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e Management of common causes of cardiac arrest.
Source publication
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 st...
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Introduction:
Outcome after out-of-hospital cardiac arrest (OHCA) remains poor. With the introduction of automated external defibrillators, percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) the prognosis of patients after OHCA appears to be improving. The aim of this study was to evaluate short and long-term outcome a...
Abstract
Background: Data on acute kidney injury (AKI) in patients with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI) after cardiac arrest are scarce. The prevalence of
AKI, as classified by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria; and its possible association with 30-day mortality were ass...
Background:
Out-of-hospital cardiac arrest (OHCA) frequently occurs in the early phase of acute myocardial infarction (MI). Survivors require percutaneous coronary intervention (PCI) with concomitant dual antiplatelet therapy. Target temperature management, including mild therapeutic hypothermia (MTH), should be applied in comatose patients after...
Background:
Aim of this study was to compare post resuscitation care of out-of-hospital cardiac arrest (OHCA) patients in Nordic (Denmark, Finland, Iceland, Norway, Sweden) intensive care units (ICUs).
Methods:
An online questionnaire was sent to Nordic ICUs in 2012 and was complemented by an additional one in 2014.
Results:
The first question...
Introduction
Short term hypothermia has been suggested to have cardio protective properties in acute myocardial infarction (AMI) by reducing infarct size as assessed by troponins. There are limited data on the kinetics of these biomarkers in comatose out-of-hospital cardiac arrest (OHCA) patients, with and without AMI, undergoing targeted temperatu...
Citations
... The goals include a comprehensive physical examination, provision of respiratory support, cardiac monitoring, maintenance of body temperature and pain control, which are routine steps in critical care [5]. The differential diagnosis of the patient and analysis of the conditions leading to cardiac arrest include an examination of metabolic values, 12-lead ECG and imaging studies such as X-ray, computed tomography, and USG [6]. ...
... Looking at risk factors for IHCA in general, several have been proven to present a higher risk for poor patient outcomes, including old age, ventilator support, and the use of vasoactive agents [6]. The key factors playing into improved post-resuscitation care that improve patient outcomes following a return of spontaneous circulation (ROSC) are assessing/stabilizing the patient's cardiopulmonary status, determining the etiology of the arrest, neuroprotection, and preventing arrest recurrence [7]. ...
Introduction
Sickle cell anemia (SCA) is a hemoglobinopathy that arises from a point mutation in the beta-globin gene, which causes the polymerization of deoxygenated hemoglobin that leads to a wide variety of clinical complications. Deaths in patients with SCA most commonly arise from renal, cardiovascular disease, infections, and stroke. In-hospital cardiac arrest has been found to be more common in older patients and those on ventilatory life support, among others. This study aims to provide more insight into how SCA affects the risk of in-hospital mortality in post-cardiac arrest patients.
Methods
The National Inpatient Survey database years 2016 to 2019 was utilized. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS) codes for cardiopulmonary resuscitation were used to identify in-hospital cardiac arrest (IHCA) patients. ICD-10 Clinical Modification (CM) codes were used to identify SCA and other medical comorbidities. Categorical data was compared using Person's chi-square test, and continuous variables were compared using the independent samples t-test. Multinomial logistic regression was used to study the effects of SCA on post-arrest in-hospital mortality controlling for age, Charlson comorbidity score, and demographic variables. Binomial logistic regression models for dichotomous variables were utilized in the subgroup and secondary outcomes analysis.
Results
In patients with IHCA, patients who had SCA were found to have a significantly increased risk of in-hospital mortality adjusted for baseline characteristics and Charlson comorbidity score (OR: 1.16, 95% CI: 1.02-1.32, p=0.0025). Patient characteristics most strongly associated with an increased risk of in-hospital mortality in this cohort were found to be Black race (OR: 1.92, 95% CI: 1.87-1.97, p<0.001) and self-payer status (OR: 2.14, 95% CI: 2.06-2.22, p<0.001). Subgroup analysis revealed only patients with sickle cell disease had a statistically significant increased risk of in-hospital mortality in this cohort (OR: 4.41, 95% CI: 3.5-5.55, p<0.001), and patients with sickle cell trait did not.
Conclusion
In patients with IHCA, SCA is associated with an increased risk of in-hospital mortality. This risk was confined to patients with sickle cell disease and not patients with sickle cell trait.
