Return Of Spontaneous Circulation Group Research Articles

Comparative Analysis of Perfusion Index and End-Tidal Carbon Dioxide in Cardiac Arrest Patients: Implications for Hemodynamic Monitoring and Resuscitation Outcomes.

During cardiopulmonary resuscitation (CPR), some parameters (e.g., intraarterial pressure measurement and end-tidal carbon dioxide (EtCO2)) indicate the quality andoutcome of resuscitation. These parameters are generally based on monitoring the hemodynamic status. Perfusion index (PI) is a calculation from the photoplethysmography (PPG) signal and displays the proportion of pulsatile to non-pulsatile light absorption or reflection in the PPG signal. It helps to evaluate cardiac output and tissue perfusion in the care of a critical patient. Its most important advantages are that it can be easily measured with a pulse oximeter probe attached to the finger (non-invasive), can be objectively repeated, can be applied quickly, and is inexpensive. Normal PI values range from 0.2% to 20%. Despite being recognized as a valuable indicator of hemodynamics, there is limited information regarding its relevance in patients experiencing cardiac arrest. Although the PI is known to be a valuable parameter to indicate hemodynamics, information about its value in cardiac arrest patients is limited. This study aims to evaluate the performance of PI and EtCO2 in predicting the return of spontaneous circulation (ROSC) among cardiac arrest patients. This was a single-center, prospective, observational clinical study including both out-of-hospital and in-hospital adult cardiac arrest patients. The study was conducted from November 1, 2018 to April 30, 2019 at the Emergency Department (ED) of the Hacettepe University Hospital, Ankara, Turkey. The EtCO2 values of the patients were recorded at the time they were intubated (t0) and every five minutes (t5, t10, t15...) during CPR. Along with these measurements, PI values were measured with the Masimo Signal Extraction Technology device (Masimo, California, United States). The study's primary outcome was PI's performance in predicting the ROSC among cardiac arrest patients. The secondary outcomes of the study were the performance of EtCO2 in predicting the ROSC among cardiac arrest patients and the association between PI and EtCO2 values. We included a total of 100 cases. The mean age of patients was 70.4 ± 13.4 years, and 65% were male. The ROSC was achieved in 29patients. There was no statistical difference in PI values between the ROSC (+) and ROSC (-) groups at any minute. However, in the ROSC (+) group, EtCO2 values were observed to be high starting from the fifth minute (t5, p=0.010; t10, p<0.001; t15, p=0.014; t20, p=0.033; t25, p=0.003, respectively). There was no correlation between the PI and EtCO2 values at 0, 5, 10, 15, 20, and 25 minutes (t0, p=0.436; t5, p=0.154; t10, p=0.557; t15, p=0.740; t20 p=0.241; t25 p=0.201, respectively). Measuring PI values during resuscitation in intubated cardiac arrest patients does not help clinicians predict the outcome. In addition, no correlation was found with EtCO2 values. However, EtCO2 values remained high in patients with the ROSC from the fifth minute onward. Further larger-scale studies are needed regarding the optimal use of PI in cardiac arrest patients.

A model for predicting return of spontaneous circulation and neurological outcomes in adults after in-hospital cardiac arrest: development and evaluation.

