Journal: Resuscitation

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Abstract

Association between Trajectories of End-tidal Carbon Dioxide and Return of Spontaneous Circulation among Emergency Department Patients with Out-of-hospital Cardiac Arrest.

Wang CH, Lu TC, Tay J, Wu CY, ... Huei-Ming Ma M, Chen WJ
Background
We aimed to identify distinct trajectories of end-tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) and to investigate the association between EtCO2 trajectories and OHCA outcomes.
Methods
This was a secondary analysis of a prospectively collected database on adult patients with OHCA who had been resuscitated in the emergency department of a tertiary medical center between 2015 and 2020. The primary outcome was the return of spontaneous circulation (ROSC). Group-based trajectory modelling was used to identify the EtCO2 trajectories. Multivariable logistic regression analysis was performed to evaluate the association between EtCO2 trajectories and ROSC. The predictive performance of the EtCO2 trajectories was assessed using the area under the receiver operating characteristic curve (AUC).
Results
The study comprised 655 patients with OHCA. In the primary analysis, three distinct EtCO2 trajectories, including 10-mmHg, 30-mmHg, and 50-mmHg trajectories, were identified. Compared with the 10-mmHg trajectory, both 30-mmHg (odds ratio [OR]: 4.66, 95% confidence interval [CI]: 3.15-6.90) and 50-mmHg (OR: 7.58, 95% CI: 4.30-13.35) trajectories were associated with a higher likelihood of ROSC. In a sensitivity analysis of excluding EtCO2 measured before tracheal intubation or after sodium bicarbonate administration, the predictive ability of the identified EtCO2 trajectories remained. As a single predictor of ROSC, EtCO2 trajectories had an acceptable discriminative performance (AUC: 0.69, 95% CI: 0.66-0.73).
Conclusion
Three distinct EtCO2 trajectories during cardiopulmonary resuscitation were identified and significantly associated with outcomes. Early identification of these EtCO2 trajectories could potentially guide the ongoing resuscitation efforts.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 21 Jun 2022; epub ahead of print
Wang CH, Lu TC, Tay J, Wu CY, ... Huei-Ming Ma M, Chen WJ
Resuscitation: 21 Jun 2022; epub ahead of print | PMID: 35750286
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Abstract

Mechanical chest compression devices under special circumstances.

Gässler H, Kurka L, Rauch S, Seewald S, Kulla M, Fischer M
Aim
According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances.
Methods
Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007-2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (>45 minutes), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression.
Results
Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79-1.60). In 3,920 cases, a resuscitation duration >45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30-4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30-0.91).
Conclusion
Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 20 Jun 2022; epub ahead of print
Gässler H, Kurka L, Rauch S, Seewald S, Kulla M, Fischer M
Resuscitation: 20 Jun 2022; epub ahead of print | PMID: 35738309
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Abstract

Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis.

Malik A, Gewarges M, Pezzutti O, Allan KS, ... Kalra S, Dorian P
Background
Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA.
Methods
We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality.
Results
Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95-1.12; I2=89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18-1.23; I2=0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1%-3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92-1.14; I2=79%).
Conclusions
In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 18 Jun 2022; epub ahead of print
Malik A, Gewarges M, Pezzutti O, Allan KS, ... Kalra S, Dorian P
Resuscitation: 18 Jun 2022; epub ahead of print | PMID: 35728744
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Abstract

Outcomes of In-Hospital Cardiac Arrest Among Hospitals With and Without Telemedicine Critical Care.

Ofoma UR, Drewry AM, Maddox TM, Boyle W, ... Joynt Maddox KE, American Heart Association\'s Get With The Guidelines®- Resuscitation Investigators
Background
Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours.
Objective
To evaluate the association between hospital availability of TCC and IHCA survival.
Methods
We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59 p.m.) vs. off-hours (Monday-Friday 11:00 p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays).
Results
14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P = .37 for interaction) or survival to discharge (P = .39 for interaction).
Conclusions
Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 17 Jun 2022; epub ahead of print
Ofoma UR, Drewry AM, Maddox TM, Boyle W, ... Joynt Maddox KE, American Heart Association's Get With The Guidelines®- Resuscitation Investigators
Resuscitation: 17 Jun 2022; epub ahead of print | PMID: 35724851
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Abstract

Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: the CRITICAL study in Osaka.

Okada Y, Irisawa T, Yamada T, Yoshiya K, ... Kitamura T, Iwami T
Aim
Extracorporeal cardiopulmonary resuscitation (ECPR) is performed in refractory out-of-hospital cardiac arrest (OHCA) patients, and the eligibility has been conventionally determined based on three criteria (initial cardiac rhythm, time to hospital arrival within 45 minutes, and age <75 years) in Japan. Owing to limited information, this study descriptively determined neurological outcomes after applying the three criteria among OHCA patients who underwent ECPR.
Methods
This study conducted a post-hoc analysis of data from the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study. This was a multi-institutional prospective observational study of OHCA patients in Osaka Prefecture, Japan. All adult (aged ≥18 years) OHCA patients with internal medical causes treated with ECPR between 1 July 2012 and 31 December 2019 were evaluated. We described one-month neurological favourable outcomes based on the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age <75 years), and we compared them using the chi-square test.
Results
Among 18,379 patients screened from the CRITICAL study database, we included 517 OHCA patients treated by ECPR; 311 (60.2%) patients met all three criteria. Favourable neurological outcomes were as follows: patients meeting no or one criterion: 2.3% (1/43), those meeting two criteria: 8% (13/163), and those meeting all criteria: 16.1% (50/311) (P-value=0.004).
Conclusions
In this study, approximately 60% of patients treated by ECPR met the three criteria (initial shockable, time to hospital arrival within 45 minutes, and age<75 years), and the greater the number of criteria met, the better were the neurological outcomes achieved.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 14 Jun 2022; epub ahead of print
Okada Y, Irisawa T, Yamada T, Yoshiya K, ... Kitamura T, Iwami T
Resuscitation: 14 Jun 2022; epub ahead of print | PMID: 35714720
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Abstract

Neonatal simulation training decreases the incidence of chest compressions in term newborns.

Eva SM, Reinhold S, Theresa K, Nicola S, ... Lukas H, Jens SC
Aim of the study
To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters.
Methods
This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions.
Results
Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001).
Conclusion
Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 11 Jun 2022; epub ahead of print
Eva SM, Reinhold S, Theresa K, Nicola S, ... Lukas H, Jens SC
Resuscitation: 11 Jun 2022; epub ahead of print | PMID: 35700883
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Abstract

A pilot evaluation of respiratory mechanics during prehospital manual ventilation.

Yang BY, Blackwood JE, Shin J, Guan S, ... Kwok H, Johnson NJ
Introduction
Respiratory mechanics, such as tidal volume (VT) and inspiratory pressures, may affect outcome in hospitalized patients with respiratory failure. Little is known about respiratory mechanics in the prehospital setting.
Methods
In this prospective, pilot investigation of patients receiving prehospital advanced airway placement, paramedics applied a device to measure respiratory mechanics. We evaluated tidal volume (VT) per predicted body weight (VTPBW) to determine the proportion of breaths within the lung-protective range of 4-10 mL/kg per PBW overall, according to ventilation bag volume (large versus small) and cardiac arrest status (active CPR, post-ROSC, non-arrest).
Results
Over 16-months, 7371 post-intubation breaths were measured in 54 patients, 32 patients with cardiac arrest and 22 with other conditions. Paramedics ventilated 19 patients with a small bag and 35 patients with a large bag. Overall, mean VT was 435 mL (95% CI 403, 467); VTPBW was 7.0 mL/kg (95% CI 6.4, 7.6) with 75% within the lung-protective range. Mean VTPBW and peak pressure differed according to arrest status (absolute difference -0.36 mL/kg and 32 cmH2O for active CPR compared to post-ROSC), though not according to bag size.
Conclusions
We observed that measuring respiratory mechanics in the prehospital setting was feasible. Tidal volumes were generally delivered within a safe range. Respiratory mechanics varied most significantly with active CPR with lower VTPBW and higher peak pressures, though did not seem to be affected by bag size. Future work might examine the relationship between respiratory mechanics and outcomes, which may identify opportunities to improve clinical outcomes.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 08 Jun 2022; epub ahead of print
Yang BY, Blackwood JE, Shin J, Guan S, ... Kwok H, Johnson NJ
Resuscitation: 08 Jun 2022; epub ahead of print | PMID: 35690127
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Abstract

Association of Pulmonary Hypertension with Survival and Neurologic Outcomes in Adults with In-Hospital Cardiac Arrest.

