Understanding Etiologies of Cardiac Arrest: Seeking Definitional Clarity

Elfassy, Michael D; Randhawa, Varinder K.; Allan, Katherine S.; Dorian, Paul

doi:10.1016/j.cjca.2022.08.005

Cited by 9 publications

(3 citation statements)

References 14 publications

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“…Universal OHCA guidelines could assist in decision making during the initial post-resuscitation period (21), addressing common questions that could include whether or not to proceed with a head CT, active temperature management, or whether all of these patients require coronary angiography.…”

Section: Discussionmentioning

confidence: 99%

Out of Hospital Cardiac Arrest - New Insights and a Call for a Worldwide Registry and Guidelines

Tabi,

Perel,

Taha

et al. 2024

Preprint

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Introduction: Out of hospital cardiac arrest (OHCA) is a common, catastrophic event. Genetic diseases and primary electrical disorders are the most common etiologies at younger ages, while ischemic heart disease and cardiomyopathies are common causes at older ages. Despite improvement in prevention and treatment in recent years, OHCA is still a major cause of cardiovascular death. Method We report prospective data regarding etiology, characteristics, clinical course, and outcomes of patients with OHCA who were admitted to a tertiary care center intensive cardiac care unit (ICCU) between 2020–2023. Results A total of 92 patients admitted after OHCA were included in the cohort. Mean age was 63.8 ± 13.8 years old and 75 (82%) were male. The most common etiology of OHCA was acute coronary syndrome (ACS) in 54 (59%) patients, of whom 46 (85%) patients had ST elevation myocardial infarction and 8 (15%) had non-ST elevation myocardial infarction. During hospitalization, 42 (46%) patients underwent targeted temperature management and 13 (14%) received mechanical circulatory support. Interestingly, 77 (84%) patients underwent coronary angiography, while only 51 (55%) received percutaneous coronary intervention (PCI). Neurologic status was favorable in 49 (53%) patients with Cerebral Performance Category score of 1–2. Overall, mortality rates were relatively low, with 15 (16%) in-hospital deaths and 24 (26%) deaths at 30-day follow-up. Conclusion Although ACS was the most common etiology for OHCA, only 55% of patients underwent PCI. Most OHCA patients admitted to the ICCU survived hospitalization and were discharged. Increased awareness, public education, worldwide registries, and specific guidelines for the treatment of OHCA patients may lead to improved outcomes for these patients who often carry poor prognoses. A worldwide database may help to better understand and treat these patients.

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Section: Discussionmentioning

confidence: 99%

Out of Hospital Cardiac Arrest - New Insights and a Call for a Worldwide Registry and Guidelines

Tabi,

Perel,

Taha

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Thus, decisions to perform CT scans should be based on a careful consideration of the associated benefits and risks. The rationale for performing CT scans after CPR has always been to determine the causes of cardiac arrest or identify CPR-related injuries ( 2 , 10 , 11 ). However, the risks are greater after ECPR than after CPR, partly because, in the former case, the hemodynamic state is characteristically more unstable and disconnection of an ECMO catheter can be catastrophic.…”

Section: Discussionmentioning

confidence: 99%

Early computed tomography after extracorporeal cardiopulmonary resuscitation on in-hospital survival: a retrospective cohort study

Tong¹,

Chen²,

Hu³

et al. 2023

J Thorac Dis

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Background: The role of computed tomography (CT) scans after extracorporeal membrane oxygenation (ECMO) implantation in patients with refractory cardiac arrest has not been frequently investigated. Early CT scan findings may have many meaningful findings and contribute significantly to patients' outcome. In this study, we sought to determine whether early CT scans in such patients indirectly improved in-hospital survival.Methods: A computerized search of the electronic medical records systems of 2 ECMO centers was conducted. A total of 132 patients who had undergone extracorporeal cardiopulmonary resuscitation (ECPR) between September 2014 and January 2022 were included in the analysis. The patients were divided into 2 groups based on whether they underwent early CT scans (the treatment group) or did not undergo early CT scans (the control group). The findings of early CT scans and in-hospital survival were investigated.Results: A total of 132 patients had undergone ECPR with 71 were male, 61were female and mean age: 48.0±14.3 years. Early CT scans did not improve patient's in-hospital survival [hazard ratio (HR): 0.705; P=0.357]. Overall, a smaller proportion of patients survived in the treatment group (22.5%) than the control group (42.6%; P=0.013). In total, 90 patients were matched in terms of age, initial shockable rhythm, Sequential Organ Failure Assessment (SOFA) score, cardiopulmonary resuscitation (CPR) duration, ECMO duration, percutaneous coronary intervention, and cardiac arrest location. In the matched cohort, fewer patients survived in the treatment group (28.9%) than the control group (37.8%; P=0.371), but the difference was not significant. According to a log-rank test, in-hospital survival did not differ significantly before and after matching (P=0.69, and P=0.63, respectively). Thirteen patients (18.3%) had complications during transportation, among which a drop in blood pressure was the most common. Conclusions:The in-hospital survival rate between treatment and control group was not different, however, early CT scan after ECPR could help clinicians to gain important information to guide clinical practice.

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“…Indeed, time-based systems to classify "sudden" death, along with the subjectiveness of the "presumed" cardiac origin have been highlighted as major sources of heterogenity between studies. 5 Moreover, because events are infrequent, large national or multinational studies are needed to collect sufficient SCD / SCA events and yield reliable conclusions. Very large studies require complex logistics, which quite often result in a substantial heterogeneity of data collection and clinical management of patients.…”

Section: Monitoring Sports-related Sudden Cardiac Death Over Time: Is...mentioning

confidence: 99%

Something is moving in sports-related sudden cardiac death … is it time to change our minds?

Guasch

Mont

2023

EP Europace

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Understanding Etiologies of Cardiac Arrest: Seeking Definitional Clarity

Cited by 9 publications

References 14 publications

Out of Hospital Cardiac Arrest - New Insights and a Call for a Worldwide Registry and Guidelines

Out of Hospital Cardiac Arrest - New Insights and a Call for a Worldwide Registry and Guidelines

Early computed tomography after extracorporeal cardiopulmonary resuscitation on in-hospital survival: a retrospective cohort study

Something is moving in sports-related sudden cardiac death … is it time to change our minds?

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