Duration Of CPR Research Articles

Successful Pre-Rewarming Resuscitation after Cardiac Arrest in Severe Hypothermia: A Retrospective Cohort Study from the International Hypothermia Registry.

The aim of our study is to investigate successful pre-rewarming resuscitation after hypothermic cardiac arrest (HCA). The hypothermic heart may be insensitive to defibrillation when core temperature is below 30 °C and after successful defibrillation, sinus rhythm often returns into ventricular fibrillation. Recurrent defibrillation attempts may induce myocardial injury. Discrepancy exists concerning pre-rewarming defibrillation between the guidelines of the European Resuscitation Council and American Heart Association. The International Hypothermia Registry (IHR) gathers hypothermia cases. The primary outcome was survival. Secondary outcomes were the characteristics of defibrillation, the effect of Adrenaline administration under 30 °C, and the duration of CPR. Of the 239 patients, eighty-eight were in cardiac arrest at arrival of the rescue team. Successful pre-rewarming resuscitation was obtained in 14 patients. The outcome showed: seven deaths, one vegetative state, two patients with reversible damage, and four patients with full recovery. A total of five patients had a shockable rhythm, and defibrillation was successful in four patients. The response rate to Adrenaline was reported as normal in six patients. There were no statistically significant differences in the presence of a shockable rhythm, the success of defibrillation, and the effect on Adrenaline administration between the survivors and non-survivors. Successful resuscitation in severe hypothermia is possible before active rewarming and arrival in the hospital, thus improving the chance of survival.

Impact of cardiopulmonary resuscitation duration on the neurological outcomes of out-of-hospital cardiac arrest

BackgroundPatients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.ObjectivesThe study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.MethodsThis is a quantitate cross-sectional study where data is collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between January 2015 and December 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death. The outcome is the survival of OHCA or death, and the neurological outcome by the cerebral performance category (CPC) score for survivors. A score of 1 or 2 defined as good CPC outcome and 3, 4, and 5 as poor outcome.ResultsThe mean for the duration of emergency CPR procedures in surviving patients is 26.5 ± 7.20 min, whereas in patients who died after the procedure it is 29.6 ± 9.15 min. Bivariate analysis showed no significant association between duration of CPR and Cerebral Performance Category (CPC) outcome but could be significant if the sample size is large. Age, however, is significantly related to the survivorship of OHCA and to a better CPC outcome. Younger patients are more likely to have better CPC outcome. A good CPC outcome was reported with a limited duration of 8.1 min of CPR, whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min.ConclusionCardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Variables such as the patient population's uniqueness, underlying medical conditions, or the specific study conditions may explain this variance between the bivariate analysis and the study conclusion. Therefore, a more comprehensive study is recommended in future.

Predictors of Survival and Favorable Neurologic Outcome in Patients Treated with eCPR: a Systematic Review and Meta-analysis.

Extracorporeal cardiopulmonary resuscitation (eCPR) can improve survival in selected patients with cardiac arrest (CA). In this meta-analysis, we evaluated factors associated with short-term survival and favorable neurologic outcome (FNO) post-eCPR. In June 2019, we systematically searched electronic databases for studies reporting on survival and predictors associated with short-term survival or FNO post-eCPR using multivariable analysis. We meta-analyzed outcomes and predictors using the inverse variance method with a random-effects model. We identified 92 studies with 13 factors amenable to meta-analysis. Pooled short-term survival and FNO were 25% and 16% respectively. Lower lactate, return of spontaneous circulation, shockable rhythm, shorter CPR duration, baseline pH, shorter low-flow time, and history of hypertension were significantly associated with short-term survival. In addition, shockable rhythm, lower lactate, and use of targeted temperature management were associated with FNO. The identified factors associated with short-term survival and FNO post-eCPR could guide prognosis prediction at the time of CA.

Survival to Discharge Rate and Favorable Neurological Outcome Related to Gender, Duration of Resuscitation and First Document of Patients In-Hospital Cardiac Arrest: A Systematic Meta-Analysis.

