Incidence Of Cardiac Arrest Research Articles

Perioperative administration of methylprednisolone was associated with postoperative pulmonary complications in elderly patients undergoing hip fracture surgery.

Postoperative pulmonary complications (PPCs) seriously affect the postoperative prognosis of elderly patients underwent hip fracture surgery. Although methylprednisolone is increasingly used, the association between perioperative methylprednisolone and PPCs is still controversial. The study aims to determine whether perioperative administration of methylprednisolone is associated with PPCs in elderlypatients during hip fracture surgery. In this retrospective cohort study, records of 584 patients (≥ 65years) who underwent hip fracture surgery between January 2013 and October 2020 were extracted. Univariate and multivariate regression analysis were performed to identify the risk factors for PPCs. To further explore the association between administration of methylprednisolone and PPCs, 53 patients received methylprednisolone and 53 patients without methylprednisolone were matched for the confounding factors using propensity score matching (PSM) analysis. The odds ratios (OR) and 95% confidence intervals (CI) for the above variables were analyzed. The incidence of PPCs during postoperative hospitalization was 6.83% (38/556) among the elderly patients following hip fracture surgery. Patients with PPCs had higher postoperative mortality rate, longer hospital stay, more hospitalization cost, and higher incidence of cardiac arrest (all P < 0.05). Multivariate logistic regression analysis showed that age, hypertension, hypoglycemia, hypoproteinemia and perioperative methylprednisolone were independent risk factors for PPCs. Moreover, administration of methylprednisolone was significantly correlated with PPCs both before PSM adjustment (OR = 3.25; 95% CI, 1.67 to 6.33; P = 0.001) and after PSM adjustment (OR = 6.68; 95% CI, 1.40 to 31.82; P = 0.017). Perioperative administration of methylprednisolone is a risk factor for PPCs in elderly patients undergoing hip fracture surgery.

Sudden cardiac arrest in commercial airports: Incidence, responses, and implications

Billions of travelers pass through airports around the world every year. Airports are a relatively common location for sudden cardiac arrest when compared with other public venues. An increased incidence of cardiac arrest in airports may be due to the large volume of movement, the stress of travel, or adverse effects related to the physiological environment of airplanes. Having said that, airports are associated with extremely high rates of witnessed arrests, bystander interventions (eg. CPR and AED use), shockable arrest rhythms, and survival to hospital discharge. Large numbers of people, a high density of public-access AEDs, and on-site emergency medical services (EMS) resources are probably the major reasons why cardiac arrest outcomes are so favorable at airports. The success of the chain of survival found at airports may imply that applying similar practices to other public venues will translate to improvements in cardiac arrest survival. Airports might, therefore, be one model of cardiac arrest preparedness that other public areas should emulate.

Epidemiology of sudden cardiac death and sudden cardiac arrest with resultant disability during high school organized sport in Japan

ObjectivesTo examine the incidence and survival rates of sudden cardiac arrest that were documented during school organized sports in Japan. DesignRetrospective cohort study. MethodsInsurance claim data of cardiac events (sudden cardiac death and sudden cardiac arrest with resultant disabilities) that occurred during Japanese high school organized sports between 2009 and 2018 were retrieved. Participation data from All Japan High School Athletic Federation and Japan High School Baseball Federation were used for incidence rate calculations. Incidence rate ratios with 95 % confidence interval were calculated to compare the risk by sports and sex. The survival rate was calculated with the proportion of resuscitated cases to total number of cardiac events in this dataset. ResultsA total of 55 cardiac events (25 survivors and 30 deceased) were identified in the dataset. The majority affected male student-athletes (92.7 %). The frequency and incidence rate of cardiac events were highest in male baseball (n = 16 [29.1 %], incidence rate: 0.91 per 100,000 athlete-years). Incidence rate ratio revealed that male basketball (2.19, 95 % confidence interval: 1.04–4.60), male baseball (2.31, 95 % confidence interval: 1.32–4.03), and first-year male baseball (4.11, 95 % confidence interval: 2.10–8.07) had significantly higher risk of cardiac events, compared to the overall incidence rate (0.38 per 100,000 athlete-years). The survival rates were 37.5 % in the first half (2009–2013) and 56.5 % in the latter half (2014–2018) of the study period. ConclusionsThe risk of cardiac events was highest in male, baseball, first-year student-athletes. Rapid AED application by bystanders should be advocated to enhance better survival.

