In-hospital Cardiac Arrest Research Articles

Abstract 349: Deep Learning Detection of Chest Compression Location Using Transesophageal Echocardiography

Background: Recent work evaluating intra-arrest transesophageal echocardiography (TEE) in cardiac arrest (CA) has demonstrated that chest compression (CC) location is a strong predictor of return of spontaneous circulation. However, advanced skills to interpret images during resuscitation represent an important barrier to implementation of this modality. Deep Learning (DL) models have been increasingly used to perform the automated interpretation of TEE images. Given the unique challenges during the interpretation of images, DL-based automation represents an attractive adjunct to facilitate the use of intra-arrest TEE. We sought to evaluate the feasibility of a DL model to identify CC location in TEE images obtained during CA resuscitation. Methods: We analyzed videos from out-of-hospital and in-hospital CA patients evaluated with TEE collected through the Resuscitative TEE Collaborative Registry (NCT04972526). We reviewed and selected images for the DL algorithm, using midesophageal long axis clips. Videos were selected based on the visualization of anatomical structures necessary to identify the CC location. Images were annotated by an expert classifying them in CC over the LV (CC-LV) vs CC over the left ventricular outflow tract (CC-LVOT). We used TEENet, an end-to-end DL approach with input of TEE clips containing single compression cycles, to classify clips in CC-LV and CC-LVOT. The TEENet architecture includes two 3D convolution layers, followed by a global average pooling layer, and then appends a fully connected layer with a sigmoid layer. We used the F1-score as the evaluation metric for the model's performance. Results: Ten videos containing a total of 47 single CC cycle clips were selected for inclusion in the model, each clip with an average of 25 frames. The model was trained using 80% of the data (37 clips) and tested using the remaining 20% (10 clips). The model achieved an F1-score of 0.7273 in classifying CC-LV from CC-LVOT. Conclusion: We report the creation of a novel DL-model with acceptable precision and recall performance in the detection of CC location using intra-arrest TEE videos. This work is a proof-of-concept for future research aimed to evaluate the potential of DL-assisted TEE-guided CA resuscitation.

Clinical features and outcomes of in-hospital cardiac arrest in code blue events: a retrospective observational study.

In-hospital cardiac arrest (IHCA) is a critical medical event with outcomes less researched compared to out-of-hospital cardiac arrest. This retrospective observational study aimed to investigate key aspects of IHCA epidemiology and prognosis in patients with Code Blue activation. This retrospective observational study enrolled patients with Code Blue events in our hospital between January 2010 and October 2019. Participant characteristics, including age and sex, and IHCA characteristics, including the time of cardiac arrest, witnessed event, bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, vital signs at 1 and 6 h before IHCA, survival to hospital discharge (SHD), and the cardiac arrest survival postresuscitation in-hospital (CASPRI) score were included in univariate and multivariate logistic regression analyses with SHD as the primary endpoint. From the 293 Code Blue events that were activated during the study period, 81 participants were enrolled. Overall, the SHD rate was 28.4%, the median CPR duration was 14 (interquartile range, 6-28) min, and the rate of initial shockable rhythm was 19.8%. There were significant intergroup differences between the SHD and non-SHD groups in the CPR duration, shockable rhythm, and CASPRI score on univariate logistic regression analysis. Multivariate logistic regression analysis showed that the CASPRI score was the most accurate predictive factor for SHD (OR = 0.98, p = 0.006). The CASPRI score is associated with SHD in patients with IHCA during Code Blue events. Therefore, the CASPRI score of IHCA patients potentially constitutes a simple, useful adjunctive tool for the management of post-cardiac arrest syndrome.

