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Sample records for witness cardiac arrest

  1. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

  2. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian

    2003-01-01

    -four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...... for medical assistance. Perceiving jeopardy had positive influence on the behaviour. Awareness of therapeutic options influences the decision-making process....

  3. Cardiac arrest

    Science.gov (United States)

    ... also run other tests, depending on your health history and the results of these tests. Treatment Cardiac arrest needs emergency treatment right away to get the heart started again. Cardiopulmonary resuscitation (CPR) . This is often the first type of ...

  4. Sudden Cardiac Arrest (SCA)

    Science.gov (United States)

    ... Arrest (SCA) Back to Heart Diseases & Disorders Sudden Cardiac Arrest (SCA) Sudden Cardiac Arrest ( SCA ) occurs when the heart stops beating, abruptly ... to saving someone who is having a sudden cardiac arrest , it is important to understand the difference. The ...

  5. A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2008-11-01

    Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

  6. Impedance Threshold Device Combined With High-Quality Cardiopulmonary Resuscitation Improves Survival With Favorable Neurological Function After Witnessed Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Sugiyama, Atsushi; Duval, Sue; Nakamura, Yuji; Yoshihara, Katsunori; Yannopoulos, Demetris

    2016-09-23

    The quality of cardiopulmonary resuscitation (CPR) has been recently shown to affect clinical outcome. The Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) trial showed no differences in outcomes with an active vs. sham impedance threshold device (ITD), a CPR adjunct that enhances circulation. It was hypothesized the active ITD would improve survival with favorable neurological outcomes in witnessed out-of-hospital cardiac arrest patients when used with high-quality CPR. Using the publicly accessible ROC PRIMED database, a post-hoc analysis was performed on all witnessed subjects with both compression rate and depth data (n=1,808) who received CPR within the study protocol definition of adequate CPR quality (compression rate 80-120/min and depth 4-6 cm; n=929). Demographics were similar between sham and active ITD groups. In witnessed subjects who received quality CPR, survival with favorable neurological function was 11.9% for the active ITD subjects (56/470) vs. 7.4% for the sham (34/459) (odds ratio 1.69 [95% confidence interval 1.08, 2.64]). There were no statistically significant differences for this primary outcome when CPR was performed outside the boundaries of the definition of adequate CPR quality. Multivariable models did not change these associations. An active ITD combined with adequate-quality conventional CPR has the potential to significantly improve survival after witnessed cardiac arrest. (Circ J 2016; 80: 2124-2132).

  7. Prearrest signs of shock and respiratory insufficiency in out-of-hospital cardiac arrests witnessed by crew of the emergency medical service.

    Science.gov (United States)

    Skrifvars, Markus B; Boyd, James; Kuisma, Markku

    2009-05-01

    The objective of this study is to determine whether prearrest shock and respiratory insufficiency influence outcome in patients with emergency medical service-witnessed out-of-hospital cardiac arrest. Analysis of data from a cardiac arrest database and data from the ambulance charts was performed. For the purpose of the study, shock was defined as prearrest heart rate below 40 or above 140/min, systolic blood pressure as below 90 mm Hg, and respiratory insufficiency as respiratory rate above 36 or oxygen saturation below 90%. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Of a total of 303 patients, 81% had prearrest shock or respiratory insufficiency. Mortality was higher in these patients indicated by fewer with return of spontaneous circulation (43% vs 75%, P respiratory insufficiency (OR, 4.2; CI, 1.4-12.5). Shock and respiratory depression are common among patients with out-of-hospital cardiac arrest witnessed by the emergency medical service, and these patients have a high mortality when compared with patients without shock or respiratory failure.

  8. About Cardiac Arrest

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More About Cardiac Arrest Updated:Mar 10,2017 What is cardiac arrest? ... and procedures related to heart disease and stroke. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  9. What Causes Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  10. What Is Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  11. Incidence and Characteristics of Ventricular Fibrillation in Bystander-witnessed Out-of-hospital Cardiac Arrest with Cardiac Etiology in the City of Sendai, Japan

    Directory of Open Access Journals (Sweden)

    Jun Watanabe, MD

    2005-01-01

    Methods and results: We analyzed Utstein-style data in Sendai City (population 1,020,000, Japan from January 2002 to March 2004. The incidence of OHCA overall was 62.3/100,000/year. The incidence of the bystander-witnessed VF was 2.5/100,000/year. In younger patients (20–65 years of age, the percentage of VF was 52% when cardiac origin was presumed by bystander witness, and ECG was recorded within 10 minutes from the collapse. In older patients (over 65 years of age, however, the percentage of VF was 21% when they were bystander-witnessed, and ECG was recorded within 10 minutes from the collapse. No VF was reported when the ECG was recorded more than 15 minutes after the collapse. The thirty-day survival rate was 21% in the bystander-witnessed VF cases with cardiac etiology, but 0% in the non-VF cases. The bystander CPR was significantly associated with improved 30-day survival rate. Conclusion: Younger age, male gender, and shorter collapse-to-ECG time are significantly associated with the appearance of VF in bystander-witnessed OHCA with cardiac etiology. Bystander CPR was significantly associated with the improvement in prognosis of those VF patients.

  12. An airline cardiac arrest program.

    Science.gov (United States)

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-11-04

    As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study was to assess the impact of making semiautomatic external defibrillators (AEDs) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation. Supervision was provided by medical volunteers or (remotely) by airline physicians. During a 64-month period, AEDs were used on 109 occasions: 63 times for monitoring an acutely ill passenger and 46 times for cardiac arrest. Twenty-seven episodes of cardiac arrest occurred in aircraft, often (11 of 27 [41%]) unwitnessed, and they were usually (21 of 27 [78%]) associated with asystole or pulseless idioventricular rhythm. All 19 arrests in terminals were witnessed; VF was present in 17 (89%). Overall, defibrillation was initially successful in 21 of 23 cases (91%). Long-term survival from VF was achieved in 26% (2 of 6 in aircraft and 4 of 17 in terminals). The ability to monitor cardiac rhythm aided decisions on diversion, which was avoided in most passengers with asystole or idioventricular rhythm. AEDs in aircraft and terminals, with appropriate crew training, are helpful in the management of cardiac emergencies. Survival from VF is practicable and is comparable with the most effective prehospital ambulance emergency services. Costly aircraft diversions can be avoided in clearly futile situations, enhancing the cost-effectiveness of the program.

  13. How Is Sudden Cardiac Arrest Treated?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  14. How Is Sudden Cardiac Arrest Diagnosed?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  15. Survival rate and factors associated with 1-month survival of witnessed out-of-hospital cardiac arrest of cardiac origin with ventricular fibrillation and pulseless ventricular tachycardia: the Utstein Osaka project.

    Science.gov (United States)

    Nishiuchi, Tatsuya; Hayashino, Yasuaki; Fukuhara, Shunichi; Iwami, Taku; Hayashi, Yasuyuki; Hiraide, Atsushi; Ikeuchi, Hisashi; Yukioka, Hidekazu; Matsuoka, Tetsuya

    2008-09-01

    We reassessed 1-month survival of patients with witnessed out-of-hospital cardiac arrest (OHCA) of cardiac origin with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in Osaka, Japan, and identified factors associated with 1-month survival using updated data from 1998 to 2004 collected based on the Utstein Style. Using the Utstein Osaka Project database, we analyzed 1028 cases which met the following criteria: (1) patient age 18 years or older; (2) presumed cardiac origin based on the definition of the Utstein Style; (3) witnessed by citizens; (4) VF or pulseless VT at the time of arrival of the ambulance. The main outcome measure was survival at 1 month after collapse. Variables to develop a predictive model for 1-month survival were selected by stepwise logistic regression. Survival at 1 month was 19.6%. Factors retained in the final logistic regression were age, sex, type of witness, and time interval from (a) ambulance call receipt to cardiopulmonary resuscitation (CPR) by the ambulance crew; (b) ambulance call to defibrillation; (c) CPR by the ambulance crew to hospital arrival. Area under the receiver-operating characteristic curve for the model developed with the six variables was 0.738 and Hosmer-Lemshow goodness-of-fit p-value was 0.94. We successfully developed a model to estimate the probability of 1-month survival using variables easy to collect in the early phase of resuscitation, and this model would help physicians and family members predict the likelihood of 1-month survival of OHCA patients on admission.

  16. Cardiac Arrest: MedlinePlus Health Topic

    Science.gov (United States)

    ... and Blood Institute Start Here About Cardiac Arrest (American Heart Association) Sudden Cardiac Arrest (Texas Heart Institute) Also in ... Blood Institute) Understand Your Risk for Cardiac Arrest (American Heart Association) Warning Signs of Heart Attack, Stroke and Cardiac ...

  17. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  18. Registry of Unexplained Cardiac Arrest

    Science.gov (United States)

    2016-05-16

    Cardiac Arrest; Long QT Syndrome; Brugada Syndrome; Catecholaminergi Polymorphic Ventricular Tachycardia; Idiopathic VentricularFibrillation; Early Repolarization Syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy

  19. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  20. Understand Your Risk for Cardiac Arrest

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More Understand Your Risk for Cardiac Arrest Updated:Mar 10,2017 Cardiac arrest may be ... arrest. This content was last reviewed March 2017. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  1. ECPR for Refractory Out-Of-Hospital Cardiac Arrest

    Science.gov (United States)

    2017-05-17

    Cardiac Arrest; Heart Arrest; Sudden Cardiac Arrest; Cardiopulmonary Arrest; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; CPR; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation

  2. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  3. An airline cardiac arrest program

    National Research Council Canada - National Science Library

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-01-01

    ...) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation...

  4. Who Is at Risk for Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  5. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  6. Sudden Cardiac Arrest (SCA) Risk Assessment

    Science.gov (United States)

    ... Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without warning, and two- ... and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool is supported in part ...

  7. When is a Cardiac Arrest Non-Cardiac?

    Science.gov (United States)

    Carter, Ryan M; Cone, David C

    2017-10-01

    Introduction While the overall survival rate for out-of-hospital cardiac arrest (OHCA) is low, ranging from 5%-10%, several characteristics have been shown to decrease mortality, such as presence of bystander cardiopulmonary resuscitation (CPR), witnessed vs unwitnessed events, and favorable initial rhythm (VF/VT). More recently, studies have shown that modified CPR algorithms, such as chest-compression only or cardio-cerebral resuscitation, can further increase survival rates in OHCA. Most of these studies have included only OHCA patients with "presumed cardiac etiology," on the assumption that airway management is of lesser impact than chest compressions in these patients. However, prehospital personnel often lack objective and consistent criteria to assess whether an OHCA is of cardiac or non-cardiac etiology. Hypothesis/Problem The relative proportions of cardiac vs non-cardiac etiology in published data sets of OHCA in the peer-reviewed literature were examined in order to assess the variability of prehospital clinical etiology assessment. A Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA) search was performed using the subject headings "OHCA" and "Emergency Medical Services" (EMS). Studies were included if they reported prevalence of cardiac etiology among OHCA in the entire patient sample, or in all arms of a comparison study. Studies that either did not report etiology of OHCA, or that excluded all cardiac or non-cardiac etiologies prior to reporting clinical data, were excluded. Twenty-four studies were identified, containing 27 datasets of OHCA which reported the prevalence of presumed cardiac vs non-cardiac etiology. These 27 datasets were drawn from 15 different countries. The prevalence of cardiac etiology among OHCA ranged from 50% to 91%. No obvious patterns were found regarding database size, year of publication, or global region (continent) of origin. There exists significant variation in published

  8. Cardiac arrest: resuscitation and reperfusion.

    Science.gov (United States)

    Patil, Kaustubha D; Halperin, Henry R; Becker, Lance B

    2015-06-05

    The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and

  9. Cardiac arrest due to lymphocytic colitis: a case report

    Directory of Open Access Journals (Sweden)

    Groth Kristian A

    2012-03-01

    Full Text Available Abstract Introduction We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis. Case presentation A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L and pH 6.86 (reference range: pH 7.37 to 7.45. As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest. Conclusion Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.

  10. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K.; Folke, Fredrik

    2013-01-01

    IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine...... temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which...... resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n...

  11. Out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Sondergaard, Kathrine B; Hansen, Steen Moller; Pallisgaard, Jannik L

    2018-01-01

    : We used data from the nationwide Danish Cardiac Arrest Registry and the Danish AED Network to identify out-of-hospital cardiac arrests and route distances to nearest accessible registered AED during 2008-2013. The association between route distance and bystander defibrillation was described using...... restricted cubic spline logistic regression. RESULTS: We included 6,971 out-of-hospital cardiac arrest cases. The proportion of arrests according to distance in meters (≤100, 101-200, >200) to the nearest accessible AED was: 4.6% (n=320), 5.3% (n=370), and 90.1% (n=6,281), respectively. For cardiac arrests......meters route distance from cardiac arrest to nearest accessible AED whereas the probability of bystander defibrillation was low for all distances in residential areas....

  12. Exercise-related cardiac cardiac rehabilitation arrest In

    African Journals Online (AJOL)

    most important being myocardial infarction and cardiac arrest. (CA).1,2. 'Normal' ... myocardial infarction and CA in cardiac rehabilitation pro- ..... The acute risk of. Strenuous exercise.JAMA 1980; 244: 1799-1801. 5. Siscovick DS, Weiss NS, Fletcber RH et al. The incidence of primary cardiac arrest during vigorous exercise.

  13. Myocardial Dysfunction and Shock after Cardiac Arrest

    Science.gov (United States)

    Jentzer, Jacob C.; Chonde, Meshe D.; Dezfulian, Cameron

    2015-01-01

    Postarrest myocardial dysfunction includes the development of low cardiac output or ventricular systolic or diastolic dysfunction after cardiac arrest. Impaired left ventricular systolic function is reported in nearly two-thirds of patients resuscitated after cardiac arrest. Hypotension and shock requiring vasopressor support are similarly common after cardiac arrest. Whereas shock requiring vasopressor support is consistently associated with an adverse outcome after cardiac arrest, the association between myocardial dysfunction and outcomes is less clear. Myocardial dysfunction and shock after cardiac arrest develop as the result of preexisting cardiac pathology with multiple superimposed insults from resuscitation. The pathophysiology involves cardiovascular ischemia/reperfusion injury and cardiovascular toxicity from excessive levels of inflammatory cytokine activation and catecholamines, among other contributing factors. Similar mechanisms occur in myocardial dysfunction after cardiopulmonary bypass, in sepsis, and in stress-induced cardiomyopathy. Hemodynamic stabilization after resuscitation from cardiac arrest involves restoration of preload, vasopressors to support arterial pressure, and inotropic support if needed to reverse the effects of myocardial dysfunction and improve systemic perfusion. Further research is needed to define the role of postarrest myocardial dysfunction on cardiac arrest outcomes and identify therapeutic strategies. PMID:26421284

  14. Sudden cardiac arrest risk in young athletes

    African Journals Online (AJOL)

    Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during ...

  15. Prediction of cardiac arrest recurrence using ensemble classifiers

    Indian Academy of Sciences (India)

    Inability of a heart to contract effectually or its failure to contract prevents blood from circulating efficiently, causing circulatory arrest or cardiac arrest or cardiopulmonary arrest. The unexpected cardiac arrest is medically referred to as sudden cardiac arrest (SCA). Poor survival rate of patients with SCA is one of themost ...

  16. Intra-arrest hypothermia during cardiac arrest: a systematic review

    Science.gov (United States)

    2012-01-01

    Introduction Therapeutic hypothermia is largely used to protect the brain following return of spontaneous circulation (ROSC) after cardiac arrest (CA), but it is unclear whether we should start therapeutic hypothermia earlier, that is, before ROSC. Methods We performed a systematic search of PubMed, EMBASE, CINAHL, the Cochrane Library and Ovid/Medline databases using "arrest" OR "cardiac arrest" OR "heart arrest" AND "hypothermia" OR "therapeutic hypothermia" OR "cooling" as keywords. Only studies using intra-arrest therapeutic hypothermia (IATH) were selected for this review. Three authors independently assessed the validity of included studies and extracted data regarding characteristics of the studied cohort (animal or human) and the main outcomes related to the use of IATH: Mortality, neurological status and cardiac function (particularly, rate of ROSC). Results A total of 23 animal studies (level of evidence (LOE) 5) and five human studies, including one randomized controlled trial (LOE 1), one retrospective and one prospective controlled study (LOE 3), and two prospective studies without a control group (LOE 4), were identified. IATH improved survival and neurological outcomes when compared to normothermia and/or hypothermia after ROSC. IATH was also associated with improved ROSC rates and with improved cardiac function, including better left ventricular function, and reduced myocardial infarct size, when compared to normothermia. Conclusions IATH improves survival and neurological outcome when compared to normothermia and/or conventional hypothermia in experimental models of CA. Clinical data on the efficacy of IATH remain limited. PMID:22397519

  17. Exercise-related cardiac arrest in cardiac rehabilitation - The ...

    African Journals Online (AJOL)

    ... to establish the safety of cardiac rehabilitation as a medical intervention at the Johannesburg Cardiac Rehabilitation Centre from its inception in September 1982 to July 1988, and analyses the medical status of patients who suffered a cardiac arrest (CA) in order to determine possible factors predictive of sudden death.

  18. Cardiac arrest leadership: in need of resuscitation?

    Science.gov (United States)

    Robinson, Philip S; Shall, Emma; Rakhit, Roby

    2016-12-01

    Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Association between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival

    Science.gov (United States)

    Chen, Lena M.; Nallamothu, Brahmajee K.; Spertus, John A.; Li, Yan; Chan, Paul S.

    2014-01-01

    Context National efforts to measure hospital performance for cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. Objective To describe the association between inpatient cardiac arrest incidence and survival rates. Design, Setting, and Patients Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000 and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital’s cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics. Main Outcome Measure The correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest. Results Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (IQR: 2.95 to 5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (IQR: 14.5% to 22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (correlation of -0.16; P=0.003). This relationship persisted after adjusting for patient characteristics (correlation of -0.15; P=0.004). After adjusting for potential mediators of this relationship (i.e., hospital characteristics), the relationship between incidence and case-survival was attenuated (correlation of -0.07; P=0.18). The one modifiable hospital factor that most attenuated this relationship was a hospital’s nurse-to-bed ratio (correlation of -0.12; P=0.03). Conclusions Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case-mix. This relationship is partially mediated by measured hospital attributes

  20. Use of Automated External Defibrillators in Cardiac Arrest

    Science.gov (United States)

    2005-01-01

    Executive Summary Objective The objectives were to identify the components of a program to deliver early defibrillation that optimizes the effectiveness of automated external defibrillators (AEDs) in out-of-hospital and hospital settings, to determine whether AEDs are cost-effective, and if cost-effectiveness was determined, to advise on how they should be distributed in Ontario. Clinical Need Survival in people who have had a cardiac arrest is low, especially in out-of-hospital settings. With each minute delay in defibrillation from the onset of cardiac arrest, the probability of survival decreases by 10%. (1) Early defibrillation (within 8 minutes of a cardiac arrest) has been shown to improve survival outcomes in these patients. However, in out-of-hospital settings and in certain areas within a hospital, trained personnel and their equipment may not be available within 8 minutes. This implies that “first responders” should take up the responsibility of delivering shock. The first responders in out-of-hospital settings are usually bystanders, firefighters, police, and community volunteers. In hospital settings, they are usually nurses. These first responders are not trained in reading electrocardiograms and identifying abnormal heart rhythms restorable by defibrillation. The Technology An AED is a device that can analyze a heart rhythm and deliver a shock if needed. Thus, AEDs can be used by first responders to deliver early defibrillation in out-of-hospital and hospital settings. However, simply providing an AED would not likely improve survival outcomes. Rather, AEDs have a role in strengthening the “chain of survival,” which includes prompt activation of the 911 telephone system, early cardiopulmonary resuscitation (CPR), rapid defibrillation, and timely advanced life support. In the chain of survival, the first step for a witness of a cardiac arrest in an out-of-hospital setting is to call 911. Second, the witness initiates CPR (if she or he is

  1. Warning Signs of Heart Attack, Stroke and Cardiac Arrest

    Science.gov (United States)

    ... Heart Attack WARNING SIGNS OF HEART ATTACK, STROKE & CARDIAC ARREST HEART ATTACK WARNING SIGNS CHEST DISCOMFORT Most heart ... to the hospital immediately. Learn more about stroke CARDIAC ARREST WARNING SIGNS SUDDEN LOSS OF RESPONSIVENESS No response ...

  2. Heart Attack or Sudden Cardiac Arrest: How Are They Different?

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More Heart Attack or Sudden Cardiac Arrest: How Are They Different? Updated:Sep 19,2016 ... flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops ...

  3. Community involvement in out of hospital cardiac arrest

    Science.gov (United States)

    Shams, Ali; Raad, Mohamad; Chams, Nour; Chams, Sana; Bachir, Rana; El Sayed, Mazen J.

    2016-01-01

    Abstract Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival. This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR. A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR. A total of 948 students completed the survey. Participants’ mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR. University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of

  4. An Audit Of Perioperative Cardiac Arrest At Lagos University ...

    African Journals Online (AJOL)

    Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests ...

  5. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt-Johansen, Ida Maria; Norsted, Kristine; Schmidt, Henrik

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors...... circulation (ROSC).ResultsThe overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC¿... rhythm of VT/VF and a cardiac etiology were the strongest....

  6. Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.

    Science.gov (United States)

    Adnet, Frederic; Triba, Mohamed N; Borron, Stephen W; Lapostolle, Frederic; Hubert, Hervé; Gueugniaud, Pierre-Yves; Escutnaire, Josephine; Guenin, Aurelien; Hoogvorst, Astrid; Marbeuf-Gueye, Carol; Reuter, Paul-Georges; Javaud, Nicolas; Vicaut, Eric; Chevret, Sylvie

    2017-02-01

    Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA. We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation. For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (pCPR duration in OHCA patients. The knowledge of (NF, LF) curves as function of age, initial rhythm, location of cardiac arrest or gender may aid in decision-making vis-à-vis the termination of CPR or employment of advanced techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. An association between snowfall and ED presentation of cardiac arrest.

    Science.gov (United States)

    Spitalnic, S J; Jagminas, L; Cox, J

    1996-10-01

    Studies from several cities have reported increased cardiovascular mortality associated with snowfall; whether this weather also results in increased emergency department (ED) presentation of cardiac arrests is not known. A retrospective review was conducted of cardiac arrest patients presenting to a New England ED during the months of October through May, from 1991 to 1994. Comparing daily frequency of cardiac arrest patients with climactic data, a 27% increase was observed in the frequency of cardiac arrest presentation to the ED on days with snowfall (P = .0004). ED physicians and staff should anticipate an increased frequency of cardiac arrest patients on days with snowfall.

  8. The Association Between Arterial Oxygen Tension and Neurological Outcome After Cardiac Arrest.

    Science.gov (United States)

    Johnson, Nicholas J; Dodampahala, Kalani; Rosselot, Babette; Perman, Sarah M; Mikkelsen, Mark E; Goyal, Munish; Gaieski, David F; Grossestreuer, Anne V

    2017-03-01

    A number of observational studies have evaluated the association between arterial oxygen tensions and outcome after cardiac arrest with variable results. The objective of this study is to determine the association between arterial oxygen tension and neurological outcome after cardiac arrest. A retrospective cohort analysis was performed using the Penn Alliance for Therapeutic Hypothermia registry. Adult patients who experienced return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest (OHCA) and had a partial pressure of arterial oxygen (PaO2) recorded within 48 hours were included. Our primary exposure of interest was PaO2. Hyperoxemia was defined as PaO2 > 300 mmHg, hypoxemia as PaO2 arrests were witnessed, and pulseless electrical activity was the most common initial rhythm (40%). More than 72% of the patients had cardiac etiology for their arrests, and 55% underwent targeted temperature management. A total of 38% of patients survived to hospital discharge. There was no significant association between PaO2 at any time interval and neurological outcome at hospital discharge. Hyperoxemia at 12 hours after cardiac arrest was associated with decreased odds of survival (OR 0.17 [0.03-0.89], p = 0.032). There was no significant association between arterial oxygen tension measured within the first 48 hours after cardiac arrest and neurological outcome.

  9. Cardiac arrest in schools: Nationwide incidence, risk, and outcome.

    Science.gov (United States)

    Hwang, Soyun; Shin, Sang Do; Lee, Kyungwon; Song, Kyoung Jun; Ahn, Ki Ok; Kim, Yu Jin; Hong, Ki Jeong; Ro, Young Sun; Lee, Eui Jung

    2017-01-01

    Schools are an important location for improving OHCA outcome. But there are few data on out of hospital cardiac arrest (OHCA) in schools. This study aimed to show incidence and outcome of OHCA in schools, specifying location and activities. We used the Korean nationwide OHCA registry from 2008 to 2014. OHCA victims were categorized regarding level of school. The average annual incidence of OHCA was calculated based on per 1000 schools. The epidemiological characteristics are analysed and location and activity at the time of arrest is further described. The outcome of OHCA victims were analysed. 511 OHCA occurred in school while 374 cases were cardiac origin, 125 cases were non-cardiac, and 12 cases were missing in information. Annual incidence was 5.72 per 1000 school while highest incidence was shown in university (11.02 per 1000 school). The majority of victims were male (84.1%), aged 19-64 (62.2%, median 44.75), either students (35.0%) or visitors (35.2%). Most victims had none shockable rhythms, did not received EMS defibrillation and were not witnessed arrests, while most received bystander CPR. A large proportion of arrests occurred at an outdoor campus (29.7%) or sports facility (28.8%), and the most frequent activity was exercise (30.7%). 100 patients (19.6%) survived to discharge, and 66 patients (12.9%) were discharged with good neurological outcome. Incidence of OHCA in school is low. Most of victims were adult visitors. About one third of OHCA occurred during sports activity or at the sports facility. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten...... in patient survival following out-of hospital cardiac arrest; utilizing the Danish nationwide registries, we sought to answer these questions. Moreover, in order to further improve understanding and target future national strategies for cardiac arrest management, we examined whether there were sex- and age...

  11. Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge.

    Science.gov (United States)

    Donoghue, Aaron J; Nadkarni, Vinay; Berg, Robert A; Osmond, Martin H; Wells, George; Nesbitt, Lisa; Stiell, Ian G

    2005-12-01

    We systematically summarize pediatric out-of-hospital cardiac arrest epidemiology and assess knowledge of effects of specific out-of-hospital interventions. We conducted a comprehensive review of published articles from 1966 to 2004, available through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EmBase, and the Cochrane Registry, describing outcomes of children younger than 18 years with an out-of-hospital cardiac arrest. Patient characteristics, process of care, and outcomes were compared using pediatric Utstein outcome report guidelines. Effects of out-of-hospital care processes on survival outcomes were summarized. Forty-one studies met inclusion criteria; 8 complied with Utstein reporting guidelines. Included in the review were 5,363 patients: 12.1% survived to hospital discharge, and 4% survived neurologically intact. Trauma patients (n=2,299) had greater overall survival (21.9%, 6.8% intact); a separate examination of studies with more rigorous cardiac arrest definition showed poorer survival (1.1% overall, 0.3% neurologically intact). Submersion injury-associated arrests (n=442) had greater overall survival (22.7%, 6% intact). Pooled data analysis of bystander cardiopulmonary resuscitation and witnessed arrest status showed increased likelihood of survival (relative risk 1.99, 95% confidence interval 1.54 to 2.57) for witnessed arrests. The effect of bystander cardiopulmonary resuscitation is difficult to determine because of study heterogeneity. Outcomes from out-of-hospital pediatric cardiac arrest are generally poor. Variability may exist in survival by patient subgroups, but differences are hard to accurately characterize. Conformity with Utstein guidelines for reporting and research design is incomplete. Witnessed arrest status remains associated with improved survival. The need for prospective controlled trials remains a high priority.

  12. Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan.

    Science.gov (United States)

    Kitamura, Tetsuhisa; Kiyohara, Kosuke; Sakai, Tomohiko; Matsuyama, Tasuku; Hatakeyama, Toshihiro; Shimamoto, Tomonari; Izawa, Junichi; Fujii, Tomoko; Nishiyama, Chika; Kawamura, Takashi; Iwami, Taku

    2016-10-27

    Early defibrillation plays a key role in improving survival in patients with out-of-hospital cardiac arrests due to ventricular fibrillation (ventricular-fibrillation cardiac arrests), and the use of publicly accessible automated external defibrillators (AEDs) can help to reduce the time to defibrillation for such patients. However, the effect of dissemination of public-access AEDs for ventricular-fibrillation cardiac arrest at the population level has not been extensively investigated. From a nationwide, prospective, population-based registry of patients with out-of-hospital cardiac arrest in Japan, we identified patients from 2005 through 2013 with bystander-witnessed ventricular-fibrillation arrests of presumed cardiac origin in whom resuscitation was attempted. The primary outcome measure was survival at 1 month with a favorable neurologic outcome (Cerebral Performance Category of 1 or 2, on a scale from 1 [good cerebral performance] to 5 [death or brain death]). The number of patients in whom survival with a favorable neurologic outcome was attributable to public-access defibrillation was estimated. Of 43,762 patients with bystander-witnessed ventricular-fibrillation arrests of cardiac origin, 4499 (10.3%) received public-access defibrillation. The percentage of patients receiving public-access defibrillation increased from 1.1% in 2005 to 16.5% in 2013 (PThe percentage of patients who were alive at 1 month with a favorable neurologic outcome was significantly higher with public-access defibrillation than without public-access defibrillation (38.5% vs. 18.2%; adjusted odds ratio after propensity-score matching, 1.99; 95% confidence interval, 1.80 to 2.19). The estimated number of survivors in whom survival with a favorable neurologic outcome was attributed to public-access defibrillation increased from 6 in 2005 to 201 in 2013 (Pbystanders was associated with an increase in the number of survivors with a favorable neurologic outcome after out

  13. Three year longitudinal study for out-of-hospital cardiac arrest in Osaka Prefecture.

    Science.gov (United States)

    Hayashi, Yasuyuki; Hiraide, Atsushi; Morita, Hiroshi; Shinya, Hiroshi; Nishiuchi, Tatsuya; Yukioka, Hidekazu; Ikeuchi, Hisashi; Matsusaka, Masanori; Shigemoto, Tatsuhiko; Ueshima, Toshifumi; Iwami, Taku; Kai, Tatsuro; Fujii, Chiiho

    2004-11-01

    To analyze the longitudinal changes in the treatment of out-of-hospital cardiac arrests. These analyses have focused on the time interval from the receipt of call until defibrillation of patients with ventricular fibrillation. Population-based, prospective longitudinal study according to the Utstein style. Osaka Prefecture (population 8, 800, 000), served by 36 municipal fire and emergency departments. Consecutive, out-of-hospital cardiac arrests occurring between May 1998 and April 2001. Change in the interval to defibrillation, and one-year survival from cardiac arrest. Of the 15,211 cases of confirmed cardiac arrests during the three years, resuscitation was attempted in 14,609 subjects. Of the 2957 cases of cardiac origin and witnessed by bystanders, 90 cases (3.0%) were alive 1 year following the episode. In 383 cases of defibrillation, the interval from receipt of call to defibrillation was evaluated annually. This interval decreased significantly during the three year course (14.5, 13.0, and 11.5 min expressed by the median), suggesting that this project to report the data of out-of-hospital arrests was an effective campaign for EMT. However, the outcome did not improve significantly during this period (3.0%, 2.6%, and 3.6% alive 1 year in witnessed arrests with cardiac etiology). This may be because the third year median duration of 11.5 min, is still insufficient to indicate a significant improvement in the outcome. This project to report the data of out-of-hospital cardiac arrest might have contributed to the reduction of the interval for defibrillation, as a campaign for the EMTs; although the decrease in this interval was still insufficient to result in a significant increase in the number of cases who are alive one year later.

  14. Interrater variability of EEG interpretation in comatose cardiac arrest patients

    DEFF Research Database (Denmark)

    Westhall, Erik; Rosén, Ingmar; Rossetti, Andrea O

    2015-01-01

    of cardiac arrest patients included in the Target Temperature Management trial. The main objective was to evaluate if malignant EEG-patterns could reliably be identified. METHODS: Full-length EEGs from 103 comatose cardiac arrest patients were interpreted by four EEG-specialists with different nationalities...... in an international context with high reliability. SIGNIFICANCE: The establishment of strict criteria with high transferability between interpreters will increase the usefulness of routine EEG to assess neurological prognosis after cardiac arrest....

  15. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars

    2013-01-01

    the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...

  16. A case of thyroid storm with cardiac arrest

    Directory of Open Access Journals (Sweden)

    Nakashima Y

    2014-05-01

    Full Text Available Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

  17. Cardiac arrest during anesthesia at a University Hospital in Nigeria ...

    African Journals Online (AJOL)

    Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably.

  18. Cooling the crisis: Therapeutic hypothermia after sickle cardiac arrest

    NARCIS (Netherlands)

    Metske, Hennie A.; Postema, Pieter G.; Biemond, Bart J.; Bouman, Catherine S. C.

    2012-01-01

    Objective: The management of patients with sickle-cell disease and cardiac arrest presents special challenges. Mild therapeutic hypothermia may improve survival and neurologic outcome after cardiac arrest, however, it may also precipitate sickling in patients with sickle-cell disease. Rigorous

  19. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  20. Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Bistra Iordanova

    2017-08-01

    Full Text Available Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.

  1. Cardiac arrest during anesthesia at a University Hospital in Nigeria

    African Journals Online (AJOL)

    2013-03-07

    Mar 7, 2013 ... Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased ...

  2. Epidemiology and Outcomes After In-Hospital Cardiac Arrest After Pediatric Cardiac Surgery

    Science.gov (United States)

    Gupta, Punkaj; Jacobs, Jeffrey P.; Pasquali, Sara K.; Hill, Kevin D.; Gaynor, J. William; O’Brien, Sean M.; He, Max; Sheng, Shubin; Schexnayder, Stephen M.; Berg, Robert A.; Nadkarni, Vinay M.; Imamura, Michiaki; Jacobs, Marshall L.

    2014-01-01

    Background Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort. Methods Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors. Results Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations. Conclusions Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted. PMID:25443018

  3. Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Nagao, Ken; Nonogi, Hiroshi; Yonemoto, Naohiro; Gaieski, David F; Ito, Noritoshi; Takayama, Morimasa; Shirai, Shinichi; Furuya, Singo; Tani, Sigemasa; Kimura, Takeshi; Saku, Keijiro

    2016-04-05

    During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation. In each of 4 groups stratified by initial cardiac arrest rhythm (shockable versus nonshockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary end point, favorable 30-day neurological outcome after out-of-hospital cardiac arrest. Prehospital resuscitation duration to achieve prehospital return of spontaneous circulation ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838-0.844). Although the frequency of favorable neurological outcome was significantly different among the 4 groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group; Pprehospital resuscitation duration did not differ widely among the 4 groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander resuscitation group). On the basis of time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with

  4. Out-of-hospital cardiac arrest in schools: A systematic review.

    Science.gov (United States)

    Smith, Christopher Matthew; Colquhoun, Michael C

    2015-11-01

    Out-of-hospital cardiac arrest (OHCA) in children and adolescents is rare, with a minority of cases occurring at school. When OHCA does occur at school it is more likely to affect an adult than a student. Developing comprehensive strategies to treat cardiac arrest occurring at schools would be helped by accurate data regarding its epidemiology. A systematic review was undertaken. An electronic search strategy of MEDLINE and EMBASE databases was devised and relevant papers reporting data on school-based OHCA incidence and/or outcome in both adults and children were identified. Further articles were obtained from the bibliographies of these papers and from related articles. Nine studies were included in the systematic review. Cardiac arrest incidence was one per 23.8-284.1 schools per year. Cardiac arrest incidence amongst students, reported in some studies, was 0.17-4.4 per 100,000 students per year. Studies also reported, although not universally, rates of witnessed OHCA (25.0-97.2%), VF (57.4-67.6%), bystander CPR (25.0-94.4%) and automated external defibrillator (AED) use (23.4-91.5%). Survival to hospital discharge or at one month was between 31.9% and 71.2%. Cardiac arrest in schools is rare, and more likely to occur in adults than children. Outcomes are better than OHCA occurring at other locations, probably due to the high proportion of witnessed arrests and high rates of bystander CPR. It is likely that school-based AEDs will rarely be needed, but have the potential to make a dramatic impact on outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Serum tau and neurological outcome in cardiac arrest

    DEFF Research Database (Denmark)

    Mattsson, Niklas; Zetterberg, Henrik; Nielsen, Niklas

    2017-01-01

    OBJECTIVE: To test serum tau as a predictor of neurological outcome after cardiac arrest. METHODS: We measured the neuronal protein tau in serum at 24, 48, and 72 h after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor...... neurological outcome, defined as Cerebral Performance Category 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median 38.5 [IQR 5.7-245] ng/L in poor versus 1.5 [0.7-2.4] ng/L in good outcome, for tau at 72 h, p... and 36°C targeted temperature after cardiac arrest. INTERPRETATION: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better than serum NSE, which is recommended in guidelines and currently used in clinical practice...

  6. Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement?

    Science.gov (United States)

    LaPar, Damien J.; Ghanta, Ravi K.; Kern, John A.; Crosby, Ivan K.; Rich, Jeffrey B.; Speir, Alan M.; Kron, Irving L.; Ailawadi, Gorav

    2016-01-01

    Background Among all postoperative complications, cardiac arrest after cardiac surgical operations has the greatest association with mortality. However, hospital variation in the ability to rescue after cardiac arrest is unknown. The purpose of this study was to characterize the impact of cardiac arrest on mortality and determine the relative impact of patient, operative, and hospital factors on failure to rescue (FTR) rates and surgical mortality after cardiac arrest. Methods A total of 79,582 patients underwent operations at 17 different hospitals (2001 through 2011), including 5.2% (n = 4,138) with postoperative cardiac arrest. Failure to rescue was defined as mortality after cardiac arrest. Patient risk, operative features, and outcomes were compared among hospitals. Results Overall FTR rate was 60% with significant variation among hospitals (range, 50% to 83%; p cardiac arrest, and FTR rates varied across hospitals and did not correlate. High-performing hospitals with lowest FTR rates accrued longer postoperative and intensive care unit stays after the index operation (2 to 3 days; p cardiac surgical mortality and FTR rates after cardiac arrest. Institutional factors appear to confer the strongest influence on the likelihood for mortality after cardiac arrest compared with patient and operative factors. Identifying best practice patterns at the highest performing centers may serve to improve surgical outcomes after cardiac arrest and improve patient quality. PMID:24820394

  7. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum.

    Science.gov (United States)

    Zou, Jianyong; Luo, Canqiao; Liu, Zhenguo; Cheng, Chao

    2017-07-24

    Cardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury. A rare case developed cardiac arrest without direct cardiac injury during Nuss procedure is presented in this article. In July 2015, a previously healthy 18-year-old man undergoing Nuss repair for pectus excavatum developed cardiac arrest while the Nuss bar was being inserted into the chest. After successful resuscitation and exclusion of direct cardiac injury, the Nuss procedure was continued. The patient suffered a second cardiac arrest during rotation of the Nuss bar. This time, the patient had poor initial response to resuscitation and defibrillation until the retrosternal bar was removed. He ultimately recovered well from the episodes of cardiac arrest, but was unable to receive surgical correction of his pectus excavatum deformity. The possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed.

  8. Sudden Cardiac Arrest during Participation in Competitive Sports.

    Science.gov (United States)

    Landry, Cameron H; Allan, Katherine S; Connelly, Kim A; Cunningham, Kris; Morrison, Laurie J; Dorian, Paul

    2017-11-16

    The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members. Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening. In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac

  9. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Hansen, Steen Møller

    2017-01-01

    BACKGROUND: Knowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent. METHODS: We studied 13,860 patients with presumed cardiac-caused OHCA...... not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005-2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify...... predictors of rhythm conversion and to compute 30-day survival chances. RESULTS: Twenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were...

  10. Characterization of mitochondrial injury after cardiac arrest (COMICA).

    Science.gov (United States)

    Donnino, Michael W; Liu, Xiaowen; Andersen, Lars W; Rittenberger, Jon C; Abella, Benjamin S; Gaieski, David F; Ornato, Joseph P; Gazmuri, Raúl J; Grossestreuer, Anne V; Cocchi, Michael N; Abbate, Antonio; Uber, Amy; Clore, John; Peberdy, Mary Anne; Callaway, Clifton W

    2017-04-01

    Mitochondrial injury post-cardiac arrest has been described in pre-clinical settings but the extent to which this injury occurs in humans remains largely unknown. We hypothesized that increased levels of mitochondrial biomarkers would be associated with mortality and neurological morbidity in post-cardiac arrest subjects. We performed a prospective multicenter study of post-cardiac arrest subjects. Inclusion criteria were comatose adults who suffered an out-of-hospital cardiac arrest. Mitochondrial biomarkers were measured at 0, 12, 24, 36 and 48h after return of spontaneous circulation as well as in healthy controls. Out of 111 subjects enrolled, 102 had evaluable samples at 0h. Cardiac arrest subjects had higher baseline cytochrome c levels compared to controls (2.18ng/mL [0.74, 7.74] vs. 0.16ng/mL [0.03, 0.91], pcardiac arrest subjects at baseline compared to the control subjects. There were no differences between survivors and non-survivors for mitochondrial DNA, nuclear DNA, or cell free DNA. Cytochrome c was increased in post- cardiac arrest subjects compared to controls, and in post-cardiac arrest non-survivors compared to survivors. Nuclear DNA and cell free DNA was increased in plasma of post-cardiac arrest subjects. There were no differences in mitochondrial DNA, nuclear DNA, or cell free DNA between survivors and non-survivors. Mitochondrial injury markers showed mixed results in the post-cardiac arrest period. Future research needs to investigate these differences. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles.

    Science.gov (United States)

    Inamasu, Joji; Miyatake, Satoru

    2013-03-01

    The great majority of non-traumatic cardiac arrests (CA) occur at home. The toilet is a closed and private room where CA occurs frequently. However, due to the feelings of privacy that are associated with this room, the circumstances and causes of CA in the toilet have rarely been investigated. A retrospective study was conducted to clarify clinical characteristics and resuscitation profiles of patients sustaining CA in the toilet. Among 907 CA patients treated during a 4-year period, 101 (11 %) sustained CA in the toilet. While the collapse was witnessed in only 10 % of these patients, return of spontaneous circulation (ROSC) was achieved in 41 %. However, the long-term survival rate was 1 %. Multivariate regression analysis revealed that a history of cardiac diseases was predictive of CA in the toilet (odds ratio 3.045; 95 % confidence interval 1.756-5.282) but that there was no correlation with advanced age. The frequency of CA in the toilet may be influenced moderately by seasonal/circadian variations. The 101 patients were classified into four subgroups according to mode of discovery of CA. The frequency of ROSC was highest in those who collapsed in the presence of caregivers and lowest in those whose collapse were discovered later by family members being worried that the patient stayed in the toilet "too long." Imaging studies revealed life-threatening extra-cardiac lesions responsible for CA, such as subarachnoid hemorrhage and aortic dissection, in 23 % of the patient cohort. The rarity of long-term survival among individuals sustaining CA in the toilet is mainly due to the delay in discovering the individual who collapsed. Although a history of cardiac diseases is a risk factor, predicting who may sustain CA in the toilet remains difficult due to etiological heterogeneity.

  12. Thiamine as a neuroprotective agent after cardiac arrest.

    Science.gov (United States)

    Ikeda, Kohei; Liu, Xiaowen; Kida, Kotaro; Marutani, Eizo; Hirai, Shuichi; Sakaguchi, Masahiro; Andersen, Lars W; Bagchi, Aranya; Cocchi, Michael N; Berg, Katherine M; Ichinose, Fumito; Donnino, Michael W

    2016-08-01

    Reduction of pyruvate dehydrogenase (PDH) activity in the brain is associated with neurological deficits in animals resuscitated from cardiac arrest. Thiamine is an essential co-factor of PDH. The objective of this study was to examine whether administration of thiamine improves outcomes after cardiac arrest in mice. Secondarily, we aimed to characterize the impact of cardiac arrest on PDH activity in mice and humans. Animal study: Adult mice were subjected to cardiac arrest whereupon cardiopulmonary resuscitation was performed. Thiamine or vehicle was administered 2min before resuscitation and daily thereafter. Mortality, neurological outcome, and metabolic markers were evaluated. Human study: In a convenience sample of post-cardiac arrest patients, we measured serial PDH activity from peripheral blood mononuclear cells and compared them to healthy controls. Animal study: Mice treated with thiamine had increased 10-day survival (48% versus 17%, Pcardiac arrest patients had lower PDH activity in mononuclear cells than did healthy volunteers (estimated difference: -5.8O.D./min/mg protein, Pcardiac arrest improved neurological outcome and 10-day survival in mice. PDH activity was markedly depressed in post-cardiac arrest patients suggesting that this pathway may represent a therapeutic target. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Cardiac Arrest in Pediatric Patients Receiving Azithromycin.

    Science.gov (United States)

    Valdés, Santiago O; Kim, Jeffrey J; Niu, Mary C; de la Uz, Caridad M; Miyake, Christina Y; Moffett, Brady S

    2017-03-01

    To compare outcomes of pediatric patients treated with azithromycin compared with penicillin or cephalosporin. We hypothesized that azithromycin use would not be associated with increased cardiac mortality in the pediatric population. Retrospective cohort study from the Pediatric Health Information System database between 2008 and 2012. Patients Azithromycin was used in 5039 (6.1%); penicillin or cephalosporin was used in 77 943 (93.9%). Overall prevalence of antibiotic-associated CPR was 0.14%. Patients receiving a macrolide antibiotic had a lower prevalence of CPR compared with patients receiving a penicillin or cephalosporin (0.04% vs 0.14%, P = .04), and there was no difference in mortality. Multivariable analysis did not find an association between macrolide use and CPR. In contrast to recent adult studies, among children hospitalized for community-acquired pneumonia, azithromycin use was not associated with a greater prevalence of cardiac arrest compared with penicillin or cephalosporin use. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Epidemiology and management of cardiac arrest: what registries are revealing.

    Science.gov (United States)

    Gräsner, Jan-Thorsten; Bossaert, Leo

    2013-09-01

    Major European institutions report cardiovascular disease (CVD) as the first cause of death in adults, with cardiac arrest and sudden death due to coronary ischaemia as the primary single cause. Global incidence of CVD is decreasing in most European countries, due to prevention, lifestyle and treatment. Mortality of acute coronary events inside the hospital decreases more rapidly than outside the hospital. To improve the mortality of cardiac arrest outside the hospital, reliable epidemiological and process figures are essential: "we can only manage what we can measure". Europe is a patchwork of 47 countries (total population of 830 million), with a 10-fold difference in incidence of coronary heart disease between North and South, East and West, and a 5-fold difference in number of EMS-treated cardiac arrest (range 17-53/1000,000/year). Epidemiology of cardiac arrest should not be calculated as a European average, but it is appropriate to describe the incidence of cardiac arrest, the resuscitation process, and the outcome in each of the European regions, for benchmarking and quality management. Epidemiological reports of cardiac arrest should specify definitions, nominator (number of cases) and denominator (study population). Recently some regional registries in North America, Japan and Europe fulfilled these conditions. The European Registry of Cardiac Arrest (EuReCa) has the potential to achieve these objectives on a pan-European scale. For operational applications, the Utstein definition of "Cardiac arrest" is used which includes the potential of survival. For application in community health, the WHO definition of "sudden death" is frequently used, describing the mode of death. There is considerable overlap between both definitions. But this explains that no single method can provide all information. Integrating data from multiple sources (local, national, multinational registries and surveys, death certificates, post-mortem reports, community statistics, medical

  15. Sudden cardiac arrest risk in young athletes | Gradidge | South ...

    African Journals Online (AJOL)

    Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during ...

  16. Evaluation of the use of automatic external defibrillation in out-of-hospital cardiac arrest in Hong Kong.

    Science.gov (United States)

    Lui, J C

    1999-07-01

    A retrospective 6-month audit of out-of-hospital cardiac arrests in Hong Kong following the introduction of automatic external defibrillators is presented. During the 6-month period from 1 July 1995 to 31 December 1995, resuscitation was attempted on 754 patients. Of the 744 patients with cardiac arrest whose records were available, 53.6% had a witnessed arrest. Few cardiac arrest patients (8.9%) received bystander cardiopulmonary resuscitation (CPR) and the majority (80%) of arrests occurred at home. Six hundred and forty-three (86.4%) patients were declared dead on arrival at hospital or in the Accident and Emergency department; 89 (12%) died in hospital and only 12 (1.6%) were discharged alive. The average ambulance response interval (call receipt to arrival of ambulance at scene) was 6.42 min. The average arrest-to-first-shock interval was 23.77 min. Factors predicting survival included initial rhythm and arrest-to-first-shock interval. The survival rate of 1.6% is low by world standards. To improve the survival rates of people with out-of-hospital cardiac arrest, the arrest-to-call interval must be reduced and the frequency of bystander CPR assistance increased. Once these changes are in place, a beneficial effect from the use of pre-hospital defibrillation might be seen.

  17. Cardiac Arrest? Someday, Drones May Come to Your Rescue

    Science.gov (United States)

    ... gov/news/fullstory_166543.html Cardiac Arrest? Someday, Drones May Come to Your Rescue Like something from ... 13, 2017 TUESDAY, June 13, 2017 (HealthDay News) -- Drones have been proposed for some pretty mundane uses, ...

  18. Fewer Heart Failure Patients Dying of Cardiac Arrest

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_167058.html Fewer Heart Failure Patients Dying of Cardiac Arrest Researchers chock it ... 6, 2017 THURSDAY, July 6, 2017 (HealthDay News) -- Heart failure patients are much less likely now to die ...

  19. The outcome of anaesthesia related cardiac arrest in a

    Directory of Open Access Journals (Sweden)

    O.O. Adekola

    2016-07-01

    Conclusion: Anaesthesia related cardiac arrest and mortality were linked to cardiovascular depression from halothane overdose in our institution. The burden can be reduced by improving on establishing standard monitoring in the perioperative period, and a team approach to patients care.

  20. Impact of donor cardiac arrest on heart transplantation.

    Science.gov (United States)

    Southerland, Kevin W; Castleberry, Anthony W; Williams, Judson B; Daneshmand, Mani A; Ali, Ayyaz A; Milano, Carmelo A

    2013-08-01

    Cardiac transplantation is an effective therapy for patients with end-stage heart failure, but it is still hindered by the lack of donor organs. A history of donor cardiac arrest raises trepidation regarding the possibility of poor post-transplant outcomes. The impact of donor cardiac arrest following successful cardiopulmonary resuscitation on heart transplant outcomes is unknown. Therefore, we sought to evaluate the impact of donor cardiac arrest on orthotropic heart transplantation using the United Network for Organ Sharing database. We performed a secondary longitudinal analysis of all cardiac transplants performed between April 1994 and December 2011 through the United Network for Organ Sharing registry. Multiorgan transplants, repeat transplants, and pediatric recipients were excluded. Survival analyses were performed using Kaplan-Meier methods as well as multivariate adjusted logistic regression and Cox proportional hazard models. A total of 19,980 patients were analyzed. In 856 cases, the donors had histories of cardiac arrest, and in the remaining 19,124 cases, there was no history of donor cardiac arrest. The unadjusted 1-, 5-, and 10-year actuarial survival rates between the arrest and the nonarrest groups were not significantly different. Multivariate logistic regression demonstrated no difference in survival in the donor arrest group at 30 days, 1 year, or 3 years. Furthermore, the adjusted Cox proportional hazard model for cumulative survival also showed no survival difference between the 2 groups. If standard recipient and donor transplantation criteria are met, a history of donor cardiac arrest should not prohibit the potential consideration of an organ for transplantation. Copyright © 2013 Mosby, Inc. All rights reserved.

  1. Temporal trends in survival after out-of-hospital cardiac arrest in patients with and without underlying chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Møller, Sidsel G.; Rajan, Shahzleen; Folke, Fredrik

    2016-01-01

    ,480 included patients, 3056 (14.2%) had history of COPD. Compared to non-COPD patients, COPD patients were older (75 vs. 71 years), less likely male (61.2% vs. 68.5%), had higher prevalence of other comorbidities, and were less likely to have: arrests outside private homes (17.7% vs. 28.3%), witnessed arrests......Aim: Survival after out-of-hospital cardiac arrest (OHCA) has tripled during the past decade in Denmark as a likely result of improvements in cardiac arrest management. This study analyzed whether these improvements were applicable for patients with chronic obstructive pulmonary disease (COPD......). Methods: Patients ≥18 years with OHCA of presumed cardiac cause were identified through the Danish Cardiac Arrest Registry, 2001-2011. Patients with a history of COPD up to ten years prior to arrest were identified from the Danish National Patient Register and compared to non-COPD patients. Results: Of 21...

  2. Might rapid implementation of cardiopulmonary bypass in patients who are failing to recover after a cardiac arrest potentially save lives?

    Science.gov (United States)

    Ishaq, Muhammad; Pessotto, Renzo

    2013-10-01

    The question addressed was whether it might be beneficial to have a rapid-response emergency cardiopulmonary bypass service for patients who suffer an in-hospital or an out-of-hospital cardiac arrest of any aetiology. Eighty-five papers were reviewed using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The concept of using emergency cardiopulmonary bypass (ECPB) for the management of cardiogenic shock and refractory cardiac arrest was developed in the late 1990s. Since this time, a large number of centres worldwide have reported success with use of ECPB for cardiac arrest refractory to conventional resuscitation techniques and for cardiogenic shock. This is a relatively new advancement in resuscitative strategy and is expanding in clinical practice. Clinical studies and experimental data reveal that ECPB is a very effective tool in the return of spontaneous circulation following refractory cardiac arrest. Resuscitation with this technique demonstrated survival benefit when compared with patients having conventional cardiopulmonary resuscitation for >10 min after witnessed in-hospital arrest, especially if the cause of arrest is of cardiac origin. The reported finding from a systematic review of 1494 patients treated with ECPB noted that the overall survival rate was 47.4%; their results indicate that the application of ECPB in cardiac arrest improves survival and the likelihood of a satisfactory neurological outcome. An additional review revealed that acceptable survival rate and neurological outcomes (30%) can be achieved with extracorporeal cardiopulmonary resuscitation in children after prolonged cardiac arrest (up to 95 min) refractory to standard resuscitation. However, no study has provided clear-cut evidence of the merits of ECPS in patients with out

  3. Heritability of Risk for Sudden Cardiac Arrest in ESRD.

    Science.gov (United States)

    Chan, Kevin E; Newton-Cheh, Christopher; Gusella, James F; Maddux, Franklin W

    2015-11-01

    Patients on dialysis are 20 times more likely to have a cardiac arrest compared with the general population. We considered whether inherited factors associate with cardiac arrest among patients on dialysis. From a sample of 647,457 patients on chronic dialysis, we identified 5117 pairs of patients who came from the same family. These patients were each matched to a control subject from the same population. McNemar's tests were used to compare the risk of cardiac arrest between the familial related and unrelated pairs. Genetically related family members who did not cohabitate had an odds ratio of 1.88 (95% confidence interval [95% CI], 1.25 to 2.84) for cardiac arrest compared with their phenotypically matched unrelated controls. Genetically related family members who lived together in the same environment had an odds ratio of 1.66 (95% CI, 1.20 to 2.28). Spouses, who are genetically unrelated but live together in the same environment, had an odds ratio of 0.95 (95% CI, 0.60 to 1.59) for cardiac arrest. The risk of cardiac arrest in patients on dialysis may be attributable to inherited factors. Additional studies are needed to identify such candidate genes that modify cardiovascular risk in ESRD. Copyright © 2015 by the American Society of Nephrology.

