350 results
Search Results
2. Cardiac arrest centres: Which patients benefit?
- Author
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Wilcox J, McDonaugh B, Redwood S, and Patterson T
- Subjects
- Humans, Heart Arrest therapy, Cardiac Care Facilities, Cardiopulmonary Resuscitation methods, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
- Full Text
- View/download PDF
3. Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest.
- Author
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Yin RT, Berve PO, Skaalhegg T, Elola A, Taylor TG, Walker RG, Aramendi E, Chapman FW, and Wik L
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Prospective Studies, Time Factors, Norway, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest physiopathology, Cardiopulmonary Resuscitation methods, Heart Massage methods, Arterial Pressure physiology
- Abstract
Background and Aims: Chest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest., Methods: We analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015-2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression., Results: We included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R
2 : 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively)., Conclusions: ABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Lars Wik reports financial support was provided by Stryker. Per Olav Berve reports financial support was provided by Norwegian Association of Heart and Lung Patients. Elisabete Aramendi reports financial support was provided by Spain Ministry of Science and Innovation, State Research Agency. Andoni Elola reports financial support was provided by Spain Ministry of Science and Innovation, State Research Agency. Rose Yin, Tyson Taylor, Rob Walker, and Fred Chapman report a relationship with Stryker that includes: employment. Lars Wik reports a relationship with Stryker that includes: consulting or advisory, funding grants, and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”., (Copyright © 2024 Elsevier B.V. All rights reserved.)- Published
- 2024
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4. Future thoughts of intramuscular adrenaline in out-of-hospital cardiac arrest resuscitation.
- Author
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Fan CY, Huang CH, Chen CH, Sung CW, and Pei-Chuan Huang E
- Subjects
- Humans, Injections, Intramuscular, Out-of-Hospital Cardiac Arrest therapy, Epinephrine administration & dosage, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
- Full Text
- View/download PDF
5. Heart to heart - Defying disparities in resuscitation.
- Author
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Wolthers SA, Kvisselgaard AD, and Christensen HC
- Subjects
- Humans, Cardiopulmonary Resuscitation methods, Healthcare Disparities
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
- Full Text
- View/download PDF
6. Effect of cardiopulmonary resuscitation training for layperson bystanders on outcomes of out-of-hospital cardiac arrest: A prospective multicenter observational study.
- Author
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Tabata R, Tagami T, Suzuki K, Amano T, Takahashi H, Numata H, Kitano S, Kitamura N, and Ogawa S
- Subjects
- Humans, Male, Female, Prospective Studies, Aged, Japan epidemiology, Middle Aged, Return of Spontaneous Circulation, Emergency Medical Services methods, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation education, Cardiopulmonary Resuscitation methods
- Abstract
Background: Effective bystander cardiopulmonary resuscitation (CPR) improves outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, the effect of CPR training on the rate of return of spontaneous circulation (ROSC) among laypersons has yet to be thoroughly evaluated., Methods: This prospective, multicenter observational study was conducted across 42 centers in Japan. We assessed OHCA patients who received bystander CPR from a layperson, excluding those performed by healthcare staff. The primary outcome was the ROSC rate. Secondary outcomes included pre-hospital ROSC, ROSC after hospital arrival, favorable neurological outcomes, and 30-day survival. Propensity score with inverse probability treatment weighting (IPTW) was used to adjust for confounders, including age, sex, presence or absence of witnesses, and past medical history., Results: A total of 969 OHCA patients were included, divided into CPR-trained (n = 322) and control (n = 647). Before adjustment, the ROSC rate was higher in the trained group than the control (40.1% vs. 30.1%, P < 0.01). After IPTW adjustment, the trained group showed a significantly higher ROSC rate (36.7% vs. 30.6%; P = 0.02). All secondary outcomes in the trained group were significantly improved before adjustment. After IPTW adjustment, the trained group showed improved rates of pre-hospital ROSC and ROSC after hospital arrival (30.7% vs. 24.0%; P < 0.01, 23.9% vs. 20.7%; P = 0.04). There were no differences in neurological outcomes and 30-day survival., Conclusion: This study demonstrated that CPR training for laypersons was associated with increased ROSC rates in OHCA patients, indicating potential advantages of CPR training for non-healthcare professionals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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7. ILCOR paediatric life support recommendations and the importance of data coming from "natural experiments" and "real world" studies in paediatric resuscitation.
- Author
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Trevisanuto D and De Luca D
- Subjects
- Humans, Child, Pediatrics methods, Pediatrics standards, Resuscitation methods, Resuscitation standards, Practice Guidelines as Topic, Life Support Care methods, Life Support Care standards, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation standards
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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8. Time to rethink post-resuscitation atrial fibrillation management?
- Author
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Mills MT, Lim SL, and Lip GYH
- Subjects
- Humans, Atrial Fibrillation therapy, Atrial Fibrillation etiology, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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9. Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest.
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Motairek I, Rvo Salerno P, Chen Z, Deo S, Makhlouf MHE, Al-Araji R, Rajagopalan S, Nasir K, and Al-Kindi S
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- Humans, Female, Male, Middle Aged, Aged, United States epidemiology, Registries, Healthcare Disparities statistics & numerical data, Neighborhood Characteristics statistics & numerical data, Residence Characteristics statistics & numerical data, Emergency Medical Services statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation methods
- Abstract
Background: Out-of-hospital cardiac arrest (OHCA) is associated with low survival rates. Bystander cardiopulmonary resuscitation (CPR) is essential for improving outcomes, but its utilization remains limited, particularly among racial and ethnic minorities. Historical redlining, a practice that classified neighborhoods for mortgage risk in 1930s, may have lasting implications for social and health outcomes. This study sought to investigate the influence of redlining on the provision of bystander CPR during witnessed OHCA., Methods: We conducted an analysis using data from the comprehensive Cardiac Arrest Registry to Enhance Survival (CARES), encompassing 736,066 non-traumatic OHCA cases across the United States. The Home Owners' Loan Corporation (HOLC) map shapefiles were utilized to categorize census tracts of arrests into four grades (A signifying "best", B "still desirable", C "declining", and D "hazardous"). Multivariable hierarchical logistic regression models were employed to predict the likelihood of CPR provision, adjusting for various factors including age, sex, race/ethnicity, arrest location, calendar year, and state of occurrence. Additionally, we accounted for the percentage of Black residents and residents below poverty levels at the census tract level., Results: Among the 43,186 witnessed cases of OHCA in graded HOLC census tracts, 37.2% received bystander CPR. The rates of bystander CPR exhibited a gradual decline across HOLC grades, ranging from 41.8% in HOLC grade A to 35.8% in HOLC grade D. In fully adjusted model, we observed significantly lower odds of receiving bystander CPR in HOLC grades C (OR 0.89, 95% CI 0.81-0.98, p = 0.016) and D (OR 0.86, 95% CI 0.78-0.95, p = 0.002) compared to HOLC grade A., Conclusion: Redlining, a historical segregation practice, is associated with reduced contemporary rates of bystander CPR during OHCA. Targeted CPR training in redlined neighborhoods may be imperative to enhance survival outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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- View/download PDF
10. Associations between initial heart rhythm and self-reported health among cardiac arrest survivors - A nationwide registry study.
- Author
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Årestedt K, Rooth M, Bremer A, Koistinen L, Attin M, and Israelsson J
- Subjects
- Humans, Male, Female, Sweden epidemiology, Aged, Middle Aged, Depression epidemiology, Depression etiology, Anxiety epidemiology, Anxiety etiology, Survivors psychology, Survivors statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest psychology, Adult, Heart Rate physiology, Registries, Self Report, Cardiopulmonary Resuscitation statistics & numerical data, Health Status, Heart Arrest therapy, Heart Arrest epidemiology, Heart Arrest psychology
- Abstract
Background: Non-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete., Aim: To examine the associations between initial rhythm and self-reported health in CA survivors., Methods: This nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3-6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes., Results: The study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses., Conclusions: Initial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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11. HIV status and lay bystander cardiopulmonary resuscitation initiation for witnessed cardiac arrest.
