Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China

Machine learning derivation of two cardiac arrest subphenotypes with distinct responses to treatment

INTRODUCTION

Cardiac arrest (CA), characterized by its heterogeneity, poses challenges in patient management. This study aimed to identify clinical subphenotypes in CA patients to aid in patient classification, prognosis assessment, and treatment decision-making.

METHODS

For this study, comprehensive data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) 2.0 database. We excluded patients under 18 years old, those not initially admitted to the intensive care unit (ICU), or treated in the ICU for less than 72 h. A total of 57 clinical parameters relevant to CA patients were selected for analysis. These included demographic data, vital signs, and laboratory parameters. After an extensive literature review and expert consultations, key factors such as temperature (T), sodium (Na), creatinine (CR), glucose (GLU), heart rate (HR), PaO2/FiO2 ratio (P/F), hemoglobin (HB), mean arterial pressure (MAP), platelets (PLT), and white blood cell count (WBC) were identified as the most significant for cluster analysis. Consensus cluster analysis was utilized to examine the mean values of these routine clinical parameters within the first 24 h post-ICU admission to categorize patient classes. Furthermore, in-hospital and 28-day mortality rates of patients across different CA subphenotypes were assessed using multivariate logistic and Cox regression analysis.

RESULTS

After applying exclusion criteria, 719 CA patients were included in the study, with a median age of 67.22 years (IQR: 55.50-79.34), of whom 63.28% were male. The analysis delineated two distinct subphenotypes: Subphenotype 1 (SP1) and Subphenotype 2 (SP2). Compared to SP1, patients in SP2 exhibited significantly higher levels of P/F, HB, MAP, PLT, and Na, but lower levels of T, HR, GLU, WBC, and CR. SP2 patients had a notably higher in-hospital mortality rate compared to SP1 (53.01% for SP2 vs. 39.36% for SP1, P < 0.001). 28-day mortality decreased continuously for both subphenotypes, with a more rapid decline in SP2. These differences remained significant after adjusting for potential covariates (adjusted OR = 1.82, 95% CI: 1.26-2.64, P = 0.002; HR = 1.84, 95% CI: 1.40-2.41, P < 0.001).

CONCLUSIONS

The study successfully identified two distinct clinical subphenotypes of CA by analyzing routine clinical data from the first 24 h following ICU admission. SP1 was characterized by a lower rate of in-hospital and 28-day mortality when compared to SP2. This differentiation could play a crucial role in tailoring patient care, assessing prognosis, and guiding more targeted treatment strategies for CA patients.

The success rate of cardiopulmonary resuscitation and its correlated factors in patients with emergency prehospital cardiac arrest

To assess the initial success rate and its correlated factors on cardiopulmonary resuscitation (CPR) in emergency prehospital cardiac arrest patients. The clinical information of 429 patients with cardiac arrest who underwent prehospital CPR in the fourth hospital of Hebei Medical University from Jan 2020 to Apr 2022 were evaluated. The patients were divided into the successful group (ROSC, n = 25) and the unsuccessful group (non-ROSC, n = 404) according to whether the autonomous circulation (ROSC) was resumed. The univariate analysis was performed to evaluate the differences in age, the start time of CPR, the application of electric defibrillation, and other related data between the two groups. The multivariate analysis evaluated protective factors affecting CPR's success in prehospital cardiac arrest patients. Patients with cardiogenic causes had the highest success rate of cardiopulmonary resuscitation. The causes of traffic accidents and drowning account for a low proportion. Furthermore, the median CPR length was 25.0 min, alternating from 1.5 to 64 mi. The univariate analysis revealed that age, the start time of CPR, application of electric defibrillation, and adrenaline dosage were correlated with CPR attempts (p < 0.05). Multivariate logistic regression analysis showed that the age of patients with prehospital CA, the location of prehospital CA, etiology, bystander CPR, CPR start time, defibrillation start time, tracheal intubation time, type of rhythm before resuscitation, adrenaline dosage <5 mg, and adrenaline administration time were all the influencing factors of prehospital CPR success (p < 0.01). The factors affecting CPR's success rate in prehospital CA patients are complicated. Establishing a few procedures to diminish the incidence of these risk factors is crucial.

Survival outcome among patients with out-of-hospital cardiac arrest who received cardiopulmonary resuscitation in China: a systematic review and meta-analysis

BACKGROUND

This study aimed to assess the survival outcomes among patients with out-of-hospital cardiac arrest (CA) who received cardiopulmonary resuscitation (CPR) in China.

METHODS

Relevant studies, published between January 1, 2010 and September 5, 2022, were retrieved from databases, including EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, China National Knowledge Infrastructure, and Wanfang databases. We included clinical studies in which all patients were diagnosed with CA and underwent out-of-hospital CPR, and the outcome variables were at least one of the following: return of spontaneous circulation (ROSC), survival to admission, survival to hospital discharge, 1-month survival, achieved good neurological outcomes, and 1-year survival. Two investigators independently extracted the study data and assessed its quality using a modified Newcastle-Ottawa Scale tool. The data were pooled using random-effects models.