  4. Improvements in Out-of-Hospital Cardiac Arrest Survival from 1998 to 2013.

    Science.gov (United States)

    Yamaguchi, Yutaka; Woodin, Jeff A; Gibo, Koichiro; Zive, Dana M; Daya, Mohamud R

    2017-01-01

    Out-of-hospital cardiac arrest (OHCA) remains a major public health burden. Aggregate OHCA survival to hospital discharge has reportedly remained unchanged at 7.6% for almost 30 years from 1970 to 2008. We examined the trends in adult OHCA survival over a 16-year period from 1998 to 2013 within a single EMS agency. Observational cohort study of adult OHCA patients treated by Tualatin Valley Fire & Rescue (TVF&R) from 1998 to 2013. This is an ALS first response fire agency that maintains an active Utstein style cardiac arrest registry and serves a population of approximately 450,000 in 9 incorporated cities in Oregon. Primary outcomes were survival to hospital discharge in all patients and in the subgroup with witnessed ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The impact of key covariates on survival was assessed using univariate logistic regression. These included patient factors (age and sex), event factors (location of arrest, witnessed status, and first recorded cardiac arrest rhythm), and EMS system factors (response time interval, bystander CPR, and non-EMS AED shock). We used multivariate logistic regression to examine the impact of year increment on survival after multiple imputation for missing data. Sensitivity analysis was performed with complete cases. During the study period, 2,528 adult OHCA had attempted field resuscitation. The survival rate for treated cases increased from 6.7% to 18.2%, with witnessed VF/VT cases increasing from 14.3% to 31.4% from 1998 to 2013. Univariate analysis showed that younger age, male sex, public location of arrest, bystander or EMS witnessed event, initial rhythm of pulseless electrical activity (PEA) or VF/VT, bystander CPR, non-EMS AED shock, and a shorter EMS response time were independently associated with survival. After adjustment for covariates, the odds of survival increased by 9% (OR 1.09, 95%CI: 1.05-1.12) per year in all treated cases, and by 6% (OR 1.06, 95% 1.01-1.10) per year in

  5. Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil.

    Science.gov (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho

    2016-01-01

    Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. [Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil].

    Science.gov (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho

    2016-01-01

    Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Post-resuscitation care for survivors of cardiac arrest

    Science.gov (United States)

    Mangla, Ashvarya; Daya, Mohamud R.; Gupta, Saurabh

    2014-01-01

    Cardiac arrest can occur following a myriad of clinical conditions. With advancement of medical science and improvements in Emergency Medical Services systems, the rate of return of spontaneous circulation for patients who suffer an out-of-hospital cardiac arrest (OHCA) continues to increase. Managing these patients is challenging and requires a structured approach including stabilization of cardiopulmonary status, early consideration of neuroprotective strategies, identifying and managing the etiology of arrest and initiating treatment to prevent recurrence. This requires a closely coordinated multidisciplinary team effort. In this article, we will review the initial management of survivors of OHCA, highlighting advances and ongoing controversies. PMID:24568821

  8. Location of cardiac arrest and impact of pre-arrest chronic disease and medication use on survival

    DEFF Research Database (Denmark)

    Granfeldt, Asger; Wissenberg, Mads; Hansen, Steen Møller

    2017-01-01

    INTRODUCTION: Cardiac arrest in a private location is associated with a higher mortality when compared to public location. Past studies have not accounted for pre-arrest factors such as chronic disease and medication. AIM: To investigate whether the association between cardiac arrest in a private...... location and a higher mortality can be explained by differences in chronic diseases and medication. METHODS: We identified 27,771 out-of-hospital cardiac arrest patients ≥18 years old from the Danish Cardiac Arrest Registry (2001-2012). Using National Registries, we identified pre-arrest chronic disease...... and medication. To investigate the importance of cardiac arrest related factors and chronic disease and medication use we performed adjusted Cox regression analyses during day 0-7 and day 8-365 following cardiac arrest to calculate hazard ratios (HR) for death. RESULTS: Day 0-7: Un-adjusted HR for death day 0...

  9. Sudden cardiac arrest during sports activity in middle age.

    Science.gov (United States)

    Marijon, Eloi; Uy-Evanado, Audrey; Reinier, Kyndaron; Teodorescu, Carmen; Narayanan, Kumar; Jouven, Xavier; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S

    2015-04-21

    Sports-associated sudden cardiac arrests (SCAs) occur mostly during middle age. We sought to determine the burden, characteristics, and outcomes of SCA during sports among middle-aged residents of a large US community. Patients with SCA who were 35 to 65 years of age were identified in a large, prospective, population-based study (2002-2013), with systematic and comprehensive assessment of their lifetime medical history. Of the 1247 SCA cases, 63 (5%) occurred during sports activities at a mean age of 51.1±8.8 years, yielding an incidence of 21.7 (95% confidence interval, 8.1-35.4) per 1 million per year. The incidence varied significantly by sex, with a higher incidence among men (relative risk, 18.68; 95% confidence interval, 2.50-139.56) for sports SCAs compared with all other SCAs (relative risk 2.58; 95% confidence interval, 2.12-3.13). Sports SCA was also more likely to be a witnessed event (87% versus 53%; Psports-associated SCA (23.2% versus 13.6%; P=0.04). Sports SCA cases presented with known preexisting cardiac disease in 16% and ≥1 cardiovascular risk factors in 56%, and overall, 36% of cases had typical cardiovascular symptoms during the week preceding the SCA. Sports-associated SCA in middle age represents a relatively small proportion of the overall SCA burden, reinforcing the idea of the high-benefit, low-risk nature of sports activity. Especially in light of current population aging trends, our findings emphasize that targeted education could maximize both safety and acceptance of sports activity in the older athlete. © 2015 American Heart Association, Inc.

  10. Contemporary animal models of cardiac arrest: A systematic review.

    Science.gov (United States)

    Vognsen, Mikael; Fabian-Jessing, Bjørn K; Secher, Niels; Løfgren, Bo; Dezfulian, Cameron; Andersen, Lars W; Granfeldt, Asger

    2017-04-01

    Animal models are widely used in cardiac arrest research. This systematic review aimed to provide an overview of contemporary animal models of cardiac arrest. Using a comprehensive research strategy, we searched PubMed and EMBASE from March 8, 2011 to March 8, 2016 for cardiac arrest animal models. Two investigators reviewed titles and abstracts for full text inclusion from which data were extracted according to pre-defined definitions. Search criteria yielded 1741 unique titles and abstracts of which 490 full articles were included. The most common animals used were pigs (52%) followed by rats (35%) and mice (6%). Studies favored males (52%) over females (16%); 17% of studies included both sexes, while 14% omitted to report on sex. The most common methods for induction of cardiac arrest were either electrically-induced ventricular fibrillation (54%), asphyxia (25%), or potassium (8%). The median no-flow time was 8min (quartiles: 5, 8, range: 0-37min). The majority of studies used adrenaline during resuscitation (64%), while bicarbonate (17%), vasopressin (8%) and other drugs were used less prevalently. In 53% of the studies, the post-cardiac arrest observation time was ≥24h. Neurological function was an outcome in 48% of studies while 43% included assessment of a cardiac outcome. Multiple animal models of cardiac arrest exist. The great heterogeneity of these models along with great variability in definitions and reporting make comparisons between studies difficult. There is a need for standardization of animal cardiac arrest research and reporting. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Acute kidney injury after cardiac arrest.

    Science.gov (United States)

    Tujjar, Omar; Mineo, Giulia; Dell'Anna, Antonio; Poyatos-Robles, Belen; Donadello, Katia; Scolletta, Sabino; Vincent, Jean-Louis; Taccone, Fabio Silvio

    2015-04-17

    The aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients. We reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output <0.5 ml/kg/h) and/or an increase in serum creatinine (≥0.3 mg/dl from admission value within 48 hours or a 1.5 time from baseline level). Demographics, comorbidities, CA details, and ICU interventions were recorded. Neurological outcome was assessed at 3 months using the Cerebral Performance Category scale (CPC 1-2 = favorable outcome; 3-5 = poor outcome). A total of 199 patients were included, 85 (43%) of whom developed AKI during the ICU stay. Independent predictors of AKI development were older age, chronic renal disease, higher dose of epinephrine, in-hospital CA, presence of shock during the ICU stay, a low creatinine clearance (CrCl) on admission and a high cumulative fluid balance at 48 hours. Patients with AKI had higher hospital mortality (55/85 vs. 57/114, p = 0.04), but AKI was not an independent predictor of poor 3-month neurological outcome. AKI occurred in more than 40% of patients after CA. These patients had more severe hemodynamic impairment and needed more aggressive ICU therapy; however the development of AKI did not influence neurological recovery.

  12. Haemodynamic consequences of mild therapeutic hypothermia after cardiac arrest.

    NARCIS (Netherlands)

    Bergman, R.; Braber, A.; Adriaanse, M.A.; Vugt, R. van; Tjan, D.H.; Zanten, A.R. van

    2010-01-01

    BACKGROUND AND OBJECTIVE: Mild therapeutic hypothermia (MTH) is used after out-of-hospital cardiac arrest (OHCA) to minimize cerebral damage. Induced hypothermia may further interfere with cardiac function and influence haemodynamics after OHCA. METHODS: This was a prospective study of haemodynamic

  13. Sudden cardiac arrest in sports - need for uniform registration

    DEFF Research Database (Denmark)

    Solberg, E E; Borjesson, M; Sharma, S

    2016-01-01

    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities....

  14. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Kudenchuk, Peter J; Brown, Siobhan P; Daya, Mohamud; Rea, Thomas; Nichol, Graham; Morrison, Laurie J; Leroux, Brian; Vaillancourt, Christian; Wittwer, Lynn; Callaway, Clifton W; Christenson, James; Egan, Debra; Ornato, Joseph P; Weisfeldt, Myron L; Stiell, Ian G; Idris, Ahamed H; Aufderheide, Tom P; Dunford, James V; Colella, M Riccardo; Vilke, Gary M; Brienza, Ashley M; Desvigne-Nickens, Patrice; Gray, Pamela C; Gray, Randal; Seals, Norman; Straight, Ron; Dorian, Paul

    2016-05-05

    Antiarrhythmic drugs are used commonly in out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, but without proven survival benefit. In this randomized, double-blind trial, we compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had nontraumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access. Paramedics enrolled patients at 10 North American sites. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurologic function at discharge. The per-protocol (primary analysis) population included all randomly assigned participants who met eligibility criteria and received any dose of a trial drug and whose initial cardiac-arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia was refractory to shock. In the per-protocol population, 3026 patients were randomly assigned to amiodarone (974), lidocaine (993), or placebo (1059); of those, 24.4%, 23.7%, and 21.0%, respectively, survived to hospital discharge. The difference in survival rate for amiodarone versus placebo was 3.2 percentage points (95% confidence interval [CI], -0.4 to 7.0; P=0.08); for lidocaine versus placebo, 2.6 percentage points (95% CI, -1.0 to 6.3; P=0.16); and for amiodarone versus lidocaine, 0.7 percentage points (95% CI, -3.2 to 4.7; P=0.70). Neurologic outcome at discharge was similar in the three groups. There was heterogeneity of treatment effect with respect to whether the arrest was witnessed (P=0.05); active drugs were associated with a survival rate that was significantly higher than the rate with placebo among patients with bystander-witnessed arrest but not among those with unwitnessed arrest. More amiodarone recipients required temporary cardiac pacing than did recipients of lidocaine or placebo. Overall, neither

  15. Electronic registration of out-of-hospital cardiac arrests

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Dahl, Michael; Gade, John

    2007-01-01

    Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number...... patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition...... of cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12...

  16. Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study

    Science.gov (United States)

    Parkash, Ratika; Tang, Anthony; Wells, George; Blackburn, Josée; Stiell, Ian; Simpson, Christopher; Dorian, Paul; Yee, Raymond; Cameron, Doug; Connolly, Stuart; Birnie, David; Nichol, Graham

    2004-01-01

    Background Survivors of out-of-hospital cardiac arrest are at high risk of recurrent arrests, many of which could be prevented with implantable cardioverter defibrillators (ICDs). We sought to determine the ICD insertion rate among survivors of out-of-hospital cardiac arrest and to determine factors associated with ICD implantation. Methods The Ontario Prehospital Advanced Life Support (OPALS) study is a prospective, multiphase, before–after study assessing the effectiveness of prehospital interventions for people experiencing cardiac arrest, trauma or respiratory arrest in 19 Ontario communities. We linked OPALS data describing survivors of cardiac arrest with data from all defibrillator implantation centres in Ontario. Results From January 1997 to April 2002, 454 patients in the OPALS study survived to hospital discharge after experiencing an out-of-hospital cardiac arrest. The mean age was 65 (standard deviation 14) years, 122 (26.9%) were women, 398 (87.7%) had a witnessed arrest, 372 (81.9%) had an initial rhythm of ventricular tachycardia or ventricular fibrillation (VT/VF), and 76 (16.7%) had asystole or another arrhythmia. The median cerebral performance category at discharge (range 1–5, 1 = normal) was 1. Only 58 (12.8%) of the 454 patients received an ICD. Patients with an initial rhythm of VT/VF were more likely than those with an initial rhythm of asystole or another rhythm to undergo device insertion (adjusted odds ratio [OR] 9.63, 95% confidence interval [CI] 1.31–71.50). Similarly, patients with a normal cerebral performance score were more likely than those with abnormal scores to undergo ICD insertion (adjusted OR 12.52, 95% CI 1.74–92.12). Interpretation A minority of patients who survived cardiac arrest underwent ICD insertion. It is unclear whether this low usage rate reflects referral bias, selection bias by electrophysiologists, supply constraint or patient preference. PMID:15505267

  17. Current Pharmacological Advances in the Treatment of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Andry Papastylianou

    2012-01-01

    Full Text Available Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.

  18. Serum tau and neurological outcome in cardiac arrest

    DEFF Research Database (Denmark)

    Mattsson, Niklas; Zetterberg, Henrik; Nielsen, Niklas

    2017-01-01

    OBJECTIVE: To test serum tau as a predictor of neurological outcome after cardiac arrest. METHODS: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome...... was poor neurological outcome, defined as Cerebral Performance Categories 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7-245ng/l in poor vs median = 1.5, IQR = 0.7-2.4ng/l in good outcome, for tau....... The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest. INTERPRETATION: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better...

  19. Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.

    LENUS (Irish Health Repository)

    Masterson, Siobhán

    2011-05-01

    SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

  20. Transcranial optical vascular imaging (TOVI) during cardiac arrest (Conference Presentation)

    Science.gov (United States)

    Kalchenko, Vyacheslav; Kuznetsov, Yuri; Meglinski, Igor; Harmelin, Alon

    2017-03-01

    Based on the recent studies the prognosis of patients after cardiac arrest (CA) remains poor. Thus it is extremely important to understand fine mechanisms related to the influence of CA on the brain and Cerebral Blood Flow (CBF) during and after cardiac arrest. Recently our group introduced Transcranial Optical Vascular Imaging (TOVI) approach that combines laser speckle and dynamic fluorescent imaging. TOVI proved to be useful during various preclinical brain research applications. For example it allows imaging of brain blood vessels of a mouse in vivo through the intact cranium. Herein for the first time we present the use of TOVI during cardiac arrest. TOVI possibly could be a useful tool for preclinical studies of CBF during and after CA.

  1. Automated external defibrillators and simulated in-hospital cardiac arrests.

    Science.gov (United States)

    Rossano, Joseph W; Jefferson, Larry S; Smith, E O'Brian; Ward, Mark A; Mott, Antonio R

    2009-05-01

    To test the hypothesis that pediatric residents would have shorter time to attempted defibrillation using automated external defibrillators (AEDs) compared with manual defibrillators (MDs). A prospective, randomized, controlled trial of AEDs versus MDs was performed. Pediatric residents responded to a simulated in-hospital ventricular fibrillation cardiac arrest and were randomized to using either an AED or MD. The primary end point was time to attempted defibrillation. Sixty residents, 21 (35%) interns, were randomized to 2 groups (AED = 30, MD = 30). Residents randomized to the AED group had a significantly shorter time to attempted defibrillation [median, 60 seconds (interquartile range, 53 to 71 seconds)] compared with those randomized to the MD group [median, 103 seconds (interquartile range, 68 to 288 seconds)] (P attempted defibrillation at attempted defibrillation by pediatric residents in simulated cardiac arrests. Further studies are needed to help determine the role of AEDs in pediatric in-hospital cardiac arrests.

  2. [Cardiac arrest in France: Why a national register?].

    Science.gov (United States)

    Gueugniaud, Pierre-Yves; Bertrand, C; Savary, Dominique; Hubert, H

    2011-06-01

    Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. French SAMU experienced registers especially in the field of acute coronary syndrom. Our national register "RéAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  3. Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry.

    Science.gov (United States)

    Rosell Ortiz, Fernando; Mellado Vergel, Francisco; López Messa, Juan Bautista; Fernández Valle, Patricia; Ruiz Montero, María M; Martínez Lara, Manuela; Vergara Pérez, Santiago; Vivar Díaz, Itziar; Caballero García, Auxiliadora; García Alcántara, Ángel; García Del Águila, Javier

    2016-05-01

    There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser

    2013-01-01

    BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use....... METHODS: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes...

  5. Primary percutaneous coronary intervention after out-of-hospital cardiac arrest: patients and outcomes.

    Science.gov (United States)

    Marcusohn, Erez; Markusohn, Erez; Roguin, Ariel; Sebbag, Anat; Aronson, Doron; Dragu, Robert; Amikam, Shlomo; Boulus, Monter; Grenadier, Ehud; Kerner, Arthur; Nikolsky, Eugenia; Markiewicz, Walter; Hammerman, Haim; Kapeliovich, Michael

    2007-04-01

    The decision to perform primary percutaneous coronary intervention in unconscious patients resuscitated after out-of-hospital cardiac arrest is challenging because of uncertainty regarding the prognosis of recovery of anoxic brain damage and difficulties in interpreting ST segment deviations. In ST elevation myocardial infarction patients after OHCA, primary PCI is generally considered the only option for reperfusion. There are few published studies and no randomized trial has yet been performed in this specific group of patients. To define the demographic, clinical and angiographic characteristics, and the prognosis of STEMI patients undergoing primary PCI after out-of-hospital cardiac arrest. We performed a retrospective analysis of medical records and used the prospectively acquired information from the Rambam Primary Angioplasty Registry (PARR) and the Rambam Intensive Cardiac Care (RICCa) databases. During the period March 1998 to June 2006, 25 STEMI patients (21 men and 4 women, mean age 56 +/- 11years) after OHCA were treated with primary PCI. The location of myocardial infarction was anterior in 13 patients (52%) and non-anterior in 12 (48%). Cardiac arrest was witnessed in 23 patients (92%), but bystander resuscitation was performed in only 2 patients (8%). Eighteen patients (72%) were unconscious on admission, and Glasgow Coma Scale > 5 was noted in 2 patients (8%). Cardiogenic shock on admission was diagnosed in 4 patients (16%). PCI procedure was successful in 22 patients (88%). In-hospital, 30 day, 6 month and 1 year survival was 76%, 76%, 76% and 72%, respectively. In-hospital, 30 day, 6 month and 1 year survival without severe neurological disability was 68%, 68%, 68% and 64%, respectively. In a selected group of STEMI patients after out-of-hospital cardiac arrest, primary PCI can be performed with a high success rate and provides reasonably good results in terms of short and longer term survival.

  6. Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival.

    Science.gov (United States)

    Drennan, Ian R; Strum, Ryan P; Byers, Adam; Buick, Jason E; Lin, Steve; Cheskes, Sheldon; Hu, Samantha; Morrison, Laurie J

    2016-04-05

    The increasing number of people living in high-rise buildings presents unique challenges to care and may cause delays for 911-initiated first responders (including paramedics and fire department personnel) responding to calls for out-of-hospital cardiac arrest. We examined the relation between floor of patient contact and survival after cardiac arrest in residential buildings. We conducted a retrospective observational study using data from the Toronto Regional RescuNet Epistry database for the period January 2007 to December 2012. We included all adult patients (≥ 18 yr) with out-of-hospital cardiac arrest of no obvious cause who were treated in private residences. We excluded cardiac arrests witnessed by 911-initiated first responders and those with an obvious cause. We used multivariable logistic regression to determine the effect on survival of the floor of patient contact, with adjustment for standard Utstein variables. During the study period, 7842 cases of out-of-hospital cardiac arrest met the inclusion criteria, of which 5998 (76.5%) occurred below the third floor and 1844 (23.5%) occurred on the third floor or higher. Survival was greater on the lower floors (4.2% v. 2.6%, p = 0.002). Lower adjusted survival to hospital discharge was independently associated with higher floor of patient contact, older age, male sex and longer 911 response time. In an analysis by floor, survival was 0.9% above floor 16 (i.e., below the 1% threshold for futility), and there were no survivors above the 25th floor. In high-rise buildings, the survival rate after out-of-hospital cardiac arrest was lower for patients residing on higher floors. Interventions aimed at shortening response times to treatment of cardiac arrest in high-rise buildings may increase survival. © 2016 Canadian Medical Association or its licensors.

  7. Pattern of perioperative cardiac arrests at University of Maiduguri Teaching Hospital.

    Science.gov (United States)

    Kwari, Y D; Bello, M R; Eni, U E

    2010-01-01

    Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern, causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes, anaesthetic chart and ICU records. Study variables which include demographic data, ASA score, anaesthetic technique, causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia, while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults. ASA class III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2 (14%) out of 14 cardiac arrests recovered to home discharge, one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early There is need to improve on patient monitoring, knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest.

  8. Use of automated external defibrillators in cardiac arrest: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    The objectives were to identify the components of a program to deliver early defibrillation that optimizes the effectiveness of automated external defibrillators (AEDs) in out-of-hospital and hospital settings, to determine whether AEDs are cost-effective, and if cost-effectiveness was determined, to advise on how they should be distributed in Ontario. Survival in people who have had a cardiac arrest is low, especially in out-of-hospital settings. With each minute delay in defibrillation from the onset of cardiac arrest, the probability of survival decreases by 10%. (1) Early defibrillation (within 8 minutes of a cardiac arrest) has been shown to improve survival outcomes in these patients. However, in out-of-hospital settings and in certain areas within a hospital, trained personnel and their equipment may not be available within 8 minutes. This implies that "first responders" should take up the responsibility of delivering shock. The first responders in out-of-hospital settings are usually bystanders, firefighters, police, and community volunteers. In hospital settings, they are usually nurses. These first responders are not trained in reading electrocardiograms and identifying abnormal heart rhythms restorable by defibrillation. An AED is a device that can analyze a heart rhythm and deliver a shock if needed. Thus, AEDs can be used by first responders to deliver early defibrillation in out-of-hospital and hospital settings. However, simply providing an AED would not likely improve survival outcomes. Rather, AEDs have a role in strengthening the "chain of survival," which includes prompt activation of the 911 telephone system, early cardiopulmonary resuscitation (CPR), rapid defibrillation, and timely advanced life support. In the chain of survival, the first step for a witness of a cardiac arrest in an out-of-hospital setting is to call 911. Second, the witness initiates CPR (if she or he is trained in CPR). If the witness cannot initiate CPR, or the first

  9. Evaluating the quality of prehospital cardiopulmonary resuscitation by reviewing automated external defibrillator records and survival for out-of-hospital witnessed arrests.

    Science.gov (United States)

    Ko, Patrick Chow-In; Chen, Wen-Jone; Lin, Chih-Hao; Ma, Matthew Huei-Ming; Lin, Fang-Yue

    2005-02-01

    Without an easy method to monitor the performance of prehospital cardiopulmonary resuscitation (CPR), earlier studies have not been able to assess the quality of CPR. In this study, we have used a new approach to evaluate prehospital CPR performance and the impact on outcome using data retrieved from the automatic external defibrillators (AED). Electrocardiography (ECG) and voice records from AED data cards from 633 out-of-hospital cardiac arrests (OHCA) were reviewed. Fifty-two witnessed cardiac arrests in ventricular fibrillation (VF) requiring post-shock CPR underwent an independent, structured review by two physicians. The adequacy of prehospital CPR was defined on the basis of noticeable deflection of the ECG with chest compressions, the actual number of chest compressions delivered per minute, and the continuity of prehospital CPR at the scene and during transport. Outcome measures included return of spontaneous circulation (ROSC) and survival to hospital admission and discharge. The quality of prehospital CPR was judged as adequate in 15 (29%, 95%; CI: 18-42%) and inadequate in 37 (71%, 95%; CI: 58-82%) of the consensus. Adequate CPR performance resulted in a higher rate of ROSC at the scene (53% versus 8%, 95% CI of the difference 14-76%), and survival to hospital discharge (53% versus 8%, 95% CI of the difference 14-76%). Two reviewers agreed on whether CPR was adequate in 92.3% of cases, with a kappa of 0.82. The quality of prehospital CPR is associated with a greater likelihood of survival in witnessed VF arrests in need of post-shock CPR. The potential of widely available electrocardiography and voice records in AEDs in providing a convenient and real-time evaluation of prehospital CPR should be explored further.

  10. Exercise-related sudden cardiac arrest in London: incidence, survival and bystander response

    OpenAIRE

    Edwards, Melanie J; Fothergill, Rachael T

    2015-01-01

    Objective The study aimed to (1) establish the incidence of exercise-related sudden cardiac arrest (SCA) in London, (2) investigate survival from exercise-related SCA and (3) examine factors related to survival. Method This retrospective observational study examined 2 years’ data from the London Ambulance Service (LAS) cardiac arrest registry for patients in whom resuscitation was attempted following an out-of-hospital cardiac arrest (OHCA), a cardiac cause was presumed and the arrest occurre...

  11. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald

    2013-01-01

    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

  12. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle

    2014-01-01

    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level...

  13. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Directory of Open Access Journals (Sweden)

    Liana Maria Torres de Araújo Azi

    2016-01-01

    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  14. [Refractory cardiac arrest patients in prehospital care, potential organ donors].

    Science.gov (United States)

    Le Jan, Arnaud; Dupin, Aurélie; Garrigue, Bruno; Sapir, David

    2016-09-01

    Under the authority of the French Biomedicine Agency, a new care pathway integrates refractory cardiac arrest patients into a process of organ donation. It is a medical, logistical and ethical challenge for the staff of the mobile emergency services. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Public Cardiac Arrest Characteristics in Enclosed Pedestrian Networks

    NARCIS (Netherlands)

    Lee, Minha; Demirtas, Derya; Buick, Jason E.; Ng, Amy; Feldman, Michael J.; Cheskes, Sheldon; Morrison, Laurie J.; Chan, Timothy C.Y.

    2015-01-01

    Background: Cities around the world have underground or above-ground enclosed networks for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrest (OHCA) and resuscitation. The characteristics of OHCAs that occur in such networks are unknown. Objective: To

  16. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    NARCIS (Netherlands)

    Westhall, Erik; Rossetti, Andrea O.; van Rootselaar, Anne-Fleur; Wesenberg Kjaer, Troels; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Rosén, Ingmar; Åneman, Anders; Erlinge, David; Gasche, Yvan; Hassager, Christian; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matt P.; Cronberg, Tobias; Saxena, Manoj; Miller, Jennene; Inskip, Deborah; Macken, Lewis; Finfer, Simon; Eatough, Noel; Hammond, Naomi; Bass, Frances; Yarad, Elizabeth; O'Connor, Anne; Bird, Simon; Jewell, Timothy; Davies, Gareth; Ng, Karl; Coward, Sharon; Stewart, Antony; Micallef, Sharon; Parker, Sharyn; Cortado, Dennis; Gould, Ann; Harward, Meg; Thompson, Kelly; Glass, Parisa; Myburgh, John; Smid, Ondrej; Belholavek, Jan; Kreckova, Marketa; Kral, Ales; Horak, Jan; Otahal, Michal; Rulisek, Jan; Malik, Jan; Prettl, Martin; Wascher, Michael; Boesgaard, Soeren; Moller, Jacob E.; Bro-Jeppesen, John; Johansen, Ane Loof; Campanile, Vincenzo; Peratoner, Alberto; Verginella, Francesca; Leone, Daniele; Pellis, Thomas; Roncarati, Andrea; Franceschino, Eliana; Sanzani, Anna; Martini, Alice; Perlin, Micol; Pelosi, Paolo; Brunetti, Iole; Insorsi, Angelo; Pezzato, Stefano; de Luca, Giorgio; Gazzano, Emanuela; Ottonello, Gian Andrea; Furgani, Andrea; Telani, Rosanna; Maiani, Simona; Werer, Christophe; Kieffer, Jaqueline; van der Veen, Annelou L.; Winters, Tineke; Juffermans, Nicole P.; Egbers, Ph; Boerma, EC; Gerritsen, R. T.; Buter, H.; de Jager, C.; de Lange, F.; Loos, M.; Koetsier, P. M.; Kingma, W. P.; Bruins, N.; de Kock, L.; Koopmans, M.; Bosch, Frank; Raaijmakers, Monique A. M.; Metz-Hermans, S. W. L.; Endeman, Henrik; Rijkenberg, Saskia; Bianchi, Addy; Bugge, Jan Frederik; Norum, Hilde; Espinoza, Andreas; Kerans, Viesturs; Brevik, Helene; Svalebjørg, Morten; Grindheim, Guro; Petersen, Arne Jan; Baratt-Due, Andreas; Laake, Jon Henrik; Spreng, Ulrik; Wallander Karlsen, Marte Marie; Langøren, Jørund; Fanebust, Rune; Holm, Marianne Sætrang; Flinterud, Stine Iren; Wickman, Carsten; Johnsson, Jesper; Ebner, Florian; Gustavsson, Nerida; Petersson, Heléne; Petersson, Jörgen; Nasiri, Faezheh; Stafilidou, Frida; Edqvist, Kristine; Uhlig, Sven; Sköld, Gunilla; Sanner, Johan; Wallskog, Jesper; Wyon, Nicholas; Golster, Martin; Samuelsson, Anders; Hildebrand, Carl; Kadowaki, Taichi; Larsson-Viksten, Jessica; de Geer, Lina; Hansson, Patrik; Appelberg, Henrik; Hellsten, Anders; Lind, Susanne; Rundgren, Malin; Kander, Thomas; Persson, Johan; Annborn, Martin; Adolfsson, Anne; Corrigan, Ingrid; Dragancea, Irina; Undén, Johan; Larsson, Marina; Chew, Michelle; Unnerbäck, Mårten; Petersen, Per; Svedung-Rudebou, Anna; Svensson, Robert; Elvenes, Hilde; Bäckman, Carl; Rylander, Christian; Martner, Patrik; Martinell, Louise; Biber, Björn; Ahlqvist, Marita; Jacobson, Caisa; Forsberg, Marie-Louise; Lindgren, Roman Desta; Bergquist, Fatma; Thorén, Anders; Fredholm, Martin; Sellgren, Johan; Hård Af Segerstad, Lisa; Löfgren, Mikael; Gustavsson, Ingvor; Henström, Christina; Andersson, Bertil; Thiringer, Karin; Rydholm, Nadja; Persson, Stefan; Jawad, Jawad; Östman, Ingela; Berglind, Ida; Bergström, Eric; Andersson, Annika; Törnqvist, Cathrine; Marques de Mello, Nubia Lafayete; Gardaz, Valérie; Kleger, Gian-Reto; Schrag, Claudia; Fässler, Edith; Zender, Hervé; Wise, Matthew; Palmer, Nicki; Fouweather, Jen; Cole, Jade M.; Cocks, Eve; Frost, Paul J.; Saayman, Anton G.; Holmes, Tom; Hingston, Christopher D.; Scholey, Gareth M.; Watkins, Helen; Fernandez, Stephen; Walden, Andrew; Atkinson, Jane; Jacques, Nicola; Brown, Abby; Cranshaw, Julius; Berridge, Peter; McCormick, Robert; Schuster-Bruce, Martin; Scott, Michelle; White, Nigel; Vickers, Emma; Glover, Guy; Ostermann, Marlies; Holmes, Paul; Koutroumanidis, Michael; Lei, Katie; Sanderson, Barnaby; Smith, John; al-Subaie, Nawaf; Moore, Matthew; Randall, Paul; Mellinghoff, Johannes; Buratti, Azul Forti; Ryan, Chris; Ball, Jonathan; Francis, Gaynor

    2016-01-01

    To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. In this cohort study, 4 EEG specialists, blinded to outcome,

  17. Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study.

    Science.gov (United States)

    Cournoyer, Alexis; Notebaert, Éric; Iseppon, Massimiliano; Cossette, Sylvie; Londei-Leduc, Luc; Lamarche, Yoan; Morris, Judy; Piette, Éric; Daoust, Raoul; Chauny, Jean-Marc; Sokoloff, Catalina; Cavayas, Yiorgos Alexandros; Paquet, Jean; Denault, André

    2017-09-01

    Out-of-hospital advanced cardiac life support (ACLS) has not consistently shown a positive impact on survival. Extracorporeal cardiopulmonary resuscitation (E-CPR) could render prolonged on-site resuscitation (ACLS or basic cardiac life support [BCLS]) undesirable in selected cases. The objectives of this study were to evaluate, in patients suffering from out-of-hospital cardiac arrest (OHCA) and in a subgroup of potential E-CPR candidates, the association between the addition of prehospital ACLS to BCLS and survival to hospital discharge, prehospital return of spontaneous circulation (ROSC), and delay from call to hospital arrival. This cohort study targets adult patients treated for OHCA between April 2010 and December 2015 in the city of Montreal, Canada. We defined potential E-CPR candidates using clinical criteria previously described in the literature (65 years of age or younger, initial shockable rhythm, absence of ROSC after 15 minutes of prehospital resuscitation, and emergency medical services-witnessed collapse or witnessed collapse with bystander cardiopulmonary resuscitation). Associations were evaluated using multivariate regression models. A total of 7,134 patients with OHCA were included, 761 (10.7%) of whom survived to discharge. No independent association between survival to hospital discharge and the addition of prehospital ACLS to BCLS was found in either the entire cohort (adjusted odds ratio [AOR] = 1.05 [95% confidence interval {CI} = 0.84-1.32], p = 0.68) or among the 246 potential E-CPR candidates (AOR = 0.82 [95% CI = 0.36-1.84], p = 0.63). The addition of prehospital ACLS to BCLS was associated with a significant increase in the rate of prehospital ROSC in all patients experiencing OHCA (AOR = 3.92 [95% CI = 3.38-4.55], p prehospital BCLS. Delay from call to hospital arrival was longer in the ACLS group than in the BCLS group (difference = 16 minutes [95% CI = 15-16 minutes], p prehospital ACLS is not associated with an improvement in

  18. Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest.

    Science.gov (United States)

    Oh, HyunSoo; Lee, KangIm; Seo, WhaSook

    2016-05-01

    To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. A retrospective case-control study. The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest. © 2016 John Wiley & Sons Ltd.

  19. Genetic Testing in the Evaluation of Unexplained Cardiac Arrest: From the CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry).

    Science.gov (United States)

    Mellor, Greg; Laksman, Zachary W M; Tadros, Rafik; Roberts, Jason D; Gerull, Brenda; Simpson, Christopher S; Klein, George J; Champagne, Jean; Talajic, Mario; Gardner, Martin; Steinberg, Christian; Arbour, Laura; Birnie, David H; Angaran, Paul; Leather, Richard; Sanatani, Shubhayan; Chauhan, Vijay S; Seifer, Colette; Healey, Jeffrey S; Krahn, Andrew D

    2017-06-01

    Unexplained cardiac arrest may be because of an inherited arrhythmia syndrome. The role of genetic testing in cardiac arrest survivors without a definite clinical phenotype is unclear. The CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) is a large registry of cardiac arrest survivors where initial assessment reveals normal coronary arteries, left ventricular function, and resting ECG. Of 375 cardiac arrest survivors in CASPER from 2006 to 2015, 174 underwent genetic testing. Patients were classified as phenotype-positive (n=72) or phenotype-negative (n=102). Genetic testing was performed at treating physicians' discretion in line with contemporary guidelines and availability. All genetic variants identified from original laboratory reports were reassessed by the investigators in line with modern criteria. Pathogenic variants were identified in 29 (17%) patients (60% channelopathy-associated and 40% cardiomyopathy-associated genes) and 70 variants of unknown significance were identified in 32 (18%) patients. Prior syncope (odds ratio, 4.0; 95% confidence interval, 1.6-9.7) and a family history of sudden death (odds ratio, 3.2; 95% confidence interval, 1.1-9.4) were independently associated with the presence of a pathogenic variant. In phenotype-negative patients, broad multiphenotype genetic testing led to higher yields (21% versus 8%; P=0.04) but was associated with more variants of unknown significance (55% versus 5%; Pcardiac arrest survivors. Prior syncope and family history of sudden death are predictors of a positive genetic test. Both arrhythmia and cardiomyopathy genes are implicated. Broad, multiphenotype testing revealed the highest frequency of pathogenic variants in phenotype-negative patients. https://www.clinicaltrials.gov. Unique Identifier: NCT00292032. © 2017 American Heart Association, Inc.

  20. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline

  1. Causes of sudden cardiac arrest in young athletes.

    Science.gov (United States)

    Westrol, Michael S; Kapitanyan, Raffi; Marques-Baptista, Andreia; Merlin, Mark A

    2010-07-01

    Knowledge of sudden cardiac death in young athletes is imperative for all physicians and allied health professionals. The complete differential diagnosis of a young patient with sudden cardiac arrest will result in proper work-up and treatment. In this article, we review several etiologies of sudden cardiac death, including hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, Wolff-Parkinson-White syndrome, long QT syndrome, Brugada syndrome, and commotio cordis. Clinical findings, work-up, treatment, long-term management, and athlete preparticipation screening guidelines are discussed.

  2. Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest.

    Science.gov (United States)

    Lee, Christopher H; Van Gelder, Carin; Burns, Kevin; Cone, David C

    2009-01-01

    The application of Advanced Cardiac Life Support (ACLS) in severe hypothermic cardiac arrest remains controversial. While the induction of mild hypothermia has been shown to improve outcomes in patients already resuscitated from cardiac arrest, it is unknown whether ACLS protocols are effective during the resuscitation of the severely hypothermic cardiac arrest patient. We describe a case of a 47-year-old man who was successfully resuscitated from a ventricular fibrillation (VF) arrest with a core body temperature of 26.4 degrees C. The patient had been found unresponsive in a bathtub of cold water following an apparent suicide attempt. An incorrect pronouncement of death by the fire department delayed his transport to the hospital by more than four hours. Once in the emergency department (ED), the patient sustained a VF cardiac arrest and was successfully defibrillated using ACLS protocols. He ultimately survived his hospitalization with near-complete neurologic recovery. In this case report, we discuss the application of ACLS to the resuscitation of the hypothermic cardiac arrest patient as well as the issues involved in the prehospital determination of death.

  3. Sildenafil after cardiac arrest and infarction; an experimental rat model.

    Science.gov (United States)

    Mennander, Ari A; Vuohelainen, Vilma; Aanismaa, Riikka S; Narkilahti, Susanna; Paavonen, Timo; Tarkka, Matti

    2013-02-01

    Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We evaluated whether sildenafil, a phosphodiesterase-5 inhibitor, has an impact on recovery after cardiac arrest in a rat cardiac transplantation model. Sixty-one Fischer344 rats underwent syngeneic heterotopic cardiac transplantation after ischemia and ligation of the left anterior coronary artery of the heart to yield myocardial infarction (IRI + MI). Of these, 22 rats received subcutaneously injected sildenafil (1 mg/kg/day) (IRI +MI + S). Twenty-three additional grafted animals with transplantation only served as controls with ischemia reperfusion injury (IRI). After 2 days, immunohistochemistry for eNOS, and RT-PCR for iNOS and Aquaporin-7 were performed after graft harvesting and histology. Two days after transplantation, remote intramyocardial arteries were more preserved in IRI + MI + S as compared with IRI +MI and IRI (0.74 ± 0.14, 0.56 ± 0.23 and 0.55 ± 0.22, PSU, p cardiac arrest and ischemia.

  4. Factors Associated With Successful Resuscitation After Out-of-Hospital Cardiac Arrest and Temporal Trends in Survival and Comorbidity

    DEFF Research Database (Denmark)

    Søholm, Helle; Hassager, Christian; Lippert, Freddy

    2015-01-01

    STUDY OBJECTIVE: Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region. METHODS: We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted...... associated with outcome. RESULTS: Of a total of 2,527 attempted resuscitations in out-of-hospital cardiac arrest patients, 40% (n=1,015) were successfully resuscitated and admitted to the hospital. The strongest independent factors associated with successful resuscitation were shockable primary rhythm...... (multivariate odds ratio [OR]=3.9; 95% confidence interval [CI] 3.1 to 5.0), witnessed arrest (multivariate OR=3.5; 95% CI 2.7 to 4.6), and out-of-hospital cardiac arrest in a public area (multivariate OR=2.1; 95% CI 1.6 to 2.8), whereas no comorbidity (multivariate OR=1.1; 95% CI 0.8 to 1.45), sex...

  5. Cardiac arrest related to anaesthesia in Williams-Beuren syndrome.

    Science.gov (United States)

    Lucena Delgado, J; Sanabria Carretero, P; Durán la Fuente, P; Gónzalez Rocafort, A; Castro Parga, L; Reinoso Barbero, F

    2017-12-12

    Williams-Beuren syndrome is the clinical manifestation of a congenital genetic disorder in the elastin gene, among others. There is a history of cardiac arrest refractory to resuscitation manoeuvres in anaesthesia. The incidence of myocardial ischaemia is high during anaesthetic induction, but there are patients who do not have this condition yet also have had very serious cardiac events, and issues that are still to be resolved. Case descriptions will enable the common pathophysiological factors to be defined, and decrease morbidity and mortality. We report the case of a 3-year-old boy with cardiac arrest at induction, rescued with circulatory assistance with extracorporeal membrane oxygenation and hypothermia induced for cerebral protection. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Cardiac Arrest in a Heart Transplant Patient Receiving Dexmedetomidine During Cardiac Catheterization.

    Science.gov (United States)

    Schwartz, Lawrence Israel; Miyamoto, Shelley D; Stenquist, Scott; Twite, Mark David

    2016-06-01

    Dexmedetomidine is an α-2 agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic in pediatric cardiac patients. Cardiac transplant patients may suffer from acute cellular rejection of the cardiac conduction system and, therefore, are at an increased risk of the electrophysiological effect of dexmedetomidine. We present such a patient who had a cardiac arrest while receiving dexmedetomidine during cardiac catheterization. Because acute cellular rejection of the cardiac conduction system is difficult to diagnose, dexmedetomidine should be used with caution in pediatric heart transplant patients. © The Author(s) 2015.

  7. Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications.

    Science.gov (United States)

    Rosman, Lindsey; Whited, Amanda; Lampert, Rachel; Mosesso, Vincent N; Lawless, Christine; Sears, Samuel F

    2015-02-15

    Survival from cardiac arrest is a medical success but simultaneously produces psychological challenges related to perception of safety and threat. The current study evaluated symptoms of cardiac-specific anxiety in sudden cardiac arrest (SCA) survivors and examined predictors of cardiac anxiety secondary to cardiac arrest. A retrospective, cross-sectional study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry completed an online questionnaire that included a measure of cardiac anxiety (CAQ) and sociodemographic, cardiac history, and psychosocial adjustment data. CAQ scores were compared to published means from implantable cardioverter defibrillator (ICD), inherited long QT syndrome (LQTS), and hypertrophic cardiomyopathy (HCM) samples and a hierarchical regression was performed. Clinically relevant cardiac anxiety and cardioprotective behaviors were frequently endorsed and 18% of survivors reported persistent worry about their heart even when presented with normal test results. Compared to all other samples, SCA survivors reported significantly higher levels of heart-focused attention (d=0.3-1.1) and greater cardiac fear and avoidance behaviors than LQTS patients. SCA patients endorsed less severe fear and avoidance symptoms than the HCM sample. Hierarchical regression analyses revealed that younger age (p=0.02), heart murmur (p=0.02), history of ICD shock≥1 (p=0.01), and generalized anxiety (p=0.008) significantly predicted cardiac anxiety. The overall model explained 29.2% of the total variance. SCA survivors endorse high levels of cardiac-specific fear, avoidance and preoccupation with cardiac symptoms. Successful management of SCA patients requires attention to anxiety about cardiac functioning and security. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Location of cardiac arrest and impact of pre-arrest chronic disease and medication use on survival.

    Science.gov (United States)

    Granfeldt, Asger; Wissenberg, Mads; Hansen, Steen Møller; Lippert, Freddy K; Torp-Pedersen, Christian; Christensen, Erika Frischknecht; Christiansen, Christian Fynbo

    2017-05-01

    Cardiac arrest in a private location is associated with a higher mortality when compared to public location. Past studies have not accounted for pre-arrest factors such as chronic disease and medication. To investigate whether the association between cardiac arrest in a private location and a higher mortality can be explained by differences in chronic diseases and medication. We identified 27,771 out-of-hospital cardiac arrest patients ≥18 years old from the Danish Cardiac Arrest Registry (2001-2012). Using National Registries, we identified pre-arrest chronic disease and medication. To investigate the importance of cardiac arrest related factors and chronic disease and medication use we performed adjusted Cox regression analyses during day 0-7 and day 8-365 following cardiac arrest to calculate hazard ratios (HR) for death. Day 0-7: Un-adjusted HR for death day 0-7 was 1.21 (95%CI:1.18-1.25) in private compared to public location. When including cardiac arrest related factors HR for death was 1.09 (95%CI:1.06-1.12). Adding chronic disease and medication to the analysis changed HR for death to 1.08 (95%CI:1.05-1.12). 8-365 day: The un-adjusted HR for death day 8-365 was 1.70 (95% CI: 1.43-2.02) in private compared to public location. When including cardiac arrest related factors the HR decreased to 1.39 (95% CI: 1.14-1.68). Adding chronic disease and medication to the analysis changed HR for death to 1.27 (95% CI:1.04-1.54). The higher mortality following cardiac arrest in a private location is partly explained by a higher prevalence of chronic disease and medication use in patients surviving until day 8. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia.

    Science.gov (United States)

    Ahn, Shin; Lee, Byung Kook; Youn, Chun Song; Kim, Youn-Jung; Sohn, Chang Hwan; Seo, Dong-Woo; Kim, Won Young

    2017-04-07

    Neurologically intact survival after cardiac arrest is possible even after prolonged resuscitation efforts. However, the factors associated with good neurologic outcome in these patients remain unknown. This study identifies predictors associated with good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). This multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between 2007 and 2012 includes adult (≥18 years) non-traumatic OHCA patients with prolonged (>30 min) downtime who underwent TTM treatment. Good neurologic outcomes were defined as cerebral performance category scores of ≤2. Of the 930 comatose adult cardiac arrest patients treated with TTM, 423 patients with prolonged downtime were included. A total of 76 (18.0%) had good neurologic outcome. Multivariable analysis reveal that age good neurologic outcome. The sensitivity and specificity for good neurologic outcome in patients with age <65 years, shockable rhythm, and witnessed arrest are 90.8% and 41.2, 67.6 and 79.5%, and 81.6 and 41.2%, respectively. In prolonged cardiac arrest patients, initial shockable rhythm, age <65 years, or witnessed arrest are predictors for neurologic intact survival.

  10. A Unique Case of Cardiac Arrest following K2 Abuse

    Directory of Open Access Journals (Sweden)

    Saif Ibrahim

    2014-01-01

    Full Text Available Sudden cardiac death (SCD accounts for up to 450,000 deaths every year in the United States (Zipes et al. (2006. Most cases of sudden cardiac death occur in subjects with no prior history of heart disease (Myerburg et al. (1998. The incidence of sudden death in a general population has been shown to increase contemporaneously with substance abuse (Phillips et al. (1999. The causative association of sudden death with cocaine, methadone, and volatile agents is well established (Adgey et al. (1995 and Isner et al. (1986. We describe a case of out-of-hospital cardiac arrest temporally related to abuse of the synthetic cannabinoid street drug known as K2. To our knowledge, there are no previously documented cases of sudden cardiac death associated with synthetic cannabinoids although they have been linked to myocardial infarction in teenagers despite normal coronary angiography (Mir et al. (2011.

  11. Drugs in cardiac arrest: the rise and fall of antiarrhythmics.

    Science.gov (United States)

    Karlis, George; Afantenou, Sevasti

    2017-10-12

    Since the publication of 2000 guidelines for resuscitation, amiodarone is considered the antiarrhythmic drug of choice for refractory ventricular fibrillation/pulseless ventricular tachycardia. However, to date there is no proven benefit in terms of neurologically intact survival to hospital discharge. A comprehensive search of the recent literature on amiodarone, nifekalant and lidocaine in cardiac arrest was performed. Amiodarone and nifekalant are superior to lidocaine with regards to the return of spontaneous circulation and survival to hospital admission. Nifekalant shows a trend towards quicker termination of ventricular fibrillation compared to amiodarone. There is great uncertainty about the efficacy of antiarrhythmics in cardiac arrest. Failure to show improvements regarding meaningful survival questions their current use and suggests the need for re-evaluating their place in cardiopulmonary resuscitation.

  12. Cardiac arrest during a twin birth caesarean delivery.

    Science.gov (United States)

    Pampín-Huerta, F R; Moreira-Gómez, D; Lozano-Requelme, M L; Molina-Nieto, F; Fontán-García-Boente, L; Moreira-Pacheco, M

    2016-04-01

    The case of a 35 year-old pregnant woman with a right ovarian vein thrombosis complicated with a floating thrombus in the inferior vena cava reaching the right atrium, is presented. The patient had a cardiac arrest due to a pulmonary embolism during a twin-birth caesarean delivery. Discussion includes the pathophysiology of this condition and management options in a cardiac arrest secondary to this aetiology, recovered with stable blood pressure, highlighting the role of thrombolytic therapy in the Postoperative Care Unit in this situation. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. The inflammatory marker suPAR after cardiac arrest

    DEFF Research Database (Denmark)

    Rundgren, Malin; Lyngbaek, Stig; Fisker, Helle

    2015-01-01

    BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is released in response to inflammatory stimuli, and plasma levels are associated with long-term outcomes. The ischemia/reperfusion injury caused by cardiac arrest (CA) and resuscitation triggers an inflammatory response...... analysis shoved an AUC of 0.76 at 6 hours. In the subgroup of CA of cardiac cause, the AUC was 0.84. CONCLUSION: suPAR levels at 6 and 36 hours after CA were significantly higher in nonsurviving patients compared with survivors; however, the overlap in suPAR levels between the outcome groups...

  14. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Kragholm, Kristian; Wissenberg, Mads; Mortensen, Rikke N; Hansen, Steen M; Malta Hansen, Carolina; Thorsteinsson, Kristinn; Rajan, Shahzleen; Lippert, Freddy; Folke, Fredrik; Gislason, Gunnar; Køber, Lars; Fonager, Kirsten; Jensen, Svend E; Gerds, Thomas A; Torp-Pedersen, Christian; Rasmussen, Bodil S

    2017-05-04

    The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (Pthe rate of bystander defibrillation increased from 2.1% to 16.8% (Pthe rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (Pbystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were

  15. Brain injury following cardiac arrest: pathophysiology for neurocritical care.

    Science.gov (United States)

    Uchino, Hiroyuki; Ogihara, Yukihiko; Fukui, Hidekimi; Chijiiwa, Miyuki; Sekine, Shusuke; Hara, Naomi; Elmér, Eskil

    2016-01-01

    Cardiac arrest induces the cessation of cerebral blood flow, which can result in brain damage. The primary intervention to salvage the brain under such a pathological condition is to restore the cerebral blood flow to the ischemic region. Ischemia is defined as a reduction in blood flow to a level that is sufficient to alter normal cellular function. Brain tissue is highly sensitive to ischemia, such that even brief ischemic periods in neurons can initiate a complex sequence of events that may ultimately culminate in cell death. However, paradoxically, restoration of blood flow can cause additional damage and exacerbate the neurocognitive deficits in patients who suffered a brain ischemic event, which is a phenomenon referred to as "reperfusion injury." Transient brain ischemia following cardiac arrest results from the complex interplay of multiple pathways including excitotoxicity, acidotoxicity, ionic imbalance, peri-infarct depolarization, oxidative and nitrative stress, inflammation, and apoptosis. The pathophysiology of post-cardiac arrest brain injury involves a complex cascade of molecular events, most of which remain unknown. Many lines of evidence have shown that mitochondria suffer severe damage in response to ischemic injury. Mitochondrial dysfunction based on the mitochondrial permeability transition after reperfusion, particularly involving the calcineurin/immunophilin signal transduction pathway, appears to play a pivotal role in the induction of neuronal cell death. The aim of this article is to discuss the underlying pathophysiology of brain damage, which is a devastating pathological condition, and highlight the central signal transduction pathway involved in brain damage, which reveals potential targets for therapeutic intervention.

  16. Effect of donor cardiac arrest and arrest duration on outcomes of lung transplantation.

    Science.gov (United States)

    Mohite, Prashant N; Zych, Bartlomiej; Sabashnikov, Anton; Popov, Aron-Frederik; Garcia-Saez, Diana; Patil, Nikhil P; Koch, Achim; Zeriouh, Mohamed; Rahmanian, Parwis B; Dhar, Dhruva; Amrani, Mohamed; Bahrami, Toufan; DeRobertis, Fabio; Carby, Martin; Reed, Anna; Simon, Andre R

    2016-04-01

    Limited data are available about lung transplantation (LTx) from donors suffering cardiac arrest (CA) prior to actual donation. A retrospective analysis of LTx performed between January 2007 and September 2012 was done with the focus on CA in donors. The recipients were grouped depending on the history of donor CA and CA duration (downtime) as: No cardiac arrest ("NoCA"), CA downtime less than 20 min ("CA 20"). Early and mid-term outcomes after LTx were compared among the three groups. A total of 237 LTx were performed during the study period. One hundred eighty-eight patients received organs from "NoCA" donors, 25 from "CA 20" donors. There was a trend toward better overall cumulative survival in both CA groups (log rank p = 0.076) whereas the survival in the "CA > 20" group was significantly better than in the "NoCA" group in the subgroup analysis (log rank p = 0.045). Freedom from bronchiolitis obliterans syndrome (BOS) also increased with increase in CA duration, although it did not reach statistical significance. Transplantation of lungs from donors with a history of CA is safe and feasible. Longer duration of cardiac arrest may improve the outcomes after the LTx in terms of survival and freedom from BOS. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed

    2016-05-01

    Full Text Available The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR. It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk.

  18. Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes.

    Science.gov (United States)

    Joundi, Raed A; Rabinstein, Alejandro A; Nikneshan, Davar; Tu, Jack V; Fang, Jiming; Holloway, Robert; Saposnik, Gustavo

    2016-07-01

    Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes. Adjusted survival curves were computed, and hazard ratios for mortality at 30 days and 1 year were determined for cardiac arrest and other major outcomes. Among the 9019 patients with acute ischemic stroke, 352 had cardiac arrest, for an overall incidence of 3.9%. In a sensitivity analysis with palliative patients removed, the incidence of cardiac arrest was 2.5%. Independent predictors of cardiac arrest were as follows: older age, greater stroke severity, preadmission dependence, and a history of diabetes, myocardial infarction, congestive heart failure, and atrial fibrillation. Systemic complications associated with cardiac arrest were as follows: myocardial infarction, pulmonary embolism, sepsis, gastrointestinal hemorrhage, and pneumonia. Patients with cardiac arrest had higher disability at discharge, and a markedly increased 30-day mortality of 82.1% compared with 9.3% without cardiac arrest. Cardiac arrest had a high incidence and was associated with poor outcomes after ischemic stroke, including multiple medical complications and very high mortality. Predictors of cardiac arrest identified in this study could help risk stratify ischemic stroke patients for cardiac investigations and prolonged cardiac monitoring. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Is Ward Experience in Resuscitation Effort Related to the Prognosis of Unexpected Cardiac Arrest?

    Directory of Open Access Journals (Sweden)

    Sen-Kuang Hou

    2007-09-01

    Conclusion: Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.

