Cardiac Arrest Of Non-cardiac Origin Research Articles

5225Bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest of non-cardiac origin

Abstract Background Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin. Methods From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all adult patients with OHCA of presumed non-cardiac origin in Denmark (2001–2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population. Results We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with an increased 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9–3.9) versus 1.8% (95% CI: 1.4–2.2) with no bystander CPR, corresponding to a significant difference of 1.6% (95% CI: 0.9–2.3). During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2–16.5) to 62.7% (95% CI: 60.2–65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7–2.6) to 4.0% (95% CI: 3.1–5.2). Similar findings were observed in subgroups of medical and non-medical OHCA. Table 1. Patient and arrest characteristics according to cause of out-of-hospital cardiac arrest Overall Medical OHCA Non-medical OHCA Patient characteristics Total patients 10761 7625 3136 Median age,y 67 70 50 Male, n (%) 6357 (59.1) 4154 (54.5) 2204 (70.4) OHCA factors Witnessed arrest, n (%) 4306 (40.0) 3574 (46.9) 732 (23.3) Public location, n (%) 6979 (64.9) 5494 (72.1) 1485 (47.4) OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation. Figure 1. Temporal trends Conclusion Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.

Bystander cardiopulmonary resuscitation and survival in patients with out-of-hospital cardiac arrest of non-cardiac origin

BackgroundKnowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin. MethodsFrom the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all patients with OHCA of presumed non-cardiac origin in Denmark (2001–2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population. ResultsWe identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with a significantly higher 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9–3.9) versus 1.8% (95% CI: 1.4–2.2) without bystander CPR. A similar association was found in subgroups of both medical and non-medical OHCA. During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2–16.5) to 62.7% (95% CI: 60.2–65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7–2.6) to 4.0% (95% CI: 3.1–5.2). ConclusionBystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.

Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study

ObjectivesTo evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin.DesignA prospective, population-based observational study.SettingThe Utstein Osaka...

Improving Cardiac Arrest Outcomes: Fine-tuning or Paradigm Shift?

In the 1970-80ies we studied barbiturates, moderately severe hypothermia, free radical scavengers and calcium blockers without impacting outcome after cerebral ischemia. In fact cardiac arrest outcome in general did not improve much until 2005. We underestimated the impact of CPR quality. Long pauses in inadequate depth chest compressions, particularly before, during and after series of defibrillation attempts were documented and found detrimental. We and others have shown that quality can be improved, but as with quality work also outside the health care industry, it requires continuous focus, local champions and continuous feedback both on performance and results. This is true both pre-and in-hospital, both during CPR and in the post-arrest period. The controversy of CPR or defibrillation first is solved, at least for the moment. The place of drugs during CPR is questionable, without solid clinical evidence for improved long term outcome for any drug. Although not universally achieved, significant improvements in cardiac arrest outcome have been reported by some pre- and in-hospital services over the last 5-6 years due to fine-tuning of the treatment process including much focus on the post-arrest period with temperature control/hypothermia and coronary interventions. There are more fine-tuning challenges ahead, and better implementation of known science is required, but what about paradigm shifts? We tend to forget that globally cardiac arrest of non-cardiac origin is a much larger challenge and opportunity that cardiac arrest of cardiac origin, both as potential lives saved, and even more as life-years saved.

Letter by Rai Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”

