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PubMedDate not supplied

Survival from cardiac arrest in an accident and emergency department: use as a performance indicator?

OBJECTIVE: To report the outcomes of patients with a cardiac arrest occurring in an accident and emergency department and discuss whether this would be an appropriate measure of performance of the department. DESIGN: A 6-year retrospective study of cardiac arrests occurring within the accident and emergency department at a single hospital. SETTING: A district general hospital accident and emergency department in the period 1991-1997. OUTCOME MEASURES: Survival to leave the emergency department, survival to leave hospital. RESULTS: There were 77 cardiac arrests occurring within the department, and of these 42 (55%) survived to be admitted to hospital. Forty-two arrests involved a rhythm of VT/VF with 81% of these arrests surviving to be admitted. Thirty-five patients had other cardiac rhythms of whom 23% survived to admission. Primarily cardiac causes of arrest occurred in 52 patients with a survival rate of 60%. Overall 33 patients (43%) survived to be discharged from hospital. CONCLUSION: Survival from cardiac arrest is a useful measure of performance of an accident and emergency department. It is a condition that has definite outcomes, and is easily auditable. Figures can be compared between departments by comparing cases with the same aetiology or arrest rhythm thus reducing the influence of cases with a poorer outcome. This would provide an additional indicator for comparison of departments other than those currently used. A national database of outcome of cardiac arrests could be created to allow valid comparisons between departments.

Emergency Service, Hospital↗
PubMed2005

The influence of cardiopulmonary resuscitation without defibrillation on serum levels of cardiac enzymes: a time course study of out-of-hospital cardiac arrest survivors.

BACKGROUND: The serum concentration of cardiac enzymes may be influenced by mechanical and electrical trauma due to cardiopulmonary resuscitation (CPR) attempts. This could complicate the determination of whether an acute myocardial infarction (AMI) had occurred. In this study, only patients without any of the known confounding factors affecting cardiac enzyme release were included, and the specific time course and patterns of serum cardiac enzyme levels after resuscitation were evaluated. The purpose is to help clinicians distinguish between spontaneous myocardial damage and that induced by CPR. METHODS AND RESULTS: This prospective, observational study was performed in the emergency department on eight patients surviving cardiac arrest. They were selected for not having heart disease, chest trauma or septic shock; and not receiving defibrillation. The median (range) duration of return of spontaneous circulation (ROSC) was 13 min (5-30 min). Cardiac enzyme measurements were taken immediately after ROSC and every 6h thereafter. Although cardiac troponin I (cTnI) level reached as high as 62.6 ng/ml at 24 h in one patient, five of the eight (62.5%) patients had their cTnI level fall below the normal reference range (i.e. 2 ng/ml) by 30 h. The time to maximum and peak concentration of cTnI was 16.50+/-10.99 h and 16.85+/-21.50 ng/ml, respectively. Both MB creatine kinase (CKMB) and total creatine kinase (CK) levels were above their normal reference ranges. In addition, the CKMB/CK ratio exceeded 5% in all patients at any time point during this study. CONCLUSION: In this study, the influence of resuscitative procedures - defibrillation excluded - on the release of cardiac enzymes were examined. During 30 h after ROSC cTnI level exhibited a bell-shaped configuration, which is distinct from that after AMI; whereas the enzymatic activities of CKMB and CK, as well as CKMB/CK ratio, were constantly higher than normal. This chronological pattern of cardiac enzyme levels may help physicians differentiate primary cardiac disease from other aetiologies in out-of-hospital cardiac arrests.

Adult↗
PubMed1986

Moderate alcohol consumption and primary cardiac arrest.

To determine if light to moderate consumption of alcohol influences the risk of primary cardiac arrest, the authors investigated 152 cases, 25-75 years of age, without prior heart disease or co-morbidity, in whom a primary cardiac arrest occurred during a 14-month period in King County, Washington state, December 1979-January 1981. Spouses of cases and those of 152 demographically similar residents of King County were interviewed to quantify average alcohol consumption over the prior year for beer, wine, and spirits combined. After adjustment for hypertension, smoking, and physical activity, light to moderate alcohol consumption was associated with a reduced risk of primary cardiac arrest. Compared to persons who were nondrinkers (less than 1 drink/month), the estimated relative risk for light drinkers (greater than or equal to 1 drink/month but less than 1 drink/day) was 0.7 (95% confidence interval, 0.5-1.0), and for moderate drinkers (1-3 drinks/day), 0.5 (95% confidence interval, 0.3-1.0). These data are consistent with the hypothesis that light to moderate alcohol consumption reduces the risk of primary cardiac arrest.