Gender-related factors and out-of-hospital cardiac arrest incidence in women and men: analysis of a population-based cohort study in the Netherlands

BackgroundThe incidence of out-of-hospital cardiac arrest (OHCA) differs consistently between women and men. Besides sex-related (biological) factors, OHCA risk may relate to gender-related (sociocultural) factors. We explored the association of...

Multiple mechanisms underlie reduced potassium conductance in the p.T1019PfsX38 variant of hERG.

Long QT syndrome type II (LQT2) is caused by loss‐of‐function mutations in the hERG K+ channel, leading to increased incidence of cardiac arrest and sudden death. Many genetic variants have been reported in the hERG gene with various consequences on channel expression, permeation, and gating. Only a small number of LQT2 causing variants has been characterized to define the underlying pathophysiological causes of the disease. We sought to determine the characteristics of the frameshift variant p.Thr1019ProfsX38 (T1019PfsX38) which affects the C‐terminus of the protein. This mutation was identified in an extended Omani family of LQT2. It replaces the last 140 amino acids of hERG with 37 unique amino acids. T1019 is positioned at a distinguished region of the C‐terminal tail of hERG, as predicted from the deep learning system AlphaFold v2.0. We employed the whole‐cell configuration of the patch‐clamp technique to study wild‐type and mutant channels that were transiently expressed in human embryonic kidney 293 (HEK293) cells. Depolarizing voltages elicited slowly deactivating tail currents that appeared upon repolarization of cells that express either wild‐type‐ or T1019PfsX38‐hERG. There were no differences in the voltage and time dependencies of activation between the two variants. However, the rates of hERG channel deactivation at hyperpolarizing potentials were accelerated by T1019PfsX38. In addition, the voltage dependence of inactivation of T1019PfsX38‐hERG was shifted by 20 mV in the negative direction when compared with wild‐type hERG. The rates of channel inactivation were increased in the mutant channel variant. Next, we employed a step‐ramp protocol to mimic membrane repolarization by the cardiac action potential. The amplitudes of outward currents and their integrals were reduced in the mutant variant when compared with the wild‐type variant during repolarization. Thus, changes in the gating dynamics of hERG by the T1019PfsX38 variant contribute to the pathology seen in affected LQT2 patients.

Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation

Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents severe hypotension, cardiac arrest, or death remains uncertain. To determine the effect of fluid bolus administration on the incidence of severe hypotension, cardiac arrest, and death. This randomized clinical trial enrolled 1067 critically ill adults undergoing tracheal intubation with sedation and positive pressure ventilation at 11 intensive care units in the US between February 1, 2019, and May 24, 2021. The date of final follow-up was June 21, 2021. Patients were randomly assigned to receive either a 500-mL intravenous fluid bolus (n = 538) or no fluid bolus (n = 527). The primary outcome was cardiovascular collapse (defined as new or increased receipt of vasopressors or a systolic blood pressure <65 mm Hg between induction of anesthesia and 2 minutes after tracheal intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after tracheal intubation). The secondary outcome was the incidence of death prior to day 28, which was censored at hospital discharge. Among 1067 patients randomized, 1065 (99.8%) completed the trial and were included in the primary analysis (median age, 62 years [IQR, 51-70 years]; 42.1% were women). Cardiovascular collapse occurred in 113 patients (21.0%) in the fluid bolus group and in 96 patients (18.2%) in the no fluid bolus group (absolute difference, 2.8% [95% CI, -2.2% to 7.7%]; P = .25). New or increased receipt of vasopressors occurred in 20.6% of patients in the fluid bolus group compared with 17.6% of patients in the no fluid bolus group, a systolic blood pressure of less than 65 mm Hg occurred in 3.9% vs 4.2%, respectively, cardiac arrest occurred in 1.7% vs 1.5%, and death occurred in 0.7% vs 0.6%. Death prior to day 28 (censored at hospital discharge) occurred in 218 patients (40.5%) in the fluid bolus group compared with 223 patients (42.3%) in the no fluid bolus group (absolute difference, -1.8% [95% CI, -7.9% to 4.3%]; P = .55). Among critically ill adults undergoing tracheal intubation, administration of an intravenous fluid bolus compared with no fluid bolus did not significantly decrease the incidence of cardiovascular collapse. ClinicalTrials.gov Identifier: NCT03787732.

