Related Cardiac Arrest Research Articles

Aberrant brain-heart coupling is associated with the severity of post cardiac arrest brain injury.

To investigate autonomic nervous system activity measured by brain-heart interactions in comatose patients after cardiac arrest in relation to the severity and prognosis of hypoxic-ischemic brain injury. Strength and complexity of bidirectional interactions between EEG frequency bands (delta, theta, and alpha) and ECG heart rate variability frequency bands (low frequency, LF and high frequency, HF) were computed using a synthetic data generation model. Primary outcome was the severity of brain injury, assessed by (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron-specific enolase levels. Secondary outcome was the 3-month neurological status, assessed by the Cerebral Performance Category score [good (1-2) vs. poor outcome (3-4-5)]. Between January 2007 and July 2021, 181 patients were admitted to ICU for a resuscitated cardiac arrest. Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with decreased LF/HF. Severity of EEG changes were proportional to higher absolute values of brain-to-heart coupling strength (p < 0.02 for all brain-to-heart frequencies) and lower values of alpha-to-HF complexity (p = 0.049). Brain-to-heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron-specific enolase levels at Day 3. This aberrant brain-to-heart coupling (increased strength and decreased complexity) was also associated with 3-month poor neurological outcome. Our results suggest that autonomic dysfunctions may well represent hypoxic-ischemic brain injury post cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients.

Speed of cooling after cardiac arrest in relation to the intervention effect: a sub-study from the TTM2-trial

BackgroundTargeted temperature management (TTM) is recommended following cardiac arrest; however, time to target temperature varies in clinical practice. We hypothesised the effects of a target temperature of 33 °C when compared to normothermia would differ based on average time to hypothermia and those patients achieving hypothermia fastest would have more favorable outcomes.MethodsIn this post-hoc analysis of the TTM-2 trial, patients after out of hospital cardiac arrest were randomized to targeted hypothermia (33 °C), followed by controlled re-warming, or normothermia with early treatment of fever (body temperature, ≥ 37.8 °C). The average temperature at 4 h (240 min) after return of spontaneous circulation (ROSC) was calculated for participating sites. Primary outcome was death from any cause at 6 months. Secondary outcome was poor functional outcome at 6 months (score of 4–6 on modified Rankin scale).ResultsA total of 1592 participants were evaluated for the primary outcome. We found no evidence of heterogeneity of intervention effect based on the average time to target temperature on mortality (p = 0.17). Of patients allocated to hypothermia at the fastest sites, 71 of 145 (49%) had died compared to 68 of 148 (46%) of the normothermia group (relative risk with hypothermia, 1.07; 95% confidence interval 0.84–1.36). Poor functional outcome was reported in 74/144 (51%) patients in the hypothermia group, and 75/147 (51%) patients in the normothermia group (relative risk with hypothermia 1.01 (95% CI 0.80–1.26).ConclusionsUsing a hospital’s average time to hypothermia did not significantly alter the effect of TTM of 33 °C compared to normothermia and early treatment of fever.