... Thus suggesting that the development of AKI and AHF during patients' index admission has no effect on 30-day unplanned readmission due to the same condition. We propose that benefits from enhanced post-arrest critical care, including closer telemetry monitoring, medical optimization of comorbidities, temperature control, minimization of recurrent cardiac rate and rhythm events, and reversal of underlying etiologies for arrhythmias may result in mitigation of acute anoxic injury, resulting in a positive index of hospital outcome, and this may be associated with decreased readmissions in the shorter term [40,41]. ...
Background:
Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTM improves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30 days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors.
Methods:
Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9th and 10th codes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems.
Results:
Of 353,379 discharges for cardiac arrest with 30-day readmission, 9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients (6.30% vs. 9.30%, p < 0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p < 0.001) and AHF (20.13% vs. 17.30%, p < 0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p < 0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p = 0.05) among TTM recipients.
Conclusions:
Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.
... After CPR, it is not only important to obtain ROSC and reduce mortality, but also survival to hospital discharge in a good neurological condition. 6 Several studies have shown that even the shortest delay in performing chest compressions can significantly reduce the chance of ROSC as well as survival in a good neurological condition. 4,7,8 Improving the quality of CPR was possible due to the latest advancements in medical technologies. ...
Background
Sudden cardiac arrest (SCA) is one of the main reasons for admission to the intensive care unit (ICU), which influences discharge in a good neurological state.
Hypothesis
To analyze patients who had recovery of spontaneous circulation (ROSC) during hospitalization in the ICU using the Glasgow Outcome Scale (GOS).
Methods
The study group comprised 78 patients after SCA (35 after out-of-hospital cardiac arrest [OHCA] and 43 after in-hospital cardiac arrest [IHCA]) with ROSC who were admitted to the ICU of Regional Hospital No. 5 in Sosnowiec from January 1, 2016 to December 31, 2016. GOS was used to assess neurological status. Basic anthropological data, with, arterial blood pH, lactate concentration (LAC), and catecholamine treatment were also collected.
Results
In the study group, 32.1% (n = 25/78) of patients survived until ICU discharge and 30.8% (n = 24/78) until discharge from the hospital. SCA in cardiac mechanism was more common in OHCA than in the IHCA group (OHCA vs. IHCA: 85.7% vs. 62.8%, p = .02). There was no statistically significant difference between the two groups for neurological status assessed using GOS. There was no statistically significant difference between LAC or arterial blood pH and survival to ICU discharge, survival to hospital discharge, or mortality. The need for using catecholamines increased the mortality rate (GOS 1) (p < .001).
Conclusions
Most patients after RSOC were assigned to a group other than GOS 1, and 25% of all subjects belonged to GOS 4–5. Treatment with catecholamines was more common in patients who do not survive hospital or ICU discharge.
... Henti jantung dapat terjadi di luar rumah sakit (out-hospital cardiac arrest -OHCA) ataupun di dalam rumah sakit (in-hospital cardiac arrest -IHCA). 1 Resusitasi pasien henti jantung dengan pendekatan bantuan hidup jantung dasar dan lanjut bertujuan mencapai keadaan kembalinya sirkulasi spontan (return of spontaneous circulation -ROSC) yang ditandai dengan terabanya nadi dan terukurnya tekanan darah. 1 Morbiditas dan mortalitas pasien pasca-henti jantung masih signifikan; kematian terutama dalam 24 jam pertama pasca-henti jantung. 2 Pasien OHCA yang bertahan hidup hingga keluar rumah sakit diperkirakan sebesar 8 -10%, sedangkan pada pasien IHCA sebesar 15 -20%. 3 Strategi tatalaksana optimal pascahenti jantung dapat meningkatkan keluaran yang baik. ...
... Henti jantung dapat terjadi di luar rumah sakit (out-hospital cardiac arrest -OHCA) ataupun di dalam rumah sakit (in-hospital cardiac arrest -IHCA). 1 Resusitasi pasien henti jantung dengan pendekatan bantuan hidup jantung dasar dan lanjut bertujuan mencapai keadaan kembalinya sirkulasi spontan (return of spontaneous circulation -ROSC) yang ditandai dengan terabanya nadi dan terukurnya tekanan darah. 1 Morbiditas dan mortalitas pasien pasca-henti jantung masih signifikan; kematian terutama dalam 24 jam pertama pasca-henti jantung. 2 Pasien OHCA yang bertahan hidup hingga keluar rumah sakit diperkirakan sebesar 8 -10%, sedangkan pada pasien IHCA sebesar 15 -20%. 3 Strategi tatalaksana optimal pascahenti jantung dapat meningkatkan keluaran yang baik. ...
