Return Of Spontaneous Circulation In Patients Research Articles

A conflict choice of treatment during defibrillation in cardiopulmonary resuscitation: Lidocaine, amiodarone or both? A retrospective study

A conflict choice of treatment during defibrillation in cardiopulmonary resuscitation: Lidocaine, amiodarone or both? A retrospective study

Standardisation facilitates reliable interpretation of ETCO2 during manual cardiopulmonary resuscitation

BackgroundInterpretation of end-tidal CO2 (ETCO2) during manual cardiopulmonary resuscitation (CPR) is affected by variations in ventilation and chest compressions. This study investigates the impact of standardising ETCO2 to constant ventilation rate (VR) and compression depth (CD) on absolute values and trends. MethodsRetrospective study of out-of-hospital cardiac arrest cases with manual CPR, including defibrillator and clinical data. ETCO2, VR and CD values were averaged by minute. ETCO2 was standardised to 10 vpm and 50 mm. We compared standardised (ETs) and measured (ETm) values and trends during resuscitation. ResultsOf 1,036 cases, 287 met the inclusion criteria. VR was mostly lower than recommended, 8.8 vpm, and highly variable within and among patients. CD was mostly within guidelines, 49.8 mm, and less varied. ETs was lower than ETm by 7.3 mmHg. ETs emphasized differences by sex (22.4 females vs. 25.6 mmHg males), initial rhythm (29.1 shockable vs. 22.7 mmHg not), intubation type (25.6 supraglottic vs. 22.4 mmHg endotracheal) and return of spontaneous circulation (ROSC) achieved (34.5 mmHg) vs. not (20.1 mmHg). Trends were different between non-ROSC and ROSC patients before ROSC (–0.3 vs. + 0.2 mmHg/min), and between sustained and rearrest after ROSC (–0.7 vs. –2.1 mmHg/min). Peak ETs was higher for sustained than for rearrest (53.0 vs. 42.5 mmHg). ConclusionStandardising ETCO2 eliminates effects of VR and CD variations during manual CPR and facilitates comparison of values and trends among and within patients. Its clinical application for guidance of resuscitation warrants further investigation.

Abstract 209: The Relationship Between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcome of Out-of-Hospital Cardiac Arrest Patients

Background: Progressive hypoxic brain injury after cardiac arrest can affect serum osmolality (SOsm) and urine osmolality (UOsm) in out-of-hospital cardiac arrest (OHCA) patients. This study aimed to examine the association between the ratios of UOsm to SOsm (USRs) within 3 days after return of spontaneous circulation (ROSC) and neurological outcomes in OHCA patients. Methods: The present study was prospective observational study and included OHCA patients with targeted temperature management (TTM) at Chonnam National University Hospital in Gwangju, Korea, between January 2016 and December 2022. We collected SOsm and UOsm at admission and at 24 h, 48 h, and 72 h after ROSC. We assessed the predictive performance of USRs to determine neurological outcome at discharge. Results: A total of 319 patients were included. UOsm levels and USRs at admission and 24 h, 48 h, and 72 h after ROSC in patients with poor outcome were lower than those in patients with good outcome. In multivariable analysis, the USRs at 24 h (odd ratio [OR], 0.363; 95% confidence interval [CI], 0.221-0.594), 48 h (OR, 0.451; 95% CI, 0.268-0.761), and 72 h (OR, 0.559; 95% CI, 0.357-0.875) after ROSC were independently associated with poor neurological outcome at discharge. The area under the receiver operating characteristic curves of USRs at admission and 24 h, 48 h, and 72 h after ROSC for predicting neurological outcome at discharge were 0.615 (95% CI, 0.559-0.669), 0.711 (95% CI, 0.658-0.760), 0.724 (95% CI, 0.671-0.772), and 0.751 (95% CI, 0.699-0.797). Conclusions: The USRs within 3 days of ROSC were associated with poor neurologic outcome at discharge in OHCA patients.

Abstract 15065: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: End-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. Pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P<0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P < 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.

Abstract 297: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: end-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P<0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P < 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.

Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and meta-analysis.

Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years. Cardiopulmonary resuscitation (CPR) increases survival outcomes in cases of cardiac arrest; however, healthcare workers often do not perform CPR within recommended guidelines. Real-time audiovisual feedback (RTAVF) devices improve the quality of CPR performed. This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in- and OHCA. We searched PubMed, SCOPUS, the Cochrane Library, and EMBASE from inception to July 27, 2020, for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA. The primary outcomes of interest were return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD), with secondary outcomes of chest compression rate and chest compression depth. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration's "risk of bias" tool. Data was analyzed using R statistical software 4.2.0. results were statistically significant if P < 0.05. Thirteen studies (n = 17600) were included. Patients were on average 69 ± 17.5 years old, with 7022 (39.8%) female patients. Overall pooled ROSC in patients in this study was 37% (95% confidence interval = 23%-54%). RTAVF-assisted CPR significantly improved ROSC, both overall [risk ratio (RR) 1.17 (1.001-1.362); P = 0.048] and in cases of IHCA [RR 1.36 (1.06-1.80); P = 0.002]. There was no significant improvement in ROSC for OHCA (RR 1.04; 0.91-1.19; P = 0.47). No significant effect was seen in SHD [RR 1.04 (0.91-1.19); P = 0.47] or chest compression rate [standardized mean difference (SMD) -2.1; (-4.6-0.5)]; P = 0.09]. A significant improvement was seen in chest compression depth [SMD 1.6; (0.02-3.1); P = 0.047]. RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA, SHD, or chest compression rate.

The role of point-of-care testing in cardiac arrest patients

BackgroundPoint-of-care testing (POCT) provides real time information to the clinical team, leading to early diagnosis and treatment. Whether POCT plays a role in improving outcomes in patients with out of hospital cardiac arrest (OHCA) remains unknown. The objective of this study was to describe use of POCT in OHCA and to explore its association with outcomes. MethodsWe conducted a retrospective chart review on patients transferred by emergency medical services (EMS) to the ED for out-of-hospital cardiac arrest (OHCA) in 2019. Data collected from patient charts included baseline information, the Utstein criteria for cardiac arrest, whether POCT was used, whether POCT was abnormal, and what treatment was given, if any, as a result of the abnormal POCT. Outcomes included return of spontaneous circulation (ROSC) and survival to hospital discharge. Outcomes in patients with and without POCT were compared using chi-square and t-tests. ResultsThere were 119 study patients. Their mean (SD) age was 65 (18) years and 65% were male. Cardiac arrest was witnessed in 48% and initial rhythm was asystole in 66%. The rates of ROSC and survival were 22.7% (95%CI, 16.1–31.1) and 3.4% (95%CI, 1.3–8.3). POCT was used in 66 patients (55.4%; 95%CI, 46.5–64.1) all of whom had at least one abnormality. The results of POCT led to administration of a therapy in 60 patients (91.0%; 95%CI, 81.6–95.8). The rates of ROSC in patients with and without POCT were 22.6% vs 22.7% respectively. The rates of survival to discharge in patients with and without POCT were 0% vs 3.8% respectively. ConclusionsPOCT is commonly used in the ED for patients with OHCA and its results often lead to changes in therapies. However, use of POCT was not associated with ROSC or survival to discharge.

Usability of EtCO2 values in the decision to terminate resuscitation by integrating them into the TOR rule (an extended TOR rule): A preliminary analysis

ObjectiveEnd tidal carbon dioxide (EtCO2) is measured to confirm the placement of an endotracheal tube and evaluate the efficacy of cardiopulmonary resuscitation (CPR), and as an assistive tool for terminating CPR. However, there are no highly accurate or definitive recommendations for its use when deciding on the termination of CPR. We aimed to merge EtCO2 values with existing termination of resuscitation (TOR) rules to obtain a more accurate combination for terminating resuscitation. MethodsThis observational, prospective study included non-traumatic adult patients who were admitted to a tertiary university hospital Emergency Medicine Department due to cardiac arrest. EtCO2 cutoff values (at 5, 10, and 20 min) were integrated into currently used TOR parameters (arrest was not witnessed, no bystander CPR was provided, no return of spontaneous circulation (ROSC) after full advanced life support care in the field, and no shock was delivered) and the extended TOR rule was created. These extended TOR rules were compared at three different times (5, 10, and 20 min) for specificity and positive predictive value for ROSC. ResultsWe included a total of 86 cases. The cutoff value of EtCO2 from ROC analysis was 19.5, 23.5, and 20.5 mmHg at 5, 10, and 20 min, respectively. “The extended TOR rule created with the 20-min EtCO2 cutoff (20.5 mmHg) was the most accurate in detecting ROSC (−) patients. The specificity was 100% (95% CI 63.1–100.0) sensitivity was 20.0% (95% CI 9.1–35.7), positive predictive value was 100% and negative predictive value was 20.0% (95% CI 17.6–22.6) for ROSC (−) patients. The parameters of this rule were as follows: arrest was not witnessed, no bystander CPR was provided, no ROSC after full advanced life support care in the field, no shock was delivered, and EtCO2 value at 20 min of resuscitation <20.5 mmHg. ConclusionsIntegration of EtCO2 values into the classically used TOR criteria increases the specificity to 100% without a significant decrease in sensitivity. These results need to be validated in larger groups before this rule is used clinically. EtCO2 seems to be a beneficial tool in establishing new TOR rules.

Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): protocol for a stepped-wedge cluster randomised controlled trial

IntroductionCardiac arrest is a critical condition, and patients often experience postcardiac arrest syndrome (PCAS) even after the return of spontaneous circulation (ROSC). Administering a restricted amount of oxygen in the...

Point-of-care testing for adult out-of-hospital cardiac arrest resuscitated at the ED to predict ROSC: Development and external validation of POC-ED-ROSC model

Background and importanceMost prediction models, like return of spontaneous circulation (ROSC) after cardiac arrest (RACA) or Utstein-based (UB)-ROSC score, were developed for prehospital settings to predict the probability of ROSC in patients with out-of-hospital cardiac arrest (OHCA). A prediction model has been lacking for the probability of ROSC in patients with OHCA at emergency departments (EDs). ObjectiveIn the present study, a point-of-care (POC) testing-based model, POC-ED-ROSC, was developed and validated for predicting ROSC of OHCA at EDs. Design, settings and participantsProspectively collected data for adult OHCA patients between 2015 and 2020 were analysed. POC blood gas analysis obtained within 5 min of ED arrival was used. Outcomes measure and analysisThe primary outcome was ROSC. In the derivation cohort, multivariable logistic regression was used to develop the POC-ED-ROSC model. In the temporally split validation cohort, the discriminative performance of the POC-ED-ROSC model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and compared with RACA or UB-ROSC score using DeLong test. Main resultsThe study included 606 and 270 patients in the derivation and validation cohorts, respectively. In the total cohort, 471 patients achieved ROSC. Age, initial cardiac rhythm at ED, pre-hospital resuscitation duration, and POC testing-measured blood levels of lactate, potassium and glucose were significant predictors included in the POC-ED-ROSC model. The model was validated with fair discriminative performance (AUC: 0.75, 95% confidence interval [CI]: 0.69–0.81) with no significant differences from RACA (AUC: 0.68, 95% CI: 0.62–0.74) or UB-ROSC score (AUC: 0.74, 95% CI: 0.68–0.79). ConclusionUsing only six easily accessible variables, the POC-ED-ROSC model can predict ROSC for OHCA resuscitated at ED with fair accuracy.

Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

ObjectiveTo demonstrate the therapeutic effect of vasopressin as an alternative treatment for cardiac arrest.DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, the Cochrane Library and Web of Science were searched for randomised controlled...

Prognostic predictors in patients with cardiopulmonary arrest: A novel equation for evaluating the 30-day mortality

BackgroundEarly prediction of outcomes after cardiopulmonary arrest (CPA) is important for considering the best support. Our purpose was to evaluate predictors of the 30-day mortality in patients with CPA after return of spontaneous circulation (ROSC) and to assess an equation for calculating the 30-day mortality using clinical parameters. MethodsWe retrospectively analyzed the data of 194 consecutive patients with CPA and ROSC in a derivation study (2015–2022). We compared clinical parameters between the survived (n = 78) and dead (n = 116) patients. We derived an equation for estimated probability of death based on clinical parameters, using multivariate logistic regression analysis. The reliability of the equation was validated in 80 additional patients with CPA. ResultsThe 30-day mortality was associated with sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), CPA due to acute myocardial infarction, pupil diameter, Glasgow Coma Scale score (GCS), presence of light reflex, arterial or venous pH, lactate levels, initial ventricular fibrillation (VF), CPA time, and age. The derived logistic regression equation was as follows: Estimated probability of death = 1 / (1 + e-x), x = (0.25 × bystander CPR) + (0.44 × pupil diameter) – (0.14 × GCS) + (0.09 × lactate) – (1.87 × initial VF) + (0.07 × CPA time) + (0.05 × age) - 7.03. The cut-off value for estimated probability of death calculated by this equation was 54.5 %, yielding a sensitivity, specificity, and accuracy of 86.2 %, 80.8 %, and 84.5 %, respectively. In the validation model, these values were 81.8 %, 85.7 %, and 82.5 %, respectively. ConclusionsThe 30-day mortality may be calculated after ROSC in patients with CPA using simple clinical parameters. This equation may facilitate further best support for patients with CPA.

