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Outcomes and interventions in patients transported to hospital with ongoing CPR after out-of-hospital cardiac arrest - An observational study.

ABSTRACT: Introduction:The main objective was to present characteristics and outcome of patients without sustained field return of spontaneous circulation (ROSC) transported to hospital with ongoing cardiopulmonary resuscitation (CPR). Our secondary objectives were to investigate hospital-based interventions and the performance of the universal Termination of Resuscitation-rule (uTOR). Methods:In this retrospective observational cohort study, out-of-hospital cardiac arrest (OHCA) patients arriving to the emergency department of a university hospital in Sweden during a six-year period (2010-2015) were identified using a prospectively recorded hospital-based registry. Additional data were retrieved from medical records and from the Swedish cardiopulmonary resuscitation registry. Results:Among 409 patients transported with ongoing CPR, 7 survived to hospital discharge (1.7%). Hospital-based interventions against a suspected cause of arrest were attempted during ongoing resuscitation in 34 patients (8.3%), of whom 3 survived to hospital discharge. The remaining 4 survivors had spontaneous in-hospital ROSC. Survivors presented with either a shockable rhythm (n = 4) or pulseless electrical activity (n = 3). The uTOR identified non-survivors with a positive predictive value (PPV) of 98.4% and a specificity of 71.4% for termination. Conclusion:Survival after OHCA where sustained prehospital ROSC is not achieved is rare and available in-hospital interventions are rarely utilised. No patient with asystole as the first recorded rhythm survived. The uTOR identified non-survivors with a PPV of 98.4% but showed poor specificity.

SUBMITTER: Schmidbauer S

PROVIDER: S-EPMC8640866 | biostudies-literature |

REPOSITORIES: biostudies-literature

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The interaction effect of bystander cardiopulmonary resuscitation (CPR) and dispatcher CPR on outcomes after out-of-hospital cardiac arrest.

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The association of race with CPR quality following out-of-hospital cardiac arrest.

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Bystander CPR and Long-Term Survival in Older Adults With Out-of-Hospital Cardiac Arrest.

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| S-EPMC10713355 | biostudies-literature

Neurobehavioral Outcomes in Children After Out-of-Hospital Cardiac Arrest.

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Project description: Not available

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Do Out-of-Hospital Cardiac Arrest Patients Have Increased Chances of Survival When Transported to a Cardiac Resuscitation Center?

Project description:Background Patients suffering from an out-of-hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta-analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out-of-hospital cardiac arrest was performed. Methods and Results PubMed, EMBASE , and the Cochrane Library databases were first searched using a specifically designed search strategy. Both original randomized controlled trials and observational studies were considered for inclusion. Cardiac resuscitation centers were defined as having on-site percutaneous coronary intervention and targeted temperature management capability at all times. The primary outcome measure was survival. Twelve nonrandomized observational studies were retained in this review. A total of 61 240 patients were included in the 10 studies that could be included in the meta-analysis regarding the survival outcome. Being transported to a cardiac resuscitation center was associated with an increase in survival (odds ratio=1.95 [95% confidence interval 1.47-2.59], P<0.001). Conclusions Adult patients suffering from an out-of-hospital cardiac arrest transported to cardiac resuscitation centers have better outcomes than their counterparts. When possible, it is reasonable to transport these patients directly to cardiac resuscitation centers (class II a, level of evidence B, nonrandomized). Clinical Trial Registration URL : www.crd.york.ac.uk/PROSPERO/ . Unique identifier: CRD 42018086608.

| S-EPMC6405559 | biostudies-other

Epidemiology and Outcomes from Out-of-Hospital Cardiac Arrest in Kuwait.

Project description:Background:Out-of-hospital cardiac arrest (OHCA) survival remains low in most countries. Few studies examine OHCA outcomes out of the Middle East region. This is the first study to describe characteristics and outcomes of patients with OHCA treated by emergency medical services (EMS) in regions of Kuwait. Objectives:To describe characteristics and outcomes of adult patients affected with OHCA in regions of Kuwait. Methods:This was a retrospective observational study on all adult OHCA patients transported by EMS to regional emergency departments over a 10- month period (21 February-31 December 2017). Data were collected from various sources: national emergency medical services archived data, emergency department, intensive care unit, and cardiac care unit of two hospitals. Results:A total of 332 EMS-treated OHCA cases were reviewed, and 286 incidents with OHCA from cardiac aetiology were included in the study. Most were non-Kuwaiti (60.8%) males (67.1%) with mean age 61 (+-16) years. Most OHCA cases occurred at home (76%) but with low witness rate (11.5%). Bystander CPR rate was low (8.7%). ROSC was achieved in ten patients (3.5%), but only 1 (0.3%) patient survived to hospital discharge. Conclusion:OHCA survival rates in this region of Kuwait are low. Targeted measures such as creating cardiac registry, dispatcher-assisted CPR with ongoing training and quality improvement, and community-based CPR education program are needed to improve the survival rates of OHCA victims.

| S-EPMC7195672 | biostudies-literature

Long-Term Outcomes Among Elderly Survivors of Out-of-Hospital Cardiac Arrest.

Project description:BackgroundMost studies on out-of-hospital cardiac arrest have focused on immediate survival. However, little is known about long-term outcomes and resource use among survivors.Methods and resultsWithin the national CARES registry, we identified 16 206 adults 65 years or older with an out-of-hospital cardiac arrest between 2005 and 2010. Among 1127 patients who were discharged alive, we evaluated whether 1-year mortality, cumulative readmission incidence, and follow-up inpatient costs differed according to patients' race, sex, initial cardiac arrest rhythm, bystander delivery of cardiopulmonary resuscitation, discharge neurological status, and functional status (hospital discharge disposition). Overall 1-year mortality after hospital discharge was 31.8%. Among survivors, there were no long-term mortality differences by sex, race, or initial cardiac arrest rhythm, but worse functional status and severe neurological disability at discharge were associated with higher mortality. Moreover, compared with first responders, cardiopulmonary resuscitation delivered by bystanders was associated with 23% lower mortality (hazard ratio 0.77 [confidence interval 0.58-1.02]). Besides mortality, 638 (56.6%) patients were readmitted within the first year, and the cumulative readmission incidence was 197 per 100 patient-years. Mean 1-year inpatient costs were $23 765±41 002. Younger age, black race, severe neurological disability at discharge, and hospital disposition to a skilled nursing or rehabilitation facility were each associated with higher 1-year inpatient costs (P for all <0.05).ConclusionAmong elderly survivors of out-of-hospital cardiac arrest, nearly 1 in 3 patients die within the first year. Long-term mortality and inpatient costs differed substantially by certain demographic factors, whether cardiopulmonary resuscitation was initiated by a bystander, discharge neurological status, and hospital disposition.

| S-EPMC4943267 | biostudies-literature

The psychological and behavioural factors associated with laypeople initiating CPR for out-of-hospital cardiac arrest: a systematic review.

Project description:BackgroundPrompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified.MethodsAim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people.DesignSystematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar.Study eligibility criteriaPrimary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021).Study appraisal and synthesis methodsPotential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively.ResultsOne hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation.ConclusionsPreparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs.Systematic review registrationPROSPERO: CRD42018117438.

| S-EPMC9840280 | biostudies-literature

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