Sudden Cardiac Arrest Victims Research Articles

Knowledge, Attitude and Practice Regarding Cardiopulmonary Resuscitation among Nurses in Selected Hospitals of Bharatpur, Nepal

Background: Cardiac arrest is a significant public health problem projected to account for 15–20% of all deaths. It is also recorded by WHO to be an important cause of cardiovascular morbidity and mortality in both developed and developing countries. Cardiopulmonary resuscitation is a lifesaving medical procedure for victims of sudden cardiac arrest. The objective of the study is to assess the knowledge, attitude and practice regarding cardiopulmonary resuscitation among nurses in selected hospitals of Bharatpur, Nepal.Methods: A cross-sectional analytical study design was employed. A convenience sampling method was used to select the study areas as well as for data collection in selected hospitals of Bharatpur. A self-administered questionnaire and Likert scale was used to obtain data. Data obtained were summarized as frequencies, percentages, mean, standard deviation and associations were then tested using Likelihood, Fisher exact and Pearson’s chi-square test, at 5% Significance. Results: Total 216 nurses participated in the study, the result of the study indicated that majority of nurses in selected hospitals had poor knowledge (52.3%), with majority of positive attitude 52.3%. Out of 216 subjects, 27.8% had taken part in in-service education/ training while only 98(45.4%) nurses had performed CPR and has good practice 64.3%. Conclusions: The study result shows that the nurses still had inadequate level of knowledge, attitude and practice. In these facilities need further training and periodic workshop on cardiopulmonary resuscitation to help nurses improve upon quality of care given to cardiac arrest patients.

Current status of cardiopulmonary resuscitation training and automatic external defibrillator availability in high schools in Halifax, Nova Scotia, Canada.

School-based cardiopulmonary resuscitation (CPR) training and early use of an automated external defibrillator (AED) have proven to increase the survival of victims of sudden cardiac arrest (SCA). This study aimed to determine the status of CPR training, availability of AEDs, and medical emergency response programs (MERPs) in high schools in Halifax Regional Municipality. High school principals were asked to participate in a voluntary online survey comprising questions about demographics, AEDs availability, CPR training for staff and students, the existence of MERPs, and perceived barriers. Three autogenerated reminders followed the initial invitation. Out of 51 schools, 21 (41%) responded, only 10% (2/21) and 33% (7/21) reported providing CPR training to students and staff, respectively. About 35% (7/20) of the schools reported having AEDs, but only 10% (2/20) have MERPs for SCA. All respondents reported in favor of AED availability in schools. The reported barriers to CPR training included limited financial resources (54%), perception of low priority (23%), and time constraints (23%). Respondents reported limited financial resources (85%) and the lack of trained staff to use (30%) as the main reasons for the unavailability of AEDs. This survey showed that all respondents overwhelmingly favour having access to AEDs. However, the availability of CPR and AED training for staff and students in schools remains inadequate. Emergency action plans have not been devised, and few schools have AED devices. More education and awareness are needed to ensure lifesaving equipment and practices in all Halifax Regional Municipality schools.

A Hybrid GAN-Based DL Approach for the Automatic Detection of Shockable Rhythms in AED for Solving Imbalanced Data Problems

Sudden cardiac arrest (SCA) is one of the global health issues causing high mortality. Hence, timely and agile detection of such arrests and immediate defibrillation support to SCA victims is of the utmost importance. An automated external defibrillator (AED) is a medical device used to treat patients suffering from SCA by delivering an electric shock. An AED implements the machine learning (ML)- or deep learning (DL)-based approach to detect whether the patient needs an electric shock and then automates the shock if needed. However, the effectiveness of these models has relied on the availability of well-balanced data in class distribution. Due to privacy concerns, collecting sufficient data is more challenging in the medical domain. Generative adversarial networks (GAN) have been successfully used to create synthetic data and are far better than standard oversampling techniques in maintaining the original data’s probability distribution. We, therefore, proposed a GAN-based DL approach, external classifier–Wasserstein conditional generative adversarial network (EC–WCGAN), to detect the shockable rhythms in an AED on an imbalanced ECG dataset. Our experiments demonstrate that the classifier trained with real and generated data via the EC–WCGAN significantly improves the performance metrics on the imbalanced dataset. Additionally, the WCGAN for generating synthetic data outperformed the standard oversampling technique, such as adaptive synthetic (ADASYN). In addition, our model achieved a high sensitivity, specificity, and F1-score (more than 99%) and a low balanced error rate (0.005) on the balanced 4-s segmented public Holter databases, meeting the American Health Association criteria for AEDs.

