Outcome Of Cardiopulmonary Resuscitation Research Articles

Impacts of Symptomatic HIV Infection on In-Hospital Cardiopulmonary Resuscitation Outcomes: 
A Population-Based Cohort Study in South Korea

BackgroundThe impact of HIV infection on survival outcomes after in-hospital cardiopulmonary resuscitation (ICPR) remains controversial. This study aimed to investigate the impacts of HIV infection on both short-term and long-term outcomes after ICPR.MethodsThis nationwide, population-based cohort study used data taken from the South Korean National Health Insurance Service database. All adult (≥18 years old) patients who experienced ICPR between January 1, 2010, and December 31, 2019, were included.ResultsA total of 298 676 adult patients who underwent ICPR were initially included in the analysis. Among them, 586 (0.2%) patients were assigned to the patients with symptomatic HIV infection (PWH) group, while 298 090 (99.8%) patients were assigned to the control group. After 1:10 propensity score (PS) matching, 586 patients in the PWH group and 5845 patients in the control group were included in the analysis. Logistic regression analysis after PS matching showed that the PWH group had a 20% lower live discharge rate after ICPR compared with the control group (odds ratio, 0.80; 95% CI, 0.65–0.97; P = .024). However, Cox regression analysis after PS matching showed that the risks of 6-month survival (hazard ratio [HR], 1.01; 95% CI, 0.93–1.11; P = .768) and 1-year survival (HR, 1.02; 95% CI, 0.93–1.11; P = .702) were not significantly different between the PWH and control groups.ConclusionsAlthough the PWH group showed lower live discharge rates compared with the control group after ICPR, long-term survival outcomes from 6 months and 1 year were not significantly different.

Vitamin C Improves the Outcomes of Cardiopulmonary Resuscitation and Alters Shedding of Syndecan-1 and p38/MAPK Phosphorylation in a Rat Model.

BackgroundPost‐resuscitation syndrome, involves a severe inflammatory response following successful cardiopulmonary resuscitation. The potential mechanism of Vitamin C (VitC) after cardiopulmonary resuscitation on myocardial and cerebral function, duration of survival is undefined.Methods and ResultsA first set of experiments were done in 18 male Sprague‐Dawley rats for the investigation of short‐term follow‐up, randomized into 3 groups: (1) sham; (2) controls; (3) VitC. Ventricular fibrillation was electrically induced and untreated for 6 minutes. Cardiopulmonary resuscitation including chest compression and mechanical ventilation were then initiated and continued for 8 minutes followed by defibrillation. At 5 minutes after return of spontaneous circulation, either VitC (200 mg/kg) or placebo was administered by intravenous infusion with a syringe pump for half an hour. There were significant improvements in myocardial function and buccal microcirculation in rats treated with VitC after return of spontaneous circulation 4 hours compared with controls. VitC inhibited proinflammatory cytokines (interleukin‐6 and tumor necrosis factor‐α), SDC‐1 (Syndecan‐1), and hyaluronic acid in plasma compared with controls (P<0.01). VitC decreased reactive oxygen species production and inhibited p38/MAPK (mitogen‐activated protein kinase) pathway phosphorylation. A second set with 20 animals was used for assessing the neurological deficit score after return of spontaneous circulation 72 hours, randomized into 2 groups: 1) controls; 2) VitC. The survival rate and neurological deficit score after return of spontaneous circulation 72 hours were improved in VitC‐treated animals compared with those of the control group.ConclusionsVitC reduces the severity of post‐resuscitation myocardial and cerebral dysfunction and improves the survival. The mechanisms may involve inhibiting transcription of inflammatory cytokines and oxidative stress, thus protecting the integrity of the vascular endothelium. Meanwhile VitC reduces shedding of SDC‐1 and alters p38/MAPK phosphorylation and microcirculation.

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions.