Adult↗
PubMed1998

Should a cancer patient be resuscitated following an in-hospital cardiac arrest?

OBJECTIVE: Previous reports from general hospitals and cancer centers have identified the presence of malignancy as a poor prognostic indicator for successful cardiopulmonary resuscitation (CPR) for an in-hospital cardiac arrest. The purpose of this study was to evaluate the initial success of CPR as determined by return of spontaneous circulation (ROSC), patient survival to hospital discharge, and 1-year survival of this group as compared to previous studies in non-oncological centers. In addition, the charges incurred in caring for these patients were analyzed. MATERIALS AND METHODS: All cardiac arrests occurring between 1 January 1993 and 31 December 1994 were identified from a centralized morbidity and mortality database and reviewed retrospectively. Cardiac arrest was defined as the absence of a palpable pulse and initiation of CPR. Patients suffering pure respiratory arrest or shock without loss of pulse were excluded. Age, gender, primary site of malignancy, initial and ultimate outcome, including Zubrod's functional status (ZFS), and total hospital charges following cardiac arrest were recorded. Computerized billing records were used to tabulate total charges. RESULTS: 83 cardiac arrests occurred during the study period (42 women, 41 men). Mean age was 56.2 years. Forty-two percent of the patients had hematologic malignancies, 19% lung, 15% gastrointestinal, 5% head and neck cancers and 19% other malignancies. Sixty-six percent of the patients had ROSC. Only eight (9.6%) patients survived to hospital discharge: three died within 6 weeks under hospice care, two died within 6 months of discharge and only three (3.6%) patients survived to 1 year. Functional status follow-up of these three patients revealed two with ZFS 1 and one with ZFS 2. Total hospital charges for these 83 patients were US$ 2,959,740. CONCLUSIONS: Although ROSC after cardiac arrest in our patients was better than that reported for most series in general hospitals, their ultimate survival and hospital discharge was extremely poor.

Cardiopulmonary Resuscitation↗
PubMed1991

Change in survival from out-of-hospital cardiac arrest and its effect on coronary heart disease mortality, Minneapolis-St. Paul. The Minnesota Heart Survey.

Emergency medical services with advanced life support systems were implemented in the Minneapolis-St. Paul, Minnesota, area in the mid-1970s. To assess the impact of emergency medical services on coronary heart disease mortality, the authors reviewed ambulance records and hospital emergency room logs for possible out-of-hospital cardiac arrest cases in the period 1972-1982. Potential cases, and their survival to discharge, were validated by hospital record review and were checked against Minnesota death certificates for the year of cardiac arrest and the year following cardiac arrest. Age-adjusted rates of survival to 1 year after cardiac arrest (per 100,000 population) for survivors of out-of-hospital cardiac arrest aged 30-74 years increased significantly from 1972 to 1982 for men (1.8 vs. 11.7; p less than 0.00001) and for women (0.5 vs. 3.5; p less than 0.01). Coronary heart disease mortality rates declined in that period by 34.9% for men (from 527.5 per 100,000 to 343.3 per 100,000) and by 41.7% for women (from 168.6 per 100,000 to 98.3 per 100,000). The authors estimate that improved survival from out-of-hospital cardiac arrest contributed 5.4% (9.9 of 184.2) of the mortality decline for men and 4.3% (3.0 of 70.3) of the decline for women. This was a significant contribution to the decline in coronary heart disease mortality, but it explains only a small part of it.

Adult↗
PubMed1996

Beta-protein immunoreactivity in the human brain after cardiac arrest.

Brain of twelve, 44-78 years old non-demented patients affected by total ischemia after cardiac arrest, were used in the study. All of them were resuscitated within a few minutes after cardiac arrest and they survived for 3 to 36 days afterward. In all cases, after cardiac arrest, beta PP overexpression was found by immunocytochemical methods in many cortical and subcortical neurons as well as in ependymal and choroid plexus cells. This overexpression of beta PP, was concomitant with formation of many A beta nonfibrillar (thioflavine-negative) plaques in the neuropil. Because of a break in the blood-brain barrier around many vessels, weakly A beta-immunoreactive material was also found. The data presented provided strong evidence that the total brain ischemia resulting from cardiac arrest is a risk factor for beta-amyloidosis.

