 3, 0.175 (0.073–0.358). Associations between subphenotypes and 30‐day neurological outcomes were validated using the validation dataset. Conclusion We identified four subphenotypes of OHCA patients with initial non‐shockable rhythm. These patient subgroups presented with different characteristics associated with 30‐day survival and neurological outcomes.
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Affiliation(s)
- Yohei Okada
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine Osaka University Suita Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center Osaka General Medical Center Osaka Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center Osaka Police Hospital Osaka Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine Takii Hospital, Kansai Medical University Moriguchi Japan
| | - Changhwi Park
- Department of Emergency Medicine Tane General Hospital Osaka Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine Osaka City University Osaka Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine Kindai University School of Medicine Osaka‐Sayama Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center Takatsuki Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine Higashi‐Osaka Japan
| | | | - Yasuyuki Hayashi
- Senri Critical Care Medical Center Saiseikai Senri Hospital Suita Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center National Hospital Organization Osaka National Hospital Osaka Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center Osaka City General Hospital Osaka Japan
| | - Haruko Sakamoto
- Department of Pediatrics Osaka Red Cross Hospital Osaka Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Center Kishiwada Tokushukai Hospital Osaka Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Norihiro Nishioka
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | - Daisuke Kobayashi
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Satoshi Yoshimura
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | - Shunsuke Kimata
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Taku Iwami
- Department of Preventive Services, School of Public Health Kyoto University Kyoto Japan
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Wissa J, Schultz BV, Wilson D, Rashford S, Bosley E, Doan TN. Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation. Emerg Med Australas 2021; 33:1088-1094. [PMID: 34382325 DOI: 10.1111/1742-6723.13841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE International guidelines recommend amiodarone for out-of-hospital cardiac arrest (OHCA) in refractory ventricular fibrillation (VF). While early appropriate interventions have been shown to improve OHCA survival, the association between time to amiodarone and survival remains to be established. METHODS Included were adult OHCA in refractory VF, between January 2015 and December 2019, who received a resuscitation attempt with amiodarone from Queensland Ambulance Service paramedics. Patient characteristics and survival outcomes were described. Factors associated with survival were investigated, with a focus on time from arrest to amiodarone administration. Optimal time window for amiodarone administration was determined, and factors influencing whether amiodarone was given within the optimal time window were examined. RESULTS A total of 502 patients were included. The average (range) time from arrest to amiodarone was 25 (4-83) min. Time to amiodarone was negatively associated with survival (adjusted odds ratio 0.93 for event survival; 95% confidence interval 0.89-0.97). The optimal time window for amiodarone was within 23 min following arrest. Patients receiving amiodarone within the optimal time had significantly better survival than those receiving it outside this window (event survival 38.3% vs 20.6%, P < 0.001; discharge survival 25.5% vs 9.7%, P < 0.001; 30-day survival 25.1% vs 9.7%, P < 0.001). Paramedic response time (adjusted odds ratio 0.96; 95% confidence interval 0.92-0.99) and time from arrest to intravenous access (0.71; 0.67-0.76) were independent factors determining whether patients received amiodarone within the optimal time. CONCLUSIONS Earlier amiodarone administration was associated with improved survival. Strategies aimed at reducing delay to amiodarone administration have the potential to improve outcome.
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Affiliation(s)
- Jessica Wissa
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.,Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Brendan V Schultz
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia
| | - Daniel Wilson
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia
| | - Stephen Rashford
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tan N Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia
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Tan BKK, Chin YX, Koh ZX, Md Said NAZB, Rahmat M, Fook-Chong S, Ng YY, Ong MEH. Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest. Resuscitation 2020; 159:129-136. [PMID: 33221362 DOI: 10.1016/j.resuscitation.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to determine if using intraosseous (IO) access when intravenous (IV) access fails improves outcomes. METHODS This was a prospective, parallel-group, cluster-randomised study that compared 'IV only' against 'IV + IO' in OHCA patients, where if 2 IV attempts failed or took more than 90 s, paramedics had 2 further attempts of IO. Primary outcome was any return of spontaneous circulation (ROSC). Secondary outcomes were insertion success rate, adrenaline administration, time to adrenaline and survival outcome. RESULTS A total of 1007 patients were included in the analysis. An Intention To Treat analysis showed a significant difference in success rates of obtaining vascular access in the IV + IO arm compared to the IV arm (76.6% vs 61.1% p = 0.001). There were significantly more patients in the IV + IO arm than the IV arm being administered prehospital adrenaline (71.3% vs 55.4% p = 0.001). The IV + IO arm also received adrenaline faster compared to the IV arm in terms of median time from emergency call to adrenaline (23 min vs 25 min p = 0.001). There was no significant difference in ROSC (adjusted OR 0.99 95%CI: 0.75-1.29), survival to discharge or survival with CPC 2 or better in both groups. A Per Protocol analysis also showed there was higher success in obtaining vascular access in the IV + IO arm, but ROSC and survival outcomes were not statistically different. CONCLUSION Using IO when IV failed led to a higher rate of vascular access, prehospital adrenaline administration and faster adrenaline administration. However, it was not associated with higher ROSC, survival to discharge, or good neurological outcome.