OBJECTIVES:The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts.DESIGN:Retrospective cohort study.SETTING:New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY.PATIENTS:Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest.INTERVENTIONS:None.MEASUREMENT AND MAIN RESULTS:Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; p = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; p < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; p = 0.03), but otherwise there were no significant differences between groups.CONCLUSIONS:Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.

Paediatric In-hospital cardiopulmonary resuscitation quality and outcomes in children with CHD during nights and weekends.

Survival after paediatric in-hospital cardiac arrest is worse on nights and weekends without demonstration of disparity in cardiopulmonary resuscitation quality. It is unknown whether these findings differ in children with CHD. This study aimed to determine whether cardiopulmonary resuscitation quality might explain the hypothesised worse outcomes of children with CHD during nights and weekends. In-hospital cardiac arrest data collected by the Pediatric Resuscitation Quality Collaborative for children with CHD. Chest compression quality metrics and survival outcomes were compared between events that occurred during day versus night, and during weekday versus weekend using multivariable logistic regression. We evaluated 3614 sixty-second epochs of chest compression data from 132 subjects between 2015 and 2020. There was no difference in chest compression quality metrics during day versus night or weekday versus weekend. Weekday versus weekend was associated with improved survival to hospital discharge (adjusted odds ratio 4.56 [1.29,16.11]; p = 0.02] and survival to hospital discharge with favourable neurological outcomes (adjusted odds ratio 6.35 [1.36,29.6]; p = 0.02), but no difference with rate of return of spontaneous circulation or return of circulation. There was no difference in outcomes for day versus night. For children with CHD and in-hospital cardiac arrest, there was no difference in chest compression quality metrics by time of day or day of week. Although there was no difference in outcomes for events during days versus nights, there was improved survival to hospital discharge and survival to hospital discharge with favourable neurological outcome for events occurring on weekdays compared to weekends.

The unrealistic expectations of CPR success: a comparative public survey of Saudi Arabia and the United States

Background: Success rates of cardiopulmonary resuscitation (CPR) in in-hospital cardiac arrest (INCA) and out-of-hospital cardiac arrest OOHCA is reported to be 15% and 3%, respectively. However, people in the general population have high and unrealistic expectations of the success of CPR outcomes. Many studies have attributed these false expectations to be due to misinformation disseminated by the mainstream television media. To this end, we have set to investigate this by performing a survey among the general public of the Kingdom of Saudi Arabia (KSA) and the general public in the United States (US). Methods: Two cross-sectional surveys were carried out in the general populations of KSA and USA. The US data was collected via an electronic questionnaire delivered on the survey platform SurveyMonkey® and the data was analyzed for the public\&amp;apos;s expectations and the source from which the information was obtained. Statistical analysis was later done to check the impact of TV and medical dramas on the public\&amp;apos;s expectations. Results: Out of 402 participants in KSA and 346 in the US, the subjects with accurate expectations of CPR outcomes in OOHCA and INCA settings were 11.4% and 14.7%, respectively, in KSA, and 10.7% and 12.7%, respectively in the US. Most subjects thought that CPR would be successful &amp;gt; 50% of the time, and a quarter of those believe that CPR is effective&amp;gt; 90% of the time! subgroup analysis showed no relation between TV dramas and the general public&amp;apos;s expectations. Conclusion: Public&amp;apos;s expectations about CPR outcomes for INCA and OOHCA settings were largely unrealistic. Only 11.6% and 13%, respectively, had accurate prognoses and realistic expectations and were not influenced by TV medical dramas.