- Author
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Javaudin F, Canon V, Heidet M, Bougouin W, Youssfi Y, Beganton F, Empana JP, Chocron R, Jouven X, Marijon E, Hubert H, Dumas F, and Cariou A
- Subjects
- Humans, Male, Female, Middle Aged, France epidemiology, Aged, Adult, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Registries, HIV Infections complications, HIV Infections epidemiology
- Abstract
Introduction: Early initiation of cardiopulmonary resuscitation (CPR) by bystanders of out-of-hospital cardiac arrest (OHCA) significantly improves survival and neurological outcomes. However, misconceptions about human immunodeficiency virus (HIV) transmission risk during CPR can deter lay bystanders from performing resuscitation. The aim of this study was to compare the rate of CPR initiation by lay bystanders who witnessed OHCA in subjects with and without HIV infection., Methods: We analysed data from the two French cardiac arrest registries (SDEC and RéAC) from 2012 to 2020. We identified HIV-positive individuals from the French National Health Insurance database for the SDEC registry, and directly from the RéAC registry data. We used logistic regression models to assess the association between CPR initiation by lay bystanders and the victim's HIV status., Results: Of 58,177 witnessed OHCA cases, 192 (0.3%) occurred in HIV-positive subjects. These individuals were younger, more often male, and presented more shockable initial rhythms compared with subjects without HIV. Overall, there was no difference in the CPR initiation rate according to the HIV status (57.3% vs 47.6%, adjusted odds ratio 1.11, 95% confidence interval 0.83-1.48). The CPR initiation rate also did not differ by location between victims with or without HIV (home: 57.7% vs 45.4%; public places: 56.0% vs 53.6%; p for interaction = 0.46). Survival and neurological outcomes at hospital discharge did not differ based on the HIV status., Conclusions: This study revealed that the rate of CPR initiation by lay bystanders did not differ between HIV and non-HIV subjects during OHCA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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12. Long-term survival following out-of-hospital cardiac arrest in women and men: Influence of comorbidities, social characteristics, and resuscitation characteristics.
- Author
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Smits RLA, Sødergren STF, Folke F, Møller SG, Ersbøll AK, Torp-Pedersen C, van Valkengoed IGM, and Tan HL
- Subjects
- Humans, Male, Female, Denmark epidemiology, Middle Aged, Netherlands epidemiology, Aged, Sex Factors, Adult, Registries, Survival Rate trends, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation methods, Comorbidity
- 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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13. Increased survival for resuscitated Utstein-comparator group patients conveyed directly to cardiac arrest centres in a large rural and suburban population in England.
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Price J, Rees P, Lachowycz K, Starr Z, Pareek N, Keeble TR, Major R, and Barnard EBG
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- Humans, Female, Male, England epidemiology, Middle Aged, Aged, Rural Population statistics & numerical data, Registries, Emergency Medical Services statistics & numerical data, Emergency Medical Services methods, Suburban Population statistics & numerical data, Aged, 80 and over, Adult, Survival Rate trends, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation methods
- Abstract
Aim: The cohort of patients in which cardiac arrest centres (CAC) in rural and suburban populations confer the greatest survival benefit remains unclear. The aim of this study was to assess whether the transfer of resuscitated Utstein-comparator out-of-hospital cardiac arrest (OHCA) patients direct to a CAC was associated with improved survival to hospital discharge compared to patients conveyed to non-specialist centres., Methods: A consecutive sample of adult (≥18 years old) Utstein-comparator patients (witnessed collapse and initial shockable rhythm) were included from the East of England Ambulance Service NHS Trust Utstein resuscitation registry; 2018-2022. Logistic regression was used to compare survival to discharge in patients transported to CACs compared with patients transported to non-specialist centres., Results: During the study period, resuscitation was attempted in 18,276 OHCA patients. N = 2448 (13.4%) met the Utstein-comparator definition and 1151 patients were included in the final analysis; per protocol. Survival was greater for patients conveyed directly to a CAC (n = 768, 60.7%) compared to non-specialist centres (n = 383, 47.3%); adjusted OR 1.44 (95%CI 1.07-1.94),p = 0.017. Amongst the centres analysed in this study, there was significant inter-hospital variability in survival between CACs (p = 0.017). There was no association between patient volume and survival (p = 0.850)., Conclusion: Direct transport to a cardiac arrest centre was associated with a 44% increase in the odds of survival compared to conveyance to a non-specialist centre for resuscitated adult patients presenting with witnessed collapse and initial shockable OHCA rhythm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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14. The link between carotid artery stenosis and outcomes in patients with refractory out-of-hospital cardiac arrest.
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Kosmopoulos M, Rojas-Salvador C, Koukousaki D, Sebastian PS, Gutierrez-Bernal A, Elliott A, Kalra R, Gurevich S, Alexy T, Bartos JA, and Yannopoulos D
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- Humans, Male, Female, Aged, Middle Aged, Ultrasonography methods, Carotid Arteries diagnostic imaging, Retrospective Studies, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest etiology, Carotid Stenosis complications, Cardiopulmonary Resuscitation methods
- Abstract
Background: Mortality of out-of-hospital cardiac arrest (OHCA) remains high. Extracorporeal cardiopulmonary resuscitation (ECPR) has revolutionized OHCA treatment, but our understanding of the ECPR responder's clinical profile is incomplete. Carotid artery stenosis (CAS) is a well-established cardiovascular disease risk factor. The impact of CAS on OHCA outcomes remains unelucidated., Objective: To assess whether CAS burden affects the outcomes of OHCA patients treated with ECPR., Methods: This study included patients with OHCA admitted for ECPR consideration, who had carotid ultrasonography performed. A numeric scale was applied to the plaque to create a CAS burden numeric scale. The primary outcome of the study was survival at discharge, compared among the different degrees of CAS. Neurologically intact survival and surrogate markers of neurologic injury were the secondary study endpoints. To assess the independent effect of CAS burden on survival to hospital discharge, we conducted a logistic regression analysis., Results: Between 2019 and 2023, carotid ultrasonography was performed on 163 patients who were admitted for refractory OHCA. CAS burden was equally distributed between the right and left carotid arteries. Logistic regression analysis indicated that the CAS burden was significantly associated with both overall and neurologically intact survival at discharge (p = 0.004). A linear relationship between the CAS burden and neuron-specific and S-100 levels was identified. Patients with normal carotids were significantly less likely to have encephalopathy on electroencephalograms., Conclusion: CAS burden independently predicts the risk for worse survival and neurologic outcomes in patients suffering refractory OHCA who are treated with ECPR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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15. The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms.
- Author
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Awad E, Klapthor B, Morgan MH, and Youngquist ST
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- Humans, Male, Female, Middle Aged, Aged, Ventricular Fibrillation therapy, Ventricular Fibrillation complications, Ventricular Fibrillation physiopathology, Tachycardia, Ventricular therapy, Tachycardia, Ventricular physiopathology, Time Factors, Retrospective Studies, Recurrence, Out-of-Hospital Cardiac Arrest therapy, Electric Countershock methods, Electric Countershock statistics & numerical data, Return of Spontaneous Circulation, Time-to-Treatment, Cardiopulmonary Resuscitation methods
- Abstract
Objective: Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms., Methods: We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC)., Results: Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%., Conclusion: Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)
- Published
- 2024
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16. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest.