To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA). The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6th, 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive meta-analysis (CMA) software version 2.0. The finding's heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test, sensitivity analysis test, funnel plot, and Eagger's regression test were used. Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration <15min, and shockable dysrhythmias. IHCA outcomes are poor in developing countries. The outcomes of IHCA in terms of gender were inconsistent with the result reported by other meta-analyses.

Impact of Cardiopulmonary Resuscitation Duration on Survival of Out-of-Hospital Cardiac Arrest

Background: Patients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative outcomes. Cardiopulmonary resuscitation duration affects survival of such patients, which suggests that duration of CPR may be vital to patient outcomes. Objectives: The study aims to evaluate the impact of cardiopulmonary resuscitation duration on survival of patients who have suffered out-of-hospital cardiac arrest.

Predictors of 30-day mortality after ACS complicated with OHCA in non-city areas

The management of acute coronary syndrome (ACS) complicated with out-of-hospital cardiac arrest (OHCA) remains challenging, particularly in non-city areas ( Fig. 1 ). The implementation of appropriate treatment strategies for improving pre-hospital emergency care is fundamental. Little is known about the resuscitation performances of emergency medical service (EMS) teams in sparsely populated areas. Built at the top of a hill, the location of our institution consists of rural areas with a low population density. Established in 1903, the hospital was initially founded to treat patients suffering from tuberculosis. To identify parameters influencing the 30-day outcome after sudden coronary death in non-city areas. Retrospective single-centre study including 40 patients resuscitated from OHCA after ACS. Resuscitation settings, time intervals, blood samples, cardiac findings and clinical outcomes at 30 days were analyzed. 30-day mortality was more likely associated with the following parameters: unwitnessed collapse, km, NF/LF duration, epinephrine dose, time to cath lab, gender, asystole, recurrent cardiac arrest, shock, lactate level, LVEF and LAD culprit lesion. Particularly, remoteness from hospital and prolonged pre-hospital management (duration of CPR, delayed cath lab admission) were predictors of early mortality ( Table 1 ). Remoteness from hospital, duration of resuscitation on-site and time to cath lab admission may represent major determinants of clinical outcomes beyond the usual prognostic factors. The relationship between early mortality and duration of NF, non-shockable rhythm, hemodynamic instability and lactate level may reflect the impact of prolonged time intervals during the pre-hospital phase of management. EMS teams should focus on improving pre-hospital response times and optimizing cardiac cath lab activation. Further RCTs should evaluate the impact of the ‘scoop and run’ approach versus the ‘stay and play’ approach in this setting.

Biomarkers associated with mortality in pediatric patients with cardiac arrest and acute respiratory distress syndrome

AimsTo identify plasma biomarkers associated with cardiac arrest in a cohort of children with acute respiratory distress syndrome (ARDS), and to assess the association of these biomarkers with mortality in children with cardiac arrest and ARDS (ARDS + CA). MethodsThis was a secondary analysis of a single-center prospective cohort study of children with ARDS from 2014-2019 with 17 biomarkers measured. Clinical characteristics and biomarkers were compared between subjects with ARDS + CA and ARDS with univariate analysis. In a sub-cohort of ARDS + CA subjects, the association between biomarker levels and mortality was tested using univariate and bivariate logistic regression. ResultsBiomarkers were measured in 333 subjects: 301 with ARDS (median age 5.3 years, 55.5% male) and 32 ARDS + CA (median age 8 years, 53.1% male). More arrests (69%) occurred out-of-hospital with a median CPR duration of 11 (IQR 5.5, 25) minutes. ARDS severity, PRISM III score, vasoactive-ionotropic score and extrapulmonary organ failures were worse in the ARDS + CA versus ARDS group. Eight biomarkers were elevated in the ARDS + CA versus ARDS cohort: sRAGE, nucleosomes, SP-D, CCL22, IL-6, HSP70, IL-8, and MIP-1b. sRAGE, SP-D, and CCL22 remained elevated when the cohorts were matched for illness severity. When controlling for severity of ARDS and cardiac arrest characteristics, sRAGE, IL-6 and granzyme B were associated with mortality in the ARDS + CA group. ConclusionsRAGE, IL-6 and granzyme B were associated with cardiac arrest mortality when controlling for illness severity. sRAGE was consistently higher in the ARDS + CA cohort compared to ARDS and retained independent association with mortality.

