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Knapp J, Steffen R, Huber M, Heilman S, Rauch S, Bernhard M, Fischer M. Mild therapeutic hypothermia after cardiac arrest - effect on survival with good neurological outcome outside of randomised controlled trials: A registry-based analysis. Eur J Anaesthesiol 2024; 41:779-786. [PMID: 39228239 PMCID: PMC11377051 DOI: 10.1097/eja.0000000000002016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
BACKGROUND For nearly 20 years, in international guidelines, mild therapeutic hypothermia (MTH) was an important component of postresuscitation care. However, recent randomised controlled trials have questioned its benefits. At present, international guidelines only recommend actively preventing fever, but there are ongoing discussions about whether the majority of cardiac arrest patients could benefit from MTH treatment. OBJECTIVE The aim of this study was to compare the outcome of adult patients treated with and without MTH after cardiac arrest. DESIGN Observational cohort study. SETTING German Resuscitation Registry covering more than 31 million inhabitants of Germany and Austria. PATIENTS All adult patients between 2006 and 2022 with out-of-hospital or in-hospital cardiac arrest and comatose on admission. MAIN OUTCOME MEASURES Primary endpoint: hospital discharge with good neurological outcome [cerebral performance categories (CPC) 1 or 2]. Secondary endpoint: hospital discharge. We used a multivariate binary logistic regression analysis to identify the effects on outcome of all known influencing variables. RESULTS We analysed 33 933 patients (10 034 treated with MTH, 23 899 without MTH). The multivariate regression model revealed that MTH was an independent predictor of CPC 1/2 survival and of hospital discharge with odds ratio (95% confidence intervals) of 1.60 (1.49 to 1.72), P < 0.001 and 1.89 (1.76 to 2.02), P < 0.001, respectively. CONCLUSION Our data indicate the existence of a positive association between MTH and a favourable neurological outcome after cardiac arrest. It therefore seems premature to refrain from giving MTH treatment for the entire spectrum of patients after cardiac arrest. Further prospective studies are needed.
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Affiliation(s)
- Jürgen Knapp
- From the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern (JK, RS, MH), Swiss Air-Rescue (Rega), Zurich, Switzerland (JK), the Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen (SH, SR, MF), the Emergency Department, University Hospital, Heinrich-Heine University, Düsseldorf, Germany (MB)
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Nakagawa K, Sagisaka R, Morioka D, Kimura R, Kijima H, Tanaka H. The factors associated with the provision of public access defibrillation in Japan - A nationwide cohort study. Resuscitation 2024; 203:110386. [PMID: 39244143 DOI: 10.1016/j.resuscitation.2024.110386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Abstract
AIM The association between out-of-hospital cardiac arrest (OHCA) and the appropriate provision of public access defibrillation (PAD) remains unclear. This study aimed to evaluate the factors associated with whether or not PAD was provided. METHODS This retrospective cohort study utilized the All-Japan Utstein and Emergency Transport Registries in 2021. We included OHCA patients who were applied to automated external defibrillators (AEDs) by bystanders and were deemed eligible for defibrillation by an AED. We defined PAD provided or no PAD provided based on bystander defibrillation. Multivariable logistic regression analysis with the Firth bias adjustment method was employed to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the exploratory evaluation of factors associated with PAD provided. RESULTS 1949 patients were eligible for analysis (PAD provided, n = 1696 [87.0%]; no PAD provided, n = 253 [13.0%]). Factors positively associated with PAD provided were male (AOR [95% CI], 1.61 [1.17-2.21]; vs. female), other public place incidence (AOR [95% CI], 10.65 [1.40-1367.54]; vs. public place), non-family member witnessed (AOR [95% CI], 2.51 [1.86-3.42]; vs. unwitnessed) and conventional cardiopulmonary resuscitation (CPR), (AOR [95% CI], 1.75 [1.17-2.67]; vs. hands-only CPR). Conversely, factors negatively associated with no PAD provided were over 65 years old (AOR [95% CI], 0.48 [0.28-0.80]; vs. 19-64 yr), night-time onset (AOR [95% CI], 0.61 [0.45-0.83]; vs. daytime), non-cardiogenic (AOR [95% CI], 0.43 [0.31-0.61]; vs. cardiogenic), home setting (AOR [95% CI], 0.33 [0.14-0.83]; vs. public place), healthcare facility setting (AOR [95% CI], 0.40 [0.23-0.66]; vs. public place), no bystander CPR (AOR [95% CI], 0.31 [0.14-0.71]; vs. hands-only CPR), and dispatcher-assistance (AOR [95% CI], 0.72 [0.53-0.97]; vs. no dispatcher-assistance). CONCLUSION Male patients, other public place onset, witnessed by non-family and conventional CPR were associated with PAD provide. Therefore, training skilled first responders to use AEDs appropriately is necessary.
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Affiliation(s)
- Koshi Nakagawa
- Department of Integrated Science and Engineering for Sustainable Societies, Faculty of Science and Engineering, Chuo University, Japan.
| | - Ryo Sagisaka
- Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Japan; Graduate School of Emergency Medical System, Kokushikan University, Japan
| | - Daigo Morioka
- Graduate School of Emergency Medical System, Kokushikan University, Japan; Faculty of Emergency Medical Science, School of Health Science and Medical Care, Meiji University of Integrative Medicine, Japan
| | - Ryu Kimura
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | - Hinata Kijima
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | - Hideharu Tanaka
- Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Japan; Graduate School of Emergency Medical System, Kokushikan University, Japan
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Kochhar S, Samagh N, Sharma J, Kaur A, Verma M. Knowledge and Skill Retention in First-Year MBBS Students After Basic Life Support Training: A One-Year Longitudinal Study. BMC MEDICAL EDUCATION 2024; 24:971. [PMID: 39238013 PMCID: PMC11378406 DOI: 10.1186/s12909-024-05922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The Indian National Medical Council has incorporated the Basic Life Support (BLS) course in the foundation course of the undergraduate (MBBS) medical curriculum. However, medical teachers raise concerns about how training would affect the retention of Basic Life Support (BLS) abilities in the longer run. So, the current study assesses the knowledge and retention of BLS skills among first-year MBBS students over one year. METHODS We included one hundred first-year MBBS students in our study who were trained for BLS, including theory, demonstrations and hands-on training using mannequins. Theoretical knowledge was assessed using pre-test and post-test questionnaires. At the same time, the skills were evaluated using Directly Observed Procedural Skills (DOPS) scores before, just after the training session, and again after one month, six months, and one year. Course feedback was also taken from the students after completing the sessions. RESULTS There was a statistically significant difference between pre-and post-test knowledge scores, indicating that training improved their knowledge. (p < 0.001) There was also a statistically significant difference between pre-and post-test skills using DOPS (p < 0.001). There was no significant difference in the score when DOPS was conducted at one month, but a significant decrease in their skills was seen at six months and one year when compared with the Post Skill Score. (P < 0.001) CONCLUSIONS: The first-year medical students' knowledge and skills were enhanced by BLS training coupled with practical sessions. Such waning skills necessitate repeating the training at periodic intervals to reinform retention of skills acquired during BLS training.
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Affiliation(s)
- Sonia Kochhar
- Department of Physiology, All India Institute Of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Navneh Samagh
- Department of Anesthesiology and Critical Care, All India Institute Of Medical Sciences, 1st Floor, IPD Block, Bathinda, Punjab, 151001, India.
| | - Jyoti Sharma
- Department of Anesthesiology and Critical Care, All India Institute Of Medical Sciences, 1st Floor, IPD Block, Bathinda, Punjab, 151001, India
| | - Amandeep Kaur
- Department of General Medicine, All India Institute Of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute Of Medical Sciences, Bathinda, Punjab, 151001, India
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Olson TL, Kilcoyne HW, Morales-Demori R, Rycus P, Barbaro RP, Alexander PMA, Anders MM. Extracorporeal cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest: A review of the Extracorporeal Life Support Organization Registry. Resuscitation 2024; 203:110380. [PMID: 39222833 DOI: 10.1016/j.resuscitation.2024.110380] [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: 06/19/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
AIMS Current data are insufficient for the leading resuscitation societies to advise on the use of extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to explore the current utilization of ECPR for pediatric OHCA and characterize the patient demographics, arrest features, and metabolic parameters associated with survival. METHODS Retrospective review of the Extracorporeal Life Support Organization Registry database from January 2020 to May 2023, including children 28 days to 18 years old who received ECPR for OHCA. The primary outcome was survival to hospital discharge. RESULTS Eighty patients met inclusion criteria. Median age was 8.8 years [2.0-15.8] and 53.8% of patients were male. OHCA was witnessed for 65.0% of patients and 46.3% received bystander cardiopulmonary resuscitation (CPR). Initial rhythm was shockable in 26.3% of patients and total CPR duration was 78 min [52-106]. Signs of life were noted for 31.3% of patients and a cardiac etiology precipitating event was present in 45.0%. Survival to discharge was 29.9%. Initial shockable rhythm was associated with increased odds of survival (unadjusted OR 4.7 [1.5-14.5]; p = 0.006), as were signs of life prior to ECMO (unadjusted OR 7.8 [2.6-23.4]; p < 0.001). Lactate levels early on-ECMO (unadjusted OR 0.89 [0.79-0.99]; p = 0.02) and at 24 h on-ECMO (unadjusted OR 0.62 [0.42-0.91]; p < 0.001) were associated with decreased odds of survival. CONCLUSIONS These preliminary data suggest that while overall survival is poor, a carefully selected pediatric OHCA patient may benefit from ECPR. Further studies are needed to understand long-term neurologic outcomes.
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Affiliation(s)
- Taylor L Olson
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Hannah W Kilcoyne
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Raysa Morales-Demori
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA.
| | - Peter Rycus
- Extracorporeal Life Support Organization, 3001 Miller Road, Ann Arbor, MI, USA.
| | - Ryan P Barbaro
- Department of Pediatrics, Division of Critical Care Medicine, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA.
| | - Peta M A Alexander
- Department of Pediatrics, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA.
| | - Marc M Anders
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA.
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Andrea L, Herman NS, Vine J, Berg KM, Choudhury S, Vaena M, Nogle JE, Halablab SM, Kaviyarasu A, Elmer J, Wardi G, Pearce AK, Crowley C, Long MT, Herbert JT, Shipley K, Bissell Turpin BD, Lanspa MJ, Green A, Ghamande SA, Khan A, Dugar S, Joffe AM, Baram M, March C, Johnson NJ, Reyes A, Denchev K, Loewe M, Moskowitz A. The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest. Crit Care Explor 2024; 6:e1149. [PMID: 39258957 PMCID: PMC11392493 DOI: 10.1097/cce.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
IMPORTANCE In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practice. DESIGN, SETTING, AND PARTICIPANTS This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individual enrolling hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. INTERVENTIONS, OUTCOMES, AND ANALYSIS The study collects data on patient characteristics including pre-arrest frailty, arrest characteristics, and detailed information on post-arrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures post-arrest temperature control interventions and post-arrest prognostication methods. Analysis will evaluate variations in practice and their association with mortality and neurologic function. CONCLUSIONS We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA, and be a vital resource for future investigations into best-practice for managing patients after IHCA.