- Author
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Palatinus HN, Johnson MA, Wang HE, Hoareau GL, and Youngquist ST
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- Humans, Male, Female, Injections, Intramuscular, Middle Aged, Aged, Time-to-Treatment, Controlled Before-After Studies, Vasoconstrictor Agents administration & dosage, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest drug therapy, Out-of-Hospital Cardiac Arrest therapy, Epinephrine administration & dosage, Emergency Medical Services methods, Cardiopulmonary Resuscitation methods
- Abstract
Background: Early administration of adrenaline is associated with improved survival after out-of-hospital cardiac arrest (OHCA). Delays in vascular access may impact the timely delivery of adrenaline. Novel methods for administering adrenaline before vascular access may enhance survival. The objective of this study was to determine whether an initial intramuscular (IM) adrenaline dose followed by standard IV/IO adrenaline is associated with improved survival after OHCA., Methods Study Design: We conducted a before-and-after study of the implementation of an early, first-dose IM adrenaline EMS protocol for adult OHCAs. The pre-intervention period took place between January 2010 and October 2019. The post-intervention period was between November 2019 and May 2024., Setting: Single-center urban, two-tiered EMS agency., Participants: Adult, nontraumatic OHCA meeting criteria for adrenaline use., Intervention: Single dose (5 mg) IM adrenaline. All other care, including subsequent IV or IO adrenaline, followed international guidelines., Main Outcomes and Measures: The primary outcome was survival to hospital discharge. Secondary outcomes were time from EMS arrival to the first dose of adrenaline, survival to hospital admission, and favorable neurologic function at discharge., Results: Among 1405 OHCAs, 420 (29.9%) received IM adrenaline and 985 (70.1%) received usual care. Fifty-two patients received the first dose of adrenaline through the IV or IO route within the post-intervention period and were included in the standard care group analysis. Age was younger and bystander CPR was higher in the IM adrenaline group. All other characteristics were similar between IM and standard care cohorts. Time to adrenaline administration was faster for the IM cohort [(median 4.3 min (IQR 3.0-6.0) vs. 7.8 min (IQR 5.8-10.4)]. Compared with standard care, IM adrenaline was associated with improved survival to hospital admission (37.1% vs. 31.6%; aOR 1.37, 95% CI 1.06-1.77), hospital survival (11.0% vs 7.0%; aOR 1.73, 95% CI 1.10-2.71) and favorable neurologic status at hospital discharge (9.8% vs 6.2%; aOR 1.72, 95% CI 1.07-2.76)., Conclusion: In this single-center before-and-after implementation study, an initial IM dose of adrenaline as an adjunct to standard care was associated with improved survival to hospital admission, survival to hospital discharge, and functional survival. A randomized controlled trial is needed to fully assess the potential benefit of IM adrenaline delivery in OHCA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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17. Association of EEG characteristics with outcomes following pediatric ICU cardiac arrest: A secondary analysis of the ICU-RESUScitation trial.
- Author
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Mazzio EL, Topjian AA, Reeder RW, Sutton RM, Morgan RW, Berg RA, Nadkarni VM, Wolfe HA, Graham K, Naim MY, Friess SH, Abend NS, and Press CA
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- Humans, Male, Female, Child, Preschool, Child, Prospective Studies, Infant, Intensive Care Units, Pediatric statistics & numerical data, Prognosis, Electroencephalography methods, Heart Arrest therapy, Heart Arrest mortality, Heart Arrest physiopathology, Heart Arrest complications, Cardiopulmonary Resuscitation methods
- Abstract
Background and Objectives: There are limited tools available following cardiac arrest to prognosticate neurologic outcomes. Prior retrospective and single center studies have demonstrated early EEG features are associated with neurologic outcome. This study aimed to evaluate the prognostic value of EEG for pediatric in-hospital cardiac arrest (IHCA) in a prospective, multicenter study., Methods: This cohort study is a secondary analysis of the ICU-Resuscitation trial, a multicenter randomized interventional trial conducted at 18 pediatric and pediatric cardiac ICUs in the United States. Patients who achieved return of circulation (ROC) and had post-ROC EEG monitoring were eligible for inclusion. Patients < 90 days old and those with pre-arrest Pediatric Cerebral Performance Category (PCPC) scores > 3 were excluded. EEG features of interest included EEG Background Category, and presence of focal abnormalities, sleep spindles, variability, reactivity, periodic and rhythmic patterns, and seizures. The primary outcome was survival to hospital discharge with favorable neurologic outcome. Associations between EEG features and outcomes were assessed with multivariable logistic regression. Prediction models with and without EEG Background Category were developed and receiver operator characteristic curves compared., Results: Of the 1129 patients with an index cardiac arrest who achieved ROC in the parent study, 261 had EEG within 24 h of ROC, of which 151 were evaluable. The cohort included 57% males with a median age of 1.1 years (IQR 0.4, 6.8). EEG features including EEG Background Category, sleep spindles, variability, and reactivity were associated with survival with favorable outcome and survival, (all p < 0.001). The addition of EEG Background Category to clinical models including age category, illness category, PRISM score, duration of CPR, first documented rhythm, highest early post-arrest arterial lactate improved the prediction accuracy achieving an AUROC of 0.84 (CI 0.77-0.92), compared to AUROC of 0.76 (CI 0.67-0.85) (p = 0.005) without EEG Background Category., Conclusion: This multicenter study demonstrates the value of EEG, in the first 24 h following ROC, for predicting survival with favorable outcome after a pediatric IHCA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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18. Cardiac arrest and medical technological innovations in the next decade: How about artificial intelligence-assisted tailored cardiopulmonary resuscitation?
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Cucino A, Palmisano F, Stirparo G, Merigo G, and Ristagno G
- Subjects
- Humans, Inventions trends, Artificial Intelligence trends, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation trends, Cardiopulmonary Resuscitation instrumentation, Heart Arrest therapy
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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19. Factors mediating community race and ethnicity differences in initial shockable rhythm for out-of-hospital cardiac arrests in Texas.
- Author
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Huebinger R, Power E, Del Rios M, Schulz K, Gill J, Panczyk M, McNally B, and Bobrow B
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- Aged, Female, Humans, Male, Middle Aged, Electric Countershock statistics & numerical data, Emergency Medical Services statistics & numerical data, Ethnicity statistics & numerical data, Hispanic or Latino statistics & numerical data, Retrospective Studies, Texas epidemiology, White People statistics & numerical data, Black or African American, White, Cardiopulmonary Resuscitation statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest ethnology, Registries
- Abstract
Background: Out-of-hospital cardiac arrest (OHCA) patients from minoritized communities have lower rates of initial shockable rhythm, which is linked to favorable outcomes. We sought to evaluate the importance of initial shockable rhythm on OHCA outcomes and factors that mediate differences in initial shockable rhythm., Methods: We performed a retrospective study of the 2013-2022 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES). Using census tract data, we stratified OHCAs into majority race/ethnicity communities: >50% White, >50% Black, and >50% Hispanic/Latino. We compared logistic regression models between community race/ethnicity and OHCA outcome: (1) unadjusted, (2) adjusting for bystander CPR (bCPR), and (3) adjusting for initial rhythm. Using structural equation modeling, we performed mediation analyses between community race/ethnicity, OHCA characteristics, and initial shockable rhythm., Results: We included 22,730 OHCAs from majority White (21.1% initial shockable rhythm), 4,749 from majority Black (15.3% shockable), and 16,054 majority Hispanic/Latino (16.1% shockable) communities. Odds of favorable neurologic outcome were lower for majority Black (0.4 [0.3-0.5]) and Hispanic/Latino (0.6 [0.6-0.7]). While adjusting for bCPR minimally changed outcome odds, adjusting for shockable rhythm increased odds for Black (0.5 [0.4-0.5]) and Hispanic/Latino (0.7 [0.6-0.8]) communities. On mediation analysis for majority Black, the top mediators of initial shockable rhythm were public location (14.6%), bystander witnessed OHCA (11.6%), and female gender (5.7%). The top mediators for majority Hispanic/Latino were bystander-witnessed OHCA (10.2%), public location (3.52%), and bystander CPR (3.49%), CONCLUSION: Bystander-witnessed OHCA and public location were the largest mediators of shockable rhythm for OHCAs from minoritized communities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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20. Neurological prognosis prediction upon arrival at the hospital after out-of-hospital cardiac arrest: R-EDByUS score.
