1
|
Morton S, Gough C. Can the MIRACLE 2 Score Be Used in the Prehospital Environment and Is It Useful? An Observational Study. Air Med J 2024; 43:146-150. [PMID: 38490778 DOI: 10.1016/j.amj.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/28/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The MIRACLE2 score has been developed for use in a primary percutaneous coronary intervention center. It is unclear if it is feasible in the helicopter emergency medical service (HEMS) setting. METHODS The computerized system at 1 UK HEMS was interrogated between December 1, 2020, and May 1, 2022, for the components of the MIRACLE2 score (recorded contemporaneously) plus demographics and outcomes in all post-return of spontaneous circulation patients conveyed to the hospital. pH was excluded because of no point-of-care testing resulting in a modified MIRACLE2 score (maximum score of 9). Data were analyzed using the chi-square test; P < .05 was statistically significant. RESULTS Three hundred thirty patients (240 males) with out-of-hospital cardiac arrests were reviewed. Ninety-two adult patients with nontraumatic out-of-hospital cardiac arrests had sustained return of spontaneous circulation and a median MIRACLE2 score of 4 (range, 0-7). Forty-seven patients died before hospital discharge; the median MIRACLE2 score was higher in those who died (4) than those who survived (1.5, P < .01); 90.3% of those with a score ≥ 5 were triaged to an emergency department rather than directly to a catheterization laboratory. CONCLUSION A modified MIRACLE2 score can be calculated in the HEMS setting. The benefit of point-of-care testing pH requires investigation. There may be a benefit in predicting outcomes in this nondifferentiated group, but additional research is required.
Collapse
Affiliation(s)
- Sarah Morton
- Lincs & Notts Air Ambulance, Lincoln, United Kingdom; Imperial College London, London, United Kingdom
| | - Chris Gough
- Lincs & Notts Air Ambulance, Lincoln, United Kingdom; Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
| |
Collapse
|
2
|
Rashid K, Waheed MA, Ansar F, Makram AM, Hasan A, Ahmed S, Khan ST, Ubaid A, Ibad AA, Basri R, Makram OM, Khan Y, Rashad N, Elzouki A. Early coronary angioplasty fails to lower all-cause mortality in patients with out-of-hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e1379. [PMID: 38299209 PMCID: PMC10828130 DOI: 10.1002/hsr2.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Out-of-hospital cardiac arrest (OHCA) is defined as the loss of functional mechanical activity of the heart in association with an absence of systemic circulation, occurring outside of a hospital. Immediate coronary angiography (CAG) with percutaneous coronary intervention is recommended for OHCA with ST-elevation. We aimed to evaluate the effect of early CAG on mortality and neurological outcomes in OHCA patients without ST-elevation. Methods This meta-analysis and systemic review was conducted as per principles of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) group. A protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, Ref No. = CRD42022327833). A total of 674 studies were retrieved after scanning several databases (PubMed Central, EMBASE, Medline, and Cochrane Central Register of Controlled Trials). Results A total of 18 studies were selected for the final analysis, including 6 randomized control trials and 12 observational studies. Statistically, there was no significant difference in primary outcome, i.e., mortality, between early and delayed CAG. In terms of the grade of neurological recovery as a secondary outcome, early and delayed CAG groups also showed no statistically significant difference. Conclusion Early CAG has no survival benefits in patients with no ST elevations on ECG after OHCA.
Collapse
Affiliation(s)
- Khalid Rashid
- Internal MedicineJames Cook University HospitalMiddlesbroughUK
| | | | - Farrukh Ansar
- Department of MedicineQuaid e Azam International HospitalIslamabadPakistan
| | - Abdelrahman M. Makram
- Public health, School of Public HealthImperial College LondonLondonUK
- Department of Anesthesia and Intensive Care MedicineOctober 6 University HospitalGizaEgypt
| | - Ahmedyar Hasan
- Department of MedicineMohammed Bin Rashid University of Medicine and Health SciencesDubaiUAE
| | - Shahab Ahmed
- MedicineKing Abdullah Teaching HospitalMansehraPakistan
| | | | - Aamer Ubaid
- Internal MedicineUniversity of Missouri Kansas CityKansas CityMissouriUSA
| | | | - Rabia Basri
- Department of MedicineHamad Medical CorporationDohaQatar
| | - Omar Mohamed Makram
- Public health, Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
- Medicine, Center for Health & NatureHouston Methodist HospitalHoustonTexasUSA
- Department of CardiologyOctober 6 University HospitalGizaEgypt
| | | | - Nabhan Rashad
- Department of MedicineKhyber Teaching HospitalPeshawarPakistan
| | - Abdelnaser Elzouki
- Department of Medicine, Hamad General HospitalWeill Cornell MedicineAr‐RayyanQatar
| |
Collapse
|
3
|
Hirsch KG, Abella BS, Amorim E, Bader MK, Barletta JF, Berg K, Callaway CW, Friberg H, Gilmore EJ, Greer DM, Kern KB, Livesay S, May TL, Neumar RW, Nolan JP, Oddo M, Peberdy MA, Poloyac SM, Seder D, Taccone FS, Uzendu A, Walsh B, Zimmerman JL, Geocadin RG. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care 2024; 40:1-37. [PMID: 38040992 PMCID: PMC10861627 DOI: 10.1007/s12028-023-01871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 12/03/2023]
Abstract
The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.
Collapse
Affiliation(s)
| | | | - Edilberto Amorim
- San Francisco-Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Mary Kay Bader
- Providence Mission Hospital Nursing Center of Excellence/Critical Care Services, Mission Viejo, USA
| | | | | | | | | | | | | | - Karl B Kern
- Sarver Heart Center, University of Arizona, Tucson, USA
| | | | | | | | - Jerry P Nolan
- Warwick Medical School, University of Warwick, Coventry, UK
- Royal United Hospital, Bath, UK
| | - Mauro Oddo
- CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | | | - Anezi Uzendu
- St. Luke's Mid America Heart Institute, Kansas City, USA
| | - Brian Walsh
- University of Texas Medical Branch School of Health Sciences, Galveston, USA
| | | | | |
Collapse
|
4
|
Nikolovski SS, Lazic AD, Fiser ZZ, Obradovic IA, Tijanic JZ, Raffay V. Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors. Cureus 2024; 16:e54827. [PMID: 38529434 PMCID: PMC10962929 DOI: 10.7759/cureus.54827] [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] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
As an important public health issue, out-of-hospital cardiac arrest (OHCA) requires several stages of high quality medical care, both on-field and after hospital admission. Post-cardiac arrest shock can lead to severe neurological injury, resulting in poor recovery outcome and increased risk of death. These characteristics make this condition one of the most important issues to deal with in post-OHCA patients hospitalized in intensive care units (ICUs). Also, the majority of initial post-resuscitation survivors have underlying coronary diseases making revascularization procedure another crucial step in early management of these patients. Besides keeping myocardial blood flow at a satisfactory level, other tissues must not be neglected as well, and maintaining mean arterial pressure within optimal range is also preferable. All these procedures can be simplified to a certain level along with using targeted temperature management methods in order to decrease metabolic demands in ICU-hospitalized post-OHCA patients. Additionally, withdrawal of life-sustaining therapy as a controversial ethical topic is under constant re-evaluation due to its possible influence on overall mortality rates in patients initially surviving OHCA. Focusing on all of these important points in process of managing ICU patients is an imperative towards better survival and complete recovery rates.