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Affiliation(s)
- Luke Andrea
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Nathaniel S Herman
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Jacob Vine
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Katherine M Berg
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Saiara Choudhury
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Mariana Vaena
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Jordan E Nogle
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Saleem M Halablab
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Aarthi Kaviyarasu
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA
| | - Alex K Pearce
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA
| | - Conor Crowley
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Micah T Long
- Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - J Taylor Herbert
- Division of Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Kipp Shipley
- Critical Care Outreach Team, Vanderbilt University Medical Center, Nashville, TN
| | - Brittany D Bissell Turpin
- Department of Pharmacy, University of Kentucky, Lexington, KY
- Department of Pharmacy, Ephraim McDowell Regional Medical Center, Danville, KY
| | - Michael J Lanspa
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Adam Green
- Division of Critical Care, Cooper University Health Care, Camden, NJ
- Cooper Medical School of Rowan University, Camden, NJ
| | - Shekhar A Ghamande
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Medical Center, Baylor College of Medicine, Temple, TX
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, OR
| | - Siddharth Dugar
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron M Joffe
- Department of Anesthesiology, Valleywise Health Medical Center, Creighton University School of Medicine, Phoenix, AZ
| | - Michael Baram
- Korman Lung Center, Thomas Jefferson University, Philadelphia, PA
| | - Cooper March
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA
| | | | | | - Michael Loewe
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
- Louisiana State University Health Sciences Center, Emergency Medicine Residency Program, Baton Rouge Campus, Baton Rouge, LA
| | - Ari Moskowitz
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
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Uehara K, Tagami T, Hyodo H, Takagi G, Ohara T, Yasutake M. The ABC (Age, Bystander, and Cardiogram) score for predicting neurological outcomes of cardiac arrests without pre-hospital return of spontaneous circulation: A nationwide population-based study. Resusc Plus 2024; 19:100673. [PMID: 38881598 PMCID: PMC11177075 DOI: 10.1016/j.resplu.2024.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/11/2024] [Accepted: 05/19/2024] [Indexed: 06/18/2024] Open
Abstract
Aim We previously proposed the ABC score to predict the neurological outcomes of cardiac arrest without prehospital return of spontaneous circulation (ROSC). Using nationwide population-based data, this study aimed to validate the ABC score through various resuscitation guideline periods. Methods We analysed cases with cardiac arrest due to internal causes and failure to achieve prehospital ROSC in the All-Japan Utstein Registry. Patients from the 2007-2009, 2012-2014, and 2017-2019 periods were classified into the 2005, 2010, and 2015 guideline groups, respectively. Neurological outcomes were assessed using cerebral performance categories (CPCs) one month after the cardiac arrest. We defined CPC 1-2 as a favourable outcome. We evaluated the test characteristics of the ABC score, which could range from 0 to 3. Results Among the 162,710, 186,228, and 190,794 patients in the 2005, 2010, and 2015 guideline groups, 0.7%, 0.8%, and 0.9% of the patients had CPC 1-2, respectively. The proportions of CPC 1-2 were 2.9%, 3.6%, and 4.6% in patients with ABC scores of 2 and were 9.5%, 13.3%, and 16.8% in patients with ABC scores of 3, respectively. Among patients with ABC scores of 0, 0.2%, 0.1%, and 0.2%, all had CPC 1-2, respectively. The areas under the receiver operating characteristic curves for the ABC score were 0.798, 0.822, and 0.828, respectively. Conclusions The ABC score had acceptable discrimination for neurological outcomes in patients without prehospital ROSC in the three guideline periods.
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Affiliation(s)
- Kazuyuki Uehara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Hideya Hyodo
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Gen Takagi
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Toshihiko Ohara
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
| | - Masahiro Yasutake
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
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Leungsuwan K, Heier KR, Henderson O, Ayoub K, Alnabelsi T, Slade E, Gupta VA. Post cardiac arrest left ventricular ejection fraction associated with survival to discharge. Resusc Plus 2024; 19:100737. [PMID: 39228405 PMCID: PMC11369395 DOI: 10.1016/j.resplu.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/11/2024] [Accepted: 07/23/2024] [Indexed: 09/05/2024] Open
Abstract
Background Post cardiac arrest left ventricular ejection fraction (LVEF) is routinely assessed, but the implications of this are unknown. This study aimed to assess the association between post cardiac arrest LVEF and survival to hospital discharge. Methods In this retrospective cohort study, all in-hospital and out of hospital cardiac arrests at our tertiary care center between January 2012 and September 2015 were included. Baseline demographics, clinical data, characteristics of the arrest, and interventions performed were collected. Earliest post cardiac arrest echocardiograms were reviewed with LVEF documented. The primary outcome was survival to discharge. Results A total of 736 patients were included in the analysis (mean age 58 years, 44% female). 15% were out of hospital cardiac arrest (24% shockable rhythm). After adjusting for covariates, patients with LVEF < 30% had 36% lower odds of surviving to hospital discharge than those with LVEF ≥ 52% (p = 0.014). Shockable initial rhythm and targeted temperature management were associated with improved survival. Conclusion After a cardiac arrest, an initial LVEF < 30% is associated with significantly lower odds of survival to hospital discharge.
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Chan PS, Girotra S, Blewer A, Kennedy KF, McNally BF, Benoit JL, Starks MA. Race and Sex Differences in the Association of Bystander CPR for Cardiac Arrest. Circulation 2024; 150:677-686. [PMID: 39109427 PMCID: PMC11347084 DOI: 10.1161/circulationaha.124.068732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/18/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) is associated with higher survival for out-of-hospital cardiac arrest, but whether its association with survival differs by patients' sex and race and ethnicity is less clear. METHODS Within a large US registry, we identified 623 342 nontraumatic out-of-hospital cardiac arrests during 2013 to 2022 for this observational cohort study. Using hierarchical logistic regression, we examined whether there was a differential association between bystander CPR and survival outcomes by patients' sex and race and ethnicity, overall and by neighborhood strata. RESULTS Mean age was 62.1±17.1 years, and 35.9% were women. Nearly half of patients (49.8%) were non-Hispanic White; 20.6% were non-Hispanic Black; 7.3% were Hispanic; 2.9% were Asian; and 0.4% were Native American. Overall, 58 098 (9.3%) survived to hospital discharge. Although bystander CPR was associated with higher survival in each race and ethnicity group, the association of bystander CPR compared with patients without bystander CPR in each racial and ethnic group was highest in individuals who were White (adjusted odds ratio [OR], 1.33 [95% CI, 1.30-1.37]) and Native American (adjusted OR, 1.40 [95% CI, 1.02-1.90]) and lowest in individuals who were Black (adjusted OR, 1.09 [95% CI, 1.04-1.14]; Pinteraction<0.001). The adjusted OR for bystander CPR compared with those without bystander CPR for Hispanic patients was 1.29 (95% CI, 1.20-1.139), for Asian patients, it was 1.27 (95% CI, 1.12-1.42), and for those of unknown race, it was 1.31 (95% CI, 1.25-1.36). Similarly, bystander CPR was associated with higher survival in both sexes, but its association with survival was higher in men (adjusted OR, 1.35 [95% CI, 1.31-1.38]) than women (adjusted OR, 1.15 [95% CI, 1.12-1.19]; Pinteraction<0.001). The weaker association of bystander CPR in Black individuals and women was consistent across neighborhood race and ethnicity and income strata. Similar results were observed for the outcome of survival without severe neurological deficits. CONCLUSIONS Although bystander CPR was associated with higher survival in all patients, its association with survival was weakest for Black individuals and women with out-of-hospital cardiac arrest.
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Affiliation(s)
- Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., K.F.K.)
- University of Missouri-Kansas City (P.S.C.)
| | - Saket Girotra
- University of Texas Southwestern Medical Center, Dallas (S.G.)
| | - Audrey Blewer
- Duke University School of Medicine, Durham, NC (A.B., M.A.S.)
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., K.F.K.)
| | - Bryan F McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA (B.F.M)
| | | | - Monique A Starks
- Duke University School of Medicine, Durham, NC (A.B., M.A.S.)
- Duke Clinical Research Institute, Durham, NC (M.A.S.)
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Bray JE, Grasner JT, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: 2024 Update of the Utstein Out-of-Hospital Cardiac Arrest Registry Template. Circulation 2024; 150:e203-e223. [PMID: 39045706 DOI: 10.1161/cir.0000000000001243] [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: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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Kojima S, Michikawa T, Tsujita K, Yonemoto N, Tahara Y, Ikeda T. Long-Term Impact of the Kumamoto Earthquake on Out-of-Hospital Cardiac Arrest With Cardiac and Non-Cardiac Origins - An Interrupted Time Series Analysis. Circ J 2024:CJ-24-0277. [PMID: 39183038 DOI: 10.1253/circj.cj-24-0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
BACKGROUND Possible etiologies of out-of-hospital cardiac arrest (OHCA), including aortic dissection, ruptured aortic aneurysms, and pulmonary embolism, may be classified as non-cardiac causes. We investigated whether cardiac and non-cardiac OHCAs increased following the Kumamoto earthquake and whether the impact on OHCAs extended to regions far from the epicenter. METHODS AND RESULTS We prospectively analyzed a nationwide registry of patients who experienced OHCAs between January 2013 and December 2019. Data from cases registered in 7 prefectures, including Kumamoto (Kyushu region; n=82,060), in the All-Japan Utstein Registry were analyzed for OHCAs of cardiac and non-cardiac origin. The numbers of OHCAs before and after the Kumamoto earthquake were compared using an interrupted time series analysis. The incidence of both cardiac (rate ratio [RR] 1.22) and non-cardiac (RR 1.27) OHCAs in Kumamoto Prefecture increased after the earthquake. The difference disappeared when the analysis was limited to patients with non-cardiac OHCAs with a clear cause of cardiac arrest. The number of cardiac and non-cardiac OHCAs did not increase in other prefectures within the Kyushu region. CONCLUSIONS The Kumamoto earthquake led to an increase in the incidence of cardiac and non-cardiac OHCAs. However, this was attenuated by increasing distance from the epicenter. Except for cardiac causes, cases complicated by earthquake-related events may include non-cardiac OHCAs due to vascular diseases that might be overlooked.
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Affiliation(s)
- Sunao Kojima
- Department of Internal Medicine, Sakurajyuji Yatsushiro Rehabilitation Hospital
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Medicine, University of Toyama
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University
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11
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Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation 2024; 201:110288. [PMID: 39045606 DOI: 10.1016/j.resuscitation.2024.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
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12
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Girotra S, Dukes KC, Sperling J, Kennedy K, Del Rios M, Crowe R, Panchal AR, Rea T, McNally BF, Chan PS. Emergency Medical Service Agency Practices and Cardiac Arrest Survival. JAMA Cardiol 2024; 9:683-691. [PMID: 38837166 PMCID: PMC11154368 DOI: 10.1001/jamacardio.2024.1189] [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: 01/26/2024] [Accepted: 04/05/2024] [Indexed: 06/06/2024]
Abstract
Importance Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival. Objective To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies. Design, Setting, and Participants This cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023. Exposure Survey of resuscitation practices at EMS agencies. Main Outcomes and Measures Risk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival. Results Of 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (β = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (β = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (β = 0.48; P = .01), perform simulation training at least every 6 months (β = 0.63; P < .001), and conduct training in the use of mechanical CPR devices at least once annually (β = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (β = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P < .001). Conclusions and Relevance In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.
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Affiliation(s)
- Saket Girotra
- University of Texas Southwestern Medical Center, Dallas
| | | | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Kevin Kennedy
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus
| | - Thomas Rea
- King County Medic One Emergency Medical Services and Harborview Medical Center, University of Washington, Seattle
| | - Bryan F. McNally
- Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
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13
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Smits RLA, Sødergren STF, Folke F, Møller SG, Ersbøll AK, Torp-Pedersen C, van Valkengoed IGM, Tan HL. Long-term survival following out-of-hospital cardiac arrest in women and men: Influence of comorbidities, social characteristics, and resuscitation characteristics. Resuscitation 2024; 201:110265. [PMID: 38866232 DOI: 10.1016/j.resuscitation.2024.110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
AIM We aimed to study sex differences in long-term survival following out-of-hospital cardiac arrest (OHCA) compared to the general population, and determined associations for comorbidities, social characteristics, and resuscitation characteristics with survival in women and men separately. METHODS We followed 2,452 Danish (530 women and 1,922 men) and 1,255 Dutch (259 women and 996 men) individuals aged ≥25 years, who survived 30 days post-OHCA in 2009-2015, until 2019. Using Poisson regression analyses we assessed sex differences in long-term survival and sex-specific associations of characteristics mutually adjusted, and compared survival with an age- and sex-matched general population. The potential predictive value was assessed with the Concordance-index. RESULTS Post-OHCA survival was longer in women than men (adjusted incidence rate ratio (IRR) for mortality 0.74, 95%CI 0.61-0.89 in Denmark; 0.86, 95%CI 0.65-1.15 in the Netherlands). Both sexes had a shorter survival than the general population (e.g., IRR for mortality 3.07, 95%CI 2.55-3.70 and IRR 2.15, 95%CI 1.95-2.37 in Danish women and men). Higher age, glucose lowering medication, no dyslipidaemia medication, unemployment, and a non-shockable initial rhythm were associated with shorter survival in both sexes. Cardiovascular medication, depression/anxiety medication, living alone, low household income, and residential OHCA location were associated with shorter survival in men. Not living with children and bystander cardiopulmonary resuscitation provision were associated with shorter survival in women. The Concordance-indexes ranged from 0.51 to 0.63. CONCLUSIONS Women survived longer than men post-OHCA. Several characteristics were associated with long-term post-OHCA survival, with some sex-specific characteristics. In both sexes, these characteristics had low predictive potential.