Fatal cocaine poisoning in a body stuffer

To describe a fatal cocaine poisoning in a body stuffer resulting from extremely high plasma concentrations. Body stuffing refers to the swallowing of small amounts of poorly wrapped drug aiming to conceal it. Usually, complications are due to the direct drug toxicity (Roberts et al., Am J Emerg Med 1986:24–27). We report a 34-year-old male who developed seizures after swallowing small drug packs in a parking. Rapidly, he presented a cardiac arrest when the prehospital medical team arrived (no flow, 1 min). During tracheal intubation, a plastic pack containing a white powder was extracted from the patient's mouth. Due to refractory cardiac arrest, venoarterial ECMO was implemented on intensive care unit (ICU) admission. Despite optimal supportive care, multiple organ failure developed, and the patient died 24 h after ICU admission. Four blood and one urine samples were collected between ICU admission and death onset. The small pack containing a white powder was sent to the laboratory. Extensive toxicological screening was performed using immunological and enzymatic methods, LC-DAD/MS, LC-HR/MS and GC-MS. Plasma concentrations of cocaine and its two major metabolites benzoylecgonine and ecgonine methyl ester (EME) were determined using a specific LC-MS/MS assay. Toxicological analysis of the powder was performed using a specific GC-MS method. Cocaine and tetrahydrocannabinol screening was positive in urine. Plasma concentrations of cocaine, benzoylecgonine and EME were 8600, 13,420 and 9540 ng/mL, respectively in the earliest sample collected 2.8 hours post-cardiac arrest onset. In the last sample collected at 21.3 hours post-cardiac arrest, plasma cocaine concentration declined to 1240 ng/mL whereas benzoylecgonine and EME concentrations increased to 32,720 and 12,700 ng/mL, respectively. Cocaine elimination half-life was estimated at 6 h. During the first 4 hours, metabolic ratios were 1.5 (benzoylecgonine/cocaine) and 1 (EME/cocaine) before a marked increase in benzoylecgonine/cocaine and EME/cocaine ratios up to 11–26 and 6–10, respectively. Positive tetrahydrocannabinol was confirmed in LC-HR/MS. No usual adulterant as levamisole or phenacetin compounds was detected in blood and urine. Quantitative analysis GC-MS analysis reported a pure cocaine powder. The acute toxicity including sudden cardiac arrest in this body stuffer appeared in relation to extremely high plasma cocaine concentrations. Such elevated concentrations were rarely observed in body stuffers/packers (Soichot et al., ToxAC 2018;30:229–238) with metabolic ratios of ∼1 in the first hour post-ingestion. Here we described the time-course of plasma concentrations of cocaine and its metabolites during a 21h-period before the patient's death. There was a marked increase in cocaine metabolite concentrations and metabolic ratios, particularly the benzoylecgonine/cocaine ratio. Prolongation to 6 h of cocaine elimination half-life was consistent with the previously reported value of 7.6 h in a body packer (De Prost et al., Hum Exp Toxicol 2010;29:49–53). However, our report presents limitations related to the lack of information regarding cocaine consumption by the patient and the small sample number not allowing performing a toxicokinetic study. By contrast, to body packers, body stuffers mostly carry small cocaine amounts. However, cocaine concentration can be extremely high following the low-quality pack rupture in the stuffer's mouth like in our case. Drug purity found in our analysis supported a street deal with the attempt to conceal the sales product. Nevertheless, body stuffers are often drug users, which could be questioned in our patient, as suggested by the positive tetrahydrocannabinol screening. Our body stuffer developed a fatal cardiac arrest in relation to elevated plasma concentrations of cocaine and its metabolites resulting from a cocaine pack rupture. Toxicokinetic data are still expected to better understand the physiopathology of cocaine toxicity in such cases.

Long-term outcomes after out-of-hospital cardiac arrest in relation to socioeconomic status

AimsThis study aimed to examine whether socioeconomic differences exist in long-term outcomes after out-of-hospital cardiac arrest (OHCA). MethodsWe included 2309 30-day OHCA survivors ≥ 30 years of age from the Danish Cardiac Arrest Registry, 2001–2014, divided in tertiles of household income (low, medium, high). Absolute probabilities were estimated using logistic regression for 1-year outcomes and cause-specific Cox regression for 5-year outcomes. Differences between income-groups were standardized with respect to age, sex, education and comorbidities. ResultsHigh-income compared to low-income patients had highest 1-year (96.4% vs. 84.2%) and 5-year (87.6% vs. 64.1%) survival, and lowest 1-year (11.3% vs. 7.4%) and 5-year (13.7% vs. 8.6%) risk of anoxic brain damage/nursing home admission. The corresponding standardized probability differences were 8.2% (95%CI 4.7–11.6%) and 13.9% (95%CI 8.2–19.7%) for 1- and 5-year survival, respectively; and −4.5% (95%CI −8.2 to −1.2%) and −5.1% (95%CI −9.3 to −0.9%) for 1- and 5-year risk of anoxic brain damage/nursing home admission, respectively. Among 831 patients < 66 years working prior to OHCA, 72.1% returned to work within 1 year and 80.8% within 5 years. High-income compared to low-income patients had the highest chance of 1-year (76.4% vs. 58.8%) and 5-year (85.3% vs. 70.6%) return to work with the corresponding absolute probability difference of 18.0% (95%CI 3.8–32.7%) for 1-year and 9.4% (95%CI −3.4 to 22.3%) for 5-year. ConclusionPatients of high socioeconomic status had higher probability of long-term survival and return to work, and lower risk of anoxic brain damage/nursing home admission after OHCA compared to patients of low socioeconomic status.