Clinical and prognostic analysis of acute pulmonary thromboembolism in the elderly

Objective: To analyse the clinical characteristics and to explore the prognostic factors of acute pulmonary thromboembolism in the elderly. Methods: The medical records of inpatients with acute pulmonary thromboembolism discharged from Peking Union Medical College Hospital from January 1, 2012, to February 1, 2019 were retrospectively reviewed. The eligible patients were divided into elderly group (≥ 60 years old) and non-elderly group (<60 years old). The clinical symptoms, complications, laboratory results, pulmonary embolism severity index (PESI) and mortality were compared between the two groups. Mortality was further compared among elderly patients of different age groups. Cox regression analysis was used to analyze the risk factors of 7-day and 30-day death in elderly patients with pulmonary embolism. Results: A total of 503 patients with acute pulmonary embolism were included, including 279 cases in the elderly group and 224 cases in the non-elderly group. The incidence of cardiac arrest was higher in the elderly group compared with non-elderly group, while the incidence of chest pain and hemoptysis was less common in the elderly group. The proportions of comorbidities, including diabetes, hypertension, and coronary heart disease were higher in the elderly group while the proportion of autoimmune diseases was higher in the non-elderly group. In terms of prognosis, the PESI score and 7-day and 30-day mortality in the elderly group were higher than those in the non-elderly group. The mortality of elderly patients increased with age. Cox univariate regression analysis showed that infection, hypoalbuminemia, hypocalcemia, elevated cardiac troponin(cTnI), elevated N-terminal prohormone of brain natriuretic pepride(NT-proBNP) and PESI grade were associated with 30-day death. Multivariate Cox regression analysis showed that PESI grade and decreased serum calcium concentration were independent risk factors for 7-day death of pulmonary embolism in elderly patients. PESI grade, decreased serum calcium concentration and infection were independent risk factors for 30-day death. Conclusions: The mortality of elderly patients with pulmonary embolism was higher than that of non-elderly patients, and the mortality increased gradually with age. PESI grade, decreased serum calcium concentration and infection were independent risk factors for 30-day death of pulmonary embolism in elderly patients.

Risk of hypertension and treatment on out-of-hospital cardiac arrest incidence: A case-control study.