In-hospital cardiac arrest due to sepsis – Aetiologies and outcomes in a Swedish cohort study

ObjectivesAwareness of causes of cardiac arrest is essential to prevent them. A recent review found that almost every sixth in-hospital cardiac arrest is caused by infection. Few studies have explored how infections cause cardiac arrest. AimTo describe the features, mechanisms and outcome of sepsis-related cardiac arrests. Material and methodsAll patients ≥18 years who suffered a cardiac arrest at Karolinska University Hospital between 2007 and 2022 with sepsis as the primary cause were included. Data were collected the Swedish Registry for Cardiopulmonary Resuscitation and medical records. The primary outcome was survival to discharge. ResultsOut of 2,327 in-hospital cardiac arrests, 5% (n = 123) suffered it due to sepsis, and 17% (21) survived to hospital discharge. Two thirds of patients were admitted to the hospital due to sepsis and suffered their cardiac arrest after a median of four days. About half (n = 59) had deranged vital signs before the event. Most were witnessed in general wards. In all, 47% (n = 58) had asystole and 24% (n = 30) as the first heart rhythm. The respiratory tract was the most common source of infection. Most patients were undergoing antibiotic therapy and one third had a positive microbiological culture with mixed gram-positive bacteria or Escherichia coli in the urine. ConclusionOur results suggest that sepsis is an uncommon and not increasing cause of in-hospital cardiac arrest and its outcome is in line with other non-shockable cardiac arrests. Deranged respiratory and/or circulatory vital signs precede the event.

Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest

Background: Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures. Methods: We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form. Results: One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (P < 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly. Conclusions: There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes.

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes.

340 The Impact of Team Leader Experience on Chest Compression Pauses during In-hospital Cardiac Arrest

340 The Impact of Team Leader Experience on Chest Compression Pauses during In-hospital Cardiac Arrest

232 Impact on survival from in-hospital cardiac arrest in COVIDinfected patients

232 Impact on survival from in-hospital cardiac arrest in COVIDinfected patients

191 Performance of the Admission CRP to Albumin Ratio in Predicting Mortality after Patients with Inhospital Cardiac Arrest

191 Performance of the Admission CRP to Albumin Ratio in Predicting Mortality after Patients with Inhospital Cardiac Arrest

325 The Impact of Recent Simulation Training for Team Leaders on Chest Compression Pauses during In-hospital Cardiac Arrest

325 The Impact of Recent Simulation Training for Team Leaders on Chest Compression Pauses during In-hospital Cardiac Arrest

254 Cardiopulmonary Resuscitation Quality during Basic- vs. Advanced Life Support during In-hospital Cardiac Arrest

254 Cardiopulmonary Resuscitation Quality during Basic- vs. Advanced Life Support during In-hospital Cardiac Arrest

393 Why do patients develop in-hospital cardiac arrest? A prospective, single-center observational study of in-hospital cardiac arrest aetiologies (WHY-IHCA) - preliminary results in non-survivor cases

393 Why do patients develop in-hospital cardiac arrest? A prospective, single-center observational study of in-hospital cardiac arrest aetiologies (WHY-IHCA) - preliminary results in non-survivor cases

233 Coverage and validity of the Swedish Registry of Cardiopulmonary Resuscitation of in-hospital cardiac arrest

233 Coverage and validity of the Swedish Registry of Cardiopulmonary Resuscitation of in-hospital cardiac arrest

Deep Learning-Based Early Warning Score for Predicting Clinical Deterioration in General Ward Cancer Patients.

Cancer patients who are admitted to hospitals are at high risk of short-term deterioration due to treatment-related or cancer-specific complications. A rapid response system (RRS) is initiated when patients who are deteriorating or at risk of deteriorating are identified. This study was conducted to develop a deep learning-based early warning score (EWS) for cancer patients (Can-EWS) using delta values in vital signs. A retrospective cohort study was conducted on all oncology patients who were admitted to the general ward between 2016 and 2020. The data were divided into a training set (January 2016-December 2019) and a held-out test set (January 2020-December 2020). The primary outcome was clinical deterioration, defined as the composite of in-hospital cardiac arrest (IHCA) and unexpected intensive care unit (ICU) transfer. During the study period, 19,739 cancer patients were admitted to the general wards and eligible for this study. Clinical deterioration occurred in 894 cases. IHCA and unexpected ICU transfer prevalence was 1.77 per 1000 admissions and 43.45 per 1000 admissions, respectively. We developed two models: Can-EWS V1, which used input vectors of the original five input variables, and Can-EWS V2, which used input vectors of 10 variables (including an additional five delta variables). The cross-validation performance of the clinical deterioration for Can-EWS V2 (AUROC, 0.946; 95% confidence interval [CI], 0.943-0.948) was higher than that for MEWS of 5 (AUROC, 0.589; 95% CI, 0.587-0.560; p < 0.001) and Can-EWS V1 (AUROC, 0.927; 95% CI, 0.924-0.931). As a virtual prognostic study, additional validation was performed on held-out test data. The AUROC and 95% CI were 0.588 (95% CI, 0.588-0.589), 0.890 (95% CI, 0.888-0.891), and 0.898 (95% CI, 0.897-0.899), for MEWS of 5, Can-EWS V1, and the deployed model Can-EWS V2, respectively. Can-EWS V2 outperformed other approaches for specificities, positive predictive values, negative predictive values, and the number of false alarms per day at the same sensitivity level on the held-out test data. We have developed and validated a deep learning-based EWS for cancer patients using the original values and differences between consecutive measurements of basic vital signs. The Can-EWS has acceptable discriminatory power and sensitivity, with extremely decreased false alarms compared with MEWS.

Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis.

Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA. We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05. Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047]. RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.

Predicting in-hospital cardiac arrest outcomes: CASPRI and GO-FAR scores

It is important to predict the neurological prognoses of in-hospital cardiac arrest (IHCA) patients immediately after recovery of spontaneous circulation (ROSC) to make further critical management. The aim of this study was to confirm the usefulness of the Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) and Good Outcome Following Attempted Resuscitation (GO-FAR) scores for predicting the IHCA immediately after the ROSC. This is a retrospective analysis of patient data from a tertiary general hospital located in South Korea. A total of 488 adult patients who had IHCA and achieved sustained ROSC from September 2016 to August 2021 were analyzed to compare effectiveness of the CASPRI and GO-FAR scores related to neurologic prognosis. The primary outcome was Cerebral Performance Category (CPC) score at discharge, defined as a CPC score of 1 or 2. The secondary outcomes were survival-to-discharge and normal neurological status or minimal neurological damage at discharge. Of the 488 included patients, 85 (20.8%) were discharged with good prognoses (CPC score of 1 or 2). The area under the receiver operating characteristic curve of CASPRI score for the prediction of a good neurological outcome was 0.75 (95% CI 0.69–0.81), whereas that of GO-FAR score was 0.67 (95% CI 0.60–0.73). The results of this study show that these scoring systems can be used for timely and satisfactory prediction of the neurological prognoses of IHCA patients after ROSC.

Outcomes in non-ST-segment elevation myocardial infarction complicated by in-hospital cardiac arrest based on management strategy

BackgroundThere are limited data on in-hospital cardiac arrest (IHCA) complicating non-ST-segment-elevation myocardial infarction (NSTEMI) based on management strategy. MethodsWe used National Inpatient Sample (2000–2017) to identify adults with NSTEMI (not undergoing coronary artery bypass grafting) and concomitant IHCA. The cohort was stratified based on use of early (hospital day 0) or delayed (≥hospital day 1) coronary angiography (CAG), percutaneous coronary intervention (PCI), and medical management. Outcomes included incidence of IHCA, in-hospital mortality, adverse events, length of stay, and hospitalization costs. ResultsOf 6,583,662 NSTEMI admissions, 375,873 (5.7 %) underwent early CAG, 1,133,143 (17.2 %) received delayed CAG, 2,326,391 (35.3 %) underwent PCI, and 2,748,255 (41.7 %) admissions were managed medically. The medical management cohort was older, predominantly female, and with higher comorbidities. Overall, 63,085 (1.0 %) admissions had IHCA, and incidence of IHCA was highest in the medical management group (1.4 % vs 1.1 % vs 0.7 % vs 0.6 %, p < 0.001) compared to early CAG, delayed CAG and PCI groups, respectively. In adjusted analysis, early CAG (adjusted OR [aOR] 0.67 [95 % confidence interval {CI} 0.65–0.69]; p < 0.001), delayed CAG (aOR 0.49 [95 % CI 0.48–0.50]; p < 0.001), and PCI (aOR 0.42 [95 % CI 0.41–0.43]; p < 0.001) were associated with lower incidence of IHCA compared to medical management. Compared to medical management, early CAG (adjusted OR 0.53, CI: 0.49–0.58), delayed CAG (adjusted OR 0.34, CI: 0.32–0.36) and PCI (adjusted OR 0.19, CI: 0.18–0.20) were associated with lower in-hospital mortality (all p < 0.001). ConclusionEarly CAG and PCI in NSTEMI was associated with lower incidence of IHCA and lower mortality among NSTEMI-IHCA admissions.