In-hospital CA (IHCA) is associated with rates of high incidence, low return of spontaneous circulation (ROSC), low survival to discharge, and poor neurological outcomes. We aimed to construct and evaluate prediction models for non-return of spontaneous circulation (non-ROSC) and poor neurological outcomes 12 months after ROSC (PNO-12). We retrospectively analyzed baseline and clinical data from patients experiencing cardiac arrest (CA) in a big academic hospital of Jilin University in China. Patients experiencing CA between September 1, 2019 and December 31, 2020 were categorized into the ROSC and non-ROSC groups. Patients maintaining ROSC >20 min were divided into the good and PNO-12 subgroups. Univariate and multivariate logistic regression identified independent factors associated with non-ROSC and PNO-12. Two nomogram prediction models were constructed and evaluated. Of 2,129 patients with IHCA, 851 were included in the study. Multivariate logistic regression analysis revealed that male sex, age >80 years, CPR duration >23 min, and total dose of adrenaline >3 mg were significant risk factors for non-ROSC. Before CA, combined arrhythmia, initial defibrillation rhythm, and advanced airway management (mainly as endotracheal intubation) also influenced outcomes. The area under the receiver operating characteristic curve in the prediction model was 0.904 (C-index: 0.901). Respiratory failure, shock, CA in the monitoring area, advanced airway management, and noradrenaline administration were independent risk factors for PNO-12. The AUC was 0.912 (C-index: 0.918). Prediction models based on IHCA data could be helpful to reduce mortality rates and improve prognosis.

Correlation of immature/total granulocyte ratio with return of spontaneous circulation and early mortality in nontraumatic out-of-hospital cardiac arrest

Objective: Aim of this study was to examine immature granulocyte/total granulocyte (IG/TG) ratio for prediction of return of spontaneous circulation (ROSC) and early mortality in post cardiac arrest survivors.&#x0D; Methods: The study was carried out prospectively between January 2021 and January 2022. Non-traumatic out-of-hospital cardiac arrest (OHCA), over the age of 18 and non-pregnant were included. Patients’ whose IG levels were not studied, with hematological disease and who receiving immunosuppressive therapy were excluded. A palpable pulsation of the main arteries for at least 15 minutes was considered ROSC. Data were compared between the&lt;4 hour and ≥4 hour survival groups and patients with and without ROSC.&#x0D; Results: Total of 254 OHCA patients were included in the study. ROSC was achieved in 84 (33.1%) of these patients and 170 (66.9%) patients were died. There were 28 patients (33.3%) with survival of &lt;4 hours and 56 patients (66.7%) with survival of ≥4 hours in patients with ROSC. The IG count and IG/TG ratio did not differ significantly between the ROSC groups and between the groups separated by survival time (P&gt;0.05).&#x0D; Conclusion: We found no significant differences between subgroups defined according to survival duration. Similarly, no differences found between OHCA patients with and without sustained ROSC.

How to predict the death risk after an in-hospital cardiac arrest (IHCA) in intensive care unit? A retrospective double-centre cohort study from a tertiary hospital in China

ObjectivesOur objective is to develop a prediction tool to predict the death after in-hospital cardiac arrest (IHCA).DesignWe conducted a retrospective double-centre observational study of IHCA patients from January 2015 to...

The Association Between Ventricular Fibrillation and Serum Catecholamine Levels.

Background and objective Epinephrine (Ep) is the first choice as a vasoconstrictor in cardiopulmonary resuscitation (CPR) for patients with cardiopulmonary arrest (CPA); however, the Ep concentration in the serum of CPA patients is still unclear. The aim of this study was to evaluate the association between serum Ep levels and achieving the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation (VF). Methods This was a prospective, observational clinical study involving OHCA patients with VFtransferred to our hospital from July 2014 to July 2017. The measurement of serum catecholamines [Ep, norepinephrine (Nep), and dopamine (DOA)] and vasopressin [antidiuretic hormone (ADH)] levels was performed with blood samples obtained immediately upon patients' arrival at our hospital. Patients were classified into two groups: the ROSC(+) group and ROSC(-) group; the serum concentrations of catecholamines and ADH were compared between these two groups. Results The serum Ep and Nep levels were lower in the ROSC(+) group than those in the ROSC(-) group and the difference was statistically significant. On the other hand, no significant differences were found in serum DOA and ADH levels between the two groups. Conclusions The results of this study suggest that an increment in serum Ep levels does not promote achieving ROSC in OHCA patients with VF.

