Outcomes Of Sudden Cardiac Arrest Research Articles

Sudden cardiac arrest in patients with cancer in the general population: insights from the Paris-SDEC registry

BackgroundData on the management of patients with cancer presenting with sudden cardiac arrest (SCA) are scarce. We aimed to assess the characteristics and outcomes of SCA according to cancer history.MethodsProspective,...

Predictors and Outcomes of Sudden Cardiac Arrest in Heart Failure With Preserved Ejection Fraction: A Nationwide Inpatient Sample Analysis

Sudden cardiac arrest (SCA) is the leading cause of cardiovascular mortality in heart failure with preserved ejection fraction (HFpEF), contributing to around 25% of deaths observed in pivotal HFpEF trials. However, predictors and outcomes of in-hospital SCA in HFpEF have not been well characterized. We queried the Nationwide Inpatient Sample (2016 to 2017) to identify adult hospitalizations with a diagnosis of HFpEF. Patients with acute or chronic conditions associated with SCA (e.g., acute myocardial infarction, acute pulmonary embolism, sarcoidosis) were excluded. We ascertained whether SCA occurred during these hospitalizations, identified predictors of SCA using multivariate logistic regression, and determined outcomes of SCA in HFpEF. Of 2,909,134 hospitalizations, SCA occurred in 1.48% (43,105). The mean age of the SCA group was 72.3 ± 12.4years, 55.8% were women, and 66.4% were White. Presence of third-degree atrioventricular block (odds ratio [OR] 5.95, 95% confidence interval [CI] 5.31 to 6.67), left bundle branch block (OR 1.96, 95% CI 1.72 to 2.25), and liver disease (OR 1.87, 95% CI 1.73 to 2.02) were the leading predictors of SCA in HFpEF. After excluding patients with do-not-resuscitate status, the SCA group versus those without SCA had higher mortality (25.9% vs 1.6%), major bleeding complications (4.1% vs 1.7%), increased use of percutaneous coronary intervention (2.5% vs 0.7%), and mechanical circulatory assist device (1.2% vs 0.1%). These observational inpatient data suggest identifiable risk factors for SCA in HFpEF including cardiac arrhythmias. Further research is warranted to identify the best tools to risk-stratify patients with HFpEF to implement targeted SCA prevention strategies.

PO-03-222 CURRENT TRENDS AND OUTCOMES OF SUDDEN CARDIAC ARREST IN YOUNG ADULTS IN THE USA: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE

Sudden cardiac arrest (SCA) is a rare but devastating event in young adults. There is a lack of population studies that evaluate the current trends and outcomes of SCA in young adults. We sought to estimate current trends in incidence, risk factors and mortality rates for out-of-hospital SCA in young adults (18 – 35 years) using the national in-patient sample of the USA. The demographic data of all young adults (18 – 35 years) admitted to hospitals in the US from 2016 to 2020 was analysed using the National Inpatient Sample database. We further identified primary admissions for sudden cardiac arrest using the ICD 10 code (I46). We analyzed the trend in the incidence and mortality of SCA during the study period using the marginal effect of years. Subsequently, we compared the sociodemographic and comorbid factors of patients with out-of-hospital SCA with other young adults admitted to the hospital. Multivariate logistic regression was then used to determine the sociodemographic and comorbid factors independently associated with SCA in our population. There were approximately 3,610 cases of out of hospital cardiac arrest in the study period, with an incidence rate of 1:10000 young adult admissions. The mean age at admission was (28.3 ± 0.4 years). We noted a 16.7% increase in SCA cases from 2016 to 2020 (660 to 770 cases). Similarly, there was a 21% increase in the mortality between 2016 and 2020 (474 to 574 deaths), with a mean mortality rate of 69.7% throughout the study period. The main factors associated with increased odds of SCA in young people were the presence of arrhythmias. Other significant risk factors were male sex, a history of stroke, electrolyte abnormalities, renal failure on hemodialysis, hypertrophic cardiomyopathy, congenital heart disease, and cocaine use disorder. There is an increase in the incidence of sudden cardiac arrest in young adults, with the main risk factors being male sex, history of stroke, hypertrophic cardiomyopathy, congenital heart disease, presence of arrhythmias and cocaine use disorder. Identifying young adults with high-risk characteristics as described above and implementing risk factor modification with aggressive surveillance can reduce the incidence of SCA and the risk of death in young adults.Tabled 1Sociodemographic and comorbid factors associated with Sudden Cardiac Arrest in Young AdultsVARIABLESOdds ratioLower limit of CIUpper limit of CIP-valueAGE1.000.981.020.373RACE (Reference, Whites)BlacksHispanicsAsians-1.070.621.25-0.850.450.78-1.360.842.01-0.5530.002*0.628Female0.410.330.51<0.001*Smoking0.760.571.030.077Dyslipidemia0.430.240.770.004*History of myocardial infarction0.730.182.960.663COPD1.270.572.840.558Stroke5.462.999.97<0.001*Hypertension0.750.561.010.057Hypothyroidism1.330.842.080.225Obesity0.920.691.240.593Arrhythmia27.5221.435.3<0.001*Electrolyte Derangement13.410.517.1<0.001*ESRD on Hemodialysis2.401.463.940.001*Oxygen Dependence1.170.363.790.792Hypertrophic cardiomyopathy7.893.0420.45<0.001*Cocaine Use Disorder1.761.202.570.004*Congenital heart disease2.941.725.03<0.001*∗Statistically significant findings, COPD - chronic obstructive pulmonary disease, CI - Confidence interval Open table in a new tab

Characteristics and outcomes of Marijuana users admitted with sudden cardiac arrest

Background: Marijuana or Cannabis is the most commonly used illicit drug in the United States. An estimated 2 million adults who reported marijuana use also have cardiovascular disease. Marijuana use has been associated with acute myocardial infarction, heart failure and arrhythmias. However, the implications of marijuana use on sudden cardiac arrest outcomes is unknown. Methods: Using the National Inpatient Sample of the years 2018 &amp; 2019, patient characteristics and in-hospital outcomes were compared between marijuana users and non-marijuana users admitted with sudden cardiac arrest. Results: The median age of marijuana users was lower at 46.8years. They had significantly lower prevalence of congestive heart failure, coronary artery disease, valvular heart disease, pulmonary circulation disorders, atrial fibrillation, hypertension, and diabetes and a significantly higher prevalence of chronic liver disease, depression, alcohol use, tobacco use, amphetamine/psychostimulant use, opioid use, cocaine use, and sedative use. Multivariable logistic regression analysis showed significantly higher odds for ventricular fibrillation (OR: 1.24; 95% CI: 1.09- 1.41; p- 0.001) but lower odds for mortality (OR: 0.86; 95% CI: 0.78- 0.96; p-0.011), need for mechanical ventilation (OR: 0.76; 95% CI: 0.67- 0.86; p- 0.000), and tracheostomy (OR: 0.46; 95% CI: 0.34- 0.62; p- 0.000). Marijuana users were also more likely to be discharged home with self-care (25.25% vs 11.53%). Conclusion: Among patients admitted with sudden cardiac arrest, marijuana users were found to have significantly higher odds for ventricular fibrillation. They were found to have lower odds for in-hospital mortality, mechanical ventilation, and tracheostomy and were more likely to be discharged home with selfcare, but this is mostly because marijuana users who are admitted with sudden cardiac arrest were younger and had considerably fewer chronic medical conditions. Large prospective cohort studies are needed to ascertain the health risks associated with marijuana use.

Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators).

Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.