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest According to Cannulation Sites: Cath Lab vs Non-Cath Lab

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest According to Cannulation Sites: Cath Lab vs Non-Cath Lab

Hemodynamic efficacy of a motor-driven automatic device performing simultaneous sternothoracic cardiopulmonary resuscitation compared to standard cardiopulmonary resuscitation in an animal model of cardiac arrest

The aim of this study was to investigate hemodynamic effects and resuscitation outcomes of simultaneous sternothoracic cardiopulmonary resuscitation (SST-CPR) with a prototype of a motor-driven automatic device, comparing to manual standard CPR (S-CPR), in an animal model of ventricular fibrillation (VF). 20 male pigs were randomized to receive standard CPR (S-CPR group) or CPR with an automatic SST-CPR device (A-CPR group) after 5 minutes of VF. Five minutes of basic life support CPR was performed, followed by 10 minutes of advanced life support CPR. Hemodynamic variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), coronary perfusion pressure (CPP), and end-tidal carbon dioxide tension (ETCO2), and resuscitation outcomes including rate of restoration of spontaneous circulation (ROSC) and 2-hour survival were compared between two groups. Ten animals among the A-CPR group and 8 animals among the S-CPR group were included in the final analysis. SBP was higher in the A-CPR group than in the S-CPR group during CPR (p = 0.046). The DBP, CPP and ETCO2 were not different between two groups (p = 0.412, 0.585, and 0.243, respectively). ROSC rate was 38% in the S-CPR group and 10% in the A-CPR group (p = 0.275). The 2-hour survival rate was 25% in the S-CPR group and 0% in the A-CPR group (p = 0.183). In a swine model of cardiac arrest, CPR with a prototype of a motor-driven automatic SST-CPR device, compared with standard CPR, produced higher systolic blood pressure, but there was no difference in diastolic pressure, coronary perfusion pressure, ROSC rate and 2-hour survival rate.

Outcome of bystander cardiopulmonary resuscitation after out-of-hospital cardiac arrest in Beijing

Abstract Aim: We aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) and survival of patients with out-of-hospital cardiac arrests (OHCA) in Beijing. Methods: This observational study analyzed adult patients with OHCA treated by the Beijing emergency medical service (EMS) from January 2013 to December 2017. Data were collected in a Utstein style with a 1-year follow-up and a primary outcome of survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, favorable neurological outcome at hospital discharge, and survival and favorable neurological outcomes of up to 1 year. Results: A total of 5016 patients with OHCA from Beijing's urban area were recorded by EMS, wherein 765 patients (15.25%) underwent bystander CPR. The data were propensity score-matched forage, sex, location, witness, aetiology, initial rhythm, and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR. The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR (3.7% vs 1.2%, respectively; P &lt; 0.001). Moreover, patients with OHCA resuscitated with bystander CPR achieved better outcomes of ROSC, survival to admission, favorable neurological outcome at hospital discharge, survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR. Conclusion: Survival and neurological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beijing. However, the rate of bystander CPR was low.

Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards

Purpose: This study investigated differences in the clinical outcomes of cardiopulmonary resuscitation (CPR) of patients hospitalized in general wards according to the operation of a rapid response team.Methods: This retrospective study included 122 patients over the age of 19 who were admitted to general ward of a hospital located in Suwon, between July 1, 2015 and December 31, 2019, and received CPR during the operating hours of the rapid response team. The collected data were analyzed by descriptive statistics, the x2 test, Fisher's exact test, and one-way analysis of variance using SPSS for Windows version 25.0.Results: The proportion of nurses who were the initial responders to cardiac arrest was 79.1% during the extended-operation period. 41.2% during the pre-operation period, and 42.2% during the limited-operation period (p&lt;.001). The rate of good neurological recovery at discharge post-CPR was 25.0% in patients who received CPR during the pre-operation period, 36.4% during the limited-operation period, and 87.5% during the extended-operation period (p=.042).Conclusion: This study identified clinical outcomes in patients who received CPR according to the operation status of the rapid response team. These results are expected to help in the further implementation of rapid response teams.

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

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

Cardiopulmonary Resuscitation Outcomes of Patients with COVID-19; a One-Year Survey.