Outcomes of out-of-hospital cardiac arrest in relation to prehospital care services in Hospital Canselor Tuanku Muhriz: A prospective study

Background: The role of prehospital care (PHC) services in out-of-hospital cardiac arrest (OHCA) is well established in developed countries. The American Heart Association has defined PHC as the ‘chain of survival’ between public and advanced medical care. For developing countries such as Malaysia, the importance of PHC services in OHCA is evolving; however, data are lacking. Objective: This study aimed to investigate OHCA outcomes in relation to PHC services in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Method: This was a prospective study conducted on OHCA cases attended by the PHC staff of Hospital Canselor Tuanku Muhriz. Independent variables were patient background, OHCA nature, and PHC interventions, while dependent variables were patient outcomes. Results: A total of 82 OHCA cases were identified. The survival rate to admission was 12.2% (n = 10), while the survival rate to discharge was 1.2% (n = 1) with cerebral performance categories of 1 or 2. The mean ambulance response time was 14.91 min. Among the variables, only OHCA location and adrenaline administration show significant association with OHCA outcome. OHCA location was significant in both outcomes (admission χ2(4) = 16.354, p &lt; 0.03, Cramer's V = 0.447, discharge χ2(4) = 19.741, p &lt; 0.001, Cramer's V = 0.491). However, adrenaline administration was significant only for survival to admission (χ2(1) = 3.776, p &lt; 0.052, Cramer's V = 0.215) but not for survival to discharge (χ2(1) = 0.964, p &lt; 0.326). Conclusion: Improvement in ambulance response time, public availability of automated external defibrillator, and public awareness of early cardiac arrest and cardiopulmonary resuscitation are required to increase the survivability of OHCA in developing countries.

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest in relation to organ donation.

Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest in relation to organ donation.

ROPIVACAINE-INDUCED CORONARY ARTERY VASOSPASM

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Ropivacaine is a frequently used nerve block for orthopedic procedures. Few cases have been reported in which the amides have caused coronary artery spasm (CAS). We present a case of CAS after ropivacaine administration. CASE PRESENTATION: An 85-year-old male with coronary artery disease, status post 4-vessel coronary artery bypass grafting 11 years prior, peripheral arterial disease, and hypertension, underwent an interscalene nerve block with 0.5% Ropivacaine prior to an orthopedic procedure. Two hours later, the patient developed ventricular fibrillation arrest. He was defibrillated 3 times, received amiodarone, epinephrine, magnesium, and an intralipid emulsion for radical binding of ropivacaine prior to return of spontaneous circulation. Patient had not received any inciting medications and his labs were unremarkable prior to the event. His only prescribed medications included low dose aspirin, clopidogrel, metoprolol, and ramipril. Bedside echocardiogram showed an ejection fraction of 20%; apical anteroseptal and anterolateral akinesis was present; electrocardiogram was remarkable for sinus tachycardia with ST segment elevation in leads V1-V6; his initial troponin T was 3.3 ng/dL. Aspirin, ticagrelor, and heparin infusion were administered, and the patient was rushed to coronary angiography. Angiography demonstrated patent bypass grafts. However, during the investigation of the Left Internal Mammary (LIMA) graft-to-Left Anterior Descending artery (LAD) anastomosis, the LAD had no flow (TIMI 1/0) beyond the LIMA anastomosis. Inframammary nitroglycerin was injected and immediately resolved the diffuse stenosis, suggesting coronary vasospasm. His other coronary arteries demonstrated stable disease related to his chronic CAD. Given the timing of cardiac arrest in relation to the nerve block, coronary vasospasm was presumed secondary to Ropivacaine injection. DISCUSSION: Ropivacaine is a highly potent, lipid soluble amide local anesthetic frequently used as an interscalene nerve block for orthopedic procedures involving the arm or hand. In addition to its arrhythmogenic properties, there have been few cases reported in which the amides have caused coronary artery spasm (CAS), relieved with calcium channel blockers. These cases were reported in individuals with and without underlying coronary artery disease, before, during, and after surgery; these reports are limited as diagnosis of CAS was not directly visualized with coronary angiography. Diagnosis was based upon relief in the setting of calcium channel blockers and nitroglycerin CONCLUSIONS: Our case is unique in that we present a patient who experienced ventricular fibrillation most likely secondary to CAS associated myocardial infarction after the interscalene administration of ropivacaine. This case is even more unique in that CAS reversal with intracoronary nitroglycerin was visualized and documented with cardiac catheterization. Reference #1: Mutlak M1, Nikolsky E. Severe coronary artery spasm induced by epidural injection of bupivacaine hydrochloride: a case report. Acute Card Care. 2011 Sep;13(3):155-8. https://doi.org/10.3109/17482941.2011.567286. Epub 2011 Apr 25. DISCLOSURES: no disclosure on file for Shahyar Gharacholou; No relevant relationships by Alexander Heckman, source=Web Response

Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity

IntroductionThe relations between specific ECG patterns and coronary angiographic findings in cardiac arrest patients with different comorbidities are not properly assessed. More evidence is needed to identify patients with the highest risk for acute coronary artery disease as a cause of the cardiac arrest. This study aims to describe the coronary artery findings after cardiac arrest in relation to ECG and comorbidity. MethodA retrospective study of out-of-hospital cardiac arrest patients, with coronary angiography performed within 28 days. ECG on admission, comorbidity, PCI attempts and angiographic findings are described. Data were retrieved from national registries in Sweden. ResultsAmong 1133 patients with available ECG and angiography information the mean age was 64 years. The rate of shockable rhythm was 79%. The total incidence of any significant stenosis in cardiac arrest patients without ST-elevation who underwent coronary angiography within 28 days was 71%. The incidence of any stenosis in patients with normal ECG was 62.1% and in patients with LBBB, 59.3%. In patients with ST-depression or RBBB, PCI attempts were made in 47.1% and 42.4% respectively, compared with 33.3% in patients with normal ECG. Among patients without ST-elevation, those with diabetes mellitus and those with initial shockable rhythm respectively, 84.8% and 71.5 had at least one significant stenosis. ConclusionOur study suggests, that evaluation of ECG patterns and comorbidities in out-of-hospital cardiac arrest patients without ST-segment elevation may be important to identify those with a high risk of coronary artery lesions that could benefit from early revascularization.

Spectral Content of Electroencephalographic Burst-Suppression Patterns May Reflect Neuronal Recovery in Comatose Post-Cardiac Arrest Patients.

To assess the potential biologic significance of variations in burst-suppression patterns (BSPs) after cardiac arrest in relation to recovery of consciousness. In the context of recent theoretical models of BSP, bursting frequency may be representative of underlying network dynamics; discontinuous activation of membrane potential during impaired cellular energetics may promote neuronal rescue. We reviewed a database of 73 comatose post-cardiac arrest patients who underwent therapeutic hypothermia to assess for the presence of BSP and clinical outcomes. In a subsample of patients with BSP (n = 14), spectral content of burst and suppression periods were quantified using multitaper method. Burst-suppression pattern was seen in 45/73 (61%) patients. Comparable numbers of patients with (31.1%) and without (35.7%) BSP regained consciousness by the time of hospital discharge. In addition, in two unique cases, BSP initially resolved and then spontaneously reemerged after completion of therapeutic hypothermia and cessation of sedative medications. Both patients recovered consciousness. Spectral analysis of bursts in all patients regaining consciousness (n = 6) showed a prominent theta frequency (5-7 Hz) feature, but not in age-matched patients with induced BSP who did not recover consciousness (n = 8). The prognostic implications of BSP after hypoxic brain injury may vary based on the intrinsic properties of the underlying brain state itself. The presence of theta activity within bursts may index potential viability of neuronal networks underlying recovery of consciousness; emergence of spontaneous BSP in some cases may indicate an innate neuroprotective mechanism. This study highlights the need for better characterization of various BSP patterns after cardiac arrest.

Changes in ventricular fibrillation quantitative waveform measures in out-of-hospital cardiac arrest in relation to acute myocardial infarction

Changes in ventricular fibrillation quantitative waveform measures in out-of-hospital cardiac arrest in relation to acute myocardial infarction

Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study.