- Author
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Shimada T, Kawai R, Shintani A, Shibata A, Otsuka K, Ito A, Yamazaki T, Izumiya Y, Fukuda D, Yonemoto N, Tahara Y, and Ikeda T
- Subjects
- Humans, Male, Female, Aged, Prognosis, Middle Aged, Japan epidemiology, Return of Spontaneous Circulation, Nomograms, Aged, 80 and over, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest etiology, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Emergency Medical Services methods, Emergency Medical Services statistics & numerical data, Registries
- Abstract
Aim: To develop a new scoring model for patients with cardiogenic out-of-hospital cardiac arrest (OHCA) to facilitate neurological prognosis prediction upon hospital arrival by using prehospital resuscitation features alone., Methods: Between 2005 and 2019, we enrolled 942,891 adult patients with OHCA of presumed cardiac aetiology from the All-Japan Utstein Registry. Scoring models applied prehospital resuscitation features a priori from the variables the American College of Cardiology algorithm including age, duration to return of spontaneous circulation (ROSC) or hospital arrival, no bystander cardiopulmonary resuscitation (CPR), unwitnessed arrest, and nonshockable rhythm (R-EDByUS score) to predict unfavorable neurological outcomes defined as Cerebral Performance Category 3, 4, or 5 at 1 month. We created nomograms as a "Regression-based model," and created a "Simplified model" in which points were assigned by category for predicting unfavorable neurological outcomes for both the prehospital ROSC cohort (67,064 patients) and the ongoing CPR cohort (875,827 patients). For internal validation, bootstrap optimism-corrected estimates of predictive performance were calculated., Results: A total of 46,971 (70.0%) and 870,991 (99.4%) patients in the prehospital ROSC and ongoing CPR cohorts, respectively, had unfavorable neurological outcomes. In the prehospital ROSC cohort, the C-statistics of the Regression-based and Simplified models were 0.851 and 0.842, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively. In the ongoing CPR cohort, the C-statistics of the Regression-based and Simplified models were 0.872 and 0.865, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively., Conclusions: The R-EDByUS score accurately predicted the neurological prognosis of cardiogenic OHCA upon hospital arrival., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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21. Brain death is common after extracorporeal cardiopulmonary resuscitation (eCPR): An undesired outcome with potential benefits.
- Author
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Sandroni C and D'Arrigo S
- Subjects
- Humans, Heart Arrest therapy, Heart Arrest etiology, Male, Female, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation adverse effects, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation adverse effects, Brain Death
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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22. Assessing feasibility of proposed extracorporeal cardiopulmonary resuscitation programmes for out-of-hospital cardiac arrest in Scotland via geospatial modelling.
- Author
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Leung KHB, Hartley L, Moncur L, Gillon S, Short S, Chan TCY, and Clegg GR
- Subjects
- Humans, Scotland epidemiology, Male, Middle Aged, Female, Aged, Adult, Adolescent, Time-to-Treatment, Young Adult, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods, Feasibility Studies, Emergency Medical Services methods, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation statistics & numerical data
- Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival for refractory out-of-hospital cardiac arrest (OHCA). We sought to assess the feasibility of a proposed ECPR programme in Scotland, considering both in-hospital and pre-hospital implementation scenarios., Methods: We included treated OHCAs in Scotland aged 16-70 between August 2018 and March 2022. We defined those clinically eligible for ECPR as patients where the initial rhythm was ventricular fibrillation, ventricular tachycardia, or pulseless electrical activity, and where pre-hospital return of spontaneous circulation was not achieved. We computed the call-to-ECPR access time interval as the amount of time from emergency medical service (EMS) call reception to either arrival at an ECPR-ready hospital or arrival of a pre-hospital ECPR crew. We determined the number of patients that had access to ECPR within 45 min, and estimated the number of additional survivors as a result., Results: A total of 6,639 OHCAs were included in the geospatial modelling, 1,406 of which were eligible for ECPR. Depending on the implementation scenario, 52.9-112.6 (13.8-29.4%) OHCAs per year had a call-to-ECPR access time within 45 min, with pre-hospital implementation scenarios having greater and earlier access to ECPR for OHCA patients. We further estimated that an ECPR programme in Scotland would yield 11.8-28.2 additional survivors per year, with the pre-hospital implementation scenarios yielding higher numbers., Conclusion: An ECPR programme for OHCA in Scotland could provide access to ECPR to a modest number of eligible OHCA patients, with pre-hospital ECPR implementation scenarios yielding higher access to ECPR and higher numbers of additional survivors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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23. Explorative study on lower inflection point dynamics during cardiopulmonary resuscitation: Potential implications for airway management.
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Bouillon A, Vanwulpen M, Tackaert T, Cornelis R, and Hachimi-Idrissi S
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- Humans, Male, Female, Middle Aged, Aged, Tidal Volume physiology, Respiration, Artificial methods, Cardiopulmonary Resuscitation methods, Out-of-Hospital Cardiac Arrest therapy, Airway Management methods, Intubation, Intratracheal methods
- Abstract
Introduction: In patients undergoing cardiopulmonary resuscitation (CPR) after an Out-of-Hospital Cardiac Arrest (OHCA), intrathoracic airway closure can impede ventilation, adversely affecting patient outcomes. This explorative study investigates the evolution of intrathoracic airway closure by analyzing the lower inflection point (LIP) during the inspiration phase of CPR, aiming to identify the potential thresholds for alveolar recruitment., Methods and Materials: Eleven OHCA patients undergoing CPR with endotracheal intubation and manual bag ventilation were included. Flow and pressure measurements were obtained using Sensirion SFM3200AW and Wika CPT2500 sensors attached to the endotracheal tube, connected to a Surface Go Tablet for data collection. Flow data was analyzed in Microsoft Excel, while pressure data was processed using the Wika USBsoft2500 application. Analysis focused on the inspiration phase of the first 6-8 breaths, with an additional 2 breaths recorded and analyzed at the end of CPR., Results: Across the cohort, the median tidal volume was 870.00 milliliter (mL), average flow was 31.90 standard liters per minute (slm), and average pressure was 17.21 cmH
2 O. The calculated average LIP was 31.47 cmH2 O. Most cases (72.7%) exhibited a negative trajectory in LIP evolution during CPR, with 2 cases (18.2%) showing a positive trajectory and 1 case remaining inconclusive. The average LIP in the first 8 breaths was significantly higher than in the last 2 breaths (p = 0.018). No significant correlation was found between average LIP and return of spontaneous circulation (ROSC), compression depth, frequency, or end-tidal CO2 (EtCO2 ). However, a significant negative correlation was observed between the average LIP of the last 2 breaths and CPR duration (p = 0.023)., Validation: LIP calculation in low-flow ventilations using the novel mathematical method yielded values consistent with those reported in the literature., Discussion/conclusion: These explorative data demonstrate a predominantly negative trajectory in LIP evolution during CPR, suggesting potential challenges in maintaining airway patency. Limitations include a small sample size and sensor recording issues. Further research is warranted to explore the evolution of LIP and its implications for personalized ventilation strategies in CPR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)- Published
- 2024
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24. Characterising trends in the initiation, timing, and completion of recommended summary plan for emergency care and treatment (ReSPECT) plans: Retrospective analysis of routine data from a large UK hospital trust.
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Anik E, Hurlow A, Azizoddin D, West R, Muehlensiepen F, Clarke G, Mitchell S, and Allsop M
- Subjects
- Humans, Retrospective Studies, Female, Male, Aged, Middle Aged, Aged, 80 and over, Emergency Medical Services trends, Emergency Medical Services statistics & numerical data, Adult, United Kingdom, Adolescent, Electronic Health Records statistics & numerical data, Time Factors, Emergency Service, Hospital statistics & numerical data, Emergency Service, Hospital trends, Patient Care Planning trends, Young Adult, England, Resuscitation Orders, Child, Preschool, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation trends
- Abstract
Aim: To assess patient socio-demographic and disease characteristics associated with the initiation, timing, and completion of emergency care and treatment planning in a large UK-based hospital trust., Methods: Secondary retrospective analysis of data across 32 months extracted from digitally stored Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans within the electronic health record system of an acute hospital trust in England, UK., Results: Data analysed from ReSPECT plans (n = 23,729), indicate an increase in the proportion of admissions having a plan created from 4.2% in January 2019 to 6.9% in August 2021 (mean = 8.1%). Forms were completed a median of 41 days before death (a median of 58 days for patients with capacity, and 21 days for patients without capacity). Do not attempt cardiopulmonary resuscitation was more likely to be recorded for patients lacking capacity, with increasing age (notably for patients aged over 74 years), being female and the presence of multiple disease groups. 'Do not attempt cardiopulmonary resuscitation' was less likely to be recorded for patients having ethnicity recorded as Asian or Asian British and Black or Black British compared to White. Having a preferred place of death recorded as 'hospital' led to a five-fold increase in the likelihood of dying in hospital., Conclusion: Variation in the initiation, timing, and completion of ReSPECT plans was identified by applying an evaluation framework. Digital storage of ReSPECT plan data presents opportunities for assessing trends and completion of the ReSPECT planning process and benchmarking across sites. Further research is required to monitor and understand any inequity in the implementation of the ReSPECT process in routine care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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25. Standardisation facilitates reliable interpretation of ETCO 2 during manual cardiopulmonary resuscitation.