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Affiliation(s)
- R L A Smits
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - S T F Sødergren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - F Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - S G Møller
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - A K Ersbøll
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, North Zealand Hospital Hilleroed, Hilleroed, Denmark
| | - I G M van Valkengoed
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - H L Tan
- Amsterdam UMC location University of Amsterdam, Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Ko YC, Lin HY, Huang EPC, Lee AF, Hsieh MJ, Yang CW, Lee BC, Wang YC, Yang WS, Chien YC, Sun JT, Ma MHM, Chiang WC. Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ 2024; 386:e079878. [PMID: 39043416 PMCID: PMC11265210 DOI: 10.1136/bmj-2024-079878] [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] [Accepted: 06/10/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To compare the effectiveness of intraosseous versus intravenous vascular access in the treatment of adult patients with out-of-hospital cardiac arrest. DESIGN Cluster randomised controlled trial. SETTING The VICTOR (Venous Injection Compared To intraOsseous injection during resuscitation of patients with out-of-hospital cardiac arrest) trial involved emergency medical service agencies with all four advanced life support ambulance teams in Taipei City, Taiwan. The enrolment period spanned 6 July 2020 to 30 June 2023 and was temporarily suspended between 20 May 2021 and 31 July 2021 owing to the covid-19 pandemic. PARTICIPANTS Adult (age 20-80 years) patients with non-traumatic out-of-hospital cardiac arrest. INTERVENTIONS Biweekly randomised clusters of four participating advanced life support ambulance teams were assigned to insert either intravenous or intraosseous access. MAIN OUTCOME MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation, sustained return of spontaneous circulation (≥2 hours), and survival with favourable neurological outcomes (cerebral performance category score ≤2) at hospital discharge. RESULTS Among 1771 enrolled patients, 1732 (741 in the intraosseous group and 991 in the intravenous group) were included in the primary analysis (median age 65.0 years; 1234 (71.2%) men). In the intraosseous group, 79 (10.7%) patients were discharged alive, compared with 102 (10.3%) patients in the intravenous group (odds ratio 1.04, 95% confidence interval 0.76 to 1.42; P=0.81). The odds ratio of intraosseous versus intravenous access was 1.23 (0.89 to 1.69; P=0.21) for pre-hospital return of spontaneous circulation, 0.92 (0.75 to 1.13; P=0.44) for sustained return of spontaneous circulation, and 1.17 (0.82 to 1.66; P=0.39) for survival with favourable neurological outcomes. CONCLUSIONS Among adults with non-traumatic out-of-hospital cardiac arrest, initial attempts to establish vascular access through the intraosseous route did not result in different outcomes compared with intravenous access in terms of the proportion of patients surviving to hospital discharge, pre-hospital return of spontaneous circulation, sustained return of spontaneous circulation, and favourable neurological outcomes. TRIAL REGISTRATION NCT04135547ClinicalTrials.gov NCT04135547.
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Affiliation(s)
- Ying-Chih Ko
- Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Yang Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - An-Fu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bin-Chou Lee
- Department of Emergency Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Yao-Cheng Wang
- Fourth District Headquarters, Taipei City Fire Department, Taipei City, Taiwan
| | - Wen-Shuo Yang
- Emergency Medical Services Division, Taipei City Fire Department, Taipei, Taiwan
| | - Yu-Chun Chien
- Disaster Rescue and Emergency Medical Services Division, National Fire Agency, Ministry of the Interior, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan
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15
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Gramespacher H, Schmieschek MHT, Warnke C, Adler C, Bittner S, Dronse J, Richter N, Zaeske C, Gietzen C, Schlamann M, Baldus S, Fink GR, Onur OA. Analysis of Cerebral CT Based on Supervised Machine Learning as a Predictor of Outcome After Out-of-Hospital Cardiac Arrest. Neurology 2024; 103:e209583. [PMID: 38857458 DOI: 10.1212/wnl.0000000000209583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In light of limited intensive care capacities and a lack of accurate prognostic tools to advise caregivers and family members responsibly, this study aims to determine whether automated cerebral CT (CCT) analysis allows prognostication after out-of-hospital cardiac arrest. METHODS In this monocentric, retrospective cohort study, a supervised machine learning classifier based on an elastic net regularized logistic regression model for gray matter alterations on nonenhanced CCT obtained after cardiac arrest was trained using 10-fold cross-validation and tested on a hold-out sample (random split 75%/25%) for outcome prediction. Following the literature, a favorable outcome was defined as a cerebral performance category of 1-2 and a poor outcome of 3-5. The diagnostic accuracy was compared with established and guideline-recommended prognostic measures within the sample, that is, gray matter-white matter ratio (GWR), neuron-specific enolase (NSE), and neurofilament light chain (NfL) in serum. RESULTS Of 279 adult patients, 132 who underwent CCT within 14 days of cardiac arrest with good imaging quality were identified. Our approach discriminated between favorable and poor outcomes with an area under the curve (AUC) of 0.73 (95% CI 0.59-0.82). Thus, the prognostic power outperformed the GWR (AUC 0.66, 95% CI 0.56-0.76). The biomarkers NfL, measured at days 1 and 2, and NSE, measured at day 2, exceeded the reliability of the imaging markers derived from CT (AUC NfL day 1: 0.87, 95% CI 0.75-0.99; AUC NfL day 2: 0.90, 95% CI 0.79-1.00; AUC NSE day: 2 0.78, 95% CI 0.62-0.94). DISCUSSION Our data show that machine learning-assisted gray matter analysis of CCT images offers prognostic information after out-of-hospital cardiac arrest. Thus, CCT gray matter analysis could become a reliable and time-independent addition to the standard workup with serum biomarkers sampled at predefined time points. Prospective studies are warranted to replicate these findings.
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Affiliation(s)
- Hannes Gramespacher
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Maximilian H T Schmieschek
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Clemens Warnke
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Christoph Adler
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Stefan Bittner
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Julian Dronse
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Nils Richter
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Charlotte Zaeske
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Carsten Gietzen
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Marc Schlamann
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Stephan Baldus
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Gereon R Fink
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Oezguer A Onur
- From the Department of Neurology (H.G., M.H.T.S., C.W., J.D., N.R., G.R.F., O.A.O.), Faculty of Medicine and University Hospital Cologne; Division of Cardiology, Pneumology, Angiology and Intensive Care (C.A., S. Baldus), Department of Internal Medicine III, University of Cologne; Department of Neurology (S. Bittner), University Medical Center Mainz; Cognitive Neuroscience (N.R., O.A.O.), Institute of Neuroscience and Medicine (INM-3), Research Center Jülich; and Institute for Diagnostic and Interventional Radiology (C.Z., C.G., M.S.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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16
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Bonizzoni MA, Scquizzato T, Pieri M, Delrio S, Nardelli P, Ortalda A, Dell'Acqua A, Scandroglio AM. Organ donation after extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest in a metropolitan cardiac arrest centre in Milan, Italy. Resuscitation 2024; 200:110214. [PMID: 38609062 DOI: 10.1016/j.resuscitation.2024.110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival in refractory out-of-hospital cardiac arrest (OHCA) but also expand the donor pool as these patients often become eligible for organ donation. Our aim is to describe the impact of organ donation in OHCA patients treated with ECPR in a high-volume cardiac arrest centre. METHODS Rate of organ donation (primary outcome), organs harvested, a composite of patient survival with favourable neurological outcome or donation of ≥1 solid organ (ECPR benefit), and the potential total number of individuals benefiting from ECPR (survivors with favourable neurological outcome and potential recipients of one solid organ) were analysed among all-rhythms refractory OHCA patients treated with ECPR between January 2013-November 2022 at San Raffaele Hospital in Milan, Italy. RESULTS Among 307 adults with refractory OHCA treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58-81] minutes), 256 (83%) died during hospital stay, 33% from brain death. Donation of at least one solid organ occurred in 58 (19%) patients, 53 (17%) after determination of brain death and 5 (1.6%) after determination of circulatory death, contributing a total of 167 solid organs (3.0 [IQR 2.5-4.0] organs/donor). Overall, 196 individuals (29 survivors with favourable neurological outcome and 167 potential recipients of 1 solid organ) possibly benefited from ECPR. ECPR benefit composite outcome was achieved in 87 (28%) patients. Solid organ donation decreased from 19% to 16% in patients with low-flow <60 min and to 11% with low-flow <60 min and initial shockable rhythm. CONCLUSIONS When ECPR fails in patients with refractory OHCA, organ donation after brain or circulatory death can help a significant number of patients awaiting transplantation, enhancing the overall benefit of ECPR. ECPR selection criteria may affect the number of potential organ donors.
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Affiliation(s)
- Matteo Aldo Bonizzoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Silvia Delrio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Dell'Acqua
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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Siriwardena AN, Patel G, Botan V, Smith MD, Phung VH, Pattinson J, Trueman I, Ridyard C, Hosseini MP, Asghar Z, Orner R, Brewster A, Mountain P, Rowan E, Spaight R. Community First Responders' role in the current and future rural health and care workforce: a mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-101. [PMID: 39054745 DOI: 10.3310/jyrt8674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background Community First Responders are trained volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved. Objectives We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce. Design We used a mixed-methods design, using a lens of pragmatism and the 'actor', 'behaviour change' and 'causal pathway' framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study. Results In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders' scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders. Limitations Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias. Future research Future research should include a robust evaluation of innovations involving Community First Responders. Trial registration This trial is registered as ClinicalTrials.gov, NCT04279262. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Gupteswar Patel
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Vanessa Botan
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Murray D Smith
- Aberystwyth Business School, Aberystwyth University, Aberystwyth, UK
| | - Viet-Hai Phung
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Julie Pattinson
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Ian Trueman
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Mehrshad Parvin Hosseini
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Zahid Asghar
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Roderick Orner
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Amanda Brewster
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Pauline Mountain
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Elise Rowan
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
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Kawauchi A, Aoki M, Kitamura N, Tagami T, Hayashida K, Aso S, Yasunaga H, Nakamura M. Neuromuscular blocking agents during targeted temperature management for out-of-hospital cardiac arrest patients. Am J Emerg Med 2024; 81:86-91. [PMID: 38704929 DOI: 10.1016/j.ajem.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Neuromuscular blocking agents (NMBAs) can control shivering during targeted temperature management (TTM) of patients with cardiac arrest. However, the effectiveness of NMBA use during TTM on neurologic outcomes remains unclear. We aimed to evaluate the association between NMBA use during TTM and favorable neurologic outcomes after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS A multicenter, prospective, observational cohort study from 2019 to 2021. It included OHCA patients who received TTM after hospitalization. We conducted overlap weight propensity-score analyses after multiple imputation to evaluate the effect of NMBAs during TTM. The primary outcome was a favorable neurological outcome, defined as a cerebral performance category of 1 or 2 at discharge. Subgroup analyses were conducted based on initial monitored rhythm and brain computed tomography findings. RESULTS Of the 516 eligible patients, 337 received NMBAs during TTM. In crude analysis, the proportion of patients with favorable neurological outcome was significantly higher in the NMBA group (38.3% vs. 16.8%; risk difference (RD): 21.5%; 95% confidence interval (CI): 14.0% to 29.1%). In weighted analysis, a significantly higher proportion of patients in the NMBA group had a favorable neurological outcome compared to the non-NMBA group (32.7% vs. 20.9%; RD: 11.8%; 95% CI: 1.2% to 22.3%). In the subgroup with an initial shockable rhythm and no hypoxic encephalopathy, the NMBA group showed significantly higher proportions of favorable neurological outcomes. CONCLUSIONS The use of NMBAs during TTM was significantly associated with favorable neurologic outcomes at discharge for OHCA patients. NMBAs may have benefits in selected patients with initial shockable rhythm and without poor prognostic computed tomography findings.