... Tatalaksana pasca-henti jantung membutuhkan pendekatan multidisiplin yang meliputi stabilisasi status kardiopulmoner, penanganan penyebab, strategi neuroproteksi dini, dan pencegahan berulangnya henti jantung. 1 POST-CARDIAC ARREST SYNDROME Patofisiologi kompleks yang terjadi selama respons iskemia seluruh tubuh selama henti jantung diikuti reperfusi selama resusitasi jantung paru (RJP) dan setelah ROSC disebut sindrom pasca-henti jantung (post-cardiac arrest syndrome -PCAS). 4 PCAS terdiri dari 5 fase, yaitu: immediate (20 menit pertama setelah ROSC), early (20 menit hingga 6-12 jam setelah ROSC), intermediate (6)(7)(8)(9)(10)(11)(12) jam hingga 72 jam setelah ROSC), recovery (3 hari setelah ROSC), dan rehabilitation (Gambar). ...
Sindrom pasca-henti jantung merupakan keadaan kompleks dan kritis dengan mortalitas tinggi. Tatalaksana pasca-henti jantung membutuhkan pendekatan multidisiplin meliputi stabilisasi status kardiopulmoner, penanganan penyebab, strategi neuroproteksi dini, dan pencegahan berulangnya henti jantung. Pendekatan multimodal diperlukan untuk prediksi keluaran neurologis. Post-cardiac arrest syndrome is complex and critical condition associated with high mortality. Post-cardiac arrest management needs multidisciplinary approach including stabilization of cardiopulmonary status, managing the underlying cause, early neuroprotective strategy, and prevention of recurrent cardiac arrest. Multimodal approach is needed to predict neurological outcome.
... e rest are of noncardiac origin, including respiratory problems, cerebrovascular problems, trauma, and metabolic disorders [2]. In accordance with the advanced cardiopulmonary life support (ACLS) algorithm [3], when cardiac arrest occurs, laboratory study or imaging is conducted to identify reversible causes [4]. Based on laboratory studies, the following Hs and Ts should be treated: hypovolemia, hypoxia, hydrogen ions, and hypo/ hyperkalemia [5]. ...
Purpose:
It is important that clinicians accurately predict the outcome of patients with sudden cardiac arrest (SCA). The complete blood count (CBC) is an easy and inexpensive test that provides information on blood content. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and delta neutrophil index (DNI) are relatively novel biomarkers that have been used in the prognosis of various diseases. We aimed to determine the usefulness of PLR, NLR, and DNI in predicting the outcomes of SCA.
Materials and methods:
This retrospective observational study was performed on patients with SCA. Patients who visited the tertiary university hospital from January 2015 to December 2019 were targeted. The inclusion criteria were all nontraumatic adult out-hospital cardiac arrest patients. We analyzed DNI, PLR, and NLR based on the CBC results of all enrolled patients. The exclusion criteria were as follows: no data on laboratory study, traumatic arrest, age < 18 years, and a history of leukemia, myelodysplastic syndrome, and myelofibrosis. The primary outcome was assessed as return of spontaneous circulation (ROSC), the secondary outcome as survival to discharge, and the tertiary outcome as neurological outcome.
Results:
From January 1, 2015, to December 31, 2019, 739 patients were enrolled. ROSC was seen in 324 patients, of whom 60 had survival to discharge and 24 had good neurological outcome at the time of discharge (cerebral performance categories (CPCs) 1-2). The PLR of the ROSC group was 42.41 (range: 4.21-508.7), which was higher than that of the No-ROSC group (p=0.006). The DNI value of the survival group was 0.00 (range: 0.00-40.9), which was lower than that of the nonsurvival group.
Conclusions:
Patients with SCA and subsequent ROSC had higher PLR and NLR, while those with survival to discharge had lower DNI values than those with nonsurvival to discharge (p=0.005).
... The main reason that the survival rate has not improved is that brain ischemic reperfusion injury (IRI) after CA and CPR remains prevalent [3]. Therefore, researchers have asked whether the brain resuscitation after CPR is directly related to mortality and quality of life [4,5]. Unfortunately, at present, no pharmacologic interventions are currently used clinically to provide neuroprotection for patients suffering from CA [6,7]. ...
