Cardiac Arrest Rates Research Articles

Abstract 398: Magnitude and Impact of Underutilization of Flu Vaccine in High-Risk US Cohorts on Cardiovascular Events

Background: Influenza vaccination has been shown to reduce myocardial infarction(MI) and other cardiac events. Several groups are considered at high risk for influenza and its complications. In this study, we explored the utilization and impact of flu vaccination in these high risk groups on various cardiovascular outcomes. Methods: Our retrospective cohort study compared utilization and outcomes in high risk groups among those who did receive vaccination during hospitalization versus those who did not. We analyzed utilization and impact of flu vaccine in several high-risk group identified by Center for Disease Control (CDC) i.e., adults 50 years and older, people with chronic medical conditions, AIDS patients, people at nursing facilities, American Indians and Alaskan natives, and obese people in the 2014 National Inpatient Sample Database. Results: The NIS database revealed 168,325 flu vaccinations among the 7,056,314 total high risk patients during hospitalization. Of note, the adults 50 years and older high risk cohort was less likely to be vaccinated during hospitalization at 1.8% compared to the general population at 15.3%. High risk groups benefited with flu vaccination and had reduced risk of MI, mortality, transient ischemic attacks (TIA) and cardiac arrest (Table). Conclusion: Flu vaccination was paradoxically underutilized in the high-risk patients and when used was associated with reduced rates of MI, TIA and cardiac arrest in all high risk cohorts compared to those who did not receive vaccination. These results underscore the need for health care policy initiatives to optimize flu vaccination among all patients and especially among high risk groups identified by the CDC.

Risk Factors for Peri-Intubation Cardiac Arrest in Pediatric Cardiac Intensive Care Patients: A Multicenter Study.

Endotracheal intubation is associated with hemodynamic adverse events, including cardiac arrest, especially in patients with cardiac disease. There are only a few studies that have evaluated the rate of and risk factors for endotracheal intubation hemodynamic complications in critically ill pediatric patients. Although some of these studies have assessed hemodynamic complications during intubation in pediatric cardiac patients, the frequency of and risk factors for peri-intubation cardiac arrest have not been adequately described in high acuity cardiac patients. This study aims to describe the frequency of and risk factors for peri-intubation cardiac arrest in critically ill pediatric cardiac patients admitted to specialized cardiac ICUs. Multicenter retrospective cohort study. Three pediatric cardiac ICUs in the United States. Critically ill pediatric patients with congenital or acquired heart disease requiring endotracheal intubation. None. Endotracheal intubations performed in three cardiac ICUs between January 2015 and December 2017 were reviewed. Clinical variables-including data on patients, clinical providers, and procedure-were evaluated for their association with peri-intubation cardiac arrest. There was a total of 186 intubation events studied, occurring in 151 individual (index) patients. The rates of peri-intubation cardiac arrest and peri-intubation mortality in this cohort were 7% and 1.6%, respectively. Among those patients with moderate or severe systolic dysfunction of the systemic ventricle, peri-intubation cardiac arrest rate was 20.7%. Statistically significant risk factors for peri-intubation cardiac arrest included: significant systolic dysfunction of the systemic ventricle, pre-intubation hypotension, pre-intubation lactate elevation, lower pre-intubation pH, and documented oxygen desaturations (> 10%) during intubation procedure. Our most significant finding was a peri-intubation cardiac arrest rate which was much higher than previously published rates for both cardiac and noncardiac children who underwent endotracheal intubation in ICUs. Peri-intubation mortality was also high in our cohort. Regarding risk factors for peri-intubation arrest, significant systolic dysfunction of the systemic ventricle was strongly associated with cardiac arrest in this cohort.

Sudden death and cardiac arrest in marathon runners: incidence rates and causes

Introduction: The marathon race is an aerobic sport that requires high training volume. Marathon runners may eventually be exposed to unfavorable environmental conditions associated with changes in blood volume and hydration level that may increase the risk of cardiac arrhythmias that can cause cardiac arrest and sudden death. Objective: To identify the existing life risks for marathon runners related to the occurrences of sudden death and cardiac arrest and the most prevalent causes of these events. Methods: Integrative literature review of descriptive-qualitative nature in the databases: Google, Academic Google, Medline, Scielo and Pubmed. Results: Sudden death incidence rates ranged from 0.75 to 2.0 per 100.000 runners while cardiac arrest rates ranged from 1.01 to 2.6 per 100.000 runners being men most susceptible to these events. Among the causes of sudden death and cardiac arrest, studies indicate that in older athletes (age > 45 years) coronary artery disease (CAD) is the most prevalent and in younger athletes (age < 45 years) structural and congenital causes are the most common as hypertrophic cardiomyopathy. Most of the events of sudden death and cardiac arrest occurred in the last quartile of the race or after the finish line. Conclusion: The risks of sudden death and cardiac arrest in marathons are low and higher in men being coronary artery disease and hypertrophic cardiomyopathy the most prevalent causes of these events.Keywords: sudden, death, sudden cardiac death, hypertrophic cardiomyopathy, exercise, heart arrest.

