Cardiac Arrest Patients Research Articles

Evaluating the effectiveness of a sliding window technique in machine learning models for mortality prediction in ICU cardiac arrest patients

Extensive research has been devoted to predicting ICU mortality, to assist clinical teams managing critical patients. Electronic health records (EHR) contain both static and dynamic medical data, with the latter accumulating during ICU stays. Existing models often rely on a fixed time window (e.g., first 24 h) for prediction, potentially missing vital post-24-hour data. The present study aims to improve mortality prediction for ICU patients following Cardiac Arrest (CA) using a dynamic sliding window approach that accommodates evolving data characteristics.Our cohort included 2331 CA patients, of whom 684 died in the ICU and 1647 survived. Applying the sliding window technique, we created six different time windows and used each separately for model training and validation. We compared our results to a baseline accumulative window.The different time windows created by the sliding window technique differed in their prediction performance and outperformed the baseline 24-hour window significantly. The XGBoost model outperformed all other models, with the 30–42 h time window achieving the best results (AUC = 0.8, accuracy = 0.77).Our work shows that the sliding window technique is effective in improving mortality prediction. We demonstrated how important time-window selection is and showed that enhancing it can save time and thus improve mortality prediction. These findings promise to improve the clinical team’s efficiency in prioritizing patients and giving greater attention to higher-risk patients.To conclude, mortality prediction in the ICU can be improved if we consider alternative time windows instead of the 24-hour window, which is currently the most widely accepted among scoring systems today.

Cerebrovascular events and thrombolysis in pulmonary embolism-induced cardiac arrest: a case series and key challenges

Background and purposeCerebrovascular events during thrombolysis in cardiac arrest (CA) caused by pulmonary embolism (PE) is a life-threatening condition. However, the balance between cerebrovascular events and thrombolytic therapy in PE-induced CA remains a great challenge.MethodsIn this study, we reported three unique cases regarding main concerns surrounding cerebrovascular events in thrombolytic therapy in PE-induced CA.ResultsThe patient in the case 1 treated with thrombolysis during CPR and finally discharged neurologically intact. The patient in the case 2 received delayed thrombolysis and died eventually. The patient in the case 3 was contraindicated to thrombolysis due to the complication of subarachioid hemorrahage and died within days.ConclusionsOur case series highlights three proposed approaches to consider before administering thrombolysis as a treatment option in PE-induced CA patients: (1) prolonging the resuscitation, (2) administering thrombolysis promptly, and (3) ruling out cerebrovascular events.

Serum lactate/creatinine ratio and acute kidney injury in cardiac arrest patients

ObjectivesSerum lactate and creatinine levels upon admission in cardiac arrest (CA) patients significantly correlate with acute kidney injury (AKI) post-restoration of autonomic circulation. However, the association between serum lactate/creatinine ratio (LCR) and AKI in this population remains unclear. This study aimed to explore the relationship between LCR at admission and cardiac arrest-associated acute kidney injury (CA-AKI). Design and methodsWe conducted a secondary analysis of previously published data on CA patient resuscitation, categorizing them into tertiles based on LCR levels. Univariate and multivariate logistic regression models and subgroup analyses were employed to investigate the association between LCR and CA-AKI. Non-linear correlations were explored using restricted cubic splines, and a two-piece wise logistic proportional hazards model for both sides of the inflection point was constructed. ResultsA total of 374 patients (72.19 % male) were included, with intensive care unit mortality, in-hospital mortality, and neurologic dysfunction rates of 51.87 %, 56.95 %, and 39.57 %, respectively. The overall CA-AKI incidence was 59.09 %. Multivariate logistic proportional hazards analysis revealed a negative association between LCR and CA-AKI incidence (adjusted odds ratio [OR] 0.85, 95 % confidence intervals [CI] = 0.78–0.93, P=0.001). Triple spline restriction analysis depicted an L-shaped correlation between baseline LCR and CA-AKI incidence. Particularly, a baseline LCR<0.051 was negatively associated with CA-AKI incidence (OR 0.494, 95 % CI=0.319–0.764, P=0.002). Beyond the LCR turning point, estimated dose–response curves remained consistent with a horizontal line. ConclusionsBaseline LCR in CA patients exhibits an L-shaped correlation with AKI incidence following restoration of autonomic circulation. The threshold for CA-AKI is 0.051. This finding suggests that LCR may aid in identifying CA patients at high risk of AKI.