Clinical Characteristics of Intraoperative Cardiac Arrest During Cancer Surgery

Purpose: Intraoperative cardiac arrest (IOCA) is rare, unpredictable, and may result in a poor outcome. The features of IOCA during cancer surgery and factors related to survival following an IOCA were examined.Methods: This was a retrospective study of patients who had cancer surgery under general anesthesia between March 2009 and March 2021 (&lt;i&gt;n&lt;/i&gt; = 84,615) to determine the number of patients who had an IOCA. Patients’ clinical information, cause of IOCA, hypoxemia during anesthesia, and the duration of hypotension and CPR were analyzed.Results: A total of 22 cases of IOCA occurred during cancer surgery (overall incidence: 2.6 per 10,000 surgeries). Return of spontaneous circulation was achieved in 17 patients, but only 13 survived until discharge. There were statistically significant differences between the deceased and the survival cancer patient groups in; (1) duration of hypoxemia (survival group: 5 minutes, range: 2-18 minutes; deceased group: 60 minutes, range, 22.5-120 minutes; &lt;i&gt;p&lt;/i&gt; = 0.019); (2) duration of hypotension (survival group: 35 minutes, range, 15-55 minutes; deceased group 160 minutes, range, 140-185 minutes; &lt;i&gt;p&lt;/i&gt; = 0.007); and (3) total duration of CPR (survival group: 3 minutes, range: 1-15 minutes; deceased group: 40 minutes, range: 19-149 minutes; &lt;i&gt;p&lt;/i&gt; = 0.005).Conclusion: The duration of hypoxemia and hypotension prior to the onset of IOCA, as well as the duration of CPR were associated with the prognosis of IOCA, highlighting the need to reduce multiorgan damage caused by hypoxemia and hypotension during surgery in high-risk patients.

Code blue: Predictors of survival.

Background and Aims:Code blue is a rapid response system developed for emergency resuscitation and stabilization of any sudden cardiac arrest (SCA) within a hospital. Literatures on outcome and factors predicting mortality from SCA in the Emergency departments (EDs) of India is scant.Material and Methods:This retrospective cohort study included all patients above the age of 15 years who had a code blue declared in the ED between the months of January 2018 and June 2019. Factors related to the sustained return of spontaneous circulation (ROSC) and mortality were analyzed using descriptive-analytic statistics and logistic regressions.Results:This study included 435 patients with a male predominance of 299 (69%). The mean age was 54.5 (SD - 16.5) years. Resuscitation was not attempted for 18 patients because of the terminal nature of the underlying disease. The majority were in-hospital cardiac arrests (74%). The nonshockable rhythm included pulseless electrical activity (PEA) (85.5%) and asystole (14.5%) cases. Shockable rhythms, that is, pulseless ventricular tachycardia/ventricular fibrillation were noted in only 10% (43/417) of cases. ROSC was attained in 184 (44.1%) patients, among which 56 (13.4%) were discharged alive from the hospital. Multivariate logistic regression analysis showed CPR >10 min (odds ratio [OR]: 13.58; 95% CI: 8.39–22.01; P < 0.001) and female gender (OR: 1.89; 95% CI: 1.13–3.17; P = 0.016) to be independent risk factors for failure to achieve ROSC in ED.Conclusion:The initial documented rhythm was nonshockable in the majority of the cases. CPR duration of more than 10 min and female gender were independent risk factors for failure to achieve ROSC in the ED. Nonshockable rhythms have a poorer outcomes than that of shockable rhythms.