GSTM3 variant is a novel genetic modifier in Brugada syndrome, a disease with risk of sudden cardiac death.

BackgroundBrugada syndrome (BrS) is a rare inherited disease causing sudden cardiac death (SCD). Copy number variants (CNVs) can contribute to disease susceptibility, but their role in Brugada syndrome (BrS) is unknown. We aimed to identify a CNV associated with BrS and elucidated its clinical implications.MethodsWe enrolled 335 unrelated BrS patients from 2000 to 2018 in the Taiwanese population. Microarray and exome sequencing were used for discovery phase whereas Sanger sequencing was used for the validation phase. HEK cells and zebrafish were used to characterize the function of the CNV variant.FindingsA copy number deletion of GSTM3 (chr1:109737011-109737301, hg38) containing the eighth exon and the transcription stop codon was observed in 23.9% of BrS patients versus 0.8% of 15,829 controls in Taiwan Biobank (P < 0.001), and 0% in gnomAD. Co-segregation analysis showed that the co-segregation rate was 20%. Patch clamp experiments showed that in an oxidative stress environment, GSTM3 down-regulation leads to a significant decrease of cardiac sodium channel current amplitude. Ventricular arrhythmia incidence was significantly greater in gstm3 knockout zebrafish at baseline and after flecainide, but was reduced after quinidine, consistent with clinical observations. BrS patients carrying the GSTM3 deletion had higher rates of sudden cardiac arrest and syncope compared to those without (OR: 3.18 (1.77–5.74), P<0.001; OR: 1.76 (1.02–3.05), P = 0.04, respectively).InterpretationThis GSTM3 deletion is frequently observed in BrS patients and is associated with reduced INa, pointing to this as a novel potential genetic modifier/risk predictor for the development of the electrocardiographic and arrhythmic manifestations of BrS.FundingThis work was supported by the Ministry of Science and Technology (107-2314-B-002-261-MY3 to J.M.J. Juang), and by grants HL47678, HL138103 and HL152201 from the National Institutes of Health to CA.

Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery.

Early extubation following pediatric cardiac surgery is common, but debate exists whether location affects outcome, with some centers performing routine early extubations in the operating room (odds ratio) and others in the cardiac ICU. We aimed to define early extubation practice variation across hospitals and assess impact of location on hospital length-of-stay and other outcomes. Secondary analysis of the Pediatric Cardiac Critical Care Consortium registry. Twenty-eight Pediatric Cardiac Critical Care Consortium hospitals. Patients undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 1-3 operations between August 2014 and February 2018. None. We defined early extubation as extubation less than 6 hours after postoperative admission. Hospitals were categorized based on the proportion of their early extubation patients who underwent an odds ratio extubation. Categories included low- (< 50% of early extubation, n = 12), medium- (50%-90%, n = 8), or high- (> 90%, n = 8) frequency odds ratio early extubation centers. The primary outcome of interest was postoperative hospital length-of-stay. We analyzed 16,594 operations (9,143 early extubation, 55%). Rates of early extubation ranged from 16% to 100% across hospitals. Odds ratio early extubation rates varied from 16% to 99%. Patient characteristics were similar across hospital odds ratio early extubation categories. Early extubation rates paralleled the hospital odds ratio early extubation rates-77% patients underwent early extubation at high-frequency odds ratio extubation centers compared with 39% at low-frequency odds ratio extubation centers (p < 0.001). High- and low-frequency odds ratio early extubation hospitals had similar length-of-stay, cardiac arrest rates, and low mortality. However, high-frequency odds ratio early extubation hospitals used more noninvasive ventilation than low-frequency hospitals (15% vs. 9%; p < 0.01), but had fewer extubation failures (3.6% vs. 4.5%; p = 0.02). Considerable variability exists in early extubation practices after low- and moderate-complexity pediatric cardiac surgery. In this patient population, hospital length-of-stay did not differ significantly between centers with different early extubation strategies based on location or frequency.