Association between regional cerebral oxygen saturation and outcome of patients with out-of-hospital cardiac arrest: An observational study

AimThis study aimed to evaluate the association between cerebral oxygen saturation (StO2) and return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). MethodsWe retrospectively evaluated the data of patients with OHCA to determine the association between ROSC and various StO2 parameters (initial_StO2, final_StO2, mean_StO2, and Δ_StO2 [=final_StO2-initial_StO2]). Time-domain near-infrared spectroscopy was used to determine absolute StO2 values. ResultsOf the 108 patients with OHCA, 23 achieved ROSC. Although initial_StO2 values did not differ between the groups, final_StO2, mean_StO2, and Δ_StO2 were higher in the ROSC group than in the non-ROSC group. The cut-off values for initial_StO2, mean_StO2, and Δ_StO2 as predictors of ROSC were 35%, 30%, and 5%, respectively. The odds ratio for ROSC had markedly increased in the Δ_StO2 ≥ 5% subgroup (19.70 [6.06–64.11], p < 0.001). When the change in StO2 (=d_StO2) at 8 min from the initiation of StO2 measurement was assessed, the d_StO2 ≥ 5% subgroup had a higher odds ratio for ROSC than the d_StO2 < 5% subgroup (5.8 [1.78–18.85], p = 0.002), and this tendency was maintained until 20 min. In the evaluation using a two-by-two contingency table with initial_StO2 and Δ_StO2 as two parameters, 61.9% of the patients fell under the categories of initial_StO2 < 35% and Δ_StO2 < 5% and had the lowest rate of ROSC achievement (4.6%). In the Δ_StO2 ≥ 5% subgroup, approximately-two-thirds of the patients achieved ROSC irrespective of the initial_StO2 (initial_StO2 ≥ 35%, 66.7%; initial_StO2 < 35%, 60.0%). ConclusionsInitial_StO2 and Δ_StO2 were associated with the achievement of ROSC.

Prediction of return of spontaneous circulation in out-of-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study.

Out-of-hospital cardiac arrest (OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation (ROSC) and its prognostic factors. Rotational thromboelastometry (ROTEM®), a point-of-care testing (POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompanying non-shockable rhythm. This is a single-center, retrospective observational study. Complete blood count, blood gas, and ROTEM POCT measurements were used. This study included patients with non-traumatic OHCA aged 18 years or older who were transported to the emergency department and evaluated using POCT between January 2013 and December 2021. The patients were divided into the ROSC and non-ROSC groups. Prehospital information and POCT parameters were compared using receiver operating characteristic (ROC) curve analysis, and further logistic regression analysis was performed. Sixty-seven and 135 patients were in the ROSC and non-ROSC groups, respectively. The ROC curves showed a high area under the curve (AUC) for K+ of 0.77 (95% confidence interval [CI]: 0.71-0.83) and EXTEM amplitude 5 min after clotting time (A5) of 0.70 (95%CI: 0.62-0.77). The odds ratios for ROSC were as follows: female sex 3.67 (95%CI: 1.67-8.04); K+ 0.64 (95%CI: 0.48-0.84); and EXTEM A5 1.03 (95%CI: 1.01-1.06). In OHCA patients with non-shockable rhythm, K+ level and the ROTEM parameter EXTEM A5 may be useful in predicting ROSC.

Cardiopulmonary resuscitation: difficulty in maintaining sufficient compression depth at the appropriate rate

