Arrest etiology among patients resuscitated from cardiac arrest

Chen, Niel; Callaway, Clifton W.; Guyette, Francis X; Rittenberger, Jon C.; Doshi, Ankur; Dezfulian, Cameron; Elmer, Jonathan

doi:10.1016/j.resuscitation.2018.06.024

Cited by 119 publications

(89 citation statements)

References 23 publications

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“…Thirdly, patients that meet TOR-criteria may have a higher chance of being salvaged in non-Western regions, which may be due to different underlying aetiologies, more patients that have pulseless electrical activity instead of asystole, or widespread use of advanced CPRtechniques. 47,48 Finally, the lower specificity was only found for death, and not for the secondary endpoint of unfavourable neurologic outcome. The lower specificity could hypothetically be driven by patients surviving with an impaired neurologic status.…”

Section: Diagnostic Performancementioning

confidence: 92%

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

et al. 2020

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Aim: To minimize termination of resuscitation (TOR) in potential survivors, the desired positive predictive value (PPV) for mortality and specificity of universal TOR-rules are !99%. In lack of a quantitative summary of the collective evidence, we performed a diagnostic meta-analysis to provide an overall estimate of the performance of the basic and advanced life support (BLS and ALS) termination rules. Data sources:We searched PubMed/EMBASE/Web-of-Science/CINAHL and Cochrane (until September 2019) for studies on either or both TORrules in non-traumatic, adult cardiac arrest. PRISMA-DTA-guidelines were followed.Results: There were 19 studies: 16 reported on the BLS-rule (205.073 patients, TOR-advice in 57%), 11 on the ALS-rule (161.850 patients, TOR-advice in 24%). Pooled specificities were 0.95 (0.89À0.98) and 0.98 (0.95À1.00) respectively, with a PPV of 0.99 (0.99À1.00) and 1.00 (0.99À1.00).Specificities were significantly lower in non-Western than Western regions: 0.84 (0.73À0.92) vs. 0.99 (0.97À0.99), p < 0.001 for the BLS rule. For the ALS-rule, specificities were 0.94 (0.87À0.97) vs. 1.00 (0.99À1.00), p < 0.001. For non-Western regions, 16 (BLS) or 6 (ALS) out of 100 potential survivors met the TOR-criteria. Meta-regression demonstrated decreasing performance in settings with lower rates of in-field shocks.Conclusions: Despite an overall high PPV, this meta-analysis highlights a clinically important variation in diagnostic performance of the BLS and ALS TOR-rules. Lower specificity and PPV were seen in non-Western regions, and populations with lower rates of in-field defibrillation. Improved insight in the varying diagnostic performance is highly needed, and local validation of the rules is warranted to prevent in-field termination of potential survivors.

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Section: Diagnostic Performancementioning

confidence: 92%

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

et al. 2020

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“…QTc prolongation should prompt investigation into the patient's medications and possible toxidromes. Less common but likely to recur causes of cardiac arrest include Brugada syndrome, Wolf‐Parkinson‐White Syndrome, and hypertrophic obstructive cardiomyopathy 28 …”

Section: Determining the Etiologymentioning

confidence: 99%

“…The general laboratory workup includes electrolytes, renal function, liver function, arterial blood gas with co‐oximetry, toxicology (eg, illicit drugs, ETOH, salicylates, acetaminophen), and CBC. Opiate overdose is a common etiology of arrest 28,29 . Electrolyte abnormalities should be corrected, especially potassium and magnesium derangements.…”

Section: Determining the Etiologymentioning

confidence: 99%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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Cardiac arrest has a high rate of morbidity and mortality. Several advances in postcardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system.The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.

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“…A respiratory or neurological cause of cardiac arrest should be considered in patients without ST-elevation on the first ECG. Examples of respiratory causes of cardiac arrest include severe pneumonia and acute on chronic respiratory failure 116 .…”

Section: Computed Tomography (Ct)-thorax and Headmentioning

confidence: 99%

“…Acute pulmonary embolism is an uncommon cause of cardiac arrest and has been reported to be responsible for 2.8-4.8% of cases 117 . Neurological causes of cardiac arrest are more or less equal to major cerebrovascular bleeding, and in particular subarachnoid hemorrhage 118 , and they have been reported as the cause of cardiac arrest in 2.0-2.4% of patients 116,118,119 . Aortic dissection/rupture is a rare cause of cardiac arrest, with a reported incidence of 0.1-2.3% 116,120 , and can be identified by CT-thorax.…”

Section: Computed Tomography (Ct)-thorax and Headmentioning

confidence: 99%

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

et al. 2019

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Arrest etiology among patients resuscitated from cardiac arrest

Abstract: Arrest etiology was identifiable in the majority cases via systematic chart review. "Cardiac" etiologies may be less common than previously thought. Substantial clinical heterogeneity exists across etiologies, suggesting previous classification systems may be insufficient.

Cited by 119 publications

References 23 publications

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

State‐of‐the‐art considerations in post‐arrest care

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

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