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Purpose The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (V.sub.T) was 7 (Interquartile range, IQR = 6.2-8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5-9) cmH.sub.20, plateau pressure was 20 cmH.sub.20 (IQR = 17-23), driving pressure was 12 cmH.sub.20 (IQR = 10-15), mechanical power 16.2 J/min (IQR = 12.1-21.8), ventilatory ratio was 1.27 (IQR = 1.04-1.6), and respiratory rate was 17 breaths/minute (IQR = 14-20). Median partial pressure of oxygen was 87 mmHg (IQR = 75-105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36-45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003-1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001-1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes., Author(s): Chiara Robba [sup.1] [sup.2], Rafael Badenes [sup.3] [sup.4], Denise Battaglini [sup.1] [sup.5], Lorenzo Ball [sup.1] [sup.2], Iole Brunetti [sup.1], Janus C. Jakobsen [sup.6] [sup.7], Gisela Lilja [sup.8], Hans Friberg [...]

Objective To investigate factors associated with survival after out-of-hospital cardiac arrest in Viet Nam. Methods We did a multicentre prospective observational study of people (> 18 years) presenting with out-of-hospital cardiac arrest (not caused by trauma) to three tertiary hospitals in Viet Nam from February 2014 to December 2018. We collected data on characteristics, management and outcomes of patients with out-of-hospital cardiac arrest and compared these data by type of transportation to hospital and survival to hospital admission. We assessed factors associated with survival to admission to and discharge from hospital using logistic regression analysis. Findings Of 590 eligible people with out-of-hospital cardiac arrest, 440 (74.6%) were male and the mean age was 56.1 years (standard deviation: 17.2). Only 24.2% (143/590) of these people survived to hospital admission and 14.1% (83/590) survived to hospital discharge. Most cardiac arrests (67.8%; 400/590) occurred at home, 79.4% (444/559) were witnessed by bystanders and 22.3% (124/555) were given cardiopulmonary resuscitation by a bystander. Only 8.6% (51/590) of the people were taken to hospital by the emergency medical services and 32.2% (49/152) received pre-hospital defibrillation. Pre-hospital defibrillation (odds ratio, OR: 3.90; 95% confidence interval, CI: 1.54-9.90) and return of spontaneous circulation in the emergency department (OR: 2.89; 95% CI: 1.03-8.12) were associated with survival to hospital admission. Hypothermia therapy during post-resuscitation care was associated with survival to discharge (OR: 5.44; 95% CI: 2.33-12.74). Conclusion Improvements are needed in the emergency medical services in Viet Nam such as increasing bystander cardiopulmonary resuscitation and public access defibrillation, and improving ambulance and post-resuscitation care. Objectif Examiner les facteurs associes a la survie apres un arret cardiaque hors hopital au Viet Nam. Methodes Nous avons mene une etude d'observation prospective multicentrique sur des personnes (> 18 ans) ayant subi un arret cardiaque hors hopital (non traumatique) et admis dans trois hopitaux tertiaires au Viet Nam entre fevrier 2014 et decembre 2018. Nous avons recolte des donnees sur les caracteristiques, la gestion et l'issue de ces patients, puis les avons compares en fonction du moyen de transport vers l'hopital et de la survie apres leur admission. Enfin, nous avons mesure des facteurs associes a la survie lors de l'admission et de la sortie de l'etablissement a l'aide d'une analyse de regression logistique. Resultats Sur les 590 patients eligibles ayant subi un arret cardiaque hors hopital, 440 (74,6%) etaient des hommes et l'age moyen s'elevait a 56,1 ans (ecart type: 17.2). Seulement 24,2% (143/590) d'entre eux ont survecu a leur admission a l'hopital, et 14,1% (83/590) a leur sortie. La plupart des arrets cardiaques (67,8%; 400/590) ont eu lieu a domicile, 79,4% (444/559) se sont deroules en presence de passants et 22,3% (124/555) ont fait l'objet d'une reanimation cardiopulmonaire pratiquee par un temoin. A peine 8,6% (51/590) des patients ont ete emmenes a l'hopital par les services medicaux d'urgence, et 32,2% (49/152) ont recu une defibrillation avant d'arriver a l'hopital. La defibrillation prehospitaliere (odds ratio, OR: 3,90; intervalle de confiance de 95%, IC: 1,54-9,90) et le retablissement d'une circulation spontanee aux urgences (OR: 2,89; IC de 95%: 1,03-8,12) allaient de pair avec la survie apres admission. Lhypothermie therapeutique administree durant les soins post-reanimation etait liee a un meilleur taux de survie au moment de la sortie (OR: 5,44; IC de 95%: 2,33-12,74). Conclusion Des amenagements sont requis en matiere de services medicaux d'urgence au Viet Nam, notamment pour encourager la pratique de la reanimation cardiopulmonaire aupres de la population, garantir l'acces a des defibrillateurs publics, mais aussi ameliorer les soins en ambulance et en post-reanimation. Objetivo Investigar los factores relacionados con la supervivencia despues de un paro cardiaco extrahospitalario en Vietnam. Metodos Se realizo un estudio observacional prospectivo multicentrico de personas (>18 anos) que sufrieron un paro cardiaco extrahospitalario (no causado por traumatismo) en tres hospitales terciarios de Vietnam entre febrero de 2014 y diciembre de 2018. Se recopilaron los datos sobre las caracteristicas, el tratamiento y los resultados de los pacientes con paro cardiaco extrahospitalario y se compararon segun el tipo de transporte hasta el hospital y la supervivencia hasta el ingreso en el hospital. Se evaluaron los factores de supervivencia hasta el ingreso y el alta hospitalaria mediante un analisis de regresion logistica. Resultados De las 590 personas que cumplian los requisitos y sufrieron un paro cardiaco extrahospitalario, 440 (74,6 %) eran hombres, cuya edad media era de 56,1 anos (desviacion estandar: 17,2). Solo el 24,2 % (143/590) de estas personas sobrevivieron al ingreso en el hospital y el 14,1 % (83/590) sobrevivieron al alta hospitalaria. La mayoria de los paros cardiacos (67,8 %; 400/590) ocurrieron en el hogar, el 79,4 % (444/559) fueron presenciados por transeuntes y el 22,3 % (124/555) recibieron reanimacion cardiopulmonar por un transeunte. Solo el 8,6 % (51/590) de las personas fueron trasladadas al hospital por los servicios medicos de emergencia y el 32,2 % (49/152) recibieron desfibrilacion prehospitalaria. La desfibrilacion prehospitalaria (oportunidad relativa, OR: 3,90; intervalo de confianza del 95 %, IC: 1,54-9,90) y la recuperacion de la circulacion espontanea en el servicio de urgencias (OR: 2,89; IC del 95 %: 1,03-8,12) se asociaron a la supervivencia hasta el ingreso hospitalario. La hipotermia terapeutica durante la atencion posterior a la reanimacion se asocio a la supervivencia hasta el alta (OR: 5,44; IC del 95 %: 2,33-12,74). Conclusion Se necesitan mejoras en los servicios medicos de emergencia de Vietnam, como el aumento de las intervenciones de reanimacion cardiopulmonar para transeuntes y de desfibrilacion de acceso publico, asi como el mejoramiento de la atencion en las ambulancias y de los cuidados posteriores a la reanimacion. [phrase omitted], Introduction Out-of-hospital cardiac arrest is one of the leading causes of death and disability worldwide [1,2] and contributes to as much as 10% of the total mortality in low- and [...]