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Affiliation(s)
- Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan; Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan.
| | - Makoto Aoki
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Kei Hayashida
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Shotaro Aso
- Department of Real World Evidence, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mitsunobu Nakamura
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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19
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Ushimoto T, Tanaka K, Kaneto Y, Nakajima K, Inaba H. Association of the COVID-19 pandemic with the incidence of suicidal/self-harm emergencies in Japan: dependence of trend on the regional length of movement restriction. Intern Emerg Med 2024:10.1007/s11739-024-03694-5. [PMID: 38926245 DOI: 10.1007/s11739-024-03694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Reportedly, coronavirus disease pandemic 2019 (COVID 19) was associated with an increased rate of emergency department visits related to suicide in youth. This study analyzed the influence of the pandemic on the incidence of emergency transportation associated with suicide attempts and self-harm. METHODS This retrospective cohort study used the Nationwide Emergency Medical Services Transportation Database between 2016 and 2021 for main analyses and extended database for resuscitation-attempted out-of-hospital cardiac arrests cases for secondary analyses. RESULTS We analyzed 204,081 cases with suicidal/self-harm emergencies. Compared with corresponding periods of 4 pre-pandemic years, the incidence of suicidal/self-harm emergencies increased after the end of the first nationwide declaration of emergency and remained high in youth (incidence rate ratio; 95% lower/upper interval, 1.29; 1.22-1.37 and 1.33; 1.28-1.39,), particularly in females (1.35; 1.27-1.46 and 1.40; 1.33-1.48) during the remaining pandemic period (Phase I (June 2020 to December 2020) and Phase II (2021), respectively). Compared with other emergencies, suicidal/self-harm emergencies were associated with a much higher proportion of outpatient deaths regardless of the pandemic. Suicidal out-of-hospital cardiac arrests cases were associated with much poorer outcomes. CONCLUSION The incidence of suicidal/self-harm emergency transportation in youth considerably increased during COVID 19 after the end of the first state of emergency declaration in Japan. This pandemic's impact varied among sex and region, appearing most prominently in young females. Rapid accumulation of suicidal/self-harm emergency transportation incidences may serve as an early warning sign for mental health problems and suicidality in Japan.
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Affiliation(s)
- Tomoyuki Ushimoto
- Department of Emergency Medicine, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan.
| | - Koichi Tanaka
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Yoshifumi Kaneto
- Department of Emergency Medicine, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Kanazawa Medical University, 1-1 Daigaku, Kahoku-Gun, Uchinada, Ishikawa, 920-0293, Japan
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20
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Bijman LAE, Chamberlain RC, Clegg G, Kent A, Halbesma N. Association of socioeconomic status with 30-day survival following out-of-hospital cardiac arrest in Scotland, 2011-2020. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:305-313. [PMID: 37727980 PMCID: PMC11187719 DOI: 10.1093/ehjqcco/qcad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to investigate the crude and adjusted association of socioeconomic status with 30-day survival after out-of-hospital cardiac arrest (OHCA) in Scotland and to assess whether the effect of this association differs by sex or age. METHODS This is a population-based, retrospective cohort study, including non-traumatic, non-Emergency Medical Services witnessed patients with OHCA where resuscitation was attempted by the Scottish Ambulance Service, between 1 April 2011 and 1 March 2020. Socioeconomic status was defined using the Scottish Index of Multiple Deprivation (SIMD). The primary outcome was 30-day survival after OHCA. Crude and adjusted associations of SIMD quintile with 30-day survival after OHCA were estimated using logistic regression. Effect modification by age and sex was assessed by stratification. RESULTS Crude analysis showed lower odds of 30-day survival in the most deprived quintile relative to least deprived [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.63-0.88]. Adjustment for age, sex, and urban/rural residency decreased the relative odds of survival further (OR 0.56, 95% CI 0.47-0.67). The strongest association was observed in males <45 years old. Across quintiles of increasing deprivation, evidence of decreasing trends in the proportion of those presenting with shockable initial cardiac rhythm, those receiving bystander cardiopulmonary resuscitation, and 30-day survival after OHCA were found. CONCLUSIONS Socioeconomic status is associated with 30-day survival after OHCA in Scotland, favouring people living in the least deprived areas. This was not explained by confounding due to age, sex, or urban/rural residency. The strongest association was observed in males <45 years old.
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Affiliation(s)
- Laura A E Bijman
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Scottish Ambulance Service, Edinburgh, UK
| | | | - Gareth Clegg
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Scottish Ambulance Service, Edinburgh, UK
- Resuscitation Research Group, The University of Edinburgh, Edinburgh, UK
| | | | - Nynke Halbesma
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Scottish Ambulance Service, Edinburgh, UK
- Resuscitation Research Group, The University of Edinburgh, Edinburgh, UK
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21
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Bian Y, Pan Y, Zheng J, Zheng W, Qin L, Zhou G, Sun X, Wang M, Wang C, Chen Y, Xu F. Extracorporeal Versus Conventional Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest: A Propensity Score Matching Cohort Study. Crit Care Med 2024; 52:e268-e278. [PMID: 38441040 DOI: 10.1097/ccm.0000000000006223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Comparing the effects of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on outcomes in patients with in-hospital cardiac arrest (IHCA) in China. The benefits of ECPR over CCPR in patients with IHCA remain controversial. DESIGN This article analyzed data from the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA) study, which consecutively enrolled patients with IHCA from July 1, 2019, to December 31, 2020. Patients who received ECPR were selected as the case group and matched with patients who received CCPR as the control group by propensity score at a ratio of 1:4. A parallel questionnaire survey of participating hospitals was conducted, to collect data on ECPR cases from January 1, 2021 to November 30, 2021. The primary outcome was survival to discharge or 30-day survival. SETTING We included 39 hospitals across 31 provinces in China. PATIENTS Patients receiving cardiopulmonary resuscitation and without contraindications to ECPR were selected from the BASIC-IHCA database. Patients older than 75 years, not witnessed, or with cardiopulmonary resuscitation duration less than 10 min were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 4853 patients met the inclusion criteria before matching, with 34 undergoing ECPR (median age, 56.5 yr; 67.65% male) and 4819 underwent CCPR (median age, 59 yr; 64.52% male). There were 132 patients receiving CCPR and 33 patients receiving ECPR who were eventually matched. The ECPR group had significantly higher survival rates at discharge or 30-day survival (21.21% vs. 7.58%, p = 0.048). The ECPR group had significantly lower mortality rates (hazard ratio 0.57; 95% CI, 0.38-0.91) than the CCPR group at discharge or 30 days. Besides the BASIC-IHCA study, the volume of ECPR implementations and the survival rate of patients with ECPR (29.4% vs. 10.4%. p = 0.004) in participating hospitals significantly improved. CONCLUSIONS ECPR may be beneficial compared with CCPR for patient survival after IHCA and should be considered for eligible patients with IHCA.
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Affiliation(s)
- Yuan Bian
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhui Pan
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Zheng
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Zheng
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijie Qin
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Guangju Zhou
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xifeng Sun
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjie Wang
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunyi Wang
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuguo Chen
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebra1 Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, China
- Department of Emergency Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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22
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Frazier AH, Topjian AA, Reeder RW, Morgan RW, Fink EL, Franzon D, Graham K, Harding ML, Mourani PM, Nadkarni VM, Wolfe HA, Ahmed T, Bell MJ, Burns C, Carcillo JA, Carpenter TC, Diddle JW, Federman M, Friess SH, Hall M, Hehir DA, Horvat CM, Huard LL, Maa T, Meert KL, Naim MY, Notterman D, Pollack MM, Schneiter C, Sharron MP, Srivastava N, Viteri S, Wessel D, Yates AR, Sutton RM, Berg RA. Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes. Ann Am Thorac Soc 2024; 21:895-906. [PMID: 38507645 PMCID: PMC11160133 DOI: 10.1513/annalsats.202311-948oc] [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: 11/08/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Adult and pediatric studies provide conflicting data regarding whether post-cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients ⩽18 years old and with a corrected gestational age of ≥37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia-defined as lowest arterial oxygen tension/pressure (PaO2) <60 mm Hg, highest PaO2 ⩾200 mm Hg, or every PaO2 60-199 mm Hg, respectively-and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (PaCO2) <30 mm Hg, highest PaCO2 ⩾50 mm Hg, or every PaCO2 30-49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58-0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87-1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64-0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74-1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.
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Affiliation(s)
- Aisha H. Frazier
- Nemours Cardiac Center, and
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexis A. Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ron W. Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deborah Franzon
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, California
| | - Kathryn Graham
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Peter M. Mourani
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather A. Wolfe
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tageldin Ahmed
- Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Michael J. Bell
- Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC
| | - Candice Burns
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd C. Carpenter
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - J. Wesley Diddle
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Myke Federman
- Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, California
| | - Stuart H. Friess
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark Hall
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio; and
| | - David A. Hehir
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher M. Horvat
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leanna L. Huard
- Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, California
| | - Tensing Maa
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio; and
| | - Kathleen L. Meert
- Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Maryam Y. Naim
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Notterman
- Department of Molecular Biology, Princeton University, Princeton, New Jersey
| | - Murray M. Pollack
- Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC
| | - Carleen Schneiter
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew P. Sharron
- Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC
| | - Neeraj Srivastava
- Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, California
| | - Shirley Viteri
- Department of Pediatrics, Nemours Children’s Health, Wilmington, Delaware
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Wessel
- Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC
| | - Andrew R. Yates
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio; and
| | - Robert M. Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
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Kawauchi A, Okada Y, Aoki M, Ogasawara T, Tagami T, Kitamura N, Nakamura M. Evaluating the impact of ELSO guideline adherence on favorable neurological outcomes among patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Resuscitation 2024; 199:110218. [PMID: 38649088 DOI: 10.1016/j.resuscitation.2024.110218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
AIM Selecting the appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is challenging. Previously, the Extracorporeal Life Support Organization (ELSO) guidelines suggested the example of inclusion criteria. However, it is unclear whether patients who meet the inclusion criteria of the ELSO guidelines have more favorable outcomes. We aimed to evaluate the relationship between the outcomes and select inclusion criteria of the ELSO guidelines. METHODS We conducted a post-hoc analysis of a multicenter prospective study conducted between 2019 and 2021. Adult patients with OHCA treated with ECPR were included. The primary outcome was a favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days. An ELSO criteria score was assigned based on four criteria: (i) age < 70 years; (ii) witness; (iii) bystander CPR; and (iv) low-flow time (<60 min). Subgroup analysis based on initial cardiac rhythm was performed. RESULTS Among 9,909 patients, 227 with OHCA were included. The proportion of favorable neurological outcomes according to the number of ELSO criteria met were: 0.0% (0/3), 0 points; 0.0% (0/23), 1 point; 3.0% (2/67), 2 points; 7.3% (6/82), 3 points; and 16.3% (7/43), 4 points. A similar tendency was observed in patients with an initial shockable rhythm. However, no such relationship was observed in those with an initial non-shockable rhythm. CONCLUSION Patients who adhered more closely to specific inclusion criteria of the ELSO guidelines demonstrated a tendency towards a higher rate of favorable neurological outcomes. However, the relationship was heterogeneous according to initial rhythm.
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Affiliation(s)
- Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan.