  20. Prognostic Value of A Qualitative Brain MRI Scoring System After Cardiac Arrest

    NARCIS (Netherlands)

    Hirsch, Karen G.; Mlynash, Michael; Jansen, Sofie; Persoon, Suzanne; Eyngorn, Irina; Krasnokutsky, Michael V.; Wijman, Christine A. C.; Fischbein, Nancy J.

    2015-01-01

    BACKGROUND AND PURPOSETo develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice. METHODSConsecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored

  1. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    DEFF Research Database (Denmark)

    Dankiewicz, J; Nielsen, N; Annborn, M

    2015-01-01

    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) tria...

  2. Good quality of life before cardiac arrest predicts good quality of life after resuscitation.

    Science.gov (United States)

    Hellevuo, H; Sainio, M; Huhtala, H; Olkkola, K T; Tenhunen, J; Hoppu, S

    2018-01-07

    The survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome. All adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow-up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre-arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q 1 , Q 3 ]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest. Six months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow-up EuroQoL (EQ-5D) quality of life questionnaire. Median values for the EQ-5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ-5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0-1.3; P = 0.02). Quality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. Cardiac Arrest in a Pregnant Patient Diagnosed with Bochdalek Hernia

    Directory of Open Access Journals (Sweden)

    Pinar Karabacak

    2016-09-01

    Full Text Available Bochdalek hernia is thought to be the result of a defect of the pleuroperitoneal fold and the septum transversum fusion in the 8th week of gestation. The majority of these patients present with respiratory distress after delivery; asymptomatic progress until adulthood is an extremely rare clinical occurrence. The adult form of a Bochdalek hernia accompanying pregnancy is a rare entity. A 39-year-old, 24-week pregnant patient applied to Emergency service with epigastric pain and vomiting. Abdominal ultrasonography was planned due to the abdominal pain; sudden cardiopulmonary arrest occurred during the procedure. In this case report, congenital diaphragmatic hernia in a young pregnant woman who underwent cardiac arrest is presented.

  4. Cariporide for pharmacologic defibrillation after prolonged cardiac arrest.

    Science.gov (United States)

    Wann, Shue-ren; Weil, Max Harry; Sun, Shijie; Tang, Wanchun; Yu, Ting

    2002-07-01

    We hypothesized that cariporide, a sodium-hydrogen exchange inhibitor, would be as cardioprotective during the global myocardial ischemia of prolonged cardiac arrest as it is in settings of coronary occlusion. Fifteen Sprague-Dawley rats were randomized to receive bolus injections of cariporide or placebo in a dose of 3 mgxkg(-1) into the right atrium either 5 minutes before, or at 8 minutes after, onset of ventricular fibrillation. Ventricular fibrillation was electrically induced and untreated for 8 minutes. Precordial compression, together with mechanical ventilation, was then started and continued for an interval of 8 minutes prior to attempted resuscitation. All but one placebo-treated animal were successfully resuscitated. Spontaneous defibrillation with restoration of circulation was observed in both cariporide-pretreatment and post-treatment groups but in none of the placebo-treated animals. Postresuscitation cardiac index, end-tidal CO(2), mean aortic pressure, left ventricular systolic pressure, left ventricular end-diastolic pressure, and left ventricular contractile and lusitropic functions (dP/dt(40), and -dP/dt) were significantly less impaired after cariporide, especially in the pretreated group, compared to electrically defibrillated controls. Postresuscitation ventricular premature beats were significantly reduced after cariporide. The duration of post-resuscitation survival was significantly increased in animals pretreated with cariporide. Cariporide, when administered prior to and during cardiac arrest, improved both the success of resuscitation and postresuscitation myocardial function.

  5. Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)

    Science.gov (United States)

    2015-10-01

    Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) PRINCIPAL INVESTIGATOR...COVERED (From - To) 26 SEP 2014 – 25 SEP 2015 4. TITLE AND SUBTITLE Emergency Preservation and Resuscitation for Cardiac Arrest 5a. CONTRACT NUMBER From...study. It was felt that patients who arrive at the hospital with a pulse, but then develop cardiac arrest in the operating room, rather than in the

  6. Bispectral index monitoring is useless during cardiac arrest patients' resuscitation.

    Science.gov (United States)

    Chollet-Xémard, Charlotte; Combes, Xavier; Soupizet, François; Jabre, Patricia; Penet, Candice; Bertrand, Catherine; Margenet, Alain; Marty, Jean

    2009-02-01

    It has been suggested that out-of-hospital bispectral (BIS) index monitoring during advanced cardiac life support (ACLS) might provide an indication of cerebral resuscitation. The aims of our study were to establish whether BIS values during ACLS might predict return to spontaneous circulation, and whether BIS values on hospital admission might predict survival. This was a prospective observational study in 92 patients with cardiac arrest who received basic life support from a fire-fighter squad and ACLS on arrival of an emergency medical team on the scene. BIS values, electromyographic activity, and signal quality index were recorded throughout resuscitation and out-of-hospital management. Seven patients had recovered spontaneous cardiac activity by the time the medical team arrived on scene. Of the 92 patients, 62 patients died on scene and 30 patients returned to spontaneous cardiac activity and were admitted to hospital. The correlation between BIS values and end-tidal CO(2) during the first minutes of ACLS was poor (r(2)=0.02, P=0.19). Of the 30 admitted patients, 27 died. Three were discharged with no disabilities. There was no significant difference in BIS values on admission between the group of patients who died and the group who survived (P=0.78). Although BIS monitoring during resuscitation was not difficult, it did not predict return to spontaneous cardiac activity, nor survival after admission to intensive care. Its use to monitor cerebral function during ACLS is therefore pointless.

  7. Survey on current practices for neurological prognostication after cardiac arrest.

    Science.gov (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro

    2015-05-01

    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Cardiac Arrest Caused by Multiple Recurrent Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Kjartan Eskjaer Hannig

    2011-01-01

    Full Text Available Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1 The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2 The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3 Thrombolytic treatment should always be considered and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.

  9. [Cardiac arrest in newborn of mother treated with labetalol].

    Science.gov (United States)

    Sala, X; Monsalve, C; Comas, C; Botet, F; Nalda, M A

    1993-01-01

    The use of beta-adrenergic antagonists for the control of high blood pressure associated to pregnancy is frequent. Their use is related with the appearance of undesirable effects of the fetus. The case of neonatal cardiac arrest attributed, to the administration of labetalol to the mother is presented. The high transplacentary passage, the different pharmacokinetics of the drug in the newborn and the clinical evolution of the patient suggests its involvement. It is concluded that labetalol may cause severe undesirable effects in newborns and fetal heart rate of the mother and neonate should be monitored upon use of this drug.

  10. Advanced life support for cardiac arrest beyond the algorithm

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Isbye, Dan Lou; Pfeiffer, Peter

    2018-01-01

    circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial......In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous......, but are not supported by firm scientific evidence....

  11. Public access defibrillation—results from the Victorian Ambulance Cardiac Arrest Registry.

    Science.gov (United States)

    Lijovic, M; Bernard, S; Nehme, Z; Walker, T; Smith, K

    2014-12-01

    To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.

  12. Rates of organ donation in a UK tertiary cardiac arrest centre following out-of-hospital cardiac arrest.

    Science.gov (United States)

    Cheetham, Olivia V; Thomas, Matthew J C; Hadfield, John; O'Higgins, Fran; Mitchell, Claire; Rooney, Kieron D

    2016-04-01

    To ascertain the rate of successful organ donation (OD) within patients who sustained an out of hospital cardiac arrest (OHCA) with initial return of spontaneous circulation (ROSC) and survival to hospital admission, but whom subsequently do not survive to hospital discharge. A retrospective audit of ambulance service and hospital databases from January 2010 to January 2015 was undertaken in a United Kingdom tertiary-referral regional cardiac arrest centre. Crude denominator data for cardiac arrests was obtained from the regional ambulance service; the ICU database was interrogated for OHCA patient admissions and outcomes. Patients who died were cross-referenced against the local Organ Donation service database. Five hundred and fourteen {514} patients were admitted to ICU following OHCA over this five year period. Two hundred and forty-one {241} patients (47%) survived to hospital discharge and 273 (53%) died of whom 106 (39%) were referred to a Specialist Nurse for Organ Donation (SNOD). The conversion rate after the family was approached was 64%. Twenty-eight {28} patients proceeded to donation and 25 patients (24%) successfully donated at least one organ. On average, a patient proceeding to donation provided 1.9 organs. A proactive, systematic approach to OD in OHCA patients can provide a good conversion rate and substantial number of donors. Most donations occur after death from circulatory criteria. There is a positive socio-economic benefit with nearly £4m in savings to the health service within the next 5 years potentially being realised during this period by liberating patients from dialysis. Copyright © 2016. Published by Elsevier Ireland Ltd.

  13. Postoperative cardiac arrest after heart surgery: does extracorporeal perfusion support a paradigm change in management?

    Science.gov (United States)

    Gologorsky, Edward; Macedo, Francisco Igor B; Carvalho, Enisa M; Gologorsky, Angela; Ricci, Marco; Salerno, Tomas A

    2010-01-01

    Early institution of extracorporeal perfusion support (ECPS) may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU) following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes) advanced cardiac life support (ACLS) protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  14. Epidemiology and outcomes of cardiac arrest among children with Down Syndrome: a multicenter analysis.

    Science.gov (United States)

    Padiyath, Asif; Rettiganti, Mallikarjuna; Gossett, Jeffrey M; Tadphale, Sachin D; Garcia, Xiomara; Seib, Paul M; Gupta, Punkaj

    2017-06-01

    With the increasing prevalence of Down Syndrome, it is unknown if children with Down Syndrome are associated with increased incidence of cardiac arrest and poor outcomes after cardiac arrest. The objective of this study was to evaluate the epidemiology of cardiac arrest and mortality after cardiac arrest among critically ill children with and without Down Syndrome. Patients ≤18 years admitted at a Pediatric Health Information Systems (PHIS) participating Intensive Care Unit were included (2004-2014). Multivariable logistic regression models were fitted to evaluate association of Down Syndrome with study outcomes after adjusting for patient and center characteristics. A total of 849,250 patients from 44 centers were included. Of the 25,143 patients with Down Syndrome, cardiac arrest was noted among 568 (2.3%) patients with an associated mortality at hospital discharge of 248 (43.6%) patients. In contrast, of the 824,107 patients without Down Syndrome, cardiac arrest was noted among 15,822 (1.9%) patients with an associated mortality at hospital discharge of 7775 (49.1%) patients. In adjusted models, patients with Down Syndrome had a higher likelihood of having cardiac arrest as compared to patients without Down Syndrome (with vs. without Down, OR: 1.14, 95% CI: 1.03-1.25, P=0.01). Despite having a higher likelihood of cardiac arrest, patients with Down Syndrome were associated with a lower mortality after cardiac arrest (OR: 0.78, 95% CI: 0.63-0.96, P=0.02). Both incidence of cardiac arrest, and mortality at hospital discharge in those with cardiac arrest vary substantially in children with and without Down Syndrome.

  15. Electrophysiological Monitoring of Brain Injury and Recovery after Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Ruoxian Deng

    2015-10-01

    Full Text Available Reliable prognostic methods for cerebral functional outcome of post cardiac-arrest (CA patients are necessary, especially since therapeutic hypothermia (TH as a standard treatment. Traditional neurophysiological prognostic indicators, such as clinical examination and chemical biomarkers, may result in indecisive outcome predictions and do not directly reflect neuronal activity, though they have remained the mainstay of clinical prognosis. The most recent advances in electrophysiological methods—electroencephalography (EEG pattern, evoked potential (EP and cellular electrophysiological measurement—were developed to complement these deficiencies, and will be examined in this review article. EEG pattern (reactivity and continuity provides real-time and accurate information for early-stage (particularly in the first 24 h hypoxic-ischemic (HI brain injury patients with high sensitivity. However, the signal is easily affected by external stimuli, thus the measurements of EP should be combined with EEG background to validate the predicted neurologic functional result. Cellular electrophysiology, such as multi-unit activity (MUA and local field potentials (LFP, has strong potential for improving prognostication and therapy by offering additional neurophysiologic information to understand the underlying mechanisms of therapeutic methods. Electrophysiology provides reliable and precise prognostication on both global and cellular levels secondary to cerebral injury in cardiac arrest patients treated with TH.

  16. Variation in Out-of-Hospital Cardiac Arrest Management

    Directory of Open Access Journals (Sweden)

    Jason M. Jones

    2016-01-01

    Full Text Available Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA. Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%], and one-quarter underwent three or more attempts (25/77 [25%]. One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]. Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

  17. Measuring survival rates from sudden cardiac arrest: the elusive definition.

    Science.gov (United States)

    Sayre, Michael R; Travers, Andrew H; Daya, Mohamud; Greene, H Leon; Salive, Marcel E; Vijayaraghavan, Krishnaswami; Craven, Richard A; Groh, William J; Hallstrom, Alfred P

    2004-07-01

    Measuring survival from sudden out-of-hospital cardiac arrest (OOH-CA) is often used as a benchmark of the quality of a community's emergency medical service (EMS) system. The definition of OOH-CA survival rates depends both upon the numerator (surviving cases) and the denominator (all cases). The purpose of the public access defibrillation (PAD) trial was to measure the impact on survival of adding an automated external defibrillator (AED) to a volunteer response system trained in CPR. This paper reports the definition of OOH-CA developed by the PAD trial investigators, and it evaluates alternative statistical methods used to assess differences in reported "survival." Case surveillance was limited to the prospectively determined geographic boundaries of the participating trial units. The numerator in calculating a survival rate should include only those patients who survived an event but who otherwise would have died except for the application of some facet of emergency medical care-in this trial a defibrillatory shock. Among denominators considered were: total population of the study unit, all deaths within the study unit, and documented ventricular fibrillation cardiac arrests. The PAD classification focused upon cases that might have benefited from the early use of an AED, in addition to the likely benefit from early recognition of OOH-CA, early access of EMS, and early cardiopulmonary resuscitation (CPR). Results of this classification system were used to evaluate the impact of the PAD definition on the distribution of cardiac arrest case types between CPR only and CPR + AED units. Potential OOH-CA episodes were classified into one of four groups: definite, probable, uncertain, or not an OOH-CA. About half of cardiac arrests in the PAD units were judged to be definite OOH-CA events and therefore potentially treatable with an AED. However, events that occurred in CPR-only units were less likely to be classified as definite or probable OOH-CA events than those

  18. Cardiac arrest during gamete release in chum salmon regulated by the parasympathetic nerve system.

    Directory of Open Access Journals (Sweden)

    Yuya Makiguchi

    Full Text Available Cardiac arrest caused by startling stimuli, such as visual and vibration stimuli, has been reported in some animals and could be considered as an extraordinary case of bradycardia and defined as reversible missed heart beats. Variability of the heart rate is established as a balance between an autonomic system, namely cholinergic vagus inhibition, and excitatory adrenergic stimulation of neural and hormonal action in teleost. However, the cardiac arrest and its regulating nervous mechanism remain poorly understood. We show, by using electrocardiogram (ECG data loggers, that cardiac arrest occurs in chum salmon (Oncorhynchus keta at the moment of gamete release for 7.39+/-1.61 s in females and for 5.20+/-0.97 s in males. The increase in heart rate during spawning behavior relative to the background rate during the resting period suggests that cardiac arrest is a characteristic physiological phenomenon of the extraordinarily high heart rate during spawning behavior. The ECG morphological analysis showed a peaked and tall T-wave adjacent to the cardiac arrest, indicating an increase in potassium permeability in cardiac muscle cells, which would function to retard the cardiac action potential. Pharmacological studies showed that the cardiac arrest was abolished by injection of atropine, a muscarinic receptor antagonist, revealing that the cardiac arrest is a reflex response of the parasympathetic nerve system, although injection of sotalol, a beta-adrenergic antagonist, did not affect the cardiac arrest. We conclude that cardiac arrest during gamete release in spawning release in spawning chum salmon is a physiological reflex response controlled by the parasympathetic nervous system. This cardiac arrest represents a response to the gaping behavior that occurs at the moment of gamete release.

  19. Association between dental caries and out-of-hospital cardiac arrests of cardiac origin in Japan.

    Science.gov (United States)

    Suematsu, Yasunori; Miura, Shin-Ichiro; Zhang, Bo; Uehara, Yoshinari; Ogawa, Masahiro; Yonemoto, Naohiro; Nonogi, Hiroshi; Nagao, Ken; Kimura, Takeshi; Saku, Keijiro

    2016-04-01

    Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin, but not non-cardiac origin. We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient=0.22, p=0.14; OHCA of cardiac origin: r=0.25, p=0.09; OHCA of non-cardiac origin: r=-0.002, p=0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r=0.47, p<0.001; OHCA of cardiac origin: r=0.37, p=0.01; OHCA of non-cardiac origin: r=0.28, p=0.054). While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years. Copyright © 2015. Published by Elsevier Ltd.

  20. Midlife risk factor exposure and incidence of cardiac arrest depending on cardiac or non-cardiac origin.

    Science.gov (United States)

    Ohlsson, Marcus Andreas; Kennedy, Linn Maria Anna; Juhlin, Tord; Melander, Olle

    2017-08-01

    Little is known about midlife risk factors of future cardiac arrest. Our objective was to evaluate cardiovascular risk factors in midlife in relation to the risk of cardiac arrest (CA) of cardiac and non-cardiac origin later in life. We cross-matched individuals of the population based Malmö Diet and Cancer study (n=30,447) with the local CA registry of the city of Malmö. Baseline exposures were related to incident CA. During a mean follow-up of 17.6±4.6years, 378 CA occurred, of whom 17.2% survived to discharge. Independent midlife risk factors for CA of cardiac origin included coronary artery disease {HR 2.84 (1.86-4.34) (porigin. Independent midlife risk factors for CA of non-cardiac origin included obesity (BMI>30kg/m(2)) {HR 2.37 (1.51-3.71) (porigin. Whereas CA of cardiac origin is predicted by history of cardiovascular disease, dyslipidemia and diabetes mellitus, the main risk factors for CA of non-cardiac origin are obesity and hypertension. In addition to control of classical cardiovascular risk factors for prevention of CA, our results suggest that prevention of midlife obesity may reduce the risk of CA of non-cardiac origin. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  1. Increased cardiac arrest survival and bystander intervention in enclosed pedestrian walkway systems.

    Science.gov (United States)

    Lee, Minha; Demirtas, Derya; Buick, Jason E; Feldman, Michael J; Cheskes, Sheldon; Morrison, Laurie J; Chan, Timothy C Y

    2017-09-01

    Cities worldwide have underground or above-ground enclosed walkway systems for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrests (OHCAs). The characteristics and outcomes of OHCAs that occur in such systems are unknown. To determine whether OHCAs occurring in enclosed pedestrian walkway systems have differing demographics, prehospital intervention, and survival outcomes compared to the encompassing city, by examining the PATH walkway system in Toronto. We identified all atraumatic, public-location OHCAs in Toronto from April 2006 to March 2016. Exclusion criteria were obvious death, existing DNR, and EMS-witnessed OHCAs. OHCAs were classified into mutually exclusive location groups: Toronto, Downtown, and PATH-accessible. PATH-accessible OHCAs were those that occurred within the PATH system between the first basement and third floor. We analyzed demographic, prehospital intervention, and survival data using t-tests and chi-squared tests. We identified 2172 OHCAs: 1752 Toronto, 371 Downtown, and 49 PATH-accessible. Compared to Toronto, a significantly higher proportion of PATH-accessible OHCAs was bystander-witnessed (62.6% vs 83.7%, p=0.003), had bystander CPR (56.6% vs 73.5%, p=0.019), bystander AED use (11.0% vs 42.6%, pinfrastructure systems worldwide should consider these findings when determining AED placement and public engagement strategies. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study.

    Science.gov (United States)

    Balki, Mrinalini; Liu, Shiliang; León, Juan Andrés; Baghirzada, Leyla

    2017-03-01

    Cardiac arrest in pregnancy is a rare and devastating condition with high mortality and morbidity. The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, potential etiologies, and survival rates. This retrospective population-based study used hospitalization data from the discharge abstract database of the Canadian Institute for Health Information relating to obstetric deliveries in Canada from April 1, 2002, to March 31, 2015. The data were accessed through the Public Health Agency of Canada's (PHAC) Canadian Perinatal Surveillance System. Cases of cardiac arrest were identified using the diagnostic and intervention codes from the International Statistical Classification of Diseases and the Canadian Classification of Health Interventions, respectively. Data on patient demographics, medical and obstetrical conditions, and potential etiologies of cardiac arrest were collected. Multivariable logistic regression analysis was used to identify conditions associated with cardiac arrest. There were 286 cases of maternal cardiac arrest among 3,568,597 hospitalizations for delivery during the 13-year period. A total of 204 (71.3%) women survived to hospital discharge (95% confidence interval, 65.7%-76.5%). There was no significant variation in the incidence of cardiac arrest or survival from arrest over time or across provinces. Among the pre-existing conditions, hypertensive disorders of pregnancy, gestational diabetes, malignancy, and diseases of the respiratory and nervous system were found to be significantly associated with cardiac arrest. Among the obstetrical conditions, placental abnormalities and polyhydramnios were associated with cardiac arrest. The common potential etiologies included postpartum hemorrhage, heart failure, amniotic fluid embolism, and complications of anesthesia. In this first Canadian study, the incidence of cardiac arrest during

  3. Cardiac Arrest During Anaesthesia In Enugu Nigeria,1994-96 | Nze ...

    African Journals Online (AJOL)

    Aim: To determine the incidence and outcome of cardiac arrest during general anaesthesia at the University of Nigerian Teaching Hospital Enugu, Nigeria. Patient and Methods: A retrospective study of 6,450 anaesthetic charts from January 1994 to December1996 was undertaken. The cases where cardiac arrest box had ...

  4. Temporal differences in out-of-hospital cardiac arrest incidence and survival

    DEFF Research Database (Denmark)

    Bagai, Akshay; McNally, Bryan F.; Al-Khatib, Sana M.

    2013-01-01

    Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care.......Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care....

  5. Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

    DEFF Research Database (Denmark)

    Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K

    2004-01-01

    To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

  6. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

    NARCIS (Netherlands)

    M.G. van Vledder (Mark); O.J.F. van Waes (Oscar); Kooij, F.O. (Fabian O.); Peters, J.H. (Joost H.); E.M.M. van Lieshout (Esther); M.H.J. Verhofstad (Michiel)

    2017-01-01

    textabstractIntroduction: Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and

  7. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

    NARCIS (Netherlands)

    van Vledder, Mark G.; van Waes, Oscar J. F.; Kooij, Fabian O.; Peters, Joost H.; van Lieshout, Esther M. M.; Verhofstad, Michael H. J.

    2017-01-01

    Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and thoracotomy, some have advocated

  8. The science of reperfusion injury post cardiac arrest--Implications for emergency nurses.

    Science.gov (United States)

    Baker, Edward; Lee, Geraldine

    2016-01-01

    Survival following cardiac arrest in the developed world remains below 10%. In those who survive the initial cardiac arrest, prognosis remains poor due to the onset of multi-organ failure with both significant cardiac and neurological dysfunction. Nurses have demonstrated good understanding of cardiac arrest/post arrest guidelines and have good technical skills but deficits remain in their understanding of pathophysiological processes involved in post cardiac arrest syndromes. This article aims to provide an overview of these pathophysiological processes involved in the post cardiac arrest phase, potential treatment options and the nursing interventions that may be required within the emergency department setting. This article will focus emergency nurses to become more involved in patient management at this critical phase of treatment and highlight potential early signs of deterioration. Although return of spontaneous circulation (ROSC) is crucial in the process of recovery from cardiac arrest, it is only the first of many complex stages. Given the complexity of post cardiac arrest syndrome and its impact on the patient, healthcare professionals need to understand the cellular changes associated with reperfusion injuries in order to improve outcomes. It is only through effective nursing care and medical management that improved outcomes will become more common in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Comparable Outcome of Out-of-Hospital Cardiac Arrest and In-Hospital Cardiac Arrest Treated With Extracorporeal Life Support.

    Science.gov (United States)

    Ellouze, Omar; Vuillet, Melitine; Perrot, Justine; Grosjean, Sandrine; Missaoui, Anis; Aho, Serge; Malapert, Ghislain; Bouhemad, Belaid; Bouchot, Oliver; Girard, Claude

    2017-09-06

    Extracorporeal life support (ECLS) has shown benefits in the management of refractory in-hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  10. Editor's Choice-Extracorporeal life support for out-of-hospital cardiac arrest: Part of a treatment bundle.

    Science.gov (United States)

    Lazzeri, Chiara; Valente, Serafina; Peris, Adriano; Gensini, Gian Franco

    2016-12-01

    In recent years, an increasing number of papers have been published on the use of extracorporeal cardiopulmonary resuscitation (ECPR) in adult patients, but, although promising results have been reported in patients with in-hospital refractory cardiac arrest supported by extracorporeal life support (ECLS), data on patients with out-of-hospital (OHCA) cardiac arrest are scarce and conflicting. The present study aims at summarizing the available evidence on the use of ECPR in adult patients with OHCA, clinically focusing on the factors most often associated with outcome in these patients. Even in the absence of randomized trials, there is growing evidence from ECLS centers documenting sound clinical benefits of ECPR in selected OHCA. According to the available evidence, three factors seem to contribute strongly to the favorable outcome of ECLS supported OHCA patients: (a) selection of patients (mainly definition of age range and a witnessed cardiac arrest); (b) the availability of an ECLS team, well skilled and experienced (to reduce time of implantation and incidence of complications); (c) a multifaceted approach to the OHCA patient (the so-called ECLS-bundle) to treat the reversible cause of CA (i.e. percutaneous coronary intervention), ensure neuroprotection (hypothermia), and maintain organ perfusion (till recovery). Taking into account the promising results of ECPR in selected OHCA patients, there is a clinical need for shared protocols to reduce differences related to the center experience and mostly to increase availability of ECLS as part of a multifaceted approach for these patients. © The European Society of Cardiology 2015.

  11. [Factors predicting survival of out-of-hospital cardiac arrest managed with semiautomatic external defibrillators in Galicia].

    Science.gov (United States)

    Soto-Araujo, Lorena; Costa-Parcero, Manuel; González-González, María Dolores; Sánchez-Santos, Luis; Iglesias-Vázquez, José Antonio; Rodríguez-Núñez, Antonio

    2015-10-01

    To determine prognostic factors in out-of-hospital cardiac arrests managed with semiautomatic external defibrillators (SAEDs) by emergency health service responders in Galicia, Spain. Retrospective descriptive study of out-of-hospital cardiac arrests treated with SAEDs over a period of 5 years. We collected Utstein outcome data from the database and analyzed the following variables: sex, age, date and time of cardiac event, rural vs urban setting, type of location, witnessed or not, bystander resuscitation attempts or not, time first heart rhythm was detected, use of orotracheal intubation or not, time of call for help, and time to arrival of emergency responders. We analyzed 2005 cases (0.14/1000 person-years; 68.2% male, 70.8% in rural locations, 61% at home). Return of spontaneous circulation (ROSC) was achieved in situ in 10.9% (in 29.9% of patients with shockable rhythms and in 3.3% of those in asystole). Intubation was necessary in 15.7%; ROSC was achieved in 24.8% of the intubated patients. ROSC was achieved in significantly more patients when responders arrived soon after the call for help (mean: 12 minutes, 26 seconds) than when arrival was delayed (mean: 16 minutes, 16 seconds when ROSC was not achieved; PGalicia were the presence of a shockable rhythm, shorter response time, continuation of basic life support measures including advanced airway management, bystander life-support maneuvers, an urban location, and night timing of the arrest.

  12. Prehospital predictors of neurological outcomes in out-of-hospital cardiac arrest patients aged 95 years and older: A nationwide population-based observational study.

    Science.gov (United States)

    Funada, Akira; Goto, Yoshikazu; Maeda, Tetsuo; Tada, Hayato; Teramoto, Ryota; Tanaka, Yoshihiro; Hayashi, Kenshi; Yamagishi, Masakazu

    2017-01-01

    Population aging has rapidly progressed in Japan. However, few data exist regarding the characteristics of extremely elderly patients with out-of-hospital cardiac arrest (OHCA). We aimed to determine the prehospital predictors of one-month survival with favorable neurological outcomes (Cerebral Performance Category scale, category 1 or 2; CPC 1-2) in this population. We investigated 23,520 OHCA patients aged ≥95 years from a prospectively recorded, nationwide, Utstein-style Japanese database between 2008 and 2012. The primary study endpoint was one-month CPC 1-2 after OHCA. The one-month CPC 1-2 rate was 0.27% (63/23,520). Only two variables were significantly associated with one-month CPC 1-2 in a multivariate logistic regression model: prehospital return of spontaneous circulation (ROSC) [adjusted odds ratio (aOR), 94.4; 95% confidential interval (CI), 50.1-191.7] and emergency medical service (EMS)-witnessed arrest (aOR, 5.1; 95% CI, 2.6-10.2). When stratified by these two predictors, the one-month CPC 1-2 rates were 20.2% (18/89) for patients who had both prehospital ROSC and EMS-witnessed arrest, 4.2% (33/783) for those who had prehospital ROSC without EMS-witnessed arrest, 0.28% (3/1065) for those who had EMS-witnessed arrest without prehospital ROSC, and 0.04% (9/21,583) for those who had neither predictor, respectively. The crucial prehospital predictors for one-month CPC 1-2 in elderly OHCA patients aged ≥95 years in Japan were prehospital ROSC and EMS-witnessed arrest and the former was the predominant predictor. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. Outdoor air pollution and out-of-hospital cardiac arrest in Okayama, Japan.

    Science.gov (United States)

    Yorifuji, Takashi; Suzuki, Etsuji; Kashima, Saori

    2014-10-01

    We evaluated the association between short-term exposure to outdoor air pollution and out-of-hospital cardiac arrest in Japan. We studied 558 residents of Okayama, Japan, who visited hospital emergency departments between January 2006 and December 2010 for out-of-hospital cardiac arrest using a time-stratified case-crossover design. We calculated city-representative average concentrations of different air pollutants and examined the association between air pollution and cardiac arrest. Exposure to air pollution was associated with an elevated risk of cardiac arrest; for example, odds ratios was 1.17 (95% confidence interval, 1.02 to 1.33) per interquartile-range increase in suspended particulate matter concentrations in the previous 48 to 72 hours. We also observed different susceptibilities to suspended particulate matter and ozone exposures by age category. Short-term exposure to outdoor air pollution was associated with increased risk of cardiac arrest.

  14. A standardized Code Blue Team eliminates variable survival from in-hospital cardiac arrest.

    Science.gov (United States)

    Qureshi, Sultana A; Ahern, Terence; O'Shea, Ryan; Hatch, Lorien; Henderson, Sean O

    2012-01-01

    Recent studies suggest that time of day affects survival from in-hospital cardiac arrest. Lower survival rates are observed during nights and on weekends, except in areas with consistent physician care, such as the Emergency Department. Since 1997, our hospital has utilized a standard, hospital-wide "Code Blue Team" (CBT) to respond to cardiac arrests at any time. This team is always led by an emergency physician, and includes specially trained nurses. To assess if time of day or week affects survival from in-hospital cardiac arrest when a trained, consistent, emergency physician-led CBT is implemented. This is an analysis of prospectively collected data on initial survival rates (return of spontaneous circulation >20 min) of all cardiac arrests that were managed by the CBT from 2000 to 2008. Cardiac arrests were also subcategorized based on initial cardiac rhythm. Survival rates were compared according to time of day or week. A total of 1692 cardiac arrests were included. There was no significant difference in the overall rate of initial survival between day/evening vs. night hours (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.83-1.29), or between weekday vs. weekend hours (OR 1.10, 95% CI 0.85-1.38). This held true for all cardiac rhythms. At our institution, there is no significant difference in survival from cardiac arrest when a standardized "Code Blue Team" is utilized, regardless of the time of day or week. Copyright © 2012. Published by Elsevier Inc.

  15. Impact of initial intervention on long-term neurological recovey after cardiac arrest: data from the Luxembourg "North Pole" cohort.

    Science.gov (United States)

    Stammet, P; Collas, D; Werer, C; Muenster, L; Clarens, C; Wagner, D

    2012-01-01

    Prognosis after cardiac arrest is variable and difficult to predict. Early prognostic markers would facilitate the care of these patients. Therefore, we evaluated the impact of initial interventions after resuscitation on neurological outcome at 6 months. We conducted a retrospective analysis of the patient charts from consecutive cardiac arrest patients admitted to our intensive care unit and treated with induced hypothermia. Over a 3-year period, 90 patients were included in our study. Sixty-four percent of the patients had bystander cardio-pulmonary resuscitation. An automated external defibrillator (AED) was used in 19% of the patients and the mean time to first defibrillation was 11 +/- 8.9 minutes. Patients being resuscitated and defibrillated by bystanders did better than those who had CPR only and far better than those patients in whom no rescue measures where attempted at all (73% vs. 56% vs. 32% for good neurological outcome, respectively, p= 0.03). Witnessed cardiac arrest was more frequent in patients with a good outcome than in those who collapsed without a witness (91% vs 75%, p = 0.03). In 76% of the patients with good outcome, CPR was performed whereas only 52% benefited from these measures in the bad outcome group (p = 0.01). Although the use of an AED was not significantly different between good and bad outcome groups (26% vs. 11%, p = 0.06), time to first defibrillation was significantly lower in patients with good outcome (8.7 +/- 6.3 vs. 13.3 +/- 11.3 minutes, p = 0.05). In the 17 patients in whom an AED was used, 12 (71%) recovered without major sequelae whereas in the 73 cases where no AED was used, only 34 (47%) had a good outcome (p = 0.06). At 6 months follow-up, 46 (51%) survivors had a good outcome (cerebral performance category 1-2), 5 (6%) survived with severe neurological sequelae or stayed in coma and 39 (43%) died. Our local data confirm that early interventions have a major impact on survival of cardiac arrest patients. Efforts

  16. The Involvement of Danger-Associated Molecular Patterns in the Development of Immunoparalysis in Cardiac Arrest Patients

    NARCIS (Netherlands)

    Timmermans, K.; Kox, M.; Gerretsen, J.; Peters, E.; Scheffer, G.J.; Hoeven, J.G. van der; Pickkers, P.; Hoedemaekers, C.W.E.

    2015-01-01

    OBJECTIVES: After cardiac arrest, patients are highly vulnerable toward infections, possibly due to a suppressed state of the immune system called "immunoparalysis." We investigated if immunoparalysis develops following cardiac arrest and whether the release of danger-associated molecular patterns

  17. Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime, and Weekends

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Wissenberg, Mads; Weeke, Peter

    2013-01-01

    BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994...

  18. Dexmedetomidine Related Bradycardia Leading to Cardiac Arrest in a Dog

    Directory of Open Access Journals (Sweden)

    C. Y. Chen2, K-S. Chen1,2, K. M. Chang2, W. M. Lee1,2, S. C. Chang1,2 and H. C. Wang1,2

    2012-10-01

    Full Text Available A 2-year-old, mixed breed female dog (16 kg underwent an exploratory laparotomy following ultrasonographic diagnosis of foreign body and a segment of small intestine intussusceptions. The patient was classified as an ASA II. Ketamine (1mg/kg, IV, and dexmedetomidine (2.5 µg/kg, IV, and morphine (0.6 mg/kg, SC were given as anesthetic premedication. Propofol (0.1 mg/kg, IV titrated to a total amount of 4 ml (2.5 mg/ kg was given for intubation. Asystole was occurred. Cardiac resuscitation was then conducted immediately. Atipamezole (0.1 ml was injected, but showed no response on ECG. Atropine (0.02 mg/kg was then injected, and a second dosage was given. Two-three mins later, the heart rate at 84 beats/min. The NIBP showed 203/132 with MAP 153 mmHg, and the SpO2 showed 95% after the cardiac function was regained. Dexmedetomidine related bradycardia leading to cardiac arrest has been suggested in this case.

  19. Hospital Variation in Survival After Pediatric In-Hospital Cardiac Arrest

    Science.gov (United States)

    Jayaram, Natalie; Spertus, John A.; Nadkarni, Vinay; Berg, Robert A.; Tang, Fengming; Raymond, Tia; Guerguerian, Anne-Marie; Chan, Paul S.

    2014-01-01

    Background Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods and Results Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,551 cardiac arrests in children (cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases. A total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute non-stroke neurologic event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 30 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 24%–42%; range: 0%–61%). After risk-standardization, the range of hospital survival rates narrowed (median, 37%; IQR: 33%–38%; range: 29%– 48%), but variation in survival persisted. Conclusion Using a national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. After risk-standardization, significant variation in survival rates across hospitals remained. Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest. PMID:24939940

  20. Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest.

    Science.gov (United States)

    Girotra, Saket; Chan, Paul S; Bradley, Steven M

    2015-12-01

    Cardiac arrest is a leading cause of death in developed countries. Although a majority of cardiac arrest patients die during the acute event, a substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-cardiac arrest syndrome. There is growing recognition that integrated post-resuscitation care, which encompasses targeted temperature management (TTM), early coronary angiography and comprehensive critical care, can improve patient outcomes. TTM has been shown to improve survival and neurological outcome in patients who remain comatose especially following out-of-hospital cardiac arrest due to ventricular arrhythmias. Early coronary angiography and revascularisation if needed may also be beneficial during the post-resuscitation phase, based on data from observational studies. In addition, resuscitated patients usually require intensive care, which includes mechanical ventilator, haemodynamic support and close monitoring of blood gases, glucose, electrolytes, seizures and other disease-specific intervention. Efforts should be taken to avoid premature withdrawal of life-supporting treatment, especially in patients treated with TTM. Given that resources and personnel needed to provide high-quality post-resuscitation care may not exist at all hospitals, professional societies have recommended regionalisation of post-resuscitation care in specialised 'cardiac arrest centres' as a strategy to improve cardiac arrest outcomes. Finally, evidence for post-resuscitation care following in-hospital cardiac arrest is largely extrapolated from studies in patients with out-of-hospital cardiac arrest. Future studies need to examine the effectiveness of different post-resuscitation strategies, such as TTM, in patients with in-hospital cardiac arrest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Out of hospital cardiac arrest outside home in Sweden, change in characteristics, outcome and availability for public access defibrillation.

    Science.gov (United States)

    Ringh, Mattias; Herlitz, Johan; Hollenberg, Jacob; Rosenqvist, Mårten; Svensson, Leif

    2009-04-17

    A large proportion of patients who suffer from out of hospital cardiac arrest (OHCA) outside home are theoretically candidates for public access defibrillation (PAD). We describe the change in characteristics and outcome among these candidates in a 14 years perspective in Sweden. All patients who suffered an OHCA in whom cardiopulmonary resuscitation (CPR) was attempted between 1992 and 2005 and who were included in the Swedish Cardiac Arrest Register (SCAR). We included patients in the survey if OHCA took place outside home excluding crew witnessed cases and those taken place in a nursing home. 26% of all OHCAs (10133 patients out of 38710 patients) fulfilled the inclusion criteria. Within this group, the number of patients each year varied between 530 and 896 and the median age decreased from 68 years in 1992 to 64 years in 2005 (p for trend = 0.003). The proportion of patients who received bystander CPR increased from 47% in 1992 to 58% in 2005 (p for trend defibrillation among witnessed cases was 12 min in 1992 and 10 min in 2005 (p for trend = 0.029). Survival to one month among all patients increased from 8.1% to 14.0% (p for trend = 0.01). Among patients found in a shockable rhythm survival increased from 15.3% in 1992 to 27.0% in 2005 (p for trend defibrillation changed only moderately.

  2. Partners in Crime in the Setting of Recurring Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Lida P. Papavasileiou

    2011-01-01

    Full Text Available No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  3. Partners in crime in the setting of recurring cardiac arrest.

    Science.gov (United States)

    Papavasileiou, Lida P; Forleo, Giovanni B; Santini, Luca; Martuscelli, Eugenio; Romeo, Francesco

    2011-03-03

    No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  4. Out-of-hospital cardiac arrests in children and adolescents

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik

    2015-01-01

    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young...... population. METHODS: All OHCA patients in Denmark, ≤21 years of age, were identified from 2001 to 2010. The population was divided into infants (children (1-5 years); school children (6-15 years); and high school adolescents/young adults (16-21 years). Multivariate logistic regression...... analyses were used to investigate associations between pre-hospital factors and study endpoints: return of spontaneous circulation and survival. RESULTS: A total of 459 individuals were included. Overall incidence of OHCA was 3.3 per 100,000 inhabitants per year. The incidence rates for infants, pre...

  5. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  6. Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia.

    Science.gov (United States)

    Rosell-Ortiz, F; Mellado-Vergel, F J; López-Messa, J B; Fernández-Valle, P; Ruiz-Montero, M M; González-Lobato, I; Martínez-Lara, M; Vergara-Pérez, S; Vivar-Díaz, I; García-Alcántara, Á; García del Águila, J

    2016-04-01

    Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. Pre-hospital Care. The study included patients aged 0-15 years between January 2008 and December 2012. Patients follow up. Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. Of 5069 patients included in the register, 125 (2.5%) were aged ≤15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  7. The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Ewy, Gordon A; Bobrow, Bentley J; Chikani, Vatsal; Sanders, Arthur B; Otto, Charles W; Spaite, Daniel W; Kern, Karl B

    2015-11-01

    Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial. To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS). A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome. Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92-0.97). The AATI had no significant effect on good neurological outcome (OR=0.96, 95% CI=0.90-1.02). In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI). Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  8. Detection of Pulmonary Embolism During Cardiac Arrest-Ultrasonographic Findings Should Be Interpreted With Caution.

    Science.gov (United States)

    Aagaard, Rasmus; Caap, Philip; Hansson, Nicolaj C; Bøtker, Morten T; Granfeldt, Asger; Løfgren, Bo

    2017-07-01

    The aim of this study was to test the hypothesis that the right ventricle is more dilated during resuscitation from cardiac arrest caused by pulmonary embolism, compared with hypoxia and primary arrhythmia. Twenty-four pigs were anesthetized and cardiac arrest was induced using three different methods. Pigs were resuscitated after 7 minutes of untreated cardiac arrest. Ultrasonographic images were obtained and the right ventricular diameter was measured. University hospital animal laboratory. Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). Pigs were randomly assigned to cardiac arrest induced by pulmonary embolism, hypoxia, or primary arrhythmia. There was no difference at baseline. During induction of cardiac arrest, the right ventricle dilated in all groups (p cardiac ultrasonography were able to detect a difference in right ventricle diameter of approximately 10 mm with a sensitivity of 79% (95% CI, 64-94) and a specificity of 68% (95% CI, 56-80). The right ventricle was more dilated during resuscitation when cardiac arrest was caused by pulmonary embolism compared with hypoxia and primary arrhythmia. However, the right ventricle was dilated, irrespective of the cause of arrest, and diagnostic accuracy by physicians with basic training in focused cardiac ultrasonography was modest. These findings challenge the paradigm that right ventricular dilatation on ultrasound during cardiopulmonary resuscitation is particularly associated with pulmonary embolism.

  9. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  10. Organisation of in-hospital cardiac arrest teams - a nationwide study.

    Science.gov (United States)

    Lauridsen, Kasper Glerup; Schmidt, Anders Sjørslev; Adelborg, Kasper; Løfgren, Bo

    2015-04-01

    In-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks. To describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks. A nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks were collected from protocols on resuscitation required for hospital accreditation in Denmark. Additional data were collected through telephone interviews and email correspondence. Psychiatric hospitals and hospitals serving outpatients only were excluded. Data on the cardiac arrest team were available from 44 of 47 hospitals. The median team size was 5 (25th percentile; 75th percentile: 4; 6) members. Teams included a nurse anaesthetist (100%), a medical house officer (82%), an orderly (73%), an anaesthesiology house officer (64%) and a medical assistant (20%). Less likely to participate was a cardiology house officer (23%) or a cardiology specialist registrar (5%). Overall, a specialist registrar was represented on 20% of teams and 20% of cardiac arrest teams had a different team composition during nights and weekends. In total, 41% of teams did not define a team leader pre-arrest, and the majority of the teams did not define the tasks of the remaining team members. In Denmark, there are major differences among cardiac arrest teams. This includes team size, profession of team members, medical specialty and seniority of the physicians. Nearly half of the hospitals do not define a cardiac arrest team leader and the majority do not define the tasks of the remaining team members. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology.

    Science.gov (United States)

    Rajan, Shahzleen; Folke, Fredrik; Hansen, Steen Møller; Hansen, Carolina Malta; Kragholm, Kristian; Gerds, Thomas A; Lippert, Freddy K; Karlsson, Lena; Møller, Sidsel; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian; Wissenberg, Mads

    2017-05-01

    Knowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent. We studied 13,860 patients with presumed cardiac-caused OHCA not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005-2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify predictors of rhythm conversion and to compute 30-day survival chances. Twenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were significantly associated with conversion to shockable rhythm, while psychiatric- and chronic obstructive pulmonary disease were significantly associated with sustained non-shockable rhythm. Compared to sustained non-shockable rhythms, converted shockable rhythms and initial shockable rhythms were significantly associated with increased 30-day survival (Adjusted odds ratio (OR) 2.6, 95% confidence interval (CI): 1.8-3.8; and OR 16.4, 95% CI 12.7-21.2, respectively). From 2005 to 2012, 30-day survival chances increased significantly for all three groups: shockable rhythms, from 16.3% (CI: 14.2%-18.7%) to 35.7% (CI: 32.5%-38.9%); converted rhythms, from 2.1% (CI: 1.6%-2.9%) to 5.8% (CI: 4.4%-7.6%); and sustained non-shockable rhythms, from 0.6% (CI: 0.5%-0.8%) to 1.8% (CI: 1.4%-2.2%). Converting to shockable rhythm during resuscitation attempt was common and associated with nearly a three-fold higher odds of 30-day survival compared to sustained non-shockable rhythms. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Ethical dilemmas during cardiac arrest incidents in the patient's home.

    Science.gov (United States)

    Karlsson, Mattias; Karlsson, Niclas; Hilli, Yvonne

    2017-01-01

    The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical considerations: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

  13. Out of hospital cardiac arrest outside home in Sweden, change in characteristics, outcome and availability for public access defibrillation

    Directory of Open Access Journals (Sweden)

    Rosenqvist Mårten

    2009-04-01

    Full Text Available Abstract Background A large proportion of patients who suffer from out of hospital cardiac arrest (OHCA outside home are theoretically candidates for public access defibrillation (PAD. We describe the change in characteristics and outcome among these candidates in a 14 years perspective in Sweden. Methods All patients who suffered an OHCA in whom cardiopulmonary resuscitation (CPR was attempted between 1992 and 2005 and who were included in the Swedish Cardiac Arrest Register (SCAR. We included patients in the survey if OHCA took place outside home excluding crew witnessed cases and those taken place in a nursing home. Results 26% of all OHCAs (10133 patients out of 38710 patients fulfilled the inclusion criteria. Within this group, the number of patients each year varied between 530 and 896 and the median age decreased from 68 years in 1992 to 64 years in 2005 (p for trend = 0.003. The proportion of patients who received bystander CPR increased from 47% in 1992 to 58% in 2005 (p for trend The median time from cardiac arrest to defibrillation among witnessed cases was 12 min in 1992 and 10 min in 2005 (p for trend = 0.029. Survival to one month among all patients increased from 8.1% to 14.0% (p for trend = 0.01. Among patients found in a shockable rhythm survival increased from 15.3% in 1992 to 27.0% in 2005 (p for trend Conclusion In Sweden, there was a change in characteristics and outcome among patients who suffer OHCA outside home. Among these patients, bystander CPR increased, but the occurrence of VF decreased. One-month survival increased moderately overall and highly significantly among patients found in VF, even though the time to defibrillation changed only moderately.

  14. Family Burden After Out-of-Hospital Cardiac Arrest in Children.

    Science.gov (United States)

    Meert, Kathleen L; Slomine, Beth S; Christensen, James R; Telford, Russell; Holubkov, Richard; Dean, J Michael; Moler, Frank W

    2016-06-01

    To describe family burden among caregivers of children who survived out-of-hospital cardiac arrest and who were at high risk for neurologic disability and examine relationships between family burden, child functioning, and other factors during the first year post arrest. Secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. Thirty-six PICUs in the United States and Canada. Seventy-seven children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial who had normal prearrest neurologic functioning and were alive 1 year post arrest. Family burden was assessed using the Infant Toddler Quality of Life Questionnaire for children less than 5 years old and the Child Health Questionnaire for children 5 years old or older at baseline (reflecting prearrest status), 3 months, and 12 months post arrest. Child functioning was assessed using the Vineland Adaptive Behavior Scale II, the Pediatric Overall Performance Category, and Pediatric Cerebral Performance Category scales and caregiver perception of global functioning. Fifty-six children (72.7%) were boys, 48 (62.3%) were whites, and 50 (64.9%) were less than 5 years old prior to out-of-hospital cardiac arrest. Family burden at baseline was not significantly different from reference values. Family burden was increased at 3 and 12 months post arrest compared with reference values (p family burden all measured 3 months post arrest were associated with higher family burden 12 months post arrest (p family burden 12 months post arrest. Families of children who survive out-of-hospital cardiac arrest and have high risk for neurologic disability often experience substantial burden during the first year post arrest. The extent of child dysfunction 3 months post arrest is associated with family burden at 12 months.

  15. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were.......17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs....

  16. Hospital discharge diagnoses of ventricular arrhythmias and cardiac arrest were useful for epidemiologic research

    DEFF Research Database (Denmark)

    De Bruin, M L; van Hemel, N M; Leufkens, H G M

    2005-01-01

    OBJECTIVE: We investigated the validity of hospital discharge diagnosis regarding ventricular arrhythmias and cardiac arrest. METHODS: We identified patients whose record in the PHARMO record linkage system database showed a code for ventricular or unspecified cardiac arrhythmias according to cod...... according to ICD-9-CM as paroxysmal ventricular tachycardia, ventricular fibrillation, ventricular flutter, ventricular premature beats, or cardiac arrest) have a high PPV and are useful for selecting events in epidemiological studies on drug-induced arrhythmias....

  17. Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study.

    Science.gov (United States)

    Kitamura, Tetsuhisa; Kiyohara, Kosuke; Sakai, Tomohiko; Iwami, Taku; Nishiyama, Chika; Kajino, Kentaro; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Katayama, Yusuke; Yoshiya, Kazuhisa; Shimazu, Takeshi

    2014-12-22

    To evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin. A prospective, population-based observational study. The Utstein Osaka Project. 14,164 adult patients aged ≥20 years old with OHCAs due to non-cardiac origin who were resuscitated by emergency-medical-service personnel or bystanders, and then were transported to medical institutions from January 2005 to December 2011. One-month survival after OHCA. Multiple logistic regression analysis was used to assess factors that were potentially associated with the outcome. During the study period, the 1-month survival rate was 5.3% (755/14,164). The proportion of 1-month survival was 6.2% (510/8239) in external causes, 6.5% (94/1148) in respiratory diseases, 0.8% (11/1309) in malignant tumours, 4.9% (55/1114) in strokes and 4.1% (85/2054) in others. As for external causes, the proportion of 1-month survival was 14.3% (382/2670) in asphyxia, 4.2% (84/1999) in hanging, 0.7% (9/1300) in fall, 1.1% (12/1062) in drowning, 1.6% (12/765) in traffic injury, 3.7% (7/187) in drug overuse and 1.6% (4/256) in unclassified external causes. In a multivariate analysis, adults aged <65 years old with arrests witnessed by bystanders, with normal activities of daily living before the arrests, having ventricular fibrillation arrests, having arrests in public places, intravenous fluid levels and early Emergency Medical Service response time were significant predictors for 1-month outcome after OHCAs of non-cardiac origin. The proportion of 1-month survival of all OHCAs of non-cardiac origin did not significantly increase (from 4.3% (86/2023) in 2005 to 4.9% (105/2126) in 2011) and the adjusted OR for one-increment of year was 1.01 (95% CI 0.97 to 1.06). From a large OHCA registry in Osaka, we demonstrated that 1-month survival after OHCAs of non-cardiac origin was poor and stable. Published by the BMJ

  18. Cardiac Arrest during Hospitalization for Delivery in the United States, 1998–2011

    Science.gov (United States)

    Mhyre, Jill M.; Tsen, Lawrence C.; Einav, Sharon; Kuklina, Elena V.; Leffert, Lisa R.; Bateman, Brian T.

    2015-01-01

    Background The objective of this analysis was to evaluate the frequency, distribution of potential etiologies, and survival rates of maternal cardiopulmonary arrest during the hospitalization for delivery in the United States. Methods By using data from the Nationwide Inpatient Sample during the years 1998 through 2011, the authors obtained weighted estimates of the number of U.S. hospitalizations for delivery complicated by maternal cardiac arrest. Clinical and demographic risk factors, potential etiologies, and outcomes were identified and compared in women with and without cardiac arrest. The authors tested for temporal trends in the occurrence and survival associated with maternal arrest. Results Cardiac arrest complicated 1 in 12,000 or 8.5 per 100,000 hospitalizations for delivery (99% CI, 7.7 to 9.3 per 100,000). The most common potential etiologies of arrest included hemorrhage, heart failure, amniotic fluid embolism, and sepsis. Among patients with cardiac arrest, 58.9% of patients (99% CI, 54.8 to 63.0%) survived to hospital discharge. Conclusions Approximately 1 in 12,000 hospitalizations for delivery is complicated by cardiac arrest, most frequently due to hemorrhage, heart failure, amniotic fluid embolism, or sepsis. Survival depends on the underlying etiology of arrest. PMID:24694844

  19. Code Blue on Orbit: Treating Cardiac Arrest on the ISS

    Science.gov (United States)

    Bacal, Kira; Redmond, Melissa

    2004-01-01

    As a result of the Columbia tragedy on February 1,2003, the International Space Station (ISS) crew size has been temporarily reduced from three to two. This change forces adaptations in many operational procedures used by the crew, including medical protocols which were designed for scenarios involving one casualty and two caregivers. The Office of Space Medicine directed that the procedure for the resuscitation of a crewmember in cardiac arrest be rewritten for use by a single care provider. Methods: Adaptation of this procedure made use of current American Heart Association Advanced Cardiac Life Support (ACLS) procedures and reflects necessary compromises between the realities of the operational environment and prompt provision of medical care. Results: Numerous changes were incorporated due to the diminution in available personnel, including substitution of endotracheal rather than intravenous delivery of drugs, more rapid defibrillation, addition of a precordial thump, removal of transcutaneous pacing, streamlining of procedural steps, and clarification of termination criteria. Discussion: The on-orbit care available to the ISS crewmembers is constrained by numerous factors, including crew medical training, minimal medical assets, limited air/ground communication , and a single caregiver for the foreseeable future. All of these combine to make a successful resuscitation unlikely, however, this procedure must ultimately deal with not only the patient's welfare, but also that of the caregiver, the mission, and the program.

  20. Induced hypothermia after cardiac arrest in trauma patients: a case series.

    Science.gov (United States)

    Tuma, Mazin A; Stansbury, Lynn G; Stein, Deborah M; McQuillan, Karen A; Scalea, Thomas M

    2011-12-01

    Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest. From Trauma Registry records, we identified all adult patients (older than 17 years) admitted to our Level I trauma center from July 1, 2008, through June 30, 2010, who experienced cardiac arrest during acute trauma care and were managed via our induced hypothermia protocol. This requires maintenance of core body temperature between 32°C and 34°C for 24 hours after arrest. Patient clinical records were then reviewed for selected factors. Six acute trauma patients (3 male and 3 female; median age, 53 years) with cardiac arrest managed per protocol were identified. All injuries were due to blunt impact, and five of six injuries were motor-vehicle-associated. Median Injury Severity Score was 27; median prearrest Glasgow Coma Scale (GCS) score was 15. One patient arrested prehospital and the other 5 in-hospital. Median duration of arrest was 8 minutes. All were comatose after arrest. One death occurred, in the patient with a prehospital cardiac arrest. Two patients were discharged to chronic care facilities with GCS11-tracheostomy; three were discharged to active rehabilitation care facilities with GCS score of 14 to 15. There were no obvious complications related to cooling. Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.