Abstract 9576: Trends and Outcomes of Sudden Cardiac Arrest in Diabetes Patients With STEMI in the US

Introduction: Sudden cardiac arrest is a serious ST-elevation myocardial infarction (STEMI) complication.Objective: We aimed to assess the impact of diabetes on sudden cardiac arrest (SCA) in patients hospitalized with STEMI and analyzed the recent cardiovascular and socioeconomic temporal trends in those patients. Methods: We used the National Inpatient Sample (2005-2017) data to identify adult patients admitted with STEMI as the primary diagnosis. The secondary diagnosis was sudden cardiac arrest. Diabetes was used as comorbidity. The primary outcome was in-hospital death. Secondary outcomes included ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), cardiogenic shock (CS), stroke, acute renal failure (ARF), and the revascularization strategy. Socioeconomic outcomes consisted of the length of stay (LoS) and total charges/stay. Results: The number of STEMI patients experiencing a SCA significantly increased from 2005 to 2017, and the mean age of participants decreased from 68 (11) to 66 (10) years old (p=0.003). While a temporal increase in risk factors was observed, mortality decreased from 65.7% to 48.6% (p&lt;0.001). However, VT, VF, AF, CS, stroke, and ARF followed an upward trend. Compared to non-diabetic patients, those with diabetes were older and more likely to be females and blacks. They had a higher risk of mortality, ARF, and pacemaker requirements (adjusted OR = 1.72 [1.68-1.83], 1.52 [1.43-1.63], 1.19 [1.06-1.34], respectively), but not stroke, VT, VF or AF. Those patients were less likely to have PCI (OR = 0.70 [0.66-0.73] and more likely to have CABG (OR = 1.18 [1.07-1.30]). Total charges/stay increased by almost 2.5-fold in all STEMI patients who develop SCA, but diabetes was associated with higher charges; no difference in the LoS was noted. Conclusion: The recent temporal trend of SCA in patients with STEMI and diabetes shows a steady decline in mortality. Diabetes patients in STEMI patients who develop a SCA have a higher likelihood of mortality and other adverse outcomes when compared to those without diabetes.

Trends, Prevalence, and Outcomes of Sudden Cardiac Arrest Post Cardiac Transplant: A Nationwide 16-Year Study.

Heart transplantation is the most effective long-term therapy for end-stage heart disease. There is limited data related to sudden cardiac arrest (SCA) in postheart transplant recipients. We aimed to describe the trends, and rate of SCA following heart transplantation and thereby identify clinical predictors as well as outcomes of SCA in patients post-transplant. We queried the National Inpatient Sample (NIS) with administrative codes for SCA and heart transplant. We assessed baseline differences between SCA and non-SCA admissions, with hazard ratios adjusted for age, gender, CCI, and race. Multivariable logistic regression models were generated to identify the independent predictors for SCA. There was a total of 30,020 hospitalizations of heart transplant recipients between 1999 and 2014 in the United States and among these 1,953 patients (6.5%) suffered SCA with an increasing trend of admissions for SCA. Among the patients who suffered from SCA, 18.83% died during the same hospitalization, 19.29% were discharged to a long-term facility, and 61.38% were discharged home. Multivariate analysis demonstrated that conduction system disorders (Hazard ratio [95% confidence interval]; 7.1 [4.5-11.1]), female gender (HR:1.2 [1.1-1.3]), diabetes (HR:1.4 [1.2-1.6]), and hypertension (HR:1.2 [1.1-1.4]) were the strongest predictors for SCA. SCA hospitalizations occur in 6.5% of patients post cardiac transplant and have been increasing from 1999 to 2014. Conduction block, graft rejection, female gender, hypertension, diabetes are independent predictors for SCA in heart transplant recipients.