Over the last 50 years, the recommended chest compression for cardiopulmonary resuscitation (CPR) has become faster and deeper, but maintaining deep compressions may be difficult at higher rates. Our study aimed to determine whether adequate compression (chest compression at an appropriate depth and rate) is being performed in emergency departments (ED). We also investigated the effect of adequate compression performance on the return of spontaneous circulation (ROSC). This prospective observational study was conducted at the EDs of two urban academic medical centers. We included adult patients (age ≥18 years) with cardiac arrest who underwent CPR in the ED between May and November 2020. We excluded patients with cardiac arrest related to trauma, repeated arrest except the first, and those for whom a monitor-defibrillator (ZOLL X-series) was not used. The following data were obtained from the monitor-defibrillator devices: compression depth, rate, chest compression fraction, CPR time, and percentage of compressions at the recommended rate and, at the recommended depth, at over and below rates, and depth, and at the appropriate depth and rate. Our study included 50 patients, from whom 441 chest compression sequences were obtained and analyzed. The mean compression depth, rate, and fraction were 6.48 ± 0.87 cm, 117 ± 5/min, 92.1 ± 3.70%, respectively. As the compression rate increased, the depth decreased, and most compressions were over-depth. Adequate compression (appropriate depth at recommended rate) was observed in 97 of the 441 compression sequences (21.9%). Below-depth and below-rate percentages were higher in the deceased group than that in the ROSC group (9.7 ± 15.2% vs. 3.3 ± 3.5%, p = 0.27; 2.7 ± 2.6% vs. 1.2± 0.9%, p = 0.06). The global ratio of chest compression showed low compliance with the recommended rate and depth, even when performed by skilled ED staff.

Transient return of spontaneous circulation related to favourable outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study

AimThis study aimed to investigate the relationship between transient return of spontaneous circulation (ROSC) before extracorporeal membrane oxygenation (ECMO) initiation and outcomes in out-of-hospital cardiac arrest (OHCA) patients, who were resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR). MethodsThis study was a secondary analysis of the SAVE-J II study, which was a retrospective multicentre registry study involving 36 participating institutions in Japan. We classified patients into two groups according to the presence or absence of transient ROSC before ECMO initiation. Transient ROSC was defined as any palpable pulse of ≥1 min before ECMO initiation. The primary outcome was favourable neurological outcomes (cerebral performance categories 1–2). ResultsOf 2,157 patients registered in the SAVE-J II study, 1,501 met the study inclusion criteria; 328 (22%) experienced transient ROSC before ECMO initiation. Patients with transient ROSC had better outcomes than those without ROSC (favourable neurological outcome, 26% vs 12%, P < 0.001; survival to hospital discharge, 46% vs 24%, respectively; P < 0.001). A Kaplan–Meier plot showed better survival in the transient ROSC group (log-rank test, P < 0.001). In multiple logistic analyses, transient ROSC was significantly associated with favourable neurological outcomes and survival (favourable neurological outcomes, adjusted odds ratio, 3.34 [95% confidence interval, 2.35–4.73]; survival, adjusted odds ratio, 3.99 [95% confidence interval, 2.95–5.40]). ConclusionsIn OHCA patients resuscitated with ECPR, transient ROSC before ECMO initiation was associated with favourable outcomes. Hence, transient ROSC is a predictor of improved outcomes after ECPR.

Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients.

Background SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE−1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR). Methods Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE−1 and other routine biochemical parameters were studied in blood samples taken at the time of admission. Results There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE−1 value of the ROSC group was significantly higher than that of the non-survivor group ( p ˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE−1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC. Conclusions The SCUBE−1 values were found to be significantly higher in the ROSC group compared with the non-survivor group.