Collapse
Affiliation(s)
- Srdjan S Nikolovski
- Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago Health Science Campus, Maywood, USA
- Emergency Medicine, Serbian Resuscitation Council, Novi Sad, SRB
| | - Aleksandra D Lazic
- Emergency Center, Clinical Center of Vojvodina, Novi Sad, SRB
- Emergency Medicine, Serbian Resuscitation Council, Novi Sad, SRB
| | - Zoran Z Fiser
- Emergency Medicine, Department of Emergency Medicine, Novi Sad, SRB
| | - Ivana A Obradovic
- Anesthesiology, Resuscitation, and Intensive Care, Sveti Vračevi Hospital, Bijeljina, BIH
| | - Jelena Z Tijanic
- Emergency Medicine, Municipal Institute of Emergency Medicine, Kragujevac, SRB
| | - Violetta Raffay
- School of Medicine, European University Cyprus, Nicosia, CYP
- Emergency Medicine, Serbian Resuscitation Council, Novi Sad, SRB
| |
Collapse
|
5
|
Hirsch KG, Abella BS, Amorim E, Bader MK, Barletta JF, Berg K, Callaway CW, Friberg H, Gilmore EJ, Greer DM, Kern KB, Livesay S, May TL, Neumar RW, Nolan JP, Oddo M, Peberdy MA, Poloyac SM, Seder D, Taccone FS, Uzendu A, Walsh B, Zimmerman JL, Geocadin RG. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation 2024; 149:e168-e200. [PMID: 38014539 PMCID: PMC10775969 DOI: 10.1161/cir.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.
Collapse
|
6
|
Ferraz Costa G, Santos I, Sousa J, Beirão S, Teixeira R. Coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation: a systematic review and meta-analysis of randomised trials. Coron Artery Dis 2024; 35:67-75. [PMID: 37861181 DOI: 10.1097/mca.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. The optimal timing and role of early coronary angiography (CAG) in OHCA patients without ST-segment elevation remains unclear. The goal of this study is to compare an early CAG versus delayed CAG strategy in OHCA patients without ST elevation. METHODS We systematically searched PubMed, Embase and Cochrane databases, in June 2022, for randomised controlled trials (RCTs) comparing early versus delayed early CAG. A random effects meta-analysis was performed. RESULTS A total of seven RCTs were included, providing a total of 1625 patients: 816 in an early strategy and 807 in a delayed strategy. In terms of outcomes assessed, our meta-analysis revealed a similar rate of all-cause mortality (pooled odds ratio [OR] 1.22 [0.99-1.50], P = 0.06, I 2 = 0%), neurological status (pooled OR 0.94 [0.74-1.21], = 0.65, I 2 = 0%), need of renal replacement therapy (pooled OR 1.11 [0.78-1.74], P = 0.47, I 2 = 0%) and major bleeding events (pooled OR 1.51 [0.95-2.40], P = 0.08, I 2 = 69%). CONCLUSION According to our meta-analysis, in patients who experienced OHCA without ST elevation, early CAG is not associated with reduced mortality or an improved neurological status.
Collapse
Affiliation(s)
- Gonçalo Ferraz Costa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitário de Coimbra
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra
| | - Iolanda Santos
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - João Sousa
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Sofia Beirão
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Rogério Teixeira
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitário de Coimbra
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra
| |
Collapse
|
7
|
Shoaib A, Salim N, Shahid AR, Amir MA, Shiraz MI, Ayaz A, Khan BS, Ansari SA, Suheb MK, Merza N, Shahid I. Effectiveness of Emergency versus Nonemergent Coronary Angiography After Out-of-Hospital Cardiac Arrest without ST-Segment Elevation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 205:379-386. [PMID: 37657411 DOI: 10.1016/j.amjcard.2023.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 09/03/2023]
Abstract
The optimal timing of coronary angiography (CAG) in patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevation remains controversial. Therefore, we conducted a meta-analysis of randomized control trials to investigate the effectiveness of emergency CAG versus delayed CAG in OHCA patients with a non-ST-segment elevated rhythm. PubMed, Scopus, CINAHL, Cochrane CENTRAL, and JBI databases were searched from inception to September 7, 2022. Our primary end point was survival with a good neurological outcome, whereas the secondary outcomes included short-term survival, mid-term survival, recurrent arrhythmias, myocardial infarction after hospitalization, major bleeding, acute kidney injury, and left ventricular ejection fraction. Nine randomized control trials involving 2,569 patients were included in this analysis. Our meta-analysis showed no significant difference in the improvement of neurological outcome (RR 0.96, 95% Confidence Interval [CI] [0.87, 1.06]), short-term survival (risk ratio [RR] 0.98, 95% CI [0.89, 1.08]), mid-term survival (RR 0.98, 95% CI [0.87, 1.10]), recurrent arrhythmias (RR 1.02, 95% CI [0.50, 2.06]), myocardial infarction (RR 0.66, 95% CI [0.13, 3.30]), major bleeding (RR 0.96, 95% CI [0.55, 1.69]), acute kidney injury (RR 1.20, 95% CI [0.32, 4.49]) and left ventricular ejection fraction (RR 0.89, 95% CI [0.69, 1.15]) in patients who underwent emergency CAG compared with delayed CAG patients. In conclusion, our analysis revealed that emergency CAG had no prognostic superiority over delayed CAG in patients with OHCA without ST-segment elevation.
Collapse
Affiliation(s)
- Aqsa Shoaib
- Department of Medicine, Karachi Medical and Dental College, Karachi, Sindh, Pakistan
| | - Najwa Salim
- Department of Medicine, Karachi Medical and Dental College, Karachi, Sindh, Pakistan
| | - Abdul Rehman Shahid
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Muhammad Ali Amir
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Moeez Ibrahim Shiraz
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Aliza Ayaz
- Department of Medicine, Karachi Medical and Dental College, Karachi, Sindh, Pakistan
| | - Bilal Shahid Khan
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Saad Ali Ansari
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside
| | - Mahammed Khan Suheb
- Department of Medicine, Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | | | - Izza Shahid
- Division of Preventive Cardiology, Department of Cardiology, Houston Methodist Academic Institute, Houston, Texas.
