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Rattananon P, Tienpratarn W, Yuksen C, Aussavanodom S, Thiamdao N, Termkijwanich P, Phongsawad S, Kaninworapan P, Tantasirin K. Associated Factors of Cardiopulmonary Resuscitation Outcomes; a Cohort Study on an Adult In-hospital Cardiac Arrest Registry. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2024; 12:e30. [PMID: 38572213 PMCID: PMC10988187 DOI: 10.22037/aaem.v12i1.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Introduction In-hospital cardiac arrest (IHCA) remains a substantial cause of morbidity and mortality for hospitalized patients worldwide. This study aimed to identify associated factors of return of spontaneous circulation (ROSC) and survival with favorable neurological outcomes of IHCA patients. Method A two-year retrospective cohort study was conducted at a university-based tertiary care hospital in Bangkok, Thailand, studying adult patients aged ≥ 18 years with IHCA from January 2021 to December 2022. The primary endpoint was sustained ROSC, and the secondary endpoint was survival with favorable neurological outcomes defined as Cerebral Performance Categories (CPC) Scale of 1 or 2 at discharge. Pre-arrest and intra-arrest variables were collected and analyzed using multivariable logistic regression to identify independent factors associated with the outcomes. Results During the study period, 156 patients were included in the study. 105 (67.3%) patients achieved sustained ROSC after the CPR, 28 patients (18.0%) were discharged alive, and 15 patients (9.6%) survived with a favorable neurological outcome at hospital discharge. Overall, sustained ROSC was higher in patients who had IHCA during the day shift (odds ratio (OR): 4.11; 95% confidence interval (CI): 1.05-16.06) and electrocardiogram (ECG) monitoring prior to arrest (OR: 6.38; 95% CI: 1.18-34.54). In contrast, higher adrenaline doses administrated, and increased CPR duration reduced the odds of sustained ROSC (OR: 0.72; 95% CI: 0.54-0.94 and OR: 0.92; 95% CI: 0.85-0.98, respectively). Arrest due to cardiac etiology was associated with increased discharged survival with favorable neurological outcomes (OR: 13.43; 95% CI: 2.00-89.80), while a higher Good Outcome Following Attempted Resuscitation (GO-FAR) score reduced the odds of the secondary outcome (OR: 0.89; 95% CI: 0.81-0.98). Conclusion The sustained ROSC was higher in IHCA during the daytime shift and under prior ECG monitoring. The administration of higher doses of adrenaline and prolonged CPR durations decreased the likelihood of achieving sustained ROSC. Furthermore, patients with cardiac-related causes of cardiac arrest exhibited a higher rate of survival to hospital discharge with favorable neurological outcomes.
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Affiliation(s)
- Parin Rattananon
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supassorn Aussavanodom
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthaphong Thiamdao
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phatcha Termkijwanich
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suraphong Phongsawad
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Moo 14, Bang Pla, Bang Phli, Samut Prakarn 10540, Thailand
| | - Parama Kaninworapan
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanda Tantasirin
- Ramathibodi Life Support Training Unit, Medical Services Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Xie W, Zhou J, Zhou H. Impact of Body Mass Index on Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis. Cardiol Rev 2023:00045415-990000000-00179. [PMID: 38032207 DOI: 10.1097/crd.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The influence of an individual's body mass index (BMI) on cardiac arrest outcomes remains uncertain. The aim of this study is to evaluate the impact of BMI categories (underweight, normal BMI, overweight, and obese) on mortality and neurological outcomes in patients experiencing cardiac arrest. We comprehensively searched standard electronic databases (PubMed, EMBASE, and Scopus) for relevant observational studies published in peer-reviewed journals written in English. We calculated pooled effect estimates using random-effects models and reported them as odds ratios (ORs) with 95% confidence intervals (CIs). We included 20 studies in our meta-analysis. Individuals with normal BMIs and those who were underweight had similar risks of in-hospital mortality (OR, 1.20; 95% CI, 0.90-1.60), mortality within 6 months of discharge (OR, 0.92; 95% CI, 0.59-1.42), mortality after the 1-year follow-up (OR, 2.42; 95% CI, 0.96-6.08), and odds of favorable neurological outcomes at hospital discharge (OR, 0.86; 95% CI, 0.53-1.39) and at the 6-month follow-up (OR, 0.73; 95% CI, 0.47-1.13). The risks of in-hospital mortality and mortality within 6 months of discharge in overweight and obese individuals were similar to those in individuals with normal BMIs. However, overweight (OR, 0.57; 95% CI, 0.35-0.92) and obese individuals (OR, 0.67; 95% CI, 0.51-0.89) had lower risks of mortality after their 1-year follow-ups. For overweight and obese subjects, the reduced risk of mortality after the 1 year of follow-up was noted only for those with in-hospital cardiac arrest and not for those with out-of-hospital cardiac arrest. The odds of favorable neurological outcomes in both overweight and obese individuals were similar to those with normal BMIs. BMI does not significantly impact short-term mortality or neurological outcomes. Overweight and obese individuals appear to have a lower risk of long-term mortality, but this differed by the place of arrest and needs to be confirmed by others.