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Gutiérrez JJ, Urigüen JA, Leturiondo M, Sandoval CL, Redondo K, Russell JK, Daya MR, and Ruiz de Gauna S
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Capnography methods, Tidal Volume physiology, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation standards, Out-of-Hospital Cardiac Arrest therapy, Carbon Dioxide analysis
- Abstract
Background: Interpretation of end-tidal CO
2 (ETCO2 ) during manual cardiopulmonary resuscitation (CPR) is affected by variations in ventilation and chest compressions. This study investigates the impact of standardising ETCO2 to constant ventilation rate (VR) and compression depth (CD) on absolute values and trends., Methods: Retrospective study of out-of-hospital cardiac arrest cases with manual CPR, including defibrillator and clinical data. ETCO2 , VR and CD values were averaged by minute. ETCO2 was standardised to 10 vpm and 50 mm. We compared standardised (ETs ) and measured (ETm ) values and trends during resuscitation., Results: Of 1,036 cases, 287 met the inclusion criteria. VR was mostly lower than recommended, 8.8 vpm, and highly variable within and among patients. CD was mostly within guidelines, 49.8 mm, and less varied. ETs was lower than ETm by 7.3 mmHg. ETs emphasized differences by sex (22.4 females vs. 25.6 mmHg males), initial rhythm (29.1 shockable vs. 22.7 mmHg not), intubation type (25.6 supraglottic vs. 22.4 mmHg endotracheal) and return of spontaneous circulation (ROSC) achieved (34.5 mmHg) vs. not (20.1 mmHg). Trends were different between non-ROSC and ROSC patients before ROSC (-0.3 vs. + 0.2 mmHg/min), and between sustained and rearrest after ROSC (-0.7 vs. -2.1 mmHg/min). Peak ETs was higher for sustained than for rearrest (53.0 vs. 42.5 mmHg)., Conclusion: Standardising ETCO2 eliminates effects of VR and CD variations during manual CPR and facilitates comparison of values and trends among and within patients. Its clinical application for guidance of resuscitation warrants further investigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)- Published
- 2024
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26. CT brain perfusion patterns and clinical outcome after successful cardiopulmonary resuscitation: A pilot study.
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Hakim A, Branca M, Kurmann C, Wagner B, Iten M, Hänggi M, and Wagner F
- Subjects
- Humans, Male, Middle Aged, Female, Pilot Projects, Retrospective Studies, Aged, Heart Arrest therapy, Heart Arrest physiopathology, Hypoxia-Ischemia, Brain therapy, Hypoxia-Ischemia, Brain physiopathology, Hypoxia-Ischemia, Brain diagnostic imaging, Hypoxia-Ischemia, Brain etiology, Adult, Brain blood supply, Brain diagnostic imaging, Brain physiopathology, Cardiopulmonary Resuscitation methods, Tomography, X-Ray Computed methods, Cerebrovascular Circulation physiology
- Abstract
Aim: CT perfusion is a valuable tool for evaluating cerebrovascular diseases, but its role in patients with hypoxic ischaemic encephalopathy is unclear. This study aimed to investigate 1) the patterns of cerebral perfusion changes that may occur early on after successful resuscitation, and 2) their correlation with clinical outcome to explore their value for predicting outcome., Methods: We conducted a retrospective analysis of perfusion maps from patients who underwent CT brain perfusion within 12 h following successful resuscitation. We classified the perfusion changes into distinct patterns. According to the cerebral performance category (CPC) score clinical outcome was categorised as favourable (CPC 1-2), or unfavourable (CPC 3-5)., Results: A total of 87 patients were included of whom 33 had a favourable outcome (60.6% male, mean age 60 ± 16 years), whereas 54 exhibited an unfavourable outcome (59.3% male, mean age 60 ± 19 years). Of the patients in the favourable outcome group, 30.3% showed no characteristic perfusion changes, in contrast to the unfavourable outcome group where all patients exhibit changes in perfusion. Eighteen perfusion patterns were identified. The most significant patterns for prediction of unfavourable outcome in terms of their high specificity and frequency were hypoperfusion of the brainstem as well as coexisting hypoperfusion of the brainstem and thalamus., Conclusion: This pilot study identified various perfusion patterns in patients after resuscitation, indicative of circulatory changes associated with post-cardiac-arrest brain injury. After validation, certain patterns could potentially be used in conjunction with other prognostic markers for stratifying patients and adjusting personalized treatment following cardiopulmonary resuscitation. Normal brain perfusion within 12 h after resuscitation is predictive of favourable outcome with high specificity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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27. Dispatcher-assistance in lay rescuer infant CPR: Promoting the enhancement of the guiding protocol.
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Vandamme K, Vermeire L, Decuyper B, Herbelet S, and Van de Voorde P
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- Humans, Infant, Female, Male, Out-of-Hospital Cardiac Arrest therapy, Adult, Emergency Medical Dispatcher, Cardiopulmonary Resuscitation education, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation standards, Manikins, Cross-Over Studies
- Abstract
In the 2021 guidelines of the European Resuscitation Council (ERC) on infant CPR, a two-thumb encircling technique (TTET) is advised instead of the former two-finger technique (TFT), even for single rescuers. It is however unclear if this is also feasible and effective in case of dispatcher-assisted CPR by untrained bystanders and was explored in a cross-over infant manikin study including CPR-trained students and lay people. Both groups performed the TTET and the TFT, with dispatcher-assistance (according to Belgian protocol) only being provided to the CPR-untrained group. Results suggest it is feasible to advice single lay rescuers to perform TTET as part of a dispatcher-assisted CPR protocol, although we identified an ongoing risk, regardless of the technique advised, of suboptimal compression depth. Further research should be performed to confirm these preliminary data and explore optimal protocols for dispatcher-assisted infant CPR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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28. Molecular mechanism of HDAC6-mediated pyroptosis in neurological function recovery after cardiopulmonary resuscitation in rats.