Purpose To study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest. Methods A prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystander-witnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergency medical services or cooling started after hospital arrival. Early cooling (intervention) was defined as intra-arrest cooling initiated < 20 min from collapse (i.e., [less than or equal to] median time to cooling in PRINCESS). Propensity score matching established comparable control patients. Primary outcome was favorable neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Complete recovery (CPC 1) was among secondary outcomes. Results In total, 300 patients were analyzed and the proportion with CPC 1-2 at 90 days was 35/150 (23.3%) in the intervention group versus 24/150 (16%) in the control group, odds ratio (OR) 1.92, 95% confidence interval (CI) 0.95-3.85, p = .07. In patients with shockable rhythm, CPC 1-2 was 29/57 (50.9%) versus 17/57 (29.8%), OR 3.25, 95%, CI 1.06-9.97, p = .04. The proportion with CPC 1 at 90 days was 31/150 (20.7%) in the intervention group and 17/150 (11.3%) in controls, OR 2.27, 95% CI 1.12-4.62, p = .02. In patients with shockable rhythms, the proportion with CPC 1 was 27/57 (47.4%) versus 12/57 (21.1%), OR 5.33, 95% CI 1.55-18.3, p = .008. Conclusions In the whole study population, intra-arrest cooling initiated < 20 min from collapse compared to cooling initiated at hospital was not associated with improved favorable neurologic outcome. In the subgroup with shockable rhythms, early cooling was associated with improved favorable outcome and complete recovery., Author(s): Akil Awad [sup.1], Fabio Silvio Taccone [sup.2], Martin Jonsson [sup.1], Sune Forsberg [sup.1], Jacob Hollenberg [sup.1], Anatolij Truhlar [sup.3] [sup.4], Mattias Ringh [sup.1], Benjamin S. Abella [sup.5], Lance B. [...]

Purpose Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. Methods Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. Results A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Conclusions Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation., Author(s): Teresa L. May [sup.1] [sup.2], Christine W. Lary [sup.3], Richard R. Riker [sup.1], Hans Friberg [sup.4], Nainesh Patel [sup.5], Eldar Søreide [sup.6] [sup.7], John A. McPherson [sup.8], Johan Undén [...]

Author(s): Ulrich Grabmaier [sup.1] [sup.2], Konstantinos D. Rizas [sup.1], Steffen Massberg [sup.1] [sup.2], Ludwig Weckbach [sup.1] [sup.2], Matthias Fischer [sup.3], Martin von der Helm Author Affiliations: Dear Editor, Out-of-hospital cardiac [...]

Author(s): Alain Cariou [sup.1], Jerry P. Nolan [sup.2], Kjetil Sunde [sup.3] Author Affiliations: (1) grid.411784.f, 0000000102743893, Medical Intensive Care Unit, AP-HP, Cochin University Hospital, , 27 rue du Faubourg Saint-Jacques, [...]