Impact factor 0.175

Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: out-of-hospital cardiac arrest (Page 1 of 2)

Major interventions are associated with survival of out of hospital cardiac arrest patients – a population based survey

Abstract

Background. The overall survival rate of out-of-hospital cardiac arrest (OHCA) in Taiwan or even in the whole of Asia is relatively low. Major interventions, such as target temperature management (TTM), coronary artery angiography, and extracorporeal membrane oxygenation (ECMO), have been associated with better patient outcome. However, studies in Taiwan revealing evidence of the benefits of these interventions are limited.

Methods. A population-based study used an 8-year database to analyze overall survival and risk factors ˝among OHCA patients. All adult non-trauma OHCA patients were identified through diagnostic and procedure codes. Hospital survival and return of spontaneous circulation (ROSC) were primary and secondary outcomes. Logistic regression and Cox regression analyses were conducted.

Results. There was a relationship between major interventions (including TTM, coronary artery angiography, and ECMO) and better hospital survival. Age, income, major interventions, and acute myocardial infarction history were associated with hospital survival. The adjusted hazard ratios (HRs) were 0.406 (95% CI, 0.295 to 0.558), 1.109 (95% CI, 1.027 to 1.197), 1.075 (95% CI, 1.002 to 1.154), 1.097 (95% CI, 1.02 to 1.181) and 0.799(95% CI, 0.677 to 0.942) for patients with major interventions, age≥50, medium low and low income, middle income, and acute myocardial infarction history, respectively.

Conclusion. This population-based study in Taiwan revealed that older age (≥50), medium low and low income were associated with a lower rate of survival. Major interventions, including TTM, coronary angiography, and ECMO, were related to better survival.

Key words: OHCA, ROSC, out-of-hospital cardiac arrest, target temperature management, ECMO

Read More

Continuous cardiopulmonary resuscitation training compared to single training by laypersons

Abstract

Background. Compression-Only Cardiopulmonary Resuscitation (COCPR) has been broadly studied during the last few years and specially introduced into lay rescuers’ training. The aim of the study was to compare the quality of COCPR performed by laypersons (Group A) who attended a single cardiopulmonary resuscitation (CPR) training course, and those (Group B) who underwent regular CPR training every 6 months.

Methods. Both groups completed the “Heartsaver CPR AED” course of the American Heart Association. After 30 minutes they were required to perform COCPR on a manikin with a skills reporter system.

Results. Comparing the 76 once only trained laypersons to the 74 continuously trained lay rescuers, we found that average age (20 versus 40 years old), male gender (54% versus 93%), body mass index (BMI) (24.9 versus 27.3 kg/m2) and regular physical exercise (55% versus 36%) proved significant predictors, p<0.01, p<0.01, p<0.01 and p=0.04 respectively. Regarding COCPR-quality, the percentage of efficient chest compressions (43% versus 58%), average depth of compression (45 versus 50 mm) and percentage of error-free compressions (36% versus 50%) indicated a significant statistical difference, with p=0.01, p=0.01 and p<0.01 respectively. However, the average frequency of compressions per minute (121 versus 124), the percentage of correct hand positioning during chest compressions (87% versus 90%) and the average duty cycle (47% versus 45%) did not display a significant difference.

Conclusion. The continuous CPR training group obtained better results regarding quality of chest compressions when compared with single CPR training.

Key words: cardiac massage, cardiopulmonary resuscitation, out-of-hospital cardiac arrest, emergency medicine, resuscitation

Read More

Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?

Abstract

Background. Whether pre-hospital laryngeal mask airway (LMA) use poses a survival benefit and should be approved as routine airway management in non-shockable cardiac arrest is of major concern. The present study examined the effectiveness of LMA, in comparison to other pre-hospital airway management on individuals who have experienced non-shockable cardiac arrest.

Methods. Adult patients who experienced non-shockable cardiac arrest with activation of the emergency medical service (EMS) made up our study cohort in Taoyuan, Taiwan. The data were abstracted from EMS records and cardiac arrest registration protocols.