Traditional versus blended CPR training program: A randomized controlled non-inferiority study

Cardiopulmonary resuscitation (CPR) training and its quality are critical in improving the survival rate of cardiac arrest. This randomized controlled study investigated the efficacy of a newly developed CPR training program for the public in a Taiwanese setting. A total of 832 adults were randomized to either a traditional or blended (18-minute e-learning plus 30-minute hands-on) compression-only CPR training program. The primary outcome was compression depth. Secondary outcomes included CPR knowledge test, practical test, quality of CPR performance, and skill retention. The mean compression depth was 5.21 cm and 5.24 cm in the blended and traditional groups, respectively. The mean difference in compression depth between groups was −0.04 (95% confidence interval −0.13 to infinity), demonstrating that the blended CPR training program was non-inferior to the traditional CPR training program in compression depth after initial training. Secondary outcome results were comparable between groups. Although the mean compression depth and rate were guideline-compliant, only half of the compressions were delivered with adequate depth and rate in both groups. CPR knowledge and skill retained similarly in both groups at 6 and 12 months after training. The blended CPR training program was non-inferior to the traditional CPR training program. However, there is still room for improvement in optimizing initial skill performance as well as skill retention. Clinical Trial Registration: NCT03586752; www.clinicaltrial.gov

Cardiac sarcoidosis and ventricular arrhythmias. A rare association of a rare disease. A retrospective cohort study from the National Inpatient Sample and current evidence for management.

Sarcoidosis is an increasingly recognized multi-systemic condition. Cardiac sarcoidosis is associated with ventricular arrhythmias and higher mortality rates. Little epidemiological data is available regarding the disease and associated ventricular arrhythmias. Data from the National Inpatient Sample (NIS) database 2012-2014, were reviewed. Dis-charges associated with sarcoidosis were identified as the target population using relevant ICD-9-CM codes. Primary outcome was a diagnosis of ventricular tachycardia (VT) in the sarcoidosis population. Secondary outcomes include rate of ventricular fibrillation (VF) and cardiac arrest. Subgroup analyses were performed to examine the association of VT with multiple potential confounding clinical variables. Of 18,013,878 health encounters, 46,289 (0.26%) subjects had a diagnosis of sarcoidosis. VT and VF were more prevalent among patients with sarcoidosis compared to those without a diagnosis of sarcoidosis (2.29% vs. 1.22%; p < 0.001 and 0.25% vs. 0.21%; p < 0.001, respectively). Sarcoidosis was also associated with a higher prevalence of cardiac arrest (0.72% vs. 0.6%; p < 0.001). In unadjusted analyses, all examined comorbidities were significantly more common in those with sar-coidosis, including diabetes mellitus (31.6% vs. 21.25%; p < 0.001), hypertension (65.2% vs. 51.74%; p < 0.001), chronic kidney disease (21.09% vs. 14.02%; p < 0.001), heart failure (24.87% vs. 15%; p < 0.001) and acute coronary syndrome (4.32% vs. 3.35%; p < 0.001). The present study showed that sarcoidosis was associated with increased rates of ven-tricular tachyarrhythmia, which can affect the overall disease morbidity and mortality.

Cardiovascular Health in the COVID-19 Era: A Call for Action and Education

Cardiovascular Health in the COVID-19 Era: A Call for Action and Education

Combination of eosinophil percentage and high-sensitivity C-reactive protein predicts in-hospital major adverse cardiac events in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

BackgroundEosinophil levels predict prognosis in ST‐segment elevation myocardial infarction (STEMI) patients. Both eosinophils and high‐sensitivity C‐reactive protein (hs‐CRP) play a major role in the acute inflammatory response of myocardial infarction. The purpose of this study was to evaluate eosinophil percentage (EOS%) and hs‐CRP as prognostic markers for in‐hospital adverse events in STEMI patients undergoing primary percutaneous coronary intervention.MethodsWe retrospectively analyzed the clinical data of 518 patients. Major adverse cardiac events (MACEs) were defined as cardiac rupture, cardiac arrest, malignant arrhythmia, and cardiac death. Based on the receiver operating characteristic (ROC) analysis, all patients were regrouped into 3 groups (None, One, and Two) according to cutoff EOS% value (≤0.3%) and hs‐CRP value (>11.8 mg/L). Both Cox regression analyses and the KM (Kaplan‐Meier) survival curve were used to examine the prognostic role of combined hs‐CRP and EOS% in cardiovascular events.ResultsOf the 518 STEMI patients, 50 of them developed MACEs. Patients who developed MACEs had a significantly lower EOS% and higher hs‐CRP than patients who remained MACE‐free. In the multivariable Cox regression analysis, the highest risk of in‐hospital MACEs was constantly observed in patients with a combined low EOS% and elevated hs‐CRP. Patients with reduced EOS% and high hs‐CRP had significantly higher incidence rates of cardiac rupture (P = .001), cardiac arrest (P = .001), and malignant arrhythmia (P < .001); furthermore, they had the worst cumulative survival compared with the other two groups.ConclusionCombined reduced EOS% and elevated hs‐CRP were valuable tools for identifying patients at risk of in‐hospital MACEs.