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.

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.

The Effect of Vasopressin and Methylprednisolone on Return of Spontaneous Circulation in Patients with In-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Cardiac arrest is often fatal if not treated immediately by cardiopulmonary resuscitation to restore a normal heart rhythm and spontaneous circulation. We aim to evaluate the clinical benefits of vasopressin and methylprednisolone versus placebo for patients with in-hospital cardiac arrest. We searched PubMed, EMBASE, Scopus, Web of Science, Cochrane Central, and Google Scholar from inception to October 17, 2021, by using search terms included "Vasopressin" AND "Methylprednisolone" AND "Cardiac arrest". We included randomized controlled trials (RCTs) that compared vasopressin and methylprednisolone to placebo. The main outcomes were the return of spontaneous circulation (ROSC) and survival to hospital discharge. A total of three RCTs, with a total of 869 patients, were included. The pooled risk ratios (RRs) were calculated along with their 95% confidence intervals (CIs). Our result showed an increase in ROSC in patients who received vasopressin and methylprednisolone (RR = 1.32; 95% CI = [1.18, 1.47], p < 0.00001) when compared with the placebo group. However, there was no difference between both groups regarding survival to hospital discharge (RR = 1.76; 95% CI = [0.68, 4.56], p= 0.25). The current guidelines recommend epinephrine for patients with in-hospital cardiac arrest. Our meta-analysis updates clinicians about using vasopressin and methylprednisolone besides epinephrine, providing them with the best available evidence in managing patients with in-hospital cardiac arrest. Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone besides epinephrine is associated with increased ROSC compared with placebo and epinephrine. However, high-quality RCTs are necessary before drawing a firm conclusion regarding the efficacy of vasopressin and methylprednisolone for patients with in-hospital cardiac arrest.

Immediate Versus Delayed Cardiac Catheterization in Post-Arrest Patients Without ST Elevation Myocardial Infarction: Is Survivorship Bias an Important Influence?: March 2022 Annals of Emergency Medicine Journal Club

Immediate Versus Delayed Cardiac Catheterization in Post-Arrest Patients Without ST Elevation Myocardial Infarction: Is Survivorship Bias an Important Influence?: March 2022 Annals of Emergency Medicine Journal Club

Efficacy of combination triple therapy with vasopressin, steroid, and epinephrine in cardiac arrest: a systematic review and meta-analysis of randomized-controlled trials

BackgroundThis study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA).Materials and methodsVarious databases were explored from inception until October 2021 for relevant published clinical trials and cohort studies.ResultsThree clinical trials were included. Pooled analysis suggested that VSE was significantly associated with increased ROSC in patients with in-hospital CA (IHCA) (odds ratio (OR): 2.281, 95% confidence interval (CI): 1.304–3.989, P value = 0.004). Meta-analysis of two studies (368 patients) demonstrated a significant difference in the reduction of mean arterial pressure (MAP) during and 15–20 min after cardiopulmonary resuscitation (standardized mean difference (SMD): 1.069, 95% CI: 0.851–1.288, P value < 0.001), renal failure free days (SMD = 0.590; 95% CI: 0.312–0.869 days; P value < 0.001), and coagulation failure free days (SMD = 0.403; 95% CI: 0.128–0.679, P value = 0.004). However, no significant difference was observed for survival-to-discharge ratio (OR: 2.082, 95% CI: 0.638–6.796, P value = 0.225) and ventilator free days (SMD = 0.201, 95% CI: − 0.677, 1.079 days; P value = 0.838).ConclusionsVSE combination therapy during and after IHCA may have beneficial effects in terms of the ROSC, renal and circulatory failure free days, and MAP.Prospero registration: CRD42020178297 (05/07/2020).

Factors Associated with Return of Spontaneous Circulation following Pre-Hospital Cardiac Arrest in Daegu Metropolitan City, South Korea; a Cross-Sectional Study.