  1. Reduced right ventricular diameter during cardiac arrest caused by tension pneumothorax - a porcine ultrasound study.

    Science.gov (United States)

    Caap, P; Aagaard, R; Sloth, E; Løfgren, B; Granfeldt, A

    2017-08-01

    Advanced life support (ALS) guidelines recommend ultrasound to identify reversible causes of cardiac arrest. Right ventricular (RV) dilatation during cardiac arrest is commonly interpreted as a sign of pulmonary embolism. The RV is thus a focus of clinical ultrasound examination. Importantly, in animal studies ventricular fibrillation and hypoxia results in RV dilatation. Tension pneumothorax (tPTX) is another reversible cause of cardiac arrest, however, the impact on RV diameter remains unknown. To investigate RV diameter evaluated by ultrasound in cardiac arrest caused by tPTX or hypoxia. Pigs were randomized to cardiac arrest by either tPTX (n = 9) or hypoxia (n = 9) and subsequently resuscitated. Tension pneumothorax was induced by injection of air into the pleural cavity. Hypoxia was induced by reducing tidal volume. Ultrasound images of the RV were obtained throughout the study. Tension pneumothorax was decompressed after the seventh rhythm analysis. The primary endpoint was RV diameter after the third rhythm analysis. At cardiac arrest the RV diameter was 17 mm (95% CI: 13; 21) in the tPTX group and 36 mm (95% CI: 33; 40) in the hypoxia group (P cardiac arrest caused by tPTX when compared with hypoxia. The difference disappears after tPTX decompression. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  2. Inhibition of the Mitochondrial Fission Protein Drp1 Improves Survival in a Murine Cardiac Arrest Model

    Science.gov (United States)

    Sharp, Willard W.; Beiser, David G.; Fang, Yong Hu; Han, Mei; Piao, Lin; Varughese, Justin; Archer, Stephen L.

    2015-01-01

    Objectives Survival following sudden cardiac arrest is poor despite advances in cardiopulmonary resuscitation (CPR) and the use of therapeutic hypothermia. Dynamin related protein 1 (Drp1), a regulator of mitochondrial fission, is an important determinant of reactive oxygen species generation, myocardial necrosis, and left ventricular function following ischemia/reperfusion injury, but its role in cardiac arrest is unknown. We hypothesized that Drp1 inhibition would improve survival, cardiac hemodynamics, and mitochondrial function in an in vivo model of cardiac arrest. Design Laboratory investigation. Setting University laboratory Interventions Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent an 8-min KCl induced cardiac arrest followed by 90 seconds of CPR. Mice were then blindly randomized to a single intravenous injection of Mdivi-1 (0.24 mg/kg), a small molecule Drp1 inhibitor or vehicle (DMSO). Measurements and Main Results Following resuscitation from cardiac arrest, mitochondrial fission was evidenced by Drp1 translocation to the mitochondrial membrane and a decrease in mitochondrial size. Mitochondrial fission was associated with increased lactate and evidence of oxidative damage. Mdivi-1 administration during CPR inhibited Drp1 activation, preserved mitochondrial morphology, and decreased oxidative damage. Mdivi-1 also reduced the time to return of spontaneous circulation (ROSC) 116±4 vs. 143±7 sec (pcardiac arrest. Conclusions Post cardiac arrest inhibition of Drp1 improves time to ROSC and myocardial hemodynamics resulting in improved survival and neurological outcomes in a murine model of cardiac arrest. Pharmacological targeting of mitochondrial fission may be a promising therapy for cardiac arrest. PMID:25599491

  3. Multiple cardiac arrests induced by pulmonary embolism in a traumatically injured patient

    Science.gov (United States)

    Sun, Shu-Qing; Li, Ke-Peng; Zhi, Jianming

    2017-01-01

    Abstract Rationale: Pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. Patient concerns: We present a case of continuous resuscitation lasting approximately 4 hours, during which 21 episodes of cardiac arrest occurred in a 46-year-old man who sustained high-level paraplegia after a road traffic accident. Diagnoses: Multiple cardiac arrests induced by pulmonary embolism. Interventions: The patient received cardiopulmonary resuscitation and thrombolytic therapy. Outcomes: The patient was discharged in 2 weeks when his condition turned for the better. Lessons: Cardiopulmonary resuscitation of patients with pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. Effective external cardiac compression can not only save the patient's life but also attenuate neurological sequelae. Thrombolytic therapy is the key to the final success of resuscitation. PMID:29245284

  4. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.

    Science.gov (United States)

    Morrison, Laurie J; Nichol, Graham; Rea, Thomas D; Christenson, Jim; Callaway, Clifton W; Stephens, Shannon; Pirrallo, Ronald G; Atkins, Dianne L; Davis, Daniel P; Idris, Ahamed H; Newgard, Craig

    2008-08-01

    To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry-Cardiac Arrest. The ROC Epistry--Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry--Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. We describe the rationale, development, design and future implications of the ROC Epistry--Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry--Cardiac Arrest and the ROC trials.

  5. Acute-phase reactants after paediatric cardiac arrest. Procalcitonin as marker of immediate outcome

    Directory of Open Access Journals (Sweden)

    Medina Alberto

    2008-04-01

    Full Text Available Abstract Objective Procalcitonin (PCT and C reactive protein (CRP have been used as infection parameters. PCT increase correlates with the infection's severity, course, and mortality. Post-cardiocirculatory arrest syndrome may be related to an early systemic inflammatory response, and may possibly be associated with an endotoxin tolerance. Our objective was to report the time profile of PCT and CRP levels after paediatric cardiac arrest and to assess if they could be use as markers of immediate survival. Materials and methods A retrospective observational study set in an eight-bed PICU of a university hospital was performed during a period of two years. Eleven children younger than 14 years were admitted in the PICU after a cardiac arrest. PCT and CRP plasma concentrations were measured within the first 12 and 24 hours of admission. Results In survivors, PCT values increased 12 hours after cardiac arrest without further increase between 12 and 24 hours. In non survivors, PCT values increased 12 hours after cardiac arrest with further increase between 12 and 24 hours. Median PCT values (range at 24 hours after cardiac arrest were 22.7 ng/mL (0.2 – 41.0 in survivors vs. 205.5 ng/mL (116.6 – 600.0 in non survivors (p Conclusion Measurement of PCT during the first 24 hours after paediatric cardiac arrest could serve as marker of mortality.

  6. Recent developments in the management of patients resuscitated from cardiac arrest.

    Science.gov (United States)

    Jentzer, Jacob C; Clements, Casey M; Murphy, Joseph G; Scott Wright, R

    2017-06-01

    Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury. To achieve best patient outcomes, comprehensive critical care management is needed, with primary goals of stabilizing hemodynamics and preventing progressive brain injury. Targeted temperature management is frequently recommended for comatose survivors of cardiac arrest to mitigate the neurologic injury that drives outcomes. Accurate neurologic assessment is central to managing care of cardiac arrest survivors and should combine physical examination with objective neurologic testing, with the caveat that delaying neurologic prognosis is essential to avoid premature withdrawal of supportive care. A combination of clinical findings and diagnostic results should be used to estimate the likelihood of functional recovery. This review focuses on recent advances in care and specific cardiac intensive care strategies that may improve morbidity and mortality for patients after cardiac arrest. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Occurrence of spontaneous and audiogenic seizures following global brain ischaemia due to cardiac arrest.

    Science.gov (United States)

    Ułamek-Kozioł, Marzena; Kocki, Janusz; Bogucka-Kocka, Anna; Januszewski, Sławomir; Czuczwar, Stanisław J; Pluta, Ryszard

    2015-01-01

    Transient cardiac arrest due to cardiac vessel bundle occlusion was used to produce a rat model of spontaneous and audiogenic seizures. Among the rats, spontaneous seizures were present in 64%, and audiogenic seizures could be evoked in 86%, during two weeks of survival after cardiac arrest, by exposure to a loud sound produced by rattling keys, beginning one day after the post-ischaemic injury. Data from literature suggested a key role for GABA-ergic system widespread dysfunction especially in the hippocampus in post-cardiac arrest onset of audiogenic seizures. Reduced GABA inhibition in the hippocampus seems responsible for audiogenic seizures following cardiac arrest. In summary it may be considered that the occurrence of audiogenic seizures following cardiac arrest is determined not only by a neuronal loss, especially in the hippocampus, but also by a condition of synapse modification by a regenerative phenomenon. Data from our study clearly indicate that global brain ischaemia due to cardiac arrest may induce the susceptibility to spontaneous and audiogenic seizures, but this effect is transient.

  8. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

    NARCIS (Netherlands)

    Monsieurs, Koenraad G.; De Regge, Melissa; Vansteelandt, Kristof; De Smet, Jeroen; Annaert, Emmanuel; Lemoyne, Sabine; Kalmar, Alain F.; Calle, Paul A.

    2012-01-01

    Background and goal of study: The relationship between chest compression rate and compression depth is unknown. In order to characterise this relationship, we performed an observational study in prehospital cardiac arrest patients. We hypothesised that faster compressions are associated with

  9. Effect of a pharmacologically induced decrease in core temperature in rats resuscitated from cardiac arrest

    Science.gov (United States)

    Targeted temperature management is recommended to reduce brain damage after resuscitation from cardiac arrest in humans although the optimal target temperature remains controversial. 1 4 The American Heart Association (AHA) and the International Liaison Committee on Resuscitation...

  10. GLP-1 analogues for neuroprotection after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Hassager, Christian; Thomsen, Jakob Hartvig

    2016-01-01

    BACKGROUND: Attenuating the neurological damage occurring after out-of-hospital cardiac arrest is an ongoing research effort. This dual-centre study investigates the neuroprotective effects of the glucagon-like-peptide-1 analogue Exenatide administered within 4 hours from the return of spontaneous...... circulation to comatose patients resuscitated from out-of-hospital cardiac arrest. METHODS/DESIGN: This pilot study will randomize a total of 120 unconscious patients with sustained return of spontaneous circulation after out-of-hospital cardiac arrest undergoing targeted temperature management in a blinded...... one-to-one fashion to a 6-hour and 15-minute infusion of either Exenatide or placebo. Patients are eligible for inclusion if resuscitated from cardiac arrest with randomization from 20 minutes to 240 minutes after return of spontaneous circulation. The co-primary endpoint is feasibility, defined...

  11. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Sørensen, Kristian Dahl Kragholm; Wissenberg, Mads; Mortensen, Rikke N

    2017-01-01

    BACKGROUND: The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS: We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year...... risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal...... changes in bystander interventions and outcomes. RESULTS: Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period...

  12. Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Do Wan Kim

    2015-05-01

    Full Text Available Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

  13. Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

    Directory of Open Access Journals (Sweden)

    Edward Gologorsky

    2010-01-01

    Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  14. Adrenaline in cardiac arrest: Prefilled syringes are faster.

    Science.gov (United States)

    Helm, Claire; Gillett, Mark

    2015-08-01

    Standard ampoules and prefilled syringes of adrenaline are widely available in Australasian EDs for use in cardiac arrest. We hypothesise that prefilled syringes can be administered more rapidly and accurately when compared with the two available standard ampoules. This is a triple arm superiority study comparing the time to i.v. administration and accuracy of dosing of three currently available preparations of adrenaline. In their standard packaging, prefilled syringes were on average more than 12 s faster to administer than the 1 mL 1:1000 ampoules and more than 16 s faster than the 10 mL 1:10,000 ampoules (P adrenaline utilising a Minijet (CSL Limited, Parkville, Victoria, Australia) is faster than using adrenaline in glass ampoules presented in their plastic packaging. Removing the plastic packaging from the 1 mL (1 mg) ampoule might result in more rapid administration similar to the Minijet. Resuscitation personnel requiring rapid access to adrenaline should consider storing it as either Minijets or ampoules devoid of packaging. These results might be extrapolatable to other clinical scenarios, including pre-hospital and anaesthesia, where other drugs are required for rapid use. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Amiodarone and cardiac arrest: Systematic review and meta-analysis.

    Science.gov (United States)

    Laina, Ageliki; Karlis, George; Liakos, Aris; Georgiopoulos, Georgios; Oikonomou, Dimitrios; Kouskouni, Evangelia; Chalkias, Athanasios; Xanthos, Theodoros

    2016-10-15

    The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest. We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected. Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475). Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. The best timing for defibrillation in shockable cardiac arrest.

    Science.gov (United States)

    Scapigliati, A; Ristagno, G; Cavaliere, F

    2013-01-01

    High quality cardiopulmonary resuscitation (CPR, i.e. chest compressions and ventilations) and prompt defibrillation when appropriate (i.e. in ventricular fibrillation and pulseless ventricular tachycardia, VF/VT) are currently the best early treatment for cardiac arrest (CA). In cases of prolonged CA due to shockable rhythms, it is reasonable to presume that a period of CPR before defibrillation could partially revert the metabolic and hemodynamic deteriorations imposed to the heart by the no flow state, thus increasing the chances of successful defibrillation. Despite supporting early evidences in CA cases in which Emergency Medical System response time was longer than 5 minutes, recent studies have failed to confirm a survival benefit of routine CPR before defibrillation. These data have imposed a change in guidelines from 2005 to 2010. To take in account all the variables encountered when treating CA (heart condition before CA, time elapsed, metabolic and hemodynamic changes, efficacy of CPR, responsiveness to defibrillation attempt), it would be very helpful to have a real-time and non invasive tool able to predict the chances of defibrillation success. Recent evidences have suggested that ECG waveform analysis of VF, such as the derived Amplitude Spectrum Area, can fit the purpose of monitoring the CPR effectiveness and predicting the responsiveness to defibrillation. While awaiting clinical studies confirming this promising approach, CPR performed according to high quality standard and with minimal interruptions together with early defibrillation are the best immediate way to achieve resuscitation in CA due to shochable rhythms..

  17. Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival.

    Science.gov (United States)

    Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta; Lippert, Freddy K; Kragholm, Kristian; Risgaard, Bjarke; Rajan, Shahzleen; Karlsson, Lena; Søndergaard, Kathrine Bach; Hansen, Steen M; Mortensen, Rikke Normark; Weeke, Peter; Christensen, Erika Frischknecht; Nielsen, Søren L; Gislason, Gunnar H; Køber, Lars; Torp-Pedersen, Christian

    2015-05-05

    Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all Pdefibrillator. All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival. © 2015 American Heart Association, Inc.

  18. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style.

    Science.gov (United States)

    Silva, Rose Mary Ferreira Lisboa da; Silva, Bruna Adriene Gomes de Lima E; Silva, Fábio Junior Modesto E; Amaral, Carlos Faria Santos

    2016-01-01

    The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

  19. Cardiac arrest after sugammadex administration in a patient with variant angina: a case report

    OpenAIRE

    KO, Myoung Jin; Kim, Yong Han; Kang, Eunsu; Lee, Byeong-Cheol; Lee, Sujung; Jung, Jae-Wook

    2016-01-01

    A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day...

  20. Clinical review: Continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest.

    OpenAIRE

    Friberg, Hans; Westhall, Erik; Rosén, Ingmar; Rundgren, Malin; Nielsen, Niklas; Cronberg, Tobias

    2013-01-01

    There has been a dramatic change in hospital care of cardiac arrest survivors in recent years, including the use of target temperature management (hypothermia). Clinical signs of recovery or deterioration, which previously could be observed, are now concealed by sedation, analgesia, and muscle paralysis. Seizures are common after cardiac arrest, but few centers can offer high-quality electroencephalography (EEG) monitoring around the clock. This is due primarily to its complexity and lack of ...

  1. [Evolution of the nurse's role in the management of a cardiac arrest].

    Science.gov (United States)

    Loosli, Florian; Hutin, Alice; Lefort, Hugues; Carli, Pierre; Lamhaut, Lionel

    2016-11-01

    In France, there are 40 000 sudden deaths each year and the cardiac arrest survival rate is less than 10%. The arrival of extracorporeal cardio pulmonary resuscitation (ECPR) offers hope in the event of refractory cardiac arrest in prehospital care. Extending ECPR programmes requires more scientific evidence, training and an evolution of the role of paramedics. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Communication between members of the cardiac arrest team--a postal survey.

    Science.gov (United States)

    Pittman, J; Turner, B; Gabbott, D A

    2001-05-01

    Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. A questionnaire on cardiac arrest team composition, leadership, communication and debriefing was distributed nationally to Resuscitation Training Officers (RTOs) and their responses analysed. One hundred and thirty (55%) RTOs replied. Physicians and anaesthetists were the most prominent members of the team. The Medical Senior House Officer is usually nominated as the team leader. Eighty-seven centres (67%) have no communication between team members prior to attending a cardiopulmonary arrest. In 33%, communication occurs but is either informal or fortuitous. The RTOs felt that communication is important to enhance team dynamics and optimise task allocation. Only 7% achieve a formal debrief following a cardiac arrest. Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.

  3. Double Sequential External Defibrillation and Survival from Out-of-Hospital Cardiac Arrest: A Case Report.

    Science.gov (United States)

    Johnston, Martin; Cheskes, Sheldon; Ross, Garry; Verbeek, P Richard

    2016-01-01

    Patients who present in ventricular fibrillation are typically treated with cardiopulmonary resuscitation (CPR), epinephrine, antiarrhythmic medications, and defibrillation. Although these therapies have shown to be effective, some patients remain in a shockable rhythm. Double sequential external defibrillation has been described as a viable option for patients in refractory ventricular fibrillation. To describe the innovative use of two defibrillators used to deliver double sequential external defibrillation by paramedics in a case of refractory ventricular fibrillation resulting in prehospital return of spontaneous circulation and survival to hospital discharge with good neurologic function. A 28-year-old female sustained a witnessed out-of-hospital cardiac arrest (OHCA). Bystander CPR was performed by her husband followed by paramedics providing high-quality CPR, antiarrhythmic medication, and 6 biphasic defibrillations using standard energy levels. Double sequential external defibrillation was applied and a return of spontaneous circulation was attained on scene and maintained through to arrival to the emergency department. Following admission to hospital the patient was diagnosed with long QT syndrome. An implantable cardioverter defibrillator was placed and the patient was discharged with a Cerebral Performance Category of 2 as well as a modified Rankin Scale of 2 after an 18-day hospital stay. The patient's functional status continued to improve post discharge. The addition of double sequential external defibrillation as part of a well-organized resuscitation effort may be a valid treatment option for OHCA patients who present in refractory ventricular fibrillation.

  4. Shock duration after resuscitation is associated with occurrence of post-cardiac arrest acute kidney injury.

    Science.gov (United States)

    Kim, Yong Won; Cha, Kyoung Chul; Cha, Yong Sung; Kim, Oh Hyun; Jung, Woo Jin; Kim, Tae Hoon; Han, Byoung Keun; Kim, Hyun; Lee, Kang Hyun; Choi, Eunhee; Hwang, Sung Oh

    2015-06-01

    This retrospective observational study investigated the clinical course and predisposing factors of acute kidney injury (AKI) developed after cardiac arrest and resuscitation. Eighty-two patients aged over 18 yr who survived more than 24 hr after cardiac arrest were divided into AKI and non-AKI groups according to the diagnostic criteria of the Kidney Disease/Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI. Among 82 patients resuscitated from cardiac arrest, AKI was developed in 66 (80.5%) patients (AKI group) leaving 16 (19.5%) patients in the non-AKI group. Nineteen (28.8%) patients of the AKI group had stage 3 AKI and 7 (10.6%) patients received renal replacement therapy during admission. The duration of shock developed within 24 hr after resuscitation was shorter in the non-AKI group than in the AKI group (OR 1.02, 95% CI 1.01-1.04, P cardiac arrest AKI was the duration of shock. In conclusion, occurrence and severity of post-cardiac arrest AKI is associated with the duration of shock after resuscitation. Renal replacement therapy is required for patients with severe degree (stage 3) post-cardiac arrest AKI.

  5. [Serum neuron-specific enolase as a prognostic marker after a cardiac arrest].

    Science.gov (United States)

    Rech, Tatiana H; Vieira, Silvia Regina Rios; Brauner, Janete Salles

    2006-12-01

    Cardiac arrest is a state of severe cerebral perfusion deficit. Patients recovering from a cardiopulmonary resuscitation are at great risk of subsequent death or incapacitating neurologic injury, including persistent vegetative state. The early definition of prognosis for these patients has ethical and economic implications. The main purpose of this manuscript was to review the prognostic value of serum Neuron-Specific Enolase (NSE) in predicting outcomes in patients early after a cardiac arrest. Severe neurologic disability is the most feared complication after a cardiac arrest. Many studies are trying to find prognostic markers that can be associated with outcomes in patients surviving a cardiac arrest. Biochemical markers of neuronal injury seem to be promising in this scenario. Therefore, NSE levels have been studied in patients after a cardiac arrest and high enzyme levels suggest more extensive brain damage and are associated with unfavorable clinical outcomes. Outcome after a cardiac arrest is mostly determined by the degree of hypoxic brain damage and early determinations of serum NSE level can be a valuable ancillary method for assessing outcome in these patients.

  6. Association between blood pressure and outcomes in patients after cardiac arrest: A systematic review.

    Science.gov (United States)

    Bhate, Tahara D; McDonald, Braedon; Sekhon, Mypinder S; Griesdale, Donald E G

    2015-12-01

    Hypoxic ischaemic brain injury (HIBI) is a major cause of disability after cardiac arrest. HIBI leads to impaired cerebral autoregulation such that adequate cerebral perfusion becomes critically dependent on blood pressure. However, the optimal blood pressure after cardiac arrest remains unclear. Therefore, we conducted a systematic review to investigate the association between blood pressure and neurologic outcome patients after cardiac arrest. We systematically searched MEDLINE, EMBASE, conference abstracts and article references to identify randomized and observational studies investigating the relationship between blood pressure and neurologic outcome. We included studies that reported adjusted point estimates for the relationship between blood pressure and neurologic status in adult patients after cardiac arrest. We included 9 studies with a total of 13,150 patients. Three studies included only patients with an out-of-hospital cardiac arrest. There was marked between-study heterogeneity with respect to blood pressure definition (MAP vs. systolic), exposure duration and modelling (dichotomous vs. continuous). All studies examined either mortality or neurological status as an outcome. Seven of nine studies demonstrated that higher blood pressure was associated with improved outcomes either by an association between higher MAP and good neurologic outcome or the presence of hypotension and increased odds of mortality. The included studies suggest improved neurologic outcomes are associated with higher blood pressures in patients after cardiac arrest. This study highlights a need for further research to define the optimal management of blood pressure in this population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirates

    Science.gov (United States)

    Batt, Alan M.; Al-Hajeri, Ahmed S.; Cummins, Fergal H.

    2016-01-01

    Objectives: To report the characteristics of out-of-hospital cardiac arrest patients and their outcomes in the emirates of Sharjah, Ras-al-Khaimah, Umm Al-Quwain, Fujairah, and Ajman in the United Arab Emirates (collectively known as the Northern Emirates). Methods: This is a prospective descriptive cohort study of out-of-hospital cardiac arrest incidents transported by the national ambulance crews between February 2014 and March 2015 in the Northern Emirates. Results: A total of 384 patients were enrolled in this study. Male victims of out-of-hospital cardiac arrest represented 76% of the participants. The mean age of the study population was 50.9 years. An over-all prehospital return of spontaneous circulation rate of 3.1% was documented, as well as a 30% rate of bystander cardiopulmonary resuscitation being performed. Public access defibrillators were applied in 0.5% of cases. Data is presented according to Utstein reporting criteria. Conclusion: Baseline data for out-of-hospital cardiac arrest was established for the first time in the Northern Emirates of the United Arab Emirates. A low survival rate for out-of-hospital cardiac arrest, low rates of bystander cardiopulmonary resuscitation, and low public access defibrillator use were discovered. Although low by comparison to established western systems results are similar to other systems in the region. Determining the baseline data presented in this study is essential in recommending and implementing strategies to reduce mortality from out-of-hospital cardiac arrest. PMID:27761558

  8. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias

    2013-01-01

    Background Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome...... is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C...... (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. Conclusions In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit...

  9. Sex differences in cardiac arrest survivors who receive therapeutic hypothermia.

    Science.gov (United States)

    Greenberg, Marna Rayl; Ahnert, Amy M; Patel, Nainesh C; Bennett, Courtney E; Elliott, Nicole; Lundquist, Mark; Miller, Andrew; Feiner, Ellina C; Kurt, Anita; Glenn-Porter, Bernadette; Scott, Mercedes; Burmeister, David B

    2014-06-01

    Sex differences have not been well defined for patients undergoing therapeutic hypothermia (TH). We aimed to determine sex differences in mortality and Cerebral Performance Category (CPC) scores at discharge among those receiving TH. This retrospective cohort study used data abstracted from an "ICE alert" database, an institutional protocol expediting mild TH for postarrest patients. Quality assurance variables (such as age, time to TH, CPC scores, and mortality) were reviewed and compared by sex. χ2 Test and Wilcoxon rank sum test were used. Stepwise logistic regression was used to assess the association between mortality and sex, while controlling for patient characteristics and clinical presentation of cardiac arrest. Three hundred thirty subjects were analyzed, 198 males and 132 females. Subjects' mean age (SD) was 61.7 years (15.0); there was no significant sex difference in age. There were no statistically significant sex differences in history of coronary artery disease, congestive heart failure, arrhythmia, hypertension, chronic obstructive pulmonary disease, renal disease, type 1 and/or type 2 diabetes mellitus, or those previously healthy. Obesity (body mass index>35 kg/m2) was more likely in females (37, 28.0%) than males (35, 17.7%); P=.03. Females (64, 49.6%) were more likely than males (71, 36.8%) to have shock; P=.02. There was no difference in arrest to initiating hypothermia, but there was a significant difference in time to target temperature (in median minutes, interquartile range): male (440, 270) vs female (310, 270), P=.003. There was no statistical difference in CPC at discharge. Crude mortality was not different between sexes: male, 67.7%; female, 70.5%; P=.594. However, after controlling for differences in age, obesity, shock, and other variables, females were less likely to die (odds ratio, 0.46; 95% confidence interval, 0.23-0.92; P=.03) than males. There is no statistically significant difference in CPC or crude mortality outcomes

  10. Pediatric In-Hospital Cardiac Arrest Secondary to Acute Pulmonary Embolism.

    Science.gov (United States)

    Morgan, Ryan W; Stinson, Hannah R; Wolfe, Heather; Lindell, Robert B; Topjian, Alexis A; Nadkarni, Vinay M; Sutton, Robert M; Berg, Robert A; Kilbaugh, Todd J

    2017-12-19

    Pulmonary embolism is a rarely reported and potentially treatable cause of cardiac arrest in children and adolescents. The objective of this case series is to describe the course of five adolescent patients with in-hospital cardiac arrest secondary to pulmonary embolism. Case series. Single, large academic children's hospital. All patients under the age of 18 years (n = 5) who experienced an in-hospital cardiac arrest due to apparent pulmonary embolism from August 1, 2013, to July 31, 2017. All five patients received systemic thrombolytic therapy (IV tissue plasminogen activator) during cardiac arrest or periarrest during ongoing resuscitation efforts. Five adolescent patients, 15-17 years old, were treated for pulmonary embolism-related cardiac arrests during the study period. These accounted for 6.3% of all children and 25% of adolescents (12-17 yr old) receiving at least 5 minutes of in-hospital cardiopulmonary resuscitation during the study period. All five had venous thromboembolism risk factors. Two patients had known, extensive venous thrombi at the time of cardiac arrest, and one was undergoing angiography at the time of arrest. The diagnoses of pulmonary embolism were based on clinical suspicion, bedside echocardiography (n = 4), and low end-tidal CO2 levels relative to arterial CO2 values (n = 5). IV tissue plasminogen activator was administered during cardiopulmonary resuscitation in three patients and after the return of spontaneous circulation, in the setting of severe hemodynamic instability, in the other two patients. Four of five patients were successfully resuscitated and survived to hospital discharge. Pulmonary embolism was recognized as the etiology of multiple adolescent cardiac arrests in this single-center series and may be more common than previously reported. Recognition, high-quality cardiopulmonary resuscitation, and treatment with thrombolytic therapy resulted in survival in four of five patients.

  11. Cardiac Arrest in Children: Long-Term Health Status and Health-Related Quality of Life.

    Science.gov (United States)

    van Zellem, Lennart; Utens, Elisabeth M; Legerstee, Jeroen S; Cransberg, Karlien; Hulst, Jessie M; Tibboel, Dick; Buysse, Corinne

    2015-10-01

    To assess long-term health status and health-related quality of life in survivors of cardiac arrest in childhood and their parents. In addition, to identify predictors of health status and health-related quality of life. This medical follow-up study involved consecutive children surviving cardiac arrest between January 2002 and December 2011, who had been admitted to the ICU. Health status was assessed with a medical interview, physical examination, and the Health Utilities Index. Health-related quality of life was assessed with the Child Health Questionnaires and Short-Form 36. A tertiary care university children's hospital. Of the eligible 107 children, 57 (53%) filled out online questionnaires and 47 visited the outpatient clinic (median age, 8.7 yr; median follow-up interval, 5.6 yr). None. Of the participants, 60% had an in-hospital cardiac arrest, 90% a nonshockable rhythm, and 50% a respiratory etiology of arrest. Mortality rate after hospital discharge was 10%. On health status, we found that 13% had long-term neurologic deficits, 34% chronic symptoms (e.g., fatigue, headache), 19% at least one sign suggestive of chronic kidney injury, and 15% needed special education. Health Utilities Index scores were significantly decreased on most utility scores and the overall Health Utilities Index mark 3 score. Compared with Dutch normative data, parent-reported health-related quality of life of cardiac arrest survivors was significantly worse on general health perception, physical role functioning, parental impact, and overall physical summary. On patient reports, no significant differences with normative data were found. Parents reported better family cohesion and better health-related quality of life for themselves on most scales. Patients' health status, general health perceptions, and physical summary scores were significantly associated with cardiac arrest-related preexisting condition. Considering the impact of cardiac arrest, the overall outcome after cardiac

  12. Long-term cognitive outcomes following out-of-hospital cardiac arrest: a population-based study.

    Science.gov (United States)

    Mateen, F J; Josephs, K A; Trenerry, M R; Felmlee-Devine, M D; Weaver, A L; Carone, M; White, R D

    2011-10-11

    To report the neurologic outcomes in long-term survivors of out-of-hospital cardiac arrest with ventricular fibrillation as the presenting rhythm (OHCA VF) at a population level. All adults who experienced OHCA VF in Olmsted County, MN, from 1990 to 2008, survived more than 6 months postarrest, and were alive at the time of study recruitment were invited to participate in structured neuropsychological testing and a neurologic examination. Cognitive test results were compared to the normal population using the Mayo's Older Adults Normative Studies. Linear regression models were fit to evaluate each neuropsychological test result in relation to call-to-shock time, sex, age at cardiac arrest, time elapsed since event, witnessed vs unwitnessed arrest, and administration of bystander cardiopulmonary resuscitation. Of 332 OHCA VF arrests, 140 people (42.2%, 95% confidence interval 36.9%-47.5%) survived to discharge. No patient entered a minimally conscious or permanent vegetative state. Long-term survivors (n = 47, median survival 7.8 years postarrest) had lower scores on measures of long-term memory and learning efficiency (p = 0.001) but higher than average scores on verbal IQ (p = 0.001). Nearly all survivors were functionally independent and scored high on the Mini-Mental State Examination (MMSE) (median Barthel Index 100/100, median MMSE 29/30). Long-term survivors of OHCA VF have long-term memory deficits compared to the normal population at the same age and education level. These findings provide a baseline for cognitive outcomes studies of OHCA VF as new techniques are developed to improve survival.

  13. Contemporary approach to neurologic prognostication of coma after cardiac arrest.

    Science.gov (United States)

    Ben-Hamouda, Nawfel; Taccone, Fabio S; Rossetti, Andrea O; Oddo, Mauro

    2014-11-01

    Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.

  14. Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Goodloe

    2014-11-01

    Full Text Available The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. [West J Emerg Med. 2014;15(7:-0.

  15. Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.

    Science.gov (United States)

    Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian

    2009-01-01

    Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

  16. Antipsychotics and associated risk of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Weeke, Peter; Jensen, Aksel; Folke, Fredrik

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug...

  17. Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm

    NARCIS (Netherlands)

    Korte, Anna K M; Derde, Lennie; van Wijk, Jeroen; Tjan, David H

    2015-01-01

    An 18-year-old man suffered a sudden cardiac arrest with ventricular fibrillation and was successfully resuscitated. He had neither a medical nor family history of cardiac disease/sudden death, but was known to have Graves' disease, for which he was treated with radioactive iodine. Recently,

  18. Systemic Inflammatory Response and Potential Prognostic Implications After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Wanscher, Michael

    2015-01-01

    OBJECTIVES: Whole-body ischemia during out-of-hospital cardiac arrest triggers immediate activation of inflammatory systems leading to a sepsis-like syndrome. The aim was to investigate the association between level of systemic inflammation and mortality in survivors after out-of-hospital cardiac...

  19. Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest.

    Science.gov (United States)

    Dalal, Aarti; Czosek, Richard J; Kovach, Joshua; von Alvensleben, Johannes C; Valdes, Santiago; Etheridge, Susan P; Ackerman, Michael J; Auld, Debbie; Huckaby, Jeryl; McCracken, Courtney; Campbell, Robert

    2016-10-01

    To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014. A total of 450 patients (257 male/193 female; median age 10.1 years [3.6-13.8 years, 25th-75th percentiles]) were enrolled. Patient age was ≤13 years for 70.4% of the cohort (n = 317). Sudden cardiac arrest was the initial presentation in 7%; others were referred on the basis of abnormal or suspicious family history, personal symptoms, or physical findings. Patients with LQTS and hypertrophic cardiomyopathy were referred most commonly because of family history concerns. ALCA-R was most likely to have abnormal signs or symptoms (eg, exercise chest pain, syncope, or sudden cardiac arrest). Patients with CPVT had a high incidence of syncope and the greatest incidence of sudden cardiac arrest (45%); 77% exhibited exercise syncope or sudden cardiac arrest. This study demonstrated that suspicious or known family history plays a role in identification of many patients ultimately affected by 1 of the 3 genetic disorders (hypertrophic cardiomyopathy, LQTS, CPVT). Important patient and family history and physical examination findings may allow medical providers to identify many pediatric patients affected by 4 cardiac disorders predisposing to sudden cardiac arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Variability of Post-Cardiac Arrest Care Practices Among Cardiac Arrest Centers: United States and South Korean Dual Network Survey of Emergency Physician Research Principal Investigators.

    Science.gov (United States)

    Coppler, Patrick J; Sawyer, Kelly N; Youn, Chun Song; Choi, Seung Pill; Park, Kyu Nam; Kim, Young-Min; Reynolds, Joshua C; Gaieski, David F; Lee, Byung Kook; Oh, Joo Suk; Kim, Won Young; Moon, Hyung Jun; Abella, Benjamin S; Elmer, Jonathan; Callaway, Clifton W; Rittenberger, Jon C

    2017-03-01

    There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC]). Single investigators from each site were surveyed (N = 40). Participants answered questions based on local institutional protocols and practice. We calculated descriptive statistics for all variables. Forty surveys were completed during the study period with 30 having greater than 50% of questions completed (75% response rate; 24 KORHN and 6 NPARC). Most centers target either 33°C (N = 16) or vary the target based on patient characteristics (N = 13). Both bolus and continuous infusion dosing of sedation are employed. No single indication was unanimous for cardiac catheterization. Only six investigators reported having an institutional protocol for withdrawal of life-sustaining therapy (WLST). US patients with poor neurological prognosis tended to have WLST with subsequent expiration (N = 5), whereas Korean patients are transferred to a secondary care facility (N = 19). Both electroencephalography modality and duration vary between institutions. Serum biomarkers are commonly employed by Korean, but not US centers. We found significant variability in post-cardiac arrest care practices among US and Korean medical centers. These practice variations must be taken into account in future studies of post-arrest care.

  1. Cardiac Surgery in Jehovah's Witness Patients: Experience of a Brazilian Tertiary Hospital

    Directory of Open Access Journals (Sweden)

    Felipe Homem Valle

    Full Text Available Abstract Introduction: The outcomes of Jehovah's Witness (JW patients submitted to open heart surgery may vary across countries and communities. The aim of this study was to describe the morbidity and mortality of JW patients undergoing cardiac surgery in a tertiary hospital center in Southern Brazil. Methods: A case-control study was conducted including all JW patients submitted to cardiac surgery from 2008 to 2016. Three consecutive surgical non-JW controls were matched to each selected JW patient. The preoperative risk of death was estimated through the mean EuroSCORE II. Results: We studied 16 JW patients with a mean age of 60.6±12.1 years. The non-JW group included 48 patients with a mean age of 63.3±11.1 years (P=0.416. Isolated coronary artery bypass graft surgery was the most frequent surgery performed in both groups. Median EuroSCORE II was 1.29 (IQR: 0.66-3.08 and 1.43 (IQR: 0.72-2.63, respectively (P=0.988. The mortality tended to be higher in JW patients (18.8% vs. 4.2%, P=0.095, and there was a higher difference between the predicted and observed mortality in JW patients compared with controls (4.1 and 18.8% vs. 2.1 and 4.2%. More JW patients needed hemodialysis in the postoperative period (20.0 vs. 2.1%, P=0.039. Conclusion: We showed a high rate of in-hospital mortality in JW patients submitted to cardiac surgery. The EuroSCORE II may underestimate the surgical risk in these patients.

  2. Localization of out-of-hospital cardiac arrest in Goteborg 1994-2002 and implications for public access defibrillation.

    Science.gov (United States)

    Engdahl, Johan; Herlitz, Johan

    2005-02-01

    The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Goteborg and to identify implications for public access defibrillation (PAD). Ambulance run reports for the years 1994-2002 were studied retrospectively and manually to establish the location of the cardiac arrest. The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims' homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners' offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. Among patients suffering from out-of-hospital cardiac arrest in Goteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.

  3. Prognostic factors associated with hospital survival in comatose survivors of cardiac arrest.

    Science.gov (United States)

    Sathianathan, Kushaharan; Tiruvoipati, Ravindranath; Vij, Sanjiv

    2016-02-04

    To identify patient, cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest. A retrospective, single centre study of comatose patients admitted to our intensive care unit (ICU) following cardiac arrest during the twenty year period between 1993 and 2012. This study was deemed by the Human Research Ethics Committee (HREC) of Monash Health to be a quality assurance exercise, and thus did not require submission to the Monash Health HREC (Research Project Application, No. 13290Q). The study population included all patients admitted to our ICU between 1993 and 2012, with a discharge diagnosis including "cardiac arrest". Patients were excluded if they did not have a cardiac arrest prior to ICU admission (i.e., if their primary arrest was during their admission to ICU), or were not comatose on arrival to ICU. Our primary outcome measure was survival to hospital discharge. Secondary outcome measures were ICU and hospital length of stay (LOS), and factors associated with survival to hospital discharge. Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest, with 35% surviving to hospital discharge. The median ICU and hospital LOS was 3 and 5 d respectively. There was no survival difference between in-hospital and out-of-hospital cardiac arrests. Males made up 62% of our cardiac arrest population, were more likely to have a shockable rhythm (56% vs 37%, P initiated (e.g., pre-hospital, emergency department, intensive care) was associated with increased survival. There was however no difference in survival associated with target temperature, time at target temperature, location of initial cooling, method of initiating cooling, method of maintaining cooling or method of rewarming. Patients that survived were more likely to have a shockable rhythm (P initial rhythm (OR = 6.4, 95%CI: 3.95-10.4; P < 0.01) and a shorter time to return of spontaneous circulation (OR = 0.95, 95%CI: 0

  4. Cardiac arrests in schools: assessing use of automated external defibrillators (AED) on school campuses.

    Science.gov (United States)

    Swor, Robert; Grace, Heather; McGovern, Heather; Weiner, Michelle; Walton, Edward

    2013-04-01

    Sudden cardiac arrest in schools are infrequent, but emotionally charged events. The purpose of our study was to: (1) describe characteristics and outcomes of school cardiac arrests; and (2) assess the feasibility of conducting school bystander interviews to describe the events surrounding cardiac arrests, assess AED availability and use, and identify barriers to AED use. We performed a telephone survey of bystanders to cardiac arrests occurring in K-12 schools in communities participating in the Cardiac Arrest Registry to Enhance Survival (CARES) database and a local cardiac arrest database. The study period was from 8/2005 to 8/2011 and continued in one community through 2011. Utstein style descriptive data and outcomes were collected. A structured telephone interview of a bystander or administrative personnel was conducted for each cardiac arrest event. We collected a descriptive event summary, including provision of bystander CPR, presence of an AED and information regarding AED deployment, training, and use and perceived barriers to AED use. Descriptive data are reported. During the study period there were 30,603 cardiac arrests identified at study communities, of which 47 (0.15%) events were at K-12 schools. Of these, 21 (45.7%) were at high schools, a minority (16, 34.0%) were children (a majority (36, 76.6%) received bystander CPR, and 27 (57.4%) were initially in ventricular fibrillation (VF). Most arrests (28/40, 70%) occurred during the school day (7a-5p). From this population, 15 (31.9%) survived to hospital discharge. A telephone interview was completed for 30 of 47 K-12 events. Nineteen schools had an AED on site. Most schools (84.2%) with AEDs reported that they had a training program, and personnel identified for its use. An AED was applied in 11 of 19 patients, of these 8 were in VF and 4 (all VF) survived to hospital discharge. Bystanders identified multiple reasons for non-use of the AED in the other eight patients. Cardiac arrests in schools are

  5. Sleep Disruption is Associated with Increased Ventricular Ectopy and Cardiac Arrest in Hospitalized Adults

    Science.gov (United States)

    Miner, Steven Edward Stuart; Pahal, Dev; Nichols, Laurel; Darwood, Amanda; Nield, Lynne Elizabeth; Wulffhart, Zaev

    2016-01-01

    Study Objectives: To determine whether sleep disruption increases ventricular ectopy and the risk of cardiac arrest in hospitalized patients. Methods: Hospital emergency codes (HEC) trigger multiple hospital-wide overhead announcements. In 2014 an electronic “code white” program was instituted to protect staff from violent patients. This resulted in an increase in nocturnal HEC. Telemetry data was examined between September 14 and October 2, 2014. The frequency of nocturnal announcements was correlated with changes in frequency of premature ventricular complexes per hour (PVC/h). Cardiac arrest data were examined over a 3-y period. All HEC were assumed to have triggered announcements. The relationship between nocturnal HEC and the incidence of subsequent cardiac arrest was examined. Results: 2,603 hours of telemetry were analyzed in 87 patients. During nights with two or fewer announcements, PVC/h decreased 33% and remained 30% lower the next day. On nights with four or more announcements, PVC/h increased 23% (P cardiac arrest/24 h rose from 0.46/day in 2012–2013 to 0.62/day in 2014 (P = 0.001). During daytime hours (06:00–22:00), from 2012 through 2014, the frequency of cardiac arrest following zero, one or at least two nocturnal HEC were 0.331 ± 0.03, 0.396 ± 0.04 and 0.471 ± 0.09 respectively (R2 = 0.99, P = 0.03). Conclusions: Sleep disruption is associated with increased ventricular ectopy and increased frequency of cardiac arrest. Citation: Miner SE, Pahal D, Nichols L, Darwood A, Nield LE, Wulffart Z. Sleep disruption is associated with increased ventricular ectopy and cardiac arrest in hospitalized adults. SLEEP 2016;39(4):927–935. PMID:26715226

  6. The Right Ventricle Is Dilated During Resuscitation From Cardiac Arrest Caused by Hypovolemia: A Porcine Ultrasound Study.

    Science.gov (United States)

    Aagaard, Rasmus; Granfeldt, Asger; Bøtker, Morten T; Mygind-Klausen, Troels; Kirkegaard, Hans; Løfgren, Bo

    2017-09-01

    Dilation of the right ventricle during cardiac arrest and resuscitation may be inherent to cardiac arrest rather than being associated with certain causes of arrest such as pulmonary embolism. This study aimed to compare right ventricle diameter during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, or primary arrhythmia (i.e., ventricular fibrillation). Thirty pigs were anesthetized and then randomized to cardiac arrest induced by three diffrent methods. Seven minutes of untreated arrest was followed by resuscitation. Cardiac ultrasonographic images were obtained during induction of cardiac arrest, untreated cardiac arrest, and resuscitation. The right ventricle diameter was measured. Primary endpoint was the right ventricular diameter at the third rhythm analysis. University hospital animal laboratory. Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). Pigs were randomly assigned to cardiac arrest caused by either hypovolemia, hyperkalemia, or primary arrhythmia. At the third rhythm analysis during resuscitation, the right ventricle diameter was 32 mm (95% CI, 29-35) in the hypovolemia group, 29 mm (95% CI, 26-32) in the hyperkalemia group, and 25 mm (95% CI, 22-28) in the primary arrhythmia group. This was larger than baseline for all groups (p = 0.03). When comparing groups at the third rhythm analysis, the right ventricle was larger for hypovolemia than for primary arrhythmia (p cardiac arrest caused by hypovolemia, hyperkalemia, and primary arrhythmia. These findings indicate that right ventricle dilation may be inherent to cardiac arrest, rather than being associated with certain causes of arrest. This contradicts a widespread clinical assumption that in hypovolemic cardiac arrest, the ventricles are collapsed rather than dilated.

  7. Predicting the Presence of an Acute Coronary Lesion Among Patients Resuscitated From Cardiac Arrest.

    Science.gov (United States)

    Waldo, Stephen W; Chang, Lee; Strom, Jordan B; O'Brien, Cashel; Pomerantsev, Eugene; Yeh, Robert W

    2015-10-01

    A mechanism to stratify patients resuscitated from a cardiac arrest according to the likelihood of an acute coronary lesion would have significant utility. We thus sought to develop and validate a risk prediction model for the presence of an acute coronary lesion among patients resuscitated from an arrest. All subjects undergoing coronary angiography after resuscitation from a cardiac arrest were identified in an ongoing institutional registry from 2009 to 2014. Backwards stepwise selection of candidate covariates was used to create a logistic regression model for the presence of an angiographic culprit lesion and internally validated with bootstrapping. A clinical point score was generated and its prognostic abilities compared with contemporary measures. Among 247 subjects undergoing coronary angiography after resuscitation from a cardiac arrest, 130 (52%) had an acute lesion in a coronary artery. A multivariable model-including angina, congestive heart failure symptoms, shockable arrest rhythm (ventricular fibrillation/ventricular tachycardia), and ST-elevations-had excellent discrimination (optimism corrected C-Statistic, 0.88) and calibration (Hosmer-Lemeshow P=0.540) for an acute coronary lesion. Compared with electrocardiographic findings alone, a point score based on this model more accurately predicted the presence of an acute lesion among patients resuscitated from a cardiac arrest (integrated discrimination improvement, 0.10; 95% confidence interval, 0.04-0.19; Plesion using 4 easily measured variables. This simple risk score may be used to improve patient selection for emergent coronary angiography among resuscitated patients. © 2015 American Heart Association, Inc.

  8. Successful heart transplantation after prolonged cardiac arrest and extracorporeal life support in organ donor-a case report.

    Science.gov (United States)

    Arroyo, Diego; Gasche, Yvan; Banfi, Carlo; Stiasny, Brian; Bendjelid, Karim; Giraud, Raphaël

    2015-12-18

    Although heart transplantation is a successful therapy for patients suffering from end-stage heart failure, the therapeutic is limited by the lack of organs. Donor cardiac arrest is a classic hindrance to heart retrieval as it raises issues on post-transplant outcomes. The present case reports a successful heart transplantation after prolonged donor cardiac arrest (total lowflow time of 95 minutes) due to anaphylactic shock necessitating extracorporeal life support. We further provide an overview of the current evidence and outcomes of heart transplantation in cases of donor cardiac arrest. Providing that donor and recipient criteria are respected, donor cardiac arrest does not seem to be an adverse predictor in heart transplantation.

  9. [Chronobiology of out-of-hospital cardiac arrest in Galicia with semi-automatic external defibrillators].

    Science.gov (United States)

    Soto-Araujo, L; Costa-Parcero, M; López-Campos, M; Sánchez-Santos, L; Iglesias-Vázquez, J A; Rodríguez-Núñez, A

    2015-04-01

    To analyze the chronobiological variations of out-hospital cardiac arrest in which an automated external defibrillator was used in Galicia. Descriptive retrospective study of the cardiac arrest attended by the Emergency Medical Service in which an automated external defibrillator was in use during a period of 5 years (2007-2011). An Utstein style database was used. The sex, age, date and hour of the event, location, cardiac arrest attended, beginning of resuscitation by the professional, first monitored rhythm, emergency team activation time and care, endotracheal intubation, and recovery of spontaneous circulation were studied as independent variables. A total of 2,005 cases (0.14/1,000 population-year) was recorded. Time slot with more frequency of cardiac arrest: between 09-11 hrs (18.4%). Months with more cases: January (10.4%) and December (9.8%). It was significantly more probable that the cardiac arrest occurred in the home between 00-08 hrs, and in the street between 08-16 hrs. Asystole was more frequent in the night period (00-08 hrs), whereas the shockable rhythm was in the evening (16-00 hrs). There is more probability of death after cardiac arrest between 00-08 hrs, with recovery of spontaneous circulation being more probable between 16-00 hrs. The time between the emergency team activation and time care was longer in night schedule. In Galicia, cardiac arrest is more frequent in the winter months and in morning schedule. There is a circadian distribution of the cardiac arrest and the rhythm detected at the time of the first assistance, with asystole being more common in night schedule and the shockable rhythm in the evening. The chronobiology of the cardiac arrest should be taken into account in order to organize the distribution and the schedule of the healthcare resources. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  10. Decoding twitter: Surveillance and trends for cardiac arrest and resuscitation communication.

    Science.gov (United States)

    Bosley, Justin C; Zhao, Nina W; Hill, Shawndra; Shofer, Frances S; Asch, David A; Becker, Lance B; Merchant, Raina M

    2013-02-01

    Twitter has over 500 million subscribers but little is known about how it is used to communicate health information. We sought to characterize how Twitter users seek and share information related to cardiac arrest, a time-sensitive cardiovascular condition where initial treatment often relies on public knowledge and response. Tweets published April-May 2011 with keywords cardiac arrest, CPR, AED, resuscitation, heart arrest, sudden death and defib were identified. Tweets were characterized by content, dissemination, and temporal trends. Tweet authors were further characterized by: self-identified background, tweet volume, and followers. Of 62,163 tweets (15,324, 25%) included resuscitation/cardiac arrest-specific information. These tweets referenced specific cardiac arrest events (1130, 7%), CPR performance or AED use (6896, 44%), resuscitation-related education, research, or news media (7449, 48%), or specific questions about cardiac arrest/resuscitation (270, 2%). Regarding dissemination (1980, 13%) of messages were retweeted. Resuscitation specific tweets primarily occurred on weekdays. Most users (10,282, 93%) contributed three or fewer tweets during the study time frame. Users with more than 15 resuscitation-specific tweets in the study time frame had a mean 1787 followers and most self-identified as having a healthcare affiliation. Despite a large volume of tweets, Twitter can be filtered to identify public knowledge and information seeking and sharing about cardiac arrest. To better engage via social media, healthcare providers can distil tweets by user, content, temporal trends, and message dissemination. Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. APACHE II scoring to predict outcome in post-cardiac arrest.

    Science.gov (United States)

    Donnino, Michael W; Salciccioli, Justin D; Dejam, Andre; Giberson, Tyler; Giberson, Brandon; Cristia, Cristal; Gautam, Shiva; Cocchi, Michael N

    2013-05-01

    Despite advancements in management of cardiac arrest, mortality remains high and few severity of illness scoring systems have been calibrated in this population. The goal of the current investigation was to assess the Acute Physiology and Chronic Health Evaluation II score in post-cardiac arrest. This is a prospective observational study of adult post-cardiac arrest patients at a tertiary-care center. The primary outcome variable was in-hospital mortality and secondary outcome variable was neurologic outcome. APACHE II scores were used to predict outcomes using logistic modeling. A total of 228 subjects were included in the analysis. The median age of the cohort was 70 (IQR: 64-71) and 32% (72/228) of the patients were female. The median downtime was 15 min (IQR: 7-27) and initial lactate 5.9 mmol/L (IQR: 3.5-8.4). 71 (57%) of deaths occurred prior to the 72-h follow-up and overall in-hospital mortality was 55% (125/228). Discrimination of APACHE II score in all cardiac arrest patients increased in stepwise fashion from 0-h to 72-h follow-up (AUC: 0-h: 0.62; 24-h: 0.75; 48-h: 0.82; 72-h: 0.86). APACHE II score is a poor predictor of outcome at time zero for out-of-hospital cardiac arrest (OHCA) post-arrest patients consistent with the original development of the score in the critically ill. For in-hospital cardiac arrest (IHCA) at time zero and for both IHCA and OHCA at 24h and beyond, the APACHE II score was a modest indicator of illness severity and predictor of mortality/neurologic morbidity. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. Decoding twitter: Surveillance and trends for cardiac arrest and resuscitation communication✩

    Science.gov (United States)

    Bosley, Justin C.; Zhao, Nina W.; Hill, Shawndra; Shofer, Frances S.; Asch, David A.; Becker, Lance B.; Merchant, Raina M.

    2013-01-01

    Aim of the study Twitter has over 500 million subscribers but little is known about how it is used to communicate health information. We sought to characterize how Twitter users seek and share information related to cardiac arrest, a time-sensitive cardiovascular condition where initial treatment often relies on public knowledge and response. Methods Tweets published April–May 2011 with keywords cardiac arrest, CPR, AED, resuscitation, heart arrest, sudden death and defib were identified. Tweets were characterized by content, dissemination, and temporal trends. Tweet authors were further characterized by: self-identified background, tweet volume, and followers. Results Of 62,163 tweets (15,324, 25%) included resuscitation/cardiac arrest-specific information. These tweets referenced specific cardiac arrest events (1130, 7%), CPR performance or AED use (6896, 44%), resuscitation-related education, research, or news media (7449, 48%), or specific questions about cardiac arrest/resuscitation (270, 2%). Regarding dissemination (1980, 13%) of messages were retweeted. Resuscitation specific tweets primarily occurred on weekdays. Most users (10,282, 93%) contributed three or fewer tweets during the study time frame. Users with more than 15 resuscitation-specific tweets in the study time frame had a mean 1787 followers and most self-identified as having a healthcare affiliation. Conclusion Despite a large volume of tweets, Twitter can be filtered to identify public knowledge and information seeking and sharing about cardiac arrest. To better engage via social media, healthcare providers can distil tweets by user, content, temporal trends, and message dissemination. Further understanding of information shared by the public in this forum could suggest new approaches for improving resuscitation related education. PMID:23108239

  13. Case definition in survival studies of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Joslyn, S A

    1994-05-01

    The purpose of this investigation was to determine problems with case definition and selection biases in studies of survival from out-of-hospital cardiac arrest, by comparing characteristics of subjects with cardiac arrest who entered the emergency medical services (EMS) system and those who did not enter the system. Data for 143 prehospital cardiac arrest patients in Johnson County, Iowa, were obtained from death certificates and EMS reports. Approximately one half of cardiac arrest patients entered the EMS system. Mean total number of causes of death listed on death certificates was significantly higher in subjects who did not enter the EMS system. Several factors, including age, sex, and number of causes of death listed on death certificates were significant univariate factors in whether a cardiac arrest victim entered the EMS system, but multivariate logistic regression indicated age by itself was the most significant factor. These results indicate there are possible initial biases determining who will enter the EMS system, which affects the generalizability of previous studies.

