Effect of Transport Interval on Out-of-Hospital Cardiac Arrest Survival in the OPALS Study: Implications for Triaging Patients to Specialized Cardiac Arrest Centers

Spaite, Daniel W.; Stiell, Ian G.; Bobrow, Bentley J.; Boer, Melanie de; Maloney, Justin; Denninghoff, Kurt R.; Vadeboncoeur, Tyler; Dreyer, Jonathan; Wells, George A.

doi:10.1016/j.annemergmed.2008.11.020

Cited by 103 publications

(73 citation statements)

References 66 publications

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“…[1][2][3][4][5][6][7][8] According to a few reports, post-hospital admission predictors for unfavorable neurological outcomes in these patients with ventricular fibrillation (VF) include lactate level elevation at intensive care unit (ICU), and OHCA patients' plasma lactate and serum creatinine levels elevation. 9,10 Neumar et al 11 reported that the high mortality rate of patients who initially achieved return of spontaneous circulation (ROSC) after experiencing cardiac arrest could be attributed to the development of post-cardiac arrest syndrome (PCAS), a unique and complex combination of pathophysiological processes.…”

Section: Introductionmentioning

confidence: 99%

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

et al. 2017

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Objective: This study aimed to test the hypothesis that coagulation, fibrinolytic markers and disseminated intravascular coagulation (DIC) score (International Society on Thrombosis and Haemostasis) at hospital admission of out-of-hospital cardiac arrest (OHCA) patients can predict neurological outcomes 1 month after cardiac arrest. Results: We analyzed data for 315 patients. Except for fibrinogen level, all coagulation variables, fibrinolytic variables, and DIC score were associated with favorable neurological outcomes. In the receiver operating characteristic curve analysis, FDP level had the largest area under the curve (AUC; 0.795). In addition, the AUC of FDP level was larger than that of 4 lactate level. The AUC value of FDP level might indicate that FDP is an independent predictor of favorable neurological outcomes. Conclusions:All of the coagulation and fibrinolytic markers, except for fibrinogen level, and DIC score at hospital admission, were associated with favorable neurological outcomes. Of all of the variables, FDP level was most closely associated with favorable neurological outcomes in OHCA patients who successfully achieved ROSC. 5

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Section: Introductionmentioning

confidence: 99%

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

et al. 2017

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“…Previous research suggests that the delay this protocol resulted in may not have any bearing on survival outcomes. 18,19 It is clear that early initiation of cooling is not the sole factor in achieving goal temperature and possible that delays arising from patient sedation, paralysis, deviation from hospital protocol, and additional TH induction measures impacted our results. Our centre's post-cardiac arrest clinical pathway is composed of a bundle of therapeutic interventions in addition to TH.…”

Section: Discussionmentioning

confidence: 80%

“…19,24,25 Our prehospital providers were not equipped with thermometers, and the first recorded temperature on study patients was on hospital arrival. Many of the sicker patients may have experienced autonomic dysregulation, which could have affected their cooling rates.…”

Section: Limitationsmentioning

confidence: 99%

Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature

Schenfeld

Studnek²,

Heffner

et al. 2015

CJEM

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Objective: Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature. Methods: All patients enrolled in an institutional postcardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4uC (39.2uF) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year. Results: One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p 5 0.64), nor was there any improvement in hospital survival (54% v. 50%, p 5 0.67), good neurologic outcome (49% v. 44%, p 5 0.61), or 1-year survival (49% v. 42%, p 5 0.46) between the two groups. Transport times were longer in the prehospital cooled group. Conclusions: Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption. RÉ SUMÉObjectif: Bien que l'amorce de l'hypothermie thé rapeutique en phase pré hospitaliè re soit de plus en plus ré pandue, on n'en connaît pas l'effet sur les ré sultats, chez les patients victimes d'un arrê t cardiaque. L'é tude visait à dé terminer si l'administration intraveineuse de liquides froids, en phase pré hospitaliè re, permettait d'atteindre plus rapidement la tempé rature cible. Mé thode: Tous les patients soumis à un parcours de traitement, en é tablissement, pour un arrê t cardiaque ont é té inscrits de maniè re prospective dans une base de donné es sur l'assurance de la qualité. Les patients soumis au refroidissement à leur arrivé e à l'hô pital ont é té comparé s avec ceux soumis au nouveau protocole de traitement mis en oeuvre durant la pé riode à l'é tude, comportant un refroidissement pré hospitalier à l'aide de l'administration d'une solution physiologique salé e maintenue à 4uC (39.2uF). Le principal critè re d'é valuation é tait le temps né cessaire à l'atteinte de la tempé rature cible. Les critè res d'é valuation secondaires comprenaient les mesures du tem...

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“…[1][2][3][4][5][6][7][8] The period of time from when a call is made to EMS to the point when EMS arrive at the scene (i.e., the response time) is another predictor. Several reports show that shorter EMS response times improve survival rates in OHCA patients.…”

Section: Introductionmentioning

confidence: 99%

The response time threshold for predicting favourable neurological outcomes in patients with bystander-witnessed out-of-hospital cardiac arrest

et al. 2016

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Abstract:Objective It is well established that the period of time between a call being made to emergency medical services (EMS) and the time at which EMS arrive at the scene (i.e., the response time) affects survival outcomes in patients who experienced out-of-hospital cardiac arrest (OHCA). However, the relationship between response time and favourable neurological outcomes remains unclear. We therefore aimed to determine a response time threshold in bystander-witnessed OHCA patients that is associated with positive neurological outcomes and to assess the relationship between response time and neurological outcomes in OHCA patients. MethodsThis study was a retrospective, observational analysis of data from 204,277 episodes of bystander-witnessed OHCA between 2006 and 2012 in Japan. We used classification and regression trees (CARTs) and receiver operating characteristic (ROC) curve analysis to determine the threshold of response time associated with favourable neurological outcomes (Cerebral Performance Category 1 or 2) one month after cardiac arrest. ResultsBoth CARTs and ROC analyses indicated that a threshold of 6.5 min was associated with improved neurological outcomes in all bystander-witnessed OHCA events from cardiac origin. Furthermore, bystander cardiopulmonary resuscitation (CPR) prolonged the threshold of response time by 1 min (to 7.5 min). The adjusted odds ratios for favorable neurological outcomes in OHCA patients who received care within ≤ 6.5 min was 1.935 (95% confidential interval: 1.834−2.041, P<0.001). ConclusionsA response time ≤ 6.5 min was closely associated with favourable neurological outcomes in all bystander-witnessed OHCA patients. Bystander CPR prolonged the response time threshold by 1 min.

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Effect of Transport Interval on Out-of-Hospital Cardiac Arrest Survival in the OPALS Study: Implications for Triaging Patients to Specialized Cardiac Arrest Centers

Cited by 103 publications

References 66 publications

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature

The response time threshold for predicting favourable neurological outcomes in patients with bystander-witnessed out-of-hospital cardiac arrest

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