Out-of-hospital cardiac arrest: contemporary management and future perspectives

Nerla, Roberto; Webb, Ian; MacCarthy, Philip

doi:10.1136/heartjnl-2014-306961

Cited by 13 publications

(5 citation statements)

References 110 publications

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“…Until now, support and counselling have been directed more towards the patient and family. 27 Being a CPR provider does not necessarily imply the need for professional treatment, but we believe that some sort of an organised follow-up may mitigate concerns, reduce uncertainty towards the CPR provided and promote coping strategies in lay rescuers. Also, a follow-up should entail mutual trust between healthcare systems and community citizens.…”

Section: Discussionmentioning

confidence: 94%

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

et al. 2016

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ObjectiveCardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims.Methods, participantsThis is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR.SettingThe study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates.ResultsThree themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident.ConclusionsLay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers.

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Section: Discussionmentioning

confidence: 94%

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

et al. 2016

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“…Several of the variables incorporated into the score, such as a witnessed arrest, initial rhythm and age are well established as being associated with outcome (23). The intra-arrest use of epinephrine in the PARAMEDIC-2 trial was not associated with improvement in postdischarge neurological recovery compared with placebo and this may represent an important surrogate of prolonged low-flow time and haemodynamic instability (24).…”

Section: Validation Cohortsmentioning

confidence: 99%

A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

Pareek

Kordis

Beckley-Hoelscher

et al. 2020

European Heart Journal

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Aims The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. Methods and results From May 2012 to December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King’s Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multivariable logistic regression to identify predictors of the primary outcome to derive a risk score. This was externally validated in two independent cohorts comprising 473 patients. The primary endpoint was poor neurological outcome at 6-month follow-up (Cerebral Performance Category 3–5). Seven independent predictors of outcome were identified: missed (unwitnessed) arrest, initial non-shockable rhythm, non-reactivity of pupils, age (60–80 years—1 point; >80 years—3 points), changing intra-arrest rhythms, low pH <7.20, and epinephrine administration (2 points). The MIRACLE2 score had an area under the curve (AUC) of 0.90 in the development and 0.84/0.91 in the validation cohorts. Three risk groups were defined—low risk (MIRACLE2 ≤2—5.6% risk of poor outcome); intermediate risk (MIRACLE2 of 3–4—55.4% of poor outcome); and high risk (MIRACLE2 ≥5—92.3% risk of poor outcome). The MIRACLE2 score had superior discrimination than the OHCA [median AUC 0.83 (0.818–0.840); P < 0.001] and Cardiac Arrest Hospital Prognosis models [median AUC 0.87 (0.860–0.870; P = 0.001] and equivalent performance with the Target Temperature Management score [median AUC 0.88 (0.876–0.887); P = 0.092]. Conclusions The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.

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“…Several of the variables incorporated into the score, such as a witnessed arrest, initial rhythm and age are well established as being associated with outcome (23). The intra-arrest use of epinephrine in the PARAMEDIC-2 trial was not associated with improvement in post-discharge neurological recovery compared with placebo and this may represent an important surrogate of prolonged low-flow time and haemodynamic instability (24).…”

Section: Discussionmentioning

confidence: 99%

“…The specificity of pupillary reflexes after ROSC in isolation for neurological outcome after OOHCA is [50% but had an odds ratio of 2.47 in our multi-variable analysis and remained a useful objective parameter in this prediction model (27). While several variables, such as zero- and low-flow times have previously been well established markers of a poor outcome, they are often unknown or inaccurately recorded at the time of admission (23), This can lead to challenges in predicting neurological outcome on arrival, especially in comatose patients treated with hypothermia. Hence, there remains significant ambiguity and limited objective guidance to support early decision making at HACs, which should have as high a specificity as possible to avoid under-treatment of cases where interval neurological recovery remains possible.…”

Section: Discussionmentioning

confidence: 99%

A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA₂CLE₂

Pareek

Kordis

Beckley-Hoelscher

et al. 2020

Preprint

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Aims The purpose of this study was to develop a practical risk−score to predict poor neurological outcome after out−of−hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. Methods and Results Between May 2012 and December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multi-variable logistic regression to identify factors independently predictive of the primary outcome in order to derive a risk score. This was externally validated in two independent cohorts comprising 474 patients. The primary outcome was poor neurological function at 6−month follow−up (Cerebral Performance Category 3-−). Seven independent variables for prediction of outcome were identified: Missed (Unwitnessed) arrest, Initial non-shockable rhythm, non-Reactivity of pupils, Age, Changing intra-arrest rhythms, Low pH<7.20 and Epinephrine administration. From these variables, the MIRA2CLE2 score was developed which had an AUC of 0.90 in the development and 0.85 and 0.89 in the validation cohorts. 3 risk groups of the MIRA2CLE2 were defined − Low risk (≤2−5.6% risk of poor outcome; Intermediate risk (3−4−55.4% of poor outcome) and high risk (≥5−92.3% risk of poor outcome). The risk-score performance was equivalent in a sub-group of patients referred for early angiography and revascularisation where appropriate. Conclusions The MIRA2CLE2 score is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission to a Heart Attack Centre.

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Out-of-hospital cardiac arrest: contemporary management and future perspectives

Cited by 13 publications

References 110 publications

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA₂CLE₂

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Out-of-hospital cardiac arrest: contemporary management and future perspectives

Cited by 13 publications

References 110 publications

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2

A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA2CLE2

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A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA₂CLE₂