Hypertension (HTN) is a high risk factor for major cardiovascular adverse events. This study aimed to investigate the effect of HTN risk on out-of-hospital cardiac arrest (OHCA) incidence and determine whether the effect of HTN on OHCA incidence differs according to antihypertensive medication.This case-control study used the Korean Cardiac Arrest Resuscitation Consortium and Korean Community Health Survey (CHS). Cases were defined as emergency medical service-treated adult OHCA patients presumed to have a cardiac etiology from 2015 to 2017. Patients without information on HTN diagnosis were excluded from the study. The Korean CHS database's controls were matched at a 1:2 ratio with strata, including age, gender, and county of residence. Multivariable conditional logistic regression analysis was conducted to estimate HTN risk and antihypertensive treatment on OHCA incidence,A total of 2633 OHCA patients and 5266 community-based controls were enrolled in this study. Among them, 1176 (44.7%) patients and 2049 (38.9%) controls were diagnosed with HTN. HTN was associated with an increased risk of OHCA (adjusted odds ratio [AOR]: 1.19 [1.07–1.32]). On comparing HTN with or without the antihypertensive treatment group with the non-HTN-diagnosed group (as a reference), the HTN without treatment group had the highest AOR (95% confidence interval) (3.41 [2.74–4.24]). The AOR in the HTN treatment group was reduced to that in the non-HTN-diagnosed group (0.96 [0.86–1.08]).HTN increased OHCA risk, and the HTN without treatment group had the highest OHCA risk. Conversely, OHCA risk decreased to the non-HTN-diagnosed group level with HTN treatment.

OR27 The COVID-19 pandemic's impact on out-of-hospital cardiac arrest incidence and survival outcomes: a systematic review

OR27 The COVID-19 pandemic's impact on out-of-hospital cardiac arrest incidence and survival outcomes: a systematic review

OR16 Incidence and Predictors of Peri-intubation Cardiac Arrest: A systematic review and meta- analysis

OR16 Incidence and Predictors of Peri-intubation Cardiac Arrest: A systematic review and meta- analysis

Competency expectations of nurses in rapid response teams: an interview-based qualitative study.

The rapid response teams (RRTs) are early intervention Teams made up of physicians, nurses, and/or other designated personnel that conduct early assessment and intervention of patients with changing conditions outside the intensive care unit (ICU) in order to reduce ICU admissions and prevent further deterioration or promote early admission to the ICU in critically ill patients. Numerous studies have shown that RRT can effectively reduce the incidence of cardiac arrest and accidental death in patients. Nurses are the most indispensable members of multidisciplinary teams (MDT), and their ability is closely related to the success rate of RRT. Using the phenomenological method of qualitative research, we conducted semi-structured interviews with 16 non-nurse members of RRT, including 6 doctors, 5 anesthesiologists and 5 respiratory therapists, in a third class a general hospital in Shanghai. Colaizzi content analysis was used for data analysis. After analysis and collation, three themes were extracted: professional theoretical knowledge, professional practical skills, and personality traits. Professional theoretical knowledge includes basic medical knowledge and knowledge of rapid response system. Professional practical skills include quick reaction capability, ability to assess illness, first aid skills and communication skills; Personality traits include imperturbable and cooperative spirit of group. Non-nurse members of the RRT expect the response team nurses to possess solid professional theoretical knowledge, skilled professional practical skills, and good personality qualities. Nursing managers should pay attention to the training of professional theoretical knowledge, professional practical skills and personality quality when carrying out the training practice of nurses' competency in RRT, so as to truly improve the success rate of RRT operation and further promote patient safety.

In-hospital Outcomes and Arrhythmia Burden in Patients with Obstructive Sleep Apnea and Heart Failure with Preserved Ejection Fraction.

Patients with obstructive sleep apnea (OSA) have an increased risk for arrhythmias compared to patients without OSA. However, data quantifying the risk of inpatient complications in patients with heart failure with preserved ejection fraction (HFpEF) are lacking. We sought to compare inpatient outcomes and the occurrence of arrhythmias in patients with HFpEF with and without OSA, respectively. Furthermore, we compared the prevalence of arrhythmias with nocturnal continuous positive airway pressure (CPAP) therapy. We performed a retrospective study using the National Inpatient Sample from 2016–2018 to identify patients with HFpEF with and without OSA. Propensity score matching, adjusting for age, gender, race, hospital characteristics, income, and comorbidities, was used to select matched samples between both groups. From 2016–2018, 127,773 hospitalizations with HFpEF were identified; among these patients, 20% had OSA. Nocturnal CPAP was utilized in 9% of these patients. Patients with OSA had a higher mortality rate, a longer duration of hospitalization, and greater medical costs. In addition, OSA was associated with higher incidence rates of atrial fibrillation, atrial flutter, premature depolarization, sick sinus syndrome, ventricular tachycardia, and atrioventricular block. Nocturnal CPAP was not associated with a lower arrhythmia incidence; however, there was a non-significant trend toward a lower cardiac arrest incidence. In conclusion, OSA in patients with HFpEF was associated with greater mortality, longer hospitalization stays, and higher medical costs relative to findings in patients without OSA. Furthermore, OSA was associated with tachyarrhythmias and bradyarrhythmias in HFpEF patients. Nocturnal CPAP was only utilized in 9% of patients, with no difference in arrhythmogenesis.