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Makoto Aoki
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba Japan
| | - Mitsunobu Nakamura
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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24
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Kieserman JM, Kuznetsov IA, Park J, Schurr JW, Toubat O, Olia S, Bermudez C, Cevasco M, Wald J. Left ventricular unloading via percutaneous assist device during extracorporeal membrane oxygenation in acute myocardial infarction and cardiac arrest. Int J Artif Organs 2024; 47:401-410. [PMID: 38853663 DOI: 10.1177/03913988241254978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
INTRODUCTION A feared complication of an acute myocardial infarction (AMI) is cardiac arrest (CA). Even if return of spontaneous circulation is achieved, cardiogenic shock (CS) is common. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) supports patients with CS and is often used in conjunction with an Impella device (2.5 and CP) to off-load the left ventricle, although limited evidence supports this approach. METHODS The goal of this study was to determine whether a mortality difference was observed in VA-ECMO alone versus VA-ECMO with Impella (ECPELLA) in patients with CS from AMI and CA. A retrospective chart review of 50 patients with AMI-CS and CA and were supported with VA-ECMO (n = 34) or ECPELLA (n = 16) was performed. The primary outcome was all-cause mortality at 6-months from VA-ECMO or Impella implantation. Secondary outcomes included in-hospital mortality and complication rates between both cohorts and intensive care unit data. RESULTS Baseline characteristics were similar, except patients with ST-elevation myocardial infarction were more likely to be in the VA-ECMO group (p = 0.044). The ECPELLA cohort had significantly worse survival after VA-ECMO (SAVE) score (p = 0.032). Six-month all-cause mortality was not significantly different between the cohorts, even when adjusting for SAVE score. Secondary outcomes were notable for an increased rate of minor complications without an increased rate of major complications in the ECPELLA group. CONCLUSIONS Randomized trials are needed to determine if a mortality difference exists between VA-ECMO and ECPELLA platforms in patients with AMI complicated by CA and CS.
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Affiliation(s)
- Jake M Kieserman
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ivan A Kuznetsov
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Park
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James W Schurr
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Toubat
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Salim Olia
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Bermudez
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce Wald
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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25
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Nishioka N, Yamada T, Nakao S, Yoshiya K, Park C, Nishimura T, Ishibe T, Yamakawa K, Kiguchi T, Kishimoto M, Ninomiya K, Ito Y, Sogabe T, Morooka T, Sakamoto H, Hironaka Y, Onoe A, Matsuyama T, Okada Y, Matsui S, Yoshimura S, Kimata S, Kawai S, Makino Y, Zha L, Kiyohara K, Kitamura T, Iwami T. External Validation of Updated Prediction Models for Neurological Outcomes at 90 Days in Patients With Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2024; 13:e033824. [PMID: 38700024 PMCID: PMC11179904 DOI: 10.1161/jaha.123.033824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Few prediction models for individuals with early-stage out-of-hospital cardiac arrest (OHCA) have undergone external validation. This study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset. METHODS AND RESULTS We performed a secondary analysis of the JAAM-OHCA (Comprehensive Registry of In-Hospital Intensive Care for Out-of-Hospital Cardiac Arrest Survival and the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest) registry. Previously developed prediction models for patients with cardiac arrest who achieved the return of spontaneous circulation were updated. External validation was conducted using data from 56 institutions from the JAAM-OHCA registry. The primary outcome was a dichotomized 90-day cerebral performance category score. Two models were updated using the derivation set (n=3337). Model 1 included patient demographics, prehospital information, and the initial rhythm upon hospital admission; Model 2 included information obtained in the hospital immediately after the return of spontaneous circulation. In the validation set (n=4250), Models 1 and 2 exhibited a C-statistic of 0.945 (95% CI, 0.935-0.955) and 0.958 (95% CI, 0.951-0.960), respectively. Both models were well-calibrated to the observed outcomes. The decision curve analysis showed that Model 2 demonstrated higher net benefits at all risk thresholds than Model 1. A web-based calculator was developed to estimate the probability of poor outcomes (https://pcas-prediction.shinyapps.io/90d_lasso/). CONCLUSIONS The updated models offer valuable information to medical professionals in the prediction of long-term neurological outcomes for patients with OHCA, potentially playing a vital role in clinical decision-making processes.
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Affiliation(s)
- Norihiro Nishioka
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center Osaka Police Hospital Osaka Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine Kansai Medical University, Takii Hospital Moriguchi Japan
| | - Changhwi Park
- Department of Emergency Medicine Tane General Hospital Osaka Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine Osaka Metropolitan University Osaka Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine Kindai University School of Medicine Osaka-Sayama Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center Osaka General Medical Center Osaka Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine Higashi-Osaka Japan
| | | | - Yusuke Ito
- Senri Critical Care Medical Center Saiseikai Senri Hospital Suita Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center National Hospital Organization Osaka National Hospital Osaka Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center Osaka City General Hospital Osaka Japan
| | - Haruko Sakamoto
- Department of Pediatrics Osaka Red Cross Hospital Osaka Japan
| | - Yuki Hironaka
- Emergency and Critical Care Medical Center Kishiwada Tokushukai Hospital Osaka Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yohei Okada
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
- Health Services and Systems Research Duke-NUS Medical School Singapore
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Satoshi Yoshimura
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Shunsuke Kimata
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Shunsuke Kawai
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Yuto Makino
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Kosuke Kiyohara
- Department of Food Science Otsuma Women's University Tokyo Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Osaka Japan
| | - Taku Iwami
- Department of Preventive Services Kyoto University School of Public Health Kyoto Japan
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26
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Preuß S, Multmeier J, Stenzel W, Major S, Ploner CJ, Storm C, Nee J, Leithner C, Endisch C. Survival, but not the severity of hypoxic-ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1337344. [PMID: 38774664 PMCID: PMC11106407 DOI: 10.3389/fcvm.2024.1337344] [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: 11/12/2023] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Background This study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA). Methods Between 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders. Results Among the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg, pgroup = 0.639). Compared to the non-survivors, 211 patients with CPC 1 and 57 patients with CPC 4 had higher MAP values that showed significant, but clinically non-relevant, MAP differences (81.2 vs. 82.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors (n = 54), who regained consciousness before death, had higher MAP values compared to those with no/mild HIE (n = 179), who remained persistently comatose (74.7 vs. 69.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors, who regained consciousness, required fewer vasopressors (CVI 2.1 vs. 3.6, pgroup < 0.001). Independent of the severity of HIE, the survivors were weaned faster from vasopressors (CVI 1.0). Conclusions Although a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.
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Affiliation(s)
- Sandra Preuß
- Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Multmeier
- Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
- Ada Health GmbH, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph J. Ploner
- Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Storm
- Department of Nephrology and Intensive Care Medicine, Cardiac Arrest Center of Excellence Berlin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Nee
- Department of Nephrology and Intensive Care Medicine, Cardiac Arrest Center of Excellence Berlin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Endisch
- Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
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27
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Haskell SE, Hoyme D, Zimmerman MB, Reeder R, Girotra S, Raymond TT, Samson RA, Berg M, Berg RA, Nadkarni V, Atkins DL. Association between survival and number of shocks for pulseless ventricular arrhythmias during pediatric in-hospital cardiac arrest in a national registry. Resuscitation 2024; 198:110200. [PMID: 38582444 DOI: 10.1016/j.resuscitation.2024.110200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Annually 15,200 children suffer an in-hospital cardiac arrest (IHCA) in the US. Ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) is the initial rhythm in 10-15% of these arrests. We sought to evaluate the association of number of shocks and early dose escalation with survival for initial VF/pVT in pediatric IHCA. METHODS Using 2000-2020 data from the American Heart Association's (AHA) Get with the Guidelines®-Resuscitation (GWTG-R) registry, we identified children >48 hours of life and ≤18 years who had an IHCA from initial VF/pVT and received defibrillation. RESULTS There were 251 subjects (37.7%) who received a single shock and 415 subjects (62.3%) who received multiple shocks. Baseline and cardiac arrest characteristics did not differ between those who received a single shock versus multiple shocks except for duration of arrest and calendar year. The median first shock dose was consistent with AHA dosing recommendations and not different between those who received a single shock versus multiple shocks. Survival was improved for those who received a single shock compared to multiple shocks. However, no difference in survival was noted between those who received 2, 3, or ≥4 shocks. Of those receiving multiple shocks, no difference was observed with early dose escalation. CONCLUSIONS In pediatric IHCA, most patients with initial VF/pVT require more than one shock. No distinctions in patient or pre-arrest characteristics were identified between those who received a single shock versus multiple shocks. Subjects who received a single shock were more likely to survive to hospital discharge even after adjusting for duration of resuscitation.
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Affiliation(s)
- Sarah E Haskell
- University of Iowa Carver College of Medicine, Iowa City, IA, United States.
| | - Derek Hoyme
- University of Wisconsin Madison School of Medicine, Madison, WI, United States
| | | | - Ron Reeder
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Saket Girotra
- UT Southwestern Medical Center, Dallas, TX, United States
| | - Tia T Raymond
- Medical City Children's Hospital, Dallas, TX, United States
| | | | - Marc Berg
- Stanford School of Medicine, Palo Alto, CA, United States
| | - Robert A Berg
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Dianne L Atkins
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
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28
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Yoshida R, Komukai K, Kubota T, Kinoshita K, Fukushima K, Yamamoto H, Niijima A, Matsumoto T, Nakayama R, Watanabe M, Yoshimura M. The relationship between the initial pH and neurological outcome in patients with out-of-hospital cardiac arrest is affected by the status of recovery of spontaneous circulation on hospital arrival. Heart Vessels 2024; 39:446-453. [PMID: 38300278 DOI: 10.1007/s00380-023-02352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
The early prediction of neurological outcomes is useful for out-of-hospital cardiac arrest (OHCA). The initial pH was associated with neurological outcomes, but the values varied among the studies. Patients admitted to our division with OHCA of cardiac origin between January 2015 and December 2022 were retrospectively examined (N = 199). A good neurological outcome was defined as a Glasgow-Pittsburgh cerebral performance category (CPC) of 1-2 at discharge. Patients were divided according to the achievement of recovery of spontaneous circulation (ROSC) on hospital arrival, and the efficacy of pH in predicting good neurological outcomes was compared. In patients with ROSC on hospital arrival (N = 100), the initial pH values for good and poor neurological outcomes were 7.26 ± 0.14 and 7.09 ± 0.18, respectively (p < 0.001). In patients without ROSC on hospital arrival (N = 99), the initial pH values for good and poor neurological outcomes were 7.06 ± 0.23 and 6.92 ± 0.15, respectively (p = 0.007). The pH associated with good neurological outcome was much lower in patients without ROSC than in those with ROSC on hospital arrival (P = 0.003). A higher initial pH is associated with good neurological outcomes in patients with OHCA. However, the pH for a good or poor neurological outcome depends on the ROSC status on hospital arrival.
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Affiliation(s)
- Ritsu Yoshida
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Kimiaki Komukai
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan.
| | - Takeyuki Kubota
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Koji Kinoshita
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Keisuke Fukushima
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Hiromasa Yamamoto
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Akira Niijima
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Takuya Matsumoto
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Ryo Nakayama
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Masato Watanabe
- Division of Cardiology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa, Chiba, 277-8567, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Kobayashi RL, Gauvreau K, Alexander PMA, Teele SA, Fynn-Thompson F, Lasa JJ, Bembea M, Thiagarajan RR. Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry. Crit Care Med 2024; 52:563-573. [PMID: 37938044 DOI: 10.1097/ccm.0000000000006103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching. DESIGN Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008-2020). SETTING Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals. PATIENTS Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period ( p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7-2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case ( n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6-2.8; p < 0.001). CONCLUSIONS E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.