Adult↗
PubMed2003

Hypothermia after cardiac arrest: a treatment that works.

PURPOSE OF REVIEW: Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome. RECENT FINDINGS AND SUMMARY: In 2002, two prospective, randomized studies reported improved outcomes when deliberate hypothermia was induced in comatose survivors after resuscitation from cardiac arrest. However, several issues with regard to resuscitative cooling are still unanswered and should be studied further. These include the optimal timing to initiate cooling, the optimal cooling period, the optimal temperature level, and rewarming strategy. Even important questions, such as which cooling technique will be available in the near future that would combine ease of use with high efficacy, are not answered yet.

Heart Arrest↗
PubMed2001

Sudden Cardiac Arrest in Athletic Medicine.

OBJECTIVE: To emphasize the importance of decreasing the response time by a trained target responder to increase the survival rate among athletes experiencing sudden cardiac arrest at an athletic event. BACKGROUND: Death due to sudden cardiac arrest that is witnessed is preventable in many cases. However, most people who experience this condition die because of a prolonged response time from onset of the fatal arrhythmia to defibrillation by trained treatment providers. If athletic trainers or other members of the athletic care medical team are trained as target responders and equipped with automated electronic defibrillators, they can immediately treat an athlete who experiences a sudden, life-threatening tachyarrhythmia. This prompt response to the life-threatening emergency should result in a higher survival rate. DESCRIPTION: We review the causes of sudden cardiac arrest during athletic events, note some unusual clinical presentations, discuss improved methods of response and new equipment for treatment, and define the athletic trainer's role as a target responder trained to treat people experiencing sudden cardiac arrest at an athletic event. CLINICAL ADVANTAGES: An athletic care team willing to become part of an emergency response team can help improve the survival rate of athletes experiencing sudden cardiac arrest at an athletic event.

Journal Article↗
PubMed1978

Electroencephalographic prediction of anoxic brain damage after resuscitation from cardiac arrest in patients with acute myocardial infarction.

The short-term prognostic value of routine electroencephalography (EEG), carried out on the days after cardiac arrest, was evaluated in a consecutive study of 185 patients with acute myocardial infarction together with an episode of clinical cardiac arrest. The individual EEGs were classified on a 5-grade scale. Of the 89 patients who survived, 18 had signs of anoxic brain damage; 96 patients died, 76 as a result of cerebral anoxia. Only 2 patients survived out of the total of 72 for whom the first EEG was classified as grades III--V. The EEGs of both these patients were recorded within a few hours after the cardiac arrest. None of the patients with an EEG of grade I died of cerebral anoxia, while all degrees of brain damage were otherwise observed in connection with EEGs of both grades I and II. It is concluded that an EEG of grades III--V indicates a fatal outcome, provided it has been recorded more than 24 hours after the cardiac arrest. A grade III--V EEG that is recorded within 24 hours after a cardiac arrest should be repeated some days later. It is not possible, on the basis of a single EEG, to predict the extent of the anoxic brain damage.

Acute Disease↗
PubMedDate not supplied

Out-of-hospital cardiac arrest in Hong Kong.

OBJECTIVES: To evaluate the effectiveness of the local emergency medical services system in resuscitation of out-of-hospital cardiac arrest and identify areas for improvement. METHODS: This was a prospective descriptive study of adults with nontraumatic out-of-hospital cardiac arrest treated in the three accident & emergency departments that serve the whole of Hong Kong Island from March 15, 1999, to October 15, 1999. Patient characteristics, circumstances of cardiac arrest, final outcomes, and response times of the ambulance service were recorded according to the Utstein style. RESULTS: Three hundred twenty patients were included. There was male predominance, and the mean age was 71.5 years. The majority of cardiac arrests occurred at patients' homes. In 57.5% of cases the arrest was not witnessed. The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%. The most common electrocardiographic (ECG) rhythm at scene was asystole. Ventricular fibrillation or pulseless ventricular tachycardia constituted 14.1%. The average call to dispatch interval was 1.04 minutes. The average call to CPR interval was 9.82 minutes. The average total prehospital interval was 27.55 minutes. The overall immediate survival rate was 14.1% and the rate of survival to hospital discharge was 1.25%. CONCLUSION: The prognosis of out-of-hospital cardiac arrest in Hong Kong was dismal. Every link in the chain of survival has to be improved.