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium.

Latest in Resuscitation Research: Highlights From the 2021 American Heart Association's Resuscitation Science Symposium.

Lack of early etiologic investigations in young sudden cardiac death

BackgroundSince majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. MethodsIn this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. ResultsFrom May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P < 0.001), computed tomography scan (24.7 vs. 46.8%, P < 0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P < 0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P = 0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. ConclusionsMore than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.

Untargeted toxicology in sudden cardiac arrest victims

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme to J.T.-H under acronym ESCAPE-NET Background Sudden cardiac arrest (SCA) is a major public health challenge and is associated with poor outcomes. Many drugs are known to increase risk of arrythmias and ultimately sudden cardiac death. To our knowledge an untargeted toxicological analysis has not previously been performed in an initially resuscitated SCA cohort. Purpose We aimed to determine the qualitative and quantitative drug composition present in SCA patients by using forensic toxicological analytical chemistry of all illicit, non-prescription and prescribed drugs, and further investigate whether these drugs are in therapeutic levels or overdosed and to correlate the clinical findings with the toxicology results. Methods We performed a prospective single-tertiary-center study and included all SCA victims (aged 18-90 years) admitted to our cardiac intensive care unit, between February 2019 to November 2019 (Figure 1). Traumatic and overt overdose related SCA were not included in the study. Drugs used during resuscitation and administered prior to sample collection were identified in each patient and excluded. Results We prospectively identified 85 all-cause SCA patients with a median age of 60 years (IQR: 53-71) and male predominance (80%). The majority had a shockable rhythm as first rhythm (95%). The major cause of cardiac arrest was acute and chronic ischemia (56/77, 66%), followed by cardiomyopathy (9/77, 12%), idiopathic ventricular fibrillation (8/77, 10%), bradycardia (2/77, 2.6%), primary arrhythmia (1/77, 1.3%), other (1/77, 1.3%). The remaining 8 patients (9.4%) died prior to diagnosis. A positive toxicology was identified in 67 patients (79%) with a total of 218 detected drugs. The most frequent drugs were mild analgesics (32/85, 38%), beta-blockers (21/85, 25%) and ACE-inhibitors/ARB (20/85, 24%). A total of 9 (11%) patients had one or more potentially abusable drugs detected, with the most common being opioid agonists in 5 patients (Figure 2). Importantly, all drugs were found at sub-therapeutic or therapeutic concentrations. None had overdose concentrations. Moreover, polypharmacy was common and a median of 2 drugs (IQR: 1-4) were detected (excluding caffeine that was detected in 83 patients). Conclusion We found that the majority had drugs detected, and polypharmacy is displayed in a considerable proportion. Potentially abusive drugs were encountered in 11%. However, we did not identify any occult overdose related cardiac arrests among all resuscitated SCA patients. In our setting, toxicological screening in cardiac arrest patients who is not obviously overdosed is excessive.

Cardiopulmonary Resuscitation and Defibrillator Use in Sports.

Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival. This review aims to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.

Multi-centre implementation of an Educational program to improve the Cardiac Arrest diagnostic accuracy of ambulance Telecommunicators and survival outcomes for sudden cardiac arrest victims: the EduCATe study design and methodology

BackgroundSudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15–25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9–1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses.We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival.MethodsIn this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9–1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation.DiscussionThe ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more.Trial registrationProspectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059.

Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project

IntroductionEarly recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since...

Abstract 250: Effect of Coaching on Dispatch-assisted Cardiopulmonary Resuscitation: A Randomized Simulation Study

Introduction: Immediate bystander cardiopulmonary resuscitation (CPR) is essential for the good outcome of sudden cardiac arrest victims. Current guidelines recommend dispatch-assisted CPR (DACPR). Its quality, however, varies from case to case. The aim of this study was todetermine the effectiveness of dispatch coaching on the quality of CPR by lay rescuers. Methods: We conducted a DACPR simulation study. Participants with no prior CPR training within 1 year were assigned randomly to one of two DACPR simulations (No Coaching Group: callers were told to perform CPR and the dispatcher sometimes confirmed if the caller was performing CPR or Coaching Group: the dispatcher coached, encouraged, and counted out loud with a metronome). The study participants performed CPR for 2 minutes under the study dispatcher. All performances were recorded by video camera and Resusci Anne® QCPR (Laerdal, Norway). Results: Forty-nine participants aged 20s to 50s were recruited, and 48 completed the simulation (Coaching Group, 27, 9 males and No Coaching Group, 21, 16 males). The average rate of chest compressions was 102.5/min in Coaching Group and 109.3/min in No Coaching group (p=0.270). The average compression depth was slightly deeper in Coaching group (43.0mm vs 41.5mm, p=0.695). When compared the average depth of the first 10 compressions to the total average in each group, the depth significantly improved in Coaching group while that decreased in No Coaching Groups (38.4mm to 43.0mm; p=0.020, 42.3mm to 41.5mm; p=0.431, respectively). The chest compression fraction was also high in Coaching Group (99.4% vs 93.0%, p=0.005). Conclusions: Participants in Coaching Group performed better CPR compared to No Coaching Group in terms of high flow fraction. Although the average compression depth was below the guideline recommendation in both groups, it significantly improved in Coaching group. This study indicates that dispatch coaching can optimize the performance of bystander CPR.

Current behavior of sudden cardiac arrest and sudden death.

Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.

ORION Space for the combat of COVID-19

This report discusses on background of the organization and the work it has been doing to fight against the COVID -19. Due to sudden outbreak of COVID-19, individuals and organizations from the diverse fields fromaround the world are working together to fight against the disease. ORION Space is an organization established to promote space technology in Nepal. Due to the sudden outbreak, ORION Space has also proposed an idea to develop an Automatic Cardiopulmonary Resuscitation (CPR) machine to provide some innovative solution to fight against current outbreak. CPR is a machine which can be used as an emergency procedure when the heart stops beating. CPR is the first step in treating victims of sudden cardiac arrest.

Left main coronary anomalies of the right ventricular sinus in patients with aortic failure due to the web sub-aortic: A case report

Coronary artery anomalies are reported to have a higher incidence in young victims of sudden cardiac arrest (4-15%), as compared to adults (1%). Among coronary anomalies, anomalous coronary artery arising from the opposite sinus of Valsalva (ACAOS) remains a major clinical problem which poses daunting challenges. The current paper reports on the first case with main left coronary anomalies with aortic failure due to the web sub-aortic. A 29-year-old woman with orthopnea referred to a doctor. Echocardiography and electrocardiogram (ECG) confirmed sub aortic web with severe aortic insufficiency. Subsequently, the patient was subjected to aortic valve replacement surgery and the subvalvular resection was performed. During the surgery, the aorta was initially opened and the left coronary hole was not found in the coronary sinus. Therefore, only a cardioplegia from the right coronary (artery) hole was administered to the patient. The cusps of the valve and subvalvular web were removed. During the release, the left main artery which apparently originated from the right coronary artery(RCA) was found to be damaged. Therefore, the damaged part of the left main coronary artery was repaired, the valve was placed, and the aorta was repaired. Following deaeration, cross-clamp was removed, and the right heart started to work; nonetheless, the left heart was not engaged in any activity. Therefore, the cross-clump was attached again to the aorta, and a vein graft on the left anterior descending (LAD) artery was placed on the aorta. After the removal of the cross-clamp, the heart recovered its normal function, and the patient was removed from the pump with low inotropic. Thereafter, she was transferred to the Intensive Care Unit (ICU) of open-heart surgery. The present report aimed to express the incidence of multiple complications, such as recurrence of illness, the optimal time for surgery, the best way of surgery, getting cardiologists' attention (colleagues) during angiography, and knowing the characteristics of these abnormalities.

The Impact of Two-Minute Training Sessions on Confidence level for Providing Compression-Only Cardiopulmonary Resuscitation

Teresa Faykus, Faculty Advisor, Nursing, West Liberty University; Taylor Curry, Nursing Student and Austin Raines, Nursing Student, West Liberty University, West Liberty, WV.The Impact of Two-Minute Training Sessions on Confidence Level For Providing Compression- Only Cardiopulmonary Resuscitation Studies have shown that bystander compression-only resuscitation for adult, out-of-hospital cardiac arrest victims improve overall survival rates. Unfortunately, 70% of Americans do not know how to administer resuscitation attempts or are afraid of hurting the victim. Therefore, only 27-41% of sudden cardiac arrest victims receive immediate resuscitation attempts. The research question is: Can simplified performance steps, simplified training, and elimination of mouth-to-mouth contact help bystanders feel more confident in taking the appropriate actions for saving a life? Objectives include training college students, staff, and faculty in chest-compression only resuscitation for an adult sudden cardiac arrest victim; measuring self-reported confidence levels before and after the training by using a Likert scale, and gathering self-reported confidence level factors. Nursing students included staff, faculty, and students to randomly participate. Data was gathered, a two-minute training and a return demonstration was completed, and post confidence levels were recorded. Of the total 134 participants, 85% reported a positive change in confidence levels. Of those, 55% had positive differences in their confidence of 2, 3, or 4 levels. When dissecting the confidence factors, three of the six options stood out as being the most chosen: “I feel that I may hurt someone if I don’t do it correctly”, “I don’t know the steps of CPR”, and “I’m afraid that I would get in trouble or get sued”. By understanding how confident the public is in initiating CPR and what influences these confidence levels, training can be better guided.

Lack of early systematic investigations among young victims of sudden cardiac arrest

Since a large proportion of patients resuscitated from out-of-hospital sudden cardiac arrest (SCA) die in the intensive care unit (ICU), early systematic investigation towards identifying etiology may be crucial to ensure appropriate future prevention among relatives, especially when the index case is young. We hypothesized that etiologic investigations were not initiated in a timely manner in a significant proportion of young SCA patients prior to death. In this prospective ongoing multicenter, population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed with a specific focus on young patients (< 45 year-old) alive at hospital admission and who eventually died in ICU. Investigations and diagnoses arrived at were analyzed from the medical records by two cardiologists for each case. Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3,028 were admitted alive to ICU. Among them, 2,190 (72.3%) died in ICU, including 367 (16.8%) young cases (< 45 y.o.). Among the young patients, while 163 cases (44.4%) had a specific diagnosis established, 204 (55.6%) remained unexplained. Coronary angiograms (18.3%), CT scan (brain and chest) (24.5%), and transthoracic echocardiography (29.1%) were all underutilized. Main SCA causes were acute coronary syndrome (44.5%), followed by structural non-ischemic heart disease (25.5%), pulmonary embolism (13.6%), chronic CAD (10%), non-structural heart disease (1.8%) and miscellaneous (4.6%). The proportion of autopsy (10.9%), as well as blood sample collection for further genetic testing (1.4%) was low. Information on family screening was rarely provided in the ICU. More than half of young SCA cases who died in ICU remained unexplained. Efforts to promote early systematic investigation through better collaboration between intensivist and cardiologist may improve future targeted preventive strategies for family members.

Prevalence and risk factors for post‐traumatic stress disorder in Japanese relatives of out‐of‐hospital cardiac arrest patients after receiving a pamphlet concerning the grieving process

To investigate the prospective frequency of post-traumatic stress disorder (PTSD) among relatives of sudden death patients following provision of a pamphlet explaining the stages of the complicated grief process and self-regulating techniques. From May 2017 to February 2018, we prospectively and consecutively provided a pamphlet to relatives of out-of-hospital sudden cardiac arrest victims who failed to obtain spontaneous circulation. We investigated the psychiatric status of the bereaved relatives using the Impact of Event Scale - Revised (IES-R). An IES-R score over 24 was defined as PTSD. Fifty-four relatives of the 54 dead patients (victims) provided permission of entry to this research. All subjects and victims were Japanese. Among them, 24 subjects had an IES-R score of 0 and 5 (9.3%) had PTSD approximately 1month after their bereavement. There were no relatives who received spontaneous psychiatric treatment. The IES-R scores for non-medical cardiac arrest, death inquests, and parent variables were significantly higher compared with medical cardiac arrest, no inquest, and no parent, respectively. The IES-R scores in those who were a child of the victim were significantly lower than in those who were not. The present study showed that the frequency of PTSD was 9.3% at 1month following bereavement among Japanese relatives of sudden death victims after an intervention. This frequency was minimal compared with previous reports.

260 The First Australian Multi-Source Sudden Cardiac Death Registry: Methodology and Early Findings

In 2019, the first multi-source registry of sudden cardiac arrest and death launched in Victoria, Australia. Sudden cardiac arrest / death (SCA/D) affects approximately one thousand younger Victorians per year. The Unexplained Cardiac Death Project enrols all SCA/D cases aged 1-50 years, whilst also offering family screening and access to psychological support through clinical sites and creating a genetic biorepository for whole-genome sequencing. Out of hospital cardiac arrest (OHCA) patients aged 1-50 years in Victoria, Australia are identified by either the existing Victorian Ambulance Cardiac Arrest Registry or the Victorian Institute of Forensic Medicine. Case adjudication is performed, and patients and first-degree relatives with a cardiac/unascertained cause of arrest referred to a clinical site (Royal Melbourne Hospital, St Vincent’s Hospital Melbourne, the Alfred Hospital or the Royal Children’s Hospital). Family screening is conducted, and the opportunity for index cases to contribute to a genetic biorepository offered (deceased cases have samples collected at post-mortem). To date, 509 OHCA patients aged 1-50 have been included in the registry. Of the cases enrolled, 434 (85%) died as a direct result of their cardiac arrest (377 (87%) deceased at scene). Genetic samples have been collected from 17 patients to commence the genetic biorepository. The launch of Australia’s first multi-source cardiac arrest surveillance registry highlights very high mortality in young and middle-aged OHCA patients. The registry will create a genetic biorepository of sudden cardiac arrest survivors and victims that will establish an ongoing Australian resource.

P2823Lack of early systematic investigations among young victims of sudden cardiac arrest

Abstract Introduction Since a large proportion of patients resuscitated from out-of-hospital sudden cardiac arrest (SCA) die in the intensive care unit (ICU), early systematic investigation towards identifying etiology may be crucial to ensure targeted therapy and appropriate future prevention among relatives, especially when the index case is young. Purpose We hypothesized that etiologic investigations were not initiated in a timely manner in a significant proportion of young SCA patients, alive at ICU admission, prior to death. Methods In this prospective, ongoing, multicenter, population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed, in collaboration with all the 48 hospitals of the area, with a specific focus on young patients (&lt;45 year-old) alive at hospital admission and who eventually died prior to ICU discharge. Investigations performed and diagnoses arrived at were analyzed from the medical records by two cardiologists for each case. Results Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3,028 were admitted alive to ICU. Among them, 2,190 (72.3%) died in ICU, including 367 (16.8%) young cases (&lt;45 yo). Among the young patients, while 163 cases (44.4%) had a specific diagnosis established, 204 (55.6%) remained unexplained. Coronary angiograms (18.3%), CT scan (brain and chest) (24.5%), and transthoracic echocardiography (29.1%) were all underutilized. Main established SCA causes were acute coronary syndrome (44.5%), followed by structural non-ischemic heart disease (25.5%), pulmonary embolism (13.6%), chronic CAD (10%), non-structural heart disease (1.8%) and miscellaneous (4.6%). The proportion of systematic autopsy (10.9%), as well as blood sample collection for further genetic testing (1.4%) was low. Information on family screening was rarely provided in the ICU. Conclusion More than half of young SCA cases who died in ICU remained unexplained. There was significant underuse of core cardiac investigations. Efforts to promote prompt and systematic investigation through better collaboration between intensivist and cardiologist may improve both acute management and future targeted preventive strategies for family members.

P5646Risk factor paradox in STEMI-related sudden cardiac arrest

Abstract Background Cardiovascular risk factors (CVRF) are associated with an increased risk of atherosclerosis and ST-segment elevation myocardial infarction (STEMI). Sudden cardiac arrest (SCA) is currently the most feared complication of STEMI. The impact of CVRF on the rate of SCA is still unknown. Purpose To assess the association between CVRF and pre-hospital SCA during acute STEMI. Methods Data were taken between 2006 and 2014 from the e-MUST study that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Characteristics of patients who presented SCA were compared to those of patients who did not, and multivariable logistic regression was developed including all variables that differed between the two groups, in order to identify characteristics associated with an increased risk of SCA. Results Over the study period, 13,253 STEMI patients were included (median age 60.1 [51.4 - 73.0], 78.1% males). Among them, 7,513 patients (58.1%) had ≥2 CVRF, 3,979 (30.8%) had 1 CVRF, and 1,432 (11.1%) did not present any CVRF. Pre-hospital SCA witnessed by emergency medical services occurred in 749 (5.6%) patients. SCA victims were younger compared to the non-SCA group (58.0 vs. 60.3 years (P&lt;0.001), with a higher proportion of patients without known CVRF (17.2 vs. 10.7%, P&lt;0.001). There was no statistical difference in sex ratio (77.5% vs. 78.2%, P=0.69) and presence of past history of coronary artery disease (18.7% vs. 19.5%, P=0.56). Patients with ≥2 CVRF had the lowest rate of SCA (4.6%), while the highest SCA rate occurred among patients without CVRF (8.9%). On multivariate analysis, the presence of ≥2 CVRF was associated with a twice-lower risk of SCA (OR 0.52, 95% CI 0.41–0.65, P&lt;0.001, when the group without risk factors was taken as a reference group). Conclusion The prevalence of CVRF is high among patients presenting STEMI. However, once STEMI has occurred, presence of CVRF is associated with a lower rate of SCA per STEMI, creating a risk factor paradox in STEMI-related SCA.

Effectiveness of Hands-Only Cardiopulmonary Resuscitation Teaching on Lay Bystander Attitudes Toward Future Resuscitation

CONTEXTIt is estimated that there are approximately 1,000 sudden cardiac events occurring daily outside of the hospital setting in the US.OBJECTIVESThe objectives of this pilot project were to determine lay participants’ ability to remember the steps of hands-only cardiopulmonary resuscitation (HOCPR) following a 30-minute instructional session regarding proper technique and their willingness to perform bystander CPR (BCPR) on victims of sudden cardiac arrest outside in the community.SAMPLE AND SETTINGA nine-item survey questionnaire that was created by the authors was first administered to a sample of 75 adults who had volunteered at their institutions’ emergency department. Inclusion criteria included all adults over the age of eighteen years.OUTCOME MEASURESTo gauge whether basic HOCPR training improved bystander preparedness and willingness to provide assistance to a victim of sudden cardiac event.METHODSAfter IRB approval, participants were shown a one-minute video by the American Heart Association (AHA) and provided a 30-minute demonstration of key HOCPR skills on a mannequin. A post-instruction nine-item survey was sent by mail/email or administered by phone at one month after training to assess participants’ retention of HOCPR knowledge and attitude.RESULTSThe initial survey responses showed 75 (100%) were able to recall the basic steps of HOCPR, with 59 (79%) “very likely” to help provide BCPR. Not needing to provide breaths made 57 (76%) of lay participants more willing to assist a person in need. A subgroup of 31 (41%) of the initial 75 participants were lost to follow-up. Out of the 44 (59%) who completed the one-month survey, 44 (100%) of participants remembered the primary HOCPR steps and technique. A subgroup of 32 (73%) one-month respondents indicated that they were more likely to assist victims if rescue breathing was not required, and 11 (25%) had reportedly tried to teach family and friends about HOCPR.CONCLUSIONSThese results indicate that of those involved in the survey, the majority could recall the correct steps and be willing to provide HOCPR. These results could help in shaping community outreach and training programs designed to improve the rate and quality of response to victims of sudden cardiac arrest.