Abstract 12398: Cardiopulmonary Resuscitation Duration Determines Phenotype of Post-Arrest Brain Injury

Introduction: Patients resuscitated from out-of-hospital cardiac arrest (OHCA) have variable severity of brain injury. Signatures of severe injury on brain imaging and EEG including diffuse cerebral edema and burst suppression with identical bursts (BSIB). Current therapies for these patterns of injury are inadequate and patient outcomes are poor. Hypothesis: We hypothesize distinct phenotypes of brain injury are associated with increasing CPR duration. Methods: We identified from our prospective registry OHCA patients treated between January 2010 to July 2019. We abstracted CPR duration, best neurological examination &lt; 6 hours from OHCA, initial brain CT grey-to-white ratio (GWR), and initial EEG pattern. We defined cerebral edema as GWR &lt;1.20. We defined BSIB according to American Clinical Neurophysiology Society guidelines. We considered four phenotypes on presentation: awake; comatose with neither BSIB nor cerebral edema; BSIB; and cerebral edema. BSIB and cerebral edema were considered as non-mutually exclusive outcomes. We compared duration of CPR across groups using Kruskal-Wallis tests with Bonferroni correction for multiple hypothesis testing. We report the probability of presenting phenotype at the median CPR duration for each group using local regression. Results: We included 2,721 patients, of whom 582 (21%) were awake, 1,428 (52%) had coma without BSIB or edema, 372 (14%) had BSIB and 356 (13%) had cerebral edema. Only 47 (2%) had both BSIB and edema. Median CPR duration was 16 [IQR 8-28] minutes overall. Median CPR duration increased in a stepwise manner across groups: awake 6 [3-12] minutes; comatose without BSIB or edema 16 [9-27] minutes; BSIB 21 [14-30] minutes; cerebral edema 32 [22-46] minutes (all P &lt;0.001). The probability of observing each phenotype at the median CPR duration for each was: awake (0.42); comatose without BSIB or edema (0.72); BSIB (0.34); cerebral edema (0.29). Conclusions: The brain injury phenotype is related to CPR duration, which is a surrogate for severity of ischemic injury. The sequence of most likely brain injury phenotype with progressively longer CPR duration is awake, coma without BSIB or edema, BSIB, and finally cerebral edema.

Abstract 14468: Machine-Learning Identifies Out-of-Hospital Cardiac Arrest Patients With Higher Probability of Survival While Undergoing Extracorporeal Cardiopulmonary Resuscitation

Introduction: Neurologically favorable survival following OHCA depends on many factors including patient age, presenting rhythm, bystander CPR, CPR duration, and return of spontaneous circulation (ROSC). This study aims to utilize machine learning to construct predictive models of neurologically favorable survival in OHCA patients receiving standard ACLS and extracorporeal cardiopulmonary resuscitation (ECPR). Methods: 3011 patients from the Amiodarone, Lidocaine, Placebo Study (ALPS) were analyzed using supervised and unsupervised machine learning approaches based on several variables available at the time of hospital presentation after OHCA. Machine learning platforms were developed to create real world predictive models of resuscitation. The model was then refined for 180 patients from the UMN-ECPR study with refractory VF/VT cardiac arrest who underwent ECPR. Resuscitative variables were selected and ranked on the likelihood ratio of predicting survival. Results: Machine learning analysis of the ALPS cohort yielded a model of survival with an area under the receiver-operating characteristic curve (AUC) of 0.92. ROSC, CPR duration and age were the highest determinants of neurologically favorable survival. The model was tested on the UMN-ECPR cohort, showing an AUC of 0.74 with a sensitivity and negative predictive value for survival of 12% and 60%, respectively. Machine learning was again used to render a model tailored for the UMN-ECPR group. The ECPR predictive algorithm had an AUC of 0.83, sensitivity and negative predictive value for survival of 70% and 80%, respectively, in which presenting rhythm to the cath lab, ROSC and CPR duration were the main determinants of neurologically favorable survival. Conclusion: Simple and effective predictive algorithms can predict the outcomes of cardiac arrest using only cardiac arrest characteristics. Use of ECPR changes the predictive determinants substantially. While this information is helpful in the appropriate context, the specificity required to withdraw care or halt resuscitation will require further data points and refinement.