Determinants and outcomes of acute pancreatitis in patients hospitalized for COVID-19: Early pandemic experience

ObjectivesTo examine the predictors and outcomes associated with the development of acute pancreatitis (AP) in patients hospitalized with Coronavirus Disease 2019 (COVID-19). MethodsThis is an observational analysis of the 2020 National Inpatient Sample Database. The study includes adult patients who were admitted with a confirmed diagnosis of COVID-19 and stratifies them based on the presence or absence of AP during their hospitalization. Predictors of AP development between the two groups and differences in outcomes are examined. Multivariate logistic regression analysis using Stata/BE 17.0 is conducted, with adjustments made for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical significance is determined at a p-value of <0.05. ResultsSignificant factors associated with an increased risk of AP in COVID-19 patients include Hispanic ethnicity, higher Charlson Comorbidity Index (CCI) score, residence in states located in the southern region, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use. COVID-19 patients who developed AP were also found to be at higher risk of adverse outcomes, including mortality, acute coronary syndrome, acute kidney injury, sepsis, septic shock, in-hospital cardiac arrest, invasive mechanical ventilation, upper gastrointestinal bleeding, prolonged length of stay, and increased healthcare cost. ConclusionsIn hospitalized patients with COVID-19, the presence of AP is associated with increased mortality and morbidity. Risk factors for developing AP in this population include Hispanic ethnicity, residence in the southern region, higher Charlson Comorbidity Index (CCI) score, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use.

All Else Being Equal: Examining Treatment Bias and Stereotypes Based on Patient Ethnicity and Socioeconomic Status With In-Hospital Cardiac Arrest Clinical Vignettes

BackgroundResearch on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination – whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. ObjectiveThe primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals’ (HCP) stereotypical beliefs about these groups. MethodsHCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). ResultsNo significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. ConclusionsSwedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

Long-term heart function in cardiac-arrest survivors

PurposeTo assess outcomes and predictors of long-term myocardial dysfunction after cardiac arrest (CA) of cardiac origin. MethodsWe retrospectively included consecutive, single-center, prospective-registry patients who survived to hospital discharge for adult out-of-hospital and in-hospital CA of cardiac origin in 2005–2019. The primary objective was to collect the 1-year New York Heart Association Functional Class (NYHA-FC) and major adverse cardiovascular events (MACE). ResultsOf 135 patients, 94 (72%) had their NYHA-FC determined after 1 year, including 75 (75/94, 80%) who were I, 17 (17/94, 18%) II, 2 (2/94, 2%) III, and none IV. The echocardiographic left ventricular ejection fraction was abnormal in 87/130 (67%) patients on day 1, 52/123 (42%) at hospital discharge, and 17/52 (33%) at 6 months. During the median follow-up of 796 [283–1975] days, 38/119 (32%) patients experienced a MACE. These events were predominantly related to acute heart failure (13/38) or ischemic cardiovascular events (16/38), with acute coronary syndrome being the most prevalent among them (8/16). Pre-CA cardiovascular disease was a risk factor for 1-year NYHA-FC > I (P = 0.01), absence of bystander cardiopulmonary resuscitation was significantly associated with NYHA-FC > I at 1 year. ConclusionMost patients had no heart-failure symptoms a year after adult out-of hospital or in-hospital CA of cardiac origin, and absence of bystander cardiopulmonary resuscitation was the only treatment component significantly associated with NYHA-FC > I at 1 year. Nearly a third experienced MACE and the most common types of MACE were ischemic cardiovascular events and acute heart failure. Early left ventricular dysfunction recovered within 6 months in half the patients with available values.

Factors Influencing Survival to Hospital Discharge in Children Following In-Hospital Cardiopulmonary Arrest

Factors Influencing Survival to Hospital Discharge in Children Following In-Hospital Cardiopulmonary Arrest