Long-term survival in patients treated with mechanical circulatory support for refractory out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: None. Background Mechanical circulatory support (MCS) is used increasingly in the setting of refractory out-of-hospital cardiac arrest (OHCA). However, limited data exist on long-term survival. Purpose To investigate the long-term outcome in patients receiving MCS compared to patients with return of spontaneous circulation (ROSC) at hospital admission. Methods Retrospective, observational single centre study from 2015-2019. The study included all patients who achieved ROSC on admission and patients receiving MCS for refractory OHCA defined as either veno-arterial extracorporeal membrane oxygenation or Impella support. Kaplan-Meier survival analysis were performed to evaluate long-term survival in both groups and compared with the log-rank test. Results A total of 698 patients with ROSC on admission and 101 patients receiving MCS were included. Acute myocardial infarction was the most common aetiology of arrest in both groups. There were no differences in witnessed arrest, bystander cardiopulmonary resuscitation or initial presenting rhythm. Low-flow time was substantially longer in the MCS group compared to the ROSC group (median 105 (IQR, 94-123) minutes versus median 15 (IQR, 8-22) minutes, p &amp;lt; 0.001). The 5-day mortality rate was 63% in the MCS group versus 24% in the ROSC group. Long-term survival from day 6 to day 90 was 71% in the MCS group and 83% in the ROSC group, p = 0.072. Conclusions In conclusion, the risk of death within the first 5 days was higher for OHCA patients treated with MCS than in patients with ROSC on admission. Among patients surviving the first 5 days, 90-day mortality was low in both groups.

Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support

AimThe aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). MethodsThis was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. ResultsAmong 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. ConclusionsShort-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.

Temporal changes in peripheral regional oxygen saturation associated with return of spontaneous circulation after out-of-hospital cardiac arrest: A prospective observational cohort study in Japan

AimTemporal changes in cerebral regional oxygen saturation (crSO2) are useful for predicting return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients. However, little is known regarding the usefulness of peripheral regional oxygen saturation (prSO2) associated with OHCA patient outcomes. This study evaluated the association between temporal changes in prSO2 and ROSC in patients with OHCA. MethodsThis was a prospective study at two tertiary emergency centres in Japan. We evaluated the relationship between ROSC and temporal changes in crSO2 and prSO2. The rSO2 sensor was attached to the patient’s forehead and upper arm, and rSO2 was continuously measured until resuscitative efforts were terminated or until the patient with sustained ROSC (>20 min) arrived at the emergency department. ResultsWe included 145 patients with OHCA, of whom 35 achieved ROSC. Witness status (odds ratio [95% confidence interval]: 11.6 [3.13–58.1]) and ΔprSO2 (1.13 [1.06–1.24]) were significantly associated with ROSC in multiple logistic analysis. In the ROSC group, ΔprSO2 increased earlier than ΔcrSO2 during cardiopulmonary resuscitation. In the non-ROSC group, there was no significant difference between ΔcrSO2 and ΔprSO2, and neither increased before termination of resuscitation (TOR). ConclusionWe demonstrated for the first time that prSO2 is associated with ROSC in OHCA patients and showed that temporal changes in prSO2 could predict ROSC earlier than those in crSO2. Our findings could provide time to prepare early interventions after ROSC and assist in determining the TOR for OHCA patients in Japan. Further studies are needed to validate these findings.

Sonoclot's usefulness in prediction of cardiopulmonary arrest prognosis: A proof of concept study.

The aim of the present study was to evaluate the usefulness of measuring whole blood coagulation with Sonoclot to predict return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiopulmonary arrest (OHCA). This was a prospective, observational clinical study on patients with OHCA who were transferred to our emergency department between August 2016 and July 2018. Patients were divided into two groups: patients with return of spontaneous circulation (ROSC[+] group) and those without (ROSC[−] group). We compared the activated clotting time (ACT), clot rate (CR), and platelet function (PF) as measured with Sonoclot, and the fibrinogen degradation products (FDP) level and D-dimer level between the two groups. We analyzed 87 patients: 37 in the ROSC(+) and 50 in the ROSC(−) groups. Regarding ACT, CR, PF, FDP, and D-dimer, we used receiver operating characteristic (ROC) curves to examine how well each factor predicts ROSC. The area under the ROC curve (AUC) of CR was higher than that of the FDP and D-dimer levels. Among patients with cardiogenic cardiac arrest, the AUC of CR was higher than the AUCs of other coagulation factors. In conclusion, viscoelastic blood coagulation measurements using Sonoclot may be useful for predicting ROSC in OHCA patients.