The Incidence and Risk Factors of Intraoperative Cardiac Arrest: A 5-Year Experience from a University Hospital in Thailand

Objective: To investigate the incidence, characteristics, and outcomes of intraoperative cardiac arrest (IOCA) and identify risk factors for death in IOCA patients. Materials and Methods: The present study was a retrospective descriptive study at Srinagarind Hospital, a tertiary care university hospital. Anesthesia incident reports between 2016 and 2020 were screened, and IOCA reports were identified. Demographics, characteristics, causes, antecedents within 24 hours of the operation, rate of return of spontaneous circulation (ROSC), and survival outcomes were among the data collected. Logistic regression analysis was used to identify the factors associated with death in IOCA patients. Results: During the present study period, 67 IOCAs occurred out of 91,139 anesthetics, with an incidence of 7.3 per 10,000 anesthetics. The incidence of IOCA was high in patients with the American Society of Anesthesiologists Physical Status (ASA-PS) 4 and 5 at 103.9 and 1337.6 per 10,000 anesthetics, respectively. The majority of IOCAs occurred during anesthesia maintenance (61.7%) and the initial electrocardiogram (EKG) were non-shockable rhythms (77.6%). The main cause of IOCA was poor patient conditions (46.3%). At the time of ICU discharge, 28 patients (41.8%) had survived, with 21 (31.3%) of these achieving full cerebral recovery. The mortality was 39 (58.2%). Patients with ASA-PS 4 or 5 (OR 4.05, 95% CI 1.45 to 11.34), poor patient conditions (OR 2.73, 95% CI 1.06 to 7.54), and non-shockable EKG (OR 9.00, 95% CI 2.23 to 36.33) were significant risk factors for death in IOCA patients, according to the univariate analysis. Only non-shockable EKG (adjusted OR 6.98, 95% CI 1.15 to 42.47) was found to be a significant risk factor for mortality after multivariate analysis. Conclusion: Although IOCA was uncommon, it was associated with a high mortality rate. The highest rate of IOCA was found in ASA-PS 5. The main cause of IOCA was poor patient condition. Non-shockable EKG increased the risk of death in IOCA. Keywords: Incidence study; Intraoperative; Cardiac arrest; IOCA

Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients.

We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery. We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported. In a secondary analysis, we assessed the association between preincision cardiac arrest and major postoperative outcomes. In a tertiary analysis, we used adjusted linear regression models to explore the association between preincision cardiac arrest and prespecified patient risk factors, including severe left main coronary artery stenosis, left ventricular ejection fraction, moderate/severe right ventricular dysfunction, low-flow low-gradient aortic stenosis, and moderate/severe pulmonary hypertension. Preincision cardiac arrests occurred in 75 of 41,238 (incidence of 0.18%; 95% CI, 0.17-0.26) patients who had elective or urgent cardiac surgery. Successful cardiopulmonary resuscitation with return of spontaneous circulation or bridge to cardiopulmonary bypass occurred in 74 of 75 (98.6%) patients. Patients who experienced preincision cardiac arrest had significantly higher in-hospital mortality than those who did not (11% vs 2%; odds ratio [OR] (95% CI), 4.14 (1.94-8.84); P < .001). They were also more likely to suffer postoperative respiratory failure (46% vs 13%; OR [95% CI], 3.94 [2.40-6.47]; P < .001), requirement for renal replacement therapy (11% vs 2%; OR [95% CI], 3.90 [1.82-8.35]; P < .001), neurologic deficit (7% vs 2%; OR [95% CI], 2.49 (1.00-6.21); P = .05), and longer median hospital stay (15 vs 8 days; hazard ratio (HR) [95% CI], 0.68 [0.55-0.85]; P < .001). Reduced left ventricular ejection fraction (per 5% decrease) (OR [95% CI], 1.13 [1.03-1.22]; P = .006) and moderate/severe pulmonary hypertension (OR [95% CI], 3.40 [1.95-5.90]; P < .001) were identified as independent risk factors for cardiac arrest. Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.

