Risk Factors For Cardiac Arrest Research Articles

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

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

The Study of Congestive Heart Failure as a Risk Factor of Cardiac Arrest in ICU

Cardiovascular disease, especially congestive heart failure, is the second most common cause of death after stroke In Indonesia, current data on cardiac arrest in the ICU, especially those related to CHF, are still limited. This study aimed to determine the relationship between congestive heart failure and cardiac arrest in Intensive Care Unit (ICU) inpatients. The study used an analytic observational method with a cross-sectional research design. To find the relationship between the two variables, a regression test was performed on subjects with congestive heart failure and cardiac arrest in the ICU. Data was collected from 316 subjects, including 111 Congestive Heart Failure (CHF) subjects and 205 without CHF. Of the 111 CHF subjects, 51 subjects (45.9%) experienced cardiac arrest, and 60 subjects (54.1%) did not experience cardiac arrest. In comparison, the 205 subjects without CHF comprised 125 subjects (61.0%) who experienced cardiac arrest, and 80 subjects (39.0%) did not experience cardiac arrest. There is a relationship between congestive heart failure (CHF) and cardiac arrest, but CHF is not the only risk factor for cardiac arrest (p&lt;0.05; OR 0.75). Congestive heart failure is associated with cardiac arrest in ICU patients with a relative risk of 0.75 times compared to subjects without congestive heart failure. Future research is needed to find the cause of congestive heart failure leading to cardiac arrest.

Progress on the Impact of Climate Change on Cardiac Arrest

Climate change is a global public health problem. With the improvement of the industrialization level of various countries, the problem is becoming more and more serious. The mortality and disability rates of cardiac arrest are very high. Climate change affects the occurrence of cardiac arrest, and extreme weather such as high temperature are the risk factors for cardiac arrest. Previous studies have explored the effects of climate change and cardiac arrest, however the study design and exposure assessment of these studies differ, and the outcome associations are inconsistent. This paper aims to review the relationship between climate change and the onset of cardiac arrest and provide a theoretical basis for the prevention and treatment of cardiac arrest.

Epidemiologic investigation of cardiac arrest and current research status on its risk factors analysis

Cardiac arrest most commonly occurs outside of the hospital, known as out-of-hospital cardiac arrest (OHCA), and is an important global health problem. Approximately 40% of cardiac arrest has no clear cause. Hereditary arrhythmias and cardiomyopathies factors contribute to cardiac arrest. The identification of genetic factors for cardiac arrest after its occurrence is of great value not only for the individual, but also for relatives who may be at risk for the disease in their family. In the United States, there are over 350 000 cases of OHCA and over 200 000 cases of in-hospital cardiac arrest (IHCA) each year, and in Western Europe, cardiac arrest accounts for 15%-20% of all adult natural deaths and 50% of all cardiovascular deaths. In order to reduce the burden caused by cardiac arrest within society, it is essential to further understand its etiological factors, such as incidence in different regions, risk factors, and populations at higher risk. For each individual, cardiac arrest is the result of a complex interaction of genetic and acquired factors. Understanding the complex interplay of pathogenic factors in cardiac arrest and the development of individualized prevention and treatment approaches requires the collection of clinical data from cardiac arrest populations and multimodal analysis in order to identify epidemiological features and risk factors for cardiac arrest. Recently, cardiac arrest-related data are being collected and integrated in Europe in different regions and populations. As a result of the commitment to the creation of large datasets of clinical information on cardiac arrest populations, the knowledge of the pathology of cardiac arrest pathogenesis as well as risk factors is steadily increasing. This article reviews the epidemiologic data of cardiac arrest in recent years and the associated risk factors, thus providing ideas for developing better strategies for the prevention and treatment of cardiac arrest.

Understanding the Risk Factors for Cardiac Arrest in Young Adults: A Systematic Review

Introduction: Cardiac arrest, once largely associated with older individuals, is increasingly affecting young adults, necessitating a deeper understanding of its risk factors in this demographic. Aim: To identify and analyse relevant literature to uncover the risk factors contributing to cardiac arrest among young adults. Materials and Methods: A comprehensive search of databases using specific keywords related to cardiac arrest, risk factors, and young adults was conducted. Out of 573 studies initially identified, 245 duplicates were removed, and 328 were screened based on eligibility criteria. After further assessment, 123 records were rejected, leaving 205 full-text papers for review. Ultimately, eight studies were included in the qualitative analysis. Results: The review highlighted modifiable lifestyle factors, cardiovascular conditions, genetic predisposition and environmental influences as significant contributors to cardiac arrest risk in young adults. Specifically, obesity, smoking, physical inactivity, and substance abuse emerged as prominent modifiable risk factors. Predisposing factors such as inherited cardiac conditions, structural heart abnormalities, and acquired cardiac disorders were also identified. Environmental factors, including air pollution and socioeconomic status, were found to play a role in shaping the risk profile of young adults. Conclusion: The review concludes by emphasising the importance of addressing modifiable risk factors and promoting cardiovascular health awareness to mitigate the incidence of cardiac arrest in young adults. By addressing these factors, healthcare providers can work towards reducing the burden of cardiac arrest and improving outcomes in this vulnerable population. The present systematic review provides valuable insights into the risk factors contributing to cardiac arrest in young adults and lays a foundation for evidence-based preventive measures.

Predictors and outcomes of perioperative cardiac arrest in children undergoing noncardiac surgery

BackgroundPerioperative cardiac arrest continues to occur. This study aims to identify risk factors for perioperative cardiac arrest in children presenting for noncardiac surgery and characterise its outcomes. MethodsUsing the National Surgical Quality Improvement Program (NSQIP) Pediatric Database 2019 and 2020, 261 276 patients were included. Patients ≥18 yr and cardiac surgical procedures were excluded. Exploratory multivariable analysis was performed to identify independent predictors of perioperative cardiac arrest and associated outcomes. ResultsThe overall rate of cardiac arrest was 0.1%, with an intraoperative rate of 0.05% and 48-h postoperative rate of 0.06%. Significant risk factors for perioperative cardiac arrest included age <12 months (adjusted odds ratios [aOR] 3.07, P<0.001), American Society of Anesthesiology Physical Status classification (ASA-PS 3 aOR=2.57, P<0.001; ASA-PS 4 aOR=5.27, P<0.001; ASA-PS 5 aOR=13.1, P<0.001), admission through the emergency room (aOR 1.7, P=0.003), inpatient (aOR 2.19, P=0.008), major and severe cardiac disease (aOR 1.58, P=0.008), impaired cognitive status (aOR 1.54, P=0.009), and longer anaesthesia duration (aOR 1.1 per 30 min, P<0.001). Perioperative cardiac arrest was significantly associated with longer hospital length of stay, reoperation, differences in discharge destination, and 30-day mortality. In addition, patients experiencing postoperative cardiac arrest had a significantly higher rate of in-hospital and 30-day mortality than those experiencing intraoperative cardiac arrest. ConclusionsThe incidence of cardiac arrest in this study is higher than previously reported. This may be related to selection bias and the rigorous data collection required by NSQIP. Lower 30-day mortality after intraoperative cardiac arrest could be related to prompt recognition and rapid initiation of intraoperative resuscitation. Identification of perioperative risk factors for cardiac arrest is crucial to improve the safety and quality of patient care.

TCT-51 Risk Factors of Cardiac Arrest During a Percutaneous Coronary Intervention Performed With Rotational Atherectomy

TCT-51 Risk Factors of Cardiac Arrest During a Percutaneous Coronary Intervention Performed With Rotational Atherectomy

Cardiac arrest and cardiopulmonary resuscitation in pediatric patients with cardiac disease: a narrative review.

Children with cardiac disease are at a higher risk of cardiac arrest as compared to healthy children. Delivering adequate cardiopulmonary resuscitation (CPR) can be challenging due to anatomic characteristics, risk profiles, and physiologies. We aimed to review the physiological aspects of resuscitation in different cardiac physiologies, summarize the current recommendations, provide un update of current literature, and highlight knowledge gaps to guide research efforts. We specifically reviewed current knowledge on resuscitation strategies for high-risk categories of patients including patients with single-ventricle physiology, right-sided lesions, right ventricle restrictive physiology, left-sided lesions, myocarditis, cardiomyopathy, pulmonary arterial hypertension, and arrhythmias. Cardiac arrest occurs in about 1% of hospitalized children with cardiac disease, and in 5% of those admitted to an intensive care unit. Mortality after cardiac arrest in this population remains high, ranging from 30 to 65%. The neurologic outcome varies widely among studies, with a favorable neurologic outcome at discharge observed in 64%-95% of the survivors. Risk factors for cardiac arrest and associated mortality include younger age, lower weight, prematurity, genetic syndrome, single-ventricle physiology, arrhythmias, pulmonary arterial hypertension, comorbidities, mechanical ventilation preceding cardiac arrest, surgical complexity, higher vasoactive-inotropic score, and factors related to resources and institutional characteristics. Recent data suggest that Extracorporeal membrane oxygenation CPR (ECPR) may be a valid strategy in centers with expertise. Overall, knowledge on resuscitation strategies based on physiology remains limited, with a crucial need for further research in this field. Collaborative and interprofessional studies are highly needed to improve care and outcomes for this high-risk population. What is Known: • Children with cardiac disease are at high risk of cardiac arrest, and cardiopulmonary resuscitation may be challenging due to unique characteristics and different physiologies. • Mortality after cardiac arrest remains high and neurologic outcomes suboptimal. What is New: • We reviewed the unique resuscitation challenges, current knowledge, and recommendations for different cardiac physiologies. • We highlighted knowledge gaps to guide research efforts aimed to improve care and outcomes in this high-risk population.

Looking to the Past to Improve the Future: A Narrative Review of Lessons Learned from Inpatient Cardiac Arrest Care During the COVID-19 Pandemic

Background: Inpatient cardiac arrest care had to be adapted to meet the needs of patients and providers during the COVID-19 pandemic. Providers working in the emergency department and in the inpatient setting have acquired extensive experience and expertise in caring for patients with COVID-19 related cardiac arrest. We summarize recent reports relevant to clinicians on inpatient cardiac arrest care, provider and patient safety, and effective use of resources. Methods: We performed literature searches of the PubMed database on inpatient cardiac arrest, COVID-19, healthcare-associated coronavirus transmission, and others. The authors’ collections of lived experience as inpatient care providers and clinically useful materials gathered during the pandemic were included. Results: We summarize current knowledge about cardiac arrest in COVID-19 relevant to hospitalist practice, describe lessons learned to date, and provide practical guidance for addressing cardiopulmonary resuscitation for patients with COVID-19. We discuss literature on risk factors for cardiac arrest in patients with COVID-19; risk of infection for rescuers performing resuscitation in patients with COVID-19 and mitigation strategies; goals of care during cardiac arrest in a patient with COVID-19; reducing the risk of exposure to rescuers (including pre–cardiac arrest care); reducing cross-contamination during cardiac arrest in patients with COVID-19; prioritizing oxygenation and ventilation strategies with lower aerosolization risk; maximizing resources during cardiac arrest in patients with COVID-19; and post–cardiac arrest care. Conclusions: Advances made in the care of inpatient cardiac arrest patients during the COVID-19 include domains of patient risk stratification, provider safety, advance directives, and others. Lessons in the management of inpatient cardiac arrest learned during this pandemic are likely to applicable to future pandemics.

Aspirin is used to mitigate the increasing frequency of marathon-related cardiac arrests

Male gender and the marathon were shown to be independent and significant risk factors for cardiac arrest in United States road races in a 10-year registry beginning in 2000, during which events increased in frequency during the latter half of the study [1].

Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study

BackgroundSudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization.MethodsWe retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients’ demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders.ResultsA total of 920 patients with STEMI and coronary angiography–documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients’ demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI.ConclusionsLeft main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.

Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients.

We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery. We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported. In a secondary analysis, we assessed the association between preincision cardiac arrest and major postoperative outcomes. In a tertiary analysis, we used adjusted linear regression models to explore the association between preincision cardiac arrest and prespecified patient risk factors, including severe left main coronary artery stenosis, left ventricular ejection fraction, moderate/severe right ventricular dysfunction, low-flow low-gradient aortic stenosis, and moderate/severe pulmonary hypertension. Preincision cardiac arrests occurred in 75 of 41,238 (incidence of 0.18%; 95% CI, 0.17-0.26) patients who had elective or urgent cardiac surgery. Successful cardiopulmonary resuscitation with return of spontaneous circulation or bridge to cardiopulmonary bypass occurred in 74 of 75 (98.6%) patients. Patients who experienced preincision cardiac arrest had significantly higher in-hospital mortality than those who did not (11% vs 2%; odds ratio [OR] (95% CI), 4.14 (1.94-8.84); P < .001). They were also more likely to suffer postoperative respiratory failure (46% vs 13%; OR [95% CI], 3.94 [2.40-6.47]; P < .001), requirement for renal replacement therapy (11% vs 2%; OR [95% CI], 3.90 [1.82-8.35]; P < .001), neurologic deficit (7% vs 2%; OR [95% CI], 2.49 (1.00-6.21); P = .05), and longer median hospital stay (15 vs 8 days; hazard ratio (HR) [95% CI], 0.68 [0.55-0.85]; P < .001). Reduced left ventricular ejection fraction (per 5% decrease) (OR [95% CI], 1.13 [1.03-1.22]; P = .006) and moderate/severe pulmonary hypertension (OR [95% CI], 3.40 [1.95-5.90]; P < .001) were identified as independent risk factors for cardiac arrest. Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.

Abstract 229: Burden And Predictors Of Sepsis-associated Cardiac Arrest: A National Inpatient Sample Analysis, 2018

Background: Sepsis-induced myocardial dysfunction with the resultant cardiomyopathy carries a high risk of mortality. We aimed to study the risk factors of cardiac arrest (CA) in Sepsis-related hospitalizations (SRH). Methods: We identified SRHs using the National Inpatient Sample (2018) and ICD10 codes to categorized them into with vs without CA. We then compared baseline characteristics and performed multivariate analysis adjusting for confounders to identify predictors of sepsis-associated CA. Results: Of SRH (1,345,595) in 2018, 0.8% (11,365) had a CA (Table1) . SRH with CA often had elderly (median age 70 vs 66 years), males (55.3% vs 48.8%), blacks (19.6% vs 13.3%), Hispanics (12.3 vs 11.7%), Medicare enrollees (69.9 vs 59.1%), and had patients from lower-income households (LIH, 36.9% vs 30.7%) than non-CA cohort. Statistically significant predictors for CA in SRH were age (5% increased risk every 5 years), male sex (aOR 1.28, 95CI 1.16-1.4), black (aOR 1.49, 95CI 1.3-1.7) &amp; Hispanic (aOR 1.26, 95CI 1.09-1.45) race, LIH (aOR 1.31, 95CI 1.13-1.52), CHF (aOR 2.4, 95CI 2.16-2.68), pulmonary circulation disorder (aOR 2.14, 95CI 1.72-2.66), prior cardiac arrest (aOR 1.95, 95CI 1.16-3.27), coagulopathy (aOR 1.69, 95CI 1.5-1.9), alcohol abuse (aOR 1.42 95CI 1.17-1.74), PVD (aOR 1.36, 95CI 1.17-1.58), CKD (aOR 1.26, 95CI 1.14-1.39), cancer without metastasis (aOR 1.49, 95CI 1.24-1.8) and with metastasis (aOR 1.24, 95CI 1.01-1.52). Urban non-teaching vs rural (aOR 1.32, 95CI 1.1-1.57) and Southern vs Northeast hospitals (aOR 1.26, 95CI 1.09-1.46) showed higher odds of CA. Conclusion: SRH associated CA had high mortality with prevalent demographic and regional disparities, evident from black and Hispanic, males, patients from LHI and Southern hospitals revealing a higher risk of sepsis-associated CA. Congestive heart failure, pulmonary disease, prior cardiac arrest, coagulopathy, alcohol abuse, PVD, CKD, and cancers were the strongest predictors of CA in SRH.

Risk factors of cardiac arrest and failure to achieve return of spontaneous circulation during anesthesia: a 20-year retrospective observational study from a tertiary care university hospital.

There is still a lack of robust data on the epidemiology of cardiac arrest during anesthesia. We investigated the frequency and risk factors of cardiac arrest during anesthesia over the past two decades at a tertiary care university hospital in Japan. We retrospectively analyzed 111,851 anesthesia records of patients who underwent surgery under anesthesia between 2000 and 2019. Cardiac arrest cases were classified according to the patient's background, surgical status, main cause and initial rhythm of cardiac arrest, and the presence of the return of spontaneous circulation (ROSC). Univariate and multivariate logistic regression analyses were used to identify the risk factors of cardiac arrest and failure to achieve ROSC. Ninety cardiac arrest cases during anesthesia were identified. The incidence of cardiac arrest was 8.05 per 10,000 anesthetics (95% CI, 6.54-9.90). There were 6 anesthesia-related cardiac arrests and 9 anesthesia-contributory cardiac arrests. The most common cause of cardiac arrest was blood loss. American Society of Anesthesiologists physical status 4-5, emergency surgery, and cardiovascular surgery were identified as independent risk factors of cardiac arrest. American Society of Anesthesiologists physical status 4-5, blood loss-induced cardiac arrest, and non-shockable rhythm were independently associated with failure to achieve ROSC. Blood loss was the most common cause of cardiac arrest and blood loss-induced cardiac arrest was independently associated with failure to achieve ROSC. Further improvements in treatment strategies for bleeding may reduce the future incidence of cardiac arrest and death during anesthesia.

Human Immunodeficiency Virus Infection and Out-of-Hospital Cardiac Arrest

Patients with human immunodeficiency virus (HIV) infection are at increased risk of cardiovascular disease, but studies on HIV as a risk factor for cardiac arrest in the general population are lacking. We aimed to examine the association of HIV infection with out-of-hospital cardiac arrests (OHCAs). We used the Office of Statewide Health Planning and Development data to evaluate HIV infection as a predictor of OHCA in all California emergency department encounters from 2005 to 2015, adjusting for age, gender, race, income, obesity, smoking, alcohol, substance abuse, hypertension (HTN), diabetes, coronary artery disease, congestive heart failure (CHF), atrial fibrillation, and chronic kidney disease (CKD). We also determined patient characteristics modifying these associations by including interaction terms in multivariable-adjusted models. In 18,542,761 patients (mean age 47±20years, 53% women, 43,849 with HIV) followed for a median 6.8years, 133,983 new OHCA events occurred. Incidence rates in patients with HIV were higher than in patients without HIV (1.99 vs 1.16 OHCA events per 1,000-person-years follow-up). After multivariable adjustment, HIV was associated with a 2.5-fold higher risk of OHCA (hazard ratio 2.47, 95% confidence interval 2.29 to 2.66, p<0.001). The risk of OHCA with HIV was disproportionately stronger in younger patients, women, and in those with HTN, CHF, and CKD. In this large prospective study, HIV was associated with a 2.5-fold increased risk of OHCA, with a greater vulnerability to this outcome in patients with HIV who were female or had HTN, CHF, or CKD.

Retrospective study of perioperative cardiac arrest from a Chinese tertiary hospital.

Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) – 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.

515. Risk Factors for Death, Intubation and Cardiac Arrest among COVID-19 Patients Hospitalized in Eastern North Carolina

BackgroundAlthough majority of coronavirus disease 2019 (COVID-19) cases demonstrate mild to asymptomatic disease, COVID-19 can cause serious complications and death. However, risk factors for development of such complications are not well understood. The purpose of this study was to identify risk factors for intubation, cardiac arrest, and death in COVID-19 patients.MethodsA retrospective chart review of COVID-19 subjects was conducted of the first 185 patients for whom we had complete data sets. Subjects were adult inpatients with a confirmed COVID-19 diagnosis who were hospitalized between March and May 2020 at Vidant Medical Center in Greenville, NC. Data including demographics, comorbidities, laboratory results, treatments, and outcomes were collected. Data were analyzed using logistic regression models and receiver operating characteristic curves in SAS 9.4.ResultsOf the first 185 subjects hospitalized for COVID-19, 26% of patients were intubated, 9% experienced cardiac arrest, and 17% died. Subjects who required intubation were more likely to exhibit elevated triglycerides, sepsis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), elevated troponin levels, altered mental status, leukocytosis, lymphopenia and elevated ferritin (P< 0.05) (Table 1). Troponin elevation, ARDS, AKI and thrombocytopenia were risks for cardiac arrest (P< 0.05) (Table 2). Risk of death was increased in those presenting with advanced age, critical or severe disease, lymphopenia or thrombocytopenia, and in those with history of coronary artery disease (CAD) (P< 0.05) (Table 3). Patients presenting with AKI, elevated Troponin, ARDS, pressor requirements, critical disease, and sepsis were at increased risk of intubation, cardiac arrest, and death (P< 0.05) (Tables 1–3).Table 1: Top non-ICU related risk factors for intubation ordered by AUC. Table 2: Top risk factors for cardiac arrest ordered by AUC. Table 3: Top risk factors for death ordered by AUC. ConclusionIn this rapidly evolving pandemic, clinician awareness of risk factors for clinically significant outcomes such as intubation and mortality is essential. Assessment of risk factors like those highlighted in this study can aid in clinical decision-making and predicting patient outcomes. As more data becomes available we aim to develop a validated scoring system to assist clinicians in patient care.Disclosures Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator)

Rescue-Thrombolysis in Cardiac Arrest: The ‘Provider’ of Last Resort

Cardiac arrest is the leading cause of death globally, and heart disease is known to be a major risk factor for cardiac arrest. In practice, an arrest is presumed to be of cardiac origin unless it is known or likely due to non-cardiac causes. The prognosis of the patient following cardiac arrest is generally poor. Although thrombolytic therapy is well known to be the treatment for myocardial thrombosis, it is not routinely recommended in cardiac arrest due to its potential bleeding adverse effect. We described a case report of successful thrombolytic therapy in cardiac arrest patient&#x0D; Bangladesh Journal of Medical Science Vol.19(2) 2020 p.319-321

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Emergent endotracheal intubation associated cardiac arrest, risks, and emergency implications.

Emergent endotracheal intubation (ETI)-related cardiac arrest (CA) is a life-threatening complication that is poorly documented. Definitions and risk factors for CA during or directly after emergent ETI have not been clearly established and may represent modifiable means of improving patient outcomes. We conducted a review of the literature to assess the incidence and risk factors associated with ETI-related CA in the Emergency Department (ED) as well as in the inpatient setting outside of the operating room. Retrospective studies demonstrated that ETI-related CA incidence was between 1.7% and 23% in both the ED and the inpatient setting. Pre-intubation hypoxemia, hypotension, Shock Index (SI), Body Mass Index, and age were most associated with CA. Medications used for induction and number of attempts were identified as risk factors. Definitions of ETI-related CA also varied considerably ranging from within 5min to within 60min of intubation; however, the majority of ETI-related CA cases occurred within 10min. Hemodynamic factors such as SI, hypotension, and hypoxemia were associated with increased rates of CA. ETI-related CA may represent a potentially modifiable complication that can improve patient outcomes in critically ill patients presenting in the ED.