  14. Main Complications of Mild Induced Hypothermia after Cardiac Arrest: A Review Article

    Directory of Open Access Journals (Sweden)

    Hassan Soleimanpour

    2014-03-01

    Full Text Available The aim of the present study is to assess the complications of mild induced hypothermia (MIH in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR in unconscious adult patients due to ventricular fibrillation (VF with out-of-hospital cardiac arrest (OOHCA is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included. Valid scientific data bases were used for data collection. The obtained results from different studies revealed that mild MIH could be associated with numerous complications and the knowledge and awareness of the medical staff from the complications is required to guarantee successful therapeutic approaches in MIH following cardiac arrest which is a novel medical facility with different styles and complications. Overall, further future studies are required to improve the quality of MIH, to increase survival and to decrease complications rates.

  15. Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes

    Science.gov (United States)

    Wolfe, Heather; Zebuhr, Carleen; Topjian, Alexis A.; Nishisaki, Akira; Niles, Dana E.; Meaney, Peter A.; Boyle, Lori; Giordano, Rita T.; Davis, Daniela; Priestley, Margaret; Apkon, Michael; Berg, Robert A.; Nadkarni, Vinay M.; Sutton, Robert M.

    2014-01-01

    Objective In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events. Design, Setting, and Patients Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU. Interventions Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers. Measurements and Main Results Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed “excellent cardiopulmonary resuscitation,” prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91–6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01–7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9–10

  16. Effectiveness of mild therapeutic hypothermia following cardiac arrest in adult patients with congenital heart disease.

    Science.gov (United States)

    Young, Michael N; Hollenbeck, Ryan D; Pollock, Jeremy S; McPherson, John A; Fredi, Joseph L; Piana, Robert N; Mah, May L; Fish, Frank A; Markham, Larry

    2014-07-01

    Mild therapeutic hypothermia (TH) is an established therapy to improve survival and reduce neurologic injury after cardiac arrest. Adult patients with congenital heart disease (ACHD) are at increased risk of sudden cardiac death. The use of TH in this population has not been extensively studied. The aim of this study is to report our institutional experience using this treatment modality in patients with ACHD after cardiac arrest. We performed a retrospective observational study of a cohort of 245 consecutive patients treated with TH after cardiac arrest from 2007 to 2013. Five patients were identified as having complex ACHD with a mean age of 28 years. All were treated with TH according to an institutional protocol utilizing active surface cooling to maintain a core body temperature of 32°C to 34°C for 24 hours after cardiac arrest. Congenital lesions in these 5 patients included anomalous left coronary artery from the pulmonary artery; l-transposition of the great arteries; d-transposition of the great arteries status post atrial switch; unoperated tricuspid atresia, atrial septal defect, and ventricular septal defect with Eisenmenger's physiology; and surgically corrected atrial septal defect, cleft mitral valve, and subaortic membrane. All 5 patients suffered cardiac arrest due to ventricular arrhythmia and all survived to discharge without significant neurologic impairment. Therapeutic interventions included anomalous left coronary artery from the pulmonary artery ligation, percutaneous coronary intervention, and defibrillator implantation. In conclusion, in 5 patients with ACHD, the use of TH after cardiac arrest resulted in 100% survival to hospital discharge with good neurologic outcome postresuscitation. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support.

    Science.gov (United States)

    Stiell, I G; Wells, G A; Field, B J; Spaite, D W; De Maio, V J; Ward, R; Munkley, D P; Lyver, M B; Luinstra, L G; Campeau, T; Maloney, J; Dagnone, E

    1999-04-07

    Survival rates for out-of-hospital cardiac arrest are low; published survival rates in Ontario are only 2.5%. This study represents phase II of the Ontario Prehospital Advanced Life Support (OPALS) study, which is designed to systematically evaluate the effectiveness and efficiency of various prehospital interventions for patients with cardiac arrest, trauma, and critical illnesses. To assess the impact on out-of-hospital cardiac arrest survival of the implementation of a rapid defibrillation program in a large multicenter emergency medical services (EMS) system with existing basic life support and defibrillation (BLS-D) level of care. Controlled clinical trial comparing survival for 36 months before (phase I) and 12 months after (phase II) system optimization. Nineteen urban and suburban Ontario communities (populations ranging from 16 000 to 750 000 [total, 2.7 million]). All patients who had out-of-hospital cardiac arrest in the study communities for whom resuscitation was attempted by emergency responders. Study communities optimized their EMS systems to achieve the target response interval from when a call was received until a vehicle stopped with a defibrillator of 8 minutes or less for 90% of cardiac arrest cases. Working both locally and provincially, communities implemented multiple measures, including defibrillation by firefighters, base paging, tiered response agreements with fire departments, continuous quality improvement for response intervals, and province-wide revision and implementation of standard dispatch policies. All response times were obtained from a central dispatch system. Survival to hospital discharge. The 4690 cardiac arrest patients studied in phase I and the 1641 in phase II were similar for all clinical and demographic characteristics, including age, sex, witnessed status, rhythm, and receipt of bystander cardiopulmonary resuscitation. The proportion of cases meeting the 8-minute response criterion improved (76.7% vs 92

  18. Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest.

    Science.gov (United States)

    White, R D; Hankins, D G; Atkinson, E J

    2001-04-01

    To determine the outcome of patients with out-of-hospital cardiac arrest and ventricular fibrillation as the presenting rhythm while using automated external defibrillators (AEDs) that delivered non-escalating, impedance-compensated low-energy (150 J) shocks. AEDs delivering low-energy biphasic truncated exponential (BTE) shocks were employed in an emergency medical services (EMS) system in which first-arriving personnel - police, firefighters or paramedics - delivered the initial shocks. Patients were classified according to their response to shocks: restoration of sustained spontaneous circulation (ROSC) without need for epinephrine and other advanced life support (ALS) interventions; and ALS, those requiring epinephrine in all instances. The primary end-point was neurologically-intact discharge survival. Secondary end-points were ROSC with shocks only and the call-to-shock time interval. Of 42 patients with VF arrest treated with BTE shocks, 35 were bystander-witnessed. Of these 35, 14 (38%) regained a sustained ROSC on-scene with shocks only, needing no epinephrine for ROSC. All 14 survived to discharge home. Of the remaining 21 patients needing ALS intervention, only two (9.5%) survived to discharge. Overall, 16/35 patients (46%) survived to discharge home, an outcome comparable to our experience with patients treated with escalating high-energy monophasic waveform shocks. Low-energy (150 J) non-escalating biphasic truncated exponential waveform shocks terminate VF in out-of-hospital cardiac arrest with high efficacy; patient outcome is comparable with that observed with escalating high-energy monophasic shocks. Low-energy shocks, in addition to high efficacy, may confer the advantage of less shock-induced myocardial dysfunction, though this will be difficult to define in the clinical circumstance of long-duration VF provoked by a pre-existing diseased myocardial substrate.

  19. Development of a data dictionary for the Strategies for Post Arrest Resuscitation Care (SPARC) network for post cardiac arrest research.

    Science.gov (United States)

    Lin, Steve; Morrison, Laurie J; Brooks, Steven C

    2011-04-01

    The widely accepted Utstein style has standardized data collection and analysis in resuscitation and post resuscitation research. However, collection of many of these variables poses significant practical challenges. In addition, several important variables in post resuscitation research are missing. Our aim was to develop a comprehensive data dictionary and web-based data collection tool as part of the Strategies for Post Arrest Resuscitation Care (SPARC) Network project, which implemented a knowledge translation program for post cardiac arrest therapeutic hypothermia in 37 Ontario hospitals. A list of data variables was generated based on the current Utstein style, previous studies and expert opinion within our group of investigators. We developed a data dictionary by creating clear definitions and establishing abstraction instructions for each variable. The data dictionary was integrated into a web-based collection form allowing for interactive data entry. Two blinded investigators piloted the data collection tool, by performing a retrospective chart review. A total of 454 variables were included of which 400 were Utstein, 2 were adapted from existing studies and 52 were added to address missing elements. Kappa statistics for two outcome variables, survival to discharge and induction of therapeutic hypothermia were 0.86 and 0.64, respectively. This is the first attempt in the literature to develop a data dictionary as part of a standardized, pragmatic data collection tool for post cardiac arrest research patients. In addition, our dataset defined important variables that were previously missing. This data collection tool can serve as a reference for future trials in post cardiac arrest care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls

    DEFF Research Database (Denmark)

    Alfsen, David; Møller, Thea Palsgaard; Egerod, Ingrid

    2015-01-01

    BACKGROUND: The chance of surviving out-of-hospital cardiac arrest (OHCA) depends on early and correct recognition of cardiac arrest by the emergency medical dispatcher during the emergency call. When cardiac arrest is identified, telephone guided cardiopulmonary resuscitation (CPR) and referral...... as influential factors. Though many of these factors are included in the algorithms used by medical dispatchers, many OHCA still remain not recognised. Qualitative studies investigating the communication between the caller and dispatcher are very scarce. There is a lack of knowledge about what influences...... the dispatchers' recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers' recognition of OHCA during emergency calls in a qualitative analysis of calls. METHODS: An investigator triangulated inductive thematic...

  1. Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    R Soleimanirad

    2013-04-01

    Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

  2. Survival after out-of-hospital cardiac arrest in relation to sex

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Hansen, Carolina Malta; Folke, Fredrik

    2014-01-01

    AIM: Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. METHODS: Patients≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation...... was attempted, were identified through the Danish Cardiac Arrest Registry 2001-2010. A total of 19,372 patients were included. RESULTS: One-third were female, with a median age of 75 years (IQR 65-83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.......g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p

  3. A case of survival after cardiac arrest and 3½ hours of resuscitation.

    Science.gov (United States)

    Nusbaum, Derek M; Bassett, Scott T; Gregoric, Igor D; Kar, Biswajit

    2014-04-01

    Although survival rates after cardiac arrest remain low, new techniques are improving patients' outcomes. We present the case of a 40-year-old man who survived a cardiac arrest that lasted approximately 3½ hours. Resuscitation was performed with strict adherence to American Heart Association/American College of Cardiology Advanced Cardiac Life Support guidelines until bedside extracorporeal membrane oxygenation could be placed. A hypothermia protocol was initiated immediately afterwards. The patient had a full neurologic recovery and was bridged from dual ventricular assist devices to a total artificial heart. On hospital day 160, he underwent orthotopic heart and cadaveric kidney transplantation. On day 179, he was discharged from the hospital in ambulatory condition. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 3½ hours. Documented cases of resuscitation with good recovery after prolonged arrest give hope for improved overall outcomes in the future.

  4. Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design.

    Science.gov (United States)

    Westhall, Erik; Rosén, Ingmar; Rossetti, Andrea O; van Rootselaar, Anne-Fleur; Kjaer, Troels Wesenberg; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Cronberg, Tobias

    2014-08-16

    Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented. A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool. The TTM-trial is registered at ClinicalTrials.gov (NCT01020916).

  5. Infectious complications after out-of-hospital cardiac arrest-A comparison between two target temperatures

    DEFF Research Database (Denmark)

    Dankiewicz, Josef; Nielsen, Niklas; Linder, Adam

    2017-01-01

    BACKGROUND: It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two...... complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24h, 48h and 72h after cardiac arrest. RESULTS: There were 939 patients in the modified intention......-to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13-1.70; p=0.001). There was no statistically significant difference in the incidence of infectious complications between...

  6. The relationship between Asian dust events and out-of-hospital cardiac arrests in Japan.

    Science.gov (United States)

    Nakamura, Takahiro; Hashizume, Masahiro; Ueda, Kayo; Kubo, Tatsuhiko; Shimizu, Atsushi; Okamura, Tomonori; Nishiwaki, Yuji

    2015-01-01

    Asian dust events are caused by dust storms that originate in the deserts of China and Mongolia and drift across East Asia. We hypothesized that the dust events would increase incidence of out-of-hospital cardiac arrests by triggering acute events or exacerbating chronic diseases. We analyzed the Utstein-Style data collected in 2005 to 2008 from seven prefectures covering almost the entire length of Japan to investigate the effect of Asian dust events on out-of-hospital cardiac arrests. Asian dust events were defined by the measurement of light detection and ranging. A time-stratified case-crossover analysis was performed. The strength of the association between Asian dust events and out-of-hospital cardiac arrests was shown by odds ratios and 95% confidence intervals in two conditional logistic models. A pooled estimate was obtained from area-specific results by random-effect meta-analysis. The total number of cases of out-of-hospital cardiac arrest was 59 273, of which 35 460 were in men and 23 813 were in women. The total number of event days during the study period was smallest in Miyagi and Niigata and largest in Shimane and Nagasaki. There was no significant relationship between Asian dust events and out-of-hospital cardiac arrests by area in either of the models. In the pooled analysis, the highest odds ratios were observed at lag day 1 in both model 1 (OR 1.07; 95% CI, 0.97-1.19) and model 2 (OR 1.08; 95% CI, 0.97-1.20). However, these results were not statistically significant. We found no evidence of an association between Asian dust events and out-of-hospital cardiac arrests.

  7. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 6: Post-cardiac arrest care.

    Science.gov (United States)

    Smarick, Sean D; Haskins, Steve C; Boller, Manuel; Fletcher, Daniel J

    2012-06-01

    To systematically examine the evidence for interventions after the return of spontaneous circulation (ROSC) on outcomes from veterinary cardiopulmonary resuscitation and to determine important knowledge gaps. Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical post-cardiac arrest care. Academia, referral practice, and general practice. Fifteen standardized clinical questions important for post-cardiac arrest care were asked and research articles relevant to answering these questions were identified through structured, explicit literature database searches. The majority of these articles report research in species other than dogs or cats or consisted of experimental work in canine cardiac arrest models. Outcome metrics reported in these studies widely varied and ranged from quantification of mechanistic endpoints, such as elaboration of reactive oxygen species, to survival, and functional neurologic outcome. Despite the near complete absence of clinical veterinary studies, the process allowed the formulation of statements for several postcardiac arrest treatments that were either supportive, such as mild therapeutic hypothermia or controlled reoxygenation, or neutral, such as for mannitol administration or seizure prophylaxis. Evidence grading allowed transparency in regards to the strength of these recommendations. Moreover, numerous knowledge gaps emerged that will allow generation of a road map for progress in veterinary post-cardiac arrest care. © Veterinary Emergency and Critical Care Society 2012.

  8. Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival.

    Science.gov (United States)

    Elliott, Vanessa J; Rodgers, David L; Brett, Stephen J

    2011-03-01

    In cardiac arrest patients (in hospital and pre hospital) does resuscitation produce a good Quality of Life (QoL) for survivors after discharge from the hospital? Embase, Medline, The Cochrane Database of Systematic Reviews, Academic Search Premier, the Central Database of Controlled Trials and the American Heart Association (AHA) Resuscitation Endnote Library were searched using the terms ('Cardiac Arrest' (Mesh) OR 'Cardiopulmonary Resuscitation' (Mesh) OR 'Heart Arrest' (Mesh)) AND ('Outcomes' OR 'Quality of Life' OR 'Depression' OR 'Post-traumatic Stress Disorder' OR 'Anxiety OR 'Cognitive Function' OR 'Participation' OR 'Social Function' OR 'Health Utilities Index' OR 'SF-36' OR 'EQ-5D' as text term. There were 9 inception (prospective) cohort studies (LOE P1), 3 follow up of untreated control groups in randomised control trials (LOE P2), 11 retrospective cohort studies (LOE P3) and 47 case series (LOE P4). 46 of the studies were supportive with respect to the search question, 17 neutral and 7 negative. The majority of studies concluded that QoL after cardiac arrest is good. This review demonstrated a remarkable heterogeneity of methodology amongst studies assessing QoL in cardiac arrest survivors. There is a requirement for consensus development with regard to quality of life and patient centred outcome assessment in this population. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Collaborative working empowers staff to cut the number of cardiac arrests.

    Science.gov (United States)

    Donaldson, Emma; Murphy, Peter

    At Salford Royal Foundation Trust, 179 patients suffered a cardiac arrest between March 2007 and April 2008. MAINE MEASURES FOR MPROVEMENT: Our primary outcome measure was the number of cardiac arrests per 1,000 admissions. Eleven wards were invited to participate in a Breakthrough Series collaborative from April 2008 to January 2009. It is a short term (6-15 months) learning system thatbrings together several teams to s eekimprovement, focusing on one topic. Frontline teams worked to develop changes in their clinical areas with the aim of reducing cardiac arrests by 50% in one year. April-December 2008 saw a reduction of 32% in the cardiac arrest rate, resulting in an average arrest rate of 0.79 per 1,000 admissions. Since the project began to upscale its work in January 2009, a further reduction has been noted. However,another 4 months' data is required to assess whether this equates to a sustained change. Preliminary data suggests that a Breakthrough Series collaborative is an effective method of engaging frontline staff in developing and implementing change, with improvements in patient care.

  10. Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR.

    Science.gov (United States)

    Buick, Jason E; Allan, Katherine S; Ray, Joel G; Kiss, Alexander; Dorian, Paul; Gozdyra, Peter; Morrison, Laurie J

    2015-05-01

    Traditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes. A retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model's ability to discriminate between those with and without each outcome. Discussion This study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.

  11. Platelet aggregation during targeted temperature management after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Jeppesen, Anni Nørgaard; Hvas, Anne-Mette; Grejs, Anders Morten

    2017-01-01

    temperature management affected platelet aggregation. We randomised 82 comatose patients resuscitated after out-of-hospital cardiac arrest to either 24 hours (standard group) or 48 hours (prolonged group) of targeted temperature management at 33±1°C. Blood samples were collected 22 hours, 46 hours and 70......® decreased by 14% (95% CI -8%;-20%), p cardiac arrest was below the normal range independent of the core temperature. Moreover, no substantial difference was found in platelet aggregation between standard and prolonged targeted temperature management....

  12. Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar Hilmar

    2010-01-01

    For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.......For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA....

  13. Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Frandsen, F; Nielsen, J R; Gram, L

    1991-01-01

    During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided...... of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients...

  14. Complement activation and its prognostic role in post-cardiac arrest patients

    DEFF Research Database (Denmark)

    Jenei, Z M; Zima, E; Csuka, D

    2014-01-01

    and then allowed to rewarm to normothermia. All patients underwent diagnostic coronary angiography. On admission, at 6 and 24 h, blood samples were taken from the arterial catheter. In these, complement products (C3a, C3, C4d, C4, SC5b9 and Bb) were measured by ELISA in blood samples. Patients were followed up...... of therapeutic hypothermia predicted 30-day mortality regardless of age, sex and the APACHE II score. Complement activation occurs in post-cardiac arrest patients, and its extent correlates with 30-day survival. The C3a/C3 ratio might prove useful for estimating the prognosis of comatose post-cardiac arrest...

  15. The Outcomes of Targeted Temperature Management After Cardiac Arrest at Emergency Department: A Real-World Experience in a Developing Country.

    Science.gov (United States)

    Srivilaithon, Winchana; Muengtaweepongsa, Sombat

    2017-03-01

    Targeted temperature management (TTM) is indicated for comatose survivors of cardiac arrest to improve outcomes. However, the benefit of TTM was verified by rigid controlled clinical trials. This study aimed at evaluating its effects in real-world practices. A prospective observational study was done at the emergency department of tertiary care, Thammasat Hospital, from March 2012 until October 2015. We included all who did not obey verbal commands after being resuscitated from cardiac arrest regardless of initial cardiac rhythm. We excluded patients with traumatic arrest, uncontrolled bleeding, younger than 15 years old, and of poor neurological status (Glasgow coma scale below 14) before cardiac arrest. Primary and secondary outcomes were survival to hospital discharge and favorable neurological outcome (Cerebral Performance Categories 1 or 2 within 30 days). We used the logistic regression model to estimate the propensity score (PS) that will be used as a weight in the analysis. To analyze outcomes, the PS was introduced as a factor in the final logistic regression model in conjunction with other factors. A total of 192 cases, 61 and 131 patients, were enrolled in TTM and non-TTM groups, respectively. Characteristics believed to be related to initiation of TTM: gender, age, cardiac etiology, out-of-hospital cardiac arrest, witness arrest, collapse time, initial rhythm, received defibrillation, and advanced airway insertion, were included in multivariable analysis and estimated PS. After adjusted regression analysis with PS, the TTM group had a better result in survival to hospital discharge (34.43% vs. 12.21%; adjusted incidence risk ratio (IRR), 2.95; 95% confidence interval (CI), 1.49-5.84; p = 0.002). For neurological outcome, the TTM group had a higher number of favorable neurological outcomes (24.59% vs. 6.87%; IRR, 3.96; 95% CI, 1.67-9.36; p = 0.002). In real-world practices without a strictly controlled environment, TTM can improve survival and

  16. Endothelial activation/injury and associations with severity of post-cardiac arrest syndrome and mortality after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Johansson, Pär I; Hassager, Christian

    2016-01-01

    BACKGROUND: Post-cardiac arrest syndrome (PCAS) is characterized by whole-body ischemia triggering systemic inflammation and damage of the endothelium. This study investigated the relationship between systemic inflammation, endothelial damage and severity of PCAS and the association between...... analyses. CONCLUSION: In comatose survivors after OHCA treated with TTM, systemic inflammation was associated with endothelial activation and endothelial damage. Sustained endothelial damage was independently associated with severity of PCAS, adjusted for level of systemic inflammation. TTM at 36°C...

  17. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest.

    Science.gov (United States)

    Cureton, Elizabeth L; Yeung, Louise Y; Kwan, Rita O; Miraflor, Emily J; Sadjadi, Javid; Price, Daniel D; Victorino, Gregory P

    2012-07-01

    The clinical utility of determining cardiac motion on ultrasound has been reported for patients presenting in pulseless medical cardiac arrest. However, the relationship between ultrasound-documented cardiac activity and the probability of surviving pulseless electrical activity has not been examined in populations with trauma. We hypothesized that cardiac activity on ultrasound predicts survival for patients presenting in pulseless traumatic arrest. We conducted a retrospective analysis at our university-based urban trauma center of adult patients with trauma, who were pulseless on hospital arrival. Results of cardiac ultrasound performed during trauma resuscitations were compared with the electrocardiogram (EKG) rhythm and survival. Among 318 pulseless patients with trauma, 162 had both EKG tracings and a cardiac ultrasound, and 4.3% of these 162 patients survived to hospital admission. Survival was higher for those with cardiac motion than for those without it (23.5% vs. 1.9% for patients with EKG electrical activity, p = 0.002, and 66.7% vs. 0% for patients without EKG electrical activity, p cardiac motion to predict survival to hospital admission was 86% (specificity, 91%; positive predictive value, 30%; negative predictive value, 99%). When examined by mechanism, sensitivity was 100% for the 111 patients with penetrating trauma and 75% for the 50 patients with blunt trauma. Survival in pulseless traumatic arrest is very low, but survival for patients with no cardiac motion on ultrasound is also exceedingly rare. Cardiac ultrasound had a negative predictive value approaching 100% for survival to hospital admission. For patients with prolonged prehospital cardiopulmonary resuscitation, ultrasound evaluation of cardiac motion in pulseless patients with trauma may be a rapid way to help determine which patients have no chance of survival in the setting of lethal injuries, so that futile resuscitations can be stopped.

  18. Importance of the First Link Description and Recognition of an Out-of-Hospital Cardiac Arrest in an Emergency Call

    NARCIS (Netherlands)

    Berdowski, Jocelyn; Beekhuis, Freerk; Zwinderman, Aeilko H.; Tijssen, Jan G. P.; Koster, Rudolph W.

    2009-01-01

    Background-The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. Methods and Results-During 8 months, voice recordings of 14 800 consecutive emergency calls were

  19. Patients with cardiac arrest are ventilated two times faster than guidelines recommend : An observational prehospital study using tracheal pressure measurement

    NARCIS (Netherlands)

    Maertens, Vicky L.; De Smedt, Lieven E. G.; Lemoyne, Sabine; Huybrechts, Sofie A. M.; Wouters, Kristien; Kalmar, Alain F.; Monsieurs, Koenraad G.

    Aim: To measure ventilation rate using tracheal airway pressures in prehospitally intubated patients with and without cardiac arrest. Methods: Prospective observational study. In 98 patients (57 with and 41 without cardiac arrest) an air-filled catheter was inserted into the endotracheal tube and

  20. Association between bystander cardiopulmonary resuscitation and redeemed prescriptions for antidepressants and anxiolytics in out-of-hospital cardiac arrest survivors

    DEFF Research Database (Denmark)

    Bundgaard, Kristian; Hansen, Steen M; Mortensen, Rikke Nørmark

    2017-01-01

    AIM: This study aimed to examine rates of redeemed prescriptions of antidepressants and anxiolytics, used as markers for cerebral dysfunction in out-of-hospital cardiac arrest (OHCA) survivors, and examine the association between bystander CPR and these psychoactive drugs. METHODS: We included all....... Among survivors who received bystander CPR, prescriptions for antidepressants and anxiolytics were redeemed in 11.1% [95% CI 9.2-13.3%] and 6.3% [95% CI 4.9-8.0%] of the cases, respectively, versus 17.2% [95% CI 13.9-21.1%] and 13.4% [95% CI 10.5-17.0%], respectively, among patients who had not received...... bystander CPR. Adjusted for age, sex, year of arrest, comorbidity, witnessed status and socioeconomic status, bystander CPR was associated with significant reductions in redeemed prescriptions for antidepressants, Hazard Ratio (HR) 0.71 [95% CI 0.52-0.98], P=0.031; and anxiolytics, HR 0.55 [95% CI 0...

  1. Sudden cardiac arrest and death following application of shocks from a TASER electronic control device.

    Science.gov (United States)

    Zipes, Douglas P

    2012-05-22

    The safety of electronic control devices (ECDs) has been questioned. The goal of this study was to analyze in detail cases of loss of consciousness associated with ECD deployment. Eight cases of TASER X26 ECD-induced loss of consciousness were studied. In each instance, when available, police, medical, and emergency response records, ECD dataport interrogation, automated external defibrillator information, ECG strips, depositions, and autopsy results were analyzed. First recorded rhythms were ventricular tachycardia/fibrillation in 6 cases and asystole (after ≈ 30 minutes of nonresponsiveness) in 1 case. An external defibrillator reported a shockable rhythm in 1 case, but no recording was made. This report offers evidence detailing the mechanism by which an ECD can produce transthoracic stimulation resulting in cardiac electrical capture and ventricular arrhythmias leading to cardiac arrest. ECD stimulation can cause cardiac electrical capture and provoke cardiac arrest resulting from ventricular tachycardia/ventricular fibrillation. After prolonged ventricular tachycardia/ventricular fibrillation without resuscitation, asystole develops.

  2. Automated External Defibrillators and Emergency Planning for Sudden Cardiac Arrest in Vermont High Schools

    OpenAIRE

    Wasilko, Scott M.; Lisle, David K.

    2013-01-01

    Background: Sudden cardiac death (SCD) events are tragic. Secondary prevention of SCD depends on availability of automated external defibrillators (AEDs). High school athletes represent a high-risk group for SCD, and current efforts aim to place AEDs in all high schools. Hypothesis: The prevalence of AEDs and emergency planning for sudden cardiac arrest (SCA) in Vermont high schools is similar to other states. Understanding specific needs and limitations in rural states may prevent SCD in rur...

  3. Out-of-hospital cardiac arrest-review of demographics in South Australia to inform decisions about the provision of automatic external defibrillators within the community.

    Science.gov (United States)

    Zeitz, Kathryn; Grantham, Hugh; Elliot, Robert; Zeitz, Chris

    2010-01-01

    Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear. A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded. A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n=121), the incidence of ROSC was 47.1%. During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes. This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in

  4. Pyruvate stabilizes electrocardiographic and hemodynamic function in pigs recovering from cardiac arrest

    Science.gov (United States)

    Cherry, Brandon H; Nguyen, Anh Q; Hollrah, Roger A; Williams, Arthur G; Hoxha, Besim; Olivencia-Yurvati, Albert H

    2015-01-01

    Cardiac electromechanical dysfunction may compromise recovery of patients who are initially resuscitated from cardiac arrest, and effective treatments remain elusive. Pyruvate, a natural intermediary metabolite, energy substrate, and antioxidant, has been found to protect the heart from ischemia-reperfusion injury. This study tested the hypothesis that pyruvate-enriched resuscitation restores hemodynamic, metabolic, and electrolyte homeostasis following cardiac arrest. Forty-two Yorkshire swine underwent pacing-induced ventricular fibrillation and, after 6 min pre-intervention arrest, 4 min precordial compressions followed by transthoracic countershocks. After defibrillation and recovery of spontaneous circulation, the pigs were monitored for another 4 h. Sodium pyruvate or NaCl were infused i.v. (0.1 mmol·kg−1·min−1) throughout precordial compressions and the first 60 min recovery. In 8 of the 24 NaCl-infused swine, the first countershock converted ventricular fibrillation to pulseless electrical activity unresponsive to subsequent countershocks, but only 1 of 18 pyruvate-treated swine developed pulseless electrical activity (relative risk 0.17; 95% confidence interval 0.13–0.22). Pyruvate treatment also lowered the dosage of vasoconstrictor phenylephrine required to maintain systemic arterial pressure at 15–60 min recovery, hastened clearance of excess glucose, elevated arterial bicarbonate, and raised arterial pH; these statistically significant effects persisted up to 3 h after sodium pyruvate infusion, while infusion-induced hypernatremia subsided. These results demonstrate that pyruvate-enriched resuscitation achieves electrocardiographic and hemodynamic stability in swine during the initial recovery from cardiac arrest. Such metabolically based treatment may offer an effective strategy to support cardiac electromechanical recovery immediately after cardiac arrest. PMID:26088865

  5. Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology.

    Science.gov (United States)

    Kamikura, Takahisa; Iwasaki, Hose; Myojo, Yasuhiro; Sakagami, Satoru; Takei, Yutaka; Inaba, Hideo

    2015-11-01

    To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs). Of 952,288 OHCAs in 2005-2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call+CPR (N=10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call-BCPR time interval=0 or 1 min), immediate Call-First (N=1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval=2-4 min), immediate CPR-First (N=5446, BCPR initiated at 0 or 1 min after witness, BCPR-to-call interval=2-4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander-patient relationship after confirming the interactions among variables. The overall survival rates in immediate Call+CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p=0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76). Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Return to Work in Out-of-Hospital Cardiac Arrest Survivors

    DEFF Research Database (Denmark)

    Sørensen, Kristian Dahl Kragholm; Wissenberg, Mads; Mortensen, Rikke Normark

    2015-01-01

    .1% in 2001-2005 versus 78.1% in 2006-2011; P=0.002). In multivariable Cox regression analysis, factors associated with return to work with >= 6 months of sustainable employment were as follows: (1) arrest during 2006-2011 versus 2001-2005, hazard ratio (HR), 1.38 (95% CI, 1.05-1.82); (2) male sex, HR, 1......Background-Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. Methods and Results-In Denmark, out-of-hospital cardiac arrests have been systematically reported...... to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4354 patients employed before arrest among 12 332 working-age patients (18-65 years), of whom 796 survived to day 30. Among 796 survivors (median age, 53 years [quartile 1-3, 46-59 years]; 81.5% men), 610 (76.6%) returned to work...

  7. Therapeutic Hypothermia Reduces Oxidative Damage and Alters Antioxidant Defenses after Cardiac Arrest

    Science.gov (United States)

    Hackenhaar, Fernanda S.; Medeiros, Tássia M.; Heemann, Fernanda M.; Behling, Camile S.; Putti, Jordana S.; Mahl, Camila D.; Verona, Cleber; da Silva, Ana Carolina A.; Guerra, Maria C.; Gonçalves, Carlos A. S.; Oliveira, Vanessa M.; Riveiro, Diego F. M.; Vieira, Silvia R. R.

    2017-01-01

    After cardiac arrest, organ damage consequent to ischemia-reperfusion has been attributed to oxidative stress. Mild therapeutic hypothermia has been applied to reduce this damage, and it may reduce oxidative damage as well. This study aimed to compare oxidative damage and antioxidant defenses in patients treated with controlled normothermia versus mild therapeutic hypothermia during postcardiac arrest syndrome. The sample consisted of 31 patients under controlled normothermia (36°C) and 11 patients treated with 24 h mild therapeutic hypothermia (33°C), victims of in- or out-of-hospital cardiac arrest. Parameters were assessed at 6, 12, 36, and 72 h after cardiac arrest in the central venous blood samples. Hypothermic and normothermic patients had similar S100B levels, a biomarker of brain injury. Xanthine oxidase activity is similar between hypothermic and normothermic patients; however, it decreases posthypothermia treatment. Xanthine oxidase activity is positively correlated with lactate and S100B and inversely correlated with pH, calcium, and sodium levels. Hypothermia reduces malondialdehyde and protein carbonyl levels, markers of oxidative damage. Concomitantly, hypothermia increases the activity of erythrocyte antioxidant enzymes superoxide dismutase, glutathione peroxidase, and glutathione S-transferase while decreasing the activity of serum paraoxonase-1. These findings suggest that mild therapeutic hypothermia reduces oxidative damage and alters antioxidant defenses in postcardiac arrest patients. PMID:28553435

  8. Hospital Variation in Survival Trends for In‐hospital Cardiac Arrest

    Science.gov (United States)

    Girotra, Saket; Cram, Peter; Spertus, John A.; Nallamothu, Brahmajee K.; Li, Yan; Jones, Philip G.; Chan, Paul S.

    2014-01-01

    Background During the past decade, survival after in‐hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. Methods and Results We identified 93 342 adults with an in‐hospital cardiac arrest at 231 hospitals in the Get With The Guidelines®‐Resuscitation registry during 2000–2010. Using hierarchical regression models, we evaluated hospital‐level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (Parrest (Pcardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, Pcardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. PMID:24922627

  9. extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital refractory cardiac arrest

    DEFF Research Database (Denmark)

    Obling, Laust; Wiberg, Sebastian; Møller, Jacob Eifer

    2017-01-01

    Out-of-hospital cardiac arrest is associated with high mortality and morbidity. Treatment options remain few in refractory cases, but extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly applied to improve the outcome. This article summarizes the use, experience and outcome of e...

  10. Cardiac arrest from intravenous indigo carmine during laparoscopic surgery -A case report-

    Science.gov (United States)

    Lee, Won-Jae

    2012-01-01

    Indigo carmine (sodium indigotindisulfonate) is a safe, biologically inactive blue dye routinely administered intravascularly during urologic and gynecologic procedures to localize the ureteral orifices and to identify severed ureters and fistulous communications. We report a case of hypotension, cardiac arrest, and cerebral ischemia after the administration of indigo carmine in a patient under total laparoscopic hysterectomy. PMID:22323961

  11. EMuRgency: Addressing cardiac arrest with socio-technical innovation in a smart learning region

    NARCIS (Netherlands)

    Kalz, Marco; Klerkx, Joris; Parra, Gonzalo; Haberstroh, Max; Elsner, Jesko; Ternier, Stefaan; Schilberg, Daniel; Jeschke, Sabina; Duval, Erik; Specht, Marcus

    2013-01-01

    Kalz, M., Klerx, J., Parra, G., Haberstroh, M., Elsner, J., Ternier, S., Schilberg, D., Jeschke, S., Duval, E., & Specht, M. (2013). EMuRgency: Addressing cardiac arrest with socio-technical innovation in a smart learning region. Interaction Design and Architectures Journal. Summer 2013 (17), 77-91.

  12. Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician's management of cardiac arrest.

    Science.gov (United States)

    Taira, Breena R; Orue, Aristides; Stapleton, Edward; Lovato, Luis; Vangala, Sitaram; Tinoco, Lucia Solorzano; Morales, Orlando

    2016-01-01

    Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician's management of simulated code scenarios. Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, PSEMILLA resuscitation course and retain these skills.

  13. Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

    Directory of Open Access Journals (Sweden)

    John Lundqvist

    2017-01-01

    Conclusion: Pulmonary emboli with subsequent right ventricular failure may cause backwards stasis, and parenchymal organ e.g. liver enlargement. The risk for laceration injuries and internal bleed must be acknowledged when applying external forces as in case of cardiac arrest and need for resuscitation. Frequent and vigilant control of positioning of manual as well as mechanical compressions is of importance.

  14. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

    DEFF Research Database (Denmark)

    Andersen, P.O.; Jensen, Michael Kammer; Lippert, A.

    2010-01-01

    2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews...

  15. Response interval is important for survival until admission after prehospital cardiac arrest

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Nielsen, Søren Loumann; Rasmussen, Lars Simon

    2010-01-01

    An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return...

  16. Comorbidity burden is not associated with higher mortality after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Nielsen, Niklas

    2016-01-01

    OBJECTIVES: We investigated whether comorbidity burden of comatose survivors of out-of-hospital cardiac arrest (OHCA) affects outcome and if comorbidity modifies the effect of target temperature management (TTM) on final outcome. DESIGN: The TTM trial randomized 939 patients to 24 h of TTM...

  17. Improved survival after an out-of-hospital cardiac arrest using new guidelines

    DEFF Research Database (Denmark)

    Steinmetz, Jacob; Barnung, S.; Nielsen, S.L.

    2008-01-01

    BACKGROUND: An out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30-day survival after OHCA. METHODS: We prospectively recorded data on all...

  18. Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Gyllenborg, Tore; Granfeldt, Asger; Lippert, Freddy

    2017-01-01

    BACKGROUND: Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM: To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OHCA...

  19. The School Nurse Role in Preparing for Sudden Cardiac Arrest in the School Setting

    Science.gov (United States)

    Evans, Warna K.; Ficca, Michelle

    2012-01-01

    Automated external defibrillators (AEDs) were introduced for first responders in 1992 to manage adult cardiac arrest and are now common in many public places. Today AEDs are capable of shocking children under 8 years of age, or less than 55 pounds. This presents a challenge for school nurses, particularly as the prevalence of chronic medical…

  20. Long-term survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Holler, Nana G; Mantoni, Teit; Nielsen, Søren L

    2007-01-01

    an initial rhythm of VF, 13% had asystole, 10% had PEA and 2% were unknown. Survival was 87% after one year and survival after 10 years was 46% with a significantly lower survival for patients over 60 years. CONCLUSION: Long-term survival after out-of-hospital cardiac arrest in a physician-staffed emergency...

  1. The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Horsted, Tina I

    2008-01-01

    AIMS: To assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA). METHODS: We prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia...

  2. A structured approach to neurologic prognostication in clinical cardiac arrest trials

    NARCIS (Netherlands)

    Cronberg, Tobias; Horn, Janneke; Kuiper, Michael A.; Friberg, Hans; Nielsen, Niklas

    2013-01-01

    Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the

  3. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian

    2016-01-01

    AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return...

  4. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  5. Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors

    NARCIS (Netherlands)

    de Vreede-Swagemakers, J. J.; Gorgels, A. P.; Dubois-Arbouw, W. I.; Dalstra, J.; Daemen, M. J.; van Ree, J. W.; Stijns, R. E.; Wellens, H. J.

    1998-01-01

    To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate. During a five year period (1991-95)

  6. Cardiac arrest from intravenous indigo carmine during laparoscopic surgery -A case report-

    OpenAIRE

    Lee, Won-Jae; Jang, Hyun-Soo

    2012-01-01

    Indigo carmine (sodium indigotindisulfonate) is a safe, biologically inactive blue dye routinely administered intravascularly during urologic and gynecologic procedures to localize the ureteral orifices and to identify severed ureters and fistulous communications. We report a case of hypotension, cardiac arrest, and cerebral ischemia after the administration of indigo carmine in a patient under total laparoscopic hysterectomy.

  7. Cardiac arrest from intravenous indigo carmine during laparoscopic surgery -A case report-.

    Science.gov (United States)

    Lee, Won-Jae; Jang, Hyun-Soo

    2012-01-01

    Indigo carmine (sodium indigotindisulfonate) is a safe, biologically inactive blue dye routinely administered intravascularly during urologic and gynecologic procedures to localize the ureteral orifices and to identify severed ureters and fistulous communications. We report a case of hypotension, cardiac arrest, and cerebral ischemia after the administration of indigo carmine in a patient under total laparoscopic hysterectomy.

  8. Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest

    NARCIS (Netherlands)

    Hofmeijer, Jeannette; Cloostermans, M.C.; Beishuizen, A.; van Putten, Michel Johannes Antonius Maria

    2014-01-01

    Objective: Electroencephalographic status epilepticus occurs in 9–35% of comatose patients after cardiac arrest. Mortality is 90–100%. It is unclear whether (some) seizure patterns represent a condition in which anti-epileptic treatment may improve outcome, or severe ischemic damage, in which

  9. Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?

    Science.gov (United States)

    Shao, Huan; Li, Chun-Sheng

    2017-01-01

    Objective: Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive. We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients. Data Sources: The EMBASE and PubMed databases were searched with the key words “epinephrine,” “cardiac arrest,” and variations of these terms. Study Selection: Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review. Results: Sudden cardiac arrest causes 544,000 deaths in China each year, with survival occurring in adrenaline was associated with improved short-term survival (ROSC). However, it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA, and it may have a harmful effect. Larger placebo-controlled, double-blind, randomized control trials are required to definitively establish the effect of epinephrine. PMID:28836556

  10. Targeted temperature management at 33°C versus 36°C after cardiac arrest

    NARCIS (Netherlands)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P.; Åneman, Anders; al-Subaie, Nawaf; Boesgaard, Søren; Bro-Jeppesen, John; Brunetti, Iole; Bugge, Jan Frederik; Hingston, Christopher D.; Juffermans, Nicole P.; Koopmans, Matty; Køber, Lars; Langørgen, Jørund; Lilja, Gisela; Møller, Jacob Eifer; Rundgren, Malin; Rylander, Christian; Smid, Ondrej; Werer, Christophe; Winkel, Per; Friberg, Hans; Pellis, Thomas; Køber, Lars V.; Annane, Djillali; Wernerman, Jan; Lange, Theis; Karlsson, Ulla-Britt; Jergle-Almqvist, Liz; Grevstad, Berit; Whitfield, Kate; Micallef, Sharon; Glass, Parisa; Myburgh, John; Saxena, Manoj; Stewart, Antony; Finfer, Simon; Bishop, Gillian; Rajbhandari, Dorrilyn; Hammond, Naomi; Willenberg, Lynsey; Miller, Jennene; Inskip, Deborah; Macken, Lewis; Eatough, Noel; Bass, Frances; Yarad, Elizabeth; O'Connor, Anne; Bird, Simon; Jewell, Timothy; Davies, Gareth; Ng, Karl; Coward, Sharon; Parker, Sharyn; Cortado, Dennis; Gould, Ann; Harward, Meg; Thompson, Kelly; Belholavek, Jan; Kreckova, Marketa; Kral, Ales; Horak, Jan; Otahal, Michal; Rulisek, Jan; Malik, Jan; Prettl, Martin; Wascher, Michael; Boesgaard, Soeren; Moller, Jacob E.; Johansen, Ane Loof; Campanile, Vincenzo; Peratoner, Alberto; Verginella, Francesca; Leone, Daniele; Roncarati, Andrea; Franceschino, Eliana; Sanzani, Anna; Martini, Alice; Perlin, Micol; Pelosi, Paolo; Insorsi, Angelo; Pezzato, Stefano; de Luca, Giorgio; Gazzano, Emanuela; Ottonello, Gian Andrea; Furgani, Andrea; Telani, Rosanna; Maiani, Simona; Kieffer, Jaqueline; vd Veen, Annelou L.; Winters, Tineke; Bosch, Frank; Raaijmakers, Monique A. M.; Metz-Hermans, S. W. L.; Endeman, Henrik; Rijkenberg, Saskia; Bianchi, Addy; Norum, Hilde; Espinoza, Andreas; Kerans, Viesturs; Brevik, Helene; Svalebjørg, Morten; Grindheim, Guro; Petersen, Arne Jan; Baratt-Due, Andreas; Laake, Jon Henrik; Spreng, Ulrik; Karlsen, Marte Marie Wallander; Langøren, Jørund; Fanebust, Rune; Holm, Marianne Sætrang; Flinterud, Stine Iren; Wickman, Carsten; Johnsson, Jesper; Ebner, Florian; Gustavsson, Nerida; Petersson, Heléne; Petersson, Jörgen; Nasiri, Faezheh; Stafilidou, Frida; Edqvist, Kristine; Uhlig, Sven; Sköld, Gunilla; Sanner, Johan; Wallskog, Jesper; Wyon, Nicholas; Golster, Martin; Samuelsson, Anders; Hildebrand, Carl; Kadowaki, Taichi; Larsson-Viksten, Jessica; de Geer, Lina; Hansson, Patrik; Appelberg, Henrik; Hellsten, Anders; Lind, Susanne; Kander, Thomas; Persson, Johan; Annborn, Martin; Adolfsson, Anne; Corrigan, Ingrid; Dragancea, Irina; Undén, Johan; Larsson, Marina; Chew, Michelle; Unnerbäck, Mårten; Petersen, Per; Svedung-Rudebou, Anna; Svensson, Robert; Elvenes, Hilde; Bäckman, Carl; Martner, Patrik; Martinell, Louise; Biber, Björn; Ahlqvist, Marita; Jacobson, Caisa; Forsberg, Marie-Louise; Lindgren, Roman Desta; Bergquist, Fatma; Thorén, Anders; Fredholm, Martin; Sellgren, Johan; Segerstad, Lisa Hård af; Löfgren, Mikael; Gustavsson, Ingvor; Henström, Christina; Andersson, Bertil; Thiringer, Karin; Rydholm, Nadja; Persson, Stefan; Jawad, Jawad; Östman, Ingela; Berglind, Ida; Bergström, Eric; Andersson, Annika; Törnqvist, Cathrine; de Mello, Nubia Lafayete Marques; Gardaz, Valérie; Kleger, Gian-Reto; Schrag, Claudia; Fässler, Edith; Zender, Hervé; Wise, Matthew; Palmer, Nicki; Fouweather, Jen; Cole, Jade M.; Cocks, Eve; Frost, Paul J.; Saayman, Anton G.; Holmes, Tom; Scholey, Gareth M.; Watkins, Helen; Fernandez, Stephen; Walden, Andrew; Atkinson, Jane; Jacques, Nicola; Brown, Abby; Cranshaw, Julius; Berridge, Peter; McCormick, Robert; Schuster-Bruce, Martin; Scott, Michelle; White, Nigel; Vickers, Emma; Glover, Guy; Ostermann, Marlies; Holmes, Paul; Koutroumanidis, Michael; Lei, Katie; Sanderson, Barnaby; Smith, John; Moore, Matthew; Randall, Paul; Mellinghoff, Johannes; Buratti, Azul Forti; Ryan, Chris; Ball, Jonathan; Francis, Gaynor

    2013-01-01

    Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our

  11. Cardiac arrest in infants, children, and adolescents: long-term emotional and behavioral functioning

    NARCIS (Netherlands)

    L. van Zellem (Lennart); E.M.W.J. Utens (Elisabeth); M.J. Madderom (Marlous); J.S. Legerstee (Jeroen); F.K. Aarsen (Femke); D. Tibboel (Dick); C.M.P. Buysse (Corinne)

    2016-01-01

    textabstractVery little is known about the psychological consequences of a cardiac arrest (CA) during childhood. Our aim was to assess long-term emotional and behavioral functioning, and its predictors, in survivors of CA in childhood. This long-term follow-up study involved all consecutive infants,

  12. Long-term neuropsychological outcomes in children and adolescents after cardiac arrest

    NARCIS (Netherlands)

    L. van Zellem (Lennart); C.M.P. Buysse (Corinne); M.J. Madderom (Marlous); F.K. Aarsen (Femke); J.S. Legerstee (Jeroen); D. Tibboel (Dick); E.M.W.J. Utens (Elisabeth)

    2015-01-01

    textabstractPurpose: Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to assess long-term neuropsychological functioning in children and adolescents surviving CA. Methods: Neuropsychological follow-up study involving all consecutive

  13. Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H

    2012-01-01

    were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. RESULTS...

  14. Cardiac Arrest During Medically-Supervised Exercise Training: A Report of Fifteen Successful Defibrillations.

    Science.gov (United States)

    Pyfer, Howard R.; And Others

    The Cardio-Pulmonary Research Institute conducted an exercise program for men with a history of coronary heart disease. Over 7 years, there were 15 cases of cardiac arrest during exercise (one for every 6,000 man-hours of exercise). Trained medical personnel were present in all cases, and all were resuscitated by electrical defibrillation with no…

  15. Defibrillation probability and impedance change between shocks during resuscitation from out-of-hospital cardiac arrest

    NARCIS (Netherlands)

    Walker, Robert G.; Koster, Rudolph W.; Sun, Charles; Moffat, George; Barger, Joseph; Dodson, Pamela P.; Chapman, Fred W.

    2009-01-01

    Objective: Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic

  16. Acute Esophageal Necrosis in an Alcoholic after Successful Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Amish Shah

    2017-01-01

    Full Text Available Introduction. We present a patient who presented to the ICU after successful resuscitation from cardiac arrest who was subsequently diagnosed with AEN. Case Presentation. A 66-year-old female presented after cardiac arrest in which return of spontaneous circulation was achieved within 7 minutes after the initiation of CPR. She was intubated on the scene and found to have coffee ground emesis in her bathroom when found unresponsive. Due to the hemodynamically significant GI bleed, patient was started on IV proton pump inhibitor, octreotide, and levophed. Subsequent endoscopy showed diffuse severe mucosal changes characterized by blackness, erythema, friability, granularity, inflammation, and decreased vascular pattern in the middle third of the esophagus and in the lower third of the esophagus. Discussion. AEN is a rare syndrome with a prevalence ranging from 0.001 to 0.2% of EGD. This patient is especially rare as this patient was female and had AEN in the middle esophagus along with lower esophagus. The pathophysiology in this patient is hypothesized that she had cardiac arrest secondary to acute upper GI hemorrhage. Subsequent low-flow state (cardiac arrest in addition to being in the setting of severe alcohol abuse led to esophageal necrosis.

  17. Electrophysiological prognostication and brain injury from cardiac arrest.

    Science.gov (United States)

    Kaplan, Peter W

    2006-09-01

    Anoxic coma after cardiorespiratory arrest warrants precocious investigation to establish probable outcome. Electroencephalogram (EEG) may uncover subclinical seizures; EEG grades have provided accurate prognosis of poor and favorable outcomes, but are weakest in those patients in between. Somatosensory evoked potentials now have proven benefit in accurately establishing a poor outcome (death or persistent vegetative state) when cortical responses (N20) are absent. These studies are particularly helpful when clinical examination of coma, early on, might yield uncertain prognosis (i.e., when brain stem reflexes are present). Combining clinical examination with electrophysiology has increasingly yielded multimodality approaches to early prognostication of coma after cardiorespiratory arrest, with more recent studies using event-related and middle-latency potentials showing promise for distinguishing good outcome (to consciousness), from awake but vegetative states. Further studies are warranted for this multimodality approach which, hopefully, may yield more widespread practical use of these testing modalities.

  18. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest*.

    Science.gov (United States)

    Bernard, Stephen A; Smith, Karen; Cameron, Peter; Masci, Kevin; Taylor, David McD; Cooper, D Jamie; Kelly, Anne-Maree; Silvester, William

    2012-03-01

    To evaluate the effects on temperature and outcome at hospital discharge of a pre-hospital rapid infusion of large volume, ice-cold intravenous Hartmann's solution in patients with out-of-hospital cardiac arrest and an initial cardiac rhythm of asystole or pulseless electrical activity. Prospective, randomized, controlled clinical trial. Pre-hospital emergency medical service and 12 critical care units in Melbourne, Australia. One hundred and sixty three patients who had been resuscitated from cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity. : Patients were randomized to either pre-hospital cooling using a rapid infusion of up to two litres ice-cold Hartmann's solution (82 patients) or cooling after hospital admission (81 patients). The planned duration of therapeutic hypothermia (32 °C-34 °C) in both groups was 24 hrs. Patients allocated to pre-hospital cooling received a median of 1500 ml of ice-cold fluid. This resulted in a mean decrease in core temperature of 1.4 °C compared with 0.2 °C in hospital cooled patients (p ice cold intravenous Hartmann's solution decreases core temperature at hospital arrival and decreases the time to therapeutic hypothermia. In patients with a cardiac cause of the arrest, this treatment may increase the rate of favorable outcome at hospital discharge. Further larger studies should evaluate the effects of pre-hospital cooling when the initial cardiac rhythm is asystole or pulseless electrical activity, particularly in patients with a cardiac cause of the arrest.

  19. Epinephrine in cardiac arrest: systematic review and meta-analysis.

    Science.gov (United States)

    Morales-Cané, Ignacio; Valverde-León, María Del Rocío; Rodríguez-Borrego, María Aurora

    2016-12-08

    evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status. avaliar a efetividade da adrenalina na parada cardíaca e seu efeito na sobrevivência e no estado neurológico. revisão sistemática da literatura científica com meta-análise utilizando um modelo de efeitos aleatórios. Revisão em Medline, Embase e Cochrane, desde 2005 até 2015 de ensaios clínicos e estudos observacionais. observou-se aumento nas taxas de retorno de circulação espontânea com a administração de adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparadas com a não administração de adrenalina. A meta-análise mostrou um aumento da sobrevivência na alta ou depois de 30 dias da administração de adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). Quando estratificados por ritmos desfibrilháveis e não desfibrilh

  20. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest.

    Science.gov (United States)

    Andersen, Lars W; Kim, Won Young; Chase, Maureen; Berg, Katherine M; Mortensen, Sharri J; Moskowitz, Ari; Novack, Victor; Cocchi, Michael N; Donnino, Michael W

    2016-01-01

    Patients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1-4h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality. We included adults from the Get With the Guidelines(®)- Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR) ≤ 60 or ≥ 100 min(-1), respiratory rate (RR) ≤ 10 or >20 min(-1) and systolic blood pressure (SBP) ≤ 90 mm Hg) and severely abnormal (HR ≤ 50 or ≥ 130 min(-1), RR ≤ 8 or ≥ 30 min(-1) and SBP ≤ 80 mm Hg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model. 7851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal vital sign 1-4h before the arrest and 13.4% had at least one severely abnormal sign. We found a step-wise increase in mortality with increasing number of abnormal vital signs within the abnormal (odds ratio (OR) 1.53 (CI: 1.42-1.64) and severely abnormal groups (OR 1.62 (CI: 1.38-1.90)). This remained in multivariable analysis (abnormal: OR 1.38 (CI: 1.28-1.48), and severely abnormal: OR 1.40 (CI: 1.18-1.65)). Abnormal vital signs are prevalent 1-4h before in-hospital cardiac arrest on hospital wards. In-hospital mortality increases with increasing number of pre-arrest abnormal vital signs as well as increased severity of vital sign derangements. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Anxiety and depression among out-of-hospital cardiac arrest survivors

    DEFF Research Database (Denmark)

    Lilja, G; Nilsson, G; Nielsen, N

    2015-01-01

    AIM: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. METHODS: OHCA-survivors randomized to targeted temperature....... Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. ClinicalTrials.gov NCT01020916/NCT...

  2. Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States

    Science.gov (United States)

    Girotra, Saket; van Diepen, Sean; Nallamothu, Brahmajee K.; Carrel, Margaret; Vellano, Kimberly; Anderson, Monique L.; McNally, Bryan; Abella, Benjamin; Sasson, Comilla; Chan, Paul S.