The impact of the italian law mandating an automatic external defibrillation in all sports venues on sudden cardiac arrest survival

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The chances of surviving a sport-related cardiac arrest depend strictly on resuscitation efforts. Since 2015, all Italian recreational and competitive sport venues must be equipped with automated external defibrillators (AEDs), and trained staff must be present during competitions. The aim of the study was to evaluate the incidence and survival rates of cardiac arrests in sport Venues in the Lombardia region of Italy before and after 2015. Methods We collected retrospectively data regarding all sudden cardiac arrests of presumed cardiac origin that involved both athletes and non-athletes (coaches, referees, spectators, etc.) and which occurred in sports venues of the Lombardia region in the period 2015-2019 versus those that occurred in the period 2011-2014, when automatic external defibrillators were not mandatory yet. All cases have been gathered thanks to the database built by the regional territorial emergency service (AREU) of the Lombardia region and consulting the news reported by the local and national press. Results Between 2015 and 2019, the incidence of cardiac arrest of presumed cardiac origin which affected athletes in sports venues of the Lombardia region was 0.19 per 100,000 inhabitants/year, versus 0.28 per 100,000 inhabitants/year in the period 2011-2014 (p&amp;lt;0.005). The average age of the victims was 49.9 years in 2015-2019 and 52 years in 2011-2014 (p=0.96). After the enactment of the "compulsory AED law", the proportion of cardiac arrests treated with onsite AEDs increased from 15% to 42.1% (p&amp;lt;0.001) and the return of spontaneous circulation (successful resuscitation) increased from 67% to 80% (p&amp;lt;0.05). The association between mandatory presence of AEDs in sports venues and resuscitation success in terms of ROSC was found significant (p&amp;lt;0.05). Conclusions Cardiac arrest in sports venues is a rare event and involves mainly male athletes older than 30 years old. A nationwide law mandating the presence of AEDs in all sport venues significantly increased the proportion of individuals suffering cardiac arrest who received defibrillation before the emergency medical system arrival and favorably influenced survival rates.

Embolic versus non- embolic acute coronary syndrome. Prognosis differences

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary embolism (CE) is a rare cause of acute coronary syndrome with current evidence from small case series. In our previous work (n=36), atrial fibrillation was the main risk factor and STEMI the most frequent presentation. Objetives In this analysis we compare severity characteristics, management and in-hospital prognosis between an embolic cohort versus a non-embolic one among patients with left anterior descending artery as culprit vessel. Methods Observational, retrospective descriptive study of patients admitted in our unit from July 2011 to march 2021 for ACS. The diagnosis of CE was established according to the National Cerebral Cardiovascular Center Criteria. Data were obtained from the ARIAM Andalucia Registry. Results 646 Patients were analysed (19 embolic vs 627 non-embolic). There were no differences in ejection fraction (EF) (43±9% vs 44±10%, p&amp;gt;0.05) or Killip-Kimbal (KK) stage at admission moment (stage I more frequent in both groups) or use of inotropes or vasoactive drugs. Embolic cohort had more in-hospital complications: worse KK stage (p=0.001; KKII 23.5% vs 15.3%; KKIII 23.5% vs 5.9%), more thrombocytopenia (5.3% vs 0.8%, p=0.046) and higher hsTnT levels (p=0.000). There was more use of non-invasive mechanical ventilation in embolic group (21.1% vs 4.9%, p=0.002). Without differences in incidence of cardiac arrest, mechanical complications, bradycardia, hemorrhage or in-hospital dead. Conservative management was more frequent in the embolic group. Percutaneous coronary intervention was the most frequent strategy in both cohorts (14.3% vs 3%; 85.6% vs 92.3%; p&amp;lt;0.05). At discharge, there were not significant differences in antithrombotic or anticoagulant therapy. Conclusions In our series the embolic group had worse KK stage and more need of non-invasive mechanical ventilation. They had no significant differences in EF, other mayor complications nor in-hospital mortality.