Prediction of return of spontaneous circulation during cardiopulmonary resuscitation by pulse-wave cerebral tissue oxygen saturation: a retrospective observational study

BackgroundIt is difficult to predict the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Cerebral tissue oxygen saturation during CPR, as measured by near-infrared spectroscopy (NIRS), is anticipated to predict ROSC. General markers of cerebral tissue oxygen saturation, such as the tissue oxygenation index (TOI), mainly reflect venous oxygenation, whereas pulse-wave cerebral tissue oxygen saturation (SnO2), which represents hemoglobin oxygenation in the pulse wave within the cerebral tissue, is an index of arterial and venous oxygenation. Thus, SnO2 may reflect arterial oxygenation to a greater degree than does TOI. Therefore, we conducted this study to verify our hypothesis that SnO2 measured during CPR can predict ROSC.MethodsCardiac arrest patients who presented at the Emergency Department of Yamagata University Hospital in Japan were included in this retrospective, observational study. SnO2 and TOI were simultaneously measured at the patient’s forehead using an NIRS tissue oxygenation monitor (NIRO 200-NX; Hamamatsu Photonics, Japan). We recorded the initial, mean, and maximum values during CPR. We plotted receiver operating characteristic curves and calculated the area under the curve (AUC) to predict ROSC.ResultsForty-two patients were included. SnO2 was significantly greater in the ROSC group than in the non-ROSC group in terms of the initial (37.5% vs 24.2%, p = 0.015), mean (44.6% vs 10.8%, p < 0.001), and maximum (79.7% vs 58.4%, p < 0.001) values. Although the initial TOI was not significantly different between the two groups, the mean (45.1% vs 36.8%, p = 0.018) and maximum (71.0% vs 46.3%, p = 0.001) TOIs were greater in the ROSC group than in the non-ROSC group. The AUC was 0.822 for the mean SnO2 (95% confidence interval [CI]: 0.672–0.973; cut-off: 41.8%), 0.821 for the maximum SnO2 (95% CI: 0.682–0.960; cut-off: 70.8%), and 0.809 for the maximum TOI (95% CI: 0.667–0.951; cut-off: 49.3%).ConclusionSnO2 values measured during CPR, including immediately after arrival at the emergency department, were higher in the ROSC group than in the non-ROSC group.

Dynamic changes of the hemoglobin index during resuscitation in patients with out-of-hospital cardiopulmonary arrest due to freshwater drowning: A retrospective observational study

BackgroundThe hemoglobin index (HbI) represents the amount of hemoglobin, which reflects the regional tissue blood volume. The HbI is calculated by a regional oxygen saturation monitor. In freshwater drowning, inhaled water is immediately absorbed into the blood causing hemodilution. We hypothesized that this blood dilution could be observed in real time using HbI values in patients with out-of-hospital cardiac arrest (OHCA) due to freshwater drowning. MethodsIn this single-center retrospective, observational study, we examined the HbI in patients with OHCA due to freshwater drowning from April 2015 to May 2020. Patients with OHCA due to hanging were selected as a control group. ResultsThirty-two patients in the freshwater drowning group and 21 in the control group were eligible for inclusion. In the freshwater drowning group, the HbI values in the return of spontaneous circulation (ROSC) group were significantly decreased in comparison to the non-ROSC group (−0.28 [IQR −0.55, −0.12] vs. −0.04 [IQR −0.16, 0.025]; p = 0.024). In the control group, the change of HbI during resuscitation in the ROSC and non-ROSC groups was not significantly different (0.11 [IQR −0.3525, 0.4225] vs. −0.02 [IQR −0.14, 0.605]; p = 0.8228). In each patient with ROSC in the freshwater drowning group, the HbI value after ROSC was significantly decreased in comparison to before ROSC (1.2±0.5 vs. 0.9±0.5]; p = 0.0156). In contrast, this difference was not observed in patients with an ROSC in the control group (3.7±1.3 vs. 3.8±1.4]; p = 0.7940). ConclusionBlood dilution induced by freshwater drowning might be detected in real time using the HbI. To prove the validity of this research’s result, further prospective large study is needed.

Do carboxyhaemoglobin and methaemoglobin levels predict the return of spontaneous circulation and prognosis of cardiac arrest patients?

Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study's goal was to investigate the value of the carboxyhaemoglobin (COHb) and methaemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups: survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. COHb levels were significantly lower in the non-ROSC group than in the ROSC group (P=.002). Urea, creatinine, potassium and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (P<.001, .001, .014, and .005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (P=.022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (P=.001, .005, .001, .010 and .008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (P=.769 and .668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (P˂.001). COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest.

Purpose The dynamic state of epinephrine (Ep) in the plasma of patients with out-of-hospital cardiac arrest (OHCA) remains unclear. The purpose of this study was to evaluate the relationship between the plasma levels of catecholamines (such as epinephrine (Ep), norepinephrine (Nep), and dopamine) and vasopressin (antidiuretic hormone (ADH)) and the acquisition of return of spontaneous circulation (ROSC) in OHCA patients. Methods This was a prospective, observational clinical study. Patients with OHCA transferred to our hospital between July 2014 and July 2017 were enrolled. The levels of catecholamines and ADH in the plasma were measured using blood samples immediately obtained on arrival at our hospital and before the administration of Ep. Patients in whom Ep was already administered prior to obtaining blood samples were excluded. Patients were divided into two groups: with and without ROSC, that is, ROSC (+) and ROSC (−) groups, respectively. The plasma levels of these agents and the conditions of resuscitation were compared between the two groups. Results A total of 96 patients with OHCA were analyzed. The ROSC (+) and ROSC (−) groups included 34 and 62 patients, respectively. There were no significant differences observed between the two groups in age, cause of cardiopulmonary arrest, and prehospital resuscitation time. The plasma levels of Ep and Nep were significantly lower in the ROSC (+) group than in the ROSC (−) group. However, there were no significant differences in the plasma levels of dopamine and ADH between the two groups. Conclusion Increased levels of Ep in the plasma may not be associated with the acquisition of ROSC in patients with OHCA.

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).

Monitoring tissue oxygenation index using near\u2010infrared spectroscopy during pre\u2010hospital resuscitation among out\u2010of\u2010hospital cardiac arrest patients: a pilot study

BackgroundTissue oxygenation index (TOI) using the near infrared spectroscopy (NIRS) has been demonstrated as a useful indicator to predict return of spontaneous circulation (ROSC) among out-of-hospital cardiac arrest (OHCA) patients in hospital setting. However, it has not been widely examined based on pre-hospital setting.MethodsIn this prospective observational study, we measured TOI in pre-hospital setting among OHCA patients receiving cardio-pulmonary resuscitation (CPR) during ambulance transportation between 2017 and 2018. Throughout the pre-hospital CPR procedure, TOI was continuously measured. The study population was divided into two subgroups: ROSC group and non-ROSC group.ResultsOf the 81 patients included in the final analysis, 26 achieved ROSC and 55 did not achieve ROSC. Patients in the ROSC group were significantly younger, had higher ∆TOI (changes in TOI) (5.8 % vs. 1.3 %; p < 0.01), and were more likely to have shockable rhythms and event witnessed than patients in the non-ROSC group. ∆TOI cut-off value of 5 % had highest sensitivity (65.4 %) and specificity (89.3 %) for ROSC. Patients with a cut-off value ≤-2.0 % did not achieve ROSC and while all OHCA patient with a cut-off value ≥ 8.0 % achieved ROSC. In addition, ROSC group had stronger positive correlation between mean chest compression rate and ∆TOI (r = 0.82) than non-ROSC group (r = 0.50).ConclusionsThis study suggests that ∆ TOI could be a useful indicator to predict ROSC in a pre-hospital setting.