    2016-01-01

    Background Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across U.S. regions, factors underlying this survival variation remain incompletely explained. Methods and Results Using data from the Cardiac Arrest Registry to Enhance Survival, we identified 96,662 adult patients with out-of-hospital cardiac in 132 U.S. counties. We used hierarchical regression models to examine county-level variation in rates of survival and survival with functional recovery (defined as Cerebral Performance Category score of 1 or 2) and examined the contribution of demographics, cardiac arrest characteristics, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and county-level socio-demographic factors in survival variation across counties. A total of 9317 (9.6%) patients survived to discharge, and 7176 (7.4%) achieved functional recovery. At a county-level, there was marked variation in rates of survival to discharge (range: 3.4%-22.0%, median odds ratio [MOR] 1.40, 95% CI 1.32-1.46) and survival with functional recovery (range: 0.8%-21.0%, MOR 1.53, 95% CI 1.43-1.62). County-level rates of bystander CPR and AED use were positively correlated with both outcomes (Pcardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively. Additional adjustment of bystander CPR and AED explained 41% of the survival variation, and this increased to 50.4% after adjustment of county-level socio-demographic factors. Similar findings were noted in analyses of survival with functional recovery. Conclusions Although out-of-hospital cardiac arrest survival varies significantly across U.S. counties, a substantial proportion of the variation is due to differences in bystander response across communities. PMID:27081119

  3. Impact of cardiac arrest resuscitated donors on heart transplant recipients' outcome.

    Science.gov (United States)

    Galeone, Antonella; Varnous, Shaida; Lebreton, Guillaume; Barreda, Eleodoro; Hariri, Sara; Pavie, Alain; Leprince, Pascal

    2017-03-01

    To evaluate the influence of cardiac arrest-resuscitated donors (CARDs) on the outcome of heart recipients. Patients transplanted between July 2004 and December 2012 were divided into 2 groups according to the history of cardiac arrest in donors and their clinical records were retrospectively reviewed. A total of 584 heart transplantations were performed during the study period, and 117 recipients received an organ from a CARD. There were no differences between the 2 groups with regards to recipient age, sex, cardiomyopathy, preoperative extracorporeal membrane oxygenation, national high emergency waiting list, and redo surgery. Donors who sustained a cardiac arrest were significantly younger (44 [32-51] vs 49 [41-56] years; P cardiac arrest duration was 15 minutes (5-25). No difference was noted in donors with regards to left ventricular ejection fraction at time of organ procurement (62% ± 8% vs 63% ± 8%; P = .2). There were no differences between the 2 groups with regards to ischemic time (179 ± 60 vs 183 ± 59 minutes; P = .43), need for postoperative extracorporeal membrane oxygenation for primary graft failure (31% vs 30%; P = .993) and 30-days mortality. Recipients receiving an organ from a CARD had a significantly better 10 year survival (69.4% vs 50.4%; P = .017). History of cardiac arrest in donors with a preserved left ventricular ejection fraction at time of organ procurement doesn't affect outcome of heart recipients. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. Variability in the determination of death after cardiac arrest: a review of guidelines and statements.

    Science.gov (United States)

    Dhanani, Sonny; Hornby, Laura; Ward, Roxanne; Shemie, Sam

    2012-01-01

    The reemergence of organ donation after circulatory determination of death (DCDD) in Canada demands the establishment of clear, evidence-based guidelines for the determination of death. The primary purpose of this study was to investigate the variability in specific criteria, diagnostic tests, and recommended wait periods for the determination of death after cardiac arrest. We used PubMed and Web of Science to perform a structured search of the medical literature for articles published up to January 1, 2010. We also performed an unstructured search of the internet for unrestricted, readily available, nonjournal sources. We limited the search to countries that are most active in DCDD. A total of 26 documents were retrieved; 21 medical professional society/institution statements and 5 national/international guidelines. Specific criteria for the determination of death after cardiac arrest were cited in 24 documents: 14 recommend cardiocirculatory criteria alone; 6 oblige the requirement of a prolonged waiting period after declaration to ensure neurological death; 3 recommend following "accepted medical practice" without specific details; and 1 leaves the definition up to "national authorities." Only 16 of the documents require specific diagnostic procedures with unresponsiveness, absent arterial pulse and apnea cited the most consistently. Specific wait periods after declaration are required for the determination of death after cardiac arrest in 24 documents, cited times range from 2 to 10 minutes, with a 5-minute period the most frequent. This review is the first to document the variability of guidelines and statements for the determination of death after cardiac arrest, in countries where the practice of DCDD is becoming increasingly common. The scarcity of peer-reviewed published guidelines in the medical literature exemplifies the need for further investigation. We believe these results will inform the ethical discussions surrounding the determination of death

  5. Clinical review: Continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest.

    Science.gov (United States)

    Friberg, Hans; Westhall, Erik; Rosén, Ingmar; Rundgren, Malin; Nielsen, Niklas; Cronberg, Tobias

    2013-07-23

    There has been a dramatic change in hospital care of cardiac arrest survivors in recent years, including the use of target temperature management (hypothermia). Clinical signs of recovery or deterioration, which previously could be observed, are now concealed by sedation, analgesia, and muscle paralysis. Seizures are common after cardiac arrest, but few centers can offer high-quality electroencephalography (EEG) monitoring around the clock. This is due primarily to its complexity and lack of resources but also to uncertainty regarding the clinical value of monitoring EEG and of treating post-ischemic electrographic seizures. Thanks to technical advances in recent years, EEG monitoring has become more available. Large amounts of EEG data can be linked within a hospital or between neighboring hospitals for expert opinion. Continuous EEG (cEEG) monitoring provides dynamic information and can be used to assess the evolution of EEG patterns and to detect seizures. cEEG can be made more simple by reducing the number of electrodes and by adding trend analysis to the original EEG curves. In our version of simplified cEEG, we combine a reduced montage, displaying two channels of the original EEG, with amplitude-integrated EEG trend curves (aEEG). This is a convenient method to monitor cerebral function in comatose patients after cardiac arrest but has yet to be validated against the gold standard, a multichannel cEEG. We recently proposed a simplified system for interpreting EEG rhythms after cardiac arrest, defining four major EEG patterns. In this topical review, we will discuss cEEG to monitor brain function after cardiac arrest in general and how a simplified cEEG, with a reduced number of electrodes and trend analysis, may facilitate and improve care.

  6. Cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate

    DEFF Research Database (Denmark)

    Balslev, U; Berild, D; Nielsen, T L

    1992-01-01

    A 27-year-old man, HIV-positive for 4 years, developed ventricular fibrillation and cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. The dosage was 4 mg/kg/day for 18 days. Nephrotoxicity occurred and raised serum potassium. The plasma co...... concentration of pentamidine was 580 nmol/l. Careful monitoring of renal and cardiac functions is recommended during intravenous therapy with pentamidine isethionate.......A 27-year-old man, HIV-positive for 4 years, developed ventricular fibrillation and cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. The dosage was 4 mg/kg/day for 18 days. Nephrotoxicity occurred and raised serum potassium. The plasma...

  7. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial).

    Science.gov (United States)

    Stub, Dion; Bernard, Stephen; Pellegrino, Vincent; Smith, Karen; Walker, Tony; Sheldrake, Jayne; Hockings, Lisen; Shaw, James; Duffy, Stephen J; Burrell, Aidan; Cameron, Peter; Smit, De Villiers; Kaye, David M

    2015-01-01

    Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia. The CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a single center, prospective, observational study conducted at The Alfred Hospital. The CHEER protocol was developed for selected patients with refractory in-hospital and out-of-hospital cardiac arrest and involves mechanical CPR, rapid intravenous administration of 30 mL/kg of ice-cold saline to induce intra-arrest therapeutic hypothermia, percutaneous cannulation of the femoral artery and vein by two critical care physicians and commencement of veno-arterial ECMO. Subsequently, patients with suspected coronary artery occlusion are transferred to the cardiac catheterization laboratory for coronary angiography. Therapeutic hypothermia (33 °C) is maintained for 24h in the intensive care unit. There were 26 patients eligible for the CHEER protocol (11 with OHCA, 15 with IHCA). The median age was 52 (IQR 38-60) years. ECMO was established in 24 (92%), with a median time from collapse until initiation of ECMO of 56 (IQR 40-85) min. Percutaneous coronary intervention was performed on 11 (42%) and pulmonary embolectomy on 1 patient. Return of spontaneous circulation was achieved in 25 (96%) patients. Median duration of ECMO support was 2 (IQR 1-5) days, with 13/24 (54%) of patients successfully weaned from ECMO support. Survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14/26 (54%) patients. A protocol including E-CPR instituted by critical care physicians for refractory cardiac arrest which includes mechanical CPR, peri-arrest therapeutic hypothermia and

  8. Hydroxocobalamin and epinephrine both improve survival in a swine model of cyanide-induced cardiac arrest.

    Science.gov (United States)

    Bebarta, Vikhyat S; Pitotti, Rebecca L; Dixon, Patricia S; Valtier, Sandra; Esquivel, Luis; Bush, Anneke; Little, Charles M

    2012-10-01

    To determine whether hydroxocobalamin will improve survival compared with epinephrine and saline solution controls in a model of cyanide-induced cardiac arrest. Forty-five swine (38 to 42 kg) were tracheally intubated, anesthetized, and central venous and arterial continuous cardiovascular monitoring catheters were inserted. Potassium cyanide was infused until cardiac arrest developed, defined as mean arterial pressure less than 30 mm Hg. Animals were treated with standardized mechanical chest compressions and were randomly assigned to receive one of 3 intravenous bolus therapies: hydroxocobalamin, epinephrine, or saline solution (control). All animals were monitored for 60 minutes after cardiac arrest. Additional epinephrine infusions were used in all arms of the study after return of spontaneous circulation for systolic blood pressure less than 90 mm Hg. A sample size of 15 animals per group was determined according to a power of 80%, a survival difference of 0.5, and an α of 0.05. Repeated-measure ANOVA was used to determine statistically significant changes between groups over time. Baseline weight, time to arrest, and cyanide dose at cardiac arrest were similar in the 3 groups. Coronary perfusion pressures with chest compressions were greater than 15 mm Hg in both treatment groups indicating sufficient compression depth. Zero of 15 (95% confidence interval [CI] 0% to 25%) animals in the control group, 11 of 15 (73%; 95% CI 48% to 90%) in the hydroxocobalamin group, and 11 of 15 (73%; 95% CI 48% to 90%) in the epinephrine group survived to the conclusion of the study (Pcyanide levels in the hydroxocobalamin group were also lower than that of the epinephrine group from cardiac arrest through the conclusion of the study. Intravenous hydroxocobalamin and epinephrine both independently improved survival compared with saline solution control in our swine model of cyanide-induced cardiac arrest. Hydroxocobalamin improved mean arterial pressure and pH, decreased

  9. Combination of initial neurologic examination and continuous EEG to predict survival after cardiac arrest.

    Science.gov (United States)

    Youn, Chun Song; Callaway, Clifton W; Rittenberger, Jon C

    2015-09-01

    Prognosticating outcome following cardiac arrest requires a multimodal approach. We tested whether the combination of initial neurologic examination combined with continuous EEG was superior to either test alone for predicting survival after cardiac arrest. Review of consecutive patients receiving continuous EEG monitoring between April 2010 and June 2013. Initial neurologic examination was evaluated using the Full Outline of UnResponsiveness (FOUR) score and organ system dysfunction determined using the SOFA score. We defined four categories of initial post-cardiac arrest illness severity (PCAC): (I) awake, (II) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score cardiac + respiratory score ≥ 4), and (IV) coma without brainstem reflexes. A second analysis focusing on neurologic injury divided subjects into three groups according to initial FOUR_B score; FOUR_B = 0-1, FOUR_B = 2 and FOUR_B = 4. A blinded rater dichotomized continuous EEG patterns during the first 48h into malignant patterns (non-convulsive status epilepticus, convulsive status epilepticus, myoclonic status epilepticus and generalized periodic epileptiform discharges). The primary outcome was survival to hospital discharge. Of 331 subjects, mean age was 58 (SD 17) years and 206 (62.2%) subjects were male. Ventricular fibrillation or tachycardia (VF/VT) was the initial rhythm for 93 (28.1%) subjects. Among subjects with malignant cEEG, survival to hospital discharge rate was 0% for FOUR_B 0-1, 8.1% for FOUR_B 2 and 12.5% for FOUR_B 4, respectively. In one multivariate analysis, survival was independently associated with VF/VT, FOUR_B of 2, FOUR_B of 4, and non-malignant cEEG. In a separate model, survival was associated with VF/VT, PCAC cardiac arrest. We caution against using these findings to speed prognostication until they are externally validated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients.

    Science.gov (United States)

    Look, Xinqi; Li, Huihua; Ng, Mingwei; Lim, Eric Tien Siang; Pothiawala, Sohil; Tan, Kenneth Boon Kiat; Sewa, Duu Wen; Shahidah, Nur; Pek, Pin Pin; Ong, Marcus Eng Hock

    2017-07-05

    Targeted temperature management post-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) of post-cardiac arrest patients undergoing internal cooling verses external cooling. A randomized controlled trial of post-resuscitation cardiac arrest patients was conducted from October 2008-September 2014. Patients were randomized to either internal or external cooling methods. Historical controls were selected matched by age and gender. Analysis using SPSS version 21.0 presented descriptive statistics and frequencies while univariate logistic regression was done using R 3.1.3. 23 patients were randomized to internal cooling and 22 patients to external cooling and 42 matched controls were selected. No significant difference was seen between internal and external cooling in terms of survival, neurological outcomes and complications. However in the internal cooling arm, there was lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02). Compared to normothermia, internal cooling had higher survival (OR=3.36, 95% CI=(1.130, 10.412), and lower risk of developing cardiac arrhythmias (OR=0.18, 95% CI=(0.04, 0.63)). Subgroup analysis showed those with cardiac cause of arrest (OR=4.29, 95% CI=(1.26, 15.80)) and sustained ROSC (OR=5.50, 95% CI=(1.64, 20.39)) had better survival with internal cooling compared to normothermia. Cooling curves showed tighter temperature control for internal compared to external cooling. Internal cooling showed tighter temperature control compared to external cooling. Internal cooling can potentially provide better survival-to-hospital discharge outcomes and reduce cardiac arrhythmia complications in carefully selected patients as compared to normothermia. Copyright © 2017. Published by Elsevier Inc.

  11. Carbon Monoxide Improves Neurologic Outcomes by Mitochondrial Biogenesis after Global Cerebral Ischemia Induced by Cardiac Arrest in Rats.

    Science.gov (United States)

    Wang, Peng; Yao, Lan; Zhou, Li-Li; Liu, Yuan-Shan; Chen, Ming-di; Wu, Hai-Dong; Chang, Rui-Ming; Li, Yi; Zhou, Ming-Gen; Fang, Xiang-Shao; Yu, Tao; Jiang, Long-Yuan; Huang, Zi-Tong

    2016-01-01

    Mitochondrial dysfunction contributes to brain injury following global cerebral ischemia after cardiac arrest. Carbon monoxide treatment has shown potent cytoprotective effects in ischemia/reperfusion injury. This study aimed to investigate the effects of carbon monoxide-releasing molecules on brain mitochondrial dysfunction and brain injury following resuscitation after cardiac arrest in rats. A rat model of cardiac arrest was established by asphyxia. The animals were randomly divided into the following 3 groups: cardiac arrest and resuscitation group, cardiac arrest and resuscitation plus carbon monoxide intervention group, and sham control group (no cardiac arrest). After the return of spontaneous circulation, neurologic deficit scores (NDS) and S-100B levels were significantly decreased at 24, 48, and 72 h, but carbon monoxide treatment improved the NDS and S-100B levels at 24 h and the 3-day survival rates of the rats. This treatment also decreased the number of damaged neurons in the hippocampus CA1 area and increased the brain mitochondrial activity. In addition, it increased mitochondrial biogenesis by increasing the expression of biogenesis factors including peroxisome proliferator-activated receptor-γ coactivator-1α, nuclear respiratory factor-1, nuclear respiratory factor-2 and mitochondrial transcription factor A. Thus, this study showed that carbon monoxide treatment alleviated brain injury after cardiac arrest in rats by increased brain mitochondrial biogenesis.

  12. Clinical Trials in Cardiac Arrest and Subarachnoid Hemorrhage: Lessons from the Past and Ideas for the Future

    Directory of Open Access Journals (Sweden)

    Jennifer A. Frontera

    2013-01-01

    Full Text Available Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH. Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest met the review criteria (103 published, 39 ongoing. The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%, while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.

  13. Out-of-hospital cardiac arrests during exercise among urban inhabitants in Japan: Insights from a population-based registry of Osaka City.

    Science.gov (United States)

    Kiyohara, Kosuke; Sado, Junya; Matsuyama, Tasuku; Nishiyama, Chika; Kobayashi, Daisuke; Kiguchi, Takeyuki; Hayashida, Sumito; Kitamura, Yuri; Sobue, Tomotaka; Nakata, Ken; Iwami, Taku; Kitamura, Tetsuhisa

    2017-08-01

    The patient characteristics, pre-hospital interventions, and outcomes of out-of-hospital cardiac arrests (OHCA) occurring during exercise, have not been sufficiently investigated among the general population. OHCA data from 2009 to 2015 were obtained from the population-based OHCA registry in Osaka City, Japan. Patients who suffered OHCA, which occurred during exercise before the arrival of emergency medical service personnel, were included. The primary endpoint was one-month survival with a favourable neurological outcome after OHCA, defined using the Glasgow-Pittsburgh cerebral performance category scale 1 or 2. During the 7-year study period, 16,278 OHCAs were observed, and 52 (0.3%) occurred during exercise (male, n=41 [79%]; median age, 62 years). These incidents occurred mainly during running activities (n=14), followed by swimming (n=8), dance/social dance (n=6), tennis (n=4), and weight training (n=3). Within these exercise-related OHCAs, 47 (90%) were of cardiac origin, 45 (87%) were bystander-witnessed cardiac arrests, 49 (94%) received bystander-initiated cardiopulmonary resuscitation, and 30 (57%) received public-access defibrillation (PAD). Overall, 56% (29/52) had one-month survival with a favourable neurological outcome after OHCA, which was significantly higher among OHCAs of cardiac origin with PAD (77%, 23/30) than among those of cardiac origin without PAD (35%, 6/17) and among those of non-cardiac origin (0%, 0/5) (pvariety of exercise activities. Patients with OHCA of cardiac origin had a good prognosis, and PAD played an important role in improving patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Readmission Rates and Long-Term Hospital Costs Among Survivors of In-Hospital Cardiac Arrest

    Science.gov (United States)

    Chan, Paul S.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Curtis, Lesley H.; Li, Yan; Hammill, Bradley G.; Spertus, John A.

    2014-01-01

    Background Although in-hospital cardiac arrest is common, little is known about readmission patterns and inpatient resource use among survivors of in-hospital cardiac arrest. Methods and Results Within a large national registry, we examined long-term inpatient utilization among 6972 adults ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8 ± 7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate: 35 readmissions/100 patients [95% CI: 33–37]) and 8751 readmissions at 1 year (cumulative incidence rate: 185 readmissions/100 patients [95% CI: 177–190]). Overall, mean inpatient costs were $7,741 ± $2323 at 30 days and $18,629 ± $9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years: $6052 [reference]; 75–84 years: $7444 [adjusted cost ratio, 1.23 [1.06–1.42]; 65–74 years: $8291 [adjusted cost ratio, 1.37 [1.19–1.59]; both Pcardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race. PMID:25351479

  15. Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest.

    Science.gov (United States)

    Koller, Allison C; Salcido, David D; Callaway, Clifton W; Menegazzi, James J

    2014-10-01

    We sought to compare characteristics of emergency medical services-treated out-of-hospital cardiac arrests resulting from suspected drug overdose with non-overdose cases and test the relationship between suspected overdose and survival to hospital discharge. Data from emergency medical services-treated, non-traumatic out-of-hospital cardiac arrests from 2006 to 2008 and late 2009 to 2011 were obtained from four EMS agencies in the Pittsburgh, Pennsylvania metropolitan area. Case definition for suspected drug overdose was naloxone administration, indication on the patient care report and/or indication by a review of hospital records. Resuscitation parameters included chest compression fraction, rate, and depth and the administration of resuscitation drugs. Demographic and outcome variables compared by suspected overdose status included age, sex, and survival to hospital discharge. From 2342 treated out-of-hospital cardiac arrests, 180 were suspected overdose cases (7.7%) and were compared to 2162 non-overdose cases. Suspected overdose cases were significantly younger (45 vs. 65, pcardiac arrest were younger, received different resuscitative care, and survived more often than non-overdose cases. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Therapeutic hypothermia and inhalation anesthesia in a patient with severe pneumococcal meningitis and secondary cardiac arrest.

    Science.gov (United States)

    Bukovnik, Nejc; Markota, Andrej; Velnar, Tomaž; Rebol, Janez; Sinkovič, Andreja

    2017-04-01

    Therapeutic hypothermia was associated with increased mortality in patients with severe bacterial meningitis in a large randomized trial. It still remains a treatment strategy for comatose survivors of cardiac arrest. There are several potential advantages of inhalational anesthetics as long-term sedation agents compared to intravenous sedation, however, uncontrollable increases of intracranial pressure were observed in neurocritical patients. Here we present a patient with severe bacterial meningitis and secondary cardiac arrest where therapeutic hypothermia and inhalational anesthesia were successfully used. A 59-year old female with a history of a vestibular Schwannoma surgery on the left side was admitted with signs of meningitis. Within minutes after admission, she further deteriorated with respiratory arrest, followed by cardiac arrest. She remained comatose after return of spontaneous circulation. The standard treatment of severe meningitis (steroids, antibiotics, insertion of intracranial pressure probe and external ventricular drainage) along with therapeutic hypothermia and inhalational anesthesia were implemented. Intracranial pressure remained stable and daily neurological examination was possible without being confounded by concurrent sedation. She was discharged home without neurological sequelae after 27days. In selected patients with meningitis, therapeutic hypothermia may still present a treatment option, and the long-term use of inhalational anesthetics could be appropriate with concomitant intracranial pressure monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. American Heart Association Response to the 2015 Institute of Medicine Report on Strategies to Improve Cardiac Arrest Survival.

    Science.gov (United States)

    Neumar, Robert W; Eigel, Brian; Callaway, Clifton W; Estes, N A Mark; Jollis, James G; Kleinman, Monica E; Morrison, Laurie J; Peberdy, Mary Ann; Rabinstein, Alejandro; Rea, Thomas D; Sendelbach, Sue

    2015-09-15

    The American Heart Association (AHA) commends the recently released Institute of Medicine (IOM) report, Strategies to Improve Cardiac Arrest Survival: A Time to Act (2015). The AHA recognizes the unique opportunity created by the report to meaningfully advance the objectives of improving outcomes for sudden cardiac arrest. For decades, the AHA has focused on the goal of reducing morbidity and mortality from cardiovascular disease though robust support of basic, translational, clinical, and population research. The AHA also has developed a rigorous process using the best available evidence to develop scientific, advisory, and guideline documents. These core activities of development and dissemination of scientific evidence have served as the foundation for a broad range of advocacy initiatives and programs that serve as a foundation for advancing the AHA and IOM goal of improving cardiac arrest outcomes. In response to the call to action in the IOM report, the AHA is announcing 4 new commitments to increase cardiac arrest survival: (1) The AHA will provide up to $5 million in funding over 5 years to incentivize resuscitation data interoperability; (2) the AHA will actively pursue philanthropic support for local and regional implementation opportunities to increase cardiac arrest survival by improving out-of-hospital and in-hospital systems of care; (3) the AHA will actively pursue philanthropic support to launch an AHA resuscitation research network; and (4) the AHA will cosponsor a National Cardiac Arrest Summit to facilitate the creation of a national cardiac arrest collaborative that will unify the field and identify common goals to improve survival. In addition to the AHA's historic and ongoing commitment to improving cardiac arrest care and outcomes, these new initiatives are responsive to each of the IOM recommendations and demonstrate the AHA's leadership in the field. However, successful implementation of the IOM recommendations will require a timely

  18. Association between a Hospital’s Quality Performance for In-Hospital Cardiac Arrest and Common Medical Conditions

    Science.gov (United States)

    Chen, Lena M.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Spertus, John A.; Tang, Fengming; Chan, Paul S.

    2015-01-01

    Background Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown if this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions. Methods and Results Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia from Hospital Compare for the same period. The relationship between a hospital’s performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26,270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an inter-quartile range (IQR) of 19.7% to 24.2%. There were no significant correlations between a hospital’s outcomes for its cardiac arrest patients and its patients admitted for AMI (correlation of −0.12; P=0.16), HF (correlation of −0.05; P=0.57), or pneumonia (correlation of −0.15, P=0.10). Conclusions Hospitals that performed better on publicly reported outcomes for three common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality. PMID:24221831

  19. In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs

    DEFF Research Database (Denmark)

    De Bruin, Marie L; Langendijk, Pim N J; Koopmans, Richard P

    2007-01-01

    AIMS: QTc interval-prolonging drugs have been linked to cardiac arrhythmias, cardiac arrest and sudden death. In this study we aimed to quantify the risk of cardiac arrest associated with the use of non-antiarrhythmic QTc-prolonging drugs in an academic hospital setting. METHODS: We performed...... a case-control study in which patients, for whom intervention of the advanced life support resuscitation team was requested for cardiac arrest between 1995 and 2003 in the Academic Medical Centre, Amsterdam, were compared with controls regarding current use of non-antiarrhythmic QTc-prolonging drugs......). CONCLUSIONS: Use of non-antiarrhythmic QTc-prolonging drugs in hospitalized patients with several underlying disease is associated with an increased risk of cardiac arrest. The effect is dose related and pharmacokinetic drug-drug interactions increase the risk substantially. Physicians caring for inpatients...

  20. Multiple cardiac arrests induced by pulmonary embolism in a traumatically injured patient: A case report and review of the literature.

    Science.gov (United States)

    Sun, Shu-Qing; Li, Ke-Peng; Zhi, Jianming

    2017-12-01

    Pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. We present a case of continuous resuscitation lasting approximately 4 hours, during which 21 episodes of cardiac arrest occurred in a 46-year-old man who sustained high-level paraplegia after a road traffic accident. Multiple cardiac arrests induced by pulmonary embolism. The patient received cardiopulmonary resuscitation and thrombolytic therapy. The patient was discharged in 2 weeks when his condition turned for the better. Cardiopulmonary resuscitation of patients with pulmonary embolism-induced cardiac arrest should not be given up arbitrarily, knowing that the etiology of pulmonary embolism is reversible in most cases. Effective external cardiac compression can not only save the patient's life but also attenuate neurological sequelae. Thrombolytic therapy is the key to the final success of resuscitation.

  1. Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.

    Science.gov (United States)

    Alsoufi, Bahaaldin; Awan, Abid; Manlhiot, Cedric; Guechef, Alexander; Al-Halees, Zohair; Al-Ahmadi, Mamdouh; McCrindle, Brian W; Kalloghlian, Avedis

    2014-02-01

    Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P=0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P=0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P=0.37). Survivors had shorter CPR duration (25 vs 34 min, P=0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P=0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, Pcardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.

  2. Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study).

    Science.gov (United States)

    Marstrand, Peter; Corell, Pernille; Henriksen, Finn Lund; Pehrson, Steen; Bundgaard, Henning; Theilade, Juliane

    2016-01-01

    When the cause of an aborted cardiac arrest is unclear the initiation of therapy, counseling and family screening is challenging. We included 43 unselected, prospectively identified cardiac arrest survivors with or without a diagnosis. Family history for cardiac disease and supplemental electrocardiograms were evaluated for additional diagnostic information. 43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48years (range 23-64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33%), cardiomyopathies (14%), miscellaneous (e.g. drug induced arrhythmias, coronary spasms) (12%) and channelopathies (5%). Family history of cardiac disease - even inheritable conditions - was not indicative of etiology in cardiac arrest survivors. Supplemental ECGs were abnormal in 10 of 43 patients; in the majority of these patients (7) no conclusive diagnosis was reached. In this study 16/43 (37%) of unselected, prospectively included cardiac arrest survivors remained without a diagnosis despite exhaustive investigations. We may extract additional diagnostic information from simple maneuvers during the recording of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. August 2014 Tucson critical care journal club: bacteremia in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Hypes C

    2014-10-01

    Full Text Available No abstract available. Article truncated at 150 words. Out-of-hospital cardiac arrest (OHCA is an uncommon, but important, condition encountered in the emergency department (ED. While cardiac arrest represents the final common pathway of multiple conditions, early evaluation often focuses on cardiac abnormalities. However, observed associations between infection, particularly pneumonia, and in-hospital cardiac arrest led Coba et al. (1 to investigate the incidence of bacteremia among OHCA patients. The study prospectively investigated 250 adult patients who presented to an academic ED with OHCA between 2007 and 2009. Two blood culture samples were drawn during resuscitation or shortly after return of spontaneous circulation through vascular devices placed for clinical purposes. Children, pregnant women, victims of trauma were excluded. To minimize false positive results, patients were classified as bacteremic if one sample was positive for a typical pathogen or both samples were positive for the same skin colonizing organism. Patients in whom only 1 sample was positive for suspected skin contaminant ...

  4. [Nurses' cardiopulmonary resuscitation performance during the first 5 minutes in in-situ simulated cardiac arrest].

    Science.gov (United States)

    Kim, Eun Jung; Lee, Kyeong Ryong; Lee, Myung Hyun; Kim, Jiyoung

    2012-06-01

    The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital. A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members. Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108±75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224±67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively. The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.

  5. Locating AED Enabled Medical Drones to Enhance Cardiac Arrest Response Times.

    Science.gov (United States)

    Pulver, Aaron; Wei, Ran; Mann, Clay

    2016-01-01

    Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies. The purpose of this study is to develop a geographic approach to the placement of a network of medical drones, equipped with an automated external defibrillator, designed to minimize travel time to victims of out-of-hospital cardiac arrest. Our goal was to have one drone on scene within one minute for at least 90% of demand for AED shock therapy, while minimizing implementation costs. In our study, the current estimated travel times were evaluated in Salt Lake County using geographical information systems (GIS) and compared to the estimated travel times of a network of AED enabled medical drones. We employed a location model, the Maximum Coverage Location Problem (MCLP), to determine the best configuration of drones to increase service coverage within one minute. We found that, using traditional vehicles, only 4.3% of the demand can be reached (travel time) within one minute utilizing current EMS agency locations, while 96.4% of demand can be reached within five minutes using current EMS vehicles and facility locations. Analyses show that using existing EMS stations to launch drones resulted in 80.1% of cardiac arrest demand being reached within one minute Allowing new sites to launch drones resulted in 90.3% of demand being reached within one minute. Finally, using existing EMS and new sites resulted in 90.3% of demand being reached while greatly reducing

  6. Adrenaline, terlipressin, and corticoids versus adrenaline in the treatment of experimental pediatric asphyxial cardiac arrest.

    Science.gov (United States)

    González, Rafael; Urbano, Javier; Botrán, Marta; López, Jorge; Solana, Maria J; García, Ana; Fernández, Sarah; López-Herce, Jesús

    2014-07-01

    To analyze if treatment with adrenaline (epinephrine) plus terlipressin plus corticoids achieves higher return of spontaneous circulation than adrenaline in an experimental infant animal model of asphyxial cardiac arrest. Prospective randomized animal study. Experimental department in a University Hospital. Forty-nine piglets were studied. Cardiac arrest was induced by at least 10 minutes of removal of mechanical ventilation and was followed by manual external chest compressions and mechanical ventilation. After 3 minutes of resuscitation, piglets that did not achieve return of spontaneous circulation were randomized to two groups: adrenaline 0.02 mg kg every 3 minutes (20 animals) and adrenaline 0.02 mg kg every 3 minutes plus terlipressin 20 μg kg every 6 minutes plus hydrocortisone 30 mg kg one dose (22 animals). Resuscitation was discontinued when return of spontaneous circulation was achieved or after 24 minutes. Return of spontaneous circulation was achieved in 14 piglets (28.5%), 14.2% with only cardiac massage and ventilation. Return of spontaneous circulation was achieved in 25% of piglets treated with adrenaline and in 9.1% of those treated with adrenaline plus terlipressin plus hydrocortisone (p = 0.167). Return of spontaneous circulation was achieved in 45.4% of animals with pulseless electric activity, 20% with asystole, and 0% with ventricular fibrillation (p = 0.037). Shorter duration of cardiac arrest, higher mean blood pressure and EtCO2 and lower PaCO2 before resuscitation, and higher mean blood pressure during resuscitation were associated with higher return of spontaneous circulation. Treatment with adrenaline plus terlipressin plus corticoids does not achieve higher return of spontaneous circulation than that with adrenaline in an infant animal model of asphyxial cardiac arrest.

  7. Feasibility and cardiac safety of inhaled xenon in combination with therapeutic hypothermia following out-of-hospital cardiac arrest.

    Science.gov (United States)

    Arola, Olli J; Laitio, Ruut M; Roine, Risto O; Grönlund, Juha; Saraste, Antti; Pietilä, Mikko; Airaksinen, Juhani; Perttilä, Juha; Scheinin, Harry; Olkkola, Klaus T; Maze, Mervyn; Laitio, Timo T

    2013-09-01

    Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. An open controlled and randomized single-centre clinical drug trial (clinicaltrials.gov NCT00879892). A multipurpose ICU in university hospital. Thirty-six adult out-of-hospital cardiac arrest patients (18-80 years old) with ventricular fibrillation or pulseless ventricular tachycardia as initial cardiac rhythm. Patients were randomly assigned to receive either mild therapeutic hypothermia treatment with target temperature of 33°C (mild therapeutic hypothermia group, n=18) alone or in combination with xenon by inhalation, to achieve a target concentration of at least 40% (Xenon+mild therapeutic hypothermia group, n=18) for 24 hours. Thirty-three patients were evaluable (mild therapeutic hypothermia group, n=17; Xenon+mild therapeutic hypothermia group, n=16). Patients were treated and monitored according to the Utstein protocol. The release of troponin-T was determined at arrival to hospital and at 24, 48, and 72 hours after out-of-hospital cardiac arrest. The median end-tidal xenon concentration was 47% and duration of the xenon inhalation was 25.5 hours. The frequency of serious adverse events, including inhospital mortality, status epilepticus, and acute kidney injury, was similar in both groups and there were no unexpected serious adverse reactions to xenon during hospital stay. In addition, xenon did not induce significant conduction, repolarization, or rhythm abnormalities. Median dose of norepinephrine during hypothermia was lower in xenon-treated patients (mild therapeutic hypothermia group=5.30 mg vs Xenon+mild therapeutic hypothermia group=2.95 mg, p=0.06). Heart rate was significantly lower in Xenon+mild therapeutic hypothermia patients during hypothermia

  8. Inhibition of monoamine oxidase A increases recovery after experimental cardiac arrest.

    Science.gov (United States)

    Vuohelainen, Vilma; Hämäläinen, Mari; Paavonen, Timo; Karlsson, Sari; Moilanen, Eeva; Mennander, Ari

    2015-10-01

    Perioperative myocardial infarction (MI) with ischaemia-reperfusion injury (IRI) is a devastating entity occurring in 1-2% of patients after cardiac surgery. The molecular pathway leading to myocardial cellular destruction after MI may include monoamine oxidases. We experimentally investigated whether moclobemide, a monoamine oxidase inhibitor, enhances myocardial recovery after cardiac arrest and MI. Fifty-six syngeneic Fischer rats underwent heterotopic cardiac transplantation to induce reversible IRI after cardiac arrest. Twenty-eight rats also underwent permanent ligation of the left anterior descending coronary artery to induce MI after cardiac arrest. Twenty-eight rats with or without MI were treated with subcutaneous moclobemide 10 mg/kg/day. Methods used to study myocardial recovery were microdialysis for intramyocardial metabolism, histology and quantitative reverse-transcription polymerase chain reaction for high-mobility group box-1 (HMGB1), haeme oxygenase-1 (HO-1), interleukin-6, hypoxia-inducible factor 1α and macrophages (CD68). Pyruvate increased in MI treated with moclobemide versus IRI with moclobemide (29.19 ± 7.64 vs 13.86 ± 8.49 µM, P = 0.028), reflecting metabolic activity after cardiac arrest and reperfusion. Myocardial inflammation increased in MI compared with IRI after 1 h (0.80 ± 0.56 vs 0, point score units [PSUs], P = 0.003), but decreased after 5 days in MI treated with moclobemide versus MI alone (0.80 ± 0.83 vs 2.00 ± 0.70, PSU, P = 0.033). Expressions of HMGB1, CD68 and HO-1 decreased in MI treated with moclobemide versus MI alone (1.33 ± 0.20 vs 1.75 ± 0.24, fold changes [FCs], P = 0.028; 5.15 ± 1.10 vs 9.59 ± 2.75, FC, P = 0.050; 10.41 ± 4.17 vs 21.28 ± 10.01, FC, P = 0.047), indicating myocardial recovery and increased cellularity of remote intramyocardial arteries. Moclobemide enhances myocardial recovery after cardiac arrest and MI; inhibition of remote myocardial changes may be achieved by targeting treatment

  9. Measuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country: A key metric for EMS systems' performance.

    Science.gov (United States)

    El Sayed, Mazen; Al Assad, Reem; Abi Aad, Yasmin; Gharios, Nour; Refaat, Marwan M; Tamim, Hani

    2017-07-01

    Out-of-hospital cardiac arrest (OHCA) can be used to evaluate the overall performance of the emergency medical services' (EMS) system. This study assessed the impact of EMS on OHCA survival rates in a setting where the prehospital system is underdeveloped.A retrospective chart review was carried out over a 5-year period of all adult OHCA patients admitted to the emergency department (ED) of a tertiary care center in Lebanon.A total of 271 patients with OHCA (179 [66.1%] men, mean age of 69.9 [standard deviation = 15.0 years] were enrolled. The most common OHCA location was residence/home (58.7%). The majority of arrests were witnessed (51.7%) with 6.1% witnessed by EMS; 211 patients (75.6%) were transported to the ED by EMS. Prehospital cardiopulmonary resuscitation (CPR) was done by EMS for 43.2% of the patients, whereas only 4.4% received CPR from a family member/bystander. Prehospital automated external defibrillator use was documented in 1.5% of cases in the prehospital setting. Only 2 patients had return of spontaneous circulation prior to ED arrival. Most patients (96.7%) were resuscitated in the ED. Patients presented to the ED mostly in asystole (79.3%). Forty-three patients (15.9%) survived to hospital admission and 13 (4.8%) were discharged alive with over half of them (53.8%) had a good neurological outcome upon discharge (cerebral performance category 1 or 2).Survival of EMS-treated OHCA victims in Lebanon is not as expected. Medical oversight of EMS activities is needed to link EMS activities to clinical outcomes and improve survival from cardiac arrest in Lebanon.

  10. Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest.

    Science.gov (United States)

    Wang, Hao; Barbut, Denise; Tsai, Min-Shan; Sun, Shijie; Weil, Max Harry; Tang, Wanchun

    2010-05-01

    We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during "low-flow" improves return of spontaneous resuscitation (ROSC). In 16 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and untreated for 15 min. Animals were randomized to either head cooling or control. CPR was initiated and continued for 5 min before defibrillation was attempted. Coincident with starting CPR, the hypothermic group was cooled with a RhinoChill device which produces evaporative cooling in the nasal cavity of pigs. No cooling was administrated to control animals. If ROSC was not achieved after defibrillation, CPR was resumed for 1 min prior to the next defibrillation attempt until either successful resuscitation or for a total of 15 min. Seven of eight animals in the hypothermic group (87.5%) and two of eight animals in control group (25%) (p=0.04) were successfully resuscitated. At ROSC, brain temperature was increased from baseline by 0.3 degrees C in the control group, and decreased by 0.1 degrees C in the hypothermic animals. Pulmonary artery temperature was above baseline in both groups. Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  11. No difference in mortality between men and women after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Wanscher, Michael

    2015-01-01

    AIM: Comparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36°C. METHODS: The TTM trial randomized 950 patients to TTM at 33 or 36°C for 24h. This predefined sub.......04 and less often had bystander defibrillation, p=0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) ... in univariate analysis, hazard ratio (HR)=1.29, CI=1.04-1.61, p=0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR=1.11, CI=0. 87-1.41, p=0.42, and sex was no longer...

  12. Cardiac arrest and ventricular arrhythmia in adults with Ebstein anomaly and left ventricular non-compaction.

    Science.gov (United States)

    Kumor, Magdalena; Lipczyńska, Magdalena; Biernacka, Elzbieta Katarzyna; Klisiewicz, Anna; Wójcik, Anna; Konka, Marek; Kożuch, Katarzyna; Szymański, Piotr; Hoffman, Piotr

    2018-01-02

    Ebstein anomaly is a complex, congenital heart defect that is associated with a variety of cardiac abnormalities. Studies found a similar sarcomere gene mutation in patients with Ebstein anomaly (EA) and patients with isolated left ventricular non-compaction (LVNC). We aimed to show the prevalence of LVNC and its potential relationship with severe cardiac events (VT - ventricular tachycardia, cardiac arrest) in adult patients with EA. We conducted a retrospective search of our institutional database from 2010 to 2014 for patients with EA and reviewed patients' medical records (age, sex, clinical presentation, electrocardiographic, echocardiographic, and CMR - cardiac magnetic resonance features). We reviewed echocardiograms and CMR scans for concomitant morphological abnormalities (LVNC, PDA - patent ductus arteriosus, VSD - ventricular septal defect, ASD - atrial septal defect, mitral valve prolapse, BAV - bicuspid aortic valve, CoA - coarctation of aorta). The studied group consisted of 84 consecutive patients (mean age 38±15 years, 50 women) with EA. We found four patients (4.8%) with LVNC, two of them had cardiac arrest, one had VT, and one was symptomless, but had QTc prolongation in Holter recordings. Concomitant abnormalities were VSD (4.8%), PDA (1.2%), CoA (1.2%), mitral valve prolapse (1.2%), and BAV (2.4%). The most common anomaly was ASD type II - 23 patients (27.3%) and WPW - Wolff-Parkinson-White's syndrome - 9 patients (10.7%). Non-compaction is a notable abnormality in adult patients with EA and it may affect their prognosis. Although other concomitant lesions were more common, only patients with LVNC suffered from cardiac arrest or ventricular arrhythmia. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. Double-valve Libman-Sacks endocarditis causing ventricular fibrillation cardiac arrest.

    Science.gov (United States)

    Tanawuttiwat, Tanyanan; Dia, Muhyaldeen; Hanif, Tabassum; Mihailescu, Mihaela

    2011-01-01

    Libman-Sacks endocarditis is a well-known and rather common cardiac manifestation of systemic lupus erythematosus. Transesophageal and transthoracic echocardiography are the definitive imaging methods used to evaluate cardiac valvular involvement in this disease. Valvular masses (vegetations) and valvular thickening are 2 common morphologic echocardiographic patterns. Libman-Sacks lesions are typically characterized by single-valve involvement and their small size of 1 to 4 mm.Herein, we present the unusual case of a 22-year-old woman with newly diagnosed systemic lupus erythematosus who had large, sterile vegetations of Libman-Sacks endocarditis that involved the mitral and aortic valves. This compromised coronary blood flow and resulted in ventricular fibrillation cardiac arrest. The vegetations were surgically excised, and the patient's cardiac function recovered. We discuss the treatment of the patient and that of Libman-Sacks endocarditis.

  14. Extracorporeal CPR and intra-aortic balloon pumping in tachycardia-induced cardiomyopathy complicating cardiac arrest.

    Science.gov (United States)

    Lee, Jun Wan; Ahn, Hong Joon; Yoo, Youn Ho; Lee, Jin Woong; Kim, Seung Whan; Choi, Si Wan

    2017-08-01

    Although tachycardia-induced cardiomyopathy (TIC) due to atrial fibrillation occurs frequently, it is under-recognized in clinical settings. TIC has a wide range of clinical manifestations, from asymptomatic tachycardia to cardiomyopathy leading to end stage heart failure. We present a case of a 48year-old-woman who presented as cardiogenic shock, and rapidly progressed to cardiac arrest from recently diagnosed but undertreated atrial fibrillation, resulting TIC in the emergency department (ED). She was rescued by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest in the ED, and received concomitant intra-aortic balloon counterpulsation (IABP) support for severe left ventricular failure. Cardiogenic shock can present as an initial manifestation of TIC, and E-CPR and subsequent IABP support can be a valuable rescue therapy for severe TIC. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Neurological prognostication of outcome in patients in coma after cardiac arrest.

    Science.gov (United States)

    Rossetti, Andrea O; Rabinstein, Alejandro A; Oddo, Mauro

    2016-05-01

    Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. During the past decade, as technology and clinical evidence have evolved, post-cardiac arrest prognostication has moved towards a multimodal paradigm combining clinical examination with additional methods, consisting of electrophysiology, blood biomarkers, and brain imaging, to optimise prognostic accuracy. Prognostication should never be based on a single indicator; although some variables have very low false positive rates for poor outcome, multimodal assessment provides resassurance about the reliability of a prognostic estimate by offering concordant evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Bystander defibrillation for out-of-hospital cardiac arrest in Public vs Residential Locations

    DEFF Research Database (Denmark)

    Hansen, Steen Møller; Hansen, Carolina Malta; Folke, Fredrik

    2017-01-01

    Importance: Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). Objective: To examine calendar changes...... in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. Design, Setting, and Participants: This nationwide study......, 2016. Exposures: Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher...

  17. Cardiac arrest after anesthetic management in a patient with hereditary sensory autonomic neuropathy type IV

    Directory of Open Access Journals (Sweden)

    Ergül Yakup

    2011-01-01

    Full Text Available Hereditary sensory autonomic neuropathy type IV is a rare disorder with an autosomal recessive transmission and characterized by self-mutilation due to a lack in pain and heat sensation. Recurrent hyperpyrexia and anhydrosis are seen in patients as a result of a lack of sweat gland innervation. Self-mutilation and insensitivity to pain result in orthopedic complications and patients undergone recurrent surgical interventions with anesthesia. However, these patients are prone to perioperative complications such as hyperthermia, hypothermia, and cardiac complications like bradycardia and hypotension. We report a 5-year-old boy with hereditary sensory autonomic neuropathy type IV, developing hyperpyrexia and cardiac arrest after anesthesia.

  18. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hamilton, Annika; Steinmetz, Jacob; Wissenberg, Mads

    2016-01-01

    AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician.......13 (95% CI=0.99-1.29). CONCLUSION: In this large population-based observational study, we found prehospital physician involvement after OHCA associated with better 30-day survival. This association was also found for ROSC, but with less certainty for 1-year survival....

  19. Response interval is important for survival until admission after prehospital cardiac arrest

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Nielsen, Søren Loumann; Rasmussen, Lars Simon

    2010-01-01

    An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return...... of spontaneous circulation (ROSC), i.e. successful resuscitation. The aim of this study was to describe the impact of response interval on sustained ROSC, i.e. ROSC at hospital admission, after OHCA with presumed cardiac aetiology....

  20. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...

  1. A case of Ventricular Tachycardia and Cardiac Arrest Associated with Sertraline and Mirtazapine Combination.

    Directory of Open Access Journals (Sweden)

    Murad Atmaca

    2014-03-01

    Full Text Available A 67-year-old male suffering from depressive symptomatology was admitted to the inpatient clinic at Firat University School of Medicine; and his psychiatric evaluation revealed major depressive episode according to DSM-IV. He developed chest discomfort, chest pain and shortness of breath of acute onset accompanying pulseless ventricular tachycardia (VT leading to cardiac arrest following sertraline and mirtazapine combination treatment. He died after two days in the Intensive Care Unit. The present case suggests that psychiatrists should be aware of unexpected cardiac events, especially when they use combination treatments.

  2. Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate wh...

  3. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik

    2016-01-01

    Background: Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective...... was to examine the association of bystander CPR with survival as time to advanced treatment increases. Methods: We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used...... out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes. Conclusions: The absolute survival...

  4. Initial arterial carbon dioxide tension is associated with neurological outcome after resuscitation from cardiac arrest.

    Science.gov (United States)

    Tolins, Molly L; Henning, Daniel J; Gaieski, David F; Grossestreuer, Anne V; Jaworski, Alison; Johnson, Nicholas J

    2017-05-01

    To determine the relationships between partial pressure of arterial carbon dioxide (PaCO2), prescribed minute ventilation (MV), and neurologic outcome in patients resuscitated from cardiac arrest. This was a retrospective cohort study utilizing a multicenter database of adult patients with return of spontaneous circulation (ROSC) after cardiac arrest. The primary outcome was neurologic status at hospital discharge, defined by Cerebral Performance Category (CPC) score: CPC 1-2 was favorable, CPC 3-5 was poor. We compared rates of initial normocarbia (PaCO2 31-49mmHg) and mean sequential PaCO2 measurements obtained over the first 24h. We also assessed the influence of MV on the PaCO2 at initial, 6, 12, 18, and 24h after cardiac arrest using univariate linear regression. One hundred and fourteen patients from 3 institutions met inclusion criteria. Overall, 46/114 (40.4%, 95% CI: 31.4-49.4%) patients survived to hospital discharge, and 33/114 (28.9%, 20.6-37.2%) had CPC 1-2 at the time of discharge. A total of 38.9% (95% CI: 29.9-47.9%) of patients had initial normocarbia; 43.2% (28.6-57.8%) of these patients were discharged with CPC 1-2, compared with 20.3% (10.8-29.8%) of dyscarbic patients. By 6h, neurologic outcomes were not significantly associated with PaCO2. Prescribed MV was not associated with PaCO2 at any time point with the exception of a weak correlation at hour 18. Initial normocarbia was associated with favorable neurological outcome in patients resuscitated from cardiac arrest. This relationship was not seen at subsequent time points. There was no significant association between prescribed MV and PaCO2 or neurologic outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis

    OpenAIRE

    Huang, Yu; He, Qing; Yang, Min; Zhan, Lei

    2013-01-01

    Introduction Antiarrhythmia agents have been used in the treatment of cardiac arrest, and we aimed to review the relevant clinical controlled trials to assess the effects of antiarrhythmics during cardiopulmonary resuscitation. Methods We searched databases including Cochrane Central Register of Controlled Trials; MEDLINE, and EMBASE. Clinical controlled trials that addressed the effects of antiarrhythmics (including amiodarone, lidocaine, magnesium, and other new potassium-channel blockers) ...

  6. Sudden cardiac arrest following ventricular fibrillation attributed to anabolic steroid use in an adolescent.

    Science.gov (United States)

    Lichtenfeld, Jana; Deal, Barbara J; Crawford, Susan

    2016-06-01

    Anabolic androgenic steroids are synthetic derivatives of testosterone that promote the growth of skeletal muscles and have many recognised cardiovascular effects. We report the clinical presentation and pathological findings of an adolescent male whose sudden cardiac arrest following ventricular fibrillation was attributed to anabolic androgenic steroid use. The age of our patient reflects the usage of anabolic androgenic steroids among younger athletes and highlights the need for increased awareness among practitioners.

  7. Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ying-Qing Li

    2013-04-01

    Full Text Available OBJECTIVE: To evaluate the effects of percutaneous coronary intervention and thrombolysis after restoration of spontaneous circulation in cardiac arrest patients with ST-elevation myocardial infarction using meta-analysis. METHODS: We performed a meta-analysis of clinical studies indexed in the PUBMED, MEDLINE and EMBASE databases and published between January 1995 and October 2012. In addition, we compared the hospital discharge and neurological recovery rates between the patients who received percutaneous coronary intervention and those who received thrombolysis. RESULTS: Twenty-four studies evaluating the effects of percutaneous coronary intervention or thrombolysis after restoration of spontaneous circulation in cardiac arrest patients with ST-elevation myocardial infarction were included. Seventeen of the 24 studies were used in this meta-analysis. All studies were used to compare percutaneous coronary intervention and thrombolysis. The meta-analysis showed that the rate of hospital discharge improved with both percutaneous coronary intervention (p<0.001 and thrombolysis (p<0.001. We also found that cardiac arrest patients with ST-elevation myocardial infarction who received thrombolysis after restoration of spontaneous circulation did not have decreased hospital discharge (p = 0.543 or neurological recovery rates (p = 0.165 compared with those who received percutaneous coronary intervention. CONCLUSION: In cardiac arrest patients with ST-elevation myocardial infarction who achieved restoration of spontaneous circulation, both percutaneous coronary intervention and thrombolysis improved the hospital discharge rate. Furthermore, there were no significant differences in the hospital discharge and neurological recovery rates between the percutaneous coronary intervention-treated group and the thrombolysis-treated group.

  8. Case Report of Cardiac Arrest After Succinylcholine in a Child With Muscle-Eye-Brain Disease.

    Science.gov (United States)

    Hackmann, Thomas; Skidmore, David L; MacManus, Brian

    2017-10-15

    Muscle-eye-brain disease is a rare autosomal recessive disorder characterized by congenital muscular dystrophy, ocular abnormalities, and brain malformation. We report an intraoperative hyperkalemic cardiac arrest following the administration of succinylcholine in a child with muscle-eye-brain disease. The disease was diagnosed only after this event. Our experience suggests that preoperative determinations of serum concentrations of lactate and creatine kinase may be useful if clinical signs consistent with myopathy are present.

  9. Enhanced pyruvate dehydrogenase activity improves cardiac outcomes in a murine model of cardiac arrest.

    Directory of Open Access Journals (Sweden)

    Lin Piao

    Full Text Available Post-ischemic changes in cellular metabolism alter myocardial and neurological function. Pyruvate dehydrogenase (PDH, the limiting step in mitochondrial glucose oxidation, is inhibited by increased expression of PDH kinase (PDK during ischemia/reperfusion injury. This results in decreased utilization of glucose to generate cellular ATP. Post-cardiac arrest (CA hypothermia improves outcomes and alters metabolism, but its influence on PDH and PDK activity following CA are unknown. We hypothesized that therapeutic hypothermia (TH following CA is associated with the inhibition of PDK activity and increased PDH activity. We further hypothesized that an inhibitor of PDK activity, dichloroacetate (DCA, would improve PDH activity and post-CA outcomes.Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent a 12-minute KCl-induced CA followed by cardiopulmonary resuscitation. Compared to normothermic (37°C CA controls, administering TH (30°C improved overall survival (72-hour survival rate: 62.5% vs. 28.6%, P<0.001, post-resuscitation myocardial function (ejection fraction: 50.9±3.1% vs. 27.2±2.0%, P<0.001; aorta systolic pressure: 132.7±7.3 vs. 72.3±3.0 mmHg, P<0.001, and neurological scores at 72-hour post CA (9.5±1.3 vs. 5.4±1.3, P<0.05. In both heart and brain, CA increased lactate concentrations (1.9-fold and 3.1-fold increase, respectively, P<0.01, decreased PDH enzyme activity (24% and 50% reduction, respectively, P<0.01, and increased PDK protein expressions (1.2-fold and 1.9-fold, respectively, P<0.01. In contrast, post-CA treatment with TH normalized lactate concentrations (P<0.01 and P<0.05 and PDK expressions (P<0.001 and P<0.05, while increasing PDH activity (P<0.01 and P<0.01 in both the heart and brain. Additionally, treatment with DCA (0.2 mg/g body weight 30 min prior to CA improved both myocardial hemodynamics 2 hours post-CA (aortic systolic pressure: 123±3 vs. 96±4 mmHg, P<0.001 and 72-hour survival rates

  10. Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian

    2009-04-01

    Full Text Available Edouard Matevossian1, Dietrich Doll4, Jakob Säckl1, Inga Sinicina5, Jürgen Schneider2, Gerhard Simon3, Norbert Hüser11Department of Surgery, 2Department of Anesthesiology and Intensive-Care Medicine; 3Department of Radiology, Technische Universität of Munich, Germany; 4Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; 5Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, GermanyAbstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS device (Jolife, Lund, Sweden undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions. Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary

  11. An evaluation of three methods of in-hospital cardiac arrest educational debriefing: The cardiopulmonary resuscitation debriefing study.