Burden of influenza in adults with cardiac arrest admissions in Australia

BackgroundCardiac arrest is the least preventable burden of cardiovascular disease, as treatment depends on timely resuscitation. The incidence of sudden cardiac arrest (SCA) is high, contributing 10–20% of cardiovascular mortality globally. The influenza vaccine reduces the risk of acute cardiovascular events. Little is known about the relationship of influenza infection to cardiac arrest. MethodsThis study aimed to determine the estimated rate of SCA hospitalisations attributable to influenza in Australian adults. A generalised-additive statistical model was applied in the study. Weekly counts of laboratory-confirmed influenza notifications were used as independent variables in the model. ResultsOur estimates showed that the yearly rate of SCA hospitalisations varied, and a significant association with influenza was observed in some years in older adults aged 65 years and over. On average, the annual estimated SCA hospitalisations rate due to influenza in adults aged 50–64 years and ≥ 65 years were 0.7 (95%CI: 0.4, 1.1) and 5.3 (95%CI: 4.4, 6.2) per 100,000 population, respectively. ConclusionThe association between influenza and SCA is evident in adults and the disease burden is significant in older people. Prevention of influenza by vaccination may reduce SCA.

Risk of hypertension on the incidence of out-of-hospital cardiac arrest: A case-control study

Objective: To analyse the effect of hypertension on the occurrence of out-of-hospital cardiac arrest, and to find out whether the effect is dependent on the use of anti-hypertensive drugs. Method: The case-control study used secondary data from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance project and comprised patients with presumed cardiac aetiology adult out-of-hospital cardiac arrest assessed by emergency medical service from 27 participating emergency departments from January 2016 to December 2017. Controls matched for age, gender and county were recruited from the Korea National Health and Nutrition Examination Survey database in a 4:1 ratio. Multivariate logistic regression analysis was used to analyse the effects of hypertension and the administration of anti-hypertensive medication on out-of-hospital cardiac arrest incidence. Data was analysed using SAS 9.4. Results: Of the 7330 subjects, 1,466(20%) were patients and 5864(80%) were controls. Hypertension was found in 662(45.2%) patients and 3,190(54.4%) controls. Hypertension lowered the incidence of out-of-hospital cardiac arrest (adjusted odds ratio: 0.69 [95% confidence interval: 0.60-0.80]); in the medication group 0.64(0.55-0.75), and 1.12(0.83–1.49) in the non-medication group. Conclusion: Administration of anti-hypertensive medications in patients of hypertension may help reduce the incidence of out-of-hospital cardiac arrest. Active hypertension diagnosis and anti-hypertensive medications to reduce the incidence of out-of-hospital cardiac arrest is critical. Key Words: Out-of-hospital cardiac arrest, Hypertension, Risk factor.

Does age influence out-of-hospital cardiac arrest incidence and outcomes among women? Insights from the Paris SDEC.