Introduction:Assessing cardiopulmonary resuscitation (CPR) outcomes of patients with COVID-19 and employing effective strategies for their improvement are essential. This study is designed in this regard. Methods:This cross-sectional study was conducted between January 20, 2020 and January 20, 2021 in the emergency departments of two hospitals in Hamadan and Kermanshah, Iran. Participants were 487 patients with confirmed COVID-19 and cardiac arrest (CA) who had undergone CPR during the study period. Data were collected using the available CPR documentation forms developed based on the Utstein Style and analyses were performed using Chi-square, Fisher’s exact, and Mann-Whitney U tests and the logistic regression analysis.Results:Participants’ mean age was 69.31±14.73 years and most of them were male (61.8%) and suffered from at least one underlying disease (58.1%). The rate of total and in-hospital CA was 9.67% and 9.39%, respectively. The most prevalent first documented rhythm was asystole (67.9%) and the highest responsivity to CPR was for shockable rhythms. The rate of the return of spontaneous circulation (ROSC) was 9% and the rate of survival to hospital discharge was 2%. The significant predictors of CPR success were age (p = 0.035), epinephrine administration time interval (p = 0.00), CPR duration (p = 0.00), and First documented rhythm (p = 0.009).Conclusion:The rate of in-hospital CA among studied COVID-19 cases was 9.39% with 9% ROSC and 2% survival to hospital discharge rates after CPR. Primary CPR success among patients with COVID-19 was poor, particularly among those with asystole and bradycardia. It seems that old age and improper doses of epinephrine can reduce CPR success.

Outcomes Following In-Hospital Cardiopulmonary Resuscitation in People Receiving Maintenance Dialysis

Rationale & ObjectivePrevious studies showing poor cardiopulmonary resuscitation (CPR) outcomes in the dialysis population have largely been derived from claims data and are somewhat limited by a lack of detailed characterization of CPR events. We aimed to analyze CPR-related outcomes in individuals receiving maintenance dialysis.Study DesignRetrospective chart review.Setting & ParticipantsUsing electronic medical records from a single academic health care system, we identified all hospitalized adult patients receiving maintenance dialysis who had undergone in-hospital CPR between 2006 and 2014.ExposureInitial in-hospital CPR.OutcomesOverall survival, predictors of unsuccessful CPR, predictors of death during the same hospitalization among initial survivors, predictors of discharge-to-home status.Analytical ApproachWe provide descriptive statistics for the study variables and used t tests, χ2 tests, or Fisher exact tests to compare differences between the groups. We built multivariable logistic regression models to examine the CPR-related outcomes.ResultsA total of 184 patients received in-hospital CPR: 51 (28%) did not survive the initial CPR event, and 77 CPR survivors died (additional 42%) later during the same hospitalization (overall mortality 70%). Only 18 (10%) were discharged home, with the remaining 32 (17%) discharged to a rehabilitation facility or a nursing home. In the multivariable model, the only predictor of unsuccessful CPR was CPR duration (OR, 1.41; 95% CI, 1.24-1.61; P < 0.001). Predictors of death during the same hospitalization after surviving the initial CPR event were CPR duration (OR, 1.15; 95% CI 1.04-1.27; P = 0.007) and older age (OR, 1.64; 95% CI, 1.23-2.2; P < 0.001). Older people also had lower odds of discharge-to-home status (OR, 0.25; 95% CI, 0.11-0.54; P < 0.001).LimitationsRetrospective study design, single-center study, no information on functional status.ConclusionsPatients receiving maintenance dialysis experience high mortality following in-hospital CPR and only 10% are discharged home. These data may help clinicians provide useful prognostic information while engaging in goals of care conversations.

Association between haemodynamics during cardiopulmonary resuscitation and patient outcomes