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Affiliation(s)
- Ryan L Kobayashi
- Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Peta M A Alexander
- Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sarah A Teele
- Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Francis Fynn-Thompson
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Javier J Lasa
- Divisions of Pediatric Cardiology and Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melania Bembea
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ravi R Thiagarajan
- Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Caputo ML, Baldi E, Burkart R, Wilmes A, Cresta R, Benvenuti C, Oezkartal T, Cianella R, Primi R, Currao A, Bendotti S, Compagnoni S, Gentile FR, Anselmi L, Savastano S, Klersy C, Auricchio A. Validation of Utstein-Based score to predict return of spontaneous circulation (UB-ROSC) in patients with out-of-hospital cardiac arrest. Resuscitation 2024; 197:110113. [PMID: 38218400 DOI: 10.1016/j.resuscitation.2024.110113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS The Utstein Based-ROSC (UB-ROSC) score has been developed to predict ROSC in OHCA victims. Aim of the study was to validate the UB-ROSC score using two Utstein-based OHCA registries: the SWiss REgistry of Cardiac Arrest (SWISSRECA) and the Lombardia Cardiac Arrest Registry (Lombardia CARe), northern Italy. METHODS Consecutive patients with OHCA of any etiology occurring between January 1st, 2019 and December 31st 2021 were included in this retrospective validation study. UB-ROSC score was computed for each patient and categorized in one of three subgroups: low, medium or high likelihood of ROSC according to the UB-ROSC cut-offs (≤-19; -18 to 12; ≥13). To assess the performance of the UB-ROSC score in this new cohort, we assessed both discrimination and calibration. The score was plotted against the survival to hospital admission. RESULTS A total of 12.577 patients were included in the study. A sustained ROSC was obtained in 2.719 patients (22%). The UB-ROSC model resulted well calibrated and showed a good discrimination (AUC 0.71, 95% CI 0.70-0.72). In the low likelihood subgroup of UB-ROSC, only 10% of patients achieved ROSC, whereas the proportion raised to 36% for a score between -18 and 12 (OR 5.0, 95% CI 2.9-8.6, p < 0.001) and to 85% for a score ≥13 (OR 49.4, 95% CI 14.3-170.6, p < 0.001). CONCLUSIONS UB-ROSC score represents a reliable tool to predict ROSC probability in OHCA patients. Its application may help the medical decision-making process, providing a realistic stratification of the probability for ROSC.
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Affiliation(s)
- Maria Luce Caputo
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland.
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roman Burkart
- Interassociation for Rescue Services (IVR-IAS), Aarau, Switzerland
| | - André Wilmes
- Interassociation for Rescue Services (IVR-IAS), Aarau, Switzerland
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | | | - Tardu Oezkartal
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland
| | - Roberto Cianella
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Luciano Anselmi
- Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biostatistics and Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Auricchio
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland; Fondazione Ticino Cuore, Lugano, Switzerland
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Larsen MB, Blom-Hanssen E, Gnesin F, Kragholm KH, Lass Klitgaard T, Christensen HC, Lippert F, Folke F, Torp-Pedersen C, Ringgren KB. Prodromal complaints and 30-day survival after emergency medical services-witnessed out-of-hospital cardiac arrest. Resuscitation 2024; 197:110155. [PMID: 38423500 DOI: 10.1016/j.resuscitation.2024.110155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a frequent and lethal condition with a yearly incidence of approximately 5000 in Denmark. Thirty-day survival is associated with the patient's prodromal complaints prior to cardiac arrest. This paper examines the odds of 30-day survival dependent on the reported prodromal complaints among OHCAs witnessed by the emergency medical services (EMS). METHODS EMS-witnessed OHCAs in the Capital Region of Denmark from 2016-2018 were included. Calls to the emergency number 1-1-2 and the medical helpline for out-of-hours were analyzed according to the Danish Index; data regarding the OHCA was collected from the Danish Cardiac Arrest Registry. We performed multiple logistic regression to calculate the odds ratio (OR) of 30-day survival with adjustment for sex and age. RESULTS We identified 311 eligible OHCAs of which 79 (25.4%) survived. The most commonly reported complaints were dyspnea (n = 209, OR 0.79 [95% CI 0.46: 1.36]) and 'feeling generally unwell' (n = 185, OR 1.07 [95% CI 0.63: 1.81]). Chest pain (OR 9.16 [95% CI 5.09:16.9]) and heart palpitations (OR 3.15 [95% CI 1.07:9.46]) had the highest ORs, indicating favorable odds for 30-day survival, while unresponsiveness (OR 0.22 [95% CI 0.11:0.43]) and blue skin or lips (OR 0.30, 95% CI 0.09, 0.81) had the lowest, indicating lesser odds of 30-day survival. CONCLUSION Experiencing chest pain or heart palpitations prior to EMS-witnessed OHCA was associated with higher 30-day survival. Conversely, complaints of unresponsiveness or having blue skin or lips implied reduced odds of 30-day survival.
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Affiliation(s)
- Mia Bang Larsen
- Department of Clinical Medicine, Aalborg University, Denmark.
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjaellands Hospital, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark
| | | | | | - Freddy Lippert
- Falck, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
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Deng MX, Haller C, Moss K, Saha S, Runeckles K, Fan CPS, Langanecha B, Floh A, Guerguerian AM, Honjo O. Early outcomes of moderate-to-high-risk pediatric congenital cardiac surgery and predictors of extracorporeal circulatory life support requirement. Front Pediatr 2024; 12:1282275. [PMID: 38523837 PMCID: PMC10957634 DOI: 10.3389/fped.2024.1282275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background Cardiopulmonary failure refractory to medical management after moderate-to-high-risk congenital cardiac surgery may necessitate mechanical support with veno-arterial extracorporeal membrane oxygenation (ECMO). On the extreme, ECMO can also be initiated in the setting of cardiac arrest (extracorporeal cardiopulmonary resuscitation, ECPR) unresponsive to conventional resuscitative measures. Methods This was a single-center retrospective cohort study of patients (n = 510) aged <3 years old who underwent cardiac surgery with cardiopulmonary bypass with a RACHS-1 score ≥3 between 2011 and 2014. Perioperative factors were reviewed to identify predictors of ECMO initiation and mortality in the operating room (OR) and the intensive care unit (ICU). Results A total of 510 patients with a mean surgical age of 10.0 ± 13.4 months were included. Among them, 21 (4%) patients received postoperative ECMO-12 were initiated in the OR and 9 in the ICU. ECMO cannulation was associated with cardiopulmonary bypass duration, aortopulmonary shunt, residual severe mitral regurgitation, vaso-inotropic score, and postprocedural lactate (p < 0.001). Of the 32 (6%) total deaths, 7 (22%) were ECMO patients-4 were elective OR cannulations and 3 were ICU ECPR. Prematurity [hazard ratio (HR): 2.61, p < 0.01), Norwood or Damus-Kaye-Stansel procedure (HR: 4.29, p < 0.001), postoperative left ventricular dysfunction (HR: 5.10, p = 0.01), residual severe tricuspid regurgitation (HR: 6.06, p < 0.001), and postoperative ECMO (ECPR: HR: 15.42, p < 0.001 vs. elective: HR: 5.26, p = 0.01) were associated with mortality. The two patients who were electively cannulated in the ICU survived. Discussion Although uncommon, postoperative ECMO in children after congenital cardiac surgery is associated with high mortality, especially in cases of ECPR. Patients with long cardiopulmonary bypass time, residual cardiac lesions, or increased vaso-inotropic requirement are at higher risk of receiving ECMO. Pre-emptive or early ECMO initiation before deterioration into cardiac arrest may improve survival.
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Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christoph Haller
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kasey Moss
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Sudipta Saha
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Kyle Runeckles
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Alejandro Floh
- Department of Critical Care Medicine, Labatt Family Heart Centre, Toronto, ON, Canada
| | | | - Osami Honjo
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Smits RL, Tan HL, van Valkengoed IG. Sex Differences in Out-of-Hospital Cardiac Arrest Survival Trends. J Am Heart Assoc 2024; 13:e032179. [PMID: 38410948 PMCID: PMC10944070 DOI: 10.1161/jaha.123.032179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest survival rates have improved over time. This study established whether improvements were similar for women and men, and to what extent resuscitation characteristics or in-hospital procedures contributed to sex differences in temporal trends. METHODS AND RESULTS This retrospective cohort study included 3386 women and 8564 men from North Holland, the Netherlands, who experienced an out-of-hospital cardiac arrest from a cardiac cause in 2005 to 2017. Yearly rates of 30-day survival and secondary outcomes were calculated. Sex differences in temporal trends were evaluated with age-adjusted Poisson regression analysis, including interaction for sex and out-of-hospital cardiac arrest year. Resuscitation characteristics and in-hospital procedures were added to the model, and a spline at 2013 was considered. During the study period, the average 30-day survival was 24.9% in men and 15.7% in women. The 30-day survival rate increased in men (20% to 27.2%; P<0.001) but not in women (15.0% to 11.6%; P=0.40). The increase in the 30-day survival rate was 3% higher per year in men than in women (rate ratio, 1.03 [95% CI, 1.00-1.05]), with a stronger difference after 2013. Men had a larger increase in survival rate to the hospital arrival than women in 2005 to 2013, and, after 2013, an advantage over women in survival rate after hospital arrival. The sex differences were partly explained by differing trends in shockable initial rhythm (eg, adjusted rate ratio, 1.01 [95% CI, 0.99-1.03] for 30-day survival) and provision of in-hospital procedures. CONCLUSIONS Changes in rates of 30-day survival, survival to hospital arrival, and, after 2013, survival from hospital arrival to 30 days were more beneficial in men than women. The differences in trends were partly explained by shockable initial rhythm and in-hospital procedures.
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Affiliation(s)
- Robin L.A. Smits
- Department of Public and Occupational HealthAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular SciencesAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
| | - Irene G.M. van Valkengoed
- Department of Public and Occupational HealthAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Vahedian-Azimi A, Hassan IF, Rahimi-Bashar F, Elmelliti H, Salesi M, Alqahwachi H, Albazoon F, Akbar A, Shehata AL, Ibrahim AS, Ait Hssain A. Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study. BMC Emerg Med 2024; 24:36. [PMID: 38438853 PMCID: PMC10913290 DOI: 10.1186/s12873-023-00905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/06/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). METHODS This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. RESULTS The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. CONCLUSIONS Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Fatima Albazoon
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Anzila Akbar
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ahmed Labib Shehata
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Abdulsalam Saif Ibrahim
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar.
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Okada Y, Nakagawa K, Tanaka H, Takahashi H, Kitamura T, Kiguchi T, Nishioka N, Kitamura N, Tagami T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Iwami T. Overview and future prospects of out-of-hospital cardiac arrest registries in Japan. Resusc Plus 2024; 17:100578. [PMID: 38362506 PMCID: PMC10867571 DOI: 10.1016/j.resplu.2024.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency with high mortality. The "chain of survival" is critical to improving patient outcomes. To develop and enhance this chain of survival, measuring and monitoring the resuscitation processes and outcomes are essential for quality assurance. In Japan, several OHCA registries have successfully been implemented at both local and national levels. We aimed to review and summarise the conception, strengths, and challenges of OHCA registries in Japan. Method and results The following representing registries in Japan were reviewed: the All-Japan Utstein registry, the Utstein Osaka Project/the Osaka-CRITICAL study, the SOS-KANTO study, the JAAM-OHCA study, and the SAVE-J II study. The All-Japan Utstein registry, operated by the Fire and Disaster Management Agency of Japan and one of the largest nationwide population-based registries in the world, collects data concerning all patients with OHCA in Japan, excluding in-hospital data. Other research- and hospital-based registries collect detailed out-of-hospital and in-hospital data. The Osaka-CRITICAL study and the SOS-KANTO study are organized at regional levels, and hospitals in the Osaka prefecture and in the Kanto area participate in these registries. The JAAM-OHCA study is managed by the Japanese Association of Acute Medicine and includes 107 hospitals throughout Japan. The Save-J II study focuses on patients with OHCA treated with extracorporeal cardiopulmonary resuscitation. Conclusion Each OHCA registry has its own philosophy, strengths, perspectives, and challenges; however, all have been successful in contributing to the improvement of emergency medical service (EMS) systems through the quality improvement process. These registries are expected to be further utilized to enhance EMS systems and improve outcomes for patients with OHCA, while also contributing to the field of resuscitation science.