- Author
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Chen C, Xia Z, Zhang M, Cao Y, Chen Q, Cao Q, Li X, and Jiang F
- Subjects
- Animals, Rats, Male, MicroRNAs metabolism, Heart Arrest complications, Heart Arrest metabolism, Recovery of Function physiology, Inflammasomes metabolism, Pyroptosis physiology, Histone Deacetylase 6 metabolism, Cardiopulmonary Resuscitation, Rats, Sprague-Dawley, NLR Family, Pyrin Domain-Containing 3 Protein metabolism
- Abstract
Brain injury after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) is the leading cause of neurological dysfunction and death. This study aimed to explore the mechanism of histone deacetylase 6 (HDAC6) in neurofunctional recovery following CA/CPR in rats. A rat model was established by CA/CPR treatment. Adenovirus-packaged sh-HDAC6 was injected into the tail vein. To evaluate the neurofunction of rats, survival time, neurofunctional scores, serum NSE/S100B, and brain water content were measured and Morris water maze test was performed. HDAC6, microRNA (miR)-138-5p, Nod-like receptor protein 3 (NLRP3), and pyroptotic factor levels were determined by real-time quantitative polymerase chain reaction or Western blot assay. HDAC6 and H3K9ac enrichment on miR-138-5p promoter were examined by chromatin immunoprecipitation. miR-138-5p-NLRP3 binding was analyzed by dual-luciferase reporter assay. NLRP3 inflammasome was activated with nigericin sodium salt. After CPR treatment, HDAC6 was highly expressed, while miR-138-5p was downregulated. HDAC6 downregulation improved neurofunction and reduced pyroptosis. HDAC6 enrichment on the miR-138-5p promoter deacetylated H3K9ac, inhibiting miR-138-5p, and promoting NLRP3-mediated pyroptosis. Downregulating miR-138-5p partially reversed the protective effect of HDAC6 inhibition after CPR. In Conclusion, HDAC6 enrichment on miR-138-5p promoter deacetylated H3K9ac, inhibiting miR-138-5p expression and promoting NLRP3-mediated pyroptosis, worsening neurological dysfunction in rats after CPR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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29. Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of-hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial
- Author
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Stephen J. Brett, Kim Kirby, Madeleine Clout, Lauren J Scott, Helena J M Smartt, Sarah Black, Barnaby C Reeves, Jodi Taylor, Adrian South, Michelle J. Lazaroo, Jonathan Benger, Maria Robinson, Jerry P. Nolan, Sarah Voss, Matthew Thomas, Sarah Wordsworth, Chris A Rogers, and Elizabeth A Stokes
- Subjects
Adult ,medicine.medical_specialty ,Emergency Medical Services ,Cost effectiveness ,medicine.medical_treatment ,Cost-Benefit Analysis ,1110 Nursing ,Airway management ,Emergency Nursing ,State Medicine ,1117 Public Health and Health Services ,law.invention ,Randomized controlled trial ,Out of hospital cardiac arrest ,law ,medicine ,Intubation, Intratracheal ,Humans ,Cluster randomised controlled trial ,business.industry ,Cost-effectiveness analysis ,Tracheal intubation ,Airways management ,1103 Clinical Sciences ,Supraglottic airway ,Emergency & Critical Care Medicine ,Cardiopulmonary Resuscitation ,Emergency ,Emergency medicine ,Emergency Medicine ,Clinical Paper ,Cardiology and Cardiovascular Medicine ,business ,Advanced airway management ,Out-of-Hospital Cardiac Arrest - Abstract
Aim Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis. Methods A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a 6-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes. Results 9,296 eligible patients were attended by 1,382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to 6 months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI –0.0059 to 0.0028). Total costs per participant up to 6 months post-OHCA were £3,570 and £3,413 in the i-gel and TI groups respectively (mean difference £157, 95% CI –£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results. Conclusion The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA.
- Published
- 2021
30. Bystander cardiopulmonary resuscitation differences by sex - The role of arrest recognition.
- Author
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Munot S, Bray JE, Redfern J, Bauman A, Marschner S, Semsarian C, Denniss AR, Coggins A, Middleton PM, Jennings G, Angell B, Kumar S, Kovoor P, Vukasovic M, Bendall JC, Evens T, and Chow CK
- Subjects
- Humans, Female, Male, Retrospective Studies, New South Wales epidemiology, Middle Aged, Aged, Sex Factors, Emergency Medical Services statistics & numerical data, Emergency Medical Services methods, Adult, Defibrillators statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data
- Abstract
Purpose: To assess whether bystander cardiopulmonary resuscitation (CPR) differed by patient sex among bystander-witnessed out-of-hospital cardiac arrests (OHCA)., Methods: This study is a retrospective analysis of paramedic-attended OHCA in New South Wales (NSW) between January 2017 to December 2019 (restricted to bystander-witnessed cases). Exclusions included OHCA in aged care, medical facilities, with advance care directives, from non-medical causes. Multivariate logistic regression examined the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED application, initial shockable rhythm, and survival outcomes., Results: Of 4,491cases, females were less likely to receive bystander CPR in private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). OHCA recognition during the emergency call was lower for females arresting in public locations (84.6% vs 91.6%, p = 0.002) and this partially explained the association of sex with bystander CPR (∼44%). This difference in recognition was not observed in private residential locations (p = 0.2). Bystander AED use was lower for females (4.8% vs 9.6%, p < 0.001); however, after adjustment for location and other covariates, this relationship was no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were less likely to be in an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61), but more likely to survive the event (AOR: 1.34, 95%CI: 1.15-1.56). There was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19)., Conclusion: OHCA recognition and bystander CPR differ by patient sex in NSW. Research is needed to understand why this difference occurs and to raise public awareness of this issue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. JB is an Editorial Board Member of Resuscitation., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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31. Ventilation and oxygenation during CPR: Is the time past to just bag it?
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Noordergraaf GJ and Venema A
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- Humans, Respiration, Artificial methods, Oxygen Inhalation Therapy methods, Heart Arrest therapy, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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32. Restarting the newborn infant heart.
- Author
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Liley HG and Haakons K
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- Humans, Infant, Newborn, Heart Arrest therapy, Heart Arrest etiology, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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33. The myth of mechanical CPR: Poorer outcomes for in-hospital cardiac arrest (IHCA)?
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Tsai RJ, Fan CY, Sung CW, and Huang EP
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- Humans, Cardiopulmonary Resuscitation methods, Heart Arrest therapy, Heart Arrest mortality
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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34. Enhancing post-arrest prognostication through good outcome prediction.
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Tam J and Elmer J
- Subjects
- Humans, Prognosis, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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35. Head up CPR is based upon the laws of physics.
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Moore JC, Bachista KM, Holley JE, Debaty GP, and Lurie KG
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- Humans, Physics, Patient Positioning methods, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest Keith G. Lurie is a co-inventor of the active compression-decompression CPR device, the impedance threshold device, and an automated head-up CPR device. Dr. Lurie is the CEO of AdvanedCPR Solutions. The remainder of the authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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36. Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest.
- Author
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Vaillancourt C, Charette M, Khorsand S, Shligold E, Lanos C, Dale-Tam J, Tran A, Boyle L, Aucoin S, Maniate J, Meggison H, Hartwick M, and Posner G
- Subjects
- Humans, Male, Female, Aged, Middle Aged, SARS-CoV-2, Personal Protective Equipment, Retrospective Studies, Time-to-Treatment, Clinical Protocols, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation standards, COVID-19 therapy, COVID-19 epidemiology, Heart Arrest therapy
- Abstract
Objective: We sought to evaluate the impact of a COVID-19 Code Blue policy on in-hospital cardiac arrest (IHCA) processes of care, cardiopulmonary resuscitation (CPR) quality metrics, and survival to hospital discharge., Methods: We completed a health record review of consecutive IHCA for which resuscitation was attempted. We report Utstein outcomes and CPR quality metrics 33 months before (July,2017-March,2020) and after (April,2020-December,2022) the implementation of a COVID-19 Code Blue policy requiring all team members to don personal protective equipment including gown, gloves, mask, and eye protection for all IHCA., Results: There were 800 IHCA with the following characteristics (Before n = 396; After n = 404): mean age 66, 62.9% male, 81.3% witnessed, 31.3% in the emergency department, 25.6% cardiac cause, and initial shockable rhythm in 16.7%. Among all 404 patients screened for COVID-19, 25 of 288 available test results before IHCA occurred were positive. Comparing the before and after periods: there were relevant time delays (min:sec) in start of chest compressions (0:17vs.0:37;p = 0.005), team arrival (0:43vs.1:21;p = 0.002), 1st rhythm analysis (1:15vs.3:16;p < 0.0001), 1st epinephrine (3:44vs.4:34;p = 0.02), and airway insertion (8:38vs. 10:18;p = 0.02). Resuscitation duration was similar (18:28vs.19:35;p = 0.34). Exception of peri-shock pause which appeared longer (0:06vs.0:14;p = 0.07), chest compression fraction, rate and depth were identical and good. Factors independently associated with survival were age (adjOR 0.98;p < 0.001), male sex (adjOR 1.51;p = 0.048), witnessed (adjOR 2.35;p = 0.02), shockable rhythm (adjOR 3.31;p < 0.0001), hospital location (p = 0.0002), and COVID-19 period (adjOR 0.68;p = 0.052)., Conclusions: The COVID-19 Code Blue policy was associated with delayed processes of care but similarly good CPR quality. The COVID-19 period appeared associated with decreased survival., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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37. Addressing the need for bilateral carotid evaluation in Doppler monitoring studies for enhanced CPR outcomes.
