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Prognostication after OHCA

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https://www.readbyqxmd.com/read/27927227/adult-termination-of-resuscitation-tor-criteria-may-not-be-suitable-for-children-a-retrospective-analysis
#1
Victoria Maria Rotering, Sonja Trepels-Kottek, Konrad Heimann, Jörg-Christian Brokmann, Thorsten Orlikowsky, Mark Schoberer
BACKGROUND: Only a small number of patients survive out-of-hospital-cardiac-arrest (OHCA). The duration of CPR varies considerably and transportation of patients under CPR is often unsuccessful. Termination-of-resuscitation (TOR)-criteria aim to preclude futile resuscitation efforts. Our goal was to find out to which extent existing TOR-criteria can be transferred to paediatric OHCA-patients with special regard to their prognostic value. METHODS: We performed a retrospective analysis of an eleven-year single centre patient cohort...
December 7, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27816529/the-influence-of-comorbidity-on-survival-and-long-term-outcomes-after-out-of-hospital-cardiac-arrest
#2
Emily Andrew, Ziad Nehme, Stephen Bernard, Karen Smith
INTRODUCTION: Comorbid conditions have been associated with morbidity, functional status and quality of life for patients with a wide range of diseases. Previous studies have attempted to elucidate the influence of pre-arrest comorbidities on survival and neurological recovery following out-of-hospital cardiac arrest (OHCA), however the findings are conflicting. METHODS: Baseline comorbidities recorded within prehospital patient care records were linked with baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for adult (≥16 years) non-traumatic OHCA patients...
November 2, 2016: Resuscitation
https://www.readbyqxmd.com/read/27810251/conversion-to-shockable-rhythms-during-resuscitation-and-survival-for-out-of-hospital-cardiac-arrest
#3
Win Wah, Khin Lay Wai, Pin Pin Pek, Andrew Fu Wah Ho, Omer Alsakaf, Michael Yih Chong Chia, Julina Md Noor, Kentaro Kajino, Nurun Nisa Amatullah De Souza, Marcus Eng Hock Ong
BACKGROUND: In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA. METHODOLOGY: This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012...
October 25, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27743918/influence-of-body-mass-index-on-the-prognosis-of-patients-successfully-resuscitated-from-out-of-hospital-cardiac-arrest-treated-by-therapeutic-hypothermia
#4
Guillaume Geri, Guillaume Savary, Stéphane Legriel, Florence Dumas, Sybille Merceron, Olivier Varenne, Bernard Livarek, Olivier Richard, Jean-Paul Mira, Jean-Pierre Bedos, Jean-Philippe Empana, Alain Cariou, David Grimaldi
BACKGROUND: Obesity prevalence has dramatically increased over recent years and is associated with cardiovascular diseases, but data are lacking on its prognostic impact in out-of-hospital cardiac arrest (OHCA) patients. METHODS: Data of all consecutive OHCA patients admitted in two cardiac arrest centers from Paris and suburbs between 2005 and 2012 were prospectively collected. Patients treated by therapeutic hypothermia (TH) were included in the analysis. Logistic and Cox regression analyses were used to quantify the association between body mass index (BMI) at hospital admission and day-30 and 1-year mortality respectively...
December 2016: Resuscitation
https://www.readbyqxmd.com/read/27716377/urine-biomarkers-give-early-prediction-of-acute-kidney-injury-and-outcome-after-out-of-hospital-cardiac-arrest
#5
Sigrid Beitland, Bård Endre Waldum-Grevbo, Espen Rostrup Nakstad, Jens-Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Geir Øystein Andersen, Kjetil Sunde
BACKGROUND: Post-resuscitation care after out-of-hospital cardiac arrest (OHCA) is challenging due to the threat of organ failure and difficult prognostication. Our aim was to examine whether urine biomarkers could give an early prediction of acute kidney injury (AKI) and outcome. METHODS: This was a prospective observational study of comatose OHCA patients at Oslo University Hospital Ullevål, Norway. Risk factors were clinical parameters and biomarkers measured in spot urine (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and the product of tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7)) at admission and day 3...
October 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27667713/high-sensitivity-troponin-t-as-a-prognostic-marker-after-out-of-hospital-cardiac-arrest-a-targeted-temperature-management-ttm-trial-substudy
#6
Patrik Gilje, Sasha Koul, Jakob Hartvig Thomsen, Yvan Devaux, Hans Friberg, Michael Kuiper, Janneke Horn, Niklas Nielsen, Tomasso Pellis, Pascal Stammet, Matthew P Wise, Jesper Kjaergaard, Christian Hassager, David Erlinge
AIM OF THE STUDY: Predicting outcome of unconscious patients after successful resuscitation is challenging and better prognostic markers are highly needed. Ischemic heart disease is a common cause of out-of-hospital cardiac arrest (OHCA). Whether or not high-sensitivity troponin T (hs-TnT) is a prognostic marker among survivors of OHCA with both ischemic and non-ischemic aetiologies remains to be determined. We sought to evaluate the ability of hs-TnT to prognosticate all-cause mortality, death due to cardiovascular causes or multi-organ failure and death due to cerebral causes after OHCA...
October 2016: Resuscitation
https://www.readbyqxmd.com/read/27553102/prevalence-and-prognostic-implications-of-bundle-branch-block-in-comatose-survivors-of-out-of-hospital-cardiac-arrest
#7
Johannes Grand, Jakob Hartvig Thomsen, Jesper Kjaergaard, Niklas Nielsen, David Erlinge, Sebastian Wiberg, Michael Wanscher, John Bro-Jeppesen, Christian Hassager
This study reports the prevalence and prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in the admission electrocardiogram (ECG) of comatose survivors of out-of-hospital cardiac arrest (OHCA). The present study is part of the predefined electrocardiographic substudy of the prospective randomized target temperature management trial, which found no benefit of targeting 33°C over 36°C in terms of outcome. Six-hundred eighty-two patients were included in the substudy. An admission ECG, which defined the present study population, was available in 602 patients (88%)...
October 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27422256/immature-total-granulocyte-ratio-improves-early-prediction-of-neurological-outcome-after-out-of-hospital-cardiac-arrest-the-myeloscore-study
#8
Bertrand Sauneuf, Claire Bouffard, Edouard Cornet, Cedric Daubin, Jennifer Brunet, Amélie Seguin, Xavier Valette, Nicolas Chapuis, Damien du Cheyron, Jean-Jacques Parienti, Nicolas Terzi
BACKGROUND: Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA. METHODS: This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012-2014) after successfully resuscitated OHCA...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27278721/prognostic-value-of-gray-matter-to-white-matter-ratio-in-hypoxic-and-non-hypoxic-cardiac-arrest-with-non-cardiac-etiology
#9
Byung Kook Lee, Won Young Kim, Jonghwan Shin, Joo Suk Oh, Jung Hee Wee, Kyoung Chul Cha, Yooseok Park, Jae Hyung Choi, Kyung Woon Jeung
PURPOSE: This study evaluated the prognostic performance of the gray to white matter ratio (GWR) on brain computed tomography (CT) in out-of-hospital cardiac arrest (OHCA) survivors with a noncardiac etiology and compared the prognostic performance of GWR between hypoxic and nonhypoxic etiologies. METHODS: Using a multicenter retrospective registry of adult OHCA patients treated with targeted temperature management, we identified those with a noncardiac etiology who underwent brain CT within 24 hours after restoration of spontaneous circulation...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27242104/effect-of-diabetes-and-pre-hospital-blood-glucose-level-on-survival-and-recovery-after-out-of-hospital-cardiac-arrest
#10
Ziad Nehme, Resmi Nair, Emily Andrew, Stephen Bernard, Marijana Lijovic, Melanie Villani, Sophia Zoungas, Karen Smith
OBJECTIVE: Diabetes mellitus and blood glucose level (BGL) are emerging as important prognosticators of outcome in critically ill patients. We evaluated the effect of diabetes and pre-hospital BGL on survival to hospital discharge and on 12-month functional recovery after out-of-hospital cardiac arrest (OHCA). DESIGN, SETTING AND PARTICIPANTS: We performed a retrospective analysis of data from a statewide cardiac arrest registry in Victoria, Australia. We included 11 873 adult patients who had had an OHCA of presumed cardiac aetiology between 1 January 2007 and 30 June 2015...
June 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27162110/neurologic-outcome-of-comatose-survivors-after-hanging-a-retrospective-multicenter-study
#11
Min Joung Kim, Yoo Sang Yoon, Joon Min Park, Junho Cho, Hoon Lim, Hyunggoo Kang, Hyun Jin Kim, Seung Whan Kim, Kyeong Ryong Lee, Gun Bea Kim, Jung Soo Park, Hye Sun Lee, Sung Phil Chung
PURPOSE: The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors. MATERIALS AND METHODS: We retrospectively investigated comatose hanging patients who arrived at the emergency departments (EDs) of twelve academic tertiary care centers during a period of seven years (2006-2012). Patients were analyzed separately according to whether out-of-hospital cardiac arrest (OHCA) occurred or not. The neurologic outcome was evaluated using the Cerebral Performance Category (CPC) at the time of hospital discharge...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27115286/improving-appropriate-neurologic-prognostication-after-cardiac-arrest-a-stepped-wedge-cluster-randomized-controlled-trial
#12
Damon C Scales, Eyal Golan, Ruxandra Pinto, Steven C Brooks, Martin Chapman, Craig M Dale, Draga Jichici, Gordon D Rubenfeld, Laurie J Morrison
RATIONALE: Predictions about neurologic prognosis that are based on early clinical findings after out-of-hospital cardiac arrest (OHCA) are often inaccurate and may lead to premature decisions to withdraw life-sustaining treatments (LST) in patients who might otherwise survive with good neurologic outcomes. OBJECTIVES: To improve adherence to recommendations for appropriate neurologic prognostication after OHCA and reduce deaths from premature decisions to withdraw LST...
November 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27109503/nt-probnp-in-patients-with-out-of-hospital-cardiac-arrest-results-from-the-finnresusci-study
#13
Peder L Myhre, Marjaana Tiainen, Ville Pettilä, Jukka Vaahersalo, Tor-Arne Hagve, Jouni Kurola, Tero Varpula, Torbjørn Omland, Helge Røsjø
AIM: To assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF). METHODS: We measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6h of OHCA-VT/VF and later after 24h, 48h, and 96h...
July 2016: Resuscitation
https://www.readbyqxmd.com/read/27073975/understanding-early-decisions-to-withdraw-life-sustaining-therapy-in-cardiac-arrest-survivors-a-qualitative-investigation
#14
Craig M Dale, Tasnim Sinuff, Laurie J Morrison, Eyal Golan, Damon C Scales
RATIONALE: Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. OBJECTIVES: To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management...
July 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27048406/good-neurological-outcome-despite-very-low-regional-cerebral-oxygen-saturation-during-resuscitation-a-prospective-preclinical-trial-in-29-patients
#15
Christian Storm, Alexander Wutzler, Lars Trenkmann, Alexander Krannich, Sabrina von Rheinbarben, Fridolin Luckenbach, Jens Nee, Natalie Otto, Tim Schroeder, Christoph Leithner
BACKGROUND: Noninvasive regional cerebral oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) might inform on extent and duration of cerebral hypoxia during cardiopulmonary resuscitation (CPR). This information may be used to guide resuscitation efforts and may carry relevant early prognostic information. METHODS: We prospectively investigated non-traumatic out-of-hospital cardiac arrest (OHCA) patients on scene. NIRS was started either during CPR or shortly after (<2 min) return of spontaneous circulation (ROSC) by emergency medical service (EMS)...
April 6, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/26977736/the-combination-of-biomarkers-for-prognostication-of-long-term-outcome-in-patients-treated-with-mild-hypothermia-after-out-of-hospital-cardiac-arrest-a-pilot-study
#16
Martin Annborn, Fredrik Nilsson, Josef Dankiewicz, Malin Rundgren, Sabine Hertel, Joachim Struck, Tobias Cronberg, Niklas Nielsen
To explore if the brain biomarker neuron-specific enolase (NSE) in combination with a biomarker for stress; CT-proAVP (copeptin), oxidation; peroxiredoxin 4 (Prx4), inflammation; procalcitonin (PCT), or with biomarkers from the heart; midregional proatrial natriuretic peptide (MR-proANP), or troponin T (TnT) can improve the prognostic accuracy of long-term outcome after out-of-hospital cardiac arrest (OHCA). Serum samples from cardiac arrest patients, treated at 33°C for 24 hours, were collected serially at 12, 24, and 48 hours after cardiac arrest...
June 2016: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/26866849/effect-of-therapeutic-hypothermia-on-survival-and-neurologic-outcome-in-the-elderly
#17
Nichole E Bosson, Amy H Kaji, William J Koenig, James T Niemann
Old age is considered a negative prognostic factor after out-of-hospital cardiac arrest (OHCA). The purpose of this study was to assess the benefit of therapeutic hypothermia (TH) on survival and neurologic outcome in the elderly. This is a retrospective study of patients treated for OHCA from April 2011 to August 2013 in a regional cardiac system. Patients with return of spontaneous circulation (ROSC) are directed to designated cardiac receiving centers with established TH protocols. The decision to initiate TH is determined by the treating physician...
June 2016: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/26796574/decreased-monocyte-hla-dr-expression-in-patients-after-non-shockable-out-of-hospital-cardiac-arrest
#18
Fabienne Venet, Martin Cour, Julie Demaret, Guillaume Monneret, Laurent Argaud
Out-of-hospital cardiac arrest (OHCA) constitutes a major health care problem with the development in immediate survivors of a post-cardiac arrest syndrome including systemic inflammatory response as observed in sepsis. As a decreased monocyte HLA-DR expression (mHLA-DR) has been repeatedly described in septic patients in association with an increased risk of death and nosocomial infections, we tested whether this immune alteration could also be observed after OHCA. Fifty-five non-shockable OHCA patients sampled at Day 0 (D0: within 4 h after OHCA), D1 (the next day), and D3: (after 2 additional days) were included...
July 2016: Shock
https://www.readbyqxmd.com/read/26375661/the-impact-of-a-pre-hospital-critical-care-team-on-survival-from-out-of-hospital-cardiac-arrest
#19
Johannes von Vopelius-Feldt, Archibald Coulter, Jonathan Benger
AIM: To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). METHODS: We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups...
November 2015: Resuscitation
https://www.readbyqxmd.com/read/26340128/resuscitation-and-post-resuscitation-care-of-the-very-old-after-out-of-hospital-cardiac-arrest-is-worthwhile
#20
Matilde Winther-Jensen, Jesper Kjaergaard, Christian Hassager, John Bro-Jeppesen, Niklas Nielsen, Freddy K Lippert, Lars Køber, Michael Wanscher, Helle Søholm
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. METHODS: During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen...
December 15, 2015: International Journal of Cardiology
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