Rhythms and outcomes of adult in-hospital cardiac arrest

American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators.
Critical care medicine (Impact Factor: 6.31). 09/2009; 38(1):101-8. DOI: 10.1097/CCM.0b013e3181b43282
Source: PubMed


To determine the relationship of electrocardiographic rhythm during cardiac arrest with survival outcomes.
Prospective, observational study.
Total of 411 hospitals in the National Registry of Cardiopulmonary Resuscitation.
Total of 51,919 adult patients with pulseless cardiac arrests from April 1999 to July 2005.
Registry data collected included first documented rhythm, patient demographics, pre-event data, event data, and survival and neurologic outcome data. Of 51,919 indexed cardiac arrests, first documented pulseless rhythm was ventricular tachycardia (VT) in 3810 (7%), ventricular fibrillation (VF) in 8718 (17%), pulseless electrical activity (PEA) in 19,262 (37%) and asystole 20,129 (39%). Subsequent VT/VF (that is, VT or VF occurring during resuscitation for PEA or asystole) occurred in 5154 (27%), with first documented rhythm of PEA and 4988 (25%) with asystole. Survival to hospital discharge rate was not different between those with first documented VF and VT (37% each, adjusted odds ratio [OR]) 1.08; 95% confidence interval [CI] 0.95-1.23). Survival to hospital discharge was slightly more likely after PEA than asystole (12% vs. 11%, adjusted OR 1.1; 95% CI 1.00-1.18), Survival to discharge was substantially more likely after first documented VT/VF than PEA/asystole (adjusted OR 1.68; 95% CI 1.55-1.82). Survival to discharge was also more likely after PEA/asystole without subsequent VT/VF compared with PEA/asystole with subsequent VT/VF (14% vs. 7% for PEA without vs. with subsequent VT/VF; 12% vs. 8% for asystole without vs. with subsequent VT/VF; adjusted OR 1.60; 95% CI, 1.44-1.80).
Survival to hospital discharge was substantially more likely when the first documented rhythm was shockable rather than nonshockable, and slightly more likely after PEA than asystole. Survival to hospital discharge was less likely following PEA/asystole with subsequent VT/VF compared to PEA/asystole without subsequent VT/VF.

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Available from: Karl B Kern, Jul 08, 2014
    • "Recently published results from the large prospective, observational study in the USA have demonstrated that 1st day survival after in-hospital cardiac arrest was approximately 50% for all patients with documented cardiac rhythms (VF/ventricular tachycardia, pulseless electrical activity and asystole) with further significant reduction in survival rate at discharge from hospital to 25% from all resuscitated patients.[10] Another recent study of in-hospital cardiac arrest has found that only 35% of all patients were alive at the end of CPR and ultimately only 11% of all resuscitated patients were discharged alive from the hospital.[11] "
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    ABSTRACT: Experimental studies both in vivo and in vitro show significantly increased survival rate in animals and in cortical neurons respectively exposed to acute hypoxia and pre-treated with opioids compared to non-treated counterparts. Thus, the main aim of the study was to examine survival rates in patients after sudden cardiac arrest (SCA) in the hospital who were or were not treated with opioids before and/or during cardiac pulmonary resuscitation (CPR). The registry SCA database at the University Hospital of Northern Norway (UNN) for the period of January 2006-December 2009 was used to obtain data for the evaluation. Inclusion criteria were observed SCA at UNN for patients with American Society of Anesthesiologists (ASA) 1-3. Exclusion criteria included ASA four to five patients and unobserved SCA. Study patients were divided into two groups: Those not treated with opioids and those treated with opioids not more then 3 h before and/or during CPR. Survival rate 1, 2, 3 and 28 days post CPR were compared for the two groups. A total of 117 patients were registered in the SCA database at UNN for the period from January 2006 to December 2009. Sixty seven patients were excluded from the study: 17 patients had an unknown time of SCA dιbut, two patients had only syncope and 48 were ASA four to five patients. A total of 50 ASA one to three patients were included in the study, 33 and 17 patients respectively in the control and opioid-treated groups. The patients who were treated with opioids before or during CPR had a significantly higher 1, 2, 3 and 28 days survival rate as compared to those receiving only conventional CPR. The model was adjusted for duration of CPR (P=0.047) and treatment with adrenaline (P=0.779) in the groups. Adjusted Odds ratio was 0.075 (95% confidence interval (CI): 0.015-0.387). Relative risk of fatal outcome in the opioids group was 0.2944 (95% CI: 0.1549-0.5594). Significantly higher 1, 2, 3 and 28 days survival rate and reduced duration of CPR were found in the patients additionally treated with opioids compared to ordinary resuscitation. Further prospective, randomized, controlled trials are needed to investigate the effects of early administration of opioids during CPR on survival and brain function in patients with witnessed in-hospital SCA.
    No preview · Article · Jul 2013
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    • "In-hospital cardiac arrest occurs in 1 to 5 per 1000 patient admissions [4]. The American Heart Association's National Registry of cardiopulmonary resuscitation (CPR) indicate that survival to hospital discharge after in-hospital cardiac arrest is 17.6% (for all rhythms) [5]. The initial rhythm is VF or pulseless-VT in 25% of cases and, of these, 37% leave the hospital alive. "
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    ABSTRACT: Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90-300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated) and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.
    Full-text · Article · Jan 2012
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    • "There are about 450,000 cardiac arrests (CAs) that take place annually in the United States (Young, 2009). With advanced resuscitation techniques, only one third achieve resumption of spontaneous circulation (ROSC), and among those patients only one-third to one-half survive to hospital discharge (Meaney et al., 2010). Prolonged hypoxic-ischemic brain injury has been recognized as the main cause of high morbidity and mortality (Geocadin et al., 2008). "
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    ABSTRACT: Impaired neural conductivity shown by delayed latency and reduced amplitude of characteristic peaks in somatosensory evoked potentials (SSEPs), has been used to monitor hypoxic-ischemic brain injury after cardiac arrest (CA). However, rather than characteristic peak deferral and suppression, the time jitter of the peak in SSEP related with time-variant neurological abnormalities is diminished by the commonly used ensemble average method. This paper utilizes the second order blind identification (SOBI) technique to extract characteristic peak information from one trial of SSEPs. Sixteen male Wistar rats were subjected to 7 or 9 min of asphyxial CA (n=8 per group). The SSEPs from median nerve stimulation were recorded for 4h after CA and then for 15 min periods at 24, 48 and 72 h. Neurological outcomes were evaluated by neurologic deficit score (NDS) at 72 h post-CA. The SSEP signal was analyzed offline with SOBI processing in Matlab. The N10 feature of SSEP was compared between good (NDS≥50) and bad (NDS<50) outcomes. After processed by SOBI, the N10 detection rate was significantly increased (p<0.001) from 90 min post-CA. Statistical difference of the latency variance of the N10 between good and bad outcome groups existed at 24, 48 and 72 h post-CA (p≤0.001). Our study is the first application using SOBI detecting variance in neural signals like SSEP. N10 latency variance, related with neurophysiological dysfunction, increased after hypoxic-ischemic injury. The SOBI technique is an efficient method in the identification of peak detection and offers a favorable alternative to reveal the neural transmission variation.
    Full-text · Article · Aug 2011 · Journal of Neuroscience Methods
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