In-hospital outcomes of splanchnic vein thrombosis including Budd Chiari syndrome associated with GI malignancies.

e16503 Background: Patients with gastrointestinal (GI) malignancies are at increased risk of developing splanchnic vein thrombosis (SVT). However, there is a dearth of information about the epidemiology of splanchnic vein thrombosis associated with specific GI malignancies. We sought to compare the differences in hospitalizations and mortality related to SVT among various GI malignancies. Methods: We included the top three discharge diagnoses to identify cases of splanchnic vein thrombosis (portal/mesenteric/hepatic and splenic vein thrombosis) along with a secondary diagnosis of a GI malignancy, namely esophagus, gastric, hepatic, colorectal, pancreatic and cholangiocarcinoma within the 2010-2014 Nationwide Inpatient Sample (NIS). Outcomes including mortality, hospitalization charges and length of stay were compared for different types of GI malignancies for SVT hospitalizations using the chi-square test. Complications related to SVT were also identified. Data was analyzed using STATA 15. Results: There were 320,804 total weighted admissions for SVT, of which 33,556 or 11.6% occurred in patients with GI malignancies. Hepatic cancer was the most common GI malignancy associated with SVT, responsible for 5.1% of all cases, followed by pancreatic cancer (2.76% cases). Hepatic vein thrombosis was the commonest type of SVT occurring in patients with GI malignancy. Hospitalizations for SVT in GI malignancies increased from 5743 in 2010 to 8415 in 2014, representing an increase of 46% over 5 years. On univariate analysis, patients with esophageal cancer and SVT had higher rates of cardiac arrest (3.5% vs 0.7% average for other cancers, p = 0.03), but there were no significant differences in rates of other complications studied including intracranial hemorrhage, requirement for blood transfusion, mechanical ventilation or variceal bleeding. Inpatient mortality rate for admission with SVT was the highest for esophageal cancer (21.1%), followed by gastric cancer (17%) against an average of 9.3% for all GI malignancies (p &lt; 0.05).The median cost of an admission for a patient with SVT were highest for esophageal cancer $102,452, followed by colorectal cancer ($97,491) and the least for hepatic cancer ($67,007). Conclusions: We found that hospitalizations for splanchnic vein thrombosis in patients with GI related malignancies has been steadily increasing and represent a significant burden. Hospitalizations for SVT in esophageal, gastric and colorectal cancer patients bear poorer outcomes as compared to hepatic cancer.

Exploratory Analyses of Cerebral Gray Matter Volumes After Out-of-Hospital Cardiac Arrest in Good Outcome Survivors.

BackgroundSurvival rates of cardiac arrest have increased over recent years, however, survivors may still be left with significant morbidity and functional impairment. A primary concern in cardiac arrest survivors is the effect of prolonged hypoxia/ischemia on the brain. The objectives of the present study were threefold: (1) to explore the effect of cardiac arrest on brain gray matter volumes (GMV) in “good outcome” survivors of out-of-hospital cardiac arrest (OHCA), (2) to examine the relationship between GMV, cognitive functioning and arrest factors, and (3) to explore whether OHCA patients differ from a group of patients with myocardial infarction (MI) uncomplicated by cardiac arrest and a group of healthy controls in terms of GMV.MethodsMedically stable OHCA survivors with preserved neurological function and who were eligible for magnetic resonance imaging scanning (MRI; n = 9), were compared to: (1) patients who had experienced a MI (n = 19) and (2) healthy controls (n = 12). Participants underwent brain MRI on a 3T Siemens Trio MRI scanner and GMV was measured by voxel-based morphometry. A comprehensive neuropsychological assessment was also conducted. Global GMV was compared in the three samples using analyses of variance. The relationships between cognition and GMV were examined within group using correlations.ResultsThe OHCA and MI groups showed a similar pattern of differences compared to the healthy control group. Both groups had decreased GMV in the anterior cingulate cortex, bilateral hippocampus, right dorsolateral prefrontal cortex, right putamen, and bilateral cerebellum. There were no significant differences in global or regional GMV between the OHCA and MI groups. Cognitive functioning was correlated with global GMV in the OHCA group; no such correlation was observed in the MI group.ConclusionRegional atrophy was observed in OHCA and MI survivors, compared to a healthy control group, suggesting a common mechanism, presumably preexisting cardiovascular disease. Although similar regional volume differences were observed between the MI and OHCA groups, the relationship between GMV and cognition was only observed in OHCA survivors. We suggest the acute hypoxia/ischemia ensuing from the arrest may interact with diminished neural reserve in select brain areas to expose occult cognitive dysfunction.