AimThere is no defined target for blood flow during chest compressions (CC). We previously reported various haemodynamic patterns in which dominant arterial and venous pressures were observed during CC. This study aimed to evaluate arterial and venous perfusion pressures during CC and determine their association with patient outcomes. MethodsIn this prospective observational single-centre study, arterial and venous pressures were recorded continuously on arrival at the emergency department for patients with non-traumatic out-of-hospital cardiac arrest. Parameters included multiple pressure measurements: the arterial systolic (A sys), mean (A mean), and diastolic (A dias); the venous systolic (V sys), mean (V mean), and diastolic (V dias); and the differences between arterial and venous systolic (ΔSys A-V), mean (ΔMean A-V), and diastolic (ΔDias A-V). We compared patients with and without return of spontaneous circulation (ROSC). ResultsAmong 50 patients, 16 (32%) had ROSC. Of the total measurement time, average A sys, A dias, ΔSys A-V, ΔDias A-V, A mean, and ΔMean A-V were significantly higher in patients with ROSC. When the average ΔMean A-V was stratified, there were 19 (38%) patients with negative average ΔMean A-V values, none of whom had ROSC. As the average ΔMean A-V increased, the ROSC rate also increased (p = 0.00002). ConclusionsROSC did not occur in patients with negative average ΔMean A-V values. ROSC may be achieved through individualised resuscitation that places a greater emphasis on differences between mean arterial and venous pressure, rather than through uniform resuscitation.

The role of bystander-initiated basic life support in exercise-related sudden cardiac arrest: a systematic review

Abstract Background Sudden cardiac arrest (SCA) is the leading cause of death amongst athletes and a common cause of death during exercise. Although the provision of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by bystanders improves outcomes after SCA, the impact of these interventions within exertional settings requires further investigation. Purpose The purpose of this systematic review was to evaluate the role of bystander CPR and AED use on survival after exercise-related SCA. Methods Literature searches in MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, and Cochrane Library were queried from inception until November 2020 using a comprehensive search strategy. Grey literature searches of Google Scholar and CADTH Grey Matters were also performed. Abstract screening, full-text review, and data extraction of eligible studies was conducted independently by two reviewers, with any conflicts discussed until consensus reached. Eligible studies included observational research studies assessing a population of exercise-related SCAs (defined as an out-of-hospital cardiac arrest which occurred during exercise or within 1-hour of cessation of activity), where the rate of bystander CPR and/or AED use was provided, and survival outcomes were reported. Abstracts, studies with overlapping patient data, and/or studies of n≤10 were excluded. Among studies with similar populations, the overall rates (median, range) of bystander CPR, AED use, and survival outcomes were calculated. Results A total of 3,718 records were identified from literature searches, and after removal of duplicates, 2,850 were screened. Among those screened, 176 articles were selected for full-text review, of which 29 studies were included in this review. Majority of included studies were cohort studies (2 case series and 2 cross-sectional), with a median sample size of 91. Most patients who suffered from an exercise-related SCA were male, middle-aged, and presented with a shockable arrest rhythm. The median rate of bystander CPR reported amongst 22 studies was 71% (31%-100%), whereas the median rate of bystander AED use reported amongst 16 studies was 31% (2%-100%) (Table). Among the 19 studies which reported the rate of survival to hospital discharge, survival ranged from 11% to 77%, with a median rate of 32% (Table). Patients who survived to hospital discharge more frequently received bystander CPR and had an AED applied than patients who died (Figure). Conclusions Survival rates after exercise-related SCA were higher than previously reported in other settings not related to exercise. These outcomes are likely related to a higher rate of bystander interventions in exertional or sport-specific settings. The findings of this review encourage layperson education in basic life support, the availability of AEDs in exercise facilities, and the development of emergency action plans to provide point-of-performance cardiac care in exertional settings. Funding Acknowledgement Type of funding sources: None.