Aged↗
PubMed2001

An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest.

We describe a case of more than 5 h cardiac arrest in a 60-year-old patient who underwent general anesthesia for a urologic operation. Before extubation, the patient suddenly developed ventricular fibrillation, pulseless ventricular tachycardia and asystole which was immediately treated by advanced life support (ALS) measures. Thirty minutes later seizures developed and were controlled by 200 mg of thiopentone and 10 mg of diazepam. A pattern of ventricular tachycardia, coarse ventricular fibrillation and asystole lasted for nearly 120 min. Termination of resuscitation maneuvers was considered, but long-term life support was continued for 5 h. After this time, peripheral pulses, with a supraventricular tachycardia-like rhythm and regular spontaneous breathing reappeared. Seven hours later, the patient had a Glasgow Coma Scale (GCS) of 5, dilated unresponsive, absence of pupils, and a systolic arterial pressure of 100 mmHg. He was then transferred to intensive care unit (ICU). The morning after, the patient was awake, responded to simple orders, breathing spontaneously, and free from sensomotor deficit. He was, therefore, extubated. Subsequently, other episodes of transitory ST-line upper wave followed by ventricular fibrillation appeared, suggesting Prinzmetal angina. This was successfully treated by percutaneous coronary angioplasty. The first electroencephalogram recorded the day after cardiac arrest showed a mild widespread background slowing. An electroencephalogram 6 days later showed a return to alpha rhythm with only mild theta-wave abnormalities. Four weeks after the first cardiac arrest the patient was discharged. This is an exceptional experience compared with the others reported. We believe that all the efforts must not be given up when such an event occurs during anesthesia and there are optimal conditions for resuscitation maneuvers.

Cardiopulmonary Resuscitation↗
PubMed1996

Cardiac arrest after Caesarean section under subarachnoid block.

Cardiac arrest occurred on arrival in the recovery room after emergency Caesarean section under subarachnoid block. The patient was resuscitated successfully and recovered with no adverse effects. The current literature is reviewed and the pathophysiological mechanisms involved in the aetiology of cardiac arrest under subarachnoid block are discussed. Early use of adrenaline to treat severe bradycardia or hypotension is recommended.

Adult↗
PubMed1999

Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.

BACKGROUND: Whether antiarrhythmic drugs improve the rate of successful resuscitation after out-of-hospital cardiac arrest has not been determined in randomized clinical trials. METHODS: We conducted a randomized, double-blind, placebo-controlled study of intravenous amiodarone in patients with out-of-hospital cardiac arrest. Patients who had cardiac arrest with ventricular fibrillation (or pulseless ventricular tachycardia) and who had not been resuscitated after receiving three or more precordial shocks were randomly assigned to receive 300 mg of intravenous amiodarone (246 patients) or placebo (258 patients). RESULTS: The treatment groups had similar clinical profiles. There was no significant difference between the amiodarone and placebo groups in the duration of the resuscitation attempt (42+/-16.4 and 43+/-16.3 minutes, respectively), the number of shocks delivered (4+/-3 and 6+/-5), or the proportion of patients who required additional antiarrhythmic drugs after the administration of the study drug (66 percent and 73 percent). More patients in the amiodarone group than in the placebo group had hypotension (59 percent vs. 48 percent, P=0.04) or bradycardia (41 percent vs. 25 percent, P=0.004) after receiving the study drug. Recipients of amiodarone were more likely to survive to be admitted to the hospital (44 percent, vs. 34 percent of the placebo group; P=0.03). The benefit of amiodarone was consistent among all subgroups and at all times of drug administration. The adjusted odds ratio for survival to admission to the hospital in the amiodarone group as compared with the placebo group was 1.6 (95 percent confidence interval, 1.1 to 2.4; P=0.02). The trial did not have sufficient statistical power to detect differences in survival to hospital discharge, which differed only slightly between the two groups. CONCLUSIONS: In patients with out-of-hospital cardiac arrest due to refractory ventricular arrhythmias, treatment with amiodarone resulted in a higher rate of survival to hospital admission. Whether this benefit extends to survival to discharge from the hospital merits further investigation.

Aged↗
PubMed2001

Hematologic and chemical changes observed during and after cardiac arrest in a canine model--a pilot study.