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Affiliation(s)
- Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | | | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu-shi, Chiba, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kiyohara K, Matsui S, Ayusawa M, Sudo T, Nitta M, Iwami T, Nakata K, Kitamura Y, Sobue T, Kitamura T. Basic life support for non-traumatic out-of-hospital cardiac arrests during school-supervised sports activities in children: A nationwide observational study in Japan. Resusc Plus 2024; 17:100531. [PMID: 38155977 PMCID: PMC10753082 DOI: 10.1016/j.resplu.2023.100531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023] Open
Abstract
Objective To investigate the prognostic impact of bystander-initiated cardiopulmonary resuscitation (CPR) and public-access automated external defibrillator (AED) use on non-traumatic out-of-hospital cardiac arrest (OHCA) occurring during school-supervised sports activities in children. Methods From a nationwide database of pediatric OHCAs occurring under school supervision in Japan, data between April 2008 and December 2020 were obtained. We analyzed non-traumatic OHCAs that occurred during school-supervised sports activities among schoolchildren from elementary, junior high, high, and technical colleges. A multivariable logistic regression model was used to evaluate the effect of basic life support (BLS) on 1-month survival with favorable neurological outcomes after OHCA. Results In total, 318 OHCA cases were analyzed. The 1-month survival with favorable neurological outcomes was 64.8% (164/253) in cases receiving both bystander-CPR and AED application, 40.7% (11/27) in cases receiving CPR only, 38.5% (5/13) in patients receiving AED application only, and 28.0% (7/25) in cases receiving no bystander intervention. Compared with cases receiving no BLS, cases receiving both CPR and AED had a significantly higher proportion of 1-month survival with favorable neurological outcomes (adjusted odds ratio [AOR]: 3.97, 95% confidence interval [CI]: 1.32-11.90, p = 0.014). However, compared to cases receiving no BLS, there was no significant difference in the outcome in the cases receiving CPR only (AOR: 1.35, 95% CI: 0.34-5.29, p = 0.671) and the cases receiving AED application only (AOR: 1.26, 95% CI: 0.25-6.38, p = 0.778). Conclusion The combination of CPR and AED as BLS performed by bystanders for non-traumatic OHCA during school-supervised sports activities improved the outcomes.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mamoru Ayusawa
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
| | - Takeichiro Sudo
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - the SPIRITS investigators
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Kyoto University Health Service, Kyoto, Japan
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
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Gupta K, Nguyen DD, Kennedy KF, Chan PS. Time to bystander cardiopulmonary resuscitation by patient sex for out-of-hospital cardiac arrest. Resuscitation 2024; 196:110126. [PMID: 38280509 DOI: 10.1016/j.resuscitation.2024.110126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Delays in bystander cardiopulmonary resuscitation (CPR) are associated with worse out-of-hospital cardiac arrest (OHCA) outcomes. Whether disparities exist in time to CPR between women and men is unknown. METHODS We included witnessed OHCAs treated with bystander CPR from the Cardiac Arrest Registry Enhancing Survival between 2013-2021. The primary outcome was time to first bystander CPR, and secondary outcomes were survival to hospital discharge and favorable neurological survival. Hierarchical ordinal regression was used to model time to first CPR, which estimates the odds of having a 2-minute longer delay (from 0 to ≥10 minutes) in receiving bystander CPR. The model included sex, age, race, location of arrest, cardiac arrest etiology, day of week, and season as fixed effects and EMS agency as a random effect to account for clustering of patients within an agency. RESULTS Of 78,043 patients with a witnessed OHCA that received bystander CPR, 25,197 (32.3%) were women. The median [IQR] time to first bystander CPR was 2 [1,5] minutes for both women and men. In adjusted analysis, time to bystander CPR was similar in men and women (p = 0.26). Moreover, there was a statistically significantly graded inverse association between time to bystander CPR and survival. CONCLUSION For patients with witnessed OHCA that received bystander CPR, women and men had similar times to CPR, although 5-minute or greater delays in initiating CPR was not uncommon. Delays in bystander CPR in OHCA were associated with worse survival outcomes.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Dan D Nguyen
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Kevin F Kennedy
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Paul S Chan
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
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Cho KJ, Kim KH, Choi J, Yoo D, Kim J. External Validation of Deep Learning-Based Cardiac Arrest Risk Management System for Predicting In-Hospital Cardiac Arrest in Patients Admitted to General Wards Based on Rapid Response System Operating and Nonoperating Periods: A Single-Center Study. Crit Care Med 2024; 52:e110-e120. [PMID: 38381018 PMCID: PMC10876170 DOI: 10.1097/ccm.0000000000006137] [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] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The limitations of current early warning scores have prompted the development of deep learning-based systems, such as deep learning-based cardiac arrest risk management systems (DeepCARS). Unfortunately, in South Korea, only two institutions operate 24-hour Rapid Response System (RRS), whereas most hospitals have part-time or no RRS coverage at all. This study validated the predictive performance of DeepCARS during RRS operation and nonoperation periods and explored its potential beyond RRS operating hours. DESIGN Retrospective cohort study. SETTING In this 1-year retrospective study conducted at Yonsei University Health System Severance Hospital in South Korea, DeepCARS was compared with conventional early warning systems for predicting in-hospital cardiac arrest (IHCA). The study focused on adult patients admitted to the general ward, with the primary outcome being IHCA-prediction performance within 24 hours of the alarm. PATIENTS We analyzed the data records of adult patients admitted to a general ward from September 1, 2019, to August 31, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Performance evaluation was conducted separately for the operational and nonoperational periods of the RRS, using the area under the receiver operating characteristic curve (AUROC) as the metric. DeepCARS demonstrated a superior AUROC as compared with the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS), both during RRS operating and nonoperating hours. Although the MEWS and NEWS exhibited varying performance across the two periods, DeepCARS showed consistent performance. CONCLUSIONS The accuracy and efficiency for predicting IHCA of DeepCARS were superior to that of conventional methods, regardless of whether the RRS was in operation. These findings emphasize that DeepCARS is an effective screening tool suitable for hospitals with full-time RRS, part-time RRS, and even those without any RRS.
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Affiliation(s)
- Kyung-Jae Cho
- Department of Research and Development, VUNO, Seoul, Republic of Korea
| | - Kwan Hyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaewoo Choi
- Department of Research and Development, VUNO, Seoul, Republic of Korea
| | - Dongjoon Yoo
- Department of Research and Development, VUNO, Seoul, Republic of Korea
- Department of Critical Care Medicine and Emergency Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Riva G, Boberg E, Ringh M, Jonsson M, Claesson A, Nord A, Rubertsson S, Blomberg H, Nordberg P, Forsberg S, Rosenqvist M, Svensson L, Andréll C, Herlitz J, Hollenberg J. Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden. Circ Cardiovasc Qual Outcomes 2024; 17:e010027. [PMID: 38445487 DOI: 10.1161/circoutcomes.122.010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/08/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. METHODS Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. RESULTS Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. CONCLUSIONS In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.
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Affiliation(s)
- Gabriel Riva
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
- Department of Cardiology, S:t Göran's Hospital, Stockholm, Sweden (G.R.)
| | - Erik Boberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Anette Nord
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Sten Rubertsson
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Hans Blomberg
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Per Nordberg
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden (S.R., H.B.)
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Mårten Rosenqvist
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
| | - Leif Svensson
- Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden (L.S.)
| | - Cecilia Andréll
- Department of Anesthesiology and Intensive Care, Lund University, Sweden (C.A.)
| | - Johan Herlitz
- Department of Caring Science, University of Borås, Sweden (J. Herlitz)
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden (G.R., E.B., M. Ringh, M.J., A.C., A.N., P.N., S.F., M. Rosenqvist, J. Hollenberg)
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Scquizzato T, Calabrò MG, Franco A, Fominskiy E, Pieri M, Nardelli P, Delrio S, Altizio S, Ortalda A, Melisurgo G, Ajello S, Landoni G, Zangrillo A, Scandroglio AM. Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: 10-year experience in a metropolitan cardiac arrest centre in Milan, Italy. Resusc Plus 2024; 17:100521. [PMID: 38130976 PMCID: PMC10733689 DOI: 10.1016/j.resplu.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Introduction Growing evidence supports extracorporeal cardiopulmonary resuscitation (ECPR) for refractory out-of-hospital cardiac arrest (OHCA) patients, especially in experienced centres. We present characteristics, treatments, and outcomes of patients treated with ECPR in a high-volume cardiac arrest centre in the metropolitan area of Milan, Italy and determine prognostic factors. Methods Refractory OHCA patients treated with ECPR between 2013 and 2022 at IRCCS San Raffaele Scientific Institute in Milan had survival and neurological outcome assessed at hospital discharge. Results Out of 307 consecutive OHCA patients treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58-81] minutes), 17% survived and 9.4% had favourable neurological outcome. Survival and favourable neurological outcome increased to 51% (OR = 8.7; 95% CI, 4.3-18) and 28% (OR = 6.3; 95% CI, 2.8-14) when initial rhythm was shockable and low-flow (time between CPR initiation and ROSC or ECMO flow) ≤60 minutes and decreased to 9.5% and 6.3% when low-flow exceeded 60 minutes (72% of patients). At multivariable analysis, shockable rhythm (aOR for survival = 2.39; 95% CI, 1.04-5.48), shorter low-flow (aOR = 0.95; 95% CI, 0.94-0.97), intermittent ROSC (aOR = 2.5; 95% CI, 1.2-5.6), and signs of life (aOR = 3.7; 95% CI, 1.5-8.7) were associated with better outcomes. Survival reached 10% after treating 104 patients (p for trend <0.001). Conclusions Patients with initial shockable rhythm, intermittent ROSC, signs of life, and low-flow ≤60 minutes had higher success of ECPR for refractory OHCA. Favourable outcomes were possible beyond 60 minutes of low-flow, especially with concomitant favourable prognostic factors. Outcomes improved as the case-volume increased, supporting treatment in high-volume cardiac arrest centres.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annalisa Franco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Delrio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Savino Altizio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Melisurgo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Tanaka C, Tagami T, Nakayama F, Kuno M, Kitamura N, Yasunaga H, Aso S, Takeda M, Unemoto K. Changes Over 7 Years in Temperature Control Treatment and Outcomes After Out-of-Hospital Cardiac Arrest: A Japanese, Multicenter Cohort Study. Ther Hypothermia Temp Manag 2024. [PMID: 38386985 DOI: 10.1089/ther.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Temperature control is the only neuroprotective intervention suggested in current international guidelines for patients with return of spontaneous circulation after cardiac arrest, but the prevalence of temperature control therapy, temperature settings, and outcomes have not been clearly reported. We aimed to investigate changes over 7 years in provision of temperature control treatment among out-of-hospital cardiac arrest (OHCA) patients in Kanto region, Japan. Data of all adult OHCA patients who survived for more than 24 hours in the prospective cohort studies, SOS-KANTO 2012 (conducted from 2012 to 2013) and SOS-KANTO 2017 (conducted from 2019 to 2021), in Japan were included. We compared the prevalence of temperature control and the proportion of mild (≥35°C) and moderate (from 32°C to 34.9°C) hypothermia between the two study groups. We also performed a Cox regression analysis to evaluate 30-day mortality adjusted by temperature control therapy (none, moderate hypothermia, or mild hypothermia), age, sex, past medical history, witnessed status, bystander cardiopulmonary resuscitation, initial rhythm, location of arrest, and dataset (SOS-KANTO 2012 or 2017). We analyzed data from 2936 patients (n = 1710, SOS-KANTO 2012; n = 1226, SOS-KANTO 2017). Use of temperature control was lower (45.3% vs. 41.4%, p = 0.04), moderate hypothermia was lower (p < 0.01), and mild hypothermia was higher (p < 0.01) in SOS-KANTO 2017 compared with SOS-KANTO 2012. The survival rate was significantly higher for patients with mild (p < 0.01) and moderate (p < 0.01) hypothermia compared with those who did not receive temperature control therapy. Overall, the incidence of moderate hypothermia decreased and that of mild hypothermia increased and the use of temperature control decreased between the two studies conducted 7 years apart in the Kanto area, Japan. Temperature control management might improve survival of patients with OHCA.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
| | - Shotaro Aso
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Okubo M, Komukai S, Izawa J, Kiyohara K, Matsuyama T, Iwami T, Kitamura T. Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2024; 7:e2356863. [PMID: 38372996 PMCID: PMC10877448 DOI: 10.1001/jamanetworkopen.2023.56863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/28/2023] [Indexed: 02/20/2024] Open
Abstract
Importance While epinephrine and advanced airway management (AAM) (supraglottic airway insertion and endotracheal intubation) are commonly used for out-of-hospital cardiac arrest (OHCA), the optimal sequence of these interventions remains unclear. Objective To evaluate the association of the sequence of epinephrine administration and AAM with patient outcomes after OHCA. Design, Setting, and Participants This cohort study analyzed the nationwide, population-based OHCA registry in Japan and included adults (aged ≥18 years) with OHCA for whom emergency medical services personnel administered epinephrine and/or placed an advanced airway between January 1, 2014, and December 31, 2019. The data analysis was performed between October 1, 2022, and May 12, 2023. Exposure The sequence of intravenous epinephrine administration and AAM. Main Outcomes and Measures The primary outcome was 1-month survival. Secondary outcomes were 1-month survival with favorable functional status and prehospital return of spontaneous circulation. To control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions, propensity scores and inverse probability of treatment weighting (IPTW) were performed for shockable and nonshockable initial rhythm subcohorts. Results Of 259 237 eligible patients (median [IQR] age, 79 [69-86] years), 152 289 (58.7%) were male. A total of 21 592 patients (8.3%) had an initial shockable rhythm, and 237 645 (91.7%) had an initial nonshockable rhythm. Using IPTW, all covariates between the epinephrine-first and AAM-first groups were well balanced, with all standardized mean differences less than 0.100. After IPTW, the epinephrine-first group had a higher likelihood of 1-month survival for both shockable (odds ratio [OR], 1.19; 95% CI, 1.09-1.30) and nonshockable (OR, 1.28; 95% CI, 1.19-1.37) rhythms compared with the AAM-first group. For the secondary outcomes, the epinephrine-first group experienced an increased likelihood of favorable functional status and prehospital return of spontaneous circulation for both shockable and nonshockable rhythms compared with the AAM-first group. Conclusions and Relevance These findings suggest that for patients with OHCA, administration of epinephrine before placement of an advanced airway may be the optimal treatment sequence for improved patient outcomes.