Risk factors and outcomes of sudden cardiac arrest in pediatric heart transplant recipients

Sudden cardiac arrest (SCA) is a prevailing cause of mortality after pediatric heart transplant (HT) but remains understudied. We analyzed the incidence, outcomes, and risk factors for SCA at our center. Retrospective review of all pediatric HT patients at our center from January 1, 2009 to January 1, 2021. SCA was defined as an abrupt loss of cardiac function requiring cardiopulmonary resuscitation and/or mechanical circulatory support (MCS). Events that occurred in the setting of limited resuscitative wishes, or while on MCS were excluded. Patient characteristics and risk factors were analyzed. Fourteen of 254 (6%) experienced SCA at a median of 3 (1, 4) years post-HT. Seven (50%) events occurred out-of-hospital. Eleven (79%) died from their initial event, 2 (18%) after failure to separate from extracorporeal membrane (ECMO). In univariate analysis, black race, younger donor age, prior acute cellular rejection (ACR) episode, pacemaker and/or ICD in place, and pre-mortem diagnosis of allograft vasculopathy were associated with SCA (P=.003-0.02). In multivariable analysis, history of ACR, younger donor age, and black race retained significance. [OR=6.3, 95% CI: 1.6-25.4, P=.01], [OR=0.9, 95% CI: 0.8-1, P=.04], and [OR=7.3, 95% CI: 1.1-49.9, P=.04], respectively. SCA occurred in 3 patients with a functioning ICD or pacemaker, which failed to restore a perfusing rhythm. SCA occurs relatively early after pediatric HT and is usually fatal. Half of events happen at home. Those who received younger donors, have a history of ACR, or are of black race are at increased risk. ICDs/pacemakers may offer limited protection.

Prediction of Sudden Cardiac Arrest in the General Population: Review of Traditional and Emerging Risk Factors.

Sudden cardiac death (SCD) is the most common and devastating outcome of sudden cardiac arrest (SCA), defined as an abrupt and unexpected cessation of cardiovascular function leading to circulatory collapse. The incidence of SCD is relatively infrequent for individuals in the general population, in the range of 0.03%-0.10% per year. Yet, the absolute number of cases around the world is high because of the sheer size of the population at risk, making SCA/SCD a major global health issue. On the basis of conservative estimates, there are at least 2 million cases of SCA occurring worldwide on a yearly basis. As such, identification of risk factors associated with SCA in the general population is an important objective from a clinical and public health standpoint. This review will provide an in-depth discussion of established and emerging factors predictive of SCA/SCD in the general population beyond coronary artery disease and impaired left ventricular ejection fraction. Contemporary studies on the association of age, sex, race, socioeconomic status, and the emerging contribution of diabetes and obesity to SCD risk beyond their role as atherosclerotic risk factors are reviewed. In addition, the role of biomarkers, particularly electrocardiographic ones, on SCA/SCD risk prediction in the general population are discussed. Finally, the use of machine learning as a tool to facilitate SCA/SCD risk prediction is examined.

Incidence and predictors of sudden cardiac arrest in the immediate post-percutaneous coronary intervention period for ST-elevation myocardial infarction: a single-center study.

Data on the incidence, predictors, and outcomes of sudden cardiac arrest (SCA) in the immediate post-percutaneous coronary intervention (PCI) period for ST-elevation myocardial infarction (STEMI) are limited. The study aimed to investigate the trends and predictors of SCA occurring within 48 h post PCI for STEMI. We systematically reviewed data from the electronic medical records of 403 patients who underwent PCI for STEMI between January 2014 and December 2019. Trends in the incidence of SCA 48 h post PCI for STEMI were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to determine the predictors of SCA within 48 h post PCI for STEMI. Of the 403 patients who underwent PCI for STEMI, 44 (11%) had SCA within 48 h post PCI. The incidence of SCA within 48 h post PCI decreased from 22% in 2014 to 8% in 2019; P = 0.03. After adjusting for underlying confounding variables in the multivariable logistic regression models, out of hospital cardiac arrest [adjusted odds ratio (aOR), 23.9; confidence interval (CI), 10.2-56.1], left main coronary artery disease (aOR, 3.1; CI, 1.1-9.4), left main PCI (aOR, 6.6; CI: 1.4-31.7), new-onset heart failure (aOR, 2.0; CI, 4.3-9.4), and cardiogenic shock (aOR, 5.8; CI, 1.7-20.2) were statistically significant predictors of SCA within 48 h post PCI for STEMI. We identified essential factors associated with SCA within 48 h post PCI for STEMI. Future studies are needed to devise effective strategies to decrease the risk of SCA in the early post-PCI period.