A Simple Scoring System for Identifying Favorable Neurologic Outcomes Among Out-of-Hospital Cardiac Arrest Patients With Asystole

Study objectiveAsystole is the most common initial rhythm in out-of-hospital cardiac arrest (OHCA), but indicates a low likelihood of neurological recovery. This study aimed to develop a novel scoring system to be easily applied at the time of emergency department arrival for identifying favorable neurological outcomes in OHCA survivors with an asystole rhythm. MethodsThis study is a secondary analysis based on a previously collected nationwide database, targeting non-traumatic adult OHCA patients aged ≥ 18 years with an asystole rhythm who achieved Return of Spontaneous Circulation (ROSC) between January 2016 and December 2020. The primary outcome was a favorable neurological outcome defined as Cerebral Performance Categories scores of 1 or 2 at hospital discharge. A prediction model was developed through multivariable logistic regression analysis in a derivation cohort in the form of a scoring system (WBC-ASystole). The performance and calibration of the model were tested using an internal validation cohort. ResultsAmong 19,803 OHCA patients with survival to hospital admission, 6,322 had asystole, and 285 (4.5%) achieved good neurological outcomes. Factors associated with favorable outcomes included age, witness arrest, bystander cardiopulmonary resuscitation, time from call to hospital arrival, and prehospital ROSC achievement. The WBC-ASystole score, totaling 11 points, exhibited a predictive performance with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval [CI]: 0.76–0.83) and 0.79 (95% CI: 0.74–0.83) in the derivation and validation cohorts, respectively. After categorizing patients into three groups based on probability for good neurological outcomes, the sensitivity and specificity were as follows: 0.98 (95% CI: 0.97–0.99) and 0.09 (95% CI: 0.09–0.10) for the very low (WBC-ASystole: ≤2), 0.85 (95% CI: 0.82–0.89) and 0.54 (95% CI: 0.53–0.55) for the low (WBC-ASystole: 3–4), and 0.36 (95% CI: 0.34–0.39) and 0.93 (95% CI: 0.92–0.93) for fair predicted probability group (WBC-ASystole: ≥5). ConclusionsAlthough external validation studies must be performed, among OHCA with asystole, the WBC-ASystole scoring system may identify those patients who are likely to have a favorable neurological outcome.

Comment on Utsumi et al. Differences in Pathophysiology and Treatment Efficacy Based on Heterogeneous Out-of-Hospital Cardiac Arrest. Medicina 2024, 60, 510.

We read with great interest the review article on pathophysiology and treatment based on different out-of-hospital cardiac arrest (OHCA) patients. We wish to present our comments on the threshold values for neuron-specific enolase (NSE) based on the initial rhythm and the misquoting of a few references in that article.

Sudden cardiac arrest in patients with cancer in the general population: insights from the Paris-SDEC registry

BackgroundData on the management of patients with cancer presenting with sudden cardiac arrest (SCA) are scarce. We aimed to assess the characteristics and outcomes of SCA according to cancer history.MethodsProspective,...

Wider Dissemination of Simplified Chest Compression-Only Cardiopulmonary Resuscitation Training Combined With Conventional Cardiopulmonary Resuscitation Training and 10-Year Trends in Cardiopulmonary Resuscitation Performed by Bystanders in a City.

Little is known about how to effectively increase bystander cardiopulmonary resuscitation (CPR), so we evaluated the 10-year trend of the proportion of bystander CPR in an area with wide dissemination of chest compression-only CPR (CCCPR) training combined with conventional CPR training.Methods and Results: We conducted a descriptive study after a community intervention, using a prospective cohort from September 2010 to December 2019. The intervention consisted of disseminating CCCPR training combined with conventional CPR training in Toyonaka City since 2010. We analyzed all non-traumatic out-of-hospital cardiac arrest (OHCA) patients resuscitated by emergency medical service personnel. The primary outcome was the trend of the proportion of bystander CPR. We conducted multivariate logistic regression models and assessed the adjusted odds ratio (AOR) using a 95% confidence interval (CI) to determine bystander CPR trends. Since 2010, we have trained 168,053 inhabitants (41.9% of the total population of Toyonaka City). A total of 1,508 OHCA patients were included in the analysis. The proportion of bystander CPR did not change from 2010 (43.3%) to 2019 (40.0%; 1-year incremental AOR 1.02 [95% CI: 0.98-1.05]). The proportion of bystander CPR did not increase even after wider dissemination of CPR training. In addition to continuing wider dissemination of CPR training, other strategies such as the use of technology are necessary to increase bystander CPR.