Abstract 11034: Extracorporeal Life-Support for Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Study

Introduction: Despite promising survival and favorable neurological results in IHCA, the outcomes of ECLS for OHCA are more heterogeneous. The clinical setting for the survival and favorable neurological outcomes of ECLS in OHCA may differ from that in IHCA. Hypothesis: This study aimed to determine whether ECLS is associated with improved survival to hospital discharge with favorable neurological outcome compared to conventional cardiopulmonary resuscitation and identify in which OHCA patients the implementation of ECLS would be beneficial. Methods: The clinical outcome of OHCA treated by ECLS or CCPR between 2015 and 2020 was retrospectively investigated using KoCARC, a nationwide multicenter OHCA registry of Korea. Differences in baseline clinical characteristics were adjusted by matching propensity for ECLS. Primary outcome was 30-day survival with neurologically favorable status of cerebral performance category of 1 or 2. Restricted mean survival time (RMST) was used to compare outcome between groups. Result: Of 12,006 patients (mean age=71, male gender=65%) included, ECLS was performed in 272 patients (2.2%). In unadjusted analysis, the frequency of survival with favorable neurological status was higher in ECLS compared to CCPR (15% versus 7%, RMST 9.4 versus 3.8 days, p&lt;0.001). Subgroup analysis revealed that the benefit of ECLS was evident in high-risk groups including initial non-shockable rhythm or CPR duration≥20 min (p&lt;0.05, all). In analysis of propensity score-matched 271 pairs, there was no difference in the clinical outcome between ECLS and CCPR (15% versus 16%, RMST 9.4 versus 9.0 days, p=0.33), but ECLS was still better than CCPR in initial non-shockable rhythm or CPR duration≥20 min (p&lt;0.05, all). Conclusions: In this real-world data analysis, ECLS compared to CCPR did not result in better clinical outcome of OHCA in overall. However, ECLS might be beneficial for high-risk patients such as initial non-shockable rhythm or CPR duration≥20 min.

Abstract 14159: Characteristics and Outcomes in COVID-19 Pediatric In-Hospital Cardiac Arrest Patients

Introduction: Survival of adult patients with COVID-19 who had an in-hospital cardiac arrest (IHCA) are poor. Characteristics and outcomes for pediatric IHCA patients with COVID-19 are unknown. Hypothesis: We hypothesized that pediatric COVID-19 patients would have worse survival outcomes when compared to non-COVID patients. Methods: A multicenter, multinational cohort of pediatric IHCA in the pediRES-Q collaborative were reviewed (March 1, 2020 - April 1, 2021). We characterized patients with COVID-19 compared to patients without COVID-19 and investigated whether COVID-19 was associated with survival outcomes using multivariate logistic regression with mixed effects. Results: We identified 362 pediatric IHCAs of which 14 were COVID-19 positive. For non-COVID-19 vs COVID-19 patients respectively, median [Q1; Q3] age was 1.0 [0.3; 7.1] vs. 7.1 [1.5; 14.0] years and 42% vs. 43% were female. Immediate cause of arrest was hypotension: 8% vs. 43%, respiratory decompensation: 19% vs. 21%, and hypoxia 22% vs. 36% for non-COVID-19 vs. COVID-19 patients. For non-COVID-19 vs COVID-19 patients, total CPR duration was 10 [4; 33] min vs 19 [5; 33] min (for non-return of spontaneous circulation (ROSC) cases only: 35 [20; 55] min vs 34 [24; 34] min). For non-COVID-19 vs COVID-19 patients, ROSC was 79% vs. 57%, aOR: 0.48 (95% CI: 0.24-0.98), survival to hospital discharge was 45% vs. 29%, aOR: 0.63 (95% CI: 0.25-1.57) and survival with favorable neurological outcome was 39% vs. 21%, aOR: 0.51 (95% CI: 0.16-1.65). Conclusions: In a pediatric resuscitation quality improvement collaborative, pediatric IHCA patients with COVID-19 were older when compared to non-COVID-19 patients. Median CPR duration was &gt;30 minutes for COVID-19 non-survivors, COVID-19 patients had lower chance of ROSC when compared to non-COVID-19 patients but considerably better survival outcomes than those reported for adults.

Abstract 11822: Comparison of Outcome of Cardiopulmonary Resuscitation in COVID Positive versus COVID Negative Patients; a Tertiary Care Hospital Experience From Pakistan Cardiopulmonary Resuscitation in COVID Positive versus COVID Negative Patients

Introduction: The impact of Covid-19 on outcomes of In-hospital cardiac arrest IHCA remains unclear. Aims &amp; Methodology: We, conducted a retrospective cohort study to compare the characteristics and outcome of CPR in Covid positive V/s Covid negative patients, at our institute. Data were retrieved from a review of the medical records of all patients who underwent cardiac arrest during the pandemic period. Taking Covid-19 as the exposure variable, our sample population was divided into two cohorts. Results: Eighty patients who underwent CPR were included in the study with;40 patients in each group. The mean age was 61 in the positive group and 65 in the negative group. The male to female ratio was equal in the covid positive group but the male population was higher in the negative group. (77%). The most frequent comorbidities were the same (Diabetes, hypertension, and ischaemic heart disease) in both groups. All of the patients had ARDS in Covid positive group while septic shock was the commonest diagnosis (48.9%) in the negative group. In the positive group, 74% of patients were in high dependency unit (HDU) and 26% were in ICU. In the negative group,94% of patients were in HDU and 6% in ICU. The initial rhythm was Pulseless electrical activity (PEA) in 52% of the positive group and all of the patients (100%) in the negative group. Eight percent of covid positive patients had shockable rhythm while remaining had asystole. The median duration of CPR was 15 minutes in the positive group and 17 minutes in the negative group. Although the return of spontaneous circulation (ROSC) was achieved in 14% of patients in covid positive, none of them survived to discharge. In the negative group, 30% of patients achieved ROSC while survival to discharge was 15%. The odds of mortality were 6.88 [95% confidence interval (CI)0.789-60] times higher in COVID-19-positive patients, compared to negative patients. Conclusions: Covid-19 infection is associated with poor outcomes in IHCA compared to non-covid illnesses.

Abstract 13071: Supraglottic Airway Devices Are Associated With Asphyxial Physiology Upon Arrival for ECPR in Patients With Refractory OHCA Treated With Prolonged CPR

Introduction: Multiple clinical trials have failed to show significant differences in survival between use of endotracheal intubation (ETI) and supraglottic airway devices (SGA) in patients with out-of-hospital cardiac arrest (OHCA). However, treatment in these trials was limited to standard ACLS, which favors short duration of CPR. We sought to compare the physiological effect of ETI versus SGA use in patients treated with prolonged CPR and extracorporeal pulmonary resuscitation (ECPR) for refractory ventricular fibrillation/ventricular tachycardia (VT/VF) by the Minnesota Mobile Resuscitation Consortium (MMRC). Methods: Consecutive refractory VT/VF OHCA patients transported by the MMRC to the University of Minnesota for ECPR between 2015 and 2021 were included in this retrospective analysis. Patients were considered ineligible for ECPR if they failed specific arterial blood gas metabolic criteria (lactic acid &gt;18 mmol/L, PaO2 &lt;50 mmHg, and ETCO2 &lt;10 mmHg). Metabolic parameters at presentation and survival were compared between patients receiving ETI and SGA. Results: Among 260 patients (58.0±11.8 years), 46.5% received ETI and 53.5% received SGA. During the index hospitalization, 78/260 (30%) achieved neurologically favorable survival. Compared to those receiving ETI, patients receiving SGA had lower PaO2 (116.8±118.7 versus 135.8±128.3 mmHg, p=0.03), higher PaCO2 (69.7±28.9 versus 60.7±25.6 mmHg, p=0.01), and lower pH (7.00±0.19 versus 7.06±0.21, p=0.008). Significantly more patients who received SGA had PaO2 &lt;50mmHg (29.1% versus 16.9%, respectively; p=0.02) and ≥1 ECPR exclusion criteria (33.1% versus 20.7%, respectively; p=0.03). Among patients excluded for PaO2 &lt;50 mmHg, the presenting PaO2 was 35.5±11.0 mmHg and the presenting PaCO2 was 94.5±26.2 mmHg, suggestive of absence of effective ventilation (asphyxia) at presentation. Survival with CPC 1-2 was 34.7% versus 25.9% for ETI versus SGA, respectively (p=0.12). Conclusion: Use of SGA, during prolonged CPR in refractory VT/VF OHCA, was associated with a significant increase in the proportion of patients presenting with significant hypoxemia and asphyxial physiology, thus increasing ineligibility for ECPR.