Outcome after out-of-hospital cardiac arrest (OHCA) remains poor. With the introduction of automated external defibrillators, percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) the prognosis of patients after OHCA appears to be improving. The aim of this study was to evaluate short and long-term outcome among a non-selected population of patients who experienced OHCA and were admitted to a hospital working within a ST elevation myocardial infarction network. All patients who achieved return of spontaneous circulation (ROSC) (n=456) admitted to one hospital after OHCA were included. Initial rhythm, reperfusion therapy with PCI, implementation of MTH and additional medical management were recorded. The primary outcome measure was survival (hospital and long term). Neurological status was measured as cerebral performance category. The inclusion period was January 2003 to August 2010. Follow-up was complete until April 2014. The mean patient age was 63±14 years and 327 (72%) were men. The initial rhythm was ventricular fibrillation, pulseless electrical activity, asystole and pulseless ventricular tachycardia in 322 (71%), 58 (13%), 55 (12%) and 21 (5%) of the 456 patients, respectively. Treatment included PCI in 191 (42%) and MTH in 188 (41%). Overall in-hospital and long-term (5-year) survival was 53% (n=240) and 44% (n=202), respectively. In the 170 patients treated with primary PCI, in-hospital survival was 112/170 (66%). After hospital discharge these patients had a 5-year survival rate of 99% and cerebral performance category was good in 92%. In this integrated ST elevation myocardial infarction network survival and neurological outcome of selected patients with ROSC after OHCA and treated with PCI was good. There is insufficient evidence about the outcome of this approach, which has a significant impact on utilisation of resources. Good quality randomised controlled trials are needed. In selected patients successfully resuscitated after OHCA of presumed cardiac aetiology, we believe that a more liberal application of primary PCI may be considered in experienced acute cardiac referral centres.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

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

Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.

Survival after out-of-hospital cardiac arrest in relation to sex: A nationwide registry-based study

AimCrude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. MethodsPatients ≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001–2010. A total of 19,372 patients were included. ResultsOne-third were female, with a median age of 75 years (IQR 65–83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p<0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p<0.001.Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72–1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07–1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year. ConclusionsTemporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.

Survival following out-of-hospital cardiac arrest in relation to gender

Purpose: Data on gender related differences in survival after out-of-hospital cardiac arrest (OHCA) are limited. 1 Kim C. Fahrenbruch C.E. Cobb L.A. Eisenberg M.S. Out-of-hospital cardiac arrest in men and women. Circulation. 2001; 104: 2699-2703 Crossref PubMed Scopus (181) Google Scholar , 2 Herlitz J. Engdahl J. Svensson L. Young M. Angquist K.A. Holmberg S. Is female sex associated with increased survival after out-of-hospital cardiac arrest?. Resuscitation. 2004; 60: 197-203 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 3 Adielsson A. Hollenberg J. Karlsson T. et al. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. 2011; 97: 1391-1396 Crossref PubMed Scopus (118) Google Scholar , 4 Johnson M.A. Haukoos J.S. Larabee T.M. et al. Females of childbearing age have a survival benefit after out-of-hospital cardiac arrest. Resuscitation. 2013; 84: 639-644 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar We examined gender specific differences in outcome after OHCA in a nationwide register.

Uticaj kontinuiranog monitoringa pacijenata na ishod kardiopulmonalne reanimacije u bolničkim uslovima

Prevention of cardiac arrest is as important as cardiopulmonary resuscitation. No monitoring in wards is the important factor affecting patient survival following in-hospital cardiac arrest. Aim: To describe characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. Methods: Total of 100 patients who suffered an in-hospital cardiac arrest during a 2-year period in Urgent Centre KCS and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. Results: Among 100 patients, 46 had a cardiac arrest in wards with monitoring facilities. Ventricular fibrillation/tachycardia was observed more often as initial arrhythmia in monitored wards (70,2% vs. 30,2%, U-test, p<0.001). The median interval between collapse and first defibrillation was 1.5 min in monitored wards and 3.71 min in non-monitored wards (t-test, p<0.0001). Among patients with arrest in monitored wards 6,3% were discharged alive compared with 2,7% of patients in non-monitored wards (Mann-Whitney U-test p=0.007<0.05). Conclusion: In Urgent Centre KCS 54% inhospital cardiac arrests in which resuscitation was attempted took place in wards without monitoring facilities. These patients differed markedly from those having arrest in wards with monitoring facilities in terms of characteristics, interval to defibrillation and outcome. A shortening of the interval between collapse and defibrillation in these patients might increase survival even further.