SODIUM BICARBONATE USE IN IN-HOSPITAL CARDIAC ARRESTS: A RETROSPECTIVE ANALYSIS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Sodium Bicarbonate has been used during advanced cardiac life support as one of the supportive measures to fight the build-up of acidosis during prolonged CPR. We aim to investigate the influence of bicarbonate administration on outcomes of cardiopulmonary resuscitation (CPR). METHODS: This was a retrospective observational study in a single medical center and included adult patients who had suffered an in-hospital cardiac arrest between 2016 and 2020. The mean age was 67.2 years (SD 15.5, range 18-95 years), with 109 males (60.2%). We used multivariable logistic regression analysis to evaluate the associations between independent variables and outcomes. The main variable for analysis was the use of bicarbonate during CPR vs no bicarbonate usage. Other factors analyzed were age, gender, comorbidities (heart failure, diabetes, hypertension, COPD, coronary artery disease, and sepsis), as well timing of CPR and total dose of epinephrine used during CPR. Favorable neurological outcome was based on clinical documentation. Kruskal-Wallis rank-sum tests and Pearson's Chi-squared tests were used to calculate p values. RESULTS: 181 patients were included in this analysis. After adjusting for comorbidities, duration of CPR, and confounding medications, the results indicated that sodium bicarbonate usage during CPR was a predictor of poor outcome, there was a significant reduction in the odds of discharge when a patient was given bicarbonate (OR = 0.18 – CI 0.09-0.37, p=<0.0001), such that there is an 82% reduction in the odds of discharge if bicarbonate is given. A likelihood ratio test was used to adjust for different dosing intervals of epinephrine and analyze outcomes for patients who received bicarbonate versus patients who did not, and bicarbonate continued to be a significant predictor of the odds of discharge, again with an 82% reduction in the odds of being discharged if bicarbonate is received (OR = 0.18 – CI 0.09-0.38, p=<0.0001). The odds of neurological recovery at 30 days were reduced by 76% for patients who were given bicarbonate during CPR (OR 0.24, CI 0.11-0.48, p<0.0001). CONCLUSIONS: Sodium Bicarbonate usage during CPR for in-hospital cardiac arrests was seen as a predictor of poor outcomes, including higher in-hospital mortality, and lesser chances of significant neurological recovery. This effect might be partly due to the fact that bicarbonate is used mainly during prolonged CPR situations, which is itself a predictor of poor outcomes. CLINICAL IMPLICATIONS: Sodium bicarbonate usage during CPR was seen to be associated with poorer neurological and mortality outcomes. Larger RCTs are needed to validate these findings. DISCLOSURES: No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Waliul Chowdhury, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response

Survival of In-Hospital Cardiac Arrest in COVID-19 Infected Patients.

Background: There are limited data regarding the outcome of in-hospital cardiopulmonary resuscitation (CPR) in COVID-19 patients. In this study, we compared the outcomes of in-hospital cardiac arrests (IHCA) before and at the peak of the COVID-19 pandemic at Montefiore Medical Center in the Bronx, New York, United States. We also identified the most common comorbidities associated with poor outcomes in our community. Methods: This was a multi-site, single-center, retrospective, observational study. Inclusion criteria for COVID patients were all confirmed positive cases who had in-hospital cardiac arrest (IHCA) between 1 March 2020 and 30 June 2020. The non-COVID cohort included all cardiac arrest cases who had IHCA in 2019. We excluded all out-of-hospital cardiac arrest (OHCA). We compared actual survival to that predicted by the GO-FAR score, a validated prediction model for determining survival following IHCA. Results: There were 334 cases in 2019 compared to 450 cases during the specified period in 2020. Patients who initially survived cardiac arrest but then had their code statuses changed to do not resuscitate (DNR) were excluded. Groups were similar in terms of sex distribution, and both had an average age of about 66 years. Seventy percent of COVID patients were of Black or Hispanic ethnicity. A shockable rhythm was present in 7% of COVID patients and 17% of non-COVID patients (p < 0.05). COVID patients had higher BMI (30.7 vs. 28.4, p < 0.05), higher prevalence of diabetes mellitus (58% vs. 38%, p < 0.05), and lower incidence of coronary artery disease (22% vs. 35%, p < 0.05). Both groups had almost similar predicted average survival rates based on the GO-FAR score, but only 1.5% of COVID patients survived to discharge compared to 7% of non-COVID patients (p < 0.05). Conclusion: The rate of survival to hospital discharge in COVID-19 patients who suffer IHCA is worse than in non-COVID patients, and lower than that predicted by the GO-FAR score. This finding may help inform our patient population about risk factors associated with high mortality in COVID-19 infection, as well as educate hospitalized patients and healthcare proxies in the setting of code status designation.