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Affiliation(s)
- Wangmin Xie
- From the Department of Critical Care Medicine, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang Province, China
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Mohamed Jiffry MZ, Hassan R, Davis A, Scharf S, Walgamage T, Ahmed-Khan MA, Dandwani M. Sickle Cell Anemia Associated With Increased In-Hospital Mortality in Post-Cardiac Arrest Patients. Cureus 2023; 15:e37987. [PMID: 37223169 PMCID: PMC10202522 DOI: 10.7759/cureus.37987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Sickle cell anemia (SCA) is a hemoglobinopathy that arises from a point mutation in the beta-globin gene, which causes the polymerization of deoxygenated hemoglobin that leads to a wide variety of clinical complications. Deaths in patients with SCA most commonly arise from renal, cardiovascular disease, infections, and stroke. In-hospital cardiac arrest has been found to be more common in older patients and those on ventilatory life support, among others. This study aims to provide more insight into how SCA affects the risk of in-hospital mortality in post-cardiac arrest patients. Methods The National Inpatient Survey database years 2016 to 2019 was utilized. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS) codes for cardiopulmonary resuscitation were used to identify in-hospital cardiac arrest (IHCA) patients. ICD-10 Clinical Modification (CM) codes were used to identify SCA and other medical comorbidities. Categorical data was compared using Person's chi-square test, and continuous variables were compared using the independent samples t-test. Multinomial logistic regression was used to study the effects of SCA on post-arrest in-hospital mortality controlling for age, Charlson comorbidity score, and demographic variables. Binomial logistic regression models for dichotomous variables were utilized in the subgroup and secondary outcomes analysis. Results In patients with IHCA, patients who had SCA were found to have a significantly increased risk of in-hospital mortality adjusted for baseline characteristics and Charlson comorbidity score (OR: 1.16, 95% CI: 1.02-1.32, p=0.0025). Patient characteristics most strongly associated with an increased risk of in-hospital mortality in this cohort were found to be Black race (OR: 1.92, 95% CI: 1.87-1.97, p<0.001) and self-payer status (OR: 2.14, 95% CI: 2.06-2.22, p<0.001). Subgroup analysis revealed only patients with sickle cell disease had a statistically significant increased risk of in-hospital mortality in this cohort (OR: 4.41, 95% CI: 3.5-5.55, p<0.001), and patients with sickle cell trait did not. Conclusion In patients with IHCA, SCA is associated with an increased risk of in-hospital mortality. This risk was confined to patients with sickle cell disease and not patients with sickle cell trait.
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Affiliation(s)
| | - Rehana Hassan
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Alexis Davis
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Shelbie Scharf
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | | | - Mohammad A Ahmed-Khan
- Department of Internal Medicine, University of Vermont, Burlington, USA
- Internal Medicine, Danbury Hospital, Danbury, USA
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Tsai JCH, Ma JW, Liu SC, Lin TC, Hu SY. Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest. J Clin Med 2021; 10:jcm10215131. [PMID: 34768649 PMCID: PMC8584360 DOI: 10.3390/jcm10215131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/22/2023] Open
Abstract
Background: This study was conducted to identify the predictive factors for survival and favorable neurological outcome in patients with emergency department cardiac arrest (EDCA). Methods: ED patients who suffered from in-hospital cardiac arrest (IHCA) from July 2014 to June 2019 were enrolled. The electronic medical records were retrieved and data were extracted according to the IHCA Utstein-style guidelines. Results: The cardiac arrest survival post-resuscitation in-hospital (CASPRI) score was associated with survival, and the CASPRI scores were lower in the survival group. Three components of the CASPRI score were associated with favorable neurological survival, and the CASPRI scores were lower in the favorable neurological survival group of patients who were successfully resuscitated. The independent predictors of survival were presence of hypotension/shock, metabolic illnesses, short resuscitation time, receiving coronary angiography, and TTM. Receiving coronary angiography and low CASPRI score independently predicted favorable neurological survival in resuscitated patients. The performance of a low CASPRI score for predicting favorable neurological survival was fair, with an AUROCC of 0.77. Conclusions: The CASPRI score can be used to predict survival and neurological status of patients with EDCA. Post-cardiac arrest care may be beneficial for IHCA, especially in patients with EDCA.
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Affiliation(s)
- Jeffrey Che-Hung Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Puli Branch, Nantou 545, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (J.-W.M.); (T.-C.L.)
- School of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Jen-Wen Ma
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (J.-W.M.); (T.-C.L.)
- School of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Shih-Chia Liu
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan;
| | - Tzu-Chieh Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (J.-W.M.); (T.-C.L.)
- School of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- College of Fine Arts and Creative Design, Tunghai University, Taichung 40705, Taiwan
| | - Sung-Yuan Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (J.-W.M.); (T.-C.L.)
- School of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung 404, Taiwan
- Correspondence: ; Tel.: +886-4-23592525
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