Patel JK, Ramkishun CA, Haw A, Mehta K, Hou W, Parikh PB
Background
Pulmonary hypertension (PH) has been associated with poor survival in multiple cardiopulmonary conditions, however its association with outcomes in cardiac arrest remains unknown. We aimed to evaluate the association of PH with survival and neurologic outcomes in adults with in-hospital cardiac arrest (IHCA).
Methods
The study population included adults with IHCA undergoing resuscitation at an academic tertiary medical center from 2011-2019. Patients were classified based upon the presence versus absence of PH, defined as a pulmonary artery systolic pressure > 35mmHg on pre-arrest echocardiogram. Survival to discharge and favorable neurological outcome (defined as a Glasgow Outcome Score of 4-5) served as the primary and secondary outcomes of interest respectively.
Results
Of the 371 patients studied, 203 (54.7%) had PH while 168 (45.3%) did not. Patients with PH had higher Charlson Comorbidity Score with higher rates of multiple baseline comorbidities. They also had worse multi-chamber enlargement, left ventricular diastolic dysfunction, right ventricular systolic dysfunction, and valvular heart disease compared to non-PH patients. Rates of survival to discharge (11.5% vs 10.9%, p=0.881) and favorable neurologic outcome (8.0% vs 6.2%, p=0.550) were similar in PH and non-PH patients respectively. In multivariable analysis, PH was not associated with survival to discharge (OR 1.23, 95%CI 0.57-2.65) or favorable neurologic outcome (OR 1.69, 95%CI 0.64 - 4.45).
Conclusions
In this contemporary registry of adults with IHCA, while PH was associated with a higher risk patient profile, it was not associated with survival or neurologic outcomes in this population.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 04 Jun 2022; epub ahead of print
Patel JK, Ramkishun CA, Haw A, Mehta K, Hou W, Parikh PB
Resuscitation: 04 Jun 2022; epub ahead of print | PMID: 35671843
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Abstract

A method for continuous rhythm classification and early detection of ventricular fibrillation during CPR.

Kwok H, Coult J, Blackwood J, Sotoodehnia N, Kudenchuk P, Rea T
Aim
We developed a method which continuously classifies the ECG rhythm during CPR in order to guide clinical care.
Methods
We conducted a retrospective study of 432 patients treated following out-of-hospital cardiac arrest. Continuous ECG sequences from two-minute CPR cycles were extracted from defibrillator recordings and further divided into five-second clips. We developed an algorithm using wavelet analysis, hidden semi-Markov modeling, and random forest classification. The algorithm classifies individual clips as asystole, organized rhythm, ventricular fibrillation, or Inconclusive, while integrating information from previous clips. Classifications were compared to manual annotations to estimate accuracy in an independent validation dataset. Continuous sequences were classified as shockable, non-shockable, or Inconclusive; classifications were used to compute shock sensitivity and specificity.
Results
Of 432 patient-cases, 290 were used for development and 142 for validation. In the 12,294 validation ECG clips during CPR, accuracies were 0.88 (95% CI 0.85-0.91) for asystole, 0.98 (95% CI 0.98-0.99) for organized rhythm, and 0.97 (95% CI 0.96-0.97) for ventricular fibrillation, with 43% classified as Inconclusive. Of 457 continuous sequences, shock sensitivity was 0.90 (95% CI 0.86, 0.93), shock specificity was 0.98 (95% CI 0.93, 0.99), and 7% were Inconclusive. Median delay to ventricular fibrillation recognition was 10 (IQR 5, 32) seconds.
Conclusion
An automated algorithm continuously classified the primary resuscitation rhythms-asystole, organized rhythms, and ventricular fibrillation-with 88-98% accuracy, enabling accurate shock advisory guidance during most two-minute CPR cycles. Additional investigation is required to understand how algorithm implementation could affect rescuer actions and clinical outcomes.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 02 Jun 2022; epub ahead of print
Kwok H, Coult J, Blackwood J, Sotoodehnia N, Kudenchuk P, Rea T
Resuscitation: 02 Jun 2022; epub ahead of print | PMID: 35662667
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Abstract

Continuous versus routine EEG in patients after cardiac arrest-Analysis of a randomized controlled trial (CERTA) - RESUS-D-22-00369.

Valentina Urbano MM, Alvarez V, Schindler K, Rüegg S, ... Novy J, Rossetti AO
Background
Electroencephalography (EEG) is essential to assess prognosis in patients after cardiac arrest (CA). Use of continuous EEG (cEEG) is increasing in critically-ill patients, but it is more resource-consuming than routine EEG (rEEG). Observational studies did not show a major impact of cEEG versus rEEG on outcome, but randomized studies are lacking.
Methods
We analyzed data of the CERTA trial (NCT03129438), including comatose adults after CA undergoing cEEG (30-48 hours) or two rEEG (20-30 minutes each). We explored correlations between recording EEG type and mortality (primary outcome), or Cerebral Performance Categories (CPC, secondary outcome), assessed blindly at 6 months, using uni- and multivariable analyses (adjusting for other prognostic variables showing some imbalance across groups).
Results
We analyzed 112 adults (52 underwent rEEG, 60 cEEG,); 31 (27.7%) were women; 68 (60.7%) patients died. In univariate analysis, mortality (rEEG 59%, cEEG 65%, p=0.318) and good outcome (CPC 1-2; rEEG 33%, cEEG 27%, p=0.247) were comparable across EEG groups. This did not change after multiple logistic regressions, adjusting for shockable rhythm, time to return of spontaneous circulation, serum neuron-specific enolase, EEG background reactivity, regarding mortality (rEEG vs cEEG: OR 1.60, 95% CI 0.43 - 5.83, p=0.477), and good outcome (OR 0.51, 95% CI 0.14 - 1.90, p=0.318).
Conclusion
This analysis suggests that cEEG or repeated rEEG are related to comparable outcomes of comatose patients after CA. Pending a prospective, large randomized trial, this finding does not support the routine use of cEEG for prognostication in this setting. Trial registration Continuous EEG Randomized Trial in Adults (CERTA); NCT03129438; July 25, 2019.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 30 May 2022; epub ahead of print
Valentina Urbano MM, Alvarez V, Schindler K, Rüegg S, ... Novy J, Rossetti AO
Resuscitation: 30 May 2022; epub ahead of print | PMID: 35654226
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Abstract

Inhaled anaesthesia compared with conventional sedation in post cardiac arrest patients undergoing temperature control: a systematic review and meta-analysis.

Parlow S, Fay Lepage-Ratte M, Jung RG, Fernando SM, ... Rochwerg B, Mathew R
Introduction
Patients admitted with return of spontaneous circulation (ROSC) following out of hospital cardiac arrest (OHCA) are often sedated to facilitate care. Volatile anaesthetics have been proposed as alternative sedatives because of their rapid offset. We performed a systematic review and meta-analysis comparing the use of volatile anaesthetics to conventional sedation in this population.
Materials
We searched four databases (MEDLINE,Embase, CENTRAL, and Scopus) from inception to January 6, 2022. We included randomized trials and observational studies evaluating patients admitted following ROSC. We pooled data and reported summary estimates using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed risk of bias using the Newcastle Ottawa Scale and certainty of evidence using GRADE methodology.
Results
Of 1,973 citations, we included three observational studies (n=604 patients). Compared to conventional sedation, volatile agents had an uncertain effect on delirium (OR 0.96, 95% CI 0.68-1.37), survival to discharge (OR 0.66, 95% CI 0.17-2.61), and ICU length of stay (MD 1.59 days fewer, 95% CI 1.17-4.36, all very low certainty). Patients who received volatile anaesthetic underwent a shorter duration of mechanical ventilation (MD 37.32 hours shorter, 95% CI 7.74-66.90), however this was based on low-certainty evidence. No harms were described with use of volatile anesthetics.
Conclusion
Volatile anaesthetics may be associated with a decreased duration of mechanical ventilation in patients admitted with ROSC however this is based on low-certainty evidence. Further data are needed to assess their role in this population.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 27 May 2022; epub ahead of print
Parlow S, Fay Lepage-Ratte M, Jung RG, Fernando SM, ... Rochwerg B, Mathew R
Resuscitation: 27 May 2022; epub ahead of print | PMID: 35636623
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Abstract

Functionality of Registered Automated External Defibrillators.

Seit Jespersen S, Samsoee Kjoelbye J, Collatz Christensen H, Andelius L, ... Malta Hansen C, Folke F
Aims
Little is known about automated external defibrillator (AED) functionality in real-life settings. We aimed to assess the functionality of all registered AEDs in a geographically selected area and calculate the proportion of historical out-of-hospital cardiac arrests (OHCAs) covered by non-functioning AEDs.
Methods
In this cross-sectional study we inspected all registered and available AEDs on the island of Bornholm in Denmark. We collected information on battery status (determined by AED self-test) and electrode status, as well as AED availability. We identified all historical OHCAs registered with the Danish Cardiac Arrest Registry on Bornholm during 2016-2019 and calculated the proportion of OHCAs covered by an AED (regardless of functionality status) within ≤100, ≤750, and ≤1800 meters and the proportion of OHCAs covered by non-functioning AEDs.
Results
Of 211 registered AEDs, 181 (81.9%) were publicly accessible and functional. The remaining 40 (18.1%) were not functional, primarily due to expired electrodes (42.5%, n=17), obstacles to AED retrieval (20.0%, n=8) or failed self-tests (17.5%, n=7). Of 197 historical OHCAs, non-functional AEDs resulted in an OHCA coverage loss of 5.6%, 4.1% and 1.0 % for ≤100 m, ≤750 m and ≤1800 m, respectively.
Conclusion
Almost one-fifth of all registered and publicly available AEDs were not functional, primarily due to expired electrodes, failed self-tests or obstacles to retrieving AEDs. One in twenty historical OHCA was covered by a non-functional AED. Although general AED functionality was high, this finding underlines the importance of regular AED maintenance.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 23 May 2022; epub ahead of print
Seit Jespersen S, Samsoee Kjoelbye J, Collatz Christensen H, Andelius L, ... Malta Hansen C, Folke F
Resuscitation: 23 May 2022; epub ahead of print | PMID: 35618078
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Impact:
Abstract

Socioeconomic status and risk of in-hospital cardiac arrest.