Reducing Cardiac Arrests in the PICU: Initiative to Improve Time to Administration of Prearrest Bolus Epinephrine in Patients With Cardiac Disease.

To evaluate the effectiveness of a quality-improvement initiative in reducing cardiac arrests in infants and children in the cardiac ICU. Prospective observational before-after cohort study. Single pediatric cardiac ICU in the United Kingdom. All patients less than 18 years old admitted to the ICU. Initial interdisciplinary training in cardiac arrest prevention followed by clinical practice change whereby patients with high-risk myocardium were identified on daily rounds. High-risk patients had bolus epinephrine preordered and prepared for immediate administration in the event of acute hypotension. Interrupted time series analysis was used to compare the cardiac arrest rate in the 18 months before and 4.5 years after implementation. Mean monthly cardiac arrest rate was 17.2 per 1,000 patient days before and 7.6 per 1,000 patient days after the initiative (56% decrease). Patient characteristics and ICU interventions were similar in the control and intervention periods. In the time series analysis, monthly cardiac arrest rate in the ICU decreased by 12.4 per 1,000 patient days (95% CI, -1.5 to -23.3; p = 0.03) immediately following the intervention, followed by a nonsignificant downward trend of 0.36 per 1,000 patient days per month (95% CI, -1.3 to 0.6; p = 0.44). Bolus epinephrine was administered during 110 hypotension events in 77 patients (eight administrations per 1,000 ICU days); responder rate was 77%. There were no significant changes in ICU and hospital mortality. Implementation of the initiative led to a significant, sustained reduction in ICU cardiac arrest rate.

Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock

There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias - atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital mortality, and resource utilization in cohorts with and without arrhythmias. Of the 420,319 admissions with AMI-CS during 2000 to 2016, arrhythmias were noted in 213,718 (51%). AF (45%), ventricular tachycardia (35%) and ventricular fibrillation (30%) were the most common arrhythmias. Compared with those without, the cohort w`ith arrhythmias was more often male, of white race, with ST-segment elevation AMI-CS presentation, and had higher rates of cardiac arrest and acute organ failure (all p <0.001). Temporal trends of prevalence revealed a stable trend of atrial and ventricular arrhythmias and declining trend in AVB. The cohort with arrhythmias had higher unadjusted (42% vs 41%; odds ratio [OR] 1.03 [95% confidence interval 1.02 to 1.05]; p <0.001), but not adjusted (OR 1.01 [95% CI 0.99 to 1.03]; p = 0.22) in-hospital mortality compared with those without. The cohort with arrhythmias had longer hospital stay (9 ± 10 vs 7 ± 9 days; p <0.001) and higher hospitalization costs ($124,000 ± 146,000 vs $91,000 ± 115,000; p <0.001). In the cohort with arrhythmias, older age, female sex, non-white race, higher co-morbidity, presence of acute organ failure, and cardiac arrest, predicted higher in-hospital mortality. In conclusion, cardiac arrhythmias in AMI-CS are a marker of higher illness severity and are associated with greater resource utilization.

Prevention strategies for traumatic cardiac arrest

The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis.

Objective: The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator.Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival.Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13–0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06–0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46–0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34–0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33–0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total.Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.