Cardiac Arrest in Patients Who Smoke Crack Cocaine

The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 +/- 10 years, >20 years younger than nonusers (68 +/- 16 years, p <0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p <0.01) and 7 of 41 age-matched controls (17%, p <0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p <0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p <0.01) and survival (p <0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.

A history of diabetes is associated with an adverse outcome among patients admitted to hospital alive after an out-of-hospital cardiac arrest

Background: Factors of importance for the outcome among patients who are admitted to hospital alive after an out-of-hospital cardiac arrest are not well described in the literature. The importance of a history of diabetes for the outcome among these patients has not been reported in detail previously. This survey aims to describe the outcome among patients who were admitted to hospital after an out-of-hospital cardiac arrest in relation to whether they had a history of diabetes. Methods: All patients who were admitted to hospital alive after an out-of-hospital cardiac arrest in the two city hospitals in the Municipality of Göteborg between 1980 and 2002 were included in the survey. Results: In all, 1377 patients fulfilled the inclusion criteria and 187 (14%) of them had a history of diabetes. Patients with diabetes differed from those without diabetes by having a previous history of myocardial infarction, angina pectoris, hypertension and heart failure more frequently. Furthermore, they were older, with a mean age of 70 years versus 66 years for patients without diabetes. Among patients with diabetes, 25% were discharged alive, as compared with 37% of patients without diabetes ( p = 0.002). When adjusting for differences at baseline, the adjusted odds ratio for diabetic patients being discharged alive (versus no diabetes) was 0.57 (95% confidence interval, 0.39–0.80). Conclusion: Among patients admitted to hospital after an out-of-hospital cardiac arrest, 14% had a history of diabetes. These patients had a lower survival rate compared with those without diabetes, even after correcting for dissimilarities at baseline. It remains to be determined whether an early metabolic intervention in these patients will improve survival.

Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age.

To describe various factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. All patients included in the Swedish Cardiac Arrest Registry during the period 1990-1999. The registry covers about 60% of all ambulance organisations in Sweden. All patients reached by the ambulance crew and in whom resuscitative efforts were attempted. Crew witnessed cases were excluded. Only patients aged over 18 years were included. Patients were divided into three age groups: less than 65 years (n=7810), 65-75 years (n=7261) and over 75 years (n=8390). The proportion of cases with a cardiac aetiology increased with increasing age (P<0.0001). The proportion of witnessed cases increased with increasing age among those with a non-cardiac aetiology (P<0.0001) and decreased with increasing age among cases with a cardiac aetiology (P=0.02). The proportion of patients exposed to bystander CPR decreased with increasing age (P<0.0001). The proportion of patients found in ventricular fibrillation (VF) decreased with increasing age among patients with a cardiac aetiology (P<0.0001) but was not related to age in those with a non-cardiac aetiology. The proportion of patients being alive after 1 month in the three age groups (youngest first) were: 4.5, 3.2 and 2.5% (P<0.0001). The corresponding figures for patients with a cardiac aetiology found in VF were: 10.7, 7.6 and 6.6% (P<0.0001). After multiple regression analysis controlling for other factors increasing age was still associated with decreased survival to 1 month (odds ratio 0.85; 95% confidence limits 0.80-0.91). Among patients suffering from out-of-hospital cardiac arrest various factors at resuscitation, including initial rhythm, aetiology and bystander CPR, are strongly related to age. The chance of survival diminishes with increasing age. When correcting for the dissimilarities in terms of factors at resuscitation, age is still significantly associated with survival, being lower among the elderly.

Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours

Aim: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Patients: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. Methods: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. Results: Among patients in whom the arrest took place during office hours (08:00–16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients ( P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% ( P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40–3.06) as compared with patients who had an arrest outside office hours. Conclusion: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.