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest

BackgroundCardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established.MethodsThis study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 h of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 h will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient-reported quality of life measures.DiscussionIn vitro and in vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms.Trial registrationClinicalTrials.gov NCT04217551. Registered on 30 December 2019.

Detecting Intrathoracic Airway Closure during Prehospital Cardiopulmonary Resuscitation Using Quasi-Static Pressure-Volume Curves: A Pilot Study.

Background: Intrathoracic airway closure frequently occurs during cardiac arrest, possibly impairing ventilation. Previously, capnogram analysis was used to detect this pathophysiological process. In other populations, quasi-static pressure-volume curves obtained during constant low-flow inflations are routinely used to detect intrathoracic airway closure. This study reports the first use of quasi-static pressure-volume curves to detect intrathoracic airway closure during prehospital cardiopulmonary resuscitation. Methods: Connecting a pressure and flow sensor to the endotracheal tube enabled the performance of low-flow inflations during cardiopulmonary resuscitation using a manual resuscitator. Users connected the device following intubation and performed a low-flow inflation during the next rhythm analysis when chest compressions were interrupted. Determining the lower inflection point on the resulting pressure-volume curves allowed for the detection and quantification of intrathoracic airway closure. Results: The research device was used during the prehospital treatment of ten cardiac arrest patients. A lower inflection point indicating intrathoracic airway closure was detected in all patients. During cardiac arrest, the median pressure at which the lower inflection point occurred was 5.56 cmH20 (IQR 4.80, 8.23 cmH20). This value varied considerably between cases and was lower in patients who achieved return of spontaneous circulation. Conclusions: In this pilot study, quasi-static pressure-volume curves were obtained during prehospital cardiopulmonary resuscitation. Intrathoracic airway closure was detected in all patients. Further research is needed to determine whether the use of ventilation strategies to counter intrathoracic airway closure could lead to improved outcomes and if the degree of airway closure could serve as a prognostic factor.

Use of Somatic Oximetry in Traumatic Organ Injuries

Somatic oximetry, despite its frequent application in the clinical assessment of trauma patients, suffers from a notable dearth of randomized controlled trials, leading to an absence of systematic reviews or a defined level of evidence pertaining to its clinical utility. Somatic oximetry can provide information not only in direct monitoring of traumatized tissue but also in monitoring standardized areas such as the thenar region, shedding light on compensatory mechanisms of the body. The employment of the vascular occlusion test in somatic oximetry affords dynamic measurements, presenting a valuable tool for assessing the efficacy of diverse therapeutic interventions. Recent research findings establish that somatic oximetry plays a pivotal role in gauging the need for resuscitation during the initial evaluation of trauma patients. Furthermore, its application extends to monitoring oxygenation levels in damaged extremities and superficially located internal organs, particularly in the pediatric population. Despite the demonstrated benefits, a significant impediment to the widespread adoption of standardized somatic oximetry, specifically utilizing StO2, arises from the prevalent practice of amalgamating data from trauma and cardiac arrest patients. This practice hinders the establishment of a standardized evaluation protocol before the completion of resuscitation efforts. Consequently, the potential of somatic oximetry in mitigating secondary damage remains inadequately explored and warrants further rigorous scientific investigation.

Intraplaque haemorrhage, coronary spasm, and resuscitated cardiac arrest in patients with non-obstructive coronary artery disease.

Intraplaque haemorrhage, coronary spasm, and resuscitated cardiac arrest in patients with non-obstructive coronary artery disease.

Machine Learning and Clinical Predictors of Mortality in Cardiac Arrest Patients: A Comprehensive Analysis.