Age and sex disparities in out-of-hospital cardiac arrest (OHCA) have been described. Reproductive age may have a protected effect on females vs. males, although results are conflicting. We aimed to clarify this using the Paris Sudden Death Expertise Centre (SDEC) registry. The Paris SDEC registry collects OHCAs occurring in the Greater Paris Area. We included all OHCAs of presumed cardiac causes occurring between 2013 and 2018. Patients were divided into age groups: 1-13, 13-50, 50-75, and >75 years. Sex and age disparities in OHCA incidence and outcomes were analysed using multivariable negative binomial and logistic regression models. There were 19 782 OHCAs meeting inclusion criteria: 0.37% aged 1-13 years, 12.4% aged 13-50 years, 40.4% aged 50-75 years, and 46.9% aged >75 years. Adjusted incidence rate ratios (IRRs) in females vs. males were for the youngest to the older age groups: 1.29 [95% confidence interval (CI) 0.78-2.13], 0.54 [0.49-0.59], 0.60 [0.56-0.64], and 0.75 [0.67-0.84]. At reproductive age, females were more likely than males to have a return of spontaneous circulation [adjusted odds ratio (OR) 1.60 (1.27-2.02)], to be alive at hospital admission [OR: 1.49 (1.18-1.89)]. In both sexes, patients aged 13-50 years were more likely to survive at hospital discharge than those aged 50-75 years [males: OR 1.81 (1.49-2.20), females: 2.24 (1.54-3.25)]. However, at reproductive age, no sex disparity was observed in survival at hospital discharge [OR: 1.16 (0.75-1.80)]. Incidence rate ratios were similar between pre- and post-menopausal aged patients. At reproductive age, no sex disparity in survival at hospital discharge was observed, suggesting that menopausal status may not influence OHCA occurrence and prognosis.

Microaxial Circulatory Support for Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

<h3>Purpose</h3> Microaxial circulatory support can facilitate percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction with cardiogenic shock (AMICS). While proper timing of support is important, data are lacking to inform a standardized approach. We sought to pool existing evidence and compare outcomes of microaxial support based on its initiation before or after PCI. <h3>Methods</h3> Electronic search identified adult patients with AMICS undergoing PCI who received Impella 2.5, CP, or 5.0 support. Cohort-level data for 543 patients from 5 studies were extracted and analyzed. Patients were categorized as pre-PCI (Impella before PCI) or post-PCI (Impella after PCI) groups. Individual Kaplan-Meier survival curves were digitized and combined to analyze pooled survival. <h3>Results</h3> Mean patient age was 66 (95% CI: 58-74) years with 23% (17-30%) being female. Pre-PCI group had a higher incidence of previous stroke or transient ischemic attack [14% (6-28%) vs. 6% (3-14%), p = 0.02] and a trend toward higher incidence of diabetes [44% (22-69%) vs. 27% (13-48%), p = 0.08]. Mean left ventricular ejection fraction [pre-PCI: 29.5% (18.2-40.8%) vs. post-PCI: 32.3% (21.9-42.6%), p = 0.72] was similar between groups. Mean serum lactate was 6.5 (2.3-10.7) mmol/L in pre-PCI group and 5.7 (2.0-9.50) mmol/L in post-PCI group (p = 0.8). Pre-PCI group's incidence of cardiac arrest before Impella was 56% (4-98%) compared to 67% (8-98%) for post PCI-group (p = 0.76). Total duration of support was 1.6 (0-3.7) and 1.3 (0-3.3) days in pre-PCI and post-PCI groups, respectively (p = 0.87). 30-day mortality was lower in pre-PCI group [41% (34-49%) vs. 61% (42-77%), p < 0.01]. Pooled Kaplan-Meier analysis showed better early survival (log rank: p < 0.001) in pre-PCI group (Figure). <h3>Conclusion</h3> Timing of microaxial support initiation may reflect higher perceived risk in pre-PCI patients and higher acuity in post-PCI patients. Early survival appears to be better when microaxial support is initiated pre-PCI.