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Tutar MS, Yildiz M, and Kozanhan B
- Subjects
- Humans, Carotid Arteries diagnostic imaging, Ultrasonography, Doppler methods, Heart Arrest therapy, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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38. Prioritizing timing over identity: No-flow time and time-to-shock as critical parameters in survival and neurological outcome analysis of out-of-hospital cardiac arrest.
- Author
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Malinverni S, Henneghien Y, Collot V, Bouazza FZ, and Farhat D
- Subjects
- Humans, Time-to-Treatment, Time Factors, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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39. Pediatric out-of-hospital cardiac arrest still needs more attention.
- Author
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Esangbedo ID
- Subjects
- Humans, Child, Emergency Medical Services methods, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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40. Cardiac arrest: Treatment is prevention?
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Descatha A and Savary D
- Subjects
- Humans, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest prevention & control, Heart Arrest therapy, Heart Arrest prevention & control, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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41. Endotracheal epinephrine at standard versus high dose for resuscitation of asystolic newborn lambs.
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Polglase GR, Brian Y, Tantanis D, Blank DA, Badurdeen S, Crossley KJ, Kluckow M, Gill AW, Camm E, Galinsky R, Thomas Songstad N, Klingenberg C, Hooper SB, and Roberts CT
- Subjects
- Animals, Sheep, Vasoconstrictor Agents administration & dosage, Dose-Response Relationship, Drug, Intubation, Intratracheal methods, Disease Models, Animal, Return of Spontaneous Circulation drug effects, Random Allocation, Epinephrine administration & dosage, Animals, Newborn, Cardiopulmonary Resuscitation methods, Heart Arrest therapy, Heart Arrest drug therapy
- Abstract
Introduction: Endotracheal (ET) epinephrine administration is an option during neonatal resuscitation, if the preferred intravenous (IV) route is unavailable., Objectives: We assessed whether endotracheal epinephrine achieved return of spontaneous circulation (ROSC), and maintained physiological stability after ROSC, at standard and higher dose, in severely asphyxiated newborn lambs., Methods: Near-term fetal lambs were asphyxiated until asystole. Resuscitation was commenced with ventilation and chest compressions. Lambs were randomly allocated to: IV Saline placebo (5 ml/kg), IV Epinephrine (20 micrograms/kg), Standard-dose ET Epinephrine (100 micrograms/kg), and High-dose ET Epinephrine (1 mg/kg). After three allocated treatment doses, rescue IV Epinephrine was administered if ROSC had not occurred. Lambs achieving ROSC were monitored for 60 minutes. Brain histology was assessed for microbleeds., Results: ROSC in response to allocated treatment (without rescue IV Epinephrine) occurred in 1/6 Saline, 9/9 IV Epinephrine, 0/9 Standard-dose ET Epinephrine, and 7/9 High-dose ET Epinephrine lambs respectively. Blood pressure during CPR increased after treatment with IV Epinephrine and High-dose ET Epinephrine, but not Saline or Standard-dose ET Epinephrine. After ROSC, both ET Epinephrine groups had lower pH, higher lactate, and higher blood pressure than the IV Epinephrine group. Cortex microbleeds were more frequent in High-dose ET Epinephrine lambs (8/8 lambs examined, versus 3/8 in IV Epinephrine lambs)., Conclusions: The currently recommended dose of ET Epinephrine was ineffective in achieving ROSC. Without convincing clinical or preclinical evidence of efficacy, use of ET Epinephrine at this dose may not be appropriate. High-dose ET Epinephrine requires further evaluation before clinical translation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2024
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42. Foreign body airway obstruction resulting in out-of-hospital cardiac arrest in Denmark - Incidence, survival and interventions.
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Wolthers SA, Holgersen MG, Jensen JT, Andersen MP, Blomberg SNF, Mikkelsen S, Christensen HC, and Jensen TW
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- Humans, Denmark epidemiology, Male, Female, Incidence, Aged, Middle Aged, Registries, Survival Rate trends, Aged, 80 and over, Adult, Cohort Studies, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest epidemiology, Out-of-Hospital Cardiac Arrest etiology, Airway Obstruction epidemiology, Airway Obstruction etiology, Airway Obstruction therapy, Airway Obstruction mortality, Emergency Medical Services statistics & numerical data, Emergency Medical Services methods, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation methods, Foreign Bodies complications, Foreign Bodies epidemiology
- Abstract
Background: Foreign body airway obstruction (FBAO) stands as an important contributor to accidental fatalities, yet prompt bystander interventions have been shown to improve survival. This study aimed to evaluate the incidence, interventions, and survival outcomes of patients with out-of-hospital cardiac arrest (OHCA) related to FBAO in comparison to patients with non-FBAO OHCA., Methods: In this population-based cohort study, we included all OHCAs in Denmark from 2016 to 2022. Cases related to FBAO were identified and linked to the patient register. Descriptive and multivariable analyses were performed to evaluate prognostic factors potentially influencing survival., Results: A total of 30,926 OHCA patients were included. The incidence rate of FBAO-related OHCA was 0.78 per 100,000 person-years. Among FBAO cases, 24% presented with return of spontaneous circulation upon arrival of the emergency medical services. The 30-day survival rate was higher in FBAO patients (30%) compared to non-FBAO patients (14%). Bystander interventions were recorded in 26% of FBAO cases. However, no statistically significant association between bystander interventions or EMS personnels' use of Magill forceps and survival was shown, aOR 1.47 (95 % CI 0.6-3.6) and aOR 0.88 (95% CI 0.3-2.1)., Conclusion: FBAO-related OHCA was rare but has a higher initial survival rate than non-FBAO related OHCA, with a considerable proportion of patients achieving return of spontaneous circulation upon arrival of the emergency medical service personnel. No definitive associations were established between survival and specific interventions performed by bystanders or EMS personnel. These findings highlight the need for further research in this area., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Signe Amalie Wolthers reports financial support was provided by Laerdal Foundation For Acute Medicine. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.]., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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43. Reply to addressing the need for bilateral carotid evaluation in doppler monitoring studies for enhanced CPR outcomes.
- Author
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Wang S and Li C
- Subjects
- Humans, Carotid Arteries diagnostic imaging, Heart Arrest therapy, Ultrasonography, Doppler methods, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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44. Resuscitation (un-)wanted: Does anyone care? A retrospective real data analysis.
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Rupp D, Heuser N, Sassen MC, Betz S, Volberg C, and Glass S
- Subjects
- Humans, Retrospective Studies, Male, Female, Aged, Aged, 80 and over, Germany, Middle Aged, Advance Directives statistics & numerical data, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation statistics & numerical data, Cardiopulmonary Resuscitation methods, Emergency Medical Services statistics & numerical data, Emergency Medical Services methods, Resuscitation Orders
- Abstract
Background and Objectives: In case of out-of-hospital cardiac arrest (OHCA) personnel of the emergency medical services (EMS) are regularly confronted with advanced directives (AD) and do-not-attempt-resuscitation (DNACPR) orders. The authors conducted a retrospective analysis of EMS operation protocols to examine the prevalence of DNACPR in case of OHCA and the influence of a presented DNACPR on CPR-duration, performed Advanced-Life-Support (ALS) measures and decision making., Materials and Methods: Retrospective analysis of prehospital medical documentation of all resuscitation incidents in a German county with 250,000 inhabitants from 1 January 2016 to 31 December 2022. Combined with data from the structured CPR team-feedback database patients characteristics, measures and course of the CPR were analysed. Statistic testing with significance level p < 0.05., Results: In total n = 1,474 CPR events were analysed. Patients with DNACPR vs. no DNACPR: n = 263 (17.8%) vs. n = 1,211 (82.2%). Age: 80.0 ± 10.3 years vs. 68.0 ± 13.9 years; p < 0.001. Patients with ASA-status III/IV: n = 214 (81.3%) vs. n = 616 (50.9%); p < 0.001. Initial layperson-CPR: n = 148 (56.3%) vs. n = 647 (55.7%); p = 0.40. Airway management: n = 185 (70.3%) vs. n = 1,069 (88.3%); p < 0.001. With DNACPR CPR-duration initiated layperson-CPR vs. no layperson-CPR: 19:14 min (10:43-25:55 min) vs. 12:40 min (06:35-20:03 min); p < 0.001., Conclusion: In case of CPR EMS-personnel are often confronted with DNACPR-orders. Patients are older and have more previous diseases than patients without DNACPR. Initiated layperson-CPR might lead to misinterpretation of patients will with impact on CPR-duration and unwanted measures. Awareness of this issue should be created through measures such as training programs in particular to train staff in the interpretation and legal admissibility of ADs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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45. Together we save: Uniting forces in manual and mechanical CPR.