RESULTS

Of the 3620 identified studies, 49 (63,378 patients) were included in the meta-analysis. The pooled ROSC rate was 9.0% (95% confidence interval [CI] 7.5-10.5%, I² = 97%), the pooled survival to admission rate was 5.0% (95% CI 2.7-8.0%, I² = 98%), and the pooled survival to discharge rate was 1.8% (95% CI 1.2-2.5%, I² = 95%). Additionally, the ROSC rate of patients with bystander CPR was significantly higher than that of those without bystander CPR, and the pooled odds ratio (OR) was 7.92 (95% CI 4.32-14.53, I² = 85%). The ROSC rate of participants who started CPR within 5 min was significantly higher than that of those who started CPR after 5 min, and the pooled OR was 5.92 (95% CI 1.92-18.26, I² = 85%). The ROSC rate of participants with defibrillation was significantly higher than that of those without defibrillation, and the pooled OR was 8.52 (95% CI 3.72-19.52, I² = 77%).

CONCLUSION

The survival outcomes of out-of-hospital CPR in China are far below the world average. Therefore, the policy of providing automated external defibrillators (AEDs) in public places and strengthening CPR training for healthcare providers and public personnel should be encouraged and disseminated nationwide. Trial registration This study was registered in PROSPERO (CRD42022326165) on 29 April 2022.

Epidemiological Analysis of Patients with Pre-Hospital First Aid in Keyouqian Banner, Hinggan League, Inner Mongolia

Objective

To summarize the characteristics of patients calling the 120 emergency number for pre-hospital first aid in Keyouqian Banner, Hinggan League.

Methods

The clinical data of adult patients with pre-hospital first aid from 2016 to 2018 were retrospectively analyzed.

Results

There were 2711 cases with pre-hospital first aid. Males significantly outnumbered females. Young and middle-aged patients comprised 81.5%. Patients were mainly Han and Mongolians. Most injuries and illnesses occurred at home and on the road. The time to arrival of medical services was 30.34 ± 28.29 minutes. The proportion of pre-hospital first aid for trauma was the highest, followed by diseases concerning the cardiovascular and neurological systems. The proportion of patients with improved medical conditions after onsite first aid was 43.3%, the proportion with unchanged conditions was 51.7%, and the total mortality rate was 3.9%.

Conclusion

The disease spectrum, ethnic distribution, age at onset, and pre-hospital first aid capabilities for outpatients were analyzed. These results may facilitate the establishment of a pre-hospital first aid system for the local prevention and control of acute and critical illnesses, increase the success rate of the region's pre-hospital first aid services, and improve the prognosis.

Periodontitis Is Associated With Heart Failure: A Population-Based Study (NHANES III)

Objectives: The aim of this study was to investigate the relationship between periodontitis and heart failure using the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Participants who had received a periodontal examination were included and investigated for the occurrence of heart failure. The included participants were divided into no/mild periodontitis and moderate/severe periodontitis groups according to their periodontal status. Weighted prevalence of heart failure was calculated, and weighted logistic regressions models were used to explore the association between periodontitis and heart failure. Possible influencing factors were then explored through subgroup analysis. Results: Compared with that of the no/mild periodontitis group, the incidence of heart failure in participants with moderate/severe periodontitis was 5.72 times higher (95% CI: 3.76-8.72, p < 0.001). After adjusting for gender, age, race, body mass index, poverty income ratio, education, marital status, smoking status, drinking status, hypertension, diabetes, stroke, and asthma, the results showed that the incidence of heart failure in the moderate/severe group was 3.03 times higher (95% CI: 1.29-7.13, p = 0.012). Subgroup analysis showed that criteria, namely, male, 40-60 years old, non-Hispanic white, body mass index >30, poverty income ratio ≥1, not more than 12 years of education, currently drinking, stroke but no diabetes, or asthma supported moderate/severe periodontitis as a risk factor for heart failure (p < 0.05). Conclusion: According to data from this nationally representative sample from the United States, periodontitis is associated with an increased risk of heart failure.

Analysis of the Status Quo and Influencing Factors of Community Residents' Awareness of Basic Life Support and Willingness to Attempt Rescue

Objective

This study aimed to investigate community residents’ awareness of basic life support (BLS) and their willingness to attempt rescue.

Methods

From October to December 2020, in the communities of Nantong City, a stratified three-stage random sampling method was adopted to select residents from 12 neighborhood committees over the age of 18 with whom to conduct a cross-sectional questionnaire survey. A self-designed questionnaire was adopted, the contents of which included the general situation of the respondent, knowledge, attitude, and behavior in relation to BLS; the Cronbach’s α coefficient of the questionnaire was 0.719.

Results

A total of 3000 questionnaires were distributed, of which 2812 were valid, with a valid response rate of 93.73%. Of the 2812 respondents, 41.18% had seen an automatic external defibrillator (AED), 48.83% had experience of’ cardiopulmonary resuscitation (CPR), and 25.07% of the respondents had experience of’ AEDs. When an accident occurred, 50.50% of residents were willing to attempt rescue, 70.80% were willing to attempt rescue under professional guidance, and 71.23% were willing to attempt rescue after learning BLS techniques. Of the residents who were unwilling to attempt rescue, 32.75% were worried about their lack of ability, 27.91% were concerned about legal issues, 14.01% feared infectious diseases, and 10.35% were unwilling to perform mouth-to-mouth artificial respiration. Age, occupation, education level, and whether they had participated in first aid training were the influencing factors.

Conclusion

Residents in Nantong have less knowledge of BLS, and their knowledge of CPR is better than that of AEDs. Residents have a strong willingness to learn BLS. Measures need to be taken to improve their understanding of BLS and their application skills. Residents have high levels of willingness to attempt rescue, but a certain percentage of residents have concerns. Interventions can be made to target the different reasons.