BACKGROUND Cardiac arrest (CA) is a global public health challenge. This study explored the predictors of mortality and their interactions utilizing machine learning algorithms and their related mortality odds among patients following CA. MATERIAL AND METHODS The study retrospectively investigated 161 medical records of CA patients admitted to the Intensive Care Unit (ICU). The random forest classifier algorithm was used to assess the parameters of mortality. The best classification trees were chosen from a set of 100 trees proposed by the algorithm. Conditional mortality odds were investigated with the use of logistic regression models featuring interactions between variables. RESULTS In the logistic regression model, male sex was associated with 5.68-fold higher mortality odds. The mortality odds among the asystole/pulseless electrical activity (PEA) patients were modulated by body mass index (BMI) and among ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) patients were by serum albumin concentration (decrease by 2.85-fold with 1 g/dl increase). Procalcitonin (PCT) concentration, age, high-sensitivity C-reactive protein (hsCRP), albumin, and potassium were the most influential parameters for mortality prediction with the use of the random forest classifier. Nutritional status-associated parameters (serum albumin concentration, BMI, and Nutritional Risk Score 2002 [NRS-2002]) may be useful in predicting mortality in patients with CA, especially in patients with PCT >0.17 ng/ml, as showed by the decision tree chosen from the random forest classifier based on goodness of fit (AUC score). CONCLUSIONS Mortality in patients following CA is modulated by many co-existing factors. The conclusions refer to sets of conditions rather than universal truths. For individual factors, the 5 most important classifiers of mortality (in descending order of importance) were PCT, age, hsCRP, albumin, and potassium.

Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest

Background and aimsChest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest. MethodsWe analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015–2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression. ResultsWe included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R2: 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively). ConclusionsABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration.

Effect of cardiopulmonary resuscitation training for layperson bystanders on outcomes of out-of-hospital cardiac arrest: A prospective multicenter observational study

BackgroundEffective bystander cardiopulmonary resuscitation (CPR) improves outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, the effect of CPR training on the rate of return of spontaneous circulation (ROSC) among laypersons has yet to be thoroughly evaluated. MethodsThis prospective, multicenter observational study was conducted across 42 centers in Japan. We assessed OHCA patients who received bystander CPR from a layperson, excluding those performed by healthcare staff. The primary outcome was the ROSC rate. Secondary outcomes included pre-hospital ROSC, ROSC after hospital arrival, favorable neurological outcomes, and 30-day survival. Propensity score with inverse probability treatment weighting (IPTW) was used to adjust for confounders, including age, sex, presence or absence of witnesses, and past medical history. ResultsA total of 969 OHCA patients were included, divided into CPR-trained (n = 322) and control (n = 647). Before adjustment, the ROSC rate was higher in the trained group than the control (40.1% vs. 30.1%, P < 0.01). After IPTW adjustment, the trained group showed a significantly higher ROSC rate (36.7% vs. 30.6%; P = 0.02). All secondary outcomes in the trained group were significantly improved before adjustment. After IPTW adjustment, the trained group showed improved rates of pre-hospital ROSC and ROSC after hospital arrival (30.7% vs. 24.0%; P < 0.01, 23.9% vs. 20.7%; P = 0.04). There were no differences in neurological outcomes and 30-day survival. ConclusionThis study demonstrated that CPR training for laypersons was associated with increased ROSC rates in OHCA patients, indicating potential advantages of CPR training for non-healthcare professionals.

The association between serum free fatty acid levels and neurological outcomes in out-of-hospital cardiac arrest patients: A prospective observational study.

Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients. This prospective observational study included adult (≥18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 hour after ROSC and at 6, 12, 24, 48, and 72 hours after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5. A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 hour after ROSC (0.72 vs 1.01 mol/L), at 6 hours (1.19 vs 1.90 mol/L), 12 hours (1.20 vs 1.66 mol/L), and 24 hours (1.20 vs 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 hours (odds ratio, 0.583; 95% confidence interval, 0.370-0.919; P = .020), and 12 hours (odds ratio, 0.509; 95% confidence interval, 0.303-0.854; P = .011) after ROSC were independently associated with poor neurological outcomes. The lower FFA levels at 6 hours and 12 hours after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.