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Affiliation(s)
- Boon Kiat Kenneth Tan
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Yun Xin Chin
- Department of Anaesthesiology, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Zhi Xiong Koh
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | | | - Masnita Rahmat
- Medical Department, Singapore Civil Defence Force, 91 Ubi Avenue 4, 408827, Singapore
| | - Stephanie Fook-Chong
- Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Yih Yng Ng
- Home Team Medical Services Division, Ministry of Home Affairs, 28 Irrawaddy Road, 329560, Singapore; Emergency Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore; Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
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Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017. PLoS One 2020; 15:e0241804. [PMID: 33156868 PMCID: PMC7647071 DOI: 10.1371/journal.pone.0241804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
Improving outcomes after out-of-hospital cardiac arrests (OHCAs) requires an integrated approach by strengthening the chain of survival and emergency care systems. This study aimed to identify the change in outcomes over a decade and effect of citywide intervention on good neurologic outcomes after OHCAs in Daegu. This is a before- and after-intervention study to examine the association between the citywide intervention to improve the chain of survival and outcomes after OHCA. The primary outcome was a good neurologic outcome, defined as a cerebral performance category score of 1 or 2. After dividing into 3 phases according to the citywide intervention, the trends in outcomes after OHCA by primary electrocardiogram rhythm were assessed. Logistic regression analysis was used to analyze the association between the phases and outcomes. Overall, 6203 patients with OHCA were eligible. For 10 years (2008–2017), the rate of survival to discharge and the good neurologic outcomes increased from 2.6% to 8.7% and from 1.5% to 6.6%, respectively. Especially for patients with an initial shockable rhythm, these changes in outcomes were more pronounced (survival to discharge: 23.3% in 2008 to 55.0% in 2017, good neurologic outcomes: 13.3% to 46.0%). Compared with phase 1, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for good neurologic outcomes was 1.20 (95% CI: 0.78–1.85) for phase 2 and 1.64 (1.09–2.46) for phase 3. For patients with an initial shockable rhythm, the AOR for good neurologic outcomes was 3.76 (1.88–7.52) for phase 2 and 5.51 (2.77–10.98) for phase 3. Citywide improvement was observed in the good neurologic outcomes after OHCAs of medical origin, and the citywide intervention was significantly associated with better outcomes, particularly in those with initial shockable rhythm.
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Kovar AJ, Olsen J, Augoustides JG. Advanced Cardiovascular Life Support: Focus on Airway Management, Vasopressor Selection, and Rescue Therapy with Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2020; 34:2015-2018. [DOI: 10.1053/j.jvca.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 01/22/2023]
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Abstract
There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.
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Affiliation(s)
- Vivian Lam
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, B1-380 Taubman Center, SPC 5305, Ann Arbor, MI 48109-5305, USA
| | - Cindy H Hsu
- Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, NCRC B026-309N, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA; Department of Surgery, Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, NCRC B026-309N, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA.
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11
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Zhang Y, Zhu J, Liu Z, Gu L, Zhang W, Zhan H, Hu C, Liao J, Xiong Y, Idris AH. Intravenous versus intraosseous adrenaline administration in out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2020; 149:209-216. [PMID: 31982506 DOI: 10.1016/j.resuscitation.2020.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/22/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adrenaline is an important component in the resuscitation of individuals experiencing out-of-hospital cardiac arrest (OHCA). The 2018 Advanced Cardiac Life Support (ACLS) algorithm gives the option of either intravenous (IV) or intraosseous (IO) routes for adrenaline administration during cardiac arrest. However, the optimal route during prehospital resuscitation remains controversial. This study aims to investigate whether IV and IO routes lead to different outcomes in OHCA patients who received prehospital adrenaline. METHODS This retrospective analysis included adult patients with OHCA of presumed cardiac origin who had Emergency Medical Services (EMS) CPR, received adrenaline, and were enrolled in the Resuscitation Outcomes Consortium (ROC) Cardiac Epistry version 3 database between 2011 and 2015. We divided the study population into IV and IO groups based on the administration route. Logistic regression analysis was performed to evaluate the association between adrenaline delivery routes and prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and favorable neurological outcome. RESULTS Of the 35,733 patients included, 27,758 (77.7%) had adrenaline administered via IV access and 7975 (22.3%) via IO access. With the IO group as a reference in the logistic regression model, the adjusted odds ratios of the IV group for prehospital ROSC, survival and favorable neurological outcome were 1.367 (95%CI, 1.276-1.464), 1.468 (95%CI, 1.264-1.705) and 1.849 (95%CI, 1.526-2.240), respectively. Similar results were found in the propensity score matched population and subgroup analysis. CONCLUSION Compared with the IO approach, the IV approach appears to be the optimal route for adrenaline administration in advanced life support for OHCA during prehospital resuscitation.
