Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia

Andrew, Emily; Nehme, Ziad; Lijovic, Marijana; Bernard, Stephen; Smith, Karen

doi:10.1016/j.resuscitation.2014.07.015

Cited by 75 publications

(53 citation statements)

References 30 publications

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“…A recent review of OHCA patients presenting in asystole or pulseless electric activity based on data from VACAR showed low survival rates with no improvement over a 10-year period. 39 Our study has a number of limitations. Fifteen per cent of patients were lost to follow-up, and a very small number were excluded owing to language barriers.…”

Section: Discussionmentioning

confidence: 93%

Quality of Life and Functional Outcomes 12 Months After Out-of-Hospital Cardiac Arrest

et al. 2015

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Background-Out-of-hospital cardiac arrest (OHCA) is a significant global health problem. There has been considerable investment in improving the emergency medical response to OHCA, with associated improvements in survival. However, concern remains that survivors have a poor quality of life. This study describes the quality of life of OHCA survivors at 1-year postarrest in Victoria, Australia. Methods and Results-Adult OHCA patients who arrested between 2010 and 2012 were identified from the Victorian Ambulance Cardiac Arrest Registry. Paramedics attended 15 113 OHCA patients of which 46.3% received an attempted resuscitation. Nine hundred and twenty-seven (13.2%) survived to hospital discharge of which 76 (8.2%) died within 12 months. Interviews were conducted with 697 (80.7%) patients or proxies, who were followed-up via telephone interview, including the Glasgow Outcome Scale-Extended, the 12-item short form health survey, and the EuroQol. The majority (55.6%) of respondents had a good recovery via the Glasgow Outcome Scale-Extended≥7 (41.1% if patients who died postdischarge were included and nonrespondents were assumed to have poor recovery

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Section: Discussionmentioning

confidence: 93%

Quality of Life and Functional Outcomes 12 Months After Out-of-Hospital Cardiac Arrest

et al. 2015

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“…It is well established that patients with initial shockable rhythms treated with conventional resuscitation have a higher chance of achieving ROSC, thereby allowing the possibility of survival. 1,29,30 However, in resuscitations unable to achieve ROSC, regardless of initial cardiac rhythm, the benefit of achieving artificial circulation through ECPR may be similar. Nearly 90% of the patients in our cohort with initial shockable rhythms survived to hospital admission, twice the proportion of those with initial non-shockable rhythms.…”

Section: Potential Candidates For Canadian Ecpr Program For Ohcamentioning

confidence: 99%

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

Grunau

Scheuermeyer

Stub

et al. 2016

CJEM

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Objective: Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. Methods: We performed a secondary analysis from a 52-month prospective registry of consecutive adult nontraumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge. Results: Of 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge. Conclusion: In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes. RÉSUMÉObjectif: La réanimation cardiorespiratoire extracorporelle (RCREC), bien qu'elle soit exigeante sur le plan des ressources, peut améliorer les résultats cliniques chez certains patients ayant subi un arrêt cardiaque extrahospitalier (ACEH) réfrac-taire. Les auteurs de l'étude cherchaient à déterminer les patients qui répondaient aux un ensemble de critères de la RCREC afin d'estimer, d'une part, la proportion de patients ayant subi un arrêt cardiaque réfractaire qui auraient pu profiter de la méthode de réanimation et, d'autre part, les résultats cliniques obtenus par la méthode habituelle de réanimation. Méthode: Les auteurs ont procédé à une analyse secondaire d'un registre prospectif, constitué de cas consécutifs d'ACEH non traumatique, survenus chez des adultes, sur une période de 52 mois, dans une seule région sanitaire urbaine d'un million de personnes, au Canada. Les auteurs ont formé une cohorte fictive d'adultes, âgés de moins de 60 ans, susceptibles d'être traités par la RCREC après avoir subi un ACEH devant des témoins et avoir fait l'objet de manoeuvres de réanimation cardiorespiratoire par des passants ou avoir reçu des soins donnés par des services médicaux d'urgence (SMU), et ce, en l'espace de cinq minutes. Le principal critère d'éval...

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“…Analyzing PEA and asystolic arrests together may not be ideal since it has been demonstrated that OHCA due to PEA may portend a better outcome than those due to asystole [7]. This was also demonstrated in the few studies that compared their outcomes [11,32,38].…”

Section: Methodsmentioning

confidence: 99%

“…The difficulty with measuring outcomes in OHCA due to nSR is that they are more likely to have many of these features, particularly when compared to VT/VF [7,12,16,18,24,25,45,47]. Also, each clinical variable may not alter outcomes in a similar fashion in VT/VF and nSR groups [32,34].…”

Section: Outcome Variablesmentioning

confidence: 99%

“…The largest RCTs on TH/TTM in OHCA have excluded nSR [2,3] or were not designed to evaluate the effects of hypothermia in nSR as a primary outcome [4]. This is likely because studies have revealed significantly worse outcomes in OHCA associated with nSR, and intervention has been assumed to have little benefit given the costs [7,8]. However, a hypothermia protocol may be beneficial in a subgroup of patients presenting with OHCA due to nSR if certain criteria are met [8].…”

Section: Introductionmentioning

confidence: 99%

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A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

Freund

Kaplan

2017

Cardiol J.

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Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia

Cited by 75 publications

References 30 publications

Quality of Life and Functional Outcomes 12 Months After Out-of-Hospital Cardiac Arrest

Quality of Life and Functional Outcomes 12 Months After Out-of-Hospital Cardiac Arrest

Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

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