Stankovic N, Holmberg MJ, Granfeldt A, Andersen LW
Aim
To investigate how socioeconomic status was associated with the risk of in-hospital cardiac arrest in Denmark.
Methods
We conducted a matched case-control study based on data from nationwide registries in Denmark. A total of 3,449 cases with in-hospital cardiac arrest in 2017 and 2018 were matched at the index time based on age and sex with up to 10 controls from the total Danish population and a hospitalized patient population, respectively. Household income, household assets, and education were used as measures of socioeconomic status. Conditional logistic regression was used to assess the association between socioeconomic status and the risk of in-hospital cardiac arrest.
Results
Across all analyses of cases and controls, high household income, high household assets, and higher education were associated with decreased odds of in-hospital cardiac arrest. In the analyses of cases and background controls, high household income was associated with 0.45 (95% CI: 0.40, 0.52) times the odds of in-hospital cardiac arrest compared to low household income, which was similar for household assets. Compared to basic education, higher education was associated with 0.50 (95% CI: 0.43, 0.58) times the odds of in-hospital cardiac arrest. The results attenuated marginally after adjustment for comorbidities. Similar albeit attenuated findings were observed in the analyses of cases and hospitalized controls.
Conclusions
In this matched case-control study, high socioeconomic status was associated with lower odds of in-hospital cardiac arrest compared to low socioeconomic status. The findings were consistent across household income, household assets, and education and persisted after adjustment for comorbidities. Strategies are needed to address the socioeconomic inequalities observed in the risk of in-hospital cardiac arrest.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 23 May 2022; epub ahead of print
Stankovic N, Holmberg MJ, Granfeldt A, Andersen LW
Resuscitation: 23 May 2022; epub ahead of print | PMID: 35618079
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Impact:
Abstract

Airway Strategy and Ventilation Rates in the Pragmatic Airway Resuscitation Trial.

Wang H, Jaureguibeitia X, Aramendi E, Nichol G, ... Irusta U, Idris A
Background
We sought to describe ventilation rates during out-of-hospital cardiac arrest (OHCA) resuscitation and their associations with airway management strategy and outcomes.
Methods
We analyzed continuous end-tidal carbon dioxide capnography data from adult OHCA enrolled in the Pragmatic Airway Resuscitation Trial (PART). Using automated signal processing techniques, we determined continuous ventilation rate for consecutive 10-second epochs after airway insertion. We defined hypoventilation as a ventilation rate <6 breaths/min. We defined hyperventilation as a ventilation rate >12 breaths/min. We compared differences in total and percentage post-airway hyper- and hypoventilation between airway interventions (laryngeal tube (LT) vs. endotracheal intubation (ETI). We also determined associations between hypo-/hyperventilation and OHCA outcomes (ROSC, 72-hour survival, hospital survival, hospital survival with favorable neurologic status).
Results
Adequate post-airway capnography were available for 1,010 (LT n=714, ETI n=296) of 3,004 patients. Median ventilation rates were: LT 8.0 (IQR 6.5-9.6) breaths/min, ETI 7.9 (6.5-9.7) breaths/min. Total duration and percentage of post-airway time with hypoventilation were similar between LT and ETI: median 1.8 vs. 1.7 minutes, p=0.94; median 10.5% vs. 11.5%, p=0.60. Total duration and percentage of post-airway time with hyperventilation were similar between LT and ETI: median 0.4 vs. 0.4 minutes, p=0.91; median 2.1% vs. 1.9%, p=0.99. Hypo- and hyperventilation exhibited limited associations with OHCA outcomes.
Conclusion
In the PART Trial, EMS personnel delivered post-airway ventilations at rates satisfying international guidelines, with only limited hypo- or hyperventilation. Hypo- and hyperventilation durations did not differ between airway management strategy and exhibited uncertain associations with OCHA outcomes.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 18 May 2022; epub ahead of print
Wang H, Jaureguibeitia X, Aramendi E, Nichol G, ... Irusta U, Idris A
Resuscitation: 18 May 2022; epub ahead of print | PMID: 35597311
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Abstract

Association of Chest Compression Pause Duration Prior to E-CPR Cannulation with Cardiac Arrest Survival Outcomes.

Lauridsen KG, Lasa JJ, Raymond TT, Yu P, ... Nadkarni VM, pediRES-Q Investigators
Objective
To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes.
Methods
Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression.
Results
Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95%CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95%CI: 0.60-0.98].
Conclusions
Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 16 May 2022; epub ahead of print
Lauridsen KG, Lasa JJ, Raymond TT, Yu P, ... Nadkarni VM, pediRES-Q Investigators
Resuscitation: 16 May 2022; epub ahead of print | PMID: 35588971
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Abstract

Acute Respiratory Distress Syndrome after In-Hospital Cardiac Arrest.

Shih JA, Robertson HK, Issa MS, V Grossestreuer A, ... Berg KM, Moskowitz A
Objective
Acute respiratory distress syndrome (ARDS) after out-of-hospital cardiac arrest is common and associated with worse outcomes. In the hospital setting, there are many potential risk factors for post-arrest ARDS, such as aspiration, sepsis, and shock. ARDS after in-hospital cardiac arrest (IHCA) has not been characterized.
Methods
We performed a single-center retrospective study of adult patients admitted to the hospital between 2014-2018 who suffered an IHCA, achieved return of spontaneous circulation (ROSC), and were either already intubated at the time of arrest or within 2 hours of ROSC. Post-IHCA ARDS was defined as meeting the Berlin criteria in the first 3 days following ROSC. Outcomes included alive-and-ventilator free days across 28 days, hospital length-of-stay, hospital mortality, and hospital disposition.
Results
Of 203 patients included, 146 (71.9%) developed ARDS. In unadjusted analysis, patients with ARDS had fewer alive-and-ventilator-free days over 28 days with a median of 1 (IQR: 0, 21) day, compared to 18 (IQR: 0, 25) days in patients without ARDS (p = 0.03). However, this association was not significant after multivariate adjustment. There was also a non-significant longer hospital length-of-stay (15 [IQR: 7, 26] vs 10 [IQR: 7, 22] days, p = 0.25; median adjusted increase in ARDS patients: 3 [95% CI: -2-8] days, p = 0.27) and higher hospital mortality (53% vs 44%, p = 0.26; aOR 1.6 [95% CI: 0.8-2.9], p = 0.17) in the ARDS group.
Conclusion
Among IHCA patients, almost three-quarters developed ARDS within 3 days of ROSC. As in out of hospital cardiac arrest, post-IHCA ARDS is common.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 14 May 2022; epub ahead of print
Shih JA, Robertson HK, Issa MS, V Grossestreuer A, ... Berg KM, Moskowitz A
Resuscitation: 14 May 2022; epub ahead of print | PMID: 35580706
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Impact:
Abstract

Bedside Monitoring of Hypoxic Ischemic Brain Injury Using Low-Field, Portable Brain Magnetic Resonance Imaging After Cardiac Arrest.

Beekman R, Crawford A, Mazurek MH, Prabhat AM, ... Taylor Kimberly W, Sheth KN
Background
Assessment of brain injury severity is critically important after survival from cardiac arrest (CA). Recent advances in low-field MRI technology have permitted the acquisition of clinically useful bedside brain imaging. Our objective was to deploy a novel approach for evaluating brain injury after CA in critically ill patients at high risk for adverse neurological outcome.
Methods
This retrospective, single center study involved review of all consecutive portable MRIs performed as part of clinical care for CA patients between September 2020 and January 2022. Portable MR images were retrospectively reviewed by a blinded board-certified neuroradiologist (S.P.). Fluid-inversion recovery (FLAIR) signal intensities were measured in select regions of interest.
Results
We performed 22 low-field MRI examinations in 19 patients resuscitated from CA (68.4% male, mean [standard deviation] age, 51.8 [13.1] years). Twelve patients (63.2%) had findings consistent with HIBI on conventional neuroimaging radiology report. Low-field MRI detected findings consistent with HIBI in all of these patients. Low-field MRI was acquired at a median (interquartile range) of 78 (40-136) hours post-arrest. Quantitatively, we measured FLAIR signal intensity in three regions of interest, which were higher amongst patients with confirmed HIBI. Low-field MRI was completed in all patients without disruption of intensive care unit equipment monitoring and no safety events occurred.
Conclusion
In a critically ill CA population in whom MR imaging is often not feasible, low-field MRI can be deployed at the bedside to identify HIBI. Low-field MRI provides an opportunity to evaluate the time-dependent nature of MRI findings in CA survivors.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 10 May 2022; epub ahead of print
Beekman R, Crawford A, Mazurek MH, Prabhat AM, ... Taylor Kimberly W, Sheth KN
Resuscitation: 10 May 2022; epub ahead of print | PMID: 35562094
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Impact:
Abstract

Prevalence of intracranial hemorrhage amongst patients presenting with out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Yi Lee K, Zheng So W, Ho JSY, Guo L, ... Tiah L, Fu Wah Ho A
Introduction
An unknown proportion of out-of-hospital cardiac arrest (OHCA) is caused by intracranial hemorrhage (ICH). There is uncertainty over the role of early head computed tomography (CT) in non-traumatic OHCA due to uncertain diagnostic yield and ways to identify high-risk patients. This study aimed to identify the prevalence of ICH in non-traumatic OHCA and possible predictors.
Methods
PubMed, EMBASE, and the Cochrane library were searched from inception to January 2022. Data extraction and quality assessment were independently reviewed by two authors. Meta-analyses estimated the prevalence of ICH amongst OHCA patients and pre-specified subgroups and geographical settings. Subgroup analysis were used to explore potential clinical predictors.
Results
23 studies involving 54,349 patients were included. The pooled ICH prevalence was 4.28% (95%CI: 3.31-5.24). Asia had a significantly larger risk ratio (RR= 3.93, P value < 0.0001) than Europe. The ICH subgroup was significantly more likely to be female (OR: 2.16; 95%CI: 1.10-4.26), and less likely to experience shockable rhythms compared with non-shockable rhythms (OR: 0.22; 95% CI: 0.04-1.22), achieve ROSC prior to arrival (OR: 0.27; 95%CI: 0.10-0.77), and survive to discharge compared to those without ICH (OR: 0.26; 95%CI: 0.11-0.59).
Conclusions
One in twenty OHCA have ICH at the time of presentation. An early head CT scan should be strongly considered after return of spontaneous circulation (ROSC), especially in patients who are female, with non-shockable rhythm and did not attain ROSC prior to arrival. These finding should influence clinical protocols to favor routine scans especially in Asia where prevalence is higher.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 09 May 2022; epub ahead of print
Yi Lee K, Zheng So W, Ho JSY, Guo L, ... Tiah L, Fu Wah Ho A
Resuscitation: 09 May 2022; epub ahead of print | PMID: 35551955
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Impact:
Abstract

Validation of the CaRdiac Arrest Survival Score (CRASS) for Predicting Good Neurological Outcome After Out-Of-Hospital Cardiac Arrest in An Asian Emergency Medical Service System.