The probability of Return of Spontaneous Circulation (ROSC) in cardiac arrest cases in pre-hospital setting is still low. This study aimed to identify the factors that may improve the rate of ROSC in patients with pre-hospital cardiac arrest. This retrospective cross-sectional study is a secondary data analysis of cardiac arrest patients, who were managed by paramedics in the pre-hospital setting, from January 1, 2019,to December 31, 2019,in Daegu, South Korea.The association of ROSC with place of arrest occurrence, cardiac arrest being witnessed, performing cardiopulmonary resuscitation (CPR), using compression device and defibrillator, administration of epinephrine, and intubationwas analyzed and independent predictive factors of ROSC were reported. 2750out-of-hospital cardiac arrest cases, which were managed by paramedics in the pre-hospital setting were studied. 2034 (86.9%) cases of arrest had occurred at home, 2028 (73.7%) were not witnessed,and CPR was not performedfor 1721 (64.1%) cases.ROSC before arriving to emergency department (ED) was more probable if the cardiac arrest was witnessed(p<0.001), if CPR was performed(p=0.044),if a mechanical compression device was used(p<0.001),if a first-aid defibrillator was used(p<0.001), and if intravenous access was secured(p<0.001). Multivariate regression analysis revealed that using mechanical compression device (OR: 0.18; 95% CI=0.08-0.40; p = 0.001), using first-aid defibrillator (OR: 3.13; 95% CI=1.40-6.99; p = 0.005), administration of epinephrine (OR: 6.57; 95% CI=2.16-19.53; p = 0.001), and intubation (OR: 1.82;95% CI=1.04-3.19; p = 0.001) were independent predictive factors of ROSCbefore arrival to ED. It seems that chest compression by hand instead of using chest compression device, using defibrillator, epinephrine administration, and intubation my increase the probability of ROSC in pre-hospital arrest cases.

Evaluation of the quality of cardiopulmonary resuscitation provided by the emergency response team at a tertiary care hospital.

Background and Aims:Chest compression fraction is the proportion of time spent on chest compression during cardiopulmonary resuscitation (CPR). The aims of this study were to know the quality of CPR provided during in-hospital cardiac arrest (IHCA) by analysing the chest compression fraction and to see the correlation of chest compression fraction with return of spontaneous circulation (ROSC) in the hospital setting.Methods:This prospective observational study was conducted in patients aged >18 years who developed IHCA. An observer would assess the quality of CPR provided by noting the time spent on chest compression. The chest compression fraction was calculated and correlated in patients with ROSC and without ROSC. Patients who survived were followed until discharge, and their neurological score was determined using the cerebral performance category (CPC).Results:We included 126 patients in the study; the mean chest compression fraction achieved was 78% (standard deviation [SD] ± 5). A total of 73 (58%) patients achieved ROSC and among them, 11 patients (9%) survived to hospital discharge. We found that the patients with ROSC had a significantly higher chest compression fraction of 80% (SD ± 5), as compared to 75% (SD ± 5), in whom ROSC could not be achieved. A multivariate logistic regression test showed higher odds (1.125) of ROSC in patients with high chest compression fraction. The mean CPC among the survivors was 1.4 (SD ± 0.5).Conclusion:Our study shows that health-care providers in our hospital provide high-quality CPR, and chest compression fraction is independently associated with ROSC in IHCA.

Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest

AimTo develop and validate a model for the early prediction of long-term neurological outcome in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). MethodsWe analysed multicentre OHCA registry data of adult patients with non-traumatic OHCA who experienced return of spontaneous circulation (ROSC) and had been admitted to the intensive care unit between 2013 and 2017. We allocated 1329 (2013–2015) and 1025 patients (2016–2017) to the derivation and validation sets, respectively. The primary outcome was the dichotomized cerebral performance category (CPC) at 90 days, defined as good (CPC 1–2) or poor (CPC 3–5). We developed 2 models: model 1 included variables without laboratory data, and model 2 included variables with laboratory data available immediately after ROSC. Logistic regression with least absolute shrinkage and selection operator regularization was employed for model development. Measures of discrimination, accuracy, and calibration (C-statistics, Brier score, calibration plot, and net benefit) were assessed in the validation set. ResultsThe C-statistic (95% confidence intervals) of models 1 and 2 in the validation set was 0.947 (0.930–0.964) and 0.950 (0.934–0.966), respectively. The Brier score of models 1 and 2 in the validation set was 0.0622 and 0.0606, respectively. The calibration plot showed that both models were well-calibrated to the observed outcome. Decision curve analysis indicated that model 2 was similar to model 1. ConclusionThe prediction tool containing detailed in-hospital information showed good performance for predicting neurological outcome at 90 days immediately after ROSC in patients with OHCA.