Abstract 12933: Myocardial Dysfunction After In-Hospital Cardiac Arrest in COVID-19 Patients

Introduction: Post resuscitation myocardial dysfunction (PRMD) is common after out-of-hospital cardiac arrest. While PRMD is a known cause of post-resuscitation circulatory failure, few studies have reported associations between PRMD and neurologic outcome or survival. Further, little is known about PRMD after in-hospital cardiac arrest (IHCA) nor on the incidence and prognosis of PRMD in COVID-19 IHCA. We sought to evaluate the incidence of PRMD in a multicenter cohort of resuscitated COVID-19 IHCA patients. Study Population and Methods: We included adult patients (≥18 y) admitted to multiple hospitals of Cleveland Clinic Health System. Patients who attained ROSC with an initial echocardiogram (EC) in the 72 hours post-arrest were included. Data were extracted from a data registry and electronic medical records. Results: From 03/2020-10/2020, 58 patients with COVID-19 had IHCA. ROSC was noted in 35 patients (60.3%), 27 (46.6%) were alive at 24 h and 13 patients (22.4%) survived to hospital discharge. Of the 35 patients who had ROSC, 14 patients (40%) had an EC within 72 h. The median age of this cohort was 67 y (IQR 47 - 73); 71% were male, and median BMI of 28 (IQR 27 - 34), and admission APACHE II score was 13 (IQR 11 - 19). One third of the patients (36%) were mechanically ventilated before arrest and 43% were on vasopressors. Initial arrest rhythms were: PEA/Asystole, 79%; and VF/VT, 21%. Most patients (93%) received manual chest compression with median CPR duration of 5 min (IQR 2 - 10). The median time of obtaining first EC post-ROSC in these 14 patients was 22 hours (IQR 6 - 62). 7/14 (50%) of the patient had systolic dysfunction on initial EC (6 had global dysfunction, 1 with regional wall motion abnormality, and 4/7 had combined LV and RV systolic dysfunction). 5/14 patients had a follow up EC with a median time of 43 days. 2/5 had normal initial EC and 3 out of these 5 patients who initially had PMRD showed complete recovery in their LV and RV systolic function. Conclusion: We report a case series of PRMD in COVID-19 patients who experienced IHCA. We found that PMRD is seen in half of the patients. Most patients with PMRD recovered to normal RV and LV function, consistent with prior studies of non-COVID-19 arrest EC.

Outcomes after mechanical versus manual chest compressions in eCPR patients

ABSTRACT Background Extracorporeal cardiopulmonary resuscitation (eCPR) is an established treatment option for cardiac arrest. Mechanical reanimation devices are increasingly used but have been associated with complications. This study evaluates typical injury patterns and differences after mechanical versus manual chest compressions among patients undergoing eCPR. Methods From 2016 to 2020, 108 eCPR patients were retrospectively analyzed. Primary endpoints were traumatic, hemorrhagic, or inner organ-related complications, defined as pneumothorax, pulmonary bleeding, major bleeding, gastrointestinal bleeding, gastrointestinal ischemia, cardiac tamponade, aortic dissection, sternal or rib fracture. Results 70 patients were treated with mechanical CPR (mCPR) and 38 with conventional CPR (cCPR). There were more CPR-related injuries in the mCPR group (55% vs. 83%, p = 0.01), CPR duration was longer (cCPR 40 ± 28 min vs. mCPR 69 ± 25 min, p = 0.01). There was no significant difference in mortality between the groups. Conclusion Mechanical CPR devices are associated with a higher incidence of traumatic and hemorrhagic injuries in patients undergoing eCPR.

201 Effect of Gender, Race, and Ethnicity on Duration of Resuscitative Efforts Following Out-of-Hospital Cardiac Arrest

The duration of unsuccessful resuscitation attempts in the emergency department (ED) following out-of- hospital cardiac arrest (OHCA) may be influenced by many factors. Factors known to be associated with a decreased likelihood of survival may influence providers to consider resuscitative efforts futile sooner, and may include: whether the arrest was witnessed, if bystander CPR was performed, duration of CPR in the pre-hospital setting, and the presence of a shockable rhythm. More subtle, and potentially sub-conscious factors may also influence the duration of unsuccessful resuscitation efforts, as well.