Liu N, Wnent J, Wee Lee J, Ning Y, ... Eng Hock Ong M, PAROS Singapore Investigators
Background
Survival with favorable neurological outcomes is an important indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). We sought to validate the CaRdiac Arrest Survival Score (CRASS), derived using data from the German Resuscitation Registry, in predicting the likelihood of good neurological outcomes after OHCA in Singapore.
Methods
We conducted a retrospective population-based validation study among EMS-attended OHCA patients (≥18 years) in Singapore, using data from the prospective Pan-Asian Resuscitation Outcomes Study registry. Good neurological outcome was defined as a cerebral performance category of 1 or 2. To evaluate the CRASS score in light of the difference in patient characteristics, we used the default constant coefficient (0.8) and the adjusted coefficient (0.2) to calculate the probability of good neurological outcomes.
Results
Out of 11,404 analyzed patients recruited between April 2010 and December 2018, 260 had good and 11,144 had poor neurological function. The CRASS score demonstrated good discrimination, with an area under the curve of 0.963 (95% confidence interval: 0.952-0.974). Using the default constant coefficient of 0.8, the CRASS score consistently overestimated the predicted probability of a good outcome. Following adjustment of the coefficient to 0.2, the CRASS score showed improved calibration.
Conclusion
CRASS demonstrated good discrimination and moderate calibration in predicting favorable neurological outcomes in the validation Singapore cohort. Our study established a good foundation for future large-scale, cross-country validations of the CRASS score in diverse sociocultural, geographical, and clinical settings.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 06 May 2022; epub ahead of print
Liu N, Wnent J, Wee Lee J, Ning Y, ... Eng Hock Ong M, PAROS Singapore Investigators
Resuscitation: 06 May 2022; epub ahead of print | PMID: 35533896
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Abstract

Long term risk of recurrence among survivors of sudden cardiac arrest: a systematic review and meta-analysis.

Jia Rong Lam T, Yang J, Elizabeth Poh J, Eng Hock Ong M, ... Masuda Y, Fu Wah Ho A
Aims
With a growing number of survivors of sudden cardiac arrest globally, their natural disease progression is of interest. This systematic review and meta-analysis aimed to determine the risk of recurrence after sudden cardiac arrest and its associated risk factors.
Methods
Medline, Embase, Cochrane Library and Scopus were searched from inception to October 2021. Studies involving survivors of an out-of-hospital sudden cardiac arrest event of any non-traumatic aetiology were included. Meta-analyses of proportions using the random-effects model estimated the primary outcome of first recurrent sudden cardiac arrest incidence as well as secondary outcomes including cumulative incidence of recurrence at 1-year and incidence of second recurrence among survivors of first recurrence. A recurrent episode was defined as a sudden cardiac arrest that occurs 28 or more days after the index event. Subgroup and meta-regression analyses were conducted for predetermined variables. The Newcastle-Ottawa Scale was used to assess risk of bias for most studies.
Results
35 studies of moderate to high quality comprising a total of 7186 survivors were analysed. The pooled incidence of first recurrence was 15.24% (32 studies; 95%CI, 11.01-19.95; mean follow-up time, 41.3±29.3 months) and second recurrence was 35.03% (3 studies; 95%CI, 19.65-51.93; mean follow-up time, 161.1±54.3 months). At 1-year, incidence of recurrence was 10.62% (3 studies; 95%CI, 0.25-30.42). Subgroup analyses found no significant difference (p=0.204) between incidence of first recurrence published from 1975-1992 and 1993-2021, and between studies with mean follow-up time of <24 months, 24-48 months, and >48 months. On meta-regression, initial shockable rhythm increased incidence of first recurrence (p=0.01).
Conclusion
15.24% of sudden cardiac arrest survivors experienced a recurrence, and of these, 35.03% experienced a second recurrence. Most recurrences occurred in the first year. Initial shockable rhythm increased this risk. Despite the limitations of inter-study heterogeneity, these findings can still guide intervention and follow-up of sudden cardiac arrest survivors.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 05 May 2022; epub ahead of print
Jia Rong Lam T, Yang J, Elizabeth Poh J, Eng Hock Ong M, ... Masuda Y, Fu Wah Ho A
Resuscitation: 05 May 2022; epub ahead of print | PMID: 35526728
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Impact:
Abstract

Pain pupillary index to prognosticate unfavorable outcome in comatose cardiac arrest patients.

Macchini E, Bertelli A, Gouvea Bogossian E, Annoni F, ... Silvio Taccone F, Peluso L
Background
The prognostic role of the Pupillary Pain Index (PPI), derived from automated pupillometry, remains unknown in post-anoxic brain injury.
Methods
Single-center retrospective study in adult comatose cardiac arrest (CA) patients. Quantitative PPI and Neurologic Pupil Index (NPi) were concomitantly recorded on day 1 and day 2 after CA. The primary outcome was to assess the prognostic value of PPI to predict 3-month unfavourable outcome (UO, defined as Cerebral Performance Category of 3-5). Secondary outcome was the agreement between PPI and NPi to predict unfavourable outcome.
Results
A total of 102 patients were included; patients with UO (n=69, 68%) showed a lower NPi (4.2 [3.5-4.5] vs. 4.6 [4.3-4.7]; p<0.01 on day 1 - 4.3 [3.8-4.7] vs 4.6 [4.3-4.8] on day 2), and PPI (3 [1-6] vs. 6 [3-7]; p<0.01 on day 1 - 3 [1-6] vs 6 [4-8]; p<0.01 on day 2) than others. A PPI=1 on day 2 showed a sensitivity of 26 [95% CI 16-38]% and a specificity of 100 [95% CI 89-100]% to predict UO (p=0.003 vs. NPi≤2). On day 2, a total of 6 patients had concomitant PPI=1 and NPi ≤2, while 12 showed NPi>2 and PPI=1; the coefficient of agreement was 0.42. Moreover, NPi and PPI values showed a moderate correlation both on day 1 and day 2.
Conclusions
In this study, PPI=1 on day 2 could predict UO in comatose CA patients with 100% specificity, but with a low sensitivity (yet higher than NPi). The agreement between PPI and NPi values was moderate.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 30 Apr 2022; epub ahead of print
Macchini E, Bertelli A, Gouvea Bogossian E, Annoni F, ... Silvio Taccone F, Peluso L
Resuscitation: 30 Apr 2022; epub ahead of print | PMID: 35504344
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Impact:
Abstract

In-hospital versus out-of-hospital cardiac arrest: characteristics and outcomes in patients admitted to intensive care after return of spontaneous circulation.

Andersson A, Arctaedius I, Cronberg T, Levin H, ... Friberg H, Lybeck A
Introduction
Cardiac arrest is characterized depending on location as in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Strategies for Post Cardiac Arrest Care were developed based on evidence from OHCA. The aim of this study was to compare characteristics and outcomes in patients admitted to intensive care after IHCA and OHCA.
Methods
A retrospective multicenter observational study of adult survivors of cardiac arrest admitted to intensive care in southern Sweden between 2014-2018. Data was collected from registries and medical notes. The primary outcome was neurological outcome according to the Cerebral Performance Category (CPC) scale at 2-6 months.
Results
799 patients were included, 245 IHCA and 554 OHCA. IHCA patients were older, less frequently male and less frequently without comorbidity. In IHCA the first recorded rhythm was more often non-shockable, all delay-times (ROSC, no-flow, low-flow, time to advanced life support) were shorter and a cardiac cause of the arrest was less common. Good long-term neurological outcome was more common after IHCA than OHCA. In multivariable analysis, witnessed arrest, age, shorter arrest duration (no-flow and low-flow times), low lactate, shockable rhythm, and a cardiac cause were all independent predictors of good long-term neurological outcome whereas location of arrest (IHCA vs OHCA) was not.
Conclusion
In patients admitted to intensive care after cardiac arrest, patients who suffered IHCA vs OHCA differed in demographics, co-morbidities, cardiac arrest characteristics and outcomes. In multivariable analyses, cardiac arrest characteristics were independent predictors of outcome, whereas location of arrest (IHCA vs OHCA) was not.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 28 Apr 2022; epub ahead of print
Andersson A, Arctaedius I, Cronberg T, Levin H, ... Friberg H, Lybeck A
Resuscitation: 28 Apr 2022; epub ahead of print | PMID: 35490935
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Impact:
Abstract

Effect of Vasopressin and Methylprednisolone vs. Placebo on Long-Term Outcomes in Patients with In-Hospital Cardiac Arrest A Randomized Clinical Trial.

