Return Of Spontaneous Circulation Time Research Articles

Parenchymal lung injuries related to standard cardiopulmonary resuscitation

ObjectivesWe analyzed chest computed tomographic scan to evaluate parenchymal lung injury and its clinical significance in patients who received standard cardiopulmonary resuscitation and were resuscitated from cardiac arrest. MethodsWe enrolled nontraumatic out-of-hospital cardiac arrest patients older than 19 years who had been admitted to the emergency department in cardiac arrest and successfully resuscitated after cardiopulmonary resuscitation. Chest computed tomography was obtained immediately after return of spontaneous circulation (ROSC). To allocate the area of lung contusion, we divided both hemithoraces into 3 regions longitudinally, and each part was subdivided into 4 segments except the lower part of the left lung. To stratify the severity of lung contusion, each segment was scored depending on the area of lung contusion. Oxygen index (OI) was measured at the time of ROSC, 24, 48, and 72 hours and 1 week after cardiac arrest. ResultsLung contusion was developed in 37 (41%) patients and median lung contusion score (LCS) was 17 (12-26). Lung contusion was not associated with hospital mortality (P = .924) or length of intensive care unit stay (P = .446). The OI at the time of ROSC was lower in patients with LCS greater than 23 than that in patients with LCS less than or equal to 23 (126 [93-224] vs 278 [202-367]; P = .008); however, the OI at the other timelines was not different between patients with LCS greater than 23 and patients with LCS less than or equal to 23. ConclusionExtensive lung contusion is associated with a lower oxygenation index at the time of ROSC, but did not affect the resuscitation outcome.

Return of spontaneous Circulation Is Not Affected by Different Chest Compression Rates Superimposed with Sustained Inflations during Cardiopulmonary Resuscitation in Newborn Piglets.

ObjectiveRecently, sustained inflations (SI) during chest compression (CC) have been suggested as an alternative to the current approach during neonatal resuscitation. However, the optimal rate of CC during SI has not yet been established. Our aim was to determine whether different CC rates during SI reduce time to return of spontaneous circulation (ROSC) and improve hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia.Intervention and measurementsTerm newborn piglets were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized into three groups: CC superimposed by SI at a rate of 90 CC per minute (SI+CC 90, n = 8), CC superimposed by SI at a rate of 120 CC per minute (SI+CC 120, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation and respiratory parameters were continuously recorded throughout the experiment.Main resultsBoth treatment groups had similar time of ROSC, survival rates, hemodynamic and respiratory parameters during cardiopulmonary resuscitation. The hemodynamic recovery in the subsequent 4h was similar in both groups and was only slightly lower than sham-operated piglets at the end of experiment.ConclusionNewborn piglets resuscitated by SI+CC 120 did not show a significant advantage in ROSC, survival, and hemodynamic recovery as compared to those piglets resuscitated by SI+CC 90.

Abrupt rise of end tidal carbon dioxide level was a specific but non-sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest

ObjectiveTo evaluate the diagnostic accuracy of an abrupt and sustained increase in end-tidal carbon dioxide (ETCO2) to indicate return of spontaneous circulation (ROSC) during resuscitation of patient with out-of-hospital cardiac arrest. DesignCross-sectional study. SettingEmergency department of two regional hospitals. MethodsPatients with age ≥18 years old, suffered non-traumatic out-of-hospital cardiac arrest with active resuscitation and endotracheal intubation performed in emergency department, were included. ETCO2 value was charted throughout resuscitation. Time of ROSC was remarked. ETCO2 levels before and after ROSC were compared. Diagnostic accuracy of ETCO2 rise ≥10mmHg, ETCO2 rise ≥20mmHg, and ETCO2 rise to the level ≥40mmHg were evaluated for indicating ROSC. ResultsETCO2 level immediately after ROSC was higher as compared to the value before return of circulation (median ETCO2 was 32mmHg and 41mmHg respectively, p=0.033). With ETCO2 rise ≥10mmHg, the sensitivity was low (33%, 95% CI 22–47%), while specificity was 97% (95% CI 91–99%). Positive and negative predictive values were 83% (95% CI 62–95%) and 74% (95% CI 66–81%) respectively. The diagnostic accuracy was higher in cardiac arrest with presumed non-cardiac etiology (sensitivity 45%, specificity 100%) as compared to those with cardiac etiology (sensitivity 18%, specificity 97%). ConclusionsThe feature of an abrupt rise of ETCO2 was a specific but non-sensitive marker of ROSC in patient with out-of-hospital cardiac arrest.

Neurological outcome after cardiac arrest: a prospective study of the predictive ability of prognostic biomarkers neuron-specific enolase, glial fibrillary acidic protein, S-100B, and procalcitonin.

Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR). Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period. Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%. In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

Abstract 284: The Relation Between Serum Procalcitonin and Perfusion Parameters After the Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest

<Introduction>Procalcitonin (PCT) has been broadly used as an infectious biomarker. However we often found that the patients without infection showed high level of PCT. In past research, PCT has been reported to be a useful biomarker in predicting neurological outcome after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA). <Hypothesis>Our hypothesis is that the level of PCT in the patients after ROSC following OHCA may relate to time from cardiac arrest and reflect tissue hypoxia. Moreover it may predict outcome. This study was aimed to evaluate relation between the serum level of PCT and perfusion parameters in OHCA patients. <Methods>Twenty sequential patients who admitted to the ICU after ROSC following OHCA were included. Infectious patients, trauma patients and extracorporeal CPR patients were excluded. This study was a retrospective, single-center analysis, conducted in the ICU of the university hospital. We evaluated the maximum PCT level within 48hr after admission, cardio-pulmonary arrest time, serum lactate level at admission, Glasgow outcome scale at 28 day. <Results>Twelve of twenty patients were cardiogenic patients. Average ROSC time from OHCA was 27±17 minutes. The maximum PCT was significantly higher in patients who died in the hospital (2.2±2.6 V.S 15.3±17 ng/mL, p=0.01). We defined Glasgow outcome scale 4-5 as favorable outcomes and eight patients showed favorable outcomes. Serum PCT in patients with favorable outcomes was lower than that of unfavorable outcomes, but there was no statistical significance (1.2±2.5 V.S 9.4±13.5 ng/mL). The maximum PCT significantly correlated with serum lactate at admission (r=0.63, p<0.01), and ROSC time from OHCA (r=0.54, p=0.01). <Conclusions>In conclusion, the maximum PCT after cardiac arrest did not predict neurological outcome. But PCT correlated with degree of tissue hypoxia. The serum PCT may reflect ischemia-reperfusion injury.

367 Post Resuscitative Factors Influencing Survival after In-Hospital Pediatric Cardiac Arrest

Background and AimsIn-hospital pediatric cardiac arrest (CA) achieves high return of spontaneous circulation (ROSC) rates but survival to hospital discharge is low. The aim of this study was to determine...

Optimal Recovery from Cardiac Arrest: Implementation of a Therapeutic Hypothermia Program

Optimal Recovery from Cardiac Arrest: Implementation of a Therapeutic Hypothermia Program

Association between interval between call for ambulance and return of spontaneous circulation and survival in out-of-hospital cardiac arrest

To describe the association between the interval between the call for ambulance and return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest. All patients suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started, included in the Swedish Cardiac Arrest Registry (SCAR) for whom information about the time of calling for an ambulance and the time of ROSC was available. Among 26,192 patients who were included in SCAR and were not witnessed by the ambulance crew, information about the time of call for an ambulance and the time of ROSC was available in 4847 patients (19%). There was a very strong relationship between the interval between call for an ambulance and ROSC and survival to one month. If the interval was less than or equal to 5 min, 47% survived to one month. If the interval exceeded 30 min, only 5% (n = 35) survived to one month. The vast majority of the latter survivors had a shockable rhythm either on admission of the rescue team or at some time during resuscitation. Among patients who have ROSC after an out-of-hospital cardiac arrest, there is a very strong association between the interval between the call for ambulance and ROSC and survival to one month. However, even if this delay is very long (> 30 min after calling for an ambulance), a small percentage will ultimately survive; they are mainly patients who at some time during resuscitation have a shockable rhythm. The overall percentage of patients for whom CPR continued for more than 30 min who are alive one month later can be assumed to be extremely low.