Temporal Trends and Outcomes of Transcatheter versus Surgical Aortic Valve Replacement in Patients with Prior Myocardial Infarction

ABSTRACT Background : There is a paucity of data regarding the comparative safety and effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior myocardial infarction (MI). Methods : We queried the NIS database (2012–2016) to identify patients with a prior history of MI who underwent isolated AVR. We conducted a propensity matching analysis comparing patients with TAVR versus SAVR based on patient demographics, comorbidities and hospital characteristics. The primary outcome was in-hospital mortality. Results : Among 24,090 hospitalizations with prior MI undergoing isolated AVR, 58.5% underwent TAVR. Over the study period, there was an increase in the proportion of patients undergoing TAVR and a decrease in patients undergoing SAVR (Ptrend<0.001). After propensity matching, in-hospital mortality was not different between TAVR and SAVR (odds ratio 1.07; 95% confidence interval 0.85–1.33). Compared with SAVR, TAVR was associated with lower rates of cardiac arrest, cardiogenic shock, acute kidney injury, respiratory complications, postoperative bleeding, blood transfusion, acute stroke, vascular complications and shorter length of stay. TAVR was associated with a higher incidence of complete heart block and pacemaker implantation. Conclusion : In this nationwide observational study, there has been a steady increase in the number of TAVRs performed in patients with prior MI. Compared with SAVR, TAVR was associated with similar in-hospital mortality and a lower rate of complications and length of stay.

The effectiveness of a focused rapid response team on reducing the incidence of cardiac arrest in the general ward.

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.

Association of left anterior descending artery involvement on clinical outcomes among patients with STEMI presenting with and without out-of-hospital cardiac arrest

BackgroundST-segment elevation myocardial infarction (STEMI) outcomes are influenced by the location of the culprit vessel with worse outcomes portended with a left anterior descending (LAD) culprit lesion. However, relatively little...

553 Smoke but No Fire: Increased MINOCA and Takotsubo Acute Coronary Syndromes in the Australian Bushfires

The 2020 Australian bushfires led to declaration of a state of emergency in multiple states. Concerns have previously been raised that smoke exposure may trigger increased rates of acute coronary syndrome, Takotsubo (stress) cardiomyopathy, and cardiac arrest. Our hospital is a major tertiary receiving hospital for Albury-Wodonga and East Gippsland, two areas most affected by the 2019/2020 bushfires. We performed a case-control analysis of acute coronary syndrome patients transferred from these regions between 29th December 2019 to 10th January 2020. Cases were compared to acute coronary syndrome cases in the identical date range from the two years prior. 11 patients were transferred from the bushfire-affected regions, representing an increase of 24.5% in case volume from previous years. All bushfire-affected patients had chest pain and elevated troponin level, with median troponin value 1,271ng/L (interquartile range 546 - 6,807ng/L, normal <16ng/L). In comparison with the control group, bushfire-affected patients were more commonly female (45.5% from bushfire areas vs 14.8% in the control group, p=0.044) and received a diagnosis of myocardial infarction with normal coronaries (MINOCA) or Takotsubo cardiomyopathy (45.5% vs 7.4%, p=0.021). There was no difference between groups in median age, presence of smoking history, median number of cardiovascular risk factors, median troponin level, or electrocardiogram appearance. Our experience demonstrates that the greatest increase in case volume was in middle-aged females (median age 62.4 years) experiencing either a MINOCA event or Takotsubo cardiomyopathy in the context of high levels of community stress.

Cardiac arrest during hemodialysis: a survey of five Japanese hospitals.

AimIntraprocedural cardiac arrest is a serious complication among patients receiving hemodialysis. However, the frequency and reaction to these events remain unclear. This study aimed to explore the clinical picture of cardiac arrest during hemodialysis.MethodsTen cardiac arrests that had occurred during 217,984 hemodialysis treatments in five Japanese hospitals, between 2008 and 2017, were reviewed. We investigated the underlying disease, vital signs, emergency responses, and outcomes using patient medical records.ResultsThe cardiac arrest rate ranged from 1.1 to 7.5 per 100,000 hemodialysis sessions. All included cases of cardiac arrest occurred in a hemodialysis unit and had been witnessed and reported by supervising clinicians. The initial rhythm was ventricular fibrillation/ventricular tachycardia in six patients (60%) and pulseless electrical activity/asystole in four patients (40%). Seven (70%) patients showed a return of spontaneous circulation (ROSC), and two (20%) patients were discharged with a cerebral performance category score of 1. There was a statistically significant difference in the ROSC rate (P = 0.048) only in the event of an emergency call. The SpO2 and respiratory rates had not been recorded in six patients. There was no significant difference in ROSC between initial rhythms of ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole.ConclusionWe evaluated the frequency of cardiac arrest during hemodialysis. Overall assessment including respiratory status is needed at initiation of hemodialysis. In case of a sudden change in a patient’s status, high‐quality resuscitation treatment that includes an emergency call can improve prognosis.