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Affiliation(s)
- Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Junichi Izawa
- Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women’s University, Tokyo, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Fovaeus H, Holmen J, Mandalenakis Z, Herlitz J, Rawshani A, Castellheim AG. Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study. Resuscitation 2024; 195:110103. [PMID: 38160903 DOI: 10.1016/j.resuscitation.2023.110103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SETTING This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods. RESULTS We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006). CONCLUSION Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.
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Affiliation(s)
- Hannah Fovaeus
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Johan Holmen
- Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Medicine, Adult Congenital Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Albert Gyllencreutz Castellheim
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Choi DH, Hong KJ, Kim KH, Shin SD, Song KJ, Kim Y, Joo YH, Park JH, Ro YS, Kang HJ. Effect of first epinephrine administration time on cerebral perfusion pressure and cortical cerebral blood flow in a porcine cardiac arrest model. Resuscitation 2024; 195:109969. [PMID: 37716402 DOI: 10.1016/j.resuscitation.2023.109969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/27/2023] [Accepted: 09/10/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE The optimal time for epinephrine administration and its effects on cerebral blood flow (CBF) and microcirculation remain controversial. This study aimed to assess the effect of the first administration of epinephrine on cerebral perfusion pressure (CePP) and cortical CBF in porcine cardiac arrest model. METHODS After 4 min of untreated ventricular fibrillation, eight of 24 swine were randomly assigned to the early, intermediate, and late groups. In each group, epinephrine was administered intravenously at 5, 10, and 15 min after cardiac arrest induction. CePP was calculated as the difference between the mean arterial pressure and intracranial pressure. Cortical CBF was measured using a laser Doppler flow probe. The outcomes were CePP and cortical CBF measured continuously during cardiopulmonary resuscitation (CPR). Mean CePP and cortical CBF were compared using analysis of variance and a linear mixed model. RESULTS The mean CePP was significantly different between the groups at 6-11 min after cardiac arrest induction. The mean CePP in the early group was significantly higher than that in the intermediate group at 8-10 min and that in the late group at 6-9 min and 10-11 min. The mean cortical CBF was significantly different between the groups at 9-11 min. The mean cortical CBF was significantly higher in the early group than in the intermediate and late group at 9-10 min. CONCLUSION Early administration of epinephrine was associated with improved CePP and cortical CBF compared to intermediate or late administration during the early period of CPR.
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Affiliation(s)
- Dong Hyun Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea.
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Ki Hong Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yoonjic Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Yoon Ha Joo
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hyun Jeong Kang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
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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.
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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
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Nguyen DD, Spertus JA, Kennedy KF, Gupta K, Uzendu AI, McNally BF, Chan PS. Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States. Circ Cardiovasc Qual Outcomes 2024; 17:e010116. [PMID: 38146663 PMCID: PMC10923150 DOI: 10.1161/circoutcomes.123.010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Prompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood. METHODS In this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR (<1 minute versus 2-3, 4-5, 6-7, 8-9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]). RESULTS Of 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1-5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge (P for trend <0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87-0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68-0.77]). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival (P for trend <0.001). CONCLUSIONS Among patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.
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Affiliation(s)
- Dan D. Nguyen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Kashvi Gupta
- University of Missouri-Kansas City, Kansas City, MO
| | - Anezi I. Uzendu
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
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48
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Kim HJ, Lee D, Moon HJ, Jeong D, Shin TY, In Hong S, Lee HJ. Real-world comparison between mechanical and manual cardiopulmonary resuscitation during the COVID-19 pandemic. Am J Emerg Med 2024; 76:217-224. [PMID: 38128162 DOI: 10.1016/j.ajem.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including an increase in out-of-hospital cardiac arrests (OHCA). Healthcare providers are now required to use personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR). Additionally, mechanical CPR devices have been introduced to reduce the number of personnel required for resuscitation. This study aimed to compare the outcomes of CPR performed with a mechanical device and the outcomes of manual CPR performed by personnel wearing PPE. METHODS This multicenter observational study utilized data from the Korean Cardiac Arrest Research Consortium registry. The study population consisted of OHCA patients who underwent CPR in emergency departments (EDs) between March 2020 and June 2021. Patients were divided into two equal propensity score matched groups: mechanical CPR group (n = 421) and PPE-equipped manual CPR group (n = 421). Primary outcomes included survival rates and favorable neurological outcomes at discharge. Total CPR duration in the ED was also assessed. RESULTS There were no significant between-group differences with respect to survival rate at discharge (mechanical CPR: 7.4% vs PPE-equipped manual CPR: 8.3%) or favorable neurological outcomes (3.3% vs. 3.8%, respectively). However, the mechanical CPR group had a longer duration of CPR in the ED compared to the manual CPR group. CONCLUSION This study found no significant differences in survival rates and neurological outcomes between mechanical CPR and PPE-equipped manual CPR in the ED setting. However, a longer total CPR duration was observed in the mechanical CPR group. Further research is required to explore the impact of PPE on healthcare providers' performance and fatigue during CPR in the context of the pandemic and beyond.
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Affiliation(s)
- Hyun Joon Kim
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Dongwook Lee
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea.
| | - Hyung Jun Moon
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Dongkil Jeong
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Tae Yong Shin
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Sun In Hong
- Department of internal medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
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Choi YH, Jhang WK, Park SJ, Choi HJ, Oh MS, Kwon JE, Kim BJ, Shin JA, Lee IK, Park JD, Lee B, Chung H, Na JY, Choi AY, Cho J, Choi J, Cho HJ, Kim AY, Shin YR, Byun JH, Kim Y. Pediatric Extracorporeal Membrane Oxygenation in Korea: A Multicenter Retrospective Study on Utilization and Outcomes Spanning Over a Decade. J Korean Med Sci 2024; 39:e33. [PMID: 38258365 PMCID: PMC10803205 DOI: 10.3346/jkms.2024.39.e33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Over the last decade, extracorporeal membrane oxygenation (ECMO) use in critically ill children has increased and is associated with favorable outcomes. Our study aims to evaluate the current status of pediatric ECMO in Korea, with a specific focus on its volume and changes in survival rates based on diagnostic indications. METHODS This multicenter study retrospectively analyzed the indications and outcomes of pediatric ECMO over 10 years in patients at 14 hospitals in Korea from January 2012 to December 2021. Four diagnostic categories (neonatal respiratory, pediatric respiratory, post-cardiotomy, and cardiac-medical) and trends were compared between periods 1 (2012-2016) and 2 (2017-2021). RESULTS Overall, 1065 ECMO runs were performed on 1032 patients, with the annual number of cases remaining unchanged over the 10 years. ECMO was most frequently used for post-cardiotomy (42.4%), cardiac-medical (31.8%), pediatric respiratory (17.5%), and neonatal respiratory (8.2%) cases. A 3.7% increase and 6.1% decrease in pediatric respiratory and post-cardiotomy cases, respectively, were noted between periods 1 and 2. Among the four groups, the cardiac-medical group had the highest survival rate (51.2%), followed by the pediatric respiratory (46.4%), post-cardiotomy (36.5%), and neonatal respiratory (29.4%) groups. A consistent improvement was noted in patient survival over the 10 years, with a significant increase between the two periods from 38.2% to 47.1% (P = 0.004). Improvement in survival was evident in post-cardiotomy cases (30-45%, P = 0.002). Significant associations with mortality were observed in neonates, patients requiring dialysis, and those treated with extracorporeal cardiopulmonary resuscitation (P < 0.001). In pediatric respiratory ECMO, immunocompromised patients also showed a significant correlation with mortality (P < 0.001). CONCLUSION Pediatric ECMO demonstrated a steady increase in overall survival in Korea; however, further efforts are needed since the outcomes remain suboptimal compared with global outcomes.
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Affiliation(s)
- Yu Hyeon Choi
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, Korea
| | - Seong Jong Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min-Su Oh
- Department of Pediatrics, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jung Eun Kwon
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Beom Joon Kim
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Ae Shin
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyung Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chung
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Ah Young Choi
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Choi
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, Korea
| | - Ah Young Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Rim Shin
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Younga Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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Tanaka C, Tagami T, Kaneko J, Kitamura N, Yasunaga H, Aso S, Takeda M, Kuno M. Impact of the COVID-19 pandemic on prehospital and in-hospital treatment and outcomes of patients after out-of-hospital cardiac arrest: a Japanese multicenter cohort study. BMC Emerg Med 2024; 24:12. [PMID: 38191311 PMCID: PMC10775511 DOI: 10.1186/s12873-024-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In the chain of survival for Out-of-hospital cardiac arrest (OHCA), each component of care contributes to improve the prognosis of the patient with OHCA. The SARS-CoV-2 (COVID-19) pandemic potentially affected each part of care in the chain of survival. The aim of this study was to compare prehospital care, in-hospital treatment, and outcomes among OHCA patients before and after the COVID-19 pandemic. METHODS We analyzed data from a multicenter prospective study in Kanto area, Japan, named SOS-KANTO 2017. We enrolled patients who registered during the pre-pandemic period (September 2019 to December 2019) and the post-pandemic period (June 2020 to March 2021). The main outcome measures were 30-day mortality and the proportion of favorable outcomes at 1 month, and secondary outcome measures were changes in prehospital and in-hospital treatments between the pre- and post-pandemic periods. RESULTS There were 2015 patients in the pre-pandemic group, and 5023 in the post-pandemic group. The proportion of advanced airway management by emergency medical service (EMS) increased (p < 0.01), and EMS call-to-hospital time was prolonged (p < 0.01) in the post- versus pre-pandemic group. There were no differences between the groups in defibrillation, extracorporeal membrane oxygenation, or temperature control therapy (p = 0.43, p = 0.14, and p = 0.16, respectively). Survival rate at 1 month and favorable outcome rate at 1 month were lower (p = 0.01 and p < 0.01, respectively) in the post- versus pre-pandemic group. CONCLUSION Survival rate and favorable outcome rate 1 month after return of spontaneous circulation of OHCA worsened, EMS response time was prolonged, and advanced airway management by EMS increased in the post- versus pre-pandemic group; however, most prehospital and in-hospital management did not change between pre- and post-COVID-19 pandemic.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Tokyo, 1138654, Japan.
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kimitsu, Chiba, 2928535, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Tokyo, 1138654, Japan
| | - Shotaro Aso
- Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, 1138654, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, 1628666, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
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