Prehospital Predictors of Initial Shockable Rhythm in Out-of-Hospital Cardiac Arrest

Lin, Yen‐Nien; Chang, Shih‐Sheng; Wang, Lee-Min; Chi, Hwan-Ting; Ueng, Kwo‐Chang; Tsai, Chin‐Feng; Phan, Chee-Seong; Lu, Laijin; Hii, Choon-Hoon; Chung, Yu-Ting; Chugh, Sumeet S.; Chen, Ming-Fong; Wu, Tsu‐Juey; Chang, Kuan-Cheng

doi:10.1016/j.mayocp.2016.10.029

Cited by 20 publications

(27 citation statements)

References 37 publications

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“…Presence of SIR, in turn, is not only determined by situational factors (eg, presence of a witness and/or basic life support prior to emergency medical services (EMS) arrival, EMS response time) but also by patient characteristics (e.g., age, sex, comorbidities). [4][5][6][7][8] Prior treatment by a cardiologist may change the likelihood of SIR and thereby survival chances by changing the distribution of underlying causes of OHCA. In particular, we focused on the occurrence of acute myocardial infarction (AMI), the most common immediate cause of OHCA.…”

Section: Key Questionsmentioning

confidence: 99%

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

et al. 2021

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AimThis study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms.MethodsA retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm.ResultsOverall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)).ConclusionHaving pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.

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Section: Key Questionsmentioning

confidence: 99%

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

et al. 2021

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“…In most cases, such studies analyse the patient's status after the recovery of spontaneous circulation (ROSC), either on arrival at the emergency department or at the critical-care unit in the hospital. Thus, the interaction between the forementioned neurological outcome and certain aspects of the CA has been evaluated, [5][6][7][8][9] such as the first monitored rhythm, the presence of first responders or the duration of resuscitation efforts, in some cases using scales and other predictive tools [10,11].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome

Torres¹,

Hernández-Tejedor²,

Bustamante³

et al. 2020

Crit Care

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Background: The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decisionmaking process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). Methods: Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO 2 , HCO 3 − , base excess (BE), Na + , K + , Ca 2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. Results: We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p = 0.020), high pCO 2 levels (adjusted OR 1.03 [1.01-1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p < 0.001), high pCO 2 (adjusted OR 1.05 [1.03-1.08], p < 0.001), low HCO 3 − (adjusted OR 0.97 [0.94-0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93-0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p < 0.001). Conclusion: There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.

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“…Preliminary reports suggest that patterns of SCD and their management may vary with geography and ethnicity. From several Asian CA registries,19 28 29 it would appear that Asian countries may have lower rates of VT/VF as presenting rhythm in OHCA and lower rates of survival to hospital discharge 28. The Douala-SCD registry reported that there were no survivors of OHCA during the entire recruitment period, reflecting the challenges of CA management in low-resource settings.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage

et al. 2020

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BackgroundSudden cardiac death (SCD) is a major global health problem, accounting for up to 20% of deaths in Western societies. Clinical quality registries have been shown in a range of disease conditions to improve clinical management, reduce variation in care and improve outcomes.AimTo identify existing cardiac arrest (CA) and SCD registries, characterising global coverage and methods of data capture and validation.MethodsBiomedical and public search engines were searched with the terms ‘registry cardio*’; ‘sudden cardiac death registry’ and ‘cardiac arrest registry’. Registries were categorised as either CA, SCD registries or ‘other’ according to prespecified criteria. SCD registry coordinators were contacted for contemporaneous data regarding registry details.ResultsOur search strategy identified 49 CA registries, 15 SCD registries and 9 other registries (ie, epistries). Population coverage of contemporary CA and SCD registries is highly variable with registries densely concentrated in North America and Western Europe. Existing SCD registries (n=15) cover a variety of age ranges and subpopulations, with some enrolling surviving patients (n=8) and family members (n=5). Genetic data are collected by nine registries, with the majority of these (n=7) offering indefinite storage in a biorepository.ConclusionsMany CA registries exist globally, although with inequitable population coverage. Comprehensive multisource surveillance SCD registries are fewer in number and more challenging to design and maintain. Challenges identified include maximising case identification and case verification.Trial registration numberCRD42019118910.

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Prehospital Predictors of Initial Shockable Rhythm in Out-of-Hospital Cardiac Arrest

Cited by 20 publications

References 37 publications

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome

Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage

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