    Science.gov (United States)

    Couper, Keith; Kimani, Peter K; Davies, Robin P; Baker, Annalie; Davies, Michelle; Husselbee, Natalie; Melody, Teresa; Griffiths, Frances; Perkins, Gavin D

    2016-08-01

    The use of cardiac arrest educational debriefing has been associated with improvements in cardiopulmonary resuscitation (CPR) quality and patient outcome. The practical challenges associated with delivering some debriefing approaches may not be generalisable to the UK health setting. The aim of this study was to evaluate the deliverability and effectiveness of three cardiac arrest debriefing approaches that were tailored to UK working practice. We undertook a before/after study at three hospital sites. During the post-intervention period of the study, three cardiac arrest educational debriefing models were implemented at study hospitals (one model per hospital). To evaluate the effectiveness of the interventions, CPR quality and patient outcome data were collected from consecutive adult cardiac arrest events attended by the hospital cardiac arrest team. The primary outcome was chest compression depth. Between November 2011 and July 2014, 1198 cardiac arrest events were eligible for study inclusion (782 pre-intervention; 416 post-intervention). The quality of CPR was high at baseline. During the post-intervention period, cardiac arrest debriefing interventions were delivered to 191 clinicians on 344 occasions. Debriefing interventions were deliverable in practice, but were not associated with a clinically important improvement in CPR quality. The interventions had no effect on patient outcome. The delivery of these cardiac arrest educational debriefing strategies was feasible, but did not have a large effect on CPR quality. This may be attributable to the high-quality of CPR being delivered in study hospitals at baseline. ISRCTN39758339. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Out of hospital cardiac arrest outside home in Sweden, change in characteristics, outcome and availability for public access defibrillation

    OpenAIRE

    Rosenqvist Mårten; Hollenberg Jacob; Herlitz Johan; Ringh Mattias; Svensson Leif

    2009-01-01

    Abstract Background A large proportion of patients who suffer from out of hospital cardiac arrest (OHCA) outside home are theoretically candidates for public access defibrillation (PAD). We describe the change in characteristics and outcome among these candidates in a 14 years perspective in Sweden. Methods All patients who suffered an OHCA in whom cardiopulmonary resuscitation (CPR) was attempted between 1992 and 2005 and who were included in the Swedish Cardiac Arrest Register (SCAR). We in...

  13. Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study)

    DEFF Research Database (Denmark)

    Marstrand, Peter; Corell, Pernille; Henriksen, Finn Lund

    2016-01-01

    and supplemental electrocardiograms were evaluated for additional diagnostic information. RESULTS: 43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48years (range 23-64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33...... of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives....

  14. CPR courses and semi-automatic defibrillators--life saving in cardiac arrest?

    Science.gov (United States)

    Schneider, Liane; Sterz, Fritz; Haugk, Moritz; Eisenburger, Philip; Scheinecker, Wolfdieter; Kliegel, Andreas; Laggner, Anton N

    2004-12-01

    The aim was to assess the knowledge of life-supporting first-aid in both cardiac arrest survivors and relatives, and their willingness to have a semi-automatic external defibrillator in their homes and use it in an emergency. Cardiac arrest survivors, their families, friends, neighbours and co-workers were interviewed by medical students using prepared questionnaires. Their knowledge and self-assessment of life-supporting first-aid, their willingness to have a semi-automatic defibrillator in their homes and their willingness to use it in an emergency before and after a course in cardiopulmonary resuscitation (CPR) with a semi-automatic external defibrillator was evaluated. Courses were taught by medical students who had received special training in basic and advanced life support. Both patients and relatives, after a course of 2-3 h, were no longer afraid of making mistakes by providing life-supporting first-aid. The automated external defibrillator (AED) was generally accepted and considered easy to handle. We consider equipping high-risk patients and their families with AEDs as a viable method of increasing their survival in case of a recurring cardiac arrest. This, of course, should be corroborated by further studies.

  15. Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Izabella Uchmanowicz

    2015-01-01

    Full Text Available Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient’s condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emergency Medical Service in Wroclaw (Poland. Results. The main risk factor of OHSCA is coexistence of external cause leading to illness or death (ICD Group V-10 as well as the occurrence of diseases from the group of endocrine disorders (group E, in particular diabetes. The increase in the risk of OHSCA incidence is affected by nervous system diseases (group G, especially epilepsy of various etiologies, respiratory diseases (group J, mainly COPD, and bronchial asthma or mental and behavioral disorders (group F, with particular emphasis on the drugs issue. The procedure for receiving calls for Emergency Notification Centre does not take into account clinical risk factors for sudden cardiac arrest (SCA. Conclusion. Having knowledge of OHSCA risk factors can increase the efficiency of rescue operations from rapid assessment and provision of appropriate medical team, through effective performance of medical emergency treatment and prevention of SCA or finally reducing the costs.

  16. The Efficacy of LUCAS in Prehospital Cardiac Arrest Scenarios: A Crossover Mannequin Study

    Science.gov (United States)

    Gyory, Robert A.; Buchle, Scott E.; Rodgers, David; Lubin, Jeffrey S.

    2017-01-01

    Introduction High-quality cardiopulmonary resuscitation (CPR) is critical for successful cardiac arrest outcomes. Mechanical devices may improve CPR quality. We simulated a prehospital cardiac arrest, including patient transport, and compared the performance of the LUCAS™ device, a mechanical chest compression-decompression system, to manual CPR. We hypothesized that because of the movement involved in transporting the patient, LUCAS would provide chest compressions more consistent with high-quality CPR guidelines. Methods We performed a crossover-controlled study in which a recording mannequin was placed on the second floor of a building. An emergency medical services (EMS) crew responded, defibrillated, and provided either manual or LUCAS CPR. The team transported the mannequin through hallways and down stairs to an ambulance and drove to the hospital with CPR in progress. Critical events were manually timed while the mannequin recorded data on compressions. Results Twenty-three EMS providers participated. Median time to defibrillation was not different for LUCAS compared to manual CPR (p=0.97). LUCAS had a lower median number of compressions per minute (112/min vs. 125/min; IQR = 102–128 and 102–126 respectively; pprehospital cardiac arrest patient. PMID:28435494

  17. Simultaneous measurement of cerebral and muscle tissue parameters during cardiac arrest and cardiopulmonary resuscitation

    Science.gov (United States)

    Nosrati, Reyhaneh; Ramadeen, Andrew; Hu, Xudong; Woldemichael, Ermias; Kim, Siwook; Dorian, Paul; Toronov, Vladislav

    2015-03-01

    In this series of animal experiments on resuscitation after cardiac arrest we had a unique opportunity to measure hyperspectral near-infrared spectroscopy (hNIRS) parameters directly on the brain dura, or on the brain through the intact pig skull, and simultaneously the muscle hNIRS parameters. Simultaneously the arterial blood pressure and carotid and femoral blood flow were recorded in real time using invasive sensors. We used a novel hyperspectral signalprocessing algorithm to extract time-dependent concentrations of water, hemoglobin, and redox state of cytochrome c oxidase during cardiac arrest and resuscitation. In addition in order to assess the validity of the non-invasive brain measurements the obtained results from the open brain was compared to the results acquired through the skull. The comparison of hNIRS data acquired on brain surface and through the adult pig skull shows that in both cases the hemoglobin and the redox state cytochrome c oxidase changed in similar ways in similar situations and in agreement with blood pressure and flow changes. The comparison of simultaneously measured brain and muscle changes showed expected differences. Overall the results show feasibility of transcranial hNIRS measurements cerebral parameters including the redox state of cytochrome oxidase in human cardiac arrest patients.

  18. Prediction of the potential clinical outcomes for post-resuscitated patients after cardiac arrest

    Science.gov (United States)

    Hong, Sungmin; Kwon, Bojun; Yun, Il Dong; Lee, Sang Uk; Kim, Kyuseok; Kim, Joonghee

    2013-02-01

    Cerebral injuries after cardiac arrest are serious causes for morbidity. Many previous researches in the medical society have been proposed to prognosticate the functional recoveries of post-resuscitated patients after cardiac arrest, but the validity of suggested features and the automation of prognostication have not been made yet. This paper presents the automatic classification method which predicts the potential clinical outcomes of post-resuscitated patients who suffered from cardiac arrest. The global features and the local features are adapted from the researches from the medical society. The global features, which are consisted of the percentage of the partial volume under the uniformly increasing thresholds, represent the global tendency of apparent diffusion coefficient value in a DWI. The local features are localized and measured on the refined local apparent diffusion coefficient minimal points. The local features represent the ischemic change of small areas in a brain. The features are trained and classified by the random forest method, which have been widely used in the machine learning society for classification. The validity of features is automatically evaluated during the classification process. The proposed method achieved the 0.129 false-positive rate while maintaining the perfect true-positive rate. The area-under-curve of the proposed method was 0.9516, which showed the feasibility and the robustness of the proposed method.

  19. Cardiac Arrest Following Drug Abuse with Intravenous Tapentadol: Case Report and Literature Review

    Science.gov (United States)

    Khaja, Misbahuddin; Lominadze, George; Millerman, Konstantin

    2017-01-01

    Patient: Female, 32 Final Diagnosis: Cardiac arrest after intravenous tapentadol abuse Symptoms: Headache Medication: — Clinical Procedure: Tapentadol drug levels in serum Specialty: Forensic Medicine Objective: Rare disease Background: Tapentadol is a centrally acting opioid analgesic, with a dual mode of action, as a norepinephrine reuptake inhibitor and an agonist of the μ-opioid receptor (MOR). Tapentadol is used for the management of musculoskeletal pain, and neuropathic pain associated with diabetic peripheral neuropathy. Case Report: A 32-year-old woman attended hospital for evaluation of an intractable headache. Computed tomography and magnetic resonance imaging of the brain were negative. She was found unresponsive in the bathroom on the day following hospital admission, and despite resuscitative measures, the patient died following cardiac arrest. Autopsy toxicology revealed significantly elevated levels of tapentadol, and bedside evidence suggested that the patient had self-administered this medication intravenously before her death. Conclusions: We report a rare adverse effect of tapentadol causing respiratory depression leading to cardiac arrest. Medical examiners and forensic toxicologists should be aware of the toxicity of this novel opiate drug. PMID:28729524

  20. Catecholaminergic Polymorphic Ventricular Tachycardia: A Rare Cause of Cardiac Arrest Following Blunt Chest Trauma.

    Science.gov (United States)

    Ozyilmaz, Isa; Ozyilmaz, Sinem; Ergul, Yakup; Akdeniz, Celal; Tuzcu, Volkan

    2015-07-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an electrophysiological disorder of a physically normal heart that occurs in children when the body is subjected to intense emotional or physical stress that causes adrenergic discharge. This troubling disease can be sporadic (spontaneous) or familial (genetic/inherited). Unfortunately, its associated ventricular tachycardia may cause sudden death, so early diagnosis of CPVT is very important. Treatment modalities include medical treatment, implantation of a cardioverter defibrillator, or surgical sympatectomy; but the implantable cardioverter defibrillator (ICD) should be the first choice in patients with a history of cardiac arrest. We herein present the case of a patient diagnosed with CPVT after a successful cardiopulmonary resuscitation triggered by blunt chest trauma. We implanted an implantable cardioverter defibrillator and started oral B-blocker treatment. During the course of follow-up, flecainide was added to his treatment depending on the patient's status regarding recurrent ICD shock. The patient has now continued follow-up without recurrent ICD shock since flecainide treatment was initiated. In conclusion, in patients with syncope and sudden cardiac arrest secondary to physical stress or blunt chest trauma, CPVT should be considered and an implantable cardioverter defibrillator must be implanted. Additionally, flecainide theraphy should be considered to decrease recurrent ICD shock. Blunt chest trauma; Cardiac arrest; CPVT.

  1. Cardiac arrest due to hyperkalemia following irradiated packed red cells transfusion

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    Miyazawa, Kazuharu [Yamamoto-kumiai General Hospital, Noshiro, Akita (Japan); Ohta, Sukejuurou; Kojima, Yukiko; Mizunuma, Takahide; Nishikawa, Toshiaki

    1998-11-01

    We describe two cases of cardiac arrest due to hyperkalemia following transfusion of irradiated packed red cells. Case 1: Because sudden, rapid and massive hemorrage occurred in a 69-year-old male patient undergoing the left lobectomy of the liver, 8 units of irradiated packed red cells were rapidly transfused, the patient developed cardiac arrest. Serum kalium concentration after transfusion was 7.6 mEq/l. Case 2: A 7-month-old girl scheduled for closure of a ventricular septal defect, developed cardiac arrest due to hyperkalemia at the start of cardiopulmonary bypass. The extracorporeal circuit was primed with 6 units of irradiated packed red blood cells. Serum kalium concentration immediately after the start of cardiopulmonary bypass was 10.6 mEq/l. Analysis of kalium concentration in the pilot tubes of the same packs revealed 56-61 mEq/l. These case reports suggest that fresh irradiated packed red cells should be transfused during massive bleeding and for pediatric patients to prevent severe hyperkalemia. (author)

  2. Hydrogen-rich saline attenuates hippocampus endoplasmic reticulum stress after cardiac arrest in rats.

    Science.gov (United States)

    Gao, Yu; Gui, Qinfang; Jin, Li; Yu, Pan; Wu, Lin; Cao, Liangbin; Wang, Qiang; Duan, Manlin

    2017-02-15

    Hydrogen-rich saline can selectively scavenge reactive oxygen species (ROS) and protect brain against ischemia reperfusion (I/R) injury. Endoplasmic reticulum stress (ERS) has been implicated in the pathological process of cerebral ischemia. However, very little is known about the role of hydrogen-rich saline in mediating pathophysiological reactions to ERS after I/R injury caused by cardiac arrest. The rats were randomly divided into three groups, sham group (n=30), ischemia/reperfusion group (n=40) and hydrogen-rich saline group (n=40). The rats in experimental groups were subjected to 4min of cardiac arrest and followed by resuscitation. Then they were randomized to receive 5ml/kg of either hydrogen-rich saline or normal saline. Hydrogen-rich saline significantly improves survival rate and neurological function. The beneficial effects of hydrogen-rich saline were associated with decreased levels of oxidative products, as well as the increased levels of antioxidant enzymes. Furthermore, the protective effects of hydrogen-rich saline were accompanied by the increased activity of glucose-regulated protein 78 (GRP78), the decreased activity of cysteinyl aspartate specific proteinase-12 (caspase-12) and C/EBP homologous protein (CHOP). Hydrogen-rich saline attenuates brain I/R injury may through inhibiting hippocampus ERS after cardiac arrest in rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after cardiac arrest.

    Science.gov (United States)

    Li, Ying-Qing; Sun, Shu-Jie; Liu, Na; Hu, Chun-Lin; Wei, Hong-Yan; Li, Hui; Liao, Xiao-Xing; Li, Xin

    2013-04-01

    To evaluate the effects of percutaneous coronary intervention and thrombolysis after restoration of spontaneous circulation in cardiac arrest patients with ST-elevation myocardial infarction using meta-analysis. We performed a meta-analysis of clinical studies indexed in the PUBMED, MEDLINE and EMBASE databases and published between January 1995 and October 2012. In addition, we compared the hospital discharge and neurological recovery rates between the patients who received percutaneous coronary intervention and those who received thrombolysis. Twenty-four studies evaluating the effects of percutaneous coronary intervention or thrombolysis after restoration of spontaneous circulation in cardiac arrest patients with ST-elevation myocardial infarction were included. Seventeen of the 24 studies were used in this meta-analysis. All studies were used to compare percutaneous coronary intervention and thrombolysis. The meta-analysis showed that the rate of hospital discharge improved with both percutaneous coronary intervention (pcirculation did not have decreased hospital discharge (p = 0.543) or neurological recovery rates (p = 0.165) compared with those who received percutaneous coronary intervention. In cardiac arrest patients with ST-elevation myocardial infarction who achieved restoration of spontaneous circulation, both percutaneous coronary intervention and thrombolysis improved the hospital discharge rate. Furthermore, there were no significant differences in the hospital discharge and neurological recovery rates between the percutaneous coronary intervention-treated group and the thrombolysis-treated group.

  4. Racial differences in out-of-hospital cardiac arrest survival and treatment.

    Science.gov (United States)

    Wilde, Elizabeth Ty; Robbins, Lindsay Speros; Pressley, Joyce C

    2012-05-01

    To determine whether there are prehospital differences between blacks and whites experiencing out-of-hospital cardiac arrest and to ascertain which factors are responsible for any such differences. Cohort study of 3869 adult patients (353 blacks and 3516 whites) in the Illinois Prehospital Database with out-of-hospital cardiac arrest as a primary or secondary indication for emergency medical service (EMS) dispatch between 1 January 1996 and 31 December 2004. Return of spontaneous circulation was lower for black patients (19.8%) than for white patients (26.3%) (unadjusted OR 0.69, 95% CI 0.53 to 0.91). After adjusting for age, sex, prior medical history, prehospital event factors, patient zip code characteristics and EMS agency characteristics, the no difference line was suggestive of a trend, with a CI just transposing 1.00 (adjusted OR 0.71, 95% CI 0.50 to 1.01, p=0.053). Blacks were less likely to experience a return of spontaneous circulation than whites, less likely to receive defibrillation or cardiopulmonary resuscitation from EMS and more likely to receive medications from EMS. Differences in underlying health, care prior to the arrival of EMS, and delays in the notification of EMS personnel may contribute to racial disparities in prehospital survival after out-of-hospital cardiac arrest.

  5. Serial measurement of neuron specific enolase improves prognostication in cardiac arrest patients treated with hypothermia: A prospective study

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    Storm Christian

    2012-01-01

    Full Text Available Abstract Background Neuron specific enolase (NSE has repeatedly been evaluated for neurological prognostication in patients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to cardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE levels and NSE kinetics in cardiac arrest patients treated with hypothermia. Methods In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four days following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received hypothermia treatment for 24 hours at 33°C with a surface cooling device according to current guidelines. Results The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5 72 hours after cardiac arrest was 57 μg/l with an area under the curve (AUC of 0.82 (sensitivity 47%, specificity 100%. The cutoff level for NSE kinetics in patients with unfavourable outcome (CPC 3-5 was an absolute increase of 7.9 μg/l (AUC 0.78, sensitivity 63%, specificity 100% and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100% at 48 hours compared to admission. Conclusion In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE kinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE levels.

  6. Urocortin Treatment Improves Acute Hemodynamic Instability and Reduces Myocardial Damage in Post-Cardiac Arrest Myocardial Dysfunction.

    Science.gov (United States)

    Huang, Chien-Hua; Wang, Chih-Hung; Tsai, Min-Shan; Hsu, Nai-Tan; Chiang, Chih-Yen; Wang, Tzung-Dau; Chang, Wei-Tien; Chen, Huei-Wen; Chen, Wen-Jone

    2016-01-01

    Hemodynamic instability occurs following cardiac arrest and is associated with high mortality during the post-cardiac period. Urocortin is a novel peptide and a member of the corticotrophin-releasing factor family. Urocortin has the potential to improve acute cardiac dysfunction, as well as to reduce the myocardial damage sustained after ischemia reperfusion injury. The effects of urocortin in post-cardiac arrest myocardial dysfunction remain unclear. We developed a preclinical cardiac arrest model and investigated the effects of urocortin. After cardiac arrest induced by 6.5 min asphyxia, male Wistar rats were resuscitated and randomized to either the urocortin treatment group or the control group. Urocortin (10 μg/kg) was administrated intravenously upon onset of resuscitation in the experimental group. The rate of return of spontaneous circulation (ROSC) was similar between the urocortin group (76%) and the control group (72%) after resuscitation. The left ventricular systolic (dP/dt40) and diastolic (maximal negative dP/dt) functions, and cardiac output, were ameliorated within 4 h after ROSC in the urocortin-treated group compared to the control group (Pcardiac arrest myocardial dysfunction.

  7. Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies.

    Science.gov (United States)

    Sandroni, Claudio; Dell'anna, Antonio M; Tujjar, Omar; Geri, Guillaume; Cariou, Alain; Taccone, Fabio S

    2016-09-01

    The prevalence of and the risk factors for acute kidney injury (AKI) after cardiac arrest (CA), and the association of AKI with outcome have not been systematically investigated so far. In this systematic review and meta-analysis, studies on adult patients (dating from January 1966 to August 2015) published as full-text articles were screened. Two authors independently extracted data and assessed study quality using the Quality Assessment Tool of the U.S. National Institute of Health. Data were summarized using weighted means. Eight studies (total 1693 patients; 68% males) were included. The incidence of AKI was 37%. In six studies where a standard AKI definition (RIFLE, AKIN or KDIGO) was used, the incidence for AKI stage 1 or higher was 52%. AKI occurred at a median of 1-2 days from cardiac arrest in 6/8 studies. Renal replacement therapy (RRT) was used in 239 AKI patients (33%), of whom five (2%) still needed RRT at 30 days after CA. An initial non-shockable rhythm, a longer duration of arrest, higher creatinine levels on admission, and the presence of shock or higher blood lactate after resuscitation were significant predictors of AKI occurrence. Hospital mortality was significantly higher in AKI vs. non-AKI patients (OR 2.63 [1.86-3.68]; Parrest AKI has an early onset, occurs in more than 50% of CA patients, and it is associated with increased mortality. Decreased renal function on admission, an initial non-shockable rhythm and both pre-arrest and post-arrest markers of hypoperfusion are associated with increased risk of AKI in this setting.

  8. Recovery From Ropivacaine-Induced or Levobupivacaine-Induced Cardiac Arrest in Rats: Comparison of Lipid Emulsion Effects.

    Science.gov (United States)

    Yoshimoto, Masashi; Horiguchi, Takashi; Kimura, Tetsu; Nishikawa, Toshiaki

    2017-11-01

    Lipid emulsion treatment appears to have application in the treatment of local anesthetic-induced cardiac arrest. To examine whether the efficacy of lipid resuscitation in the treatment of local anesthetic-induced cardiac arrest is affected by lipophilicity, the effects of lipid infusions were compared between levobupivacaine-induced (high lipophilicity) and ropivacaine-induced (lower lipophilicity) rat cardiac arrest model. A total of 28 female Sprague-Dawley rats were anesthetized using sevoflurane, which subsequently underwent tracheostomy, followed by femoral artery and vein cannulation. Two hours after the discontinuation of sevoflurane, either levobupivacaine 0.2% (n = 14) or ropivacaine 0.2% (n = 14) was administered at a rate of 2 mg/kg/min to the awake rats. When the pulse pressure decreased to 0, the infusion of local anesthetic was discontinued, and treatment with chest compressions and ventilation with 100% oxygen were immediately initiated. The total doses of local anesthetics needed to trigger the first seizure and pulse pressure of 0 mm Hg were calculated. The 2 groups were each subdivided into a lipid emulsion group (n = 7) and a control group (n = 7). In the lipid emulsion group, 20% lipid emulsion was administered intravenously (5 mL/kg bolus plus continuous infusion of 0.5 mL/kg/min), while in the control group, the same volume of normal saline was administered. Chest compressions were discontinued when the rate-pressure product had increased by more than 20% of baseline. The cumulative doses of levobupivacaine and ropivacaine that produced seizures and 0 pulse pressure showed no significant difference. Mean arterial blood pressure (MAP) values were higher in the levobupivacaine group than in the ropivacaine group after resuscitation was initiated (P cardiac arrest, heart rate and MAP values were higher in the lipid group than in the control group after starting resuscitation (P 20% baseline), while only 2 of 7 rats in the control group achieved

  9. Hypothermia Modulates Arrhythmia Substrates During Different Phases of Resuscitation From Ischemic Cardiac Arrest.

    Science.gov (United States)

    Piktel, Joseph S; Cheng, Aurelia; McCauley, Matthew; Dale, Zack; Nassal, Michelle; Maleski, Danielle; Pawlowski, Gary; Laurita, Kenneth R; Wilson, Lance D

    2017-11-17

    We designed an innovative porcine model of ischemia-induced arrest to determine dynamic arrhythmia substrates during focal infarct, global ischemia from ventricular tachycardia or fibrillation (VT/VF) and then reperfusion to determine the effect of therapeutic hypothermia (TH) on dynamic arrhythmia substrates and resuscitation outcomes. Anesthetized adult pigs underwent thoracotomy and regional plunge electrode placement in the left ventricle. Subjects were then maintained at either control (CT; 37°C, n=9) or TH (33°C, n=8). The left anterior descending artery (LAD) was occluded and ventricular fibrillation occurred spontaneously or was induced after 30 minutes. Advanced cardiac life support was started after 8 minutes, and LAD reperfusion occurred 60 minutes after occlusion. Incidences of VF/VT and survival were compared with ventricular ectopy, cardiac alternans, global dispersion of repolarization during LAD occlusion, and LAD reperfusion. There was no difference in incidence of VT/VF between groups during LAD occlusion (44% in CT versus 50% in TH; P=1s). During LAD occlusion, ectopy was increased in CT and suppressed in TH (33±11 ventricular ectopic beats/min versus 4±6 ventricular ectopic beats/min; P=0.009). Global dispersion of repolarization and cardiac alternans were similar between groups. During LAD reperfusion, TH doubled the incidence of cardiac alternans compared with CT, with a marked increase in VF/VT (100% in TH versus 17% in CT; P=0.004). Ectopy and global dispersion of repolarization were similar between groups during LAD reperfusion. TH alters arrhythmia substrates in a porcine translational model of resuscitation from ischemic cardiac arrest during the complex phases of resuscitation. TH worsens cardiac alternans, which was associated with an increase in spontaneous VT/VF during reperfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  10. Population density predicts outcome from out-of-hospital cardiac arrest in Victoria, Australia.

    Science.gov (United States)

    Nehme, Ziad; Andrew, Emily; Cameron, Peter A; Bray, Janet E; Bernard, Stephen A; Meredith, Ian T; Smith, Karen

    2014-05-05

    To examine the impact of population density on incidence and outcome of out-of-hospital cardiac arrest (OHCA). Data were extracted from the Victorian Ambulance Cardiac Arrest Registry for all adult OHCA cases of presumed cardiac aetiology attended by the emergency medical service (EMS) between 1 January 2003 and 31 December 2011. Cases were allocated into one of five population density groups according to their statistical local area: very low density (≤ 10 people/km(2)), low density (11-200 people/km(2)), medium density (201-1000 people/km(2)), high density (1001-3000 people/km(2)), and very high density (> 3000 people/km(2)). Survival to hospital and survival to hospital discharge. The EMS attended 27 705 adult presumed cardiac OHCA cases across 204 Victorian regions. In 12 007 of these (43.3%), resuscitation was attempted by the EMS. Incidence was lower and arrest characteristics were consistently less favourable for lower population density groups. Survival outcomes, including return of spontaneous circulation, survival to hospital and survival to hospital discharge, were significantly poorer in less densely populated groups (P density populations, the risk-adjusted odds ratios of surviving to hospital discharge were: low density, 1.88 (95% CI, 1.15-3.07); medium density, 2.49 (95% CI, 1.55-4.02); high density, 3.47 (95% CI, 2.20-5.48) and very high density, 4.32 (95% CI, 2.67-6.99). Population density is independently associated with survival after OHCA, and significant variation in the incidence and characteristics of these events are observed across the state.

  11. The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres.

    Science.gov (United States)

    Pollak, P Timothy; Wee, Vinnie; Al-Hazmi, Ahmed; Martin, Janet; Zarnke, Kelly B

    2006-03-01

    Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests. To determine whether the use of amiodarone, as recommended by the year 2000 American Heart Association Advanced Cardiac Life Support guidelines, improved survival following its introduction to the resuscitation algorithm at two tertiary care institutions. Charts of 374 cardiac resuscitations were retrospectively studied at the two institutions. Basic survival outcomes and demographic data were recorded for cardiac arrests with ventricular tachyarrhythmias qualifying for administration of antiarrhythmic agents. Qualifying rhythms were present in 95 patients. Clinical uptake of amiodarone was limited. In the 36 patients who received amiodarone, survival of resuscitation was 67% versus 83% (P=0.07) in the 59 patients receiving only other antiarrhythmic agents (chiefly lidocaine [94%]), while survival to discharge was 36.1% and 55.9% (P=0.06) in these two groups, respectively. Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.

  12. Early multimodal outcome prediction after cardiac arrest in patients treated with hypothermia.

    Science.gov (United States)

    Oddo, Mauro; Rossetti, Andrea O

    2014-06-01

    Therapeutic hypothermia and pharmacological sedation may influence outcome prediction after cardiac arrest. The use of a multimodal approach, including clinical examination, electroencephalography, somatosensory-evoked potentials, and serum neuron-specific enolase, is recommended; however, no study examined the comparative performance of these predictors or addressed their optimal combination. Prospective cohort study. Adult ICU of an academic hospital. One hundred thirty-four consecutive adults treated with therapeutic hypothermia after cardiac arrest. Variables related to the cardiac arrest (cardiac rhythm, time to return of spontaneous circulation), clinical examination (brainstem reflexes and myoclonus), electroencephalography reactivity during therapeutic hypothermia, somatosensory-evoked potentials, and serum neuron-specific enolase. Models to predict clinical outcome at 3 months (assessed using the Cerebral Performance Categories: 5 = death; 3-5 = poor recovery) were evaluated using ordinal logistic regressions and receiving operator characteristic curves. Seventy-two patients (54%) had a poor outcome (of whom, 62 died), and 62 had a good outcome. Multivariable ordinal logistic regression identified absence of electroencephalography reactivity (p < 0.001), incomplete recovery of brainstem reflexes in normothermia (p = 0.013), and neuron-specific enolase higher than 33 μg/L (p = 0.029), but not somatosensory-evoked potentials, as independent predictors of poor outcome. The combination of clinical examination, electroencephalography reactivity, and neuron-specific enolase yielded the best predictive performance (receiving operator characteristic areas: 0.89 for mortality and 0.88 for poor outcome), with 100% positive predictive value. Addition of somatosensory-evoked potentials to this model did not improve prognostic accuracy. Combination of clinical examination, electroencephalography reactivity, and serum neuron-specific enolase offers the best outcome

  13. Outcomes of Out‐of‐Hospital Cardiac Arrest by Public Location in the Public‐Access Defibrillation Era

    Science.gov (United States)

    Murakami, Yukiko; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Kawamura, Takashi

    2014-01-01

    Background The strategy to place public‐access automated external defibrillators (AEDs) has not yet been established in real settings. Methods and Results This, prospective, population‐based observational study in Osaka, Japan, included consecutive out‐of‐hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public‐access AED use and 1‐month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander‐witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public‐access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public‐access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1‐minute increment, 0.89; 95% confidence interval, 0.87 to 0.92). Conclusions This large, population‐based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public‐access defibrillation program was successfully implemented so that shocks with public‐access AEDs were delivered to over 40% of bystander‐witnessed OHCAs

  14. Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

    Science.gov (United States)

    Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark

    2014-01-01

    This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH).

    Science.gov (United States)

    Kuck, K H; Cappato, R; Siebels, J; Rüppel, R

    2000-08-15

    We conducted a prospective, multicenter, randomized comparison of implantable cardioverter-defibrillator (ICD) versus antiarrhythmic drug therapy in survivors of cardiac arrest secondary to documented ventricular arrhythmias. From 1987, eligible patients were randomized to an ICD, amiodarone, propafenone, or metoprolol (ICD versus antiarrhythmic agents randomization ratio 1:3). Assignment to propafenone was discontinued in March 1992, after an interim analysis conducted in 58 patients showed a 61% higher all-cause mortality rate than in 61 ICD patients during a follow-up of 11.3 months. The study continued to recruit 288 patients in the remaining 3 study groups; of these, 99 were assigned to ICDs, 92 to amiodarone, and 97 to metoprolol. The primary end point was all-cause mortality. The study was terminated in March 1998, when all patients had concluded a minimum 2-year follow-up. Over a mean follow-up of 57+/-34 months, the crude death rates were 36.4% (95% CI 26.9% to 46.6%) in the ICD and 44.4% (95% CI 37.2% to 51.8%) in the amiodarone/metoprolol arm. Overall survival was higher, though not significantly, in patients assigned to ICD than in those assigned to drug therapy (1-sided P=0.081, hazard ratio 0.766, [97.5% CI upper bound 1.112]). In ICD patients, the percent reductions in all-cause mortality were 41.9%, 39.3%, 28. 4%, 27.7%, 22.8%, 11.4%, 9.1%, 10.6%, and 24.7% at years 1 to 9 of follow-up. During long-term follow-up of cardiac arrest survivors, therapy with an ICD is associated with a 23% (nonsignificant) reduction of all-cause mortality rates when compared with treatment with amiodarone/metoprolol. The benefit of ICD therapy is more evident during the first 5 years after the index event.

  16. Cardiopulmonary resuscitation interruptions with use of a load-distributing band device during emergency department cardiac arrest.

    Science.gov (United States)

    Ong, Marcus Eng Hock; Annathurai, Annitha; Shahidah, Ahmad; Leong, Benjamin Sieu-Hon; Ong, Victor Yeok Kein; Tiah, Ling; Ang, Shiang Hu; Yong, Kok Leong; Sultana, Papia

    2010-09-01

    Our primary aim is to measure no-flow time and no-flow ratio before and after an emergency department (ED) switched from manual to a load-distributing band mechanical cardiopulmonary resuscitation (CPR) device. This was a phased, before-after cohort evaluation at an urban tertiary hospital ED. We collected continuous video and chest compression data with the Physiocontrol CodeStat Suite 7.0 for resuscitations during the period just before and after adoption of load-distributing band CPR. All out-of-hospital, nontraumatic cardiac arrest, adult patients were eligible. From February 2007 to July 2008, there were 26 manual and 41 load-distributing band cases. Patients in both phases were comparable in terms of demographics, medical history, witnessed arrest, arrest location, bystander CPR rates, out-of-hospital defibrillation, initial rhythm, and ED defibrillation. The median no-flow time, defined as the sum of all pauses between compressions longer than 1.5 seconds, during the first 5 minutes of resuscitation, was manual CPR 85 seconds (interquartile range [IQR] 45 to 112 seconds) versus load-distributing band 104 seconds (IQR 69 to 151 seconds). The mean no-flow ratio, defined as no-flow time divided by segment length, was manual 0.28 versus load-distributing band 0.40 (difference=-0.12; 95% confidence interval -0.22 to -0.02). However, from 5 to 10 minutes into the resuscitation, median no-flow time was manual 85 seconds (IQR 59 to 151 seconds) versus load-distributing band 52 seconds (IQR 34 to 82 seconds) and mean no-flow ratio manual 0.34 versus load-distributing band 0.21 (difference=0.13; 95% confidence interval 0.02 to 0.24). The average time to apply load-distributing band CPR during this period was 152 seconds. Application of a load-distributing band in the ED is associated with a higher no-flow ratio than manual CPR in the first 5 minutes of resuscitation. We suggest that attention to team training, rapid application of the device to minimize interruption

  17. Awakening following cardiac arrest: Determined by the definitions used or the therapies delivered?

    Science.gov (United States)

    Eid, Shaker M; Albaeni, Aiham; Vaidya, Dhananjay; Nazarian, Skon M; Llinas, Rafael; Chandra-Strobos, Nisha

    2016-03-01

    To investigate patterns of neurologic "awakening" in out-of-hospital cardiac arrest (OHCA) patients using different criteria for prognostication post-arrest. Data was collected on 194 OHCA survivors to hospital admission. Patients were assigned to one of two groups based on whether they received therapeutic hypothermia (TH). Three separate criteria were used to assess neurologic "awakening": motor-GCS=6, total-GCS ≥ 9, and CPC=1 or 2. Demographics, arrest characteristics and intensive care events were compared using unpaired t-test, Chi-square or nonparametric Wilcoxon rank-sum test as appropriate. Primary outcome was the time from arrest to neurologic awakening. Of 194 OHCA survivors, TH was implemented in 94 patients (48%). Compared to conventional care patients, hypothermia treated patients were more likely to be younger (58 vs. 69 years, parrest rhythm (27% vs. 10%, parrest. Use of different criteria for the assessment of neurologic "awakening" can yield different prognostication predictions which calls for standardization and validation of a single definition of "awakening" by the resuscitation community. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Post-cardiac arrest therapeutic hypothermia: overcoming the barrier of workplace culture and other implementation lessons.

    Science.gov (United States)

    Wang, Henry E; Thomas, Jarred Jeremy; James, David; Barlotta, Kevin; Fellman, Amy; Viles, Andres; Strother, Doris; Lai, Katherine Robin

    2011-09-01

    Therapeutic hypothermia (TH) is associated with improved neurologically intact survival after out-of-hospital cardiopulmonary arrest. Because of its complex multidisciplinary nature, many hospitals in the United States have resisted implementing TH. A post-cardiac arrest (post-arrest) TH program was implemented at a major urban academic medical center. IMPLEMENTING THE THERAPEUTIC HYPOTHERMIA PROGRAM: After initial efforts at TH at the University of Alabama at Birmingham Hospital nearly failed, the leaders restructured the TH program. Key elements included frequent multidisciplinary meetings involving all stakeholders, development of TH protocols and techniques consistent with customary institutional practices, introduction of cooling technology, and implementation of a TH physician rapid response system. During its first 21 months, the program initiated TH on 93 post-arrest patients. Of the 83 patients who achieved goal hypothermia temperature, 30 (36%; 95% confidence interval [CI]: 26%-47%) survived to hospital discharge. Care teams successfully managed expected complications. Of two patients with TH-associated coagulopathy, one required TH termination. The program illustrates key lessons for successful TH program implementation, such as the difficulty of organizing and coordinating complex interventions in complex institutions, the importance of overcoming workplace culture, the value of technology, the need for mid-course corrections, and the advantages of a physician-based rapid response system. Many of these lessons are applicable to any quality improvement intervention.

  19. Whole body periodic acceleration (pGz) preserves heart rate variability after cardiac arrest.

    Science.gov (United States)

    Adams, Jose A; Uryash, Arkady; Nadkarni, Vinay; Berg, Robert A; Lopez, Jose R

    2016-02-01

    Heart rate variability (HRV) is a measure of the balance between the sympathetic and parasympathetic autonomic nervous system and lack thereof an ominous sign in many cardiac and neurological conditions including post-cardiac arrest syndrome. Whole body periodic acceleration (pGz) has been shown to be cardio protective when applied prior to during and after cardiac arrest (CA). Here, we investigate whether or not pGz pre or post treatment after CA preserves HRV. Eight min of unsupported ventricular fibrillation followed by CPR and defibrillation was carried out in 32 anesthetized and paralyzed male swine who were randomized to pretreatment (1h pGz prior to CA, pre-pGz [n=8]) or post-treatment (pGz beginning at 30min after return of spontaneous circulation ([ROSC], post-pGz [n=8]) or none (CONT [n=8]). pGz was applied together with conventional mechanical ventilation. In a separate group (n=8), infusion of TRIM (nNOS inhibitor) was used to determine the effects of nNOS inhibition on HRV. Time and frequency domain measures of HRV were determined along with measurements of blood gases and hemodynamics, obtained at baseline and at 30, 60, 120 and 180min after ROSC. All animals had ROSC and there were no significant differences for arterial blood gases, mean blood pressure and coronary perfusion pressure after ROSC among the groups. HRV was significantly depressed after cardiac arrest and remained depressed in CONT group. In contrast, both pre and post pGz treated groups had significantly higher and preserved time domain measures of HRV (RMSSD and SDNN) from 60 to 180min after ROSC, and nNOS inhibition markedly reduced HRV. The frequency domain of HRV did not show changes. In a pig model of CA, pre or post treatment with pGz preserves HRV. Inhibition of nNOS markedly reduced HRV. Post-treatment with pGz is a novel therapeutic strategy that might serve as an adjunct to current pharmacological or hypothermia modalities to potentially improve outcomes from post-cardiac

  20. Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest.

    Science.gov (United States)

    Larsson, Ing-Marie; Wallin, Ewa; Rubertsson, Sten

    2010-01-01

    Hypothermia treatment with cold intravenous infusion and ice packs after cardiac arrest has been described and used in clinical practice. We hypothesised that with this method a target temperature of 32-34 degrees C could be achieved and maintained during treatment and that rewarming could be controlled. Thirty-eight patients treated with hypothermia after cardiac arrest were included in this prospective observational study. The patients were cooled with 4 degrees C intravenous saline infusion combined with ice packs applied in the groins, axillae, and along the neck. Hypothermia treatment was maintained for 26 h after cardiac arrest. It was estimated that passive rewarming would occur over a period of 8h. Body temperature was monitored continuously and recorded every 15 min up to 44 h after cardiac arrest. All patients reached the target temperature interval of 32-34 degrees C within 279+/-185 min from cardiac arrest and 216+/-177 min from induction of cooling. In nine patients the temperature dropped to below 32 degrees C during a period of 15 min up to 2.5h, with the lowest (nadir) temperature of 31.3 degrees C in one of the patients. The target temperature was maintained by periodically applying ice packs on the patients. Passive rewarming started 26 h after cardiac arrest and continued for 8+/-3h. Rebound hyperthermia (>38 degrees C) occurred in eight patients 44 h after cardiac arrest. Intravenous cold saline infusion combined with ice packs is effective in inducing and maintaining therapeutic hypothermia, with good temperature control even during rewarming. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  1. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest.

    Science.gov (United States)

    Deakin, Charles D; Shewry, Elizabeth; Gray, Huon H

    2014-04-01

    Public access defibrillation (PAD) prior to ambulance arrival is a key determinant of survival from out-of-hospital (OOH) cardiac arrest. Implementation of PAD has been underway in the UK for the past 12 years, and its importance in strengthening the chain of survival has been recognised in the government's recent 'Cardiovascular Disease Outcomes Strategy'. The extent of use of PAD in OOH cardiac arrests in the UK is unknown. We surveyed all OOH cardiac arrests in Hampshire over a 12-month period to ascertain the availability and effective use of PAD. A retrospective review of all patients with OOH cardiac arrest attended by South Central Ambulance Service (SCAS) in Hampshire during a 1-year period (1 September 2011 to 31 August 2012) was undertaken. Emergency calls were reviewed to establish the known presence of a PAD. Additionally, a review of all known PAD locations in Hampshire was undertaken, together with a survey of public areas where a PAD may be expected to be located. The current population of Hampshire is estimated to be 1.76 million. During the study period, 673 known PADs were located in 278 Hampshire locations. Of all calls confirmed as cardiac arrest (n=1035), the caller reported access to an automated external defibrillator (AED) on 44 occasions (4.25%), successfully retrieving and using the AED before arrival of the ambulance on only 18 occasions (1.74%). Despite several campaigns to raise public awareness and make PADs more available, many public areas have no recorded AED available, and in those where an AED was available it was only used in a minority of cases by members of the public before arrival of the ambulance. Overall, a PAD was only deployed successfully in 1.74% OOH cardiac arrests. This weak link in the chain of survival contributes to the poor survival rate from OOH cardiac arrest and needs strengthening.

  2. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne

    2012-02-01

    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  3. The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest.

    Science.gov (United States)

    Drennan, Ian R; Lin, Steve; Thorpe, Kevin E; Morrison, Laurie J

    2014-11-01

    Cardiac arrest physiology has been proposed to occur in three distinct phases: electrical, circulatory and metabolic. There is limited research evaluating the relationship of the 3-phase model of cardiac arrest to functional survival at hospital discharge. Furthermore, the effect of post-cardiac arrest targeted temperature management (TTM) on functional survival during each phase is unknown. To determine the effect of TTM on the relationship between the time of initial defibrillation during each phase of cardiac arrest and functional survival at hospital discharge. This was a retrospective observational study of consecutive adult (≥18 years) out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythms. Included patients obtained a return of spontaneous circulation (ROSC) and were eligible for TTM. Multivariable logistic regression was used to determine predictors of functional survival at hospital discharge. There were 20,165 OHCA treated by EMS and 871 patients were eligible for TTM. Of these patients, 622 (71.4%) survived to hospital discharge and 487 (55.9%) had good functional survival. Good functional survival was associated with younger age (OR 0.94; 95% CI 0.93-0.95), shorter times from collapse to initial defibrillation (OR 0.73; 95% CI 0.65-0.82), and use of post-cardiac arrest TTM (OR 1.49; 95% CI 1.07-2.30). Functional survival decreased during each phase of the model (65.3% vs. 61.7% vs. 50.2%, Pdefibrillation and was decreased during each successive phase of the 3-phase model. Post-cardiac arrest TTM was associated with improved functional survival. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Development of a theoretical guide for nursing care in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Aliandra Bittencourt da Silva

    2013-11-01

    Full Text Available This study aimed to identify the knowledge on cardiorespiratory arrest among nurses in a hospital of Vale do Paraíba, São Paulo, Brazil, and develop a theoretical guide for care of this emergency. We prepared an instrument of data collection based on relevant literature and the 2010 AHA Guidelines for CPR, from August to October 2012. The sample consisted of 41 nurses who deliver care activities in various units of the hospital. The study showed that professional participants said they were able to act in cardiopulmonary resuscitation, however, there were limitations of knowledge about the theme. Given the above, we developed a theoretical guide for cardiac arrest care based on scientific literature and covering questions submitted by nurses.

  5. [Diagnosis of essential thrombocythemia after myocardial infarction and cardiac arrest: A case report].

    Science.gov (United States)

    Cartigny, G; Faivre, V; Stamboul, K; Aulagne, J; Cottin, Y

    2015-09-01

    Acute coronary syndrome is now a well-known disease, with codified treatments. The main presentation is chest pain, but more and more cases are revealed by cardiorespiratory arrest thanks to pre-hospital care. And, depending on the evolution in such situations, cardiocirculatory support techniques like extracorporeal membrane oxygenation (ECMO) can be implemented. If the more common cause of SCA is atherosclerosis, consequence of the combination of one or more cardiovascular risk factors, there are rare aetiologies, which include myeloproliferative syndromes, in particular essential thrombocythemia. We describe the case of a 34-year-old man presenting with anterior ST-elevation myocardial infarction complicated by an initial cardiac arrest, whose aetiology is unknown essential thrombocythemia, and its therapeutic management requiring circulatory support by ECMO and IMPELLA(®) techniques. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Rosuvastatin improves myocardial and neurological outcomes after asphyxial cardiac arrest and cardiopulmonary resuscitation in rats.

    Science.gov (United States)

    Qiu, Yun; Wu, Yichen; Meng, Min; Luo, Man; Zhao, Hongmei; Sun, Hong; Gao, Sumin

    2017-03-01

    Rosuvastatin, a potent HMG-CoA reductase inhibitor, is cholesterol-lowering drugs and reduce the risk of myocardial infarction and stroke. This study is to explore whether rosuvastatin improves outcomes after cardiac arrest in rats. Male Sprague-Dawley rats were subjected to 8min of cardiac arrest (CA) by asphyxia and randomly assigned to three experimental groups immediately following successful resuscitation: Sham; Control; and Rosuvastatin. The survival, hemodynamics, myocardial function, neurological outcomes and apoptosis were assessed. The 7-d survival rate was greater in the rosuvastatin treated group compared to the Control group (P=0.019 by log-rank test). Myocardial function, as measured by cardiac output and ejection fraction, was significantly impaired after CA and notably improved in the animals treated with rosuvastatin beginning at 60min after return of spontaneous circulation (ROSC) (Pcardiac troponin T and neuron-specific enolase and the caspase-3 activity were significantly decreased in the Rosuvastatin group when compared with the Control group (P<0.05). In conclusion, rosuvastatin treatment substantially improves the 7-d survival rate as well as myocardial function and neurological outcomes after ROSC. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion.

    Science.gov (United States)

    Abu-Laban, Riyad B; Migneault, David; Grant, Meghan R; Dhingra, Vinay; Fung, Anthony; Cook, Richard C; Sweet, David

    2015-03-01

    Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.

  8. Influence of Chest Compressions on Circulation during the Peri-Cardiac Arrest Period in Porcine Models.

    Directory of Open Access Journals (Sweden)

    Jun Xu

    Full Text Available Starting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the peri-cardiac arrest period.Prospective, randomized controlled study.Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China.Healthy 3-month-old male domestic pigs.44 pigs (28±2 kg were randomly assigned to three groups: Group I (non-arrested with compressions (n = 12; Group II (arrested with compressions only (n = 12; Group III (ROSC after compressions and defibrillation (n = 20. In Groups I and II, compressions were performed to a depth of 5cm (Ia and IIa, n = 6 or a depth of 3cm (Ib and IIb, n = 6 respectively, while in Group III, the animals which had just achieved ROSC (n = 18 were compressed to a depth of 5cm (IIIa, n = 6, a depth of 3cm (IIIb, n = 6, or had no compressions (IIIc, n = 6. Hemodynamic parameters were collected and analyzed.Hemodynamics were statistically different between Groups Ia and Ib when different depths of compressions were performed (p < 0.05. In Group II, compressions were beneficial and hemodynamics correlated with the depth of compressions (p < 0.05. In Group III, compressions that continued after ROSC produced a reduction in arterial pressure (p < 0.05.Chest compressions might be detrimental to hemodynamics in the early post-ROSC stage. The deeper the compressions were, the better the effect on hemodynamics during cardiac arrest, but the worse the effect on hemodynamics after ROSC.

  9. Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial.

    Science.gov (United States)

    Ali, Bakhtiar; Bloom, Heather; Veledar, Emir; House, Dorothy; Norvel, Robert; Dudley, Samuel C; Zafari, A Maziar

    2008-06-11

    In-hospital cardiac arrest has a poor prognosis despite active electrocardiography monitoring. The initial rhythm of approximately 25% of in-hospital cardiopulmonary resuscitation (CPR) events is pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). Early defibrillation is an independent predictor of survival in CPR events caused by VT/VF. The automated external cardioverter defibrillator (AECD) is a device attached by pads to the chest wall that monitors, detects, and within seconds, automatically delivers electric countershock to an appropriate tachyarrhythmia. To evaluate safety of AECD monitoring in hospitalized patients. To evaluate whether AECDs provide earlier defibrillation than hospital code teams. The study is a prospective trial randomizing patients admitted to the telemetry ward to standard CPR (code team) or standard CPR plus AECD monitoring (PowerHeart CRM). The AECD is programmed to deliver one 150 J biphasic shock to patients in sustained VT/VF. Data is collected using the Utstein criteria for cardiac arrest. The primary endpoint is time-to-defibrillation; secondary outcomes include neurological status and survival to discharge, with 3-year follow-up. To date, 192 patients have been recruited in the time period between 10/10/2006 to 7/20/2007. A total of 3,655 hours of telemetry data have been analyzed in the AECD arm. The AECD has monitored ambulatory telemetry patients in sinus rhythm, sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, with premature ventricular complexes and non-sustained VT without delivery of inappropriate shocks. One patient experienced sustained VT during AECD monitoring, who was successfully defibrillated (17 seconds after meeting programmed criteria). There are no events to report in the control arm. The patient survived the event without neurological complications. During the same time period, mean time to shock for VT/VF cardiac arrest occurring outside the telemetry ward was

  10. Cardiac arrest in an American Cocker Spaniel during a deep ear flush procedure.

    Science.gov (United States)

    Gould, Alexandra; Garcia-Pereira, Fernando L; Gram, W Dunbar

    2017-05-01

    CASE DESCRIPTION A 14-year-old spayed female American Cocker Spaniel with bilateral otitis media and no evidence of cardiovascular instability was anesthetized to allow performance of a deep ear flush. CLINICAL FINDINGS Otoscopic examination of the left ear revealed evidence of chronic inflammation; the ear was flushed with sterile saline (0.9% NaCl) solution. Examination of the right ear revealed more severe chronic inflammation than in the left ear, including a ruptured tympanum (timing of rupture unknown). The right ear was flushed with sterile saline solution, and several drops of otic medication were instilled. During infusion of saline solution, the ECG revealed a rapid decrease in heart rate until no more electrical activity was noted. Pulse also ceased to be detectable via pulse oximetry and femoral artery palpation. TREATMENT AND OUTCOME Isoflurane was discontinued immediately after recognition of cardiac arrest. Shortly after, atropine (0.04 mg/kg [0.02 mg/lb]) and epinephrine (0.3 mg/kg [0.14 mg/lb]) were administered IV, chest compressions and ventilation were performed for 2 to 3 minutes, and 3 boluses (each 5 mL/kg) of lactated Ringer solution were administered IV. The dog was extubated 8 minutes after anesthesia was discontinued, and its recovery was monitored for the next 5 hours. No further incidents of cardiac arrest occurred after recovery from anesthesia. CLINICAL RELEVANCE This case represented a rarely documented potential complication associated with otic manipulation in a dog: cardiac arrest secondary to stimulation of the auricular branch of the vagus nerve. Veterinarians should be prepared for and warn clients of this possibility prior to otic flushing.

  11. Prognostic Factors for Outcomes of In-Flight Sudden Cardiac Arrest on Commercial Airlines.

    Science.gov (United States)

    Alves, Paulo M; DeJohn, Charles A; Ricaurte, Eduard M; Mills, William D

    In-flight cardiac arrest (IFCA) is a relatively rare but challenging event. Outcomes and prognostic factors are not entirely understood for victims of IFCAs in commercial aviation. This was a retrospective cohort study of airline passengers who experienced IFCA. Demographic and operational variables were studied to identify association in a multivariate logistic regression model with the outcome of survival-to-hospital. In-flight medical emergencies were processed by a ground-based medical center. Subsequent comparisons were made between reported shockable-rhythm (RSR) and reported non-shockable-rhythm (RNSR) groups. Logistic regression was also used to identify predictors for shock advised and flight diversions using a case control study design. Significant predictors for survival-to-hospital were RSR and remaining flight time to destination. The percentage of RSR cases was 24.6%. The survival to hospital admission was 22.7% (22/97) for passengers in RSR compared with 2.4% (7/297) in the RNSR group. The adjusted odds ratio for survival-to-hospital for the RSR group compared to the RNSR group was 13.6 (5.5-33.5). The model showed odds for survival to hospital decreased with longer scheduled remaining flight duration with adjusted OR = 0.701 (0.535-0.920) per hour increase. No correlation between diversions and survival for RSR cases was found. Survival-to-hospital from IFCAs is best when an RSR is present. The percentage of RSR cases was lower than in other out-of-hospital cardiac arrest (OHCA) settings, which suggests delayed discovery. Flight diversions did not significantly affect resuscitation outcome. We emphasize good quality cardio-pulmonary resuscitation (CPR) and early defibrillation as key factors for IFCA survival. Alves PM, DeJohn CA, Ricaurte EM, Mills WD. Prognostic factors for outcomes of in-flight sudden cardiac arrest on commercial airlines. Aerosp Med Hum Perform. 2016; 87(10):862-868.

  12. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams.

    Science.gov (United States)

    Andersen, Peter Oluf; Jensen, Michael Kammer; Lippert, Anne; Østergaard, Doris

    2010-06-01

    The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care. A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams' inability to maintain focus on chest compressions. Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy

    Directory of Open Access Journals (Sweden)

    Niković Vuk

    2013-01-01

    Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anti­coagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

  14. Amiodarone Versus Lidocaine for Pediatric Cardiac Arrest Due to Ventricular Arrhythmias: A Systematic Review.

    Science.gov (United States)

    McBride, Mary E; Marino, Bradley S; Webster, Gregory; Lopez-Herce, Jesús; Ziegler, Carolyn P; De Caen, Allan R; Atkins, Dianne L

    2017-02-01

    We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation's Consensus on Science and Treatment Recommendations. Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library. Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest. Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter. We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%; p = 0.009) and a lack of statistical difference for survival at discharge (p = 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36-3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and

  15. Prehospital surface cooling is safe and can reduce time to target temperature after cardiac arrest.

    Science.gov (United States)

    Uray, Thomas; Mayr, Florian B; Stratil, Peter; Aschauer, Stefan; Testori, Christoph; Sterz, Fritz; Haugk, Moritz

    2015-02-01

    Mild therapeutic hypothermia proved to be beneficial when induced after cardiac arrest in humans. Prehospital cooling with i.v. fluids was associated with adverse side effects. Our primary objective was to compare time to target temperature of out-of hospital cardiac arrest patients cooled non-invasively either in the prehospital setting vs. the in-hospital (IH) setting, to assess surface-cooling safety profile and long term outcome. In this retrospective, single center cohort study, a group of adult patients with restoration of spontaneous circulation (ROSC) after out-of hospital cardiac arrest were cooled with a surface cooling pad beginning either in the prehospital or IH setting for 24h. Time to target temperature (33.9°C), temperature on admission, time to admission after ROSC and outcome were compared. Also, rearrests and pulmonary edema were assessed. Neurologic outcome at 12 months was evaluated (Cerebral Performance Category, CPC 1-2, favorable outcome). Between September 2005 and February 2010, 56 prehospital cooled patients and 54 IH-cooled patients were treated. Target temperature was reached in 85 (66-117)min (prehospital) and in 135 (102-192)min (IH) after ROSC (ptemperature was 35.2 (34.2-35.8)°C, and in the IH-cooling patients initial temperature was 35.8 (35.2-36.3)°C (p=0.001). No difference in numbers of rearrests and pulmonary edema between groups was observed. In both groups, no skin lesions were observed. Favorable outcome was reached in 26.8% (prehospital) and in 37.0% (IH) of the patients (p=0.17). Using a non-invasive prehospital surface cooling method after cardiac arrest, target temperature can be reached faster without any major complications than starting cooling IH. The effect of early non-invasive cooling on long-term outcome remains to be determined in larger studies. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  16. Prognostic significance of clinical seizures after cardiac arrest and target temperature management

    DEFF Research Database (Denmark)

    Lybeck, Anna; Friberg, Hans; Aneman, Anders

    2017-01-01

    AIM: Clinical seizures are common after cardiac arrest and predictive of a poor neurological outcome. Seizures may be myoclonic, tonic-clonic or a combination of seizure types. This study reports the incidence and prognostic significance of clinical seizures in the target temperature management......-findings, and long-term neurological outcome. The trial randomised 939 comatose survivors to TTM at 33°C or 36°C with strict criteria for withdrawal of life-sustaining therapies. Sensitivity, specificity and false positive rate for poor outcome were reported for different types of seizures. RESULTS: Clinical...

  17. Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Madsen, Kristian Rørbæk; Nielsen, Jesper Meng Rahn

    2015-01-01

    A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma...... for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach...

  18. Emergency cricothyrotomy for trismus caused by instantaneous rigor in cardiac arrest patients.

    Science.gov (United States)

    Lee, Jae Hee; Jung, Koo Young

    2012-07-01

    Instantaneous rigor as muscle stiffening occurring in the moment of death (or cardiac arrest) can be confused with rigor mortis. If trismus is caused by instantaneous rigor, orotracheal intubation is impossible and a surgical airway should be secured. Here, we report 2 patients who had emergency cricothyrotomy for trismus caused by instantaneous rigor. This case report aims to help physicians understand instantaneous rigor and to emphasize the importance of securing a surgical airway quickly on the occurrence of trismus. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Prehospital care and outcome of pediatric out-of-hospital cardiac arrest.

    Science.gov (United States)

    Pitetti, Raymond; Glustein, Joseph Z; Bhende, Mananda S

    2002-01-01

    Cardiac arrest in children outside the hospital is associated with high mortality rates. Recent investigations have suggested that the use of advanced life support (ALS) measures by emergency medical services (EMS) personnel may decrease survival. These studies have used the pediatric Utstein style of defining ALS and basic life support (BLS) measures. The pediatric Utstein style defines BLS as "an attempt to restore effective ventilation and circulation" using noninvasive means to open the airway but specifically excludes the use of bag-valve-mask devices. Advanced life support is defined as the "addition of invasive maneuvers to restore effective ventilation and circulation." The authors of the study described below believe that using this definition would categorize some patients into an ALS group who would otherwise be categorized as having received BLS (i.e., "bag-valve-mask only"). To compare survival rates among children receiving BLS or ALS following out-of-hospital cardiac arrest using amended definitions of prehospital life support measures. Specifically, the definition of BLS was expanded to include the use of bag-valve-mask devices only. This was a retrospective chart review in an urban, pediatric emergency department. Patients included all children presenting to the emergency department between January 1, 1986, and December 31, 1999, following out-of-hospital cardiac arrest. The main outcome measure was survival to hospital discharge. Two hundred ten children were identified. Twenty-one patients were excluded from further analysis because of absent or incomplete medical records. One hundred eighty-nine patients were studied. Five children (2.6%) survived to discharge from the hospital. Of 189 children, 39 (20.6%) were provided BLS measures by prehospital personnel; 150 (79.4%) received ALS. There was no significant difference between groups in survival to hospital discharge. Patients who survived to hospital discharge were more likely to be in sinus

  20. Debriefing bystanders of out-of-hospital cardiac arrest is valuable

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Hansen, Carolina Malta; Fjordholt, Martin

    2014-01-01

    AIM OF THE STUDY: To explore the concept of debriefing bystanders after participating in an out-of-hospital cardiac arrest resuscitation attempt including (1) bystanders' most commonly addressed reactions after participating in a resuscitation attempt when receiving debriefing from medical dispat...... Dispatch Centres is a low complexity and a low cost intervention though the logistic challenges have to be considered....... the phenomenological approach. RESULTS: Six themes emerged from analysis of debriefing audio files: (1) identification of OHCA; (2) emotional and perceptual experience with OHCA; (3) collaboration with healthcare professionals; (4) patients outcome; (5) coping with the experience and (6) general reflections. When...

  1. Interposed Abdominal Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing Traditional CPR

    Directory of Open Access Journals (Sweden)

    Christian D. McClung

    2015-10-01

    Full Text Available Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR is an alternative technique to traditional cardiopulmonary resuscitation (CPR that can improve perfusion and lead to restoration of circulation in patients with chest wall deformity either acquired through vigorous CPR or co-morbidity such as chronic obstructive pulmonary disease. We report a case of out-of-hospital cardiac arrest where IAC-CPR allowed for restoration of spontaneous circulation and eventual full neurologic recovery when traditional CPR was failing to generate adequate pulses with chest compression alone.

  2. Evaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei.

    Science.gov (United States)

    Ma, Matthew Huei-Ming; Lu, Tsung-Chien; Ng, Josh Chian-Shuin; Lin, Chih-Hao; Chiang, Wen-Chu; Ko, Patrick Chow-In; Shih, Fuh-Yuan; Huang, Chien-Hua; Hsiung, Kuang-Hua; Chen, Shyr-Chyr; Chen, Wen-Jone

    2007-05-01

    Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch. This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei. This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (age >or=18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic. A total of 199 audio recordings were reviewed. A mean ECCS of 1.42+/-0.64 (95% CI: 1.33-1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; pskills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A kappa value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills. Most callers were found to be emotional stable and

  3. Scandinavian clinical practice guidelines for therapeutic hypothermia and post-resuscitation care after cardiac arrest

    DEFF Research Database (Denmark)

    Castrén, M; Silfvast, T; Rubertsson, S

    2009-01-01

    studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society...... fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide...

  4. EMuRgency: Addressing cardiac arrest with socio-technical innovation in a smart learning region

    Directory of Open Access Journals (Sweden)

    Sabina Jeschke

    2013-08-01

    Full Text Available This paper introduces the EMuRgency project. The project has the goal to increase awareness and competences regarding the problem of cardiac arrest in the Euregio Meuse-Rhine (EMR and to use socio-technical innovations to transfer it into a smart learning region. Based on the conscious competence framework solutions for stakeholders on different levels of the framework are introduced, namely a public display network, mobile learning apps and a volunteer notification system. Finally, a future research outlook is given.

  5. Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John

    2015-01-01

    BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB...... the hypothermia phase of TH had a 17% 180-day mortality rate compared to 38% in no-SB patients (phypothermia was directly associated with lower odds of unfavorable...... neurological outcome (ORunadjusted=0.42 (0.23-0.75, phypothermia is independently associated with a lower 180-day mortality rate and may thus be a novel, early marker of favorable outcome in comatose survivors of OHCA....

  6. Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Hassager, Christian; Kjaergaard, Jesper

    2017-01-01

    BACKGROUND: Out-of-hospital cardiac arrest is more often reported in men than in women. OBJECTIVES: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out......-of-hospital cardiac arrest. METHODS: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007-2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review...... after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31-0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23-1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01-0.78, p=0...

  7. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns.

    Science.gov (United States)

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strategies. This paper describes an OHCA web mapping application that was developed to provide users with interactive maps and data for them to quickly visualize and analyze the geographic pattern of cardiac arrest rates, bystander CPR rates, and survival rates at the neighborhood level in different U.S. cities. The data comes from the CARES Registry and is provided over a period spanning several years so users can visualize trends in neighborhood out-of-hospital cardiac arrest patterns. Users can also visualize areas that are statistical hot and cold spots for cardiac arrest and compare OHCA and bystander CPR rates in the hot and cold spots. Although not designed as a public participation GIS (PPGIS), this application seeks to provide a forum around which data and maps about local patterns of OHCA can be shared, analyzed and discussed with a view of empowering local communities to take action to address the high rates of OHCA in their vicinity.

  8. Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

    Science.gov (United States)

    2012-01-01

    Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia

  9. Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

    Directory of Open Access Journals (Sweden)

    Skrifvars Markus B

    2012-11-01

    Full Text Available Abstract Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or

  10. Age discrimination in out-of-hospital cardiac arrest care: a case-control study.

    Science.gov (United States)

    Wiel, Eric; Di Pompéo, Christophe; Segal, Nicolas; Luc, Gérald; Marc, Jean-Baptiste; Vanderstraeten, Carine; El Khoury, Carlos; Escutnaire, Joséphine; Tazarourte, Karim; Gueugniaud, Pierre-Yves; Hubert, Hervé

    2017-12-01

    Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care. The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients. We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration. We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77-0.92, p<0.001), transport to hospital (OR=0.58, 95% CI 0.51-0.61, p<0.001), vital status at hospital admission (OR=0.55, 95% CI 0.50-0.60, p<0.001) and vital status 30 days after CA (OR=0.42, 95% CI 0.35-0.50, p<0.001). All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.

  11. Clinical characteristics and vital and functional prognosis of out-of-hospital cardiac arrest survivors admitted to five cardiac intensive care units.

    Science.gov (United States)

    Loma-Osorio, Pablo; Aboal, Jaime; Sanz, Maria; Caballero, Ángel; Vila, Montserrat; Lorente, Victoria; Sánchez-Salado, José Carlos; Sionis, Alessandro; Curós, Antoni; Lidón, Rosa-Maria

    2013-08-01

    Survivors of out-of-hospital cardiac arrest constitute an increasing patient population in cardiac intensive care units. Our aim was to characterize these patients and determine their vital and functional prognosis in accordance with the latest evidence. A multicenter, prospective register was constructed with information from patients admitted to 5 cardiac intensive care units from January 2010 through January 2012 with a diagnosis of resuscitated out-of-hospital cardiac arrest. The information included clinical status, cardiac arrest characteristics, in-hospital course, and vital and neurologic status at discharge and at 6 months. A total of 204 patients were included. In 64% of cases, a first shockable rhythm was identified. The time to return of spontaneous circulation was 29 (18) min. An etiologic diagnosis was made in 86% of patients; 44% were discharged with no neurologic sequelae; 40% died in the hospital. At 6 months, 79% of survivors at discharge were still alive and neurologically intact with minimal sequelae. Short resuscitation time, first recorded rhythm, pH on admission >7.1, absence of shock, and use of hypothermia were the independent variables associated with a good neurologic prognosis. Half the patients who recovered from out-of-hospital cardiac arrest had good neurologic prognosis at discharge, and 79% of survivors were alive and neurologically intact after 6 months of follow-up. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  12. Modifications of myofilament protein phosphorylation and function in response to cardiac arrest induced in a swine model

    Directory of Open Access Journals (Sweden)

    Mike eWoodward

    2015-07-01

    Full Text Available Cardiac arrest is a prevalent condition with a poor prognosis, attributable in part to persistent myocardial dysfunction following resuscitation. The molecular basis of this dysfunction remains unclear. We induced cardiac arrest in a porcine model of acute sudden death and assessed the impact of ischemia and reperfusion on the molecular function of isolated cardiac contractile proteins. Cardiac arrest was electrically induced, left untreated for 12 minutes, and followed by a resuscitation protocol. With successful resuscitations, the heart was reperfused for 2hrs (IR2 and the muscle harvested. In failed resuscitations, tissue samples were taken following the failed efforts (IDNR. Actin filament velocity, using myosin isolated from IR2 or IDNR cardiac tissue, was nearly identical to myosin from the control tissue in a motility assay. However both maximal velocity (25% faster than control and calcium sensitivity (pCa50 6.57± 0.04 IDNR vs. 6.34±0.07 control were significantly (p<0.05 enhanced using native thin filaments (actin+troponin+tropomyosin from IDNR samples, suggesting that the enhanced velocity is mediated through an alteration in muscle regulatory proteins (troponin+tropomyosin. Mass spectrometry analysis showed that only samples from the IR2 had an increase in total phosphorylation levels of troponin (Tn and tropomyosin (Tm, but both IR2 and IDNR samples demonstrated a significant shift from mono-phosphorylated to bis-phosphorylated forms of the inhibitory subunit of Tn (TnI compared to control. This suggests that the shift to bis-phosphorylation of TnI is associated with the enhanced function in IDNR, but this effect may be attenuated when phosphorylation of Tm is increased in tandem, as observed for IR2. There are likely many other molecular changes induced following cardiac arrest, but to our knowledge, these data provide the first evidence that this form cardiac arrest can alter the in vitro function of the cardiac contractile

  13. ANESTHETIC MANAGEMENT OF ATONIC POST - PARTUM HEMORRHAGE WITH HEMORRHAGIC SHOCK AND IMPENDING CARDIAC ARREST FOR EMERGENCY PERIPARTUM HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Ravishankar

    2015-07-01

    Full Text Available Post - partum hemorrhagic complication is a critical situation for an anesthesiologist, which requires timely and skillful anesthetic management. A massive post - partum bleeding leading to severe hypovolemic shock may result in life threatening cardio - pulmonary arrest. Here is a case report of 25 year old with atonic post - partum hemorrhage resulting in hypovolemic shock & impending cardiac arrest and successful anesthetic management for emergency peripartum hysterectomy to save the life of the patient.

  14. Incremental Value of Circulating MiR-122-5p to Predict Outcome after Out of Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Devaux, Yvan; Salgado-Somoza, Antonio; Dankiewicz, Josef

    2017-01-01

    Rationale. The value of microRNAs (miRNAs) as biomarkers has been addressed in various clinical contexts. Initial studies suggested that miRNAs, such as the brain-enriched miR-124-3p, might improve outcome prediction after out-of-hospital cardiac arrest. The aim of this study is to determine...... the prognostic value of miR-122-5p in a large cohort of comatose survivors of out-of-hospital cardiac arrest. Methods. We analyzed 590 patients from the Targeted Temperature Management trial (TTM-trial). Circulating levels of miR-122-5p were measured in serum samples obtained 48 hours after return of spontaneous...... hazards models, miR-122-5p was a significant predictor of survival at the end of the trial. Conclusion. Circulating levels of miR-122-5p improve the prediction of outcome after out-of-hospital cardiac arrest....

  15. Hypothermia after cardiac arrest as a novel approach to increase survival in cardiopulmonary cerebral resuscitation: a review.

    Science.gov (United States)

    Soleimanpour, Hassan; Rahmani, Farzad; Safari, Saeid; Golzari, Samad Ej

    2014-07-01

    The aim of this review study was to evaluate therapeutic mild hypothermia, its complications and various methods for induced mild hypothermia in patients following resuscitation after out-of-hospital cardiac arrest. Studies conducted on post-cardiac arrest cares, history of induced hypothermia, and therapeutic hypothermia for patients with cardiac arrest were included in this study. We used the valid databases (PubMed and Cochrane library) to collect relevant articles. According to the studies reviewed, induction of mild hypothermia in patients after cardiopulmonary resuscitation would lead to increased survival and better neurological outcome; however, studies on the complications of hypothermia or different methods of inducing hypothermia were limited and needed to be studied further. This study provides strategic issues concerning the induction of mild hypothermia, its complications, and different ways of performing it on patients; using this method helps to increase patients' neurological survival rate.

  16. Cardiac arrest in a 21-year-old man after ingestion of 1,3-DMAA-containing workout supplement.

    Science.gov (United States)

    Karnatovskaia, Lioudmila V; Leoni, Juan C; Freeman, Michelle L

    2015-01-01

    Dietary supplements containing 1,3-dimethylamylamine (DMAA) have been determined to be illegal by the Food and Drug Administration (FDA); although banned, the products are still widely available for purchase. Adverse effects reported include cardiac arrest, hemorrhagic stroke, and death. Nonetheless, such products remain popular among young people because of advertised claims of exercise performance enhancement and fat burning. We describe a case of a young man who took such a supplement and suffered a cardiac arrest. Notably, the product consumed was not on the FDA list of substances containing DMAA. This case highlights the importance for clinicians to be aware of the potential harm of the DMAA-containing products by maintaining a high index of suspicion in otherwise healthy individuals presenting with cardiac arrest. It is of particular importance to sports medicine physicians who are most involved in education and counseling of patients potentially at risk of taking such products.

  17. Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden.

    Science.gov (United States)

    Strömsöe, A; Afzelius, S; Axelsson, C; Södersved Källestedt, M L; Enlund, M; Svensson, L; Herlitz, J

    2013-06-01

    In a review based on estimations and assumptions, to report the estimated number of survivors after out-of-hospital cardiac arrest (OHCA) in whom cardiopulmonary resuscitation (CPR) was started and to speculate about possible future improvements in Sweden. An observational study. All ambulance organisations in Sweden. Patients included in the Swedish Cardiac Arrest Registry who suffered an OHCA between January 1, 2008 and December 31, 2010. Approximately 80% of OHCA cases in Sweden in which CPR was started are included. None In 11 005 patients, the 1-month survival rate was 9.4%. There are approximately 5000 OHCA cases annually in which CPR is started and 30-day survival is achieved in up to 500 patients yearly (6 per 100 000 inhabitants). Based on findings on survival in relation to the time to calling for the Emergency Medical Service (EMS) and the start of CPR and defibrillation, it was estimated that, if the delay from collapse to (i) calling EMS, (ii) the start of CPR, and (iii) the time to defibrillation were reduced to <2 min, <2 min, and <8 min, respectively, 300-400 additional lives could be saved. Based on findings relating to the delay to calling for the EMS and the start of CPR and defibrillation, we speculate that 300-400 additional OHCA patients yearly (4 per 100 000 inhabitants) could be saved in Sweden. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  18. Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest.

    Science.gov (United States)

    Clarke, Samuel; Carolina Apesoa-Varano, Ester; Barton, Joseph

    2016-01-12

    In-hospital cardiac arrest (IHCA) is a particularly vexing entity from the perspective of preparedness, as it is neither common nor truly rare. Survival from IHCA requires the coordinated efforts of multiple providers with different skill sets who may have little prior experience working together. Survival rates have remained low despite advances in therapy, suggesting that human factors may be at play. This qualitative study uses a quasiethnographic data collection approach combining focus group interviews with providers involved in IHCA resuscitation as well as analysis of video recordings from in situ-simulated cardiac arrest events. Using grounded theory-based analysis, we intend to understand the organisational, interpersonal, cognitive and behavioural dimensions of IHCA resuscitation, and to build a descriptive model of code team functioning. This ongoing study has been approved by the IRB at UC Davis Medical Center. The results will be disseminated in a subsequent manuscript. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Pathophysiology and the Monitoring Methods for Cardiac Arrest Associated Brain Injury

    Directory of Open Access Journals (Sweden)

    Cesar Reis

    2017-01-01

    Full Text Available Cardiac arrest (CA is a well-known cause of global brain ischemia. After CA and subsequent loss of consciousness, oxygen tension starts to decline and leads to a series of cellular changes that will lead to cellular death, if not reversed immediately, with brain edema as a result. The electroencephalographic activity starts to change as well. Although increased intracranial pressure (ICP is not a direct result of cardiac arrest, it can still occur due to hypoxic-ischemic encephalopathy induced changes in brain tissue, and is a measure of brain edema after CA and ischemic brain injury. In this review, we will discuss the pathophysiology of brain edema after CA, some available techniques, and methods to monitor brain oxygen, electroencephalography (EEG, ICP (intracranial pressure, and microdialysis on its measurement of cerebral metabolism and its usefulness both in clinical practice and possible basic science research in development. With this review, we hope to gain knowledge of the more personalized information about patient status and specifics of their brain injury, and thus facilitating the physicians’ decision making in terms of which treatments to pursue.

  20. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate.

    Science.gov (United States)

    Fallon, K M; Fuller, J G; Morley-Forster, P

    2001-01-01

    This case report describes a cardiac arrest during a cemented hip arthroplasty procedure. Hemodynamic instability during methylmethacrylate use in arthroplasty surgery can be explained by fat embolization rather than the inherent toxicity of the monomer. A 78-yr-old woman required a cemented hemiarthroplasty for a pathologic left subcapital fracture. The patient's past medical history included stable angina, diet-controlled type II diabetes and metastatic breast cancer. During the cementing of the canal and insertion of the femoral prosthesis, desaturation, hypotension and cardiac arrest occurred. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit where she subsequently developed disseminated intravascular coagulopathy. The patient died 24 hr later and autopsy confirmed the cause of death as fat embolization. The deleterious cardiovascular effects of methylmethacrylate have been discussed in the literature. However, clinical evidence supports fat embolization during arthroplasty surgery as a greater determinant of hemodynamic compromise. Surgical precautions are paramount in minimizing the sequelae of Bone Implantation Syndrome and anesthetic treatment consists of supportive care.

  1. The effect of brain death protocol duration on potential donor losses due to cardiac arrest.

    Science.gov (United States)

    Westphal, Glauco Adrieno; Slaviero, Tiago Amaral; Montemezzo, Artur; Lingiardi, Gabriel Torres; de Souza, Fernanda Carolina Cani; Carnin, Tiago Costa; Soares, Diego Roberto; Hachiya, Alisson Hideto; Ferraz, Letícia Lopes; de Andrade, Joel

    2016-11-01

    The severe inflammatory reaction that occurs after brain death (BD) tends to amplify over time, contributing to cardiovascular deterioration and occurrence of cardiac arrest (CA). Our purpose is to evaluate the effect of BD protocol duration (BDPD) on potential donor losses due to CA. This retrospective analysis included potential donors reported during the period from May 2012 to April 2014. The risk of losses due to CA was analyzed to identify the chronological threshold at which the probability of loss due to CA increases. Three hundred and eighty-four potential donors were analyzed. There was a greater chance of CA after a 30-hour threshold (OR 1.67, 95% CI: 1.38-1.83), and the lowest risk of was identified for the range from 12 to 30 hours (OR 0.32, 95% CI: 0.19-0.52). Multivariate analysis identified the following variables as being associated with lower occurrence of CA: BDPD between 12 and 30 hours, management of a potential donor inside the intensive care unit, and the adherence to a goal-directed protocol. A long duration between the first clinical test for BD diagnosis and the procurement of organs may be an important risk factor for the occurrence of cardiac arrest in deceased potential donors. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær

    2017-01-01

    BACKGROUND: Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with byst......BACKGROUND: Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated...... with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. METHODS: We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from...... the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. RESULTS: We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised...

  3. Neuroprognostication after cardiac arrest in the light of targeted temperature management.

    Science.gov (United States)

    Oddo, Mauro; Friberg, Hans

    2017-06-01

    Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction. Studies from the TTM era confirmed that combining neurological examination with electrophysiological assessment [electroencephalography (EEG) and somato-sensory evoked potentials (SSEP)] greatly improves coma prognostication. This combination is nowadays recognized as the most useful by many clinicians and appears widely applicable as part of initial patient assessment. Additional tests (serum neuron specific enolase and neuroimaging) may be most useful to orient clinical decisions in patients with prolonged coma. Advanced analysis of EEG and SSEP recordings and the emergence of quantitative pupillometry hold great promise. Multimodal prognostication offers a comprehensive approach of anoxic-ischemic encephalopathy and is increasingly used in postresuscitation care. Worldwide implementation and future advancements of available modalities, together with the increasing use of novel automated devices for quantitative neurological examination, may further optimize prognostic accuracy in the early ICU phase following cardiac arrest.

  4. Automated auditory mismatch negativity paradigm improves coma prognostic accuracy after cardiac arrest and therapeutic hypothermia.

    Science.gov (United States)

    Rossetti, Andrea O; Tzovara, Athina; Murray, Micah M; De Lucia, Marzia; Oddo, Mauro

    2014-08-01

    EEG and somatosensory evoked potential are highly predictive of poor outcome after cardiac arrest; their accuracy for good recovery is however low. We evaluated whether addition of an automated mismatch negativity-based auditory discrimination paradigm (ADP) to EEG and somatosensory evoked potential improves prediction of awakening. EEG and ADP were prospectively recorded in 30 adults during therapeutic hypothermia and in normothermia. We studied the progression of auditory discrimination on single-trial multivariate analyses from therapeutic hypothermia to normothermia, and its correlation to outcome at 3 months, assessed with cerebral performance categories. At 3 months, 18 of 30 patients (60%) survived; 5 had severe neurologic impairment (cerebral performance categories = 3) and 13 had good recovery (cerebral performance categories = 1-2). All 10 subjects showing improvements of auditory discrimination from therapeutic hypothermia to normothermia regained consciousness: ADP was 100% predictive for awakening. The addition of ADP significantly improved mortality prediction (area under the curve, 0.77 for standard model including clinical examination, EEG, somatosensory evoked potential, versus 0.86 after adding ADP, P = 0.02). This automated ADP significantly improves early coma prognostic accuracy after cardiac arrest and therapeutic hypothermia. The progression of auditory discrimination is strongly predictive of favorable recovery and appears complementary to existing prognosticators of poor outcome. Before routine implementation, validation on larger cohorts is warranted.

  5. Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Ghan-Shyam Lohiya

    2011-01-01

    Full Text Available A 20-year-old nonverbal patient with profound developmental disabilities was treated with intravenous piperacillin-tazobactam for respiratory infection. After 8 days, he became afebrile with normal pulmonary status, but his pulse remained inexplicably rapid (114/minute. Investigations revealed severe normochromic normocytic hemolytic anemia (hemoglobin: 40 g/L, reticulocytes: 9.4%, nucleated erythrocytes: 5%. While being hospitalized, patient experienced sudden cardiac arrest from which he was successfully resuscitated. He had no blood loss or intrinsic heart disease to explain the acute anemia or cardiac arrest. He had uneventfully received piperacillin-tazobactam on 7 occasions during the preceding 5 years for >50 days. Patient was treated with intravenous crystalloids, methylprednisolone and transfusion of 3 units of packed erythrocytes. Piperacillin-tazobactam was discontinued. A direct antiglobulin test was positive for immunoglobulin G and complement. Antibody to piperacillin was detected in patient's serum by the “immune-complex” method confirming “piperacillin-induced immune hemolytic anemia (PIHA”. On discharge (day 15, patient's hemoglobin improved to 115 g/L (baseline: 131 g/L. Vigilant clinical and hematological monitoring for anemia is indicated in piperacillin-treated patients, particularly in those unable to verbalize their discomfort. Repeated piperacillin exposure may sensitize and predispose patients to PIHA.

  6. Assessment of muscle tissue oxygen saturation after out-of-hospital cardiac arrest.

    Science.gov (United States)

    Orban, Jean-Christophe; Scarlatti, Audrey; Danin, Pierre-Eric; Dellamonica, Jean; Bernardin, Gilles; Ichai, Carole

    2015-12-01

    Pathophysiology of cardiac arrest corresponds to an ischemia-reperfusion syndrome with deep impairment of microcirculation. Muscular tissue oxygen saturation (StO2) is a noninvasive method of evaluation of microcirculation. Our study was aimed at assessing the prognosis value of muscular StO2 in patients admitted for out-of-hospital cardiac arrest (OHCA) and treated with hypothermia. We conducted a prospective bicentric observational study including OHCA patients treated with therapeutic hypothermia. Baseline StO2, derived variables (desaturation and resaturation slopes), and lactate levels were compared at different times between patients with good and poor outcomes. Prognosis was assessed by the Cerebral Performance Category (CPC) score at 6 months after admission (CPC 1-2, good outcome; CPC 3-5, poor outcome). Forty-four patients were included, 17 good and 27 poor outcomes at 6 months. At admission, StO2 and lactate levels were lower in good outcome patients. Desaturation and resaturation slopes did not differ between groups. After an OHCA treated with therapeutic hypothermia, StO2 was correlated with outcome. Further research is needed to better understand the pathophysiological process underlying our results. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology.

    Science.gov (United States)

    Abend, Nicholas S; Massey, Shavonne L; Fitzgerald, Mark; Fung, France; Atkin, Natalie J; Xiao, Rui; Topjian, Alexis A

    2017-11-01

    We evaluated interrater agreement of EEG interpretation in a cohort of critically ill children resuscitated after cardiac arrest using standardized EEG terminology. Four pediatric electroencephalographers scored 10-minute EEG segments from 72 consecutive children obtained 24 hours after return of circulation using the American Clinical Neurophysiology Society's (ACNS) Standardized Critical Care EEG terminology. The percent of perfect agreement and the kappa coefficient were calculated for each of the standardized EEG variables and a predetermined composite EEG background category. The overall background category (normal, slow-disorganized, discontinuous, or attenuated-featureless) had almost perfect agreement (kappa 0.89).The ACNS Standardized Critical Care EEG variables had agreement that was (1) almost perfect for the seizures variable (kappa 0.93), (2) substantial for the continuity (kappa 0.79), voltage (kappa 0.70), and sleep transient (kappa 0.65) variables, (3) moderate for the rhythmic or periodic patterns (kappa 0.55) and interictal epileptiform discharge (kappa 0.60) variables, and (4) fair for the predominant frequency (kappa 0.23) and symmetry (kappa 0.31) variables. Condensing variable options led to improved agreement for the continuity and voltage variables. These data support the use of the standardized terminology and the composite overall background category as a basis for standardized EEG interpretation for subsequent studies assessing EEG background for neuroprognostication after pediatric cardiac arrest.

  8. High acceptance of a home AED programme by survivors of sudden cardiac arrest and their families.

    Science.gov (United States)

    Haugk, Moritz; Robak, Oliver; Sterz, Fritz; Uray, Thomas; Kliegel, Andreas; Losert, Heidrun; Holzer, Michael; Herkner, Harald; Laggner, Anton N; Domanovits, Hans

    2006-08-01

    The feasibility and acceptance of providing sudden cardiac arrest survivors with life supporting first aid training and automated external defibrillators (AEDs) at their homes is unknown. Preliminary experiences are reported here. Trained medical students provided life supporting first aid courses including AED training to cardiac arrest survivors. Patients were asked to invite relatives and friends to such training sessions at their home. Laerdal Little Anne and Heartstart AED Trainer were used. An AED was placed at the patients' disposal. A refresher course took place 1 year later. Questionnaires were used to evaluate the project. Since 1999, 88 families have been trained and provided with an AED. Immediately after the training 90% (66% "agree", 24% "maybe yes") believed they would perform first aid correctly, 1 year later 98% did so (68% "agree", 29% "maybe yes") (p=0.03). Families considered feeling much safer having an AED at home. The handling of an AED was regarded to be easy and AEDs would even be used on strangers. Only on one occasion an AED was used in a real emergency situation. Providing patients and relatives with life support first aid and AED training at their homes is feasible and has raised no major objections by the family members. All have considered handling of an AED much simpler than providing basic life support and therefore none think that it would be a major problem to use it in case of an emergency. This still has to be proven.

  9. Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis.

    Science.gov (United States)

    Ross, Elliot M; Redman, Theodore T; Harper, Stephen A; Mapp, Julian G; Wampler, David A; Miramontes, David A

    2016-09-01

    The goal of our study is to determine if prehospital dual defibrillation (DD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest. This study is a retrospective cohort analysis of prospectively collected Quality Assurance/Quality Improvement data from a large urban fire based EMS system out-of-hospital cardiac arrest (OHCA) database between Jan 2013 and Dec 2015. Our inclusion criteria were administration of DD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF). We excluded any case with incomplete data. The primary outcome for our study was neurologically intact survival (defined as Cerebral Performance Category 1 and 2). A total of 3470 cases of OHCA were treated during the time period of Jan 2013 to Dec 2015. There were 302 cases of recurrent and refractory VF identified. Twenty-three cases had incomplete data. Of the remaining 279 cases, 50 were treated with DD and 229 received standard single shock 200J defibrillations. There was no statistically significant difference in the primary outcome of neurologically intact survival between the DD group (6%) and the standard defibrillation group (11.4%) (p=0.317) (OR 0.50, 95% CI 0.15-1.72). Our retrospective cohort analysis on the prehospital use of DD in OHCA found no association with neurologically intact survival. Case-control studies are needed to further evaluate the efficacy of DD in the prehospital setting. Published by Elsevier Ireland Ltd.

  10. Impact of time to cooling initiation and time to target temperature in patients treated with hypothermia after cardiac arrest.

    Science.gov (United States)

    Uribarri, Aitor; Bueno, Héctor; Pérez-Castellanos, Alberto; Loughlin, Gerard; Sousa, Iago; Viana-Tejedor, Ana; Fernández-Avilés, Francisco

    2015-08-01

    Little is known about the role of time to initiation of therapeutic hypothermia and time to target temperature (TTT) in the prognosis of patients resuscitated from cardiac arrest. A retrospective analysis was performed in 145 survivors of cardiac arrest who underwent therapeutic hypothermia between January 2003 and January 2013. The objective was to identify predictors of survival free from significant neurological sequelae (Cerebral Performance Categories Scale (CPC): >2) six months after cardiac arrest. We evaluated the effect of faster and earlier cooling. Overall survival at six months was 42.1% (61 patients); 59 of these were considered to have a good neurological status (CPC ≤ 2), and in whom therapeutic hypothermia was initiated earlier (87 ± 17 min vs. 111 ± 14 min; p=0.042), and the target temperature was reached at an earlier time (TTT: 316 ± 30 min vs. 365 ± 27 min; p=0.017). Multivariate analysis selected longer duration of cardiac arrest (odds ratio (OR) = 1.06 per min), a non-shockable initial rhythm (OR=13.8), severe acidosis (OR=0.009 per 0.01 unit), older age (OR=1.04 per year) and longer TTT (OR=1.005 per min) as associated with poor prognosis. The most important prognostic factors for death or lack of neurological recovery in patients with cardiac arrest treated with therapeutic hypothermia are initial-rhythm, time from cardiac arrest to return of spontaneous circulation and arterial-pH at admission. Although the speed of cooling initiation and the time to reach target temperature may play a role, its influence on prognosis seems to be less important. © The European Society of Cardiology 2014.

  11. Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model

    Directory of Open Access Journals (Sweden)

    Wagner Henrik

    2011-12-01

    Full Text Available Abstract Background Mechanical chest compressions (CCs have been shown capable of maintaining circulation in humans suffering cardiac arrest for extensive periods of time. Reports have documented a visually normalized coronary blood flow during angiography in such cases (TIMI III flow, but it has never been actually measured. Only indirect measurements of the coronary circulation during cardiac arrest with on-going mechanical CCs have been performed previously through measurement of the coronary perfusion pressure (CPP. In this study our aim was to correlate average peak coronary flow velocity (APV to CPP during mechanical CCs. Methods In a closed chest porcine model, cardiac arrest was established through electrically induced ventricular fibrillation (VF in eleven pigs. After one minute, mechanical chest compressions were initiated and then maintained for 10 minutes upon which the pigs were defibrillated. Measurements of coronary blood flow in the left anterior descending artery were made at baseline and during VF with a catheter based Doppler flow fire measuring APV. Furthermore measurements of central (thoracic venous and arterial pressures were also made in order to calculate the theoretical CPP. Results Average peak coronary flow velocity was significantly higher compared to baseline during mechanical chests compressions and this was observed during the entire period of mechanical chest compressions (12 - 39% above baseline. The APV slowly declined during the 10 min period of mechanical chest compressions, but was still higher than baseline at the end of mechanical chest compressions. CPP was simultaneously maintained at > 20 mmHg during the 10 minute episode of cardiac arrest. Conclusion Our study showed good correlation between CPP and APV which was highly significant, during cardiac arrest with on-going mechanical CCs in a closed chest porcine model. In addition APV was even higher during mechanical CCs compared to baseline. Mechanical

  12. Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques.

    Science.gov (United States)

    Gillies, Michael A; Pratt, Rosalie; Whiteley, Craig; Borg, Jamie; Beale, Richard J; Tibby, Shane M

    2010-09-01

    Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome. Retrospective cohort study. Thirty-bed teaching hospital intensive care unit (ICU). All patients (n=83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61+/-16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia. Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n=41) or endovascular (n=42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 degrees C for 12-24 h, followed by rewarming at a rate of 0.25 degrees Ch(-1). Endovascular cooling provided a longer time within the target temperature range (p=0.02), less temperature fluctuation (p=0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p=0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p=0.05) and failure to reach the target temperature (p=0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome. Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Transthoracic impedance does not decrease with rapidly repeated countershocks in a swine cardiac arrest model.

    Science.gov (United States)

    Niemann, James T; Garner, Daniel; Lewis, Roger J

    2003-01-01

    Successful defibrillation is dependent upon the delivery of adequate electrical current to the myocardium. One of the major determinant of current flow is transthoracic impedance. Prior work has suggested that impedance falls with repeated shocks during sinus rhythm. The purpose of this study was to evaluate changes in transthoracic impedance with repeated defibrillation shocks in an animal model of cardiac arrest due to ventricular fibrillation (VF). VF was electrically induced in anesthetized swine. After 5 min of untreated VF, monophasic or biphasic waveform defibrillation was attempted using a standard sequence of 'stacked shocks' (200, 300, then 360 J, if necessary) administered via adhesive electrodes. If one of the first three shocks failed to convert VF, conventional CPR was initiated and defibrillation (360 J) attempted 1 min later. Strength-duration curves for delivered voltage and current were measured during each shock and transthoracic impedance calculated. Animals requiring a minimum of four shocks were selected for study inclusion. Impedance data from sequential shocks were analyzed using mixed linear models to account for the repeated-measures design and the variability of the initial impedance of individual animals. Thirteen animals (monophasic waveform, n=7, biphasic waveform, n=6) required at least four shocks to terminate VF (range 4-6). Transthoracic impedance did not change from the first shock in the 13 animals (46+/-8 Omega) to the fourth shock (46+/-9 Omega). In animals receiving more than four shocks, transthoracic impedance likewise did not change significantly from the first to the last shock, which terminated VF. The lack of a significant change in impedance was also observed when animals were analyzed according to defibrillation waveform. Transthoracic impedance does not change significantly with repeated shocks in a VF cardiac arrest model. This is likely due to the lack of reactive skin and soft tissue hyperemia and edema observed in

  14. Serum neuron-specific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study.

    Science.gov (United States)

    Rech, Tatiana H; Vieira, Silvia Regina Rios; Nagel, Fabiano; Brauner, Janete Salles; Scalco, Rosana

    2006-01-01

    Outcome after cardiac arrest is mostly determined by the degree of hypoxic brain damage. Patients recovering from cardiopulmonary resuscitation are at great risk of subsequent death or severe neurological damage, including persistent vegetative state. The early definition of prognosis for these patients has ethical and economic implications. The main purpose of this study was to investigate the prognostic value of serum neuron-specific enolase (NSE) in predicting outcomes in patients early after in-hospital cardiac arrest. Forty-five patients resuscitated from in-hospital cardiac arrest were prospectively studied from June 2003 to January 2005. Blood samples were collected, at any time between 12 and 36 hours after the arrest, for NSE measurement. Outcome was evaluated 6 months later with the Glasgow outcome scale (GOS). Patients were divided into two groups: group 1 (unfavorable outcome) included GOS 1 and 2 patients; group 2 (favorable outcome) included GOS 3, 4 and 5 patients. The Mann-Whitney U test, Student's t test and Fisher's exact test were used to compare the groups. The Glasgow coma scale scores were 6.1 +/- 3 in group 1 and 12.1 +/- 3 in group 2 (means +/- SD; p cardiac arrest.

  15. Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest.

    Science.gov (United States)

    Stein, Philipp; Spahn, Gabriela H; Müller, Stefan; Zollinger, Andreas; Baulig, Werner; Brüesch, Martin; Seifert, Burkhardt; Spahn, Donat R

    2017-09-01

    Out of hospital cardiac arrest (OHCA) occurs frequently and the outcome is often dismal. Early defibrillation saves lives and brain function in OHCA. The Zurich city police (STAPO) forces were instructed and equipped to provide basic life support (BLS) and to use an AED in 2009. Retrospective observational study comparing period 1 (P1) 2004-2009 before equipping and training of the STAPO and period 2 (P2) 2010-2015 after the implementation. Patients suffering from OHCA of cardiac or presumed cardiac origin in the city of Zurich undergoing CPR by EMS in P1 (n=709) and P2 (n=684) were included. Intervention periods and outcome were compared between the periods. Outcome variables were adjusted for patient age and gender, witnessed status, and defibrillation by the EMS, STAPO, layperson or no defibrillation. In P2, CPR was started by the STAPO in a median of 8 (IQR 6-9) minutes after the arrest and thus significantly earlier (median 3min) than by the EMS (pdefibrillation in a median of 9 (IQR 8-10) minutes and thus significantly earlier (median 6min) than the EMS (pdefibrillated by the STAPO, ROSC (STAPO 74.4%, adj. OR 2.6, 95% CI 1.3-5.4, p=0.010) and hospital admission (STAPO 72.1%, adj. OR 2.8, 95% CI 1.4-5.6, p=0.005) was higher compared to patients firstly defibrillated by the EMS. Survival to hospital discharge (STAPO 30.2%, adj. OR 1.4, 95% CI 0.7-2.9, p=0.38) was unchanged. Dispatching BLS trained and AED equipped police forces results in earlier and more successful resuscitation of OHCA victims, leading to higher proportions of patients with ROSC, hospital admission and survival to hospital discharge. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Prevalence of myocardial fibrosis patterns in patients with systolic dysfunction: prognostic significance for the prediction of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy.

    Science.gov (United States)

    Almehmadi, Fahad; Joncas, Sebastien Xavier; Nevis, Immaculate; Zahrani, Mohammad; Bokhari, Mahmoud; Stirrat, John; Fine, Nowell M; Yee, Raymond; White, James A

    2014-07-01

    Late gadolinium enhancement-cardiac magnetic resonance is increasingly performed in patients with systolic dysfunction. Numerous patterns of fibrosis are commonly reported among this population. However, the relative prevalence and prognostic significance of these findings remains uncertain. Three hundred eighteen consecutive patients referred for late gadolinium enhancement-cardiac magnetic resonance and a left ventricular ejection fraction 35% (40% versus 6%; P=0.005). Patients with systolic dysfunction frequently demonstrate multiple patterns of myocardial fibrosis. Of these, a midwall striae pattern of fibrosis is the strongest independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. © 2014 American Heart Association, Inc.

  17. Adrenaline increases blood-brain-barrier permeability after haemorrhagic cardiac arrest in immature pigs.

    Science.gov (United States)

    Semenas, E; Sharma, H S; Wiklund, L

    2014-05-01

    Adrenaline (ADR) and vasopressin (VAS) are used as vasopressors during cardiopulmonary resuscitation. Data regarding their effects on blood-brain barrier (BBB) integrity and neuronal damage are lacking. We hypothesised that VAS given during cardiopulmonary resuscitation (CPR) after haemorrhagic circulatory arrest will preserve BBB integrity better than ADR. Twenty-one anaesthetised sexually immature male piglets (with a weight of 24.3 ± 1.3 kg) were bled 35% via femoral artery to a mean arterial blood pressure of 25 mmHg in the period of 15 min. Afterwards, the piglets were subjected to 8 min of untreated ventricular fibrillation followed by 15 min of open-chest CPR. At 9 min of circulatory arrest, piglets received amiodarone 1.0 mg/kg and hypertonic-hyperoncotic solution 4 ml/kg infusions for 20 min. At the same time, VAS 0.4 U/kg was given intravenously to the VAS group (n = 9) while the ADR group received ADR 20 μg/kg (n = 12). Internal defibrillation was attempted from 11 min of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3 h after resuscitation. The intracranial pressure (ICP) in the post-resuscitation phase was significantly greater in ADR group than in VAS group. VAS group piglets exhibited a significantly smaller BBB disruption compared with ADR group. Cerebral pressure reactivity index showed that cerebral blood flow autoregulation was also better preserved in VAS group. Resuscitation with ADR as compared with VAS after haemorrhagic circulatory arrest increased the ICP and impaired cerebrovascular autoregulation more profoundly, as well as exerted an increased BBB disruption though no significant difference in neuronal injury was observed. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  18. [Inferior myocardial infarction complicated by complete heart block and cardiac arrest following a gadolinium injection: A case of Kounis syndrome].

    Science.gov (United States)

    Demoulin, R; Poyet, R; Capilla, E; Cardinale, M; Tortat, A V; Pons, F; Brocq, F-X; Jego, C; Foucault, G; Cellarier, G-R

    2017-11-01

    Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature.

    Science.gov (United States)

    Efendijev, Ilmar; Nurmi, Jouni; Castrén, Maaret; Skrifvars, Markus B

    2014-04-01

    Significant amount of data on the incidence and outcome of out-of-hospital and in-hospital cardiac arrest have been published. Cardiac arrest occurring in the intensive care unit has received less attention. To evaluate and summarize current knowledge of intensive care unit cardiac arrest including quality of data, and results focusing on incidence and patient outcome. We conducted a literature search of the PubMed, CINAHL and Cochrane databases with the following search terms (medical subheadings): heart arrest AND intensive care unit OR critical care OR critical care nursing OR monitored bed OR monitored ward OR monitored patient. We included articles published from the 1st of January 1990 till 31st of December 2012. After exclusion of all duplicates and irrelevant articles we evaluated quality of studies using a predefined quality assessment score and summarized outcome data. The initial search yielded 794 articles of which 780 were excluded. Three papers were added after a manual search of the eligible studies' references. One paper was identified manually from the literature published after our initial search was completed, thus the final sample consisted of 18 papers. Of the studies included thirteen were retrospective, two based on prospective registries and three were focused prospective studies. All except two studies were from a single institution. Six studies reported the incidence of intensive care unit cardiac arrest, which varied from 5.6 to 78.1 cardiac arrests per 1000 intensive care unit admissions. The most frequently reported initial cardiac arrest rhythms were non-shockable. Patient outcome was variable with survival to hospital discharge being in the range of 0-79% and long-term survival ranging from 1 to 69%. Nine studies reported neurological status of survivors, which was mostly favorable, either no neurological sequelae or cerebral performance score mostly of 1-2. Studies focusing on post cardiac surgery patients reported the best long

  20. Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation

    DEFF Research Database (Denmark)

    Folke, Fredrik; Gislason, Gunnar H; Lippert, Freddy

    2010-01-01

    The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillat......The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external...... defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations....

  1. NORMOTHERMIC EXTRACORPOREAL PERFUSION IN SITU IN DECEASED ORGAN DONORS WITH IRREVERSIBLE CARDIAC ARREST AND ONE HOUR OF ASYSTOLE. 5-YEAR OUTCOMES OF KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. E. Skvortsov

    2016-01-01

    Full Text Available Aim. The global shortage of deceased organ donors caused increasing interest to the transplant program based on the use of organs from the donors with sudden irreversible cardiac arrest, or asystolic donors (DCD. Ischemia-reperfusion injury as a result of cardiac arrest remains a key problem that limits the use of organs from DCD. Our clinical study was intended to determine the acceptability of renal transplants derived from the DCD using extracorporeal perfusion in situ after 60 minutes of asystole. Materials and methods. In 2009–2014, St. Petersburg Organ Procurement Organization (OPO obtained kidneys from 29 DCD with critically expanded warm ischemic time (WIT. The design of this study was approved by the Scientifi c Board and Ethics Committee of the State Research Institute for Emergency Medicine (Decision 7/0615/09. Initially, no one of died patients was considered as potential organ donors. In case of failed advanced CPR the death of a patient was declared initiating the protocol of subnormothermic extracorporeal abdominal perfusion with ECMO, thrombolytics (strepokinase 1.5 mln U, and LD. The procedures were established by the authorized OPO team which arrived with perfusion equipment in 30–40 minutes after declaration of donors’ death. Mean WIT was 58.1 (19.39 minutes (Mean (SD. Resuscitated grafts were transplanted into 58 recipients. The outcomes of transplantation of resuscitated kidneys were compared to those of 112 KTx from 115 brain death donors (BDDs. Results. Immediate functioning of kidney grafts was observed in 28 (48.3% of 58 recipients. There were 4 cases of primary graft non-function. By the end of the fi rst post-transplant year there was an acute rejection rate of 12.1% (9 episodes of rejection in the DCD group vs. 23.2% (26 episodes of rejection in the BDD group (p < 0.05. The actuarial 5-year graft survival rate was 82.8% (n = 48 in DCD group, and 87.5% (n = 98 in BDD group (p > 0.05. Creatinine levels at the end

  2. Effects of adrenaline on rhythm transitions in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Neset, Andres; Nordseth, Trond; Kramer-Johansen, Jo; Wik, Lars; Olasveengen, Theresa M

    2013-11-01

    We wanted to study the effects of intravenous (i.v.) adrenaline (epinephrine) on rhythm transitions during cardiac arrest with initial or secondary ventricular fibrillation/tachycardia (VF/VT). Post hoc analysis of patients included in a randomised controlled trial of i.v. drugs in adult, non-traumatic out-of-hospital cardiac arrest patients who were defibrillated and had a readable electrocardiography recording. Patients who received adrenaline were compared with patients who did not. Cardiac rhythms were annotated manually using the defibrillator data. Eight hundred and forty-nine patients were included in the randomised trial of which 223 were included in this analysis; 119 in the adrenaline group and 104 in the no-adrenaline group. The proportion of patients with one or more VF/VT episodes after temporary return of spontaneous circulation (ROSC) was higher in the adrenaline than in the no-adrenaline group, 24% vs. 12%, P = 0.03. Most relapses from ROSC to VF/VT in the no-adrenaline group occurred during the first 20 min of resuscitation, whereas patients in the adrenaline group experienced such relapses even after 20 min. Fibrillations from asystole or pulseless electrical activity, shock resistant VF/VT and the number of rhythm transitions per patient was higher in the adrenalin group compared with the no-adrenalin group: 90% vs. 69%, P adrenaline had more rhythm transitions from ROSC and non-shockable rhythms to VF/VT. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. Cognitive function after cardiac arrest and temperature management; rationale and description of a sub-study in the Target Temperature Management trial

    NARCIS (Netherlands)

    Lilja, Gisela; Nielsen, Niklas; Friberg, Hans; Horn, Janneke; Kjaergaard, Jesper; Pellis, Tommaso; Rundgren, Malin; Wetterslev, Jørn; Wise, Matt P.; Nilsson, Fredrik; Cronberg, Tobias

    2013-01-01

    Mild to moderate cognitive impairment is common amongst long-term survivors of cardiac arrest. In the Target Temperature Management trial (TTM-trial) comatose survivors were randomized to 33[degree sign]C or 36[degree sign]C temperature control for 24 hours after cardiac arrest and the effects on

  4. Clinical Use of Magnetic Resonance Imaging for the Diagnosis of Acute Myocardial Infarction in the Survivors of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Miroslav Solař

    2007-01-01

    Full Text Available The ventricular arrhythmias with underlying coronary artery disease are a leading cause of sudden cardiac death (SCD. While the SCD survivors with proven AMI are considered to be at low risk of SCD recurrence, those without the evidence of AMI represent a high risk group that benefits from implantable cardioverter defibrillator. Therefore, the evaluation of SCD survivors for the presence of acute myocardial infarction (AMI as a triggering factor of cardiac arrest is essential. In SCD survivors, the use of the standard diagnostic criteria of AMI may be difficult, as both serum cardiac biomarkers and electrocardiogram can be influenced by previous cardiac arrest. A novel technique that may be used for the diagnosis of AMI is magnetic resonance imaging (MRI. We report its use in four patients after cardiopulmonary resuscitation where the diagnosis of AMI could not be definitely established or excluded by means of other diagnostic procedures.

  5. Variations in survival after cardiac arrest among academic medical center-affiliated hospitals.

    Directory of Open Access Journals (Sweden)

    Michael Christopher Kurz

    Full Text Available Variation exists in cardiac arrest (CA survival among institutions. We sought to determine institutional-level characteristics of academic medical centers (AMCs associated with CA survival.We examined discharge data from AMCs participating with Vizient clinical database-resource manager. We identified cases using ICD-9 diagnosis code 427.5 (CA or procedure code 99.60 (CPR. We estimated hospital-specific risk-standardized survival rates (RSSRs using mixed effects logistic regression, adjusting for individual mortality risk. Institutional and community characteristics of AMCs with higher than average survival were compared with those with lower survival.We analyzed data on 3,686,296 discharges in 2012, of which 33,700 (0.91% included a CA diagnosis. Overall survival was 42.3% (95% CI 41.8-42.9 with median institutional RSSR of 42.6% (IQR 35.7-51.0; Min-Max 19.4-101.6. We identified 28 AMCs with above average survival (median RSSR 61.8% and 20 AMCs with below average survival (median RSSR 26.8%. Compared to AMCs with below average survival, those with high CA survival had higher CA volume (median 262 vs.119 discharges, p = 0.002, total beds (722 vs. 452, p = 0.02, and annual surgical volume (24,939 vs. 13,109, p<0.001, more likely to offer cardiac catheterization (100% vs. 72%, p = 0.007 or cardiac surgery (93% vs. 61%, p = 0.02 and cared for catchment areas with higher household income ($61,922 vs. $49,104, p = 0.004 and lower poverty rates (14.6% vs. 17.3%, p = 0.03.Using discharge data from Vizient, we showed AMCs with higher CA and surgical case volume, cardiac catheterization and cardiac surgery facilities, and catchment areas with higher socioeconomic status had higher risk-standardized CA survival.

  6. The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery.

    Science.gov (United States)

    2017-03-01

    The Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery provides this professional society perspective on resuscitation in patients who arrest after cardiac surgery. This document was created using a multimodal methodology for evidence generation and includes information from existing guidelines, from the International Liaison Committee on Resuscitation, from our own structured literature reviews on issues particular to cardiac surgery, and from an international survey on resuscitation hosted by CTSNet. In gathering evidence for this consensus paper, searches were conducted using the MEDLINE keywords "cardiac surgery," "resuscitation," "guideline," "thoracic surgery," "cardiac arrest," and "cardiac massage." Weight was given to clinical studies in humans, although some case studies, mannequin simulations of potential protocols, and animal models were also considered. Consensus was reached using a modified Delphi method consisting of two rounds of voting until 75% agreement on appropriate wording and strength of the opinions was reached. The Society of Thoracic Surgeons Workforce on Critical Care was enlisted in this process to provide a wider variety of experiences and backgrounds in an effort to reinforce the opinions provided. We start with the premise that external massage is ineffective for an arrest due to tamponade or hypovolemia (bleeding), and therefore these subsets of patients will receive inadequate cerebral perfusion during cardiac arrest in the absence of resternotomy. Because these two situations are common causes for an arrest after cardiac surgery, the inability to provide effective external cardiopulmonary resuscitation highlights the importance of early emergency resternotomy within 5 minutes. In addition, because internal massage is more effective than external massage, it should be used preferentially if other quickly reversible causes are not found. We present a protocol for the cardiac arrest situation that

  7. Validation of an ICD code for accurately identifying emergency department patients who suffer an out-of-hospital cardiac arrest.

    Science.gov (United States)

    Shelton, Shelby K; Chukwulebe, Steve B; Gaieski, David F; Abella, Benjamin S; Carr, Brendan G; Perman, Sarah M

    2018-01-16

    International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA. Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return of spontaneous circulation (ROSC) were collected. Separately, the EMR was searched for patients who received ICD-9 code 427.5. The kappa coefficient (κ) was calculated, as was the sensitivity and specificity of the code for identifying OHCA. The keyword search identified 1717 patients, of which 385 suffered OHCA and 333 were assigned the code 427.5. The agreement between ICD-9 code and cardiac arrest was excellent (κ = 0.895). The ICD-9 code 427.5 was both specific (99.4%) and sensitive (86.5%). Of the 52 cardiac arrests that were not identified by ICD-9 code, 33% had ROSC before arrival to the ED. When searching independently on ICD-9 code, 347 patients with ICD-9 code 427.5 were found, of which 320 were "true" arrests. This yielded a positive predictive value of 92% for ICD-9 code 427.5 in predicting OHCA. ICD-9 code 427.5 is sensitive a