Results. Among the 1912 enrolled patients, most received LMA insertion (72.4%), 108 (5.6%) bag-valve-mask (BVM) ventilation, 376 (19.7%) high-flow oxygen non-rebreather facemask, and only 44 (2.3%) received endotracheal tube intubation (ETI). With regard to survival to discharge, no significant differences in prevalence were evident among the groups: 2.8% of oxygen facial mask, 1.1% of BVM, 2.1% of LMA, and 4.5% of the ETI group survived to discharge (p = 0.314). In comparison to oxygen facial mask use, different types of airway management remained unassociated with survival to discharge after adjusting for variables by logistic regression analysis (BVM: 95% confidence interval [CI], 0.079 – 1.639 [p = 0.186]; LMA: 95% CI, 0.220–2.487 [p = 0.627]; ETI: 95% CI, 0.325–17.820 [p = 0.390]). The results of Hosmer-Lemeshow goodness-of-fit test of logistic regression model revealed good calibration.

Conclusions. Pre-hospital LMA use was not associated with additional survival to discharge compared with facial oxygen mask, BVM, or ETI following non-shockable cardiac arrest.

Key words: emergency medical service, out-of-hospital cardiac arrest, laryngeal mask airway, ventilation, cardiopulmonary resuscitation

Read More

A seven-year follow-up of discharged patients after out-of-hospital cardiac arrest with respect to ST-segment elevation myocardial infarction

Abstract

Introduction. The aim of this multicentre prospective study was to describe the seven-year survival of patients, from the region of East Bohemia, after out-of-hospital cardiac arrest (OHCA), occurring between  2002 and  2004. The main focus of this study was on the survival of patients with ST-segment elevated myocardial infarction (STEMI).
Patients and Methods. A total 718 patients  with OHCA were included in the study. Of these patients, 149 were admitted to hospital. The main cohort of our study consisted of 53 patients (41 men; median 59; average 58±13), who survived acute hospitalization. In these patients, STEMI was the main cause of OHCA in 15 cases (28%), whereas without STEMI was found in 38 cases (72%). Patients who survived hospitalization were periodically followed-up at six-monthly intervals.
Results. In the first follow-up year, 42 patients survived (79% of 53 patients), in the third year 38 patients (72%), in the fifth year 33 patients (62%) and in the seventh year 31 patients (59%). Ninety-four percent of patients were in good neurological condition after the seventh follow-up year. The whole period of seven years was survived by 12 (80%) out of 15 patients with STEMI, and by 19 (50%) out of 38 patients without STEMI. In patients who survived the seventh year after STEMI, direct percutaneous coronary intervention was performed in 11 cases.
Conclusions. Fifty-nine percent of patients discharged from hospital after OHCA   survived until the seventh year. The highest rate of survival during this period was seen in patients with STEMI, i.e. in 80%.

 

Key words: cardiac arrest, myocardial infarction, out-of-hospital cardiac arrest, sudden cardiac death, survivors, ventricular fibrillation

Read More

Targeting out-of-hospital cardiac arrest: the effect of heparin administered during cardiopulmonary resuscitation (T-ARREST)

Abstract

Introduction. Heparin administration during cardiopulmonary resuscitation (CPR) may prevent activation of coagulation after successful resuscitation for out-of-hospital cardiac arrest (OHCA). We hypothesize that such an approach is not associated with an increased rate of bleeding, but it has not been evaluated. We performed a pilot randomized clinical study assessing the safety of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AMI) and its impact on their prognosis.
Materials and Methods.  OHCA patients were randomized during CPR to 10 000 units of intra-arrest intravenous heparin (Group H) or to treatment without heparin (Group C). The occurrence of major bleeding and the presence of a favourable neurological result 3 months after OHCA, were analyzed.
Results. Out of 88 randomized patients, AMI was subsequently confirmed in 63 of them (71.6 %). There were 30 patients in group H and 33 in group C. No major bleeding event was observed in either group. Return of spontaneous circulation (ROSC, Group H: 40.0%, Group C: 45.4%, p=0.662) and a good neurological result 3 months after OHCA (Group H: 6.7 %, Group C: 9.1 %, p=0.921) did not differ between groups.
Conclusions. Intravenous administration of 10 000 units of heparin during CPR for OHCA in patients with supposed AMI was safe. We did not find any improvement in prognosis for our sample of limited size. Though the procedure proved safe, we recommend postponing the administration of heparin until ROSC, assessment of  clinical state and  recording of a  twelve-lead ECG.

Key words: out-of-hospital cardiac arrest, heparin, major bleeding

Read More

Page 1 of 2

© 2015. Signa Vitae. Except where otherwise noted, content on this site is licensed under a Creative Commons Attribution 4.0 International license.