Abstract 14287: Outcomes of Sudden Cardiac Arrest in Liquid vs Solid Cancers. A Nationwide Inpatient Sample Analysis

Background: The comparative outcomes of Liquid and Solid cancer in Sudden cardiac arrest (SCA) population is not well studied in literature. Methods: The National inpatient sample database from the year 2015-2018 was used to compare liquid cancer and Solid cancer patients that underwent sudden cardiac arrest (SCA). Means and medians were calculated for continuous variables, p -value (&lt;0.05), and Pearson chi-square used to calculate weighted outcomes. Results: A total of 7,695.00 SCA patients (solid cancer n= 475.0 ; liquid cancer n=7,220.0) were included in our study analysis. Among participants, male and female percentages in Solid (65.3 % and 34.7%) and liquid cancers (61.9% and 38.1%) respectively. The median age of solid cancer with SCA was 67 years (IQR 51-77) while median age for liquid cancer with SCA was 70 years (IQR 58-79). The median length of stay of solid cancer with SCA is 8 days (IQR 3-20) whereas liquid cancer with SCA is 5 days (IQR 1-13). There was no statistical significant difference among solid or liquid cancer with SCA in terms of in-hospital mortality (76.6% vs 78.1%, p = 0.742), acute kidney injury (55.8% vs 61%, p = 0.319), major bleeding (5.3% vs 10.7%, p = 0.098), transfusion requirement (82.1% vs 81.2%, p = 0.837), and cardiogenic shock (3.2% vs 3.6%, p= 0.824) in sudden cardiac arrest (SCA) patients respectively. There was higher prevalence of cerebrovascular accidents (3% vs 7.4%, p= 0.024) and mechanical circulatory support use including ventricular assist devices (VAD) and Extracorporeal membrane oxygen (ECMO) in liquid cancer patients as compared to solid cancers in SCA (1.1% vs 3.3%, p = 0.001). Conclusion: Liquid cancers with SCA can have higher prevalence of stroke and mechanical circulatory support requirement as compared to solid cancers with SCA

Evaluation of Sudden Cardiac Arrest by Race/Ethnicity Among Residents of Ventura County, California, 2015-2020

Sudden cardiac arrest (SCA) is a major public health problem. Owing to a lack of population-based studies in multiracial/multiethnic communities, little information is available regarding race/ethnicity-specific epidemiologic factors of SCA. To evaluate the association of race/ethnicity with burden, outcomes, and clinical profile of individuals experiencing SCA. A 5-year prospective, population-based cohort study of out-of-hospital SCA was conducted from February 1, 2015, to January 31, 2020, among residents of Ventura County, California (2018 population, 848 112: non-Hispanic White [White], 45.8%; Hispanic/Latino [Hispanic], 42.4%; Asian, 7.3%; and Black, 1.7% individuals). All individuals with out-of-hospital SCA of likely cardiac cause and resuscitation attempted by emergency medical services were included. Data on circumstances and outcomes of SCA from prehospital emergency medical services records and data on demographics and pre-SCA clinical history from detailed archived medical records, death certificates, and autopsies. Annual age-adjusted SCA incidence by race and ethnicity and SCA circumstances and outcomes by ethnicity. Clinical profile (cardiovascular risk factors, comorbidity burden, and cardiac history) by ethnicity, overall, and stratified by sex. A total of 1624 patients with SCA were identified (1059 [65.2%] men; mean [SD] age, 70.9 [16.1] years). Race/ethnicity data were available for 1542 (95.0%) individuals, of whom 1022 (66.3%) were White, 381 (24.7%) were Hispanic, 86 (5.6%) were Asian, 31 (2.0%) were Black, and 22 (1.4%) were other race/ethnicity. Annual age-adjusted SCA rates per 100 000 residents of Ventura County were similar in White (37.5; 95% CI, 35.2-39.9), Hispanic (37.6; 95% CI, 33.7-41.5; P = .97 vs White), and Black (48.0; 95% CI, 30.8-65.2; P = .18 vs White) individuals, and lower in the Asian population (25.5; 95% CI, 20.1-30.9; P = .006 vs White). Survival to hospital discharge following SCA was similar in the Asian (11.8%), Hispanic (13.9%), and non-Hispanic White (13.0%) (P = .69) populations. Compared with White individuals, Hispanic and Asian individuals were more likely to have hypertension (White, 614 [76.3%]; Hispanic, 239 [79.1%]; Asian, 57 [89.1%]), diabetes (White, 287 [35.7%]; Hispanic, 178 [58.9%]; Asian, 37 [57.8%]), and chronic kidney disease (White, 231 [29.0%]; Hispanic, 123 [40.7%]; Asian, 33 [51.6%]) before SCA. Hispanic individuals were also more likely than White individuals to have hyperlipidemia (White, 380 [47.2%]; Hispanic, 165 [54.6%]) and history of stroke (White, 107 [13.3%]; Hispanic, 55 [18.2%]), but less likely to have a history of atrial fibrillation (White, 251 [31.2%]; Hispanic, 59 [19.5%]). The results of this study suggest that the burden of SCA was similar in Hispanic and White individuals and lower in Asian individuals. The Asian and Hispanic populations had shared SCA risk factors, which were different from those of the White population. These findings underscore the need for an improved understanding of race/ethnicity-specific differences in SCA risk.

Surviving sudden cardiac arrest-successes, challenges, and opportunities.

Sudden cardiac arrest (SCA) is the most common cause of death in the world. This manuscript highlights the various challenges in prevention and early management of SCA and also discusses the current state of SCA awareness. The manuscript also outlines the various national and international initiatives in improving SCA awareness and their impact on improving outcomes in SCA. Various campaigns have strived for widespread dissemination of cardiopulmonary resuscitation training and advocated for broader public access defibrillator availability. Finally, the manuscript describes future directions including harnessing technology with voice command and artificial intelligence to allow lay person deliver effective CPR, to improve EMS response times, and to allow wider CPR knowledge dissemination in schools and places of employment. Future research should be focused on optimizing SCA outcomes among vulnerable populations and minorities. Advancements in resuscitation science and use of big data for improvement of EMS services will improve outcomes in SCA.

Association between Novel Marker (Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio, and Delta Neutrophil Index) and Outcomes in Sudden Cardiac Arrest Patients.

Purpose It is important that clinicians accurately predict the outcome of patients with sudden cardiac arrest (SCA). The complete blood count (CBC) is an easy and inexpensive test that provides information on blood content. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and delta neutrophil index (DNI) are relatively novel biomarkers that have been used in the prognosis of various diseases. We aimed to determine the usefulness of PLR, NLR, and DNI in predicting the outcomes of SCA. Materials and Methods This retrospective observational study was performed on patients with SCA. Patients who visited the tertiary university hospital from January 2015 to December 2019 were targeted. The inclusion criteria were all nontraumatic adult out-hospital cardiac arrest patients. We analyzed DNI, PLR, and NLR based on the CBC results of all enrolled patients. The exclusion criteria were as follows: no data on laboratory study, traumatic arrest, age < 18 years, and a history of leukemia, myelodysplastic syndrome, and myelofibrosis. The primary outcome was assessed as return of spontaneous circulation (ROSC), the secondary outcome as survival to discharge, and the tertiary outcome as neurological outcome. Results From January 1, 2015, to December 31, 2019, 739 patients were enrolled. ROSC was seen in 324 patients, of whom 60 had survival to discharge and 24 had good neurological outcome at the time of discharge (cerebral performance categories (CPCs) 1-2). The PLR of the ROSC group was 42.41 (range: 4.21–508.7), which was higher than that of the No-ROSC group (p=0.006). The DNI value of the survival group was 0.00 (range: 0.00–40.9), which was lower than that of the nonsurvival group. Conclusions Patients with SCA and subsequent ROSC had higher PLR and NLR, while those with survival to discharge had lower DNI values than those with nonsurvival to discharge (p=0.005).

Abstract 228: Evaluation of Telephone-Assisted Cardiopulmonary Resuscitation Performance Recommendations for Out-Of-Hospital Sudden Cardiac Arrest

Introduction: Telephone-assisted CPR (T-CPR) may improve bystander CPR (B-CPR) rates and survival from sudden cardiac arrest (SCA). The American Heart Association (AHA) has specified performance measures to ensure rapid provision of T-CPR instructions. Few studies have examined whether these individual T-CPR recommendations are associated with SCA outcomes. Objectives: We sought to assess whether the 2012 AHA Scientific Statement’s T-CPR evaluation metrics are associated with increased B-CPR and survival from SCA. We hypothesized that recognition of arrest and compliance with the T-CPR protocol will result in increased likelihood of B-CPR. Methods: We conducted a retrospective assessment of non-traumatic SCAs from the Singapore T-CPR Pan-Asian Resuscitation Outcomes Study. We modeled the likelihood of receipt of B-CPR and survival to hospital discharge controlling for potential confounders. Exposure variables were identified from the Scientific Statement including adherence to T-CPR algorithms, dispatcher recognition of need for CPR, barriers to CPR (yes/no), and time intervals. Results: From 7/2012-2016, the Singapore T-CPR registry contained 3,224 adjudicated SCA events. Mean age was 67±19, 62% of the patients were male, and 87% of the arrests occurred in the home; of these arrests, 75% received T-CPR and 4% survived to hospital discharge. Compliance with the T-CPR protocol algorithm was not associated with an increased likelihood of B-CPR and survival (p=ns, both). Dispatcher recognition of the need for CPR was associated with a 24.9 (12.9-47.9) increased likelihood of B-CPR p&lt;0.01, but was not associated with survival (OR: 1.77(0.37-8.45)). Recognized barriers to CPR were associated with a lower likelihood of B-CPR and survival (p&lt;0.05, both). B-CPR was associated with a 2.40 (1.04-5.45) increased likelihood of survival (p=0.04). Call time to dispatch of EMS of &lt;2 min was associated with a 1.33 (1.07-1.67) p=0.01 increased likelihood of receipt of B-CPR. Conclusion: Rapid dispatch of EMS (&lt;2 min) and successful recognition of need for CPR increased the likelihood of B-CPR. B-CPR was associated with a two-fold increased likelihood of survival. Future work should consider refining T-CPR evaluation metrics using a data driven approach.

INNOVATIONS IN RESUSCITATION SCIENCE: ASSESSMENT OF DEFIBRILLATION EFFICACY OF A NEXT-GENERATION MINIATURIZED AUTOMATED EXTERNAL DEFIBRILLATOR

Efforts to improve the outcomes of sudden cardiac arrest have largely hinged on making AEDs more accessible, with technologies that are smaller & more portable. Defibrillation (DF) efficacy with a novel miniaturized AED device (Avive) was evaluated in a swine model (4 adult [28-43kg] & 1 pediatric

Abstract 148: Installation and Deployment of Automated External Defibrillators in New York State Schools

Introduction: AHA recommends that automated external defibrillators (AEDs) be made available in public areas with high likelihood of a sudden cardiac arrest (SCA). Only 18 US states have regulations requiring AEDs in schools and the legislation varies. There is no comprehensive evaluation of the epidemiology of sudden death in schools. School nurses are often the only healthcare providers within a school. New York State (NYS) enrolls almost 3.5 million students with New York City (NYC) being the largest school system in the US; legislation requires AEDs in all public but not in private schools. Purpose: Our aims were threefold: to gain epidemiologic data on SCAs in NYS schools, to evaluate the availability and utilization of AEDs, and to identify factors affecting deployment of AEDs. Methods: Electronic surveys were sent to school nurse members of the NYS Association of School Nurses and NYC school nurses. We also conducted structured interviews with a representative sample of NYS school nurses. Results: Nurses representing 750 public schools and 116 private schools responded, a response rate of 36.4%. There were 71 SCA events, with majority affecting adults on school grounds 41 (58%). AEDs were deployed in 59 (73%). Short term survival occurred in 50 (69%) with 40 (56%) returning to regular activity. While not required to have AEDs available, most private schools had them 69(60%). There were 21 (30%) SCA events in private schools with 8 (11%) occurring in private schools with no AEDs. Of these, 6 (75%) had a negative outcome. Interviews revealed that staff attitude, fear, and training adequacy were factors influencing AED utilization. Conclusions: AEDs in schools improve survival outcomes. There has been no comprehensive evaluation of SCA events in US schools and no uniformity in AED legislation among states. While focus is on students, NYS data suggests that attention should also encompass adult SCAs in schools. Comparisons of AED utilization and SCA outcomes in states with and without AED legislation will be of interest, and may have health policy implications.

Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study.

Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.

Prevalence and Outcomes of Sudden Cardiac Arrest in a University Hospital in the Western Region, Saudi Arabia.

Background:Sudden cardiac arrest (SCA) is a major cause of mortality, yet its epidemiological and outcome data in hospitals from Saudi Arabia are limited.Objectives:This study aimed to evaluate the prevalence, risk factors and outcomes of SCA in a teaching hospital in Jeddah, Saudi Arabia.Methods:This retrospective study included all patients aged ≥18 years with SCA who were resuscitated at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 1 and December 31, 2016. Data were retrieved from the hospital medical records as flow sheets designed in accordance with the Utstein-style recommendations. Factors relating to mortality were analyzed using descriptive analyses and chi-square test.Results:A total of 429 cases of SCA met the inclusion criteria, and its prevalence was 7.76 cases/1000 adult hospital admission. Of these, 61.3% were male, and the mean age was 58.4 years, with 36.6% aged >65 years. Only 3.5% were outside-hospital cardiac arrests. The most common initial rhythm was pulseless electrical activity/asystole (93.2%), while ventricular tachycardia/ventricular fibrillation was documented in only 29 cases (6.8%). The overall rate of return to spontaneous circulation (ROSC) was 56.2%, and 56.8% in cases of in-hospital cardiac arrest (IHCA). Patients with SCA due to sepsis had significantly increased mortality (P < 0.000; odds ratio [OR] = 0.24 [0.12–0.47 95% confidence interval [CI]]), while those with SCA due to respiratory causes had significantly better survival outcomes (P = 0.001; OR = 2.3 [1.5–3.8 95% CI]). No significant differences in outcomes were found between other risk factors, including cardiac causes.Conclusion:In this population, the prevalence of SCA in adults was higher than reported in many similar studies. Further, sepsis was found to affect the survival rate. Although the rate of ROSC for IHCA patients was favorable compared with other studies, it is relatively poor. This finding signifies the need to identify and control risk factors for SCA to improve survival.

Automated External Defibrillator and Emergency Action Plan Preparedness Amongst Canadian University Athletics

Sudden cardiac death is the leading medical cause of death in athletes. The use of an automated external defibrillator (AED) and an emergency action plan (EAP) are effective strategies for improving outcomes of sudden cardiac arrest. The availability of an AED and the presence of an EAP amongst Canadian universities (U-SPORTS) are unknown. Surveys were sent to the athletic directors from U-SPORTS representing the universities within Canada. Questions were directed towards AED and EAP preparedness. All schools reported an on-site AED for sanctioned events. However, less than half of schools reported bringing the AED on-site for field sports. A total of 89% of U-SPORTS universities estimated that their EAP is capable of delivering defibrillation within 5 minutes of collapse. The majority of U-SPORTS universities have accessible AEDs and satisfactory EAP strategies. However, AED availability and EAPs during sport require continuous improvement.