The impact of selection criteria and study design on reported survival outcomes in extracorporeal oxygenation cardiopulmonary resuscitation (ECPR): a systematic review and meta-analysis

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially. However, reported outcomes vary considerably due to differing study designs and selection criteria. This review assessed the impact of pre-defined selection criteria on ECPR survival.MethodsSystematic review applying PRISMA guidelines. We searched Medline, Embase, and Evidence-Based Medicine Reviews for RCTs and observational studies published from January 2000 to June 2021. Adult patients (> 12 years) receiving ECPR were included. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Outcomes included overall and neurologically favourable survival. Meta-analysis and meta-regression were performed.Results67 studies were included: 14 prospective and 53 retrospective. No RCTs were identified at time of search. The number of inclusion criteria to select ECPR patients (p = 0.292) and study design (p = 0.962) was not associated with higher favourable neurological survival. However, amongst prospective studies, increased number of inclusion criteria was associated with improved outcomes in both OHCA and IHCA cohorts. (β = 0.12, p = 0.026) and arrest to ECMO flow time was predictive of survival. (β = -0.023, p < 0.001).ConclusionsProspective studies showed number of selection criteria and, in particular, arrest to ECMO time were associated with significant improved survival. Well-designed prospective studies assessing the relative importance of criteria as well as larger efficacy studies are required to ensure appropriate application of what is a costly intervention.

496P Outcomes of adult patients with colorectal cancer after in-hospital cardiopulmonary resuscitation: An analysis of the US nationwide inpatient sample

The outcomes of in-hospital cardiopulmonary resuscitation (ICPR) in cancer patients was worse than general population. Certain cancer types were also identified as poor prognostic factors. We aim to investigate the impact of colorectal cancer (CRC), the third most common cancer in the US, in the outcomes of ICPR, which are relatively unknown.

Does cerebral near‐infrared spectroscopy (NIRS) help to predict futile cannulation in extracorporeal cardiopulmonary resuscitation (ECPR)?

Aim of the studyExtracorporeal cardiopulmonary resuscitation (ECPR) is an evolving technique to improve cardiopulmonary resuscitation (CPR) outcomes. Identifying a readily available tool helpful for predicting patient's outcome is warranted. The aim of the study was to evaluate the capability of cranial near-infrared spectroscopy (cNIRS) to identify non-survivors or patients with unfavorable neurologic outcome prior to cannulation for ECPR to avoid futile cannulations. MethodsRetrospective analysis (2015–2021) of 97 patients requiring ECPR due to cardiac arrest with prior cNIRS measurement, which was performed immediately after ECPR team arrived on scene. Lowest possible regional cerebral oxygen saturation (rSO2) is 15%. ResultsMortality was 72.1% (70/97). Survivors showed in 88.9% (24/27) good neurological outcome (Cerebral Performance Category (CPC) 1 + 2). rSO2 = 15% (11/97) prior to cannulation was only found in non-survivors. Among survivors, initial rSO2 was not associated with neurological outcome. Non-shockable initial rhythm was associated with higher mortality (44/50). In survivors, time to ECPR was shorter (p = 0.006), and initial lactate was significantly lower, whereas initial pH and hemoglobin levels were higher (p = 0.001). Survivors and those with favorable neurological outcome showed lower maximal NSE levels in the first 72 hours (p < 0.001; p = 0.041). ConclusionIn our patient cohort, rSO2 = 15% immediately prior to cannulation for ECPR did not result in any survivors, thus might be a marker for futile cannulation in ECPR. Higher rSO2 values were not associated with favorable neurologic outcome. Lower initial lactate and lower maximal NSE within the first 72 h after arrest were associated with favorable outcome.

Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center.

Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age ( p < 0.018), respiratory cause ( p < 0.001), bradycardia ( p < 0.018), and short duration of CPR ( p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome ( p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR ( p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.