Incidence Of Cardiac Arrest Research Articles

Abstract 4114705: Clinical Predictors of Stress Induced Cardiomyopathy

Introduction: Stress Induced Cardiomyopathy is increasingly becoming more prevalent with increasing awareness about disease condition with annual incidence of 30 cases/100000 per year and an incidence of 1-2% in the patients presenting with acute coronary syndrome.[1] Physical and emotional triggers have been linked with occurrence of Stress induced Cardiomyopathy. Methods: We have obtained the National Readmission database for the year of 2020. We have used the ICD 10 code I51.81 for stress induced cardiomyopathy and found 10450 patients in the data base. Total 494 patients had cardiac arrest and 191 patients out of this 494 had died. We have used Binary logistic regression methods to find the odd ratio for physical and emotional risk factors for stress induced cardiomyopathy. Results: Grief disorder with an odd ratio of 7.2, followed by female gender with an odd ratio of 4.1, septic shock with an odd ratio of 3.3, Hemorrhagic stroke with an odd ratio of 1.73, ischemic stroke with an odd ratio of 1.72, depression with an odd ratio of 1.5, followed by asthma exacerbation with an odd ratio of 1.35 and seizure disorder with an odd ratio of 1.34 were among the few predictors for stress induced cardiomyopathy. Incidence of Cardiac Arrest was 4.7% and mortality rate of 1.8% was observed in the patients with stress induced Cardiomyopathy. Discussion: Extreme emotional and physical triggers like stroke, septic shock are among few significant risk factors for the stress induced cardiomyopathy.

Abstract 4120924: Effect Of Colchicine On Myocardial Infarction: Updated Systematic Review And Meta-analysis Of Randomized Controlled Trials

Background: Colchicine, in multiple ways, has beneficial as well as adverse effects on patients with myocardial infarction. Objective: Our current study aims to study the efficacy as well as harmful effects of colchicine on patients with myocardial infarction. Methods: A comprehensive search was conducted on PubMed, the Cochrane Library, Scopus, Google Scholar, and Clinical trials till May 2024, and Randomized controlled trials were searched investigating the effect of Colchicine on patients with Myocardial Infarction. The quality of trials was assessed with the Cochrane risk of bias tool. Our primary Outcomes include adverse cardiovascular events while secondary outcomes include All-cause Mortality, adverse gastrointestinal effects, levels of hs-CRP, incidence of stroke, cardiac arrest, and hospitalization urgency. Risk ratios and mean differences were pooled under the Random-effect Model. Results: Statistical analysis shows that colchicine did not impact all-cause Mortality (RR =1.00, 95% CI=0.72-1.39, P=0.98, I2=0%), cardiac arrest (RR=0.81, 95% CI=0.33-1.95, P=0.63, I2=0), incidence of stroke(RR=0.45, 95% CI= 0.17-1.19, P=0.11, I2=36%) recurrent myocardial infarction (RR=0.78, 95%CI=0.57-1.06, P=0.11, I2=11%) and levels of hs-CRP (MD= -0.87, 95% CI=-1.80-0.06, P=0.07, I2=67%). However, colchicine shows statistically significant reduction in cardiovascular events(RR=0.75, 95%CI=0.60-0.94 , P=0.01, I2= 48%) , hospitalization urgency(RR=0.46, 95% CI=0.31-0.68, P=0.0001, I2=0%) and statistically significant increase adverse gastrointestinal events (RR=1.86, CI=1.14-3.02, P=0.01, I2=79%). Conclusion: Hence, we conclude that colchicine reduces adverse cardiovascular events, hospitalization urgency and increases adverse gastrointestinal events especially diarrhea in patients with myocardial infarction. However, colchicine did not reduce all-cause deaths, cardiac arrest, stroke incidence, the incidence of recurrent myocardial infarction, and hs-CRP; we still believe that the effect of colchicine on myocardial infarction needs further investigation and encourages the researcher to conduct more trials, especially with long-term follow-up.