Amiodarone Administration during Cardiopulmonary Resuscitation Is Not Associated with Changes in Short-Term Mortality or Neurological Outcomes in Cardiac Arrest Patients with Shockable Rhythms.

Background: The search for the best therapeutic approach in cardiopulmonary resuscitations (CPR) remains open to question. In this study, we evaluated if Amiodarone administration during CPR was associated with short-term mortality or neurological development. Methods: A total of 232 patients with sudden cardiac arrest (CA) with shockable rhythms were included in our analysis. Propensity score matching based on age, gender, type of CA, and CPR duration was used to stratify between patients with and without Amiodarone during CPR. Primary endpoints were short-term mortality (30-day) and neurological outcomes assessed by the cerebral performance category. Secondary endpoints were plasma lactate, phosphate levels at hospital admission, and the peak Neuron-specific enolase. Results: Propensity score matching was successful with a caliper size used for matching of 0.089 and a sample size of n = 82 per group. The 30-day mortality rates were similar between both groups (p = 0.24). There were no significant differences in lactate levels at hospital admission and during the following five days between the groups. Patients receiving Amiodarone showed slightly higher phosphate levels at hospital admission, while the levels decreased to a similar value during the following days. Among CA survivors to hospital discharge, no differences between the proportion of good neurological outcomes were detected between the two groups (p = 0.58), despite slightly higher peak neuron-specific enolase levels in CA patients receiving Amiodarone (p = 0.03). Conclusions: Amiodarone administration is not associated with short-term mortality or neurological outcomes in CA patients with shockable rhythms receiving CPR.

Performance of the MRI lesion pattern score in predicting neurological outcome after out of hospital cardiac arrest: a retrospective cohort analysis

BackgroundDespite advances in resuscitation practice, patient survival following cardiac arrest remains poor. The utilization of MRI in neurological outcome prognostication post-cardiac arrest is growing and various classifications has been proposed; however a consensus has yet to be established. MRI, though valuable, is resource-intensive, time-consuming, costly, and not universally available. This study aims to validate a MRI lesion pattern score in a cohort of out of hospital cardiac arrest patients at a tertiary referral hospital in Switzerland.MethodsThis cohort study spanned twelve months from February 2021 to January 2022, encompassing all unconscious patients aged ≥ 18 years who experienced out-of-hospital cardiac arrest of any cause and were admitted to the intensive care unit (ICU) at Inselspital, University Hospital Bern, Switzerland. We included patients who underwent the neuroprognostication process, assessing the performance and validation of a MRI scoring system.ResultsOver the twelve-month period, 137 patients were admitted to the ICU, with 52 entering the neuroprognostication process and 47 undergoing MRI analysis. Among the 35 MRIs indicating severe hypoxic brain injury, 33 patients (94%) experienced an unfavourable outcome (UO), while ten (83%) of the twelve patients with no or minimal MRI lesions had a favourable outcome. This yielded a sensitivity of 0.94 and specificity of 0.83 for predicting UO with the proposed MRI scoring system. The positive and negative likelihood ratios were 5.53 and 0.07, respectively, resulting in an accuracy of 91.49%.ConclusionWe demonstrated the effectiveness of the MLP scoring scheme in predicting neurological outcome in patients following cardiac arrest. However, to ensure a comprehensive neuroprognostication, MRI results need to be combined with other assessments. While neuroimaging is a promising objective tool for neuroprognostication, given the absence of sedation-related confounders—compared to electroencephalogram (EEG) and clinical examination—the current lack of a validated scoring system necessitates further studies. Incorporating standardized MRI techniques and grading systems is crucial for advancing the reliability of neuroimaging for neuroprognostication.Trial Registration: Registry of all Projects in Switzerland (RAPS) 2020-01761.