HomeCirculationVol. 123, No. 7Letter by Rai Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Rai Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin” Mridula Rai Mridula RaiMridula Rai Department of Internal Medicine University of Connecticut Farmington, CT (Rai) Search for more papers by this author Originally published22 Feb 2011https://doi.org/10.1161/CIRCULATIONAHA.110.984286Circulation. 2011;123:e248To The Editor:I read with interest the study by Kitamura et al published in a recent issue of Circulation.1 This nationwide, population-based study found significantly higher rate of favorable neurological outcome in the conventional-cardiopulmonary resuscitation (CPR) group compared to the compression-only-CPR group for out-of-hospital cardiac arrest (OHCA) of noncardiac origin (NCO). However, 2 recent randomized controlled trials showed no benefit of rescue-breathing in for OHCA.2,3 Even for NCO-OHCA, Rea et al found no significant difference in survival to hospital discharge (P=0.29) or in neurological outcome (P=0.42) between compression-only-CPR and conventional-CPR groups.2Although important, these findings are not new. However, they do add significant evidence and knowledge to our understanding about differential effects of CPR with and without rescue-breathing on outcomes of cause-specific OHCA. These results also highlight the importance of study size and power in evaluating such narrow differences in outcomes. Unlike preceding studies that failed because of a lack of statistical power, study by Kitumura et al was large enough to allow evaluation of the differences in outcomes between the each type of bystander-initiated CPR among NCO-OHCA.1 Rea et al noted a trend favoring compression-only-CPR in OHCA of cardiac origin (CO) (P=0.09), but similar to previous studies, found no significant difference or superiority of compression-only-CPR in CO-OHCA, likely because the studies were underpowered to rigorously evaluate the type of CPR in these subgroups.2 Larger, powerful studies would be required to plausibly demonstrate benefit of compression-only-CPR in CO-OHCA. Much larger studies would be required to demonstrate significant benefit of compression-only-CPR in all-cause-OHCA, if any, given the fact that majority of adult OHCA are cardiac in origin.Cardiac arrest is a heterogeneous condition. The pathophysiology of each arrest is dynamic, and the relative importance of oxygenation may depend on the time-dependent phase of the arrest. Failure of bystanders to perform CPR because of aversion to or the complicated nature of mouth-to-mouth ventilations, delays chest compressions which are central to survival. Rescue-breathing not only results in excessive interruption of chest compression generated marginal blood flow but also decreases coronary and cerebral blood flow by decreasing venous return to the chest. Additionally, arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality has been associated.4 Initial reperfusion with hypoxemic blood may also result in reduced cardiomyocyte loss by inhibiting free-oxygen-radical generation.5 In contrast, NCO-OHCA involves asphyxia resulting in hypoxemia and acidemia, and rescue-breathing is important under these conditions.Taken together, the potential differential effects of CPR with and without rescue-breathing may support a more targeted application of type-specific CPR. Rea et al calculated that such a tailored approach, if correctly applied according to the cause of arrest, would theoretically result in 156 survivors with favorable neurological outcome per 1000 patients, compared with 144 per 1000 if compression-only-CPR was used for all patients or 115 per 1000 if conventional-CPR was used for all patients.2 Given these numbers, the small impact of rescue-breathing on survival after NCO-OHCA,1 and the fact that majority of adult OHCA are cardiac in origin, it would be best to continue following the current AHA recommended hands-only CPR, a much simpler technique that is easier to teach, learn, and perform.Mridula Rai, MD Department of Internal Medicine University of Connecticut Farmington, CTDisclosuresNone.

Letter by Arrich et al Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”

To The Editor: With interest we have read the article by Kitamura and colleagues about bystander initiated rescue breathing for out-of-hospital cardiac arrest of noncardiac origin.1 The authors included a large number of patients from a population based registry and concluded that rescue breathing has an incremental benefit for out-of-hospital cardiac arrests of noncardiac origin. We would like to discuss some aspects of the study design: The main question was a comparison between compression-only CPR to conventional CPR including …

Factors associated with sustained return of spontaneous circulation in children after out-of-hospital cardiac arrest of noncardiac origin

Purpose The study aimed to determine the factors predictive of sustained return of spontaneous circulation (ROSC) in children with out-of-hospital cardiac arrest (OHCA) of noncardiac origin. Methods Eighty children were included in this retrospective study. The variables that lead to sustained ROSC and those that do not lead to sustained ROSC were analyzed. Survival analyses, including chance of achieving sustained ROSC and sum duration of ROSC, were conducted according to the duration of in-hospital cardiopulmonary resuscitation (CPR). Results Etiologies of noncardiac OHCA differed significantly across different age groups ( P < .001). Only 8.8% of children had initial arrest rhythms that were shockable. Predictors of sustained ROSC included the initial cardiac rhythm ( P = .002), a shorter period between collapse and the first chest compression ( P = .002), a shorter in-hospital CPR duration ( P = .004), and prehospital CPR ( P = .007). In children where ROSC was initially sustained, those with in-hospital CPR of more than 20 minutes, ROSC was sustained for less time ( P < .001). Conclusions Few children with noncardiac OHCA present with shockable cardiac rhythms. Furthermore, long-term ROSC is difficult to maintain in children who receive in-hospital CPR for more than 20 minutes.

Epidemiology and outcome of out-of-hospital resuscitation from cardiac arrest of non-cardiac origin

Epidemiology and outcome of out-of-hospital resuscitation from cardiac arrest of non-cardiac origin

Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin

The majority of victims who experience out-of-hospital cardiac arrest (OHCA) have ventricular fibrillation (VF) as the presenting rhythm and are thought to have a cardiac etiology for their arrest. Over the past decade, the incidence of VF OHCA has declined. The aims of this study were to describe the epidemiology of OHCA of non-cardiac origin in Olmsted County MN and to determine the trends that have occurred over time. All residents with a traumatic OHCA from 1995 to 2005 were included for analysis. OHCA data were collected prospectively according to the Utstein method. Cardiac arrests were classified as cardiac or non-cardiac in origin and the etiology determined based on autopsy reports, electronic medical records, and/or emergency medical services reports. During the study period, 414 OHCAs were identified, 90 (21.7%) of which were classified as non-cardiac. Mean age was 61.5+/-19.7 years. Response time was 7.73+/-2.9 min, and 40 (44.4%) were bystander-witnessed. Sixty-eight (75.6%) arrests occurred at home, 13 (14.4%) in a public place, and 9 (10%) in other locations. Bystander CPR was performed in 17 (18.9%) cases. The presenting rhythm was VF in 2 (2.2%) cases, PEA in 54 (60%), and asystole in 34 (37.8%). Eight (8.9%) patients survived to hospital discharge. Respiratory failure (35.6%), unknown (15.6%), and pulmonary embolism (13.3%) were the most common etiologies. The mean percentage of arrests due to a non-cardiac cause in three sequential time-periods (1995-1999, 2000-2002, 2003-2005) was 9.4%, 20.1% and 37.7%, respectively. Over the study period, 21.7% of OHCAs were non-cardiac in origin. PEA was the most common presenting rhythm and respiratory failure the most common etiology. 8.9% of patients survived. The decreasing number of VF arrests may be a contributing factor to the increasing proportion of OHCAs of non-cardiac etiology observed in the out-of-hospital setting.

Epidemiology, Trends, and Outcome of Out-of-hospital Cardiac Arrest of Noncardiac Origin

Epidemiology, Trends, and Outcome of Out-of-hospital Cardiac Arrest of Noncardiac Origin

Therapeutic cooling in cardiac arrest of noncardiac origin

On the basis of previous published data, the Interliaison Committee on Resuscitation has advised that unconscious adults with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 33°C during 24 hours when the initial rhythm was ventricular fibrillation (VF) and the cause of the cardiac arrest is of cardiac origin. We postulate that other rhythms might beneficiate from cooling as well as cardiac arrest of noncardiac origin. We therefore started a prospective study, and we compare the effect of cooling on long-term outcome in patients resuscitated after cardiac arrest of noncardiac origin or having rhythms other than VF. Twenty-eight patients were included, 14 of them were subjected to hypothermia after achieving return of spontaneous circulation (ROSC) (hypothermia group), the remaining other 14 patients were subjected to normothermia (normothermia group). The cause of cardiac arrest was near asphyxia after strangulation or secondary to choking. Other patients had asystole or pulseless electrical activity (PEA) at the first rhythm assessment. The postresuscitation phase was similar in both groups. In the hypothermia group, the cooling was initiated either by surface or intravenous cooling. The patient was cooled to 33°C as soon as possible in the Emergency Department, and the temperature was maintained for 24 hours. The re-warming phase was slowly started 24 hours later by increasing the body temperature by 1°C each 4 hours. No difference in complications was observed in the both groups. Good neurological outcome was highly significant in the hypothermia group (Table ​(Table11). Table 1 In conclusion, cooling seems to improve the neurological outcome after cardiac arrest even in rhythms other than VF and cardiac arrest of noncardiac origin. Surprisingly cooling also mitigates the brain damage associated with asphyxial cardiac arrest in humans.

Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome.

The aim of the study was to determine the epidemiology of out-of-hospital cardiac arrests of non-cardiac origin and survival following resuscitation, using the Utstein method of data collection. The study was of prospective cohort design and was conducted in a middle-sized urban city (population 525000) served by a single emergency medical services system. Consecutive out-of-hospital cardiac arrests of non-cardiac origin occurring between 1 January 1994 and 31 December 1995 were included. Survival from cardiac arrest to hospital discharge, and factors associated with survival were considered as main outcome measures. Of the 809 patients, 276 (34.1%) had a cardiac arrest of non-cardiac origin. The mean (SD) age of the patients was 49.8 (20.9) years. Resuscitation was attempted in 204 cases, 82 of whom (40.2%) were hospitalized alive and 23 (11.3%) were discharged. Thirteen (56.5%) of the survivors were discharged neurologically intact or with mild disability (overall performance category I or II). The survivors, during the study period, who suffered an out-of-hospital cardiac arrest of non-cardiac origin comprised 19.2% of all out-of-hospital cardiac arrest survivors. Trauma (62), non-traumatic bleeding (36), intoxication (31), near drowning (22) and pulmonary embolism (18) were the most common aetiologies, comprising 61.2% of cases. The non-cardiac aetiology was suspected pre-hospital in 176 (63.8%) cases; in the remaining cases, the aetiology was revealed only after in-hospital investigations or autopsy. In a logistic regression model, time interval to first responding unit, collapse outside the home, and aetiologies of near-drowning, airway obstruction, intoxication and convulsions were associated with survival. These results indicate that sudden out-of-hospital cardiac arrest more often has a non-cardiac cause than previously believed. Although survival is not as likely as from cardiac arrest of cardiac origin, since non-cardiac-cause survivors comprise one fifth of all out-of-hospital cardiac arrest survivors, resuscitation efforts are worthwhile.