Pulseless electrical activity in in-hospital cardiac arrest – A crossroad for decisions

Norvik, Anders; Unneland, Eirik; Bergum, Daniel; Buckler, David G; Bhardwaj, Abhishek; Eftestøl, Trygve; Aramendi, Elisabete; Nordseth, Trond; Abella, Benjamin S.; Kvaløy, Jan Terje; Skogvoll, Eirik

doi:10.1016/j.resuscitation.2022.04.024

Cited by 13 publications

(5 citation statements)

References 24 publications

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“…An analysis of more than 700 episodes of pulseless electrical activity during CPR for patients with in-hospital cardiac arrest showed that it was the primary rhythm in around 60% ( n = 423) of their included episodes ( 38 ). ROSC was recorded in over half of these episodes, with initial pulseless electrical activity ( n = 230).…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study

Fuchs,

Franzmeier,

Cheseaux-Carrupt

et al. 2023

Front. Med.

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IntroductionLittle is known about intraoperative cardiac arrest during anesthesia care. In particular, data on characteristics of cardiac arrest and neurological survival are scarce.MethodsWe conducted a single-center retrospective observational study evaluating anesthetic procedures from January 2015 until December 2021. We included patients with an intraoperative cardiac arrest and excluded cardiac arrest outside of the operating room. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes were sustained ROSC over 20 min, 30-day survival, and favorable neurological outcome according to Clinical Performance Category (CPC) 1 and 2.ResultsWe screened 228,712 anesthetic procedures, 195 of which met inclusion criteria and were analyzed. The incidence of intraoperative cardiac arrest was 90 (CI 95% 78–103) in 100,000 procedures. The median age was 70.5 [60.0; 79.4] years, and two-thirds of patients (n = 135; 69.2%) were male. Most of these patients with cardiac arrest had ASA physical status IV (n = 83; 42.6%) or V (n = 47; 24.1%). Cardiac arrest occurred more frequently (n = 104; 53.1%) during emergency procedures than elective ones (n = 92; 46.9%). Initial rhythm was pre-dominantly non-shockable with pulseless electrical activity mostly. Most patients (n = 163/195, 83.6%; CI 95 77.6–88.5%) had at least one instance of ROSC. Sustained ROSC over 20 min was achieved in most patients with ROSC (n = 147/163; 90.2%). Of the 163 patients with ROSC, 111 (68.1%, CI 95 60.4–75.2%) remained alive after 30 days, and most (n = 90/111; 84.9%) had favorable neurological survival (CPC 1 and 2).ConclusionIntraoperative cardiac arrest is rare but is more likely in older patients, patients with ASA physical status ≥IV, cardiac and vascular surgery, and emergency procedures. Patients often present with pulseless electrical activity as the initial rhythm. ROSC can be achieved in most patients. Over half of the patients are alive after 30 days, most with favorable neurological outcomes, if treated immediately.

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Section: Discussionmentioning

confidence: 99%

“…In our cohort, 30-day survival was higher than reported by Stankovic et al ( 39 ) and significantly higher than reported in the registry analysis ( 22 ). Unfortunately, all studies ( 22 , 38 , 39 ) did not report the neurological outcome of the patients.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study

Fuchs,

Franzmeier,

Cheseaux-Carrupt

et al. 2023

Front. Med.

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“…A greater understanding of rhythm transitions during cardiac arrest could help improve outcomes. A study of 700 IHCA defibrillator downloads in 642 patients from three hospitals identified that the initial rhythm was PEA in 60%, asystole in 18% and VF/pVT in 22% [30]. In addition, PEA was the most commonly observed rhythm during a resuscitation attempt (85% of attempts) and preceded 75% of cases of ROSC.…”

Section: Improving Outcomesmentioning

confidence: 99%

In-hospital cardiac arrest

Soar

2023

Current Opinion in Critical Care

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Purpose of reviewTo describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.Recent findingsImproving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are disparities in care based on patient sex, ethnicity and socioeconomic status that need to be tackled. The increased use of emergency treatment plans that include do-not attempt cardiopulmonary resuscitation recommendations will help to decrease the number of resuscitation attempts. System approaches and strong local leadership through resuscitation champions can improve patient outcomes.SummaryIn-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.

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“…PEA is increasingly and particularly prevalent in both in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest. 11 , 12 Recent research from our research group at NTNU 13 , 14 shows that PEA behaves very differently in terms of developing ROSC, depending on the preceding rhythm (primary, or secondary to temporary ROSC, ventricular fibrillation (VF), ventricular tachycardia (VT), or asystole). Thus, incorrect decisions about the presence or absence of a carotid pulse, both initially and when evaluating the response to treatment, may deprive the patient of an individualized approach.…”

Section: Introductionmentioning

confidence: 99%

Hands-free continuous carotid Doppler ultrasound for detection of the pulse during cardiac arrest in a porcine model

et al. 2023

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Pulseless electrical activity in in-hospital cardiac arrest – A crossroad for decisions

Cited by 13 publications

References 24 publications

Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study

Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study

In-hospital cardiac arrest

Hands-free continuous carotid Doppler ultrasound for detection of the pulse during cardiac arrest in a porcine model

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