Abstract 4134863: Major Cardiovascular Events Following Non-Cardiovascular Surgeries in Minority Patients Compared to White Patients

Introduction: Racial disparities are pervasive in cardiovascular outcomes. Although disparities following cardiovascular surgery have been extensively studied, fewer current, nationwide reports exist for postoperative outcomes in non-cardiovascular surgery. Research Aim: To investigate the incidence of 30-day post-operative major adverse cardiac, cerebral and thrombotic events (MACCTE) following non-cardiovascular surgeries in non-White patients as compared to White patients. Methods: This retrospective cohort study used the 2018-2022 National Surgical Quality Improvement Program database. Patients aged 18 or older who underwent non-cardiovascular surgeries (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, obstetrics, and interventional radiology) were included. Race/ethnicity was categorized as non-Hispanic White (Whites), Hispanic, non-Hispanic Asian (Asians), non-Hispanic Black or African American (Blacks), and non-Hispanic Others. MACCTE was defined as a composite of death, MI, cardiac arrest, stroke, PE, or DVT. Five multivariable logistic regression models were used to hierarchically adjust for age, gender, ASA class, surgical subspecialty, operation time, transfer status, and all other comorbidities. Results: Among the 3,775,920 patients: 70.9% were Whites, 11.8% Hispanics, 4.1% Asians, 11.6% Blacks, 1.5% of Other race, 58.9% female, and 46.7% had an ASA classification of 3 or greater. The MACCTE incidence was 1.95% overall and 2.01% in Whites, 1.27% Hispanics, 1.48% Asians, 2.11% Blacks, and 1.69% Others. Compared to Whites, Blacks had higher incidences of cardiac arrest (0.40% vs. 0.23%), stroke (0.17% vs. 0.15%), PE (0.47% vs. 0.34%), and DVT (0.55% vs. 0.48%), and Asians (0.18% vs 0.15%) and Others (0.21% vs. 0.15%) had a higher incidence of stroke (p<0.001). With Whites as reference, the crude odds ratios, OR (95% CI) were 0.63 (0.61-0.65) in Hispanics, 0.73 (0.70-0.76) Asians, 1.05 (1.03-1.07) Blacks, and 0.84 (0.78-0.89) Others. The fully adjusted model odds ratios, OR (95% CI) were 0.88 (0.82-0.95) Hispanics, 0.89 (0.80-1.00) Asians, 1.11 (1.04-1.18) Blacks, and 0.80 (0.69-0.94) Others. Conclusion: Black patients experienced a higher MACCTE risk compared to Whites, even after adjustment for age, sex, ASA class, type of surgical procedure, and other comorbidities. These findings emphasize the importance of implementing comprehensive measures to prevent excess risk and promote equitable surgical care.

Cardiac arrest in adult cardiology patients receiving anaesthetic care: analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists.

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing. We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures. There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation. Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.

Incidence and trend of cardiac events among children and young adults exposed to psychopharmacological treatment (2006-2018): A nationwide register-based study.

The aim of this study was to assess cardiac event incidence and trends by sex and age in young patients on psychopharmacological treatment in Sweden. This nationwide incidence study encompassed data from Swedish registers (2006-2018). Patients aged 5-30 years were exposed to one or more psychotropic medications (attention deficit hyperactivity disorder medications, antihistamines, selective serotonin reuptake inhibitors, other antidepressants, anxiolytics, antipsychotics, hypnotics/sedatives). Annual incidences, trends and mean incidences of cardiac events (cardiac arrest, arrhythmias, fainting/collapse, sudden death) and recurrent events were calculated. Among those exposed (n = 875 430, 2 647 957 patient-years, 55% female), 26 750 cardiac events were identified. The mean annual incidence of cardiac events and first-ever events were 0.99% and 0.80%, respectively, showing significant upward annual trends of 4.26% and 2.48%, respectively (P< .001). The highest incidences were among females aged 15-19 years (1.50%) and those exposed to polypharmacy (1.63%), anxiolytics (1.53%) or antihistamines (1.27%). The mean annual incidences of cardiac arrest and arrythmias, for both sexes, were 0.01% and 0.51%, respectively. Fainting/collapse accounted for about half of all events, occurring more often in females. The pattern of rising annual incidence remained after excluding fainting/collapse. In all, 21.1% of events were recurrent. Death, including sudden death, occurred in 13 patients. The mean annual incidence of cardiac events among young patients receiving psychopharmacological treatment was low, 0.99%, with an upward trend of 4.26% annually. Incidence was highest in adolescent females and patients exposed to polypharmacy. Our study highlights the need for more knowledge regarding the possible association between exposure to psychopharmacological treatment and cardiac events.