STUDY OBJECTIVE: To evaluate the effect of cardiac arrest and cardiopulmonary resuscitation (CPR) on blood chemistry in a canine model. DESIGN: Evaluative canine animal study. SETTING: Animal laboratory accredited by the Association for Assessment and Accreditation of Laboratory Animals. SUBJECTS: Twenty-six adult mongrel dogs. INTERVENTION: The dogs underwent an episode of induced fibrillatory cardiac arrest for 3 minutes followed by 10 minutes of standard CPR. Blood samples were taken at baseline (before cardiac arrest), after 10 minutes of ventricular fibrillation, and 10 minutes after successful resuscitation for determination of blood chemistries and hematologic parameters. MEASUREMENTS AND MAIN RESULTS: Glucose, blood urea nitrogen, serum creatinine, sodium, potassium, chloride, calcium, phosphorus, uric acid, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, protein, albumin, cholesterol, triglycerides, iron, white blood cell count, red blood cell count, and hematocrit were measured. Significant changes (p<0.05) in values obtained during CPR versus baseline values were noted for all laboratory parameters except blood urea nitrogen, chloride, and alkaline phosphatase. Eighteen dogs achieved return of spontaneous circulation (ROSC); their laboratory values were obtained after CPR. Significant changes (p<0.05) after ROSC compared with baseline were noted for all laboratory values except chloride, blood urea nitrogen, uric acid, alkaline phosphatase, glucose, potassium, calcium, triglycerides, iron, red blood cell count, and hematocrit. CONCLUSION: Results indicate that significant changes in blood chemistries and hematologic parameters occur during and after CPR. Clinicians should note these normal laboratory parameter changes when interpreting laboratory data in patients who experience cardiac arrest.

Animals↗
PubMed1987

Natural course of iron delocalization and lipid peroxidation during the first eight hours following a 15-minute cardiac arrest in dogs.

Lipid peroxidation is thought to be a major contributing factor in neurological injury following cardiac arrest. Because iron availability is a prerequisite for lipid peroxidation, this experiment was designed to examine the natural time course of iron release, lipid peroxidation, and cerebral polyunsaturated fatty acid content following a 15-minute cardiac arrest in dogs. Large mongrel dogs were anesthetized with ketamine and halothane and divided into three groups of five each. In two groups, cardiac arrest was induced with KCl. After 15 minutes of cardiac arrest, the dogs were resuscitated by five minutes of internal cardiac massage, epinephrine, bicarbonate, and internal defibrillation. All ten dogs were resuscitated and supported by a standard intensive care protocol until tissue harvest. A 3-g portion of parietal cerebral cortex was obtained from the nonischemic dogs (n = 5), or at two hours (n = 5), or eight hours (n = 5) after resuscitation. Total tissue iron was measured by an atomic emission spectrometer; low molecular weight species (LMWS) iron by the o-phenanthroline test on an ultrafiltered sample; and lipid peroxidation by both the thiobarbituric acid test (TBARS) and determination of the tissue content of lipid double bonds, calculated by first fractionating the lipids by gas-liquid chromatography and then measuring the double bonds in each fraction by spectrometry and summing the results. Univariate ANOVA demonstrated all variables except total tissue iron to have significance at P less than .02. At two hours of reperfusion, LMWS iron and TBARS were significantly elevated above nonischemic control levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden.

OBJECTIVE: To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. METHODS: This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. RESULTS: In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P = 0.025) and an increase of females from 29 to 32% (P = 0.0001). There was a change in witnessed status (P < 0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P < 0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P < 0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P < 0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P = 0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). CONCLUSIONS: Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.

Age Distribution↗
PubMed1990

Survival rates from out-of-hospital cardiac arrest: recommendations for uniform definitions and data to report.

Survival rates for out-of-hospital cardiac arrest vary widely among locations. We surveyed the definitions used in published studies of out-of-hospital cardiac arrest. Data from 74 studies involving 36 communities showed survival rates ranging from 2% to 44%. There were five different case definitions and 11 different definitions of survivors. The absence of uniform definitions prevents meaningful intersystem comparisons, prohibits explorations of hypotheses about effective interventions, and interferes with the efforts of quality assurance. The most satisfactory numerator for a survival rate appears to be survival to hospital discharge; the most appropriate denominator appears to be witnessed adult cardiