Search Results (200)

Background: Cangrelor provides rapid platelet inhibition, making it a potential option for out-of-hospital cardiac arrest (OHCA) survivors undergoing percutaneous coronary intervention (PCI). However, clinical data on its use after OHCA are limited. This study investigates in-hospital outcomes of cangrelor use in this population. Methods: We conducted a prospective, observational study involving OHCA patients from the Lombardia CARe Registry (January 2015–December 2022) who underwent PCI in seven centers in Northern Italy. Propensity score (PS) matching compared patients who received cangrelor to those who did not. Logistic regression tested associations between cangrelor and discharge outcomes. Results: Of 612 OHCA patients admitted, 414 (67.4%) underwent PCI with known antithrombotic therapy, of whom 34 (8.2%) received cangrelor. Radial access was more common in the cangrelor group, which also had a higher troponin peak and a final TIMI flow grade of 3. Survival at discharge was 82.4% in the cangrelor group, compared to 65.3% in the no-cangrelor group (p = 0.043). Univariable logistic regression showed that cangrelor use was associated with higher survival at discharge (OR 2.5; 95% CI: 1.1–6.1, p = 0.049). After multiple PS matchings, cangrelor remained associated with better survival (OR 2.07; 95% CI: 1.16–2.98). Major bleeding rates were higher in the cangrelor group, even after adjusting for baseline bleeding risk (OR: 7.0; 95% CI: 2.9–17.0; p < 0.001). Conclusions: In OHCA patients undergoing PCI, cangrelor use was linked to improved in-hospital survival but higher major bleeding, suggesting a potential net clinical benefit. Full article

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11–1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24–1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2–1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions. Full article

Background/Objectives: Sudden cardiac arrest (SCA) is a severe medical condition involving the cessation of the heart’s mechanical activity. Following the chain of survival, which includes early recognition and calling for help, early initiation of cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care, offers the greatest chances of saving a person who has experienced SCA. The aim of this study was to analyze cases of out-of-hospital cardiac arrest (OHCA) and assess the actions taken by bystanders. Methods: The input for analysis consisted of 49,649 dispatch records from the emergency medical team (EMT) at the Voivodeship Emergency Medical Station in Bialystok in 2018–2019. Results: Among the patients where bystanders performed CPR, the return of spontaneous circulation (ROSC) occurred in 30.53% of cases, whereas in the cases where the bystander did not perform CPR, ROSC occurred in 2.35% of cases. When cardiac arrest rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), ROSC occurred in 58.62% of cases, while there was asystole or pulseless electrical activity (PEA) present, ROSC occurred in 26.56% of cases. In patients who experienced OHCA in a VF/pVT rhythm and who underwent intubation, ROSC occurred in 58.73% of cases, whereas in patients who underwent alternative procedures for airway management, ROSC occurred in 83.33% of cases. Conclusions: The most significant factor influencing the occurrence of ROSC in patients is CPR initiation by bystanders. The presence of a rhythm that requires defibrillation increases the likelihood of achieving ROSC in the patient. Alternative methods for airway management appear to be more beneficial in VF/pVT rhythms. Full article

Background/Objectives: This study uses machine learning and multicenter registry data for analyzing the determinants of a favorable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) and developing decision support systems for various subgroups. Methods: The data came from the Korean Cardiac Arrest Research Consortium registry, with 2679 patients who underwent OHCA aged 18 or above with the return of spontaneous circulation (ROSC). The dependent variable was a favorable neurological outcome (Cerebral Performance Category score 1–2), and 68 independent variables were included, e.g., first monitored rhythm, in-hospital cardiopulmonary resuscitation (CPR) duration and post-ROSC pH. A random forest was used for identifying the major determinants of the favorable neurological outcome and developing decision support systems for the various subgroups stratified by the major variables. Results: Based on the random forest variable importance, the major determinants of the OHCA patient outcomes were the in-hospital CPR duration (0.0824), in-hospital electrocardiogram on emergency room arrival (0.0692), post-ROSC pH (0.0579), prehospital ROSC before emergency room arrival (0.0565), coronary angiography (0.0527), age (0.0415), first monitored rhythm (EMS) (0.0402), first monitored rhythm (community) (0.0401), early coronary angiography within 24 h (0.0304) and time from scene arrival to CPR stop (0.0301). It was also found that the patients could be divided into six subgroups in terms of their prehospital ROSC and first monitored rhythm (EMS), and that a decision tree could be developed as a decision support system for each subgroup to find the effective cut-off points regarding the in-hospital CPR duration, post-ROSC pH, age and hemoglobin. Conclusions: We identified the major determinants of favorable neurological outcomes in successfully resuscitated patients who underwent OHCA using machine learning. This study demonstrates the strengths of a random forest as an effective decision support system for each stratified subgroup (prehospital ROSC and first monitored rhythm by EMS) to find its own optimal cut-off points for the major in-hospital variables (in-hospital CPR duration, post-ROSC pH, age and hemoglobin). Full article

Background: Out-of-hospital cardiac arrest (OHCA) is a critical health issue with survival influenced by multiple factors. This study analyzed resuscitation outcomes at the County Clinical Emergency Hospital of Sibiu, Romania, during pre-COVID-19 and pandemic periods. Methods: A retrospective analysis of 508 OHCA patients (2017–2020) assessed the return of spontaneous circulation (ROSC) as the primary endpoint. Statistical methods included decision tree analysis, logistic regression and ROC curve analysis to evaluate the predictive value of adrenaline dose and patient factors. Results: The mortality rate was 68.7%, with non-shockable rhythms predominant among fatalities. Rural patients, though younger, had lower ROSC rates than urban counterparts. Logistic regression showed that lower adrenaline doses (≤4 mg, OR 11.835 [95% CI: 6.726–20.27]; 4–6 mg, OR 2.990 [95% CI: 1.773–5.042]) were associated with better ROSC outcomes. Conclusions: A multivariable model (AUC = 0.773) incorporating demographics and pandemic status outperformed adrenaline dose alone (AUC = 0.711). Full article

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been recognized as predictors of various critical illnesses. Our study aimed to investigate whether the NLR and PLR measured at different timepoints could predict poor neurological outcomes at 6 months. This observational retrospective cohort study included adults who had experienced out-of-hospital cardiac arrest (OHCA) and received targeted temperature management between November 2015 and December 2020. Patients with an active infection, as confirmed by an initial blood culture, were excluded. Multivariate logistic regression models were used to determine the association between the NLR and PLR at 0, 24, and 48 h after return of spontaneous circulation and poor neurological outcomes, defined as a Cerebral Performance Category score of ≥3 at 6 months. The NLR at 24 h, but not the NLR or PLR at other timepoints, was significantly associated with poor neurological outcomes (odds ratio: 1.05; 95% CI: 1.01–1.09; p = 0.018). The NLR at 24 h showed moderate accuracy in predicting poor neurological outcomes, with an AUC of 0.619. A cutoff value of 9.0 achieved 72.5% sensitivity and 47.7% specificity. The NLR measured at 24 h after ROCS could be used for early neuroprognostication given its low cost and widespread availability. Full article

Background: Out-of-hospital cardiac arrest (OHCA) is a critical global health challenge and a leading cause of mortality. This study investigates the combined effect of initial cardiac arrest rhythm, patient age, and location on the return of spontaneous circulation (ROSC) in OHCA patients. Methods: This retrospective study analyzed medical records from the National Emergency Medical Service (EMS) in Poland between January 2021 and June 2022. Data from 33,636 patients with OHCA who received cardiopulmonary resuscitation (CPR) at the scene were included. Results: Public incidents were associated with higher ROSC rates (54.10% vs. 31.53%, p < 0.001). Initial shockable rhythms (VF/pVT) significantly increased the odds of ROSC (OR = 3.74, 95% CI 3.39–4.13, p < 0.001). Obesity decreased the odds of ROSC in at-home cases (OR = 0.85, 95% CI 0.73–0.99, p = 0.036) but had no significant effect in public cases. The effect of age on ROSC outcomes varied significantly depending on the location. In patients younger than 60 years, better ROSC outcomes were observed in at-home cases, while for those older than 60 years, the odds of ROSC were higher in public locations. Each additional year of age decreased the odds of ROSC by 1.62% in at-home incidents (p < 0.001) and by 0.40% in public incidents (p = 0.009). Sex differences were significant in public locations, with women having higher odds of ROSC compared to men (OR = 0.57, 95% CI 0.37–0.87, p = 0.009 for VF/pVT). Conclusions: The interaction between the location of OHCA, initial cardiac rhythm, and patient age significantly impacts ROSC outcomes. Public locations show higher ROSC rates, especially in cases with shockable rhythms (VF/pVT). Age modifies ROSC outcomes, with younger patients benefiting more at home, and older patients showing better outcomes in public places. Full article

Introduction: Cardiopulmonary resuscitation with mechanical devices (MCPR) was developed to provide high-quality cardiopulmonary resuscitation (CPR) for patients with cardiac arrest. However, the effect of this procedure on treatment outcomes remains controversial. Nevertheless, during the coronavirus disease-19 (COVID-19) pandemic, in-hospital MCPR gained attention, owing to its advantages such as saving medical staff and preventing infection. This study compared the treatment outcomes of in-hospital MCPR and manual CPR for out-of-hospital cardiac arrest (OHCA) patients during the COVID-19 pandemic. Materials and Methods: This retrospective nationwide population-based study was conducted in South Korea. Data were collected from the Out-of-Hospital Cardiac Arrest surveillance database managed by the Korea Disease Control and Prevention Agency. We included adult OHCA patients transported by emergency medical services from 2016 to 2021. The study compared outcomes during the COVID-19 pandemic years (2020–2021) with the preceding non-pandemic years (2018–2019). The primary outcome was survival to hospital discharge, and the secondary outcomes were good neurological outcome and sustained return of spontaneous circulation (ROSC). Results: The entire study included 72,050 patients with OHCA and, in the multivariable analyses, MCPR was associated with lower survival rates compared to manual CPR (AOR 0.63; 95% CI 0.51–0.77; p < 0.001). Interestingly, during the COVID-19 pandemic, while MCPR use increased, the survival rate did not differ significantly between the MCPR and manual-CPR groups. Conclusion: Our study findings suggest that while MCPR may offer potential benefits, such as decreased infection risk for healthcare workers, it did not demonstrate superior outcomes compared to manual CPR in our study population. Full article

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases. Full article

Background: Cardiac arrest is a critical condition affecting approximately 1 in every 1000 people in Europe. Feedback devices have been developed to enhance the quality of chest compressions during CPR, but their clinical impact remains uncertain. This study aims to evaluate the effect of feedback devices on key clinical outcomes in adult patients experiencing both out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA). The primary objective is to assess their impact on the return of spontaneous circulation (ROSC); secondary objectives include the evaluation of neurological status and survival to discharge. Methods: A systematic review was conducted following PRISMA guidelines, utilizing databases including PubMed, Scopus, Web of Science, and Embase. Studies published between 2000 and 2023 comparing CPR with and without the use of feedback devices were included. A fixed-effects network meta-analysis was performed for ROSC and survival, while a frequentist meta-analysis was conducted for neurological outcomes. Results: Twelve relevant studies met the inclusion criteria. The meta-analysis results showed that the use of audiovisual feedback devices significantly increases the likelihood of ROSC (OR 1.26, 95% CI 1.13–1.41, p < 0.0001) and survival (OR 1.52, 95% CI 1.27–1.81, p < 0.0001) compared to CPR without feedback. However, the effect of metronomes did not reach statistical significance. Conclusions: Feedback devices, particularly audiovisual ones, are associated with improved clinical outcomes in cardiac arrest patients. Their use should be encouraged in both training settings and real-life emergency scenarios to enhance survival rates and ROSC. However, further studies are needed to confirm long-term impacts and to explore the potential benefits of metronomes. Full article

Out-of-hospital cardiac arrest (OHCA) represents a significant global public health burden, characterized by low survival and few established diagnostic tools to guide intervention. OHCA presents with a wide variety of etiologies in a heterogeneous population, posing a clinical challenge to care teams. In this review, we describe evolving research focused on diagnostic approaches to OHCA following resuscitation, including electrocardiography, coronary angiography, computed tomography, ultrasonography, and serologic biomarker assessment. These diagnostic tools have been employed in post-resuscitative efforts for diagnosing ischemic and non-ischemic cardiac, respiratory, neurologic, vascular, traumatic, and metabolic causes of arrest. Full article

Delivering an automated external defibrillator (AED) to a patient suffering from out-of-hospital cardiac arrest (OHCA) as quickly as possible is a critical task. In this field, airborne drones may help to overcome long response times, especially in mountainous regions where topography and weather pose several challenges for rescuers. Drones are considered a fast option to shorten the time to the first AED shock. This study presents insights into the safety regulations, performance, reliability and public perception of this specific drone-based application. The findings are based on field tests that focused on the operational/logistical benefits and challenges of semi-autonomous drone-based AED delivery to simulated emergency sites in mountainous terrain. The generated results underline the operational and technical feasibility of the proposed system given successful AED delivery in all simulation scenarios. Several challenges remain, such as improvements in terms of the AED pick-up, mobile phone connectivity, tracking of GPS coordinates and weather resistance of the used drone are required. Overall, the study supports paving the way for future trials and real-world implementations of drones into existing emergency response systems. Full article

Background: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and cerebral disability in survivors. Current models of risk prediction and survival are mainly based on resuscitation duration. We examined the prognostic value of circulating biomarkers in predicting mortality and severe cerebral disability for OHCA survivors, alongside traditional clinical risk indicators. Methods: Biomarkers including BNP, troponin I, and galectin-3 were measured at hospital admission in resuscitated OHCA patients. Prognostic significance for mortality and cerebral disability involving circulating biomarkers, resuscitation duration, demographics, and laboratory and clinical characteristics was examined via univariate and multivariate Cox proportional hazards regression models. The incremental prognostic value of the index covariates was examined through model diagnostics, focusing on the Akaike information criterion (AIC) and Harrell’s concordance statistic (c-statistic). Results: In a combinatorial analysis of 144 OHCA survivors (median follow-up 5.7 years (IQR 2.9–6.6)), BNP, galectin-3, arterial pH, and resuscitation time were significant predictors of all-cause death and severe cerebral disability, whereas troponin I levels were not. Multivariate regression, adjusting for BNP, arterial pH, and resuscitation time, identified galectin-3 as an independent predictor of long-term mortality. Multiple linear regression models also confirmed galectin-3 as the strongest predictor of cerebral disability. The incorporation of galectin-3 into models for predicting mortality and cerebral disability enhanced fit and discrimination, demonstrating the incremental value of galectin-3 beyond traditional risk predictors. Conclusions: Galectin-3 is a significant, independent long-term risk predictor of cerebral disability and mortality in OHCA survivors. Incorporating galectin-3 into current risk stratification models may enhance early prognostication and guide targeted clinical interventions. Full article

Background/Objective: Out-of-hospital cardiac arrest (OHCA) poses a substantial public health concern. A collective evaluation of clinical trials is crucial for understanding systemic trends and progress within a specific research area of interest, ultimately shaping future directions. We performed a comprehensive analysis of the characteristics of trials in the adult OHCA population registered on ClinicalTrials.gov. Methods: Aided by medical subject headings (MeSH), we systematically searched the ClinicalTrials.gov database. Trends over time were assessed with the Cochran–Mantel–Haenszel test. The association between publication year and annual number was assessed with the Pearson correlation coefficient. Results: Out of 152 trials spanning the 2003–2023 period, 29.6% were observational and 70.4% were interventional. Compared with the observational trials, interventional trials were more often randomized (RCT) and achieved full publication status in 84% of cases (p = 0.03). The primary focus of interventional trials was “procedures” (43%), “devices” (23%), and “drugs” (21%). Observational studies focused on “biomarkers” (16%) and “diagnostic test” (13%) (p < 0.001). A decrement in the number of interventional trials with a sample size ≥100 patients across three temporal study points was observed. Nevertheless, published studies predominantly had a sample size ≥100 patients (76%), in contrast to unpublished trials (p ≤ 0.001). An increase in the number of interventional studies funded by the “academic/university” sector was also recorded. Conclusions: Clinical trials on OHCA primarily involved interventions aimed at treatment and were more often randomized, single-center, with small (<100) sample sizes, and funded by the “academic/university” sector. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the impact of age on ECPR effectiveness, emphasizing the need to consider age alongside other clinical factors in patient selection. Survival rates differ notably between in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA), highlighting the importance of rapid intervention. The potential of artificial intelligence to develop predictive models for ECPR outcomes is discussed, aiming to improve decision-making. Ethical considerations around age-based treatment decisions are also addressed. This review advocates for a balanced approach to ECPR, integrating clinical and ethical perspectives to optimize patient outcomes across all age groups. Full article