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Edgar R and Bonnes JL
- Subjects
- Humans, Out-of-Hospital Cardiac Arrest therapy, Heart Arrest therapy, Cardiopulmonary Resuscitation methods
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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46. Lactate and lactate clearance as predictors of one-year survival in extracorporeal cardiopulmonary resuscitation - An international, multicentre cohort study.
- Author
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Thevathasan T, Gregers E, Rasalingam Mørk S, Degbeon S, Linde L, Bønding Andreasen J, Smerup M, Eifer Møller J, Hassager C, Laugesen H, Dreger H, Brand A, Balzer F, Landmesser U, Juhl Terkelsen C, Flensted Lassen J, Skurk C, and Søholm H
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Heart Arrest therapy, Heart Arrest mortality, Heart Arrest blood, Prognosis, Biomarkers blood, Cohort Studies, Survival Rate trends, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest blood, Lactic Acid blood, Cardiopulmonary Resuscitation methods, Extracorporeal Membrane Oxygenation methods
- Abstract
Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. In this study, it was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients., Methods: Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes., Results: 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30-13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09-0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank < 0.001) and subgroup analyses., Conclusion: Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2024
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47. The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study.
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Crowley C, Salciccioli J, Wang W, Tamura T, Kim EY, and Moskowitz A
- Subjects
- Humans, Male, Female, Aged, Middle Aged, United States epidemiology, Patient Discharge statistics & numerical data, Cohort Studies, Propensity Score, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Heart Arrest therapy, Heart Arrest mortality
- Abstract
Aim: We sought to investigate the relationship between mechanical cardiopulmonary resuscitation (CPR) during in-hospital cardiac arrest and survival to hospital discharge., Methods: Utilizing the prospectively collected American Heart Association's Get With The Guidelines database, we performed an observational study. Data from 153 institutions across the United States were reviewed with a total of 351,125 patients suffering cardiac arrest between 2011 and 2019 were screened. After excluding patients with cardiac arrests lasting less than 5 minutes, and patients who had incomplete data, a total of 111,143 patients were included. Our primary exposure was mechanical vs. manual CPR, and the primary outcome was survival to hospital discharge. Multivariate logistic regression models and propensity weighted analyses were used., Results: 11.8% of patients who received mechanical CPR survived to hospital discharge versus 16.9% in the manual CPR group. Patients who received mechanical CPR had a lower probability of survival to discharge compared to patients who received manual CPR (OR 0.66 95% CI 0.58-0.75; p < 0.001). This association persisted with multi-variable adjustment (OR 0.57 95% CI 0.46-0.70, p < 0.0001) and propensity weighted analysis (OR 0.68 95% CI 0.44-0 0.92, p < 0.0001). Mechanical CPR was associated with decrease likelihood of return of spontaneous circulation after multivariate adjustment (OR 0.68, 95% CI 0.60-0.76; p < 0.001)., Conclusions: Mechanical CPR was associated with a decreased likelihood of survival to hospital discharge and ROSC compared to manual CPR. This finding should be interpreted within the context of important limitations of this study and randomized trials are needed to better investigate this relationship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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48. Prodromal complaints and 30-day survival after emergency medical services-witnessed out-of-hospital cardiac arrest.
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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, and Ringgren KB
- Subjects
- Humans, Registries, Arrhythmias, Cardiac, Chest Pain diagnosis, Chest Pain etiology, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services
- 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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49. Survival and neurobehavioral outcomes following out-of-hospital cardiac arrest in pediatric patients with pre-existing morbidity: An analysis of the THAPCA out-of-hospital arrest data.
- Author
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Wormington SN, Best K, Tumin D, Li X, Desher K, Thiagarajan RR, and Raman L
- Subjects
- Child, Humans, Middle Aged, Morbidity, Survivors, Hospitals, Out-of-Hospital Cardiac Arrest, Hypothermia, Induced, Cardiopulmonary Resuscitation
- Abstract
Aim: Pre-arrest morbidity in adults who suffer out-of-hospital cardiac arrest (OHCA) is associated with increased mortality and poorer neurologic outcomes. The objective of this study was to determine if a similar association is seen in pediatric patients., Methods: We performed a secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. Study sites included 36 pediatric intensive care units across the United States and Canada. The study enrolled children between the ages of 48 hours and 18 years following an OHCA between September 1, 2009 and December 31, 2012. For our analysis, patients with (N = 151) and without (N = 142) pre-arrest comorbidities were evaluated to assess morbidity, survival, and neurologic function following OHCA., Results: No significant difference in 28-day survival was seen between groups. Dependence on technology and neurobehavioral outcomes were assessed among survivors using the Vineland Adaptive Behavior Scales-Second Edition (VABS-II), Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC). Children with pre-existing comorbidities maintained worse neurobehavioral function at twelve months, evidenced by poorer scores on POPC (p = 0.016), PCPC (p = 0.044), and VABS-II (p = 0.020). They were more likely to have a tracheostomy at hospital discharge (p = 0.034), require supplemental oxygen at three months (p = 0.039) and twelve months (p = 0.034), and be mechanically ventilated at twelve months (p = 0.041)., Conclusions: There was no difference in survival to 28 days following OHCA in children with pre-existing comorbidity compared to previously healthy children. The group with pre-existing comorbidity was more reliant on technology following arrest and exhibited worse neurobehavioral outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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50. Acute liver failure after out-of-hospital cardiac arrest: An observational study.
- Author
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Delignette MC, Stevic N, Lebossé F, Bonnefoy-Cudraz E, Argaud L, and Cour M
- Subjects
- Humans, Middle Aged, Cohort Studies, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest complications, Liver Failure, Acute complications, Hepatitis complications, Cardiopulmonary Resuscitation
- Abstract
Rationale: Apart from hypoxic hepatitis (HH), the hepatic consequences of out-of-hospital cardiac arrest (OHCA) have been little studied. This cohort study aimed to investigate the characteristics of liver dysfunction resulting from OHCA and its association with outcomes., Methods: Among the conventional static liver function tests used to define acute liver failure (ALF), we determined which one correlated more closely with the reference indocyanine green (ICG) clearance test in a series of OHCA patients from the CYRUS trial (NCT01595958). Subsequently, we assessed whether ALF, in addition to HH (i.e., acute liver injury), was an independent risk factor for death in a large cohort of OHCA patients admitted to two intensive care units between 2007 and 2017., Results: ICG clearance, available for 22 patients, was impaired in 17 (77.3%) cases. Prothrombin time (PT) ratio was the only static liver function test that correlated significantly (r = -0.66, p < 0.01) with ICG clearance and was therefore used to define ALF, with the usual cutoff of < 50%. Of the 418 patients included in the analysis (sex ratio: 1.4; median age: 64 [53-75] years; non-shockable rhythm: 73%), 67 (16.0%) presented with ALF, and 61 (14.6%) had HH at admission. On day 28, 337 (80.6%) patients died. Following multivariate analysis, ALF at admission, OHCA occurring at home, absence of bystander, non-cardiac cause of OHCA, low-flow duration ≥ 20 min, and SOFA score excluding liver subscore at admission were independently associated with day 28 mortality., Conclusions: ALF occurred frequently after OHCA and, unlike HH, was independently associated with day 28 mortality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
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