Granfeldt A, Sindberg B, Isbye D, Kjærgaard J, ... Holmberg MJ, Andersen LW
Objective
The primary results from the Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial have previously been reported. The objective of the current manuscript is to report long-term outcomes.
Methods
The VAM-IHCA trial was a multicenter, randomized, double-blind, placebo-controlled trial conducted at ten hospitals in Denmark. Adult patients (age ≥ 18 years) were eligible for the trial if they had an in-hospital cardiac arrest and received at least one dose of epinephrine during resuscitation. The trial drugs consisted of 40 mg methylprednisolone (Solu-Medrol®, Pfizer) and 20 IU of vasopressin (Empressin®, Amomed Pharma GmbH) given as soon as possible after the first dose of epinephrine. This manuscript report outcomes at 6 months and 1 year including survival, survival with favorable neurological outcome, and health-related quality of life.
Results
501 patients were included in the analysis. At 1 year, 15 patients (6.3%) in the intervention group and 22 patients (8.3%) in the placebo group were alive corresponding to a risk ratio of 0.76 (95% CI, 0.41-1.41). A favorable neurologic outcome at 1 year, based on the Cerebral Performance Category score, was observed in 14 patients (5.9%) in the intervention group and 20 patients (7.6%) in the placebo group (risk ratio, 0.78 [95% CI, 0.41-1.49]. No differences existed between groups for favorable neurological outcome and health-related quality of life at either 6 months or 1 year.
Conclusions
Administration of vasopressin and methylprednisolone, compared with placebo, in patients with in-hospital cardiac arrest did not improve long-term outcomes in this trial.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 28 Apr 2022; epub ahead of print
Granfeldt A, Sindberg B, Isbye D, Kjærgaard J, ... Holmberg MJ, Andersen LW
Resuscitation: 28 Apr 2022; epub ahead of print | PMID: 35490936
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Impact:
Abstract

Pulseless Electrical Activity in In-Hospital Cardiac Arrest - A crossroad for decisions.

Norvik A, Unneland E, Bergum D, Buckler DG, ... Kvaløy JT, Skogvoll E
Background
PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore and quantify the evolution from primary/secondary PEA to ROSC in adults during in-hospital cardiac arrest (IHCA).
Methods
We analyzed 700 IHCA episodes at one Norwegian hospital and three U.S. hospitals at different time periods between 2002 and 2021. During resuscitation ECG, chest compressions, and ventilations were recorded by defibrillators. Each event was manually annotated using a graphical application. We quantified the transition intensities, i.e., the propensity to change from PEA to another clinical state using time-to-event statistical methods.
Results
Most patients experienced PEA at least once before achieving ROSC or being declared dead. Time average transition intensities to ROSC from primary PEA (n= 230) and secondary PEA after ASY (n= 72) were 0.1 per min, peaking at 4 and 7 minutes, respectively; thus, a patient in these types of PEA showed a 10% chance of achieving ROSC in one minute. Much higher transition intensities to ROSC, average of 0.15 per min, were observed for secondary PEA after VF/VT (n= 83) or after ROSC (n=134).
Discussion
PEA is a crossroad in which the subsequent course is determined. The four distinct presentations of PEA behave differently on important characteristics. A transition to PEA during resuscitation should encourage the resuscitation team to continue resuscitative efforts.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 28 Apr 2022; epub ahead of print
Norvik A, Unneland E, Bergum D, Buckler DG, ... Kvaløy JT, Skogvoll E
Resuscitation: 28 Apr 2022; epub ahead of print | PMID: 35490937
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Impact:
Abstract

Intra-Cardiac Arrest Transport and Survival from Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study.

Holmberg MJ, Granfeldt A, Stankovic N, Andersen LW
Aim
To assess whether intra-cardiac arrest transport as compared to continued on-scene resuscitation was associated with improved clinical outcomes among out-of-hospital cardiac arrest patients in Denmark.
Methods
This was an observational study using data from population-based registries in Denmark. Adults (aged ≥18 to ≤65 years) with an out-of-hospital cardiac arrest attended by Emergency Medical Services (EMS) between 2016 and 2018 were included. The primary outcome was survival to 30 days. Time-dependent propensity score matching was used to match patients transported to the hospital within 20 minutes of EMS arrival to patients with assumed on-scene resuscitation (with or without subsequent intra-cardiac arrest transport) at risk of being transported within the same minute.
Results
The full cohort included 2,873 cardiac arrests. The median age was 56 (quartiles: 48 to 62) years, 1987 (69%) were male, and 104 (4%) were transported within 20 minutes. A total of 87 transported patients were matched to 87 patients at risk of being transported based on the propensity score. Although not reaching statistical significance, in comparison with on-scene resuscitation, intra-cardiac arrest transport was associated with increased survival to 30 days (risk ratio, 1.55; 95%CI, 0.99 to 2.44; P = 0.06). Similar associations were observed for return of spontaneous circulation and survival to one year.
Conclusions
Among patients aged 18 to 65 years, intra-cardiac arrest transport was associated with a non-significant increase in survival within 20 minutes of EMS on-scene arrival. However, the results did not eliminate the potential for bias and the results should be interpreted carefully.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 26 Apr 2022; epub ahead of print
Holmberg MJ, Granfeldt A, Stankovic N, Andersen LW
Resuscitation: 26 Apr 2022; epub ahead of print | PMID: 35487463
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Impact:
Abstract

PRE-HOSPITAL AIRWAY MANAGEMENT AND SURVIVAL OUTCOMES AFTER PAEDIATRIC OUT-OF-HOSPITAL CARDIAC ARRESTS.

Peng Tham L, Fook-Chong S, Shahidah N, Fu-Wah Ho A, ... Eng Hock Ong M, Pan-Asian Resuscitation Outcomes Study Clinical Research Network
Background
Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region.
Methods
We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort.
Results
We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95%CI, 0.25 - 0.69), p = 0.001] and survival with favourable neurological status.
Conclusion
In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 25 Apr 2022; epub ahead of print
Peng Tham L, Fook-Chong S, Shahidah N, Fu-Wah Ho A, ... Eng Hock Ong M, Pan-Asian Resuscitation Outcomes Study Clinical Research Network
Resuscitation: 25 Apr 2022; epub ahead of print | PMID: 35483494
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Impact:
Abstract

Assessment of Telecommunicator Cardiopulmonary Resuscitation Performance During Out-of-Hospital Cardiac Arrest Using a Standardized Tool for Audio Review.

Dowker SR, Smith G, O\'Leary M, Missel AL, ... Nallamothu BK, Emergent Health Partners Collaborators
Objective
Telecommunicator cardiopulmonary resuscitation (T-CPR) is a critical component of optimized out-of-hospital cardiac arrest (OHCA) care. We assessed a pilot tool to capture American Heart Association (AHA) T-CPR measures and T-CPR coaching by telecommunicators using audio review.
Methods
Using a pilot tool, we conducted a retrospective review of 911 call audio from 65 emergency medical services-treated out-of-hospital cardiac arrest (OHCA) patients. Data collection included events (e.g., OHCA recognition), time intervals, and coaching quality measures. We calculated summary statistics for all performance and quality measures.
Results
Among 65 cases, the patients\' mean age was 64.7 years (SD: 14.6) and 17 (26.2%) were women. Telecommunicator recognition occurred in 72% of cases (47/65). Among 18 non-recognized cases, reviewers determined 12 (66%) were not recognizable based on characteristics of the call. Median time-to-recognition was 76 seconds (n=40; IQR:39-138), while median time-to-first-instructed-compression was 198 seconds (n=26; IQR:149-233). In 36 cases where coaching was needed, coaching on compression-depth occurred in 27 (75%); -rate in 28 (78%); and chest recoil in 10 (28%) instances. In 30 cases where repositioning was needed, instruction to position the patient\'s body flat occurred in 18 (60%) instances, on-back in 22 (73%) instances, and on-ground in 22 (73%) instances.
Conclusions
Successful collection of data to calculate AHA T-CPR measures using a pilot tool for audio review revealed performance near AHA benchmarks, although coaching instructions did not occur in many instances. Application of this standardized tool may aid in T-CPR quality review.

Published by Elsevier B.V.

Resuscitation: 25 Apr 2022; epub ahead of print
Dowker SR, Smith G, O'Leary M, Missel AL, ... Nallamothu BK, Emergent Health Partners Collaborators
Resuscitation: 25 Apr 2022; epub ahead of print | PMID: 35483496
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Impact:
Abstract

Establishing a multicenter, preclinical consortium in resuscitation: A pilot experimental trial evaluating epinephrine in cardiac arrest.

Lin S, Ramadeen A, Sundermann ML, Dorian P, ... Zviman MM, Menegazzi JJ
Background
Large animal studies are an important step in the translation pathway, but single laboratory experiments do not replicate the variability in patient populations. Our objective was to demonstrate the feasibility of performing a multicenter, preclinical, randomized, double-blinded, placebo-controlled cardiac arrest trial. We evaluated the effect of epinephrine on coronary perfusion pressure (CPP) as previous single laboratory studies have reported mixed results.
Methods
Forty-five swine from 5 different laboratories (Ann Arbor, MI; Baltimore, MD; Los Angeles, CA; Pittsburgh, PA; Toronto, ON) using a standard treatment protocol. Ventricular fibrillation was induced and left untreated for 6 min before starting continuous cardiopulmonary resuscitation (CPR). After 2 min of CPR, 9 animals from each lab were randomized to 1 of 3 interventions given over 12 minutes: 1) Continuous IV epinephrine infusion (0.00375 mg/kg/min) with placebo IV normal saline (NS) boluses every 4 min, 2) Continuous placebo IV NS infusion with IV epinephrine boluses (0.015 mg/kg) every 4 min or 3) Placebo IV NS for both infusion and boluses. The primary outcome was mean CPP during the 12 mins of drug therapy.
Results
There were no significant differences in mean CPP between the three groups: 14.4±6.8 mmHg (epinephrine Infusion), 16.9±5.9 mmHg (epinephrine bolus), and 14.4±5.5 mmHg (placebo) (p=NS). Sensitivity analysis demonstrated inter-laboratory variability in the magnitude of the treatment effect (p=0.004).
Conclusion
This study demonstrated the feasibility of performing a multicenter, preclinical, randomized, double-blinded cardiac arrest trials. Standard dose epinephrine by bolus or continuous infusion did not increase coronary perfusion pressure during CPR when compared to placebo.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 23 Apr 2022; epub ahead of print
Lin S, Ramadeen A, Sundermann ML, Dorian P, ... Zviman MM, Menegazzi JJ
Resuscitation: 23 Apr 2022; epub ahead of print | PMID: 35472628
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Impact:
Abstract

Bystander-initiated cardiopulmonary resuscitation and automated external defibrillator use after out-of-hospital cardiac arrest: Uncovering disparities in care and survival across the urban-rural spectrum.

Grubic N, Peng YP, Walker M, Brooks SC, CARES Surveillance Group
Aim
To evaluate the association between bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and survival after out-of-hospital cardiac arrest (OHCA) across the urban-rural spectrum.
Methods
This was a retrospective cohort study of 325,477 adult OHCAs within the Cardiac Arrest Registry to Enhance Survival from 2013-2019. Bystander interventions were categorized into no bystander intervention, bystander CPR alone, and bystander AED use (with or without CPR). The primary outcome was survival to hospital discharge with good neurological outcome. Multivariable logistic regression was used to evaluate the association between bystander interventions and survival by geographical status (urban, suburban, large rural, small town, or rural).
Results
Bystander CPR alone occurred most often in rural areas (50.8%), and least often in urban areas (35.4%). Bystander AED use in public settings was similar across the urban-rural spectrum (10.5%-13.1%). Survival with good neurological outcome varied for urban (8.1%), suburban (7.7%), large rural (9.1%), small town (7.1%), and rural areas (6.1%). In comparison to no bystander intervention, the adjusted odds ratios (95% confidence intervals) for bystander AED use and survival were 2.57 (2.37-2.79) in urban areas, 2.58 (1.81-3.67) in suburban areas, 1.99 (1.44-2.76) in large rural areas, 1.90 (1.27-2.86) in small towns, and 3.05 (1.99-4.68) in rural areas. Bystander CPR alone was also associated with survival in all areas (adjusted odds ratio range: 1.29-1.45). There was no strong evidence of interaction between bystander interventions and geographical status on the primary outcome (p=0.63).
Conclusion
Bystander CPR and AED use are associated with positive clinical outcomes after OHCA in all areas along the urban-rural spectrum.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 22 Apr 2022; epub ahead of print
Grubic N, Peng YP, Walker M, Brooks SC, CARES Surveillance Group
Resuscitation: 22 Apr 2022; epub ahead of print | PMID: 35469933
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Impact:
Abstract

Socioeconomic Status and Post-Arrest Care after Out-of-Hospital Cardiac Arrest in Texas.

Huebinger R, Abella BS, Chavez S, Luber S, ... Villa N, Bobrow B
Introduction
Post-arrest care after out-of-hospital cardiac arrest (OHCA) is critical to optimizing outcomes, but little is known about socioeconomic disparities in post-arrest care. We evaluated the association of socioeconomic status (SES) with post-arrest care and outcomes.
Methods
We included adult OHCAs surviving to hospital admission from the 2014-2020 Texas Cardiac Arrest Registry to Enhance Survival (CARES) and stratified cases into SES quartiles based on census tract data. Outcomes were targeted temperature management (TTM), percutaneous coronary intervention (PCI), survival to discharge, and survival with a Cerebral Performance Category (CPC) 1-2. We applied both a multivariable logistic regression and a mixed effects logistic regression, comparing lower quartiles to top quartile for outcomes. We modeled receiving hospital as a random intercept.
Results
We included 9,936 OHCAs. Using multivariable logistic regression and ignoring the receiving hospital, lower income had lower TTM (Q3 aOR 0.6, 95% CI 0.5-0.7; Q4 aOR 0.5, 95% CI 0.5-0.6), lower PCI (Q4 aOR 0.6, 95% CI 0.4-0.8), and lower survival with good CPC. Lower education had lower TTM (Q2 aOR 0.7, 95% CI 0.7-0.8; Q3 aOR, 0.6 95% CI 0.5-0.7; Q4 aOR 0.6, 95% CI 0.5-0.7), lower survival, and lower survival with good CPC. Lower employment had lower TTM (Q3 aOR 0.7, 95% CI 0.6-0.9; Q4 aOR 0.7, 95% CI 0.6-0.9) and survival with good CPC. These relationships for post-arrest care were not significant on mixed model analyses though.
Conclusion
Lower SES was linked to lower rates of post-arrest care and outcomes, but many of the associations diminished when adjusting for receiving hospital random effect. Further study is needed to evaluate for inter-hospital disparities in care.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 16 Apr 2022; epub ahead of print
Huebinger R, Abella BS, Chavez S, Luber S, ... Villa N, Bobrow B
Resuscitation: 16 Apr 2022; epub ahead of print | PMID: 35439577
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Impact:
Abstract

Deterioration in Quality of Life and Long-term Mortality Among Survivors of In-hospital Cardiopulmonary Arrest: A Population-based Cohort Study in South Korea.

Song IA, Hwan Jo Y, Kyu Oh T
Aim
This study investigated the changes in quality of life (QOL) after in-hospital cardiopulmonary arrest (IHCA) among survivors and examined the association between worsening QOL and 3-year all-cause mortality.
Methods
This population-based cohort study used data from the National Health Insurance Service database in South Korea. Adult survivors who experienced IHCA between January 1, 2010, and December 31, 2018, and were alive for over 1 year after IHCA were included. Worsening QOL among IHCA survivors was determined using three criteria: decreased household income, unemployment, and acquired disability.
Results
A total of 22,611 IHCA survivors from 903 hospitals were included in the final analysis, and 7,796 (34.5%) experienced worsening QOL. Specifically, 5,595 (24.7%), 1,694 (7.5%), and 1,617 (7.2%) survivors experienced decreased household income, unemployment, and acquired disability, respectively. The proportion of brain lesion disability increased from 6.3% to 10.8% after IHCA. In multivariable Cox regression, worsening QOL was not associated with 3-year all-cause mortality (adjusted hazard ratio [aHR]: 1.03, 95% confidence interval [CI]: 0.96, 1.11; P=0.372). However, among the QOL factors, acquired disability was associated with a 1.29-fold higher risk of 3-year all-cause mortality among IHCA survivors (aHR: 1.29, 95% CI: 1.15, 1.46; P<0.001).
Conclusion
Approximately one-third of IHCA survivors experienced worsening QOL (decreased household income, unemployment, and acquired disability) at 1-year follow-up after IHCA in South Korea. Although overall worsening of QOL was not associated with 3-year all-cause mortality, acquired disability was associated with increased 3-year all-cause mortality among IHCA survivors.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 16 Apr 2022; epub ahead of print
Song IA, Hwan Jo Y, Kyu Oh T
Resuscitation: 16 Apr 2022; epub ahead of print | PMID: 35439578
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Impact:
Abstract

Out-of-hospital Cardiac Arrest with Onset Witnessed by Emergency Medical Services: Implications for Improvement in Overall Survival.

Holmström L, Reinier K, Toft L, Halperin H, ... Jui J, Chugh SS
Out-of-hospital cardiac arrest (OHCA) remains a major public health problem. Even in high-income countries, survival rates have plateaued in the range of ten percent, stimulating an ongoing interest in developing novel approaches to resuscitation. Emergency Medical Services (EMS)-witnessed OHCAs constitute a subgroup of overall OHCA that occur after the arrival of EMS, leading to rapid initiation of resuscitation and significantly improved survival. In this narrative review we summarize and interpret recent developments in knowledge of EMS-witnessed OHCA regarding prevalence, demographics, location, circumstances, survival outcomes and clinical profile. We examine the possibility of informing novel resuscitation approaches and enhancing mechanistic knowledge by studying EMS-witnessed OHCA, with the goal of improving overall survival from OHCA.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 11 Apr 2022; epub ahead of print
Holmström L, Reinier K, Toft L, Halperin H, ... Jui J, Chugh SS
Resuscitation: 11 Apr 2022; epub ahead of print | PMID: 35421535
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Impact:
Abstract

Cardiac arrest with successful cardiopulmonary resuscitation and survival induce histologic changes that correlate with survival time and lead to misdiagnosis in sudden arrhythmic death syndrome.

Coelho-Lima J, Westaby J, Sheppard MN
Background
Sudden arrhythmic death syndrome (SADS), defined as sudden cardiac death (SCD) with a morphologically normal heart, is an important cause of sudden death. Hypoperfusion due to cardiac arrest followed by successful cardiopulmonary resuscitation (CPR) may induce histologic changes that mimic pathologic conditions. Detailed characterisation of such features and whether they could confound SADS diagnosis are not described.
Methods
Retrospective observational study analysing all consecutive cases of sudden death prospectively referred to a UK national cardiac pathology centre between 2017-2021. Cases showing hypoperfusion features were identified after review of clinical information and examination by expert cardiac pathologists.
Results
Out of 2,568 SCD cases, 126 (4.9%) were identified with hypoperfusion changes. Macroscopically, the commonest finding was left ventricular focal or diffuse subendocardial haemorrhage (13.5%). Microscopically, haemorrhage and contraction band necrosis (n=50, 37.7%), subendocardial acute infarction (n=44, 34.1%), interstitial mixed inflammatory cell infiltrates (n=31, 24.9%), healing granulation tissue (n=9, 7.1%) and subendocardial fibrosis (n=1, 0.7%) were observed. These changes correlated to duration of survival following resuscitation. In a subcohort of 41 cases, autopsy pathologists misinterpreted such changes as ischaemic myocardial infarction (n=7; 17%), myocarditis (n=5; 12.1%), or other pathologies (n=2; 4.8%) in 14 SADS cases.
Conclusion
We provide a comprehensive characterisation of hypoperfusion-related changes in the heart following successful CPR with survival, which are time related. These features can lead to diagnostic confusion among pathologists but knowledge of history of resuscitation with survival should help with general and expert pathology assessment and improve SADS diagnostic yield, prompting genetic screening of decedents\' relatives.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 08 Apr 2022; epub ahead of print
Coelho-Lima J, Westaby J, Sheppard MN
Resuscitation: 08 Apr 2022; epub ahead of print | PMID: 35405310
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Impact:
Abstract

Race and Ethnicity Disparities in Post-Arrest Care in Texas.

Huebinger R, Chavez S, Abella BS, Al-Araji R, ... Villa N, Bobrow B
Introduction
Post-arrest care is essential to the chain of survival after out-of-hospital cardiac arrest (OHCA). Sparse literature evaluates disparities in post-arrest care. We sought to measure post-arrest care disparities using a statewide OHCA registry.
Methods
We evaluated 2014-2020 data in the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) and included adult OHCAs surviving to hospital admission. We stratified subjects by race/ethnicity. Outcomes were targeted temperature management (TTM), percutaneous intervention (PCI), early withdrawal of life-sustaining therapies (WLST), survival to discharge, and survival with cerebral performance category (CPC) of 1-2 (considered favorable). We used both multivariable and mixed-effects, logistic regression models to evaluate the association between race/ethnicity and outcomes, adjusting for confounders. We modeled receiving hospital as a random intercept for the mixed-models analysis.
Results
We included 8,363 OHCAs; 3,916 White, 2,251 Black, 2,196 Hispanic/Latino. On multivariable analysis, Black patients had a lower PCI (aOR 0.4, 95% CI 0.3-0.5) and survival with good CPC (aOR 0.6, 95% CI 0.6-0.7). Hispanic/Latino patients had lower TTM (aOR 0.8, 95% CI 0.7-0.9), PCI (aOR 0.6, 95% CI 0.5-0.8), survival (aOR 0.8, 95% CI 0.7-0.9), and survival with good CPC (aOR 0.7, 95% CI 0.6-0.7). However, after adjusting for clustering by receiving hospital, most of the post-arrest care relationships were negated, and Black patients actually had a higher rate of TTM (aOR 1.2, 95% CI 1.1-1.3).
Conclusions
Minority OHCA victims experienced disparities in post-arrest care and outcomes. However, adjusting for receiving hospital random-effect largely diminished these findings. Inter-hospital, post-arrest care disparities may exist.

Copyright © 2022. Published by Elsevier B.V.

Resuscitation: 08 Apr 2022; epub ahead of print
Huebinger R, Chavez S, Abella BS, Al-Araji R, ... Villa N, Bobrow B
Resuscitation: 08 Apr 2022; epub ahead of print | PMID: 35405311
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Impact:
Abstract

A new variant position of head-up CPR may be associated with improvement in the measurements of cranial near-infrared spectroscopy suggestive of an increase in cerebral blood flow in non-traumatic out-of-hospital cardiac arrest patients: A prospective interventional pilot study.

Kim DW, Choi JK, Won SH, Yun YJ, ... Lee DK, Jang DH
Aim of the study
This study aimed to investigate the effect of the head-up position implemented during cardiopulmonary resuscitation (CPR) on cerebral blood flow (CBF) using near-infrared spectroscopy in out-of-hospital cardiac arrest patients.
Methods
Baseline characteristics (age, sex, cerebral performance category before cardiac arrest, witnessed cardiac arrest, bystander CPR, first monitored rhythm, no-flow time, prehospital low-flow time, CPR duration in the emergency department (ED), and reason for stopping CPR in the ED) were recorded. The changes of CBF were derived from the optical oscillation waveform measured by near-infrared spectroscopy in adult patients with out-of-hospital cardiac arrest by alternating head-up and supine positions at 4-minute intervals while performing CPR. The CBF velocity according to the head position was also evaluated using the time derivative of the oscillation waveform.
Results
During the study period, 28 patients were enrolled. The median increase in CBF in the prefrontal area in the head-up position was 14.6% (Interquartile range, 8.8-65.0), more than that in the supine position. An increase in CBF was observed in the head-up position compared with the supine position in 83.3% of the patients included in the analysis.
Conclusion
CBF increased when the head-up position was used during CPR in non-traumatic out-of-hospital cardiac arrest patients.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 05 Apr 2022; epub ahead of print
Kim DW, Choi JK, Won SH, Yun YJ, ... Lee DK, Jang DH
Resuscitation: 05 Apr 2022; epub ahead of print | PMID: 35395338
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Impact:
Abstract

Routine Reporting of Grey-White Matter differentiation in Early Brain Computed Tomography in comatose patients after cardiac arrest: a substudy of the COACT trial.

Adriaansens KO, Jewbali LSD, Lemkes JS, Spoormans EM, ... van Royen N, den Uil CA
Aim
A multimodal approach is advised for neurological prognostication in comatose patients after out-of-hospital cardiac arrest (OHCA). Grey-white matter differentiation (grey-white ratio, GWR) obtained from a brain CT scan performed <24 hours after return of circulation can be part of this approach. The aims of this study were to investigate the frequency and method of reporting the GWR in brain CT scan reports and their association with outcome.
Methods
This is a post-hoc descriptive analysis of the COACT trial. The primary endpoint was the reporting of GWR by the radiologist. Secondary endpoints were APACHE IV score, Cerebral Performance Categories at discharge and 90-day follow-up, Glasgow Coma Scale at discharge, GWR-stratified 1-year survival, and RAND-36 stratified by normal versus abnormal GWR. Associations were analysed using multivariable analysis.
Results
A total of 427 OHCA patients were included in this study, 234 (55%) of whom underwent a brain CT scan within 24 hours after ROSC. Median time between arrest and initial CT scan was 12 hours. In 195 patients (83%), the GWR was described in the reports, but always expressed qualitatively. The GWR was deemed abnormal in 57 (29%) CT scans. No differences were found in secondary endpoints between the two groups.
Conclusion
GWR was frequently described in CT scan reports. Early abnormal GWR, as assessed qualitatively by a radiologist within 24 hours after ROSC, was a poor predictor of neurological prognosis.

Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Resuscitation: 01 Apr 2022; epub ahead of print
Adriaansens KO, Jewbali LSD, Lemkes JS, Spoormans EM, ... van Royen N, den Uil CA
Resuscitation: 01 Apr 2022; epub ahead of print | PMID: 35378224
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Impact:
Abstract

Healthy lifestyle factors, cardiovascular comorbidities, and the risk of sudden cardiac arrest: A case-control study in Korea.

Ho Park J, Cha KC, Sun Ro Y, Jun Song K, ... Cardiac Arrest Pursuit Trial with Unique Registration, Epidemiologic Surveillance CAPTURES project investigators
Aims
We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for sudden cardiac arrest.
Methods
A case-control study, including patients with sudden cardiac arrest aged 20-79 years and community-based 1:2 matched controls, was conducted from September 2017 to December 2020. All participants completed a structured questionnaire. Using multivariable logistic regression, we assessed cardiovascular comorbidities (diabetes, hypertension, dyslipidaemia, myocardial infarction, congestive heart failure, arrhythmia, and stroke) and healthy lifestyle factors (low red meat consumption, low fish consumption, high fruit consumption, high vegetable consumption, current non-smoking, regular exercise, and adequate sleep duration) as sudden cardiac arrest risk factors.
Results
Among 3,027 eligible cases, informed consent was obtained from 949 (31.3%) cases. A total of 1,731 controls were enrolled. Cardiovascular comorbidities, except dyslipidaemia, were associated with an increased risk of sudden cardiac arrest, whereas all healthy lifestyle factors were associated with a decreased risk. Relative to patients in the 0-2 healthy lifestyle factors group, the adjusted odds ratio (95% confidence interval) for sudden cardiac arrest was 0.25 (0.16-0.40) in patients with 3 healthy lifestyle factors, 0.08 (0.05-0.13) in patients with 4 healthy lifestyle factors, and 0.04 (0.03-0.06) in patients with over 5 healthy lifestyle factors. When the number of healthy lifestyle factors was analysed as a continuous variable, each additional factor was associated with a significant decrease in the likelihood of sudden cardiac arrest (adjusted odds ratio [95% confidence interval]: 0.41 [0.36-0.46]).
Conclusion
The increased risk of sudden cardiac arrest by cardiovascular comorbidities could be significantly reduced with healthy lifestyle factors.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 01 Apr 2022; epub ahead of print
Ho Park J, Cha KC, Sun Ro Y, Jun Song K, ... Cardiac Arrest Pursuit Trial with Unique Registration, Epidemiologic Surveillance CAPTURES project investigators
Resuscitation: 01 Apr 2022; epub ahead of print | PMID: 35378225
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Impact:
Abstract

Association between physician turnover and survival outcome after in-hospital cardiopulmonary resuscitation: A nationwide cohort study in South Korea.

Oh TK, Jo YH, Song IA
Aim
We investigated the association between physician turnover and survival outcomes after in-hospital cardiopulmonary resuscitation (ICPR) in South Korea.
Methods
This population-based cohort study used the South Korean national registration database as the data source. All adult patients admitted to the hospital and who underwent ICPR between 1 January 2010 and 31 December 2019, were included. Patients who underwent ICPR in March were included in the turnover group, while those who underwent ICPR in the other months were included in the non-turnover group. Propensity score (PS) matching was performed.
Results
Overall, 298,676 adult patients who underwent ICPR in 2,553 South Korean hospitals were included in the analysis. Among them, 26,342 (8.8%) and 272,334 (91.2%) were included in the turnover and non-turnover groups, respectively. In total, 7,009 (26.6%) and 6,903 (26.2%) of the 26,342 patients each in the turnover and non-turnover groups, respectively, were discharged alive after ICPR. Using logistic regression analysis in the PS-matched cohort, the two groups did not show any significant association in the live discharge rate after ICPR (odds ratio: 1.02, 95% confidence interval: 0.98, 1.06; P = 0.295). This non-significant association was also observed in patients who underwent ICPR in tertiary general hospitals that had cardiopulmonary resuscitation teams for ICPR (P = 0.136). Moreover, the median survival time in the turnover and non-turnover groups was 4.0 days (95% confidence interval: 3.8 days, 4.2 days; log-rank test, P = 0.796).
Conclusion
Significant association between physician turnover and survival outcomes was not observed after ICPR in South Korea.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 01 Apr 2022; 174:75-82
Oh TK, Jo YH, Song IA
Resuscitation: 01 Apr 2022; 174:75-82 | PMID: 35378226
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Impact:
Abstract

Mode of transportation of out-of-hospital cardiac arrest patients, the role of community actions and interventions.

Musi ME, Perman SM
The Emergency Medical Services constitutes a critical component in treating patients with out-of-hospital cardiac arrest (OHCA). Activating the EMS system is the first important step in deploying resources, but community involvement in the care of emergent patients is multifaceted and complex. How does the public access EMS services versus other modes of transport remains under investigated; and if the public opts for a different mode of transport to the hospital, how does this affect outcomes?

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 31 Mar 2022; 173:144-146
Musi ME, Perman SM
Resuscitation: 31 Mar 2022; 173:144-146 | PMID: 35276313
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Impact:
Abstract

The need to teach gender medicine in medical school.

Mattioli AV, Palumbo C
The present letter to editor comments the manuscript \"Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States.\" by Verghese D and coworkers.\" presenting some comment on sex disparities in treatment and the need for an action on medical school.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 31 Mar 2022; 173:182-183
Mattioli AV, Palumbo C
Resuscitation: 31 Mar 2022; 173:182-183 | PMID: 35369972
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Impact:
Abstract

Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation.

Rob D, Kavalkova P, Smalcova J, Kral A, ... Linhart A, Belohlavek J
Objectives
This study aimed to examine coronary angiography (CAG) findings, percutaneous coronary intervention (PCI) results and outcomes in out-of-hospital cardiac arrest patients (OHCA) without return of spontaneous circulation (ROSC) on admission to hospital.
Methods
We analyzed the OHCA register and compared CAG, PCI, and outcome data in patients with and without ROSC on admission to hospital.
Results
Between January 2012 and December 2020, 697 OHCA patients were analyzed. Of these, 163 (23%) did not have ROSC at admission. Patients without ROSC were younger (59 vs. 61 years, p = 0.001) and had a longer resuscitation time (62 vs. 18 minutes, p < 0.001) than patients with ROSC. Significant coronary artery disease was highly prevalent in both groups (65% vs. 68%, p = 0.48). Patients without ROSC had higher rates of acute coronary occlusions (42% vs. 33%, p = 0.046), specifically affecting the left main stem (16% vs. 1%, p < 0.001). PCI was performed in 81 patients (50%) without ROSC and in 295 (55%) with ROSC (p = 0.21). The success rate was 86% in patients without ROSC and 90% in patients with ROSC (p = 0.33). Thirty-day survival was 24% in patients without ROSC and 70% in patients with ROSC.
Conclusions
OHCA patients without ROSC on admission to hospital had higher acute coronary occlusion rates than patients with prehospital ROSC. PCI is feasible with a high success rate in patients without ROSC. Despite prolonged resuscitation times, meaningful survival in patients admitted without ROSC is achievable.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 30 Mar 2022; epub ahead of print
Rob D, Kavalkova P, Smalcova J, Kral A, ... Linhart A, Belohlavek J
Resuscitation: 30 Mar 2022; epub ahead of print | PMID: 35367316
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Impact:
Abstract

Global variation in the incidence and outcome of emergency medical services witnessed out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Gowens P, Smith K, Clegg G, Williams B, Nehme Z
Aim of the review
To examine global variation in the incidence and outcomes of emergency medical services (EMS) witnessed out-of-hospital cardiac arrest (OHCA).
Data sources
We systematically reviewed four electronic databases for studies between 1990 and 5th April 2021 reporting EMS-witnessed OHCA populations. Studies were included if they reported sufficient data to calculate the primary outcome of survival to hospital discharge or 30-day survival. Random-effects models were used to pool incidence and survival outcomes, and meta-regression was used to examine sources of heterogeneity. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools.
Results
The search returned 1178 non-duplicate titles of which 66 articles comprising 133,981 EMS-witnessed patients treated by EMS across 33 countries were included. All but one study was observational and only 12 studies (18%) were deemed to be at low risk of bias. The pooled incidence of EMS-treated cases was 4.1 per 100,000 person-years (95% CI: 3.5, 4.7), varying almost 4-fold across continents. The pooled proportion of survivors to hospital discharge or 30-days was 20% overall (95% CI: 18%, 22%; I2 = 98%), 43% (95% CI: 37%, 49%; I2 = 94%) for initial shockable rhythms and 6% (95% CI: 5%, 8%; I2 = 79%) for initial non-shockable rhythms. In the meta-regression analysis, only region and aetiology were significantly associated with survival. When compared to studies from North America, pooled survival was significantly higher in studies from Europe (14% vs. 26%; p = 0.04) and Australasia (14% vs. 31%, p < 0.001).
Conclusion
We identified significant global variation in the incidence and survival outcome of EMS-witnessed OHCA. Further research is needed to understand the factors contributing to these variations.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 30 Mar 2022; epub ahead of print
Gowens P, Smith K, Clegg G, Williams B, Nehme Z
Resuscitation: 30 Mar 2022; epub ahead of print | PMID: 35367317
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Impact:
Abstract

Temporal changes in peripheral regional oxygen saturation associated with return of spontaneous circulation after out-of-hospital cardiac arrest: A prospective observational cohort study in Japan.

Taniguchi H, Abe T, Doi T, Nakamura K, Matsumoto J, Takeuchi I
Aim
Temporal changes in cerebral regional oxygen saturation (crSO2) are useful for predicting return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients. However, little is known regarding the usefulness of peripheral regional oxygen saturation (prSO2) associated with OHCA patient outcomes. This study evaluated the association between temporal changes in prSO2 and ROSC in patients with OHCA.
Methods
This was a prospective study at two tertiary emergency centres in Japan. We evaluated the relationship between ROSC and temporal changes in crSO2 and prSO2. The rSO2 sensor was attached to the patient\'s forehead and upper arm, and rSO2 was continuously measured until resuscitative efforts were terminated or until the patient with sustained ROSC (>20 min) arrived at the emergency department.
Results
We included 145 patients with OHCA, of whom 35 achieved ROSC. Witness status (odds ratio [95% confidence interval]: 11.6 [3.13-58.1]) and ΔprSO2 (1.13 [1.06-1.24]) were significantly associated with ROSC in multiple logistic analysis. In the ROSC group, ΔprSO2 increased earlier than ΔcrSO2 during cardiopulmonary resuscitation. In the non-ROSC group, there was no significant difference between ΔcrSO2 and ΔprSO2, and neither increased before termination of resuscitation (TOR).
Conclusion
We demonstrated for the first time that prSO2 is associated with ROSC in OHCA patients and showed that temporal changes in prSO2 could predict ROSC earlier than those in crSO2. Our findings could provide time to prepare early interventions after ROSC and assist in determining the TOR for OHCA patients in Japan. Further studies are needed to validate these findings.

Copyright © 2022 Elsevier B.V. All rights reserved.

Resuscitation: 28 Mar 2022; 174:68-74
Taniguchi H, Abe T, Doi T, Nakamura K, Matsumoto J, Takeuchi I
Resuscitation: 28 Mar 2022; 174:68-74 | PMID: 35358664
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Impact:

This program is still in alpha version.