Temperature Control Parameters Are Important: Earlier Preinduction Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest

Temperature control trials in cardiac arrest patients have not reliably conferred neuroprotective benefit but have been limited by inconsistent treatment parameters. To evaluate the presence of a time dependent treatment effect, we assessed the association between preinduction time and clinical outcomes. In this retrospective, single academic center study between 2014 and 2022, consecutive out-of-hospital cardiac arrest (OHCA) patients treated with temperature control were identified. Preinduction was defined as the time from hospital arrival to initiation of a closed-loop temperature feedback device [door to temperature control initiation time], and early door to temperature control device time was defined a priori as <3 hours. We assessed the association between good neurologic outcome (cerebral performance category 1 to 2) and door to temperature control device time using logistic regression. The proportion of patients who survived to hospital discharge was evaluated as a secondary outcome. A sensitivity analysis using inverse probability treatment weighting, created using a propensity score, was performed to minimize measurable confounding. Three hundred and forty-seven OHCA patients were included; the early door to temperature control device cohort included 75 (21.6%) patients with a median (interquartile range) door to temperature control device time of 2.50 (2.03 to 2.75) hours, whereas the late door to temperature control device cohort included 272 (78.4%) patients with a median (interquartile range) door to temperature control device time of 5.18 (4.19 to 6.41) hours. In the multivariable logistic regression model, early door to temperature control device time was associated with improved good neurologic outcome and survival before [adjusted odds ratio (OR) (95% confidence interval) 2.36 (1.16 to 4.81) and 3.02 (1.54 to 6.02)] and after [adjusted OR (95% confidence interval) 1.95 (1.19 to 3.79) and 2.14 (1.33 to 3.36)] inverse probability of treatment weighting, respectively. In our study of OHCA patients, a shorter preinduction time for temperature control was associated with improved good neurologic outcome and survival. This finding may indicate that early initiation in the emergency department will confer benefit. Our findings are hypothesis generating and need to be validated in future prospective trials.

Identifying Subgroups with Differential Responses to Amiodarone among Cardiac Arrest Patients with a Shockable Rhythm at Hospital Arrival using the Machine Learning Approach.

There are few reports of studies on the differential effects of amiodarone among out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm at hospital arrival. The present study aimed to investigate the clinical heterogeneity of OHCA patients with a shockable rhythm upon hospital arrival and to identify subgroups with differential responses to amiodarone, using a machine learning approach. We used the Japanese nationwide OHCA registry of the Japanese Association for Acute Medicine for this study; data from OHCA patients with a shockable rhythm at hospital arrival were included in the analyses. The primary outcome was a favorable neurological outcome at 30 days. We developed a scoring system by the weighting method with logistic likelihood loss to identify patient subgroups showing differential effects of amiodarone from the point of view of the neurological outcome and survival at 30 days. Among the 68,111 cases of OHCA in the registry, the data of 2333 OHCA patients with an initial shockable rhythm at hospital arrival were analyzed. The developed score identified higher age, longer interval between the call to the emergency medical service and hospital arrival, absence of a "witness", no defibrillation prior to hospital arrival, hypothermia at hospital arrival, and pre-hospital epinephrine administration as variables that were significantly associated with a beneficial effect of amiodarone. Based on the results of the developed scoring system, 47% (1107/2333) of the patients were considered to greatly benefit from amiodarone administration, whereas 53% (1226/2333) of patients were considered to not benefit from amiodarone administration. The effect of amiodarone on the neurological outcome at 30 days varied significantly among the subgroups identified by the developed score ( : 1.07 [95% confidence interval (CI): 0.99-1.13], p = 0.005). We successfully developed a model that could discriminate between OHCA patients with an initial shockable rhythm at hospital arrival who would benefit or not benefit from the administration of amiodarone in terms of the neurological outcome at 30 days. There was clinical heterogeneity among OHCA patients with a shockable rhythm in terms of their response to amiodarone.

Implementing debriefing after cardiac arrest: benefits and challenges.

Healthcare professionals, including nurses, will be involved in the care and management of patients in cardiac arrest. This highly stressful and demanding situation can lead to breakdowns in communication, difficulty in decision-making and emotional distress for members of the healthcare team. Debriefing is a recommended tool that team members can use to acknowledge what went well, what could be improved and areas for learning or development. However, debriefing is often not prioritised due to pressures in clinical practice. This article discusses the benefits of debriefing and outlines some of the approaches and tools that may be used. The author argues that by recognising the importance of debriefing after cardiac arrests in the hospital setting and committing to best practices, nurses can be better prepared for the challenges of resuscitation and improve patient outcomes.