This study examined the activation of mitophagy following cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) and the relationship between the change with time and apoptosis.
Main methods:
The male Sprague-Dawley rats were randomized into four groups: Sham group, CPR24h group, CPR48h group, CPR72h group. The rat model of cardiac arrest was established by asphyxiation. We employed western blot to analyze the levels of mitophagy related proteins of hippocampus, JC-1 to detect mitochondrial membrane potential (MMP) and flow cytometry to measure the rate of apoptosis of hippocampal neurons. Moreover, we also intuitively observed the occurrence of mitophagy through electron microscopy.
Key findings:
The results showed that the levels of TOMM20 and Tim23 protein were significantly decreased after CPR, which were more remarkable following 72 h of CPR. However, the protein levels of dynamin related protein 1 (Drp1) and cytochrome C (Cyt-c) were strongly up-regulated after CPR. Meanwhile, the hippocampal MMP decreased gradually with time after CPR. Furthermore, we more intuitively verified the activation of mitophagy through electron microscopy. In addition, the rats of apoptosis rate of hippocampus after CPR were significantly increased, which were gradually enhanced over time from 24 h until at least 72 h following CPR.
Significance:
with the enhancement of mitophagy, the apoptosis of hippocampal neurons was gradually enhanced, which suggested mitophagy may be excessive activated and aggravating brain damage after CA and CPR.
... 4 The Emergency Department staff conducts coordinated and organized actions based on a specific protocol, following the algorithm of Advanced Cardiopulmonary Resuscitation, with the main objective of resuscitating the victim and treating the possible reversible causes of the arrest. 5 Van de Glind and his colleagues showed a survival rate of patients with a rate of arrest ranging from 0% to 20%, which has not improved over the past 30 years. 6 ...
Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.
Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.
Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.
Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.
Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.
... Kardiyopulmoner resüsitasyon (KPR) çabalarında esas hedef arrestin geri döndürülebilir sebeplerinin aydınlatılması ve spontan dolaşımın geri dönüşü (SDGD)'dür. KPR çabaları sırasında ve SDGD sonrasında kardiyak arrestin (KA) geri döndürülebilir sebeplerinin açıklanmasına yönelik; vital bulgular, fizik muayene, elektrokardiyografi, kan gazı analizi, ultrasonografi, tam kan sayımı (TKS), kardiyak belirteçler ve rutin kan tetkikleri sıklıkla kullanılmaktadır (1)(2)(3) . ...
... Since postresuscitation comorbidities require high medical resources and decrease the chance of long-term survival, knowledge regarding the prevention or early treatment of comorbidities should be emphasized. However, most current studies concerning OHCA have focused on increasing survival rates or neurological outcomes [20,21]. Information regarding the prevalence of postresuscitation comorbidities, demographics, and patient characteristics is not well known; in particular, data on long-term follow-ups are lacking. ...
The outcome of patients suffering from out-of-hospital cardiac arrest (OHCA) is very poor, and postresuscitation comorbidities increase long-term mortality. This study aims to analyze new-onset postresuscitation comorbidities in patients who survived from OHCA for over one year. The Taiwan National Health Insurance (NHI) Database was used in this study. Study and comparison groups were created to analyze the risk of suffering from new-onset postresuscitation comorbidities from 2011 to 2012 (until December 31, 2013). The study group included 1,346 long-term OHCA survivors; the comparison group consisted of 4,038 matched non-OHCA patients. Demographics, patient characteristics, and risk of suffering comorbidities (using Cox proportional hazards models) were analyzed. We found that urinary tract infections ( n=225 , 16.72%), pneumonia ( n=206 , 15.30%), septicemia ( n=184 , 13.67%), heart failure ( n=111 , 8.25%) gastrointestinal hemorrhage ( n=108 , 8.02%), epilepsy or recurrent seizures ( n=98 , 7.28%), and chronic kidney disease ( n=62 , 4.61%) were the most common comorbidities. Furthermore, OHCA survivors were at much higher risk (than comparison patients) of experiencing epilepsy or recurrent seizures (HR = 20.83; 95% CI: 12.24–35.43), septicemia (HR = 8.98; 95% CI: 6.84–11.79), pneumonia (HR = 5.82; 95% CI: 4.66–7.26), and heart failure (HR = 4.88; 95% CI: 3.65–6.53). Most importantly, most comorbidities occurred within the first half year after OHCA.