Sudden cardiac arrest during marathons among young, middle-aged, and senior runners

AimThere is limited evidence showing a relationship with age in the incidence of sudden cardiac arrest during exercise, which can be lethal at times. MethodsTo examine the incidence by age group in sudden cardiac arrest, we prospectively observed cases of sudden cardiac arrest in full marathons certified by the Japan Association of Athletics Federations held between April 2011 and March 2019. Sudden cardiac arrest was defined as collapse during or 1 h after the race requiring chest compressions or the use of an automatic electrical defibrillation. Results4.1 million persons ran in 516 marathons. Of the participants, 78.6 % were men. By age group, 37.4 %, 34.7 %, 19.6 %, and 8.3 % belonged to the < 40 s, 40 s, 50 s, and ≥ 60 s groups, respectively. During the study period, 69 sudden cardiac arrests (1.7 per 100,000 participants, 95 % confidence interval [CI]: 1.3–2.1) were observed, of which 66 were men. The incidence per 100,000 runners of sudden cardiac arrest was 0.9 (95 % CI: 0.4, 1.4), 0.9 (95 % CI: 0.4, 1.4), 2.6 (95 % CI: 1.5, 3.8), and 5.5 (95 % CI: 2.9, 8.2) for those in their under 40 s, 40 s, 50 s, and over 60 s, respectively, with higher rates for older age groups. Compared to men, the cases of SCA among women were less common (only three cases), and the incidence did not differ by age group. ConclusionsMen, unlike women, had a higher incidence of sudden cardiac arrest during marathons according to age. Identification of this high-risk population could be important information in encouraging marathoners pre-participation self-screening.

Clinical outcomes following hospitalization for COVID-19 in patients with cardiac sarcoidosis in the United States: a propensity-matched analysis from national inpatient sample database from April 2020 to December 2021.

The highly arrhythmogenic nature of cardiac sarcoidosis (CS) leads to high morbidity and mortality, the rates of which may be higher in COVID-19 patients. This study aimed to evaluate the outcomes of CS patients admitted to hospitals with COVID-19. The study utilised the 2020-2021 National Inpatient Sample database, examining primary COVID-19 cases in adults aged older than or equal to 18 years. Those with CS were identified using ICD-10 code "D86.85" and compared with and without propensity matching (1:10) to those without CS for baseline characteristics and primary outcomes of acute kidney injury (AKI), use of mechanical ventilation, cardiac arrest and mortality. In total, 2543912 COVID-19 cases were identified. Before propensity matching, CS patients were more likely to be younger (58.0 vs. 64.0years, P<0.01), male (64.0% vs. 52.6%, P=0.011), of Black ethnicity (60.0% vs. 15.9%, P<0.01), exhibit higher Charlson Comorbidity Index (CCI) scores (3.00 vs. 1.00, P<0.01) and had a higher incidence of in-hospital cardiac arrest (aOR 2.649, 95% CI 1.366-5.134, P=0.004). After propensity matching (CS, N=95; non-CS, N=875), those with CS were at a statistically significant reduced risk of AKI (aOR 0.484, P=0.01); however, the outcomes of death, cardiac arrest, mechanical ventilation, length of stay (LOS) and healthcare costs did not reach significance. In a propensity-matched cohort admitted with COVID-19, CS patients had a reduced risk of AKI, but comparable LOS, rates of cardiac arrest, mechanical ventilator use, and mortality. Future research is warranted to develop evidence-based guidelines for managing COVID-19 in patients with CS.

Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest

Abstract Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.

Improving Cardiopulmonary Resuscitation skills for layperson in cases of heart attack: a scoping review

The proficiency of trained individuals in effectively administering Cardiopulmonary Resuscitation (CPR) is paramount in mitigating the impact of out-of-hospital cardiac arrest incidents. Inadequate CPR skills among laypersons can result in missed opportunities to save lives. Therefore, it is imperative to prioritize unified efforts to enhance CPR competencies within the general populace. This scoping review aims to consolidate literature discussing the enhancement of laypeople's CPR skills using various methodologies.This scoping review employed the PRISMA methodology and encompassed an extensive search across four critical databases (Science Direct, Proquest, Pubmed, and Google Scholar) for literature published between 2013 and 2023. The search utilized the keywords "CPR Teaching," "Skill," and "Layperson." Out of 487 collected articles, 20 were deemed relevant. The findings of all relevant articles consistently indicated an improvement in laypeople's CPR skills following training.Incorporating concise CPR instructional videos and smartphone applications has shown potential for enhancing CPR knowledge and improving emergency responsiveness. Nonetheless, integrating these modern technological approaches with traditional simulation methods has demonstrated greater efficacy in CPR training, resulting in enhanced compression quality and depth.In conclusion, Integrating traditional and technology-based learning methodologies improves the capability of individuals without specialized medical training to administer CPR effectively.

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units.

The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined. To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement. This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP-participating hospitals. The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work. Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed. There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, -0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up. In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.

Risk factors of cardiac arrest during a percutaneous coronary intervention performed with rotational atherectomy - analysis based on a Large National Registry.

Rotational atherectomy (RA) is traditionally administered for patients with heavily calcified lesions and is thereby characterized by a high risk of the performed intervention. However, the prevalence characteristics of cardiac arrest are poorly studied in this group of patients. We aimed to evaluate the frequency and risk factors of cardiac arrest during percutaneous coronary interventions (PCI) performed with RA and preceding coronary angiography (CA). Based on the data collected in the Polish Registry of Invasive Cardiology Procedures (ORPKI) from 2014 to 2021, we included 6522 patients who were treated with RA-assisted PCI. We scrutinized patient and procedural characteristics, as well as periprocedural complications, subsequently comparing groups in terms of cardiac arrest incidence with the use of univariable and multivariable analyses. Thirty-five (0.5%) patients suffered from cardiac arrest during RA-PCI or preceding CA. They were characterized by significantly higher rates of prior stroke, acute coronary syndromes (ACS) as indications and higher Killip class (P < 0.001) at the admission time. Among the confirmed independent predictors of in-procedure cardiac arrest, the following can be noted: factors related to patients' clinical characteristics (e.g., older age, female sex, and disease burden), periprocedural characteristics (e.g., PCI within left main coronary artery [LMCA]), and periprocedural complications (e.g., coronary artery perforation and no-reflow phenomenon). Severe clinical condition at baseline, expressed by ACS presence and Killip class IV, as well as RA-PCI performed within LMCA and other periprocedural complications, were the strongest predictors of cardiac arrest during RA-assisted PCI and CA.

Intraoperative cardiac arrest in patients undergoing congenital cardiac surgery

ObjectiveTo describe intraoperative cardiac arrest in patients undergoing congenital heart surgery. MethodsThe Society of Thoracic Surgeons Congenital Heart Surgery Database was queried. Predictors of intraoperative cardiac arrest were assessed using univariate and multivariable analyses. The univariate relationship between intraoperative cardiac arrest was also compared with available outcomes in the database. ResultsA total of 92,764 cases had anesthesia adverse event data, and 357 patients (0.38%) had an intraoperative cardiac arrest. Multivariable predictors of an intraoperative cardiac arrest included age (odds ratio [OR], 0.98 per year; 95% confidence interval [CI], 0.97-0.99; P = .036), preoperative cardiac arrest (<48 hours) (OR, 9.6; 95% CI 6.3-14.6, P < .001), preoperative neurologic deficit (OR, 2.0; 95% CI, 1.3-3.1, P = .002), noninsulin-dependent diabetes mellitus (OR, 6.4; 95% CI, 1.9-21.9, P = .003), increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (OR, 2.3 for STAT 5 vs STAT 1; 95% CI, 1.3-3.9, P = .003), urgent (OR, 2.0; 95% CI, 1.6-2.6, P < .001) or emergent surgery (OR, 3.1; 95% CI, 1.9-5.0, P < .001), and increasing length of total operating room time (OR, 1.2 per hour; 95% CI, 1.2-1.3, P < .001). Intraoperative cardiac arrest was associated with a greater 30-day mortality (14.6% vs 1.8%, P < .001). There were more morbidities in the intraoperative cardiac arrest group including postoperative neurologic deficits (12% vs 1.0%, P < .001), multisystem organ failure (5.9% vs 0.7%, P < .001), and greater rates of unplanned reoperation (19.3% vs 5.0%, P < .001) or interventional cardiac catheterization (7% vs 3.2%, P < .001). ConclusionsThe incidence of intraoperative cardiac arrest is low; however, it is an important indicator of significant patient perioperative morbidity and mortality.

Synthetic opioids have disrupted conventional wisdom for treating opioid overdose

More than 90 % of opioid overdose deaths in North America are now caused by synthetic opioids, and while they are not as prevalent in the European illicit drug market, there are indications that they may become so in the near future. Multiple publications have argued that neither higher doses of naloxone nor more potent opioid receptor antagonists are needed to reverse a synthetic opioid overdose. However, the unique physicochemical properties of synthetic opioids result in a very rapid onset of respiratory depression compared to opium-based molecules, reducing the margin of opportunity to reverse an overdose. While intravenous administration rapidly delivers the high naloxone concentrations needed to reverse a synthetic opioid overdose, this option is often unavailable to first responders. A translational mechanistic model of opioid overdose developed by the FDA’s Division of Applied Regulatory Science provides an unbiased approach to evaluate the effectiveness of overdose reversal strategies. Reports using this model demonstrated the naloxone tools (2mg intramuscular and 4mg intranasal) used by many first responders can result in an unacceptable loss of life following a synthetic opioid (fentanyl, carfentanil) overdose. Moreover, sequential (2.5minutes between doses) administration of up to four doses of intranasal naloxone was no more effective at reducing the incidence of cardiac arrest (a surrogate endpoint for lethality) than a single dose, suggesting that attempts at titration may not provide the rapid absorption required to reverse a synthetic opioid overdose. This model was also used to compare the effectiveness of intranasal naloxone to intranasal nalmefene, a recently FDA-approved opioid receptor antagonist with a more rapid absorption and a higher affinity at mu-opioid receptors compared to intranasal naloxone. Intranasal nalmefene resulted in large and clinically meaningful reductions in the incidence of cardiac arrest compared to intranasal naloxone. Furthermore, simultaneous administration of four doses of intranasal naloxone was needed to reduce the incidence of cardiac arrest to levels approaching those produced by a single dose of intranasal nalmefene. These data are consistent with evidence that synthetics have indeed disrupted conventional wisdom in the treatment of opioid overdose.

The Role and Implications of COVID-19 in Incident and Prevalent Heart Failure.

This review examines the pathophysiological interactions between COVID-19 and heart failure, highlighting the exacerbation of heart failure in COVID-19 patients. It focuses on the complex mechanisms driving worse outcomes in these patients. Patients with pre-existing heart failure experience more severe symptoms and higher mortality rates due to mechanisms such as cytokine storms, myocardial infarction, myocarditis, microvascular dysfunction, thrombosis, and stress cardiomyopathy. Elevated biomarkers like troponin and natriuretic peptides correlate with severe disease. Long-term cardiovascular risks for COVID-19 survivors include increased incidence of heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock. COVID-19 significantly impacts patients with pre-existing heart failure, leading to severe symptoms and higher mortality. Elevated cardiac biomarkers are indicators of severe disease. Acute and long-term cardiovascular complications are common, calling for ongoing research into targeted therapies and improved management strategies to better prevent, diagnose, and treat heart failure in the context of COVID-19.

Analysis of cardiac arrest after coronary artery bypass grafting

BackgroundCardiac arrest after coronary artery bypass grafting (CABG) is a serious complication with low survival rate. The prognosis of patients with cardiac arrest in the general ward is worse than that in the intensive care unit (ICU) because of the delayed and poor rescue conditions.MethodsThis retrospective study included patients who experienced cardiac arrest after CABG surgery between January 2010 and December 2019 at the Fuwai Hospital. Differences in cardiac arrest between the ICU and the general ward were compared. The patients were divided into shockable and non-shockable rhythm groups, and the differences between the two groups were compared. Finally, we proposed a management protocol for cardiac arrest in the general ward.ResultsWe retrospectively analyzed 41,450 patients who underwent CABG only, of whom 231 (0.56%) experienced cardiac arrest post-surgery in the ICU (185/231) or in the general ward (46/231). The rescue success rate and 30-day survival rate of the patients with cardiac arrest in the general ward were 76.1% (35/46) and 58.7% (27/46), respectively. The incidence of the different arrhythmia types of cardiac arrest in the general ward compared with that in the ICU was different (P = 0.010). The 30-day survival rate of the non-shockable rhythm group was 31.8% (7/22), which was worse than that of the shockable rhythm group (83.3% [20/24]; P = 0.001). Kaplan–Meier survival analysis showed that the prognosis of the non-shockable group was poor (P < 0.001).ConclusionsThe incidence of cardiac arrest after CABG was low. The prognosis of patients in the general ward was worse than that of those in the ICU. The proportion of non-shockable rhythm type cardiac arrest was higher in the general ward than in the ICU, and patients in this group had a worse early prognosis.

Comparison of Interfacility Transfer of Critically Ill Pediatric Patients by Helicopter Versus Ground Ambulance in a Remote and Rural Domain

ObjectiveSince 2018, Thailand's helicopter emergency medical service (HEMS) has been used to transport critically ill pediatric patients from Tak Province's community hospitals to the tertiary care hospital. This article describes a pilot study to look at the feasibility of comparing mortality rates and complications during transport. MethodsThis retrospective pilot study used data from the medical records of the referring and receiving hospitals. Participants were critically ill patients under 18 years of age who were transferred between facilities using HEMS or ground emergency medical services (GEMS) between January 2018 and December 2022. HEMS transported 9 patients, whereas GEMS transported 52. ResultsThe predominant age group was newborns. Respiratory-related conditions were the most common diagnoses. The majority of patients underwent intubation and displayed abnormal respiratory rates and levels of consciousness before flight. Approximately one third were hypotensive or required vasoactive drugs. Cardiac arrest requiring cardiopulmonary resuscitation was the most common significant complication during transport in the HEMS group (22.2%). Meanwhile, changing hospital destination because of an unstable patient condition was the most common complication during transport in the GEMS group (3.9%). Hypotension was the most common complication upon arrival at the receiving hospital in both groups (25% versus 8%). HEMS demonstrated shorter transport times. ConclusionHEMS reduced transport times compared with GEMS. However, there was a higher incidence of cardiac arrest requiring cardiopulmonary resuscitation during transfer and hypotension upon arrival.

Standby extracorporeal membrane oxygenation: a better strategy for high-risk percutaneous coronary intervention.

The incidence of cardiac arrest (CA) during percutaneous coronary intervention (PCI) is relatively rare. However, when it does occur, the mortality rate is extremely high. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promising survival rates for in-hospital cardiac arrests (IHCA), with low-flow time being an independent prognostic factor for CA. However, there is no definitive answer on how to reduce low-flow time. This retrospective study, conducted at a single center, included 39 patients who underwent ECPR during PCI between January 2016 and December 2022. The patients were divided into two cohorts based on whether standby extracorporeal membrane oxygenation (ECMO) was utilized during PCI: standby ECPR (SBE) (n = 13) and extemporaneous ECPR (EE) (n = 26). We compared the 30-day mortality rates between these two cohorts and investigated factors associated with survival. Compared to the EE cohort, the SBE cohort showed significantly lower low-flow time (P < 0.01), ECMO operation time (P < 0.01), and a lower incidence of acute kidney injury (AKI) (P = 0.017), as well as peak lactate (P < 0.01). Stand-by ECMO was associated with improved 30-day survival (p = 0.036), while prolonged low-flow time (p = 0.004) and a higher SYNTAX II score (p = 0.062) predicted death at 30 days. Standby ECMO can provide significant benefits for patients who undergo ECPR for CA during PCI. It is a viable option for high-risk PCI cases and may enhance the overall prognosis. The low-flow time remains a critical determinant of survival.

The burden of sudden cardiac arrest in the setting of acute coronary syndrome

BackgroundThe incidence of sudden cardiac arrest (SCA) during acute coronary syndrome is somewhat unclear, since often subjects dying before the first healthcare contact are not included in the estimates. We aimed to investigate the complete incidence of SCA during ACS. MethodsThe study population consists of two cohorts. The first cohort includes 472 ACS patients from Northern Ostrobothnia, Finland from year 2016 and the second cohort 162 autopsy-verified SCD subjects (extrapolated) from the same region and year, whose death was attributable to coronary artery disease (CAD) and ACS. An extrapolation of SCA incidence during ACS was done by utilizing autopsy data and data from prior autopsy study on this sample. ResultsThe overall incidence of SCA in the setting of ACS was 17.5%. The incidence of SCA was 20.6% in all ACS subjects without prior CAD diagnosis, and 25.4% in STEMI subjects without prior CAD diagnosis. In subjects with previously diagnosed CAD, the incidence of SCA was 10.9% in all ACS subjects and 16.1% in STEMI subjects. There was a statistically significant difference in the incidence of SCA between subjects with and without prior CAD diagnosis (p = 0.0052). ConclusionThe inclusion of ACS-SCA subjects dying before the first emergency medical service (EMS) contact results in a higher and likely more accurate estimation of SCA during ACS. The incidence of SCA was higher among subjects without prior CAD diagnosis. The high mortality rate highlights the importance of early ACS detection to reduce the burden of CAD-related premature deaths.

Comparison of intranasal naloxone and intranasal nalmefene in a translational model assessing the impact of synthetic opioid overdose on respiratory depression and cardiac arrest.

Using a validated translational model that quantitatively predicts opioid-induced respiratory depression and cardiac arrest, we compared cardiac arrest events caused by synthetic opioids (fentanyl, carfentanil) following rescue by intranasal (IN) administration of the μ-opioid receptor antagonists naloxone and nalmefene. This translational model was originally developed by Mann et al. (Clin Pharmacol Ther 2022) to evaluate the effectiveness of intramuscular (IM) naloxone. We initially implemented this model using published codes, reproducing the effects reported by Mann et al. on the incidence of cardiac arrest events following intravenous doses of fentanyl and carfentanil as well as the reduction in cardiac arrest events following a standard 2 mg IM dose of naloxone. We then expanded the model in terms of pharmacokinetic and µ-opioid receptor binding parameters to simulate effects of 4 mg naloxone hydrochloride IN and 3 mg nalmefene hydrochloride IN, both FDA-approved for the treatment of opioid overdose. Model simulations were conducted to quantify the percentage of cardiac arrest in 2000 virtual patients in both the presence and absence of IN antagonist treatment. Following simulated overdoses with both fentanyl and carfentanil in chronic opioid users, IN nalmefene produced a substantially greater reduction in the incidence of cardiac arrest compared to IN naloxone. For example, following a dose of fentanyl (1.63 mg) producing cardiac arrest in 52.1% (95% confidence interval, 47.3-56.8) of simulated patients, IN nalmefene reduced this rate to 2.2% (1.0-3.8) compared to 19.2% (15.5-23.3) for IN naloxone. Nalmefene also produced large and clinically meaningful reductions in the incidence of cardiac arrests in opioid naïve subjects. Across dosing scenarios, simultaneous administration of four doses of IN naloxone were needed to reduce the percentage of cardiac arrest events to levels that approached those produced by a single dose of IN nalmefene. Simulations using this validated translational model of opioid overdose demonstrate that a single dose of IN nalmefene produces clinically meaningful reductions in the incidence of cardiac arrest compared to IN naloxone following a synthetic opioid overdose. These findings are especially impactful in an era when >90% of all opioid overdose deaths are linked to synthetic opioids such as fentanyl.

Concomitant use of lansoprazole and ceftriaxone is associated with an increased risk of ventricular arrhythmias and cardiac arrest in a large Japanese hospital database

To determine whether concomitant use of ceftriaxone and oral or intravenous lansoprazole increases the risk of ventricular arrhythmia and cardiac arrest in the real-world setting in Japan. The data analyzed were obtained from the JMDC hospital-based administrative claims database for the period April 2014 to August 2022. Patients who received a proton pump inhibitor (PPI) while receiving ceftriaxone or sulbactam/ampicillin were identified. The frequency of ventricular arrhythmia and cardiac arrest was analyzed according to whether oral or intravenous PPI was concomitant with ceftriaxone or sulbactam/ampicillin. Estimates of the incidence of ventricular arrhythmia and cardiac arrest were then compared among the groups, using the Fine-Gray competing risk regression model. The results showed that the risk of ventricular arrhythmia and cardiac arrest was significantly higher with concomitant ceftriaxone and oral lansoprazole (hazard ratio 2.92, 95% confidence interval 1.99-4.29, P<0.01) or intravenous lansoprazole (hazard ratio 4.57, 95% confidence interval 1.24-16.80, P=0.02) than with concomitant sulbactam/ampicillin and oral or intravenous lansoprazole. Oral and intravenous lansoprazole may increase the risk of ventricular arrhythmia and cardiac arrest in patients who are receiving ceftriaxone.