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Affiliation(s)
- Yongshu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Jieming Zhu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, China
| | - Zhihao Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Liwen Gu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Wanwan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Hong Zhan
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Chunlin Hu
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Jinli Liao
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China.
| | - Yan Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China; University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, Texas 75390-8579, USA.
| | - Ahamed H Idris
- University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, Texas 75390-8579, USA
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Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e881-e894. [PMID: 31722552 DOI: 10.1161/cir.0000000000000732] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.
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Al-Mulhim MA, Alshahrani MS, Asonto LP, Abdulhady A, Almutairi TM, Hajji M, Alrubaish MA, Almulhim KN, Al-Sulaiman MH, Al-Qahtani LB. Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting. J Int Med Res 2019; 47:4272-4283. [PMID: 31311363 PMCID: PMC6753528 DOI: 10.1177/0300060519860952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest
(OHCA). However, whether epinephrine improves or adversely affects OHCA
outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine
administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the
Emergency Department at King Fahd University Hospital, Saudi Arabia between
2005 and 2015. The primary outcomes were mortality and survival rates until
discharge. The impact of epinephrine administration timing and frequency on
patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the
overall mean age of 50.4 ± 20.6 years. The overall survival rate until
hospital discharge was 12%. There was no statistically significant
difference between in gender, age, or time interval to the first epinephrine
dose in the survival and non-survival groups. Only the number of epinephrine
doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with
survivors. However, a causal relationship between OHCA patient survival and
epinephrine dose and time cannot be confirmed. Further studies are needed to
investigate whether the long-term outcomes in OHCA patients are influenced
by the timing and frequency of epinephrine administration.
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Affiliation(s)
- Mohammed A Al-Mulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Mohammed S Alshahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Laila Perlas Asonto
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Ahmad Abdulhady
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Talal M Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | | | - Mohammed A Alrubaish
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Khalid N Almulhim
- College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | | | - Layla B Al-Qahtani
- Children's Specialist Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Vasopressors during adult cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 139:106-121. [DOI: 10.1016/j.resuscitation.2019.04.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
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Which PART of the question are you asking? Resuscitation 2019; 139:359-360. [DOI: 10.1016/j.resuscitation.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/20/2022]
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Lupton JR, Schmicker R, Daya MR, Aufderheide TP, Stephens S, Le N, May S, Puyana JC, Idris A, Nichol G, Wang H, Hansen M. Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest. Resuscitation 2019; 139:314-320. [PMID: 30902690 DOI: 10.1016/j.resuscitation.2019.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Epinephrine and advanced airway management are commonly used during treatment of out-of-hospital cardiac arrest (OHCA). Recent studies suggest that early but not late administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of initial airway strategy on timing to the first epinephrine dose in OHCA. METHODS This is a secondary analysis of patients enrolled in the Pragmatic Airway Resuscitation Trial who had an advanced airway attempted. We examined differences in time to epinephrine administration by randomly assigned airway strategy, laryngeal tube (LT) or endotracheal tube (ETI); by the duration of airway attempt; and by number of attempts. We used survival methods to account for interval censoring due to unknown administration time. We also examined the association of epinephrine administration timing with survival to hospital discharge. RESULTS Among 2652 subjects (1299 ETI and 1353 LT), 2579 received epinephrine.There were no significant differences between ETI and LT in median time to initial epinephrine administration (min) (ETI - 9.0 vs. LT - 8.6, p = 0.55). There was no significant association between the duration of airway attempt or number of attempts and time to initial epinephrine administration (p = 0.12 and 0.66, respectively). Early administration of epinephrine (<10 min from EMS arrival) was significantly associated with survival compared to administration ≥10 min (OR 1.36, 95% CI: 1.05, 1.77). CONCLUSIONS There was no significant association between airway strategy and time to initial epinephrine administration. Earlier administration of epinephrine (< 10 min from EMS arrival) was associated with improved survival.
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Affiliation(s)
| | | | | | | | | | - Nancy Le
- Oregon Health and Science University United States.
| | | | | | | | | | - Henry Wang
- University of Texas Health Science Center United States.
| | - Matt Hansen
- Oregon Health and Science University United States.
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