PREDICTIVE VALUE OF CLINICAL MEASURES FOR RSO2 DURING IN-HOSPITAL CARDIAC ARREST

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Cerebral oximetry is a non-invasive method of monitoring regional cerebral oxygenation (rSO2). rSO2 has been proposed as an alternative to end-tidal CO2 (ETCO2) as a predictor of return of spontaneous circulation (ROSC) and end-organ perfusion. Previously, we demonstrated that higher rSO2 is associated with higher rates of ROSC and improved neurologic recovery in in-hospital cardiac arrest (IHCA) patients. However, there are currently no studies examining patient-specific, peri-cardiac arrest variables that correlate with higher rSO2. Identifying modifiable variables can help tailor patient-specific interventions in addition to ACLS to optimize rSO2 and improve survival and neurologic recovery from IHCA. The aim of this study was to identify which clinical variables, particularly modifiable ones, are predictive of a higher rSO2. METHODS: We performed an ancillary cohort analysis of data collected as part of an ongoing multicenter prospective study of adult IHCA in 15 hospitals across the US and UK. rSO2 values were collected in real-time using a portable near-infrared spectroscopy device (SedLine, Nonin). Demographics, vitals, and labs were collected via chart review. Among 323 adult IHCA patients, under a multivariable regression model, we investigated the predictive value of age, hemoglobin (hgb), partial pressure of oxygen (PaO2), epinephrine dose, and APACHE II score for mean rSO2. Using two-sample t-tests, we also investigated the difference in mean rSO2 in relation to sex, shockable versus non-shockable rhythm, and manual versus mechanical CPR. RESULTS: We demonstrated a small, statistically significant, negative correlation for hgb (coefficient = -0.17, p = 0.03). Due to the unexpected negative correlation, an individual linear regression was performed, demonstrating no statistically significant correlation (coefficient = -0.14, p = 0.07). We did not find any statistically significant correlation with the other variables. We also did not find a statistically significant difference in mean rSO2 in relation to sex, initial rhythm, and type of CPR. CONCLUSIONS: Our study demonstrates no statistically significant correlation between PaO2, hgb, epinephrine dose, APACHE II scores, and rSO2. The lack of correlation for hgb is particularly interesting, as hgb has been demonstrated to positively correlate with rSO2 in healthy individuals. However, there are limitations to this study. Intra-cardiac paO2 and hgb were generally high in our sample size (92 mmHg and 14.0 g/dL, respectively), which may explain the lack of statistical significance. In addition, rSO2 data from each individual patient across the duration of CPR is variable, and utilizing mean rSO2 may be an oversimplification. CLINICAL IMPLICATIONS: The current standard of care is to apply a single ACLS protocol to an inherently heterogeneous group of patients undergoing cardiac arrest. As a result, there is ongoing interest in identifying modifiable variables to optimize survival and neurologic recovery. Our study demonstrates that clinical measures we expect to correlate with ROSC and neurologic recovery may not actually have a very large impact on clinical outcome. However, given the limitations of this study, further studies need to be conducted to identify and tailor patient-specific approaches to enhance resuscitative care. DISCLOSURES: No relevant relationships by Hon Chau, source=Web Response No relevant relationships by Elise Huppert, source=Web Response No relevant relationships by Sam Parnia, source=Web Response No relevant relationships by Thaddeus Tarpey, source=Web Response No relevant relationships by Jing Xu, source=Web Response

Do carboxyhaemoglobin and methaemoglobin levels predict the return of spontaneous circulation and prognosis of cardiac arrest patients?

Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study's goal was to investigate the value of the carboxyhaemoglobin (COHb) and methaemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups: survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. COHb levels were significantly lower in the non-ROSC group than in the ROSC group (P=.002). Urea, creatinine, potassium and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (P<.001, .001, .014, and .005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (P=.022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (P=.001, .005, .001, .010 and .008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (P=.769 and .668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (P˂.001). COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.