A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study

Gaspari, Romolo; Weekes, Anthony J.; Adhikari, Srikar; Noble, Vicki E.; Nomura, Jason T.; Theodoro, Daniel; Woo, Michael Y.; Atkinson, Paul; Blehar, David; Brown, Samuel M.; Caffery, Terrell; Douglass, Emily; Fraser, Jacqueline; Haines, Christine; Lam, Samuel H.F.; Lanspa, Michael J.; Lewis, Margaret Reed; Liebmann, Otto; Limkakeng, Alexander T.; López, Fernando García; Platz, Elke; Mendoza, Michelle C.; Minnigan, Hal; Moore, Christopher L.; Novik, Joseph; Rang, Louise; Scruggs, Will; Raio, Christopher

doi:10.1016/j.resuscitation.2017.09.008

Cited by 55 publications

(31 citation statements)

References 17 publications

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“…Previous studies suggest that in addition to predicting outcome in cardiac arrest, PoCUS may be useful in identifying patients who may respond to more aggressive resuscitation efforts, as well as in aiding the decision to terminate resuscitation [10-13].…”

Section: Introductionmentioning

confidence: 99%

Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators

Atkinson¹,

Beckett²,

French³

et al. 2019

Cureus

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Introduction This third study in the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) series examined potential relationships between point-of-care ultrasound (PoCUS) use and the length of resuscitation, the frequency of interventions, and clinical outcomes during cardiac arrest. Methods A health records review was completed for adult patients (>19 years, without a do not resuscitate (DNR) order) who presented to a tertiary emergency department in cardiac arrest between 2010 and 2014. Patients were grouped based on PoCUS use and findings for cardiac activity. Data were analyzed for length of resuscitation, frequency of interventions, return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD). Results Of the 223 patients who met inclusion criteria, 180 (80.7%) received assessment by PoCUS during cardiac arrest management in the emergency department (ED). In the PoCUS group, 21 (11.6%) demonstrated cardiac activity and 159 (88.4%) did not. Patients with activity on PoCUS had longer mean resuscitation times (27.3; 95% confidence interval 17.7-37.0 min) than patients with no activity (11.51; 10.2-12.8 min) and patients who did not receive a PoCUS exam (14.36; 9.89-18.8 min). Patients with cardiac activity on PoCUS were more likely to receive endotracheal intubation (ET; 95.23%; 86.13-104.35%) and epinephrine (Epi; 100%; 100-100%) than patients with no activity (ET: 46.54%; 38.8-54.3%; Epi: 82.39%; 76.50-88.31%) and those with no PoCUS (ET: 65.11%; 50.87-79.36%; Epi: 81.39%; 69.76-93.03%). Those with no cardiac activity on PoCUS were much less likely to achieve ROSC (19.5%; 13.4-25.6), SHA (6.9%; 2.97-10.86%) and SHD (0.6%; -0.5-1.8%) compared to those with cardiac activity on PoCUS (ROSC; 76.19%; 57.97-94.4%), SHA (33.3%; 13.2-53.5%), SHD (9.5%; -3-22.07%), and those with no PoCUS (ROSC 39.5%; 24.9-54.1%; SHA 27.9%; 14.5- 41.3%, and SHD 6.9%; -0.6-14.59). Conclusions Emergency department cardiac arrest patients with cardiac activity on PoCUS received longer resuscitation with higher rates of intervention as compared to those with negative findings or when no PoCUS was performed. Patients with cardiac activity on PoCUS had improved clinical outcomes as compared with patients not receiving PoCUS, and patients with no activity on PoCUS.

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Section: Introductionmentioning

confidence: 99%

Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators

Atkinson¹,

Beckett²,

French³

et al. 2019

Cureus

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“…Arrhythmia episodes during the index hospitalization were as documented as follows: ventricular fibrillation (VF), ventricular tachycardia (VT), pulseless electrical activity (PEA; defined as a syndrome of electrical cardiac activity in an unconscious patient without a palpable pulse not attributed to a ventricular tachyarrhythmia) and electrical storm (three or more VA within 24 hours). Atrial fibrillation was subclassified as paroxysmal (≤7 days of onset), persistent (episodes sustained ≥7 days or requiring cardioversion), and permanent (cessation of further attempts to restore and/or maintain sinus rhythm).…”

Section: Methodsmentioning

confidence: 99%

Section: Index Hospitalizationmentioning

confidence: 99%

Sudden cardiac arrest and ventricular arrhythmias following first type I myocardial infarction in the contemporary era

Amin

Kella

Killu

et al. 2019

Cardiovasc electrophysiol

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Introduction Myocardial infarction (MI) is associated with an increase in subsequent heart failure (HF), recurrent ischemic events, sudden cardiac arrest, and ventricular arrhythmias (SCA‐VA). The primary objective of the study to determine the role of intercurrent HF and ischemic events on the development of SCA‐VA following first type I MI. Methods and results A retrospective cohort study of patients experiencing first type 1 MI in Olmsted County, Minnesota (2002‐2012) was conducted by identifying patients using the medical records linkage system (Rochester epidemiology project). Patients aged ≥18 years were followed from the time of MI till death or 31 July, 2017. Intercurrent HF and ischemic events were the primary exposures following MI and their association with outcome SCA‐VA was assessed. Eight hundred and sixty‐seven patients (mean age was 63 ± 14.5 years; 69% male; 49.8% ST‐elevation myocardial infarction) who had their first type I MI during the study period were included. Majority of acute MI patients were revascularized using percutaneous coronary intervention and bypass surgery (628 [72.43%] and 87 [10.03%] respectively). During a mean follow‐up of 7.69 ± 4.17 years, HF, recurrent ischemic events and SCA‐VA occurred in 155 (17.9%), 245 (28.3%), and 40 (4.61%) patients respectively. Low ejection fraction (adjusted hazard ratio [HR] 0.95; 95% confidence interval [CI], 0.93‐0.98; P < .001), intercurrent HF (adjusted HR 3.11; 95% CI, 1.39‐6.95; P = .006) and recurrent ischemic events (adjusted HR 3.47; 95% CI, 1.68‐7.18; P < .001) were associated with subsequent SCA‐VA. Conclusion SCA‐VA occurred in a small proportion of patients after MI and is associated with intercurrent HF and recurrent ischemic events.

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“…In patients with PEA there is a possibility to use ultrasound to determine the cause of the arrest 112 . Cardiac tamponade illustrates an example where ultrasound is the best tool to provide the correct diagnosis, with a high sensitivity and specificity 113 .…”

Section: Ultrasoundmentioning

confidence: 99%

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

et al. 2019

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A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study

Cited by 55 publications

References 17 publications

Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators

Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators

Sudden cardiac arrest and ventricular arrhythmias following first type I myocardial infarction in the contemporary era

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

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