| |
Collapse
|
8
|
Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet 2023; 402:1329-1337. [PMID: 37647928 PMCID: PMC10877072 DOI: 10.1016/s0140-6736(23)01351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The International Liaison Committee on Resuscitation has called for a randomised trial of delivery to a cardiac arrest centre. We aimed to assess whether expedited delivery to a cardiac arrest centre compared with current standard of care following resuscitated cardiac arrest reduces deaths. METHODS ARREST is a prospective, parallel, multicentre, open-label, randomised superiority trial. Patients (aged ≥18 years) with return of spontaneous circulation following out-of-hospital cardiac arrest without ST elevation were randomly assigned (1:1) at the scene of their cardiac arrest by London Ambulance Service staff using a secure online randomisation system to expedited delivery to the cardiac catheter laboratory at one of seven cardiac arrest centres or standard of care with delivery to the geographically closest emergency department at one of 32 hospitals in London, UK. Masking of the ambulance staff who delivered the interventions and those reporting treatment outcomes in hospital was not possible. The primary outcome was all-cause mortality at 30 days, analysed in the intention-to-treat (ITT) population excluding those with unknown mortality status. Safety outcomes were analysed in the ITT population. The trial was prospectively registered with the International Standard Randomised Controlled Trials Registry, 96585404. FINDINGS Between Jan 15, 2018, and Dec 1, 2022, 862 patients were enrolled, of whom 431 (50%) were randomly assigned to a cardiac arrest centre and 431 (50%) to standard care. 20 participants withdrew from the cardiac arrest centre group and 19 from the standard care group, due to lack of consent or unknown mortality status, leaving 411 participants in the cardiac arrest centre group and 412 in the standard care group for the primary analysis. Of 822 participants for whom data were available, 560 (68%) were male and 262 (32%) were female. The primary endpoint of 30-day mortality occurred in 258 (63%) of 411 participants in the cardiac arrest centre group and in 258 (63%) of 412 in the standard care group (unadjusted risk ratio for survival 1·00, 95% CI 0·90-1·11; p=0·96). Eight (2%) of 414 patients in the cardiac arrest centre group and three (1%) of 413 in the standard care group had serious adverse events, none of which were deemed related to the trial intervention. INTERPRETATION In adult patients without ST elevation, transfer to a cardiac arrest centre following resuscitated cardiac arrest in the community did not reduce deaths. FUNDING British Heart Foundation.
Collapse
Affiliation(s)
- Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Gavin D Perkins
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Perkins
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Tim Clayton
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Richard Evans
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Steven Robertson
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Karen Wilson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rachael T Fothergill
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Clinical Audit and Research Unit, London Ambulance Service, London, UK; Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Miles Dalby
- Department of Cardiology, Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sam Firoozi
- Department of Cardiology, St Georges Hospital, London, UK
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free Hospital Foundation Trust, London, UK
| | - Ajay Jain
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Jerry P Nolan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Anaesthesia, Royal United Hospital, Bath, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
9
|
Wilcox J, Redwood S, Patterson T. Cardiac arrest centres: what do they add? Resuscitation 2023:109865. [PMID: 37315916 DOI: 10.1016/j.resuscitation.2023.109865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
There are wide regional variations in outcome following resuscitated out of hospital cardiac arrest. These geographical differences appear to be due to hospital infrastructure and provider experience rather than baseline characteristics. It is proposed that post-arrest care be delivered in a systematic fashion by concentrating services in Cardiac Arrest Centres, with greater provider experience, 24-hour access to diagnostics, and specialist treatment to minimise the impact of ischaemia-reperfusion injury and treat the causative pathology. These cardiac arrest centres would provide access to targeted critical care, acute cardiac care, radiology services and appropriate neuro-prognostication. However implementation of cardiac arrest networks with specialist receiving hospitals is complex and requires alignment of pre-hospital care services with those delivered in hospital. Furthermore there are no randomised trial data currently supporting pre-hospital delivery to a Cardiac Arrest Centre and definitions are heterogeneous. In this review article, we propose a universal definition of a Cardiac Arrest Centre and review the current observational data evidence and the potential impact of the ARREST trial.
Collapse
Affiliation(s)
- Joshua Wilcox
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust.
| | - Simon Redwood
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust; Cardiovascular, FOLSM, King's College London
| | - Tiffany Patterson
- Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust
| |
Collapse
|
10
|
Heyne S, Macherey S, Meertens MM, Braumann S, Nießen FS, Tichelbäcker T, Baldus S, Adler C, Lee S. Coronary angiography after cardiac arrest without ST-elevation myocardial infarction: a network meta-analysis. Eur Heart J 2023; 44:1040-1054. [PMID: 36300362 DOI: 10.1093/eurheartj/ehac611] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS This network meta-analysis aimed to assess the effect of early coronary angiography (CAG) compared with selective CAG (late and no CAG) for patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction (NSTE-OHCA). METHODS AND RESULTS A systematic literature search was performed using the EMBASE, MEDLINE and Web of Science databases without restrictions on publication date. The last search was performed on 15 July 2022. Randomized controlled trials (RCTs) and non-randomized studies (NRS) comparing the effect of early CAG to selective CAG after NSTE-OHCA on survival and/or neurological outcomes were included. Meta-analyses were performed based on a DerSimonian-Laird random effects model. A total of 18 studies were identified by the literature search. After the exclusion of two studies due to high risk of bias, 16 studies (six RCTs, ten NRS) were included in the final analyses. Meta-analyses showed a statistically significant increase in survival after early CAG compared with selective CAG in the overall analysis [OR: 1.40, 95% confidence interval (CI): (1.12-1.76), P < 0.01, I2 = 68%]. This effect was lost in the subgroup analysis of RCTs [OR: 0.89, 95% CI: (0.73-1.10), P = 0.29, I2 = 0%]. Random effects model network meta-analysis of NRS based on a Bayesian method showed statistically significant increased survival after late compared with early CAG [OR: 4.20, 95% CI: (1.22, 20.91)]. CONCLUSION The previously reported superiority of early CAG after NSTE-OHCA is based on NRS at high risk of selection and survivorship bias. The meta-analysis of RCTs does not support routinely performing early CAG after NSTE-OHCA.
Collapse
Affiliation(s)
- Sebastian Heyne
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sascha Macherey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Max M Meertens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Simon Braumann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Franz S Nießen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Tobias Tichelbäcker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Christoph Adler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Samuel Lee
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
11
|
Jorge-Perez P, Nikolaou N, Donadello K, Khoury A, Behringer W, Hassager C, Boettiger B, Sionis A, Nolan J, Combes A, Quinn T, Price S, Grand J. Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM). EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:96-105. [PMID: 36454812 DOI: 10.1093/ehjacc/zuac153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
AIMS International guidelines give recommendations for the management of comatose out-of-hospital cardiac arrest (OHCA) survivors. We aimed to investigate adherence to guidelines and disparities in the treatment of OHCA in hospitals in Europe. METHODS AND RESULTS A web-based, multi-institutional, multinational survey in Europe was conducted using an electronic platform with a predefined questionnaire developed by experts in post-resuscitation care. The survey was disseminated to all members of the societies via email, social media, websites, and newsletters in June 2021. Of 252 answers received, 237 responses from different units were included and 166 (70%) were from cardiac arrest centres. First-line vasopressor used was noradrenaline in 195 (83%) and the first-line inotrope was dobutamine in 148 (64%) of the responses. Echocardiography is available 24/7 in 204 (87%) institutions. Targeted temperature management was used in 160 (75%) institutions for adult comatose survivors of OHCA with an initial shockable rhythm. Invasive or external cooling methods with feedback were used in 72 cardiac arrest centres (44%) and 17 (24%) non-cardiac arrest centres (P < 0.0003). A target temperature between 32 and 34°C was preferred by 46 centres (21%); a target between 34 and 36°C by 103 centres (52%); and <37.5°C by 35 (16%). Multimodal neuroprognostication was poorly implemented and a follow-up at 3 months after discharge was done in 71 (30%) institutions. CONCLUSION Post-resuscitation care is not well established and varies among centres in European hospitals. Cardiac arrest centres have a higher coherence with guidelines compared with respondents from non-cardiac arrest centres. The overall inconsistency in approaches and deviation from recommendations could be a focus for improvement.
Collapse
Affiliation(s)
- Pablo Jorge-Perez
- Department of Cardiology, Canary Islands University Hospital, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Nikolaos Nikolaou
- Intensive Cardiac Care Unit, Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Katia Donadello
- Department of Anesthesia and Intensive Care B, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, AOUI-University Hospital Integrated Trust of Verona, Policlinico G.B. Rossi, P.le L. Scuro, Verone, Italy
| | - Abdo Khoury
- Department of Emergency Medicine and Critical Care, Besançon University Hospital, Besançon, France.,INSERM CIC 1431, Besançon University Hospital, Besançon, France
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
| | - Christian Hassager
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, The Heart Center, Copenhagen, Denmark
| | - Bernd Boettiger
- Medical Faculty and University Hospital, University of Cologne, Cologne, Germany.,European Resuscitation Council (ERC), Niel, Belgium.,German Resuscitation Council (GRC), Ulm, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jerry Nolan
- Warwick Medical School, University of Warwick, Coventry, UK.,Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Alain Combes
- Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tom Quinn
- Kingston University and St. Georges, University of London, London, UK
| | - Susanna Price
- Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Johannes Grand
- Department of Cardiology, Amager-Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Hamed M, Neupane G, Abdelsalam M, Elkhawas I, Morsy M, Khalili H, Elgendy IY, Elbadawi A. Meta-Analysis on Early Versus Delayed Coronary Angiography for Patients With Out-of-Hospital Cardiac Arrest Without ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 188:41-43. [PMID: 36463781 DOI: 10.1016/j.amjcard.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/08/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Gagan Neupane
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Mahmoud Abdelsalam
- Division of Cardiology, Charleston Area Medical Center, Charleston, West Virginia
| | - Ibrahim Elkhawas
- Department of Internal Medicine, Steward Carney Hospital, Dorchester, Massachusetts
| | - Mohamed Morsy
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Houman Khalili
- Division of Cardiology, Florida Atlantic University, Boca Raton, Florida
| | - Islam Y Elgendy
- Division of Cardiology, University of Kentucky, Lexington, Kentucky
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
13
|
López-de-Sá E. What is the role of coronary angiography in the management of postarrest syndrome? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:80-82. [PMID: 36336226 DOI: 10.1016/j.rec.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
|
14
|
Kiyohara Y, Matsumoto S, Takagi H, Kuno T. Immediate coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation: a meta-analysis of randomized trials. J Cardiovasc Med (Hagerstown) 2022; 23:811-813. [PMID: 36219165 DOI: 10.2459/jcm.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yuko Kiyohara
- Department of Medicine, Yokohama Rosai Hospital, Kanagawa
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| |
Collapse
|
15
|
López-de-Sá E. ¿Cuál es el papel de la coronariografía precoz en el tratamiento del síndrome posparada? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Bavishi C, Trivedi V, Bhatt DL. Meta-Analysis of Early Versus Delayed or Selective Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Elevation Myocardial Infarction. Am J Cardiol 2022; 175:180-182. [PMID: 35613951 DOI: 10.1016/j.amjcard.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chirag Bavishi
- University Hospital, Columbia, University of Missouri School of Medicine, Columbia, Missouri
| | - Vrinda Trivedi
- University Hospital, Columbia, University of Missouri School of Medicine, Columbia, Missouri
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
17
|
Alves N, Mota M, Cunha M, Ribeiro JM. Impact of emergent coronary angiography after out-of-the-hospital cardiac arrest without ST-segment elevation - a systematic review and meta-analysis. Int J Cardiol 2022; 364:1-8. [PMID: 35660557 DOI: 10.1016/j.ijcard.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronary artery disease is a leading cause of out-of-the-hospital cardiac arrest (OHCA). However, there is no consensus on whether OHCA patients without ST-segment elevation (STE) benefit from emergent (ie < 2 h) coronary angiography (CAG). Our aim was to assess the impact of emergent CAG in no-STE OHCA patients. METHODS We performed a systematic review and meta-analysis by searching the MEDLINE, Cochrane, Scopus, CINAHL and JBI databases for randomized controlled trials (RCTs) comparing emergent CAG versus standard of care (ie CAG >2 h after OHCA or not performed) in no-STE OHCA patients of presumed cardiac aetiology. The primary outcome was short term survival. Secondary outcomes included survival with good neurological outcome, mid-term survival, left ventricle ejection fraction (LVEF), acute kidney injury (AKI) and renal replacement therapy (RRT), ventricular arrhythmias and major bleeding during hospital stay. RESULTS Seven RCTs met the inclusion and exclusion criteria and were included; one was included only in the analysis of mid-term survival and another in the LVEF analysis. Five studies (1278 patients, 643 with early CAG and 635 with no early CAG) were included in the analysis of the primary endpoint. The groups were balanced for all baseline characteristics but previous PCI, which was more frequent in the standard of care groups. There were no significant differences between groups for short-term survival (57 vs 61%; OR0.85, 95% CI0.68-1.07; I2 = 0%). There were also no differences for any of the secondary endpoints. CONCLUSION Routine emergent CAG did not improve survival in comatose survivors of OHCA with shockable rhythm and no-STE.
Collapse
Affiliation(s)
- Nuno Alves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; UICISA:E, ESEnfC, Coimbra / SIGMA - Phi Xi Chapter, ESEnfC, Coimbra, Portugal
- CIEC -, UM, Braga, Portugal
| | - Mauro Mota
- Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA:E)
- Unidade Local de Saúde da Guarda, Portugal
| | - Madelena Cunha
- Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Joana Maria Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
| |
Collapse
|
18
|
Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series. J Clin Med 2022; 11:jcm11051395. [PMID: 35268485 PMCID: PMC8911187 DOI: 10.3390/jcm11051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.
Collapse
|
19
|
Yeo JW, Ng ZHC, Goh AXC, Gao JF, Liu N, Lam SWS, Chia YW, Perkins GD, Ong MEH, Ho AFW. Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 11:e023806. [PMID: 34927456 PMCID: PMC9075197 DOI: 10.1161/jaha.121.023806] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm (P=0.006) and without prehospital return of spontaneous circulation (P=0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.
Collapse
Affiliation(s)
- Jun Wei Yeo
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Zi Hui Celeste Ng
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | | | | | - Nan Liu
- Centre for Quantitative Medicine Duke-NUS Medical SchoolNational University of Singapore Singapore
| | - Shao Wei Sean Lam
- Health Services Research Centre SingHealth Duke-NUS Academic Medical Centre Singapore
| | - Yew Woon Chia
- Department of Cardiology Tan Tock Seng Hospital Singapore
| | - Gavin D Perkins
- Warwick Medical School University of Warwick Coventry United Kingdom
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine Singapore General Hospital Singapore.,Health Services & Systems Research Duke-NUS Medical School Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine Singapore General Hospital Singapore.,Pre-Hospital and Emergency Research Centre Health Services and Systems Research Duke-NUS Medical School Singapore
| | | |
Collapse
|
20
|
Abusnina W, Al-Abdouh A, Latif A, Alkhouli M, Alraies MC, Daggubati R, Alasnag M, Kerrigan J, Paul TK. Timing of coronary angiography in patients following out-of-hospital cardiac arrest without ST-segment elevation: A systematic review and Meta-analysis of randomized trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:92-98. [PMID: 34844869 DOI: 10.1016/j.carrev.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. The timing and role of early coronary angiography (CAG) in OHCA patients without ST elevation remains unclear. OBJECTIVE We performed a meta-analysis of randomized controlled trials (RCTs) that compared early CAG to delayed CAG in OHCA patients without ST elevation. METHODS We searched PubMed, Cochrane, and ClinicalTrials.gov databases (from inception to September 2021) for studies comparing early CAG to delayed CAG in OHCA patients without ST elevation. We used a random-effect model to calculate relative ratio (RR) with 95% confidence interval (CI). The primary outcome was all-cause mortality at 30 days. Secondary outcomes included neurological status with cerebral performance category ≤2 (CPC) and the rate of percutaneous coronary intervention (PCI) following CAG. RESULTS A total of 6 RCTs including 1822 patients, of whom 895 underwent early CAG, and 927 underwent delayed CAG, were included in this meta-analysis. There was no statistically significant difference between the 2 groups in terms of 30-day all-cause mortality (Relative risk [RR] 1.06; 95%CI 0.94-1.20; P = 0.32; I2 = 13%), neurological status (CPC ≤2) (RR 1.01; 95%CI 0.90-1.13; P = 0.85, I2 = 37%), and rates of PCI following CAG (RR 1.08; 95%CI 0.84-1.39; P = 0.56; I2 = 49%). CONCLUSION In patients suffering OHCA without ST-elevation, early CAG is not associated with reduced 30-day mortality when compared to patients who underwent delayed CAG. Given our meta-analysis results including multiple trials that have not shown a benefit, it is likely that updated guidelines will not support early angiography in patients suffering OHCA without ST-elevation.
Collapse
Affiliation(s)
- Waiel Abusnina
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Azka Latif
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | | | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, Heart Hospital, Detroit, MI, USA
| | | | | | - Jimmy Kerrigan
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, USA
| | - Timir K Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, USA.
| |
Collapse
|
21
|
Nehme Z, Stub D. Triage of post-cardiac arrest patients: To PCI or not to PCI, that is the question. Resuscitation 2021; 170:335-338. [PMID: 34822936 DOI: 10.1016/j.resuscitation.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ziad Nehme
- Centre of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
| | - Dion Stub
- Centre of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia
| |
Collapse
|
22
|
Harhash AA, May TL, Hsu CH, Agarwal S, Seder DB, Mooney MR, Patel N, McPherson J, McMullan P, Riker R, Soreide E, Hirsch KG, Stammet P, Dupont A, Rubertsson S, Friberg H, Nielsen N, Rab T, Kern KB. Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography. J Am Coll Cardiol 2021; 77:360-371. [PMID: 33509392 DOI: 10.1016/j.jacc.2020.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed "unfavorable feature" on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age >85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC >30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate >7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH <7.2 OR: 0.78 (95% CI: 0.63 to 0.98), and chronic kidney disease OR: 0.96 (95% CI: 0.70 to 1.33). The presence of any 3 or more unfavorable features predicted <40% survival. Presence of the 3 strongest risk factors (age >85 years, time-to-ROSC >30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge. CONCLUSIONS Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable.
Collapse
Affiliation(s)
- Ahmed A Harhash
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA; University of Vermont, Burlington, Vermont, USA
| | | | - Chiu-Hsieh Hsu
- University of Arizona College of Public Health, Tucson, Arizona, USA
| | | | | | | | - Nainesh Patel
- Lehigh Valley Medical Center, Lehigh, Pennsylvania, USA
| | - John McPherson
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | | | | | | | | | - Tanveer Rab
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA.
| |
Collapse
|
23
|
Verma BR, Sharma V, Shekhar S, Kaur M, Khubber S, Bansal A, Singh J, Ahuja KR, Nazir S, Chetrit M, Menon V, Reed G, Kapadia S. Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2021; 13:2193-2205. [PMID: 33032706 DOI: 10.1016/j.jcin.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The authors conducted a meta-analysis to study clinical outcomes in patients who underwent early versus nonearly coronary angiography (CAG) in the setting of out-of-hospital cardiac arrest (OHCA) without ST-segment elevation. BACKGROUND The benefit of performing early CAG in patients with OHCA without STE remains disputed. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from inception until February 21, 2020. Early and nonearly CAG patients were identified on the basis of the definitions mentioned in respective published studies. The primary outcome studied was 30-day mortality. Secondary outcomes were neurological status and the rate of percutaneous coronary intervention (PCI) following cardiac arrest. RESULTS Of 4,516 references, 11 studies enrolling 3,581 patients were included in the final meta-analysis. Random-effects analysis showed no differences in 30-day mortality (risk ratio [RR]: 0.86; 95% confidence interval [CI]: 0.71 to 1.04; p = 0.12; I2 = 74%), neurological status (RR: 1.08; 95% CI: 0.94 to 1.24; p = 0.28; I2 = 69%), and rate of PCI (RR: 1.22; 95% CI: 0.94 to 1.59; p = 0.13; I2 = 67%) between the 2 groups. Diabetes mellitus, chronic renal failure, previous PCI, and lactate level were found to be significant predictors of 30-day mortality on meta-regression (p < 0.05). CONCLUSIONS This analysis shows that there is no significant difference in 30-day mortality, neurological status, or rate of PCI among patients with OHCA without STE treated with early versus nonearly CAG. Thirty-day mortality is determined by presentation comorbidities rather than revascularization.
Collapse
Affiliation(s)
- Beni R Verma
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Vikram Sharma
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Shekhar
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Manpreet Kaur
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Shameer Khubber
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Agam Bansal
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Jarmanjeet Singh
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Keerat Rai Ahuja
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Salik Nazir
- Department of Cardiology, University of Toledo, Toledo, Ohio
| | - Michael Chetrit
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Grant Reed
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Heart and Vascular Institute, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
24
|
Coronary angiography in patients after cardiac arrest without ST-elevation myocardial infarction : A retrospective cohort analysis. Wien Klin Wochenschr 2021; 133:762-769. [PMID: 34191110 PMCID: PMC8373755 DOI: 10.1007/s00508-021-01899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
Background Coronary artery disease (CAD) is the most common cause of sudden cardiac arrest (SCA). Although coronary angiography (CAG) should be performed also in the absence of ST-elevation (STE) after sustained return of spontaneous circulation (ROSC), this recommendation is not well implemented in daily routine. Methods A retrospective database analysis was conducted in a tertiary care center between January 2005 and December 2014. We included all SCA patients aged ≥ 18 years with presumed cardiac cause and sustained ROSC in the absence of STE at hospital admission. The rate and timing of CAG were defined as the primary endpoints. As secondary endpoints, the reasons pro and contra CAG were analyzed. Furthermore, we observed if the signs and symptoms used for decision making occurred more often in patients with treatable CAD. Results We included 645 (53.6%) of the 1203 screened patients, CAG was performed in 343 (53.2%) patients with a diagnosis of occlusive CAD in 214 (62.4%) patients. Of these, 151 (71.0%) patients had occlusive CAD treated with coronary intervention, thrombus aspiration, or coronary artery bypass grafting. In an adjusted binomial logistic regression analysis, age ≥ 70 years, female sex, non-shockable rhythms, and cardiomyopathy were associated with withholding of CAG. In patients diagnosed and treated with occlusive CAD, initially shockable rhythms, previously diagnosed CAD, hypertension, and smoking were found more often. Conclusion Although selection bias is unavoidable due to the retrospective design of this study, a high proportion of the examined patients had occlusive CAD. The criteria used for patient selection may be suboptimal.
Collapse
|
25
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
26
|
|
27
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 386] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
Collapse
Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| |
Collapse
|
28
|
Abstract
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.
Collapse
|
29
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Mariero Olasveengen T, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161:220-269. [PMID: 33773827 DOI: 10.1016/j.resuscitation.2021.02.012] [Citation(s) in RCA: 315] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
Collapse
Affiliation(s)
- Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W Böttiger
- University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Brussels, Belgium; Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Room A108, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Véronique R M Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| |
Collapse
|
30
|
Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
Collapse
|
31
|
Yang MC, Meng-Jun W, Xiao-Yan X, Peng KL, Peng YG, Wang RR. Coronary angiography or not after cardiac arrest without ST segment elevation: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22197. [PMID: 33031262 PMCID: PMC7544299 DOI: 10.1097/md.0000000000022197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to review the available evidence and evaluate the necessity of immediate coronary angiography (CAG) to obtain positive outcomes for out-of-hospital cardiac arrest (OHCA) patients without ST segment elevation. DATA SOURCES Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases. STUDY SELECTION We included observational and case-control studies of outcomes among individuals without ST segment elevation experiencing OHCA who had immediate, delayed, or no CAG. DATA EXTRACTION We extracted study details, as well as patient characteristics and outcomes. DATA SYNTHESIS Six studies (n = 2665) investigating mortality until discharge demonstrated a significant increase in survival benefit with early CAG (odds ratio [OR] = 1.78; 95%CI = 1.51-2.11; I = 81%; P < .0001). Seven studies (n = 2909) showed a significant preservation of neurological functions with early CAG at discharge (OR = 1.66; 95%CI = 1.37-2.02; P < .00001). Four studies (n = 1357) investigating survival outcomes with middle-term follow-up revealed no significant benefit with early CAG (OR = 1.21; 95%CI = 0.93-1.57; I = 66%; P = .15). CONCLUSIONS Our meta-analysis demonstrates that there may be significant benefits in performing immediate CAG on patients who experience OHCA without ST segment elevation.
Collapse
Affiliation(s)
- Meng-Chang Yang
- Department of Anesthesiology, West China Hospital, Sichuan University
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital
| | - Wu Meng-Jun
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, P.R. China
| | - Xu Xiao-Yan
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, P.R. China
| | | | - Yong G. Peng
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ru-Rong Wang
- Department of Anesthesiology, West China Hospital, Sichuan University
| |
Collapse
|
32
|
Kern KB, Radsel P, Jentzer JC, Seder DB, Lee KS, Lotun K, Janardhanan R, Stub D, Hsu CH, Noc M. Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study. Circulation 2020; 142:2002-2012. [PMID: 32985249 DOI: 10.1161/circulationaha.120.049569] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation. METHODS Adult (>18 years) comatose survivors without ST-segment elevation after resuscitation from out-of-hospital cardiac arrest were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multicenter study. Early angiography was defined as ≤120 minutes from arrival at the percutaneous coronary intervention-capable facility. The primary end point was a composite of efficacy and safety measures, including efficacy measures of survival to discharge, favorable neurologic status at discharge (Cerebral Performance Category score ≤2), echocardiographic measures of left ventricular ejection fraction >50%, and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included rearrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mm Hg), and pneumonia. Secondary end points included the incidence of culprit vessels with acute occlusion. RESULTS The study was terminated prematurely before enrolling the target number of patients. A total of 99 patients were enrolled from 2015 to 2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary end point of efficacy and safety was not different between the 2 groups (55.1% versus 46.0%; P=0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% versus 48.0%; P=0.55) or adverse events (26.5% versus 26.0%; P=1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery. CONCLUSIONS This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02387398.
Collapse
Affiliation(s)
- Karl B Kern
- Department of Medicine, Sarver Heart Center (K.B.K., K.S.L., K.L., R.J.), University of Arizona, Tucson
| | - Peter Radsel
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia (P.R., M.N.)
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (J.C.J.)
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland (D.B.S.)
| | - Kwan S Lee
- Department of Medicine, Sarver Heart Center (K.B.K., K.S.L., K.L., R.J.), University of Arizona, Tucson
| | - Kapildeo Lotun
- Department of Medicine, Sarver Heart Center (K.B.K., K.S.L., K.L., R.J.), University of Arizona, Tucson
| | - Rajesh Janardhanan
- Department of Medicine, Sarver Heart Center (K.B.K., K.S.L., K.L., R.J.), University of Arizona, Tucson
| | - Dion Stub
- Alfred Hospital & Monash University, Melbourne, Australia (D.S.)
| | - Chiu-Hsieh Hsu
- College of Public Health (C.-H.H.), University of Arizona, Tucson
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia (P.R., M.N.)
| |
Collapse
|
33
|
Spoormans EM, Lemkes JS, Janssens GN, van der Hoeven NW, Bonnes JL, van Royen N. The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review. Neth Heart J 2020; 28:108-114. [PMID: 32780340 PMCID: PMC7419423 DOI: 10.1007/s12471-020-01460-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the post-resuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population.
Collapse
Affiliation(s)
- E M Spoormans
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - J S Lemkes
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
| | - G N Janssens
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - N W van der Hoeven
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - J L Bonnes
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N van Royen
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
34
|
Subahi A, Kheiri B, Yassin AS, Ali OE. Coronary Angiography in Patients Resuscitated From Cardiac Arrest Without ST-Segment Elevation: Does It Confer Survival Benefit? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:989-991. [DOI: 10.1016/j.carrev.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/31/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
|
35
|
Inter-Hospital Transfer after Return of Spontaneous Circulation Shows no Correlation with Neurological Outcomes in Cardiac Arrest Patients Undergoing Targeted Temperature Management in Cardiac Arrest Centers. J Clin Med 2020; 9:jcm9061979. [PMID: 32599840 PMCID: PMC7356325 DOI: 10.3390/jcm9061979] [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: 05/28/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
This study evaluated whether inter-hospital transfer (IHT) after the return of spontaneous circulation (ROSC) was associated with poor neurological outcomes after 6 months in post-cardiac-arrest patients treated with targeted temperature management (TTM). We used data from the Korean Hypothermia Network prospective registry from November 2015 to December 2018. These out-of-hospital cardiac arrest (OHCA) patients had either received post-cardiac arrest syndrome (PCAS) care at the same hospital or had been transferred from another hospital after ROSC. The primary endpoint was the neurological outcome 6 months after cardiac arrest. Subgroup analyses were performed to determine differences in the time from ROSC to TTM induction according to the electrocardiography results after ROSC. We enrolled 1326 patients. There were no significant differences in neurological outcomes between the direct visit and IHT groups. In patients without ST elevation, the mean time to TTM was significantly shorter in the direct visit group than in the IHT group. IHT after achieving ROSC was not associated with neurologic outcomes after 6 months in post-OHCA patients treated with TTM, even though TTM induction was delayed in transferred patients.
Collapse
|
36
|
Dennis M, Lal S, Forrest P, Nichol A, Lamhaut L, Totaro RJ, Burns B, Sandroni C. In-Depth Extracorporeal Cardiopulmonary Resuscitation in Adult Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2020; 9:e016521. [PMID: 32375010 PMCID: PMC7660839 DOI: 10.1161/jaha.120.016521] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of extracorporeal cardiopulmonary resuscitation (E‐CPR) for the treatment of patients with out‐of‐hospital cardiac arrest who do not respond to conventional cardiopulmonary resuscitation CPR) has increased significantly in the past 10 years, in response to case reports and observational studies reporting encouraging results. However, no randomized controlled trials comparing E‐CPR with conventional CPR have been published to date. The evidence from systematic reviews of the available observational studies is conflicting. The inclusion criteria for published E‐CPR studies are variable, but most commonly include witnessed arrest, immediate bystander CPR, an initial shockable rhythm, and an estimated time from CPR start to establishment of E‐CPR (low‐flow time) of <60 minutes. A shorter low‐flow time has been consistently associated with improved survival. In an effort to reduce low‐flow times, commencement of E‐CPR in the prehospital setting has been reported and is currently under investigation. The provision of an E‐CPR service, whether hospital based or prehospital, carries considerable cost and technical challenges. Despite increased adoption, many questions remain as to which patients will derive the most benefit from E‐CPR, when and where to implement E‐CPR, optimal post‐arrest E‐CPR care, and whether this complex invasive intervention is cost‐effective. Results of ongoing trials are awaited to determine whether E‐CPR improves survival when compared with conventional CPR.
Collapse
Affiliation(s)
- Mark Dennis
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Sean Lal
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Paul Forrest
- Sydney Medical SchoolUniversity of SydneyAustralia
- Department of AnaesthesiaRoyal Prince Alfred HospitalSydneyAustralia
| | - Alistair Nichol
- University College Dublin‐Clinical Research CentreSt Vincent’s University HospitalDublinIreland
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Intensive CareThe Alfred HospitalMelbourneAustralia
| | - Lionel Lamhaut
- INSERM U970 Team 4 “Sudden Death Expertise Center”ParisFrance
- Paris Descartes UniversityParisFrance
- SAMU de Paris‐DAR Necker University Hospital‐Assistance Public Hopitaux de ParisParisFrance
| | - Richard J. Totaro
- Department of Intensive CareRoyal Prince Alfred HospitalSydneyAustralia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical ServiceNew South Wales, Ambulance Service???Australia
| | - Claudio Sandroni
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore – Policlinico Universitario Agostino Gemelli – IRCCSRomeItaly
| |
Collapse
|
37
|
Impact of Structured Pathways for Postcardiac Arrest Care: A Systematic Review and Meta-Analysis. Crit Care Med 2020; 47:e710-e716. [PMID: 31306259 DOI: 10.1097/ccm.0000000000003827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Recent research has demonstrated value in selected therapeutic and prognostic interventions delivered to patients following cardiac arrest. The aim of this work was to determine if the implementation of a structured care pathway, which combines different interventions, could improve outcomes in survivors of cardiac arrest. DATA SOURCES PubMed and review of citations in retrieved articles. STUDY SELECTION Randomized trials and prospective observational studies conducted in adult cardiac arrest patients, which evaluated the impact on outcome of a structured care pathway, defined as an organized set of interventions designed specifically for postcardiac arrest patients. DATA EXTRACTION Data collected included study characteristics and methodologic quality, populations enrolled, interventions that were part of the cardiac arrest structured care pathway, and outcomes. The principal outcome was favorable functional status defined as a Cerebral Performance Category score of 1-2 at or after hospital discharge. DATA SYNTHESIS The systematic search retrieved 481 articles of which nine (total, 1,994 patients) were selected for systematic review, and six (1,422 patients) met criteria for meta-analysis. Interventions in the care pathways included early coronary angiography with or without percutaneous coronary intervention (eight studies), targeted temperature management (nine studies), and protocolized management in the ICU (seven studies). Neurologic prognostication was not a part of any of the structured pathways. Meta-analysis found significantly higher odds of achieving a favorable functional outcome in patients who were treated in a structured care pathway, when compared with standard care (odds ratio, 2.35; 95% CI, 1.46-3.81). CONCLUSIONS Following cardiac arrest, patients treated in a structured care pathway may have a substantially higher likelihood of favorable functional outcome than those who receive standard care. These findings suggest benefit of a highly organized approach to postcardiac arrest care, in which a cluster of evidence-based interventions are delivered by a specialized interdisciplinary team. Given the overall low certainty of evidence, definitive recommendations will need confirmation in additional high-quality studies.
Collapse
|
38
|
Adult post-cardiac arrest interventions: An overview of randomized clinical trials. Resuscitation 2020; 147:1-11. [DOI: 10.1016/j.resuscitation.2019.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 02/02/2023]
|
39
|
Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MHM, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O’Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, Fran Hazinski M. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2019; 140:e826-e880. [DOI: 10.1161/cir.0000000000000734] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
Collapse
|
40
|
2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2019; 145:95-150. [DOI: 10.1016/j.resuscitation.2019.10.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
41
|
Pareek N, Kordis P, Webb I, Noc M, MacCarthy P, Byrne J. Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions. ACTA ACUST UNITED AC 2019; 14:113-123. [PMID: 31867056 PMCID: PMC6918505 DOI: 10.15420/icr.2019.3.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.
Collapse
Affiliation(s)
- Nilesh Pareek
- King's College Hospital NHS Foundation Trust London, UK.,School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence King's College London, UK
| | | | - Ian Webb
- King's College Hospital NHS Foundation Trust London, UK
| | - Marko Noc
- University Medical Centre Ljubljana, Slovenia
| | - Philip MacCarthy
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence King's College London, UK
| | - Jonathan Byrne
- King's College Hospital NHS Foundation Trust London, UK.,School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence King's College London, UK
| |
Collapse
|
42
|
Panchal AR, Berg KM, Cabañas JG, Kurz MC, Link MS, Del Rios M, Hirsch KG, Chan PS, Hazinski MF, Morley PT, Donnino MW, Kudenchuk PJ. 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e895-e903. [PMID: 31722563 DOI: 10.1161/cir.0000000000000733] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post-cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.
Collapse
|
43
|
Barbarawi M, Zayed Y, Kheiri B, Barbarawi O, Al-Abdouh A, Dhillon H, Rizk F, Bachuwa G, Alkotob ML. Optimal timing of coronary intervention in patients resuscitated from cardiac arrest without ST-segment elevation myocardial infarction (NSTEMI): A systematic review and meta-analysis. Resuscitation 2019; 144:137-144. [DOI: 10.1016/j.resuscitation.2019.06.279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023]
|
44
|
Eshcol JO, Chhatriwalla AK. Selective Coronary Angiography Following Cardiac Arrest. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
45
|
Yeung J, Matsuyama T, Bray J, Reynolds J, Skrifvars MB. Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? - A systematic review. Resuscitation 2019; 137:102-115. [PMID: 30779976 DOI: 10.1016/j.resuscitation.2019.02.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
Abstract
AIM To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' METHODS The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTS: We included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95% CI 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95% CI 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34). CONCLUSIONS Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.
Collapse
Affiliation(s)
- J Yeung
- Warwick Medical School, University of Warwick, United Kingdom.
| | - T Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - J Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
| | - J Reynolds
- Department of Emergency Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - M B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| |
Collapse
|
46
|
Passi NN, Oliver CM, Dhadwal K. Hospital management of the post-cardiac arrest patient: priorities and challenges. Br J Hosp Med (Lond) 2019; 80:C22-C27. [PMID: 30747004 DOI: 10.12968/hmed.2019.80.2.c22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Neha N Passi
- Junior Clinical Fellow, Department of Intensive Care Medicine, Royal Free Hospital, London NW3 2QG
| | - C Matthew Oliver
- Anaesthetic Registrar (ST6), North Central Thames School of Anaesthesia and Honorary Lecturer, UCL Division of Surgery and Interventional Science, London
| | - Kulwant Dhadwal
- Anaesthetic and Intensive Care Consultant, Department of Intensive Care Medicine, Royal Free Hospital, London
| |
Collapse
|
47
|
Randhawa VK, Grunau BE, Debicki DB, Zhou J, Hegazy AF, McPherson T, Nagpal AD. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins. Can J Cardiol 2018; 34:156-167. [PMID: 29407008 DOI: 10.1016/j.cjca.2017.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022] Open
Abstract
Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins.
Collapse
Affiliation(s)
- Varinder K Randhawa
- Division of Cardiology, University of Toronto/University Health Network, Toronto, Ontario, Canada
| | - Brian E Grunau
- Department of Emergency Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derek B Debicki
- Department of Clinical Neurologic Sciences, Western University/London Health Sciences Centre, London, Ontario, Canada
| | - Jian Zhou
- Department of Anesthesia and Perioperative Medicine, Western University/London Health Sciences Centre, London, Ontario, Canada
| | - Ahmed F Hegazy
- Critical Care Western, Western University/London Health Sciences Centre, London, Ontario, Canada; Department of Anesthesia and Perioperative Medicine, Western University/London Health Sciences Centre, London, Ontario, Canada
| | - Terry McPherson
- Division of Cardiology, Western University/London Health Sciences Centre, London, Ontario, Canada
| | - A Dave Nagpal
- Division of Cardiac Surgery, Western University/London Health Sciences Centre, London, Ontario, Canada; Critical Care Western, Western University/London Health Sciences Centre, London, Ontario, Canada.
| |
Collapse
|
48
|
Patterson T, Perkins A, Perkins GD, Clayton T, Evans R, Nguyen H, Wilson K, Whitbread M, Hughes J, Fothergill RT, Nevett J, Mosweu I, McCrone P, Dalby M, Rakhit R, MacCarthy P, Perera D, Nolan JP, Redwood SR. Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial. Am Heart J 2018; 204:92-101. [PMID: 30092413 DOI: 10.1016/j.ahj.2018.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/30/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a global public health issue. There is wide variation in both regional and inter-hospital survival rates from OHCA and overall survival remains poor at 7%. Regionalization of care into cardiac arrest centers (CAC) improves outcomes following cardiac arrest from ST elevation myocardial infarction (STEMI) through concentration of services and greater provider experience. The International Liaison Committee on Resuscitation (ILCOR) recommends delivery of all post-arrest patients to a CAC, but that randomized controlled trials are necessary in patients without ST elevation (STE). METHODS/DESIGN Following completion of a pilot randomized trial to assess safety and feasibility of conducting a large-scale randomized controlled trial in patients following OHCA of presumed cardiac cause without STE, we present the rationale and design of A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation OHCA (ARREST). In total 860 patients will be enrolled and randomized (1:1) to expedited transfer to CAC (24/7 access to interventional cardiology facilities, cooling and goal-directed therapies) or to the current standard of care, which comprises delivery to the nearest emergency department. Primary outcome is 30-day all-cause mortality and secondary outcomes are 30-day and 3-month neurological status and 3, 6 and 12-month mortality. Patients will be followed up for one year after enrolment. CONCLUSION Post-arrest care is time-critical, requires a multi-disciplinary approach and may be more optimally delivered in centers with greater provider experience. This trial would help to demonstrate if regionalization of post-arrest care to CACs reduces mortality in patients without STE, which could dramatically reshape emergency care provision.
Collapse
Affiliation(s)
- Tiffany Patterson
- Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK.
| | - Alexander Perkins
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tim Clayton
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Richard Evans
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Hanna Nguyen
- Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK
| | - Karen Wilson
- Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK
| | - Mark Whitbread
- Medical Directorate, London Ambulance Service, London, UK
| | - Johanna Hughes
- Medical Directorate, London Ambulance Service, London, UK
| | - Rachael T Fothergill
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, UK; Medical Directorate, London Ambulance Service, London, UK
| | - Joanne Nevett
- Medical Directorate, London Ambulance Service, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Middlesex, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free NHS Foundation Trust, London, UK
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Divaka Perera
- Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK
| | - Jerry P Nolan
- School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, UK
| | - Simon R Redwood
- Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King's College London, St. Thomas' Hospital, London, UK
| |
Collapse
|
49
|
ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement. Resuscitation 2018; 127:132-146. [DOI: 10.1016/j.resuscitation.2018.03.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
50
|
Patterson T, Perkins GD, Hassan Y, Moschonas K, Gray H, Curzen N, de Belder M, Nolan JP, Ludman P, Redwood SR. Temporal Trends in Identification, Management, and Clinical Outcomes After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2018; 11:e005346. [DOI: 10.1161/circinterventions.117.005346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Tiffany Patterson
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, Warwick Medical School, University of Warwick, Coventry, United Kingdom (G.D.P.)
| | - Yahma Hassan
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| | | | - Huon Gray
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust & Faculty of Medicine, University of Southampton, United Kingdom (H.G., N.C.)
| | - Mark de Belder
- Cardiology Department, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)
| | - Jerry P. Nolan
- School of Clinical Sciences, University of Bristol and Department of Anaesthesia, Royal United Hospital, Bath, United Kingdom (J.P.N.)
| | - Peter Ludman
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (P.L.)
| | - Simon R. Redwood
- From the Cardiovascular Division, The Rayne Institute BHF Centre of Research Excellence, King’s College London, St. Thomas’ Hospital, United Kingdom (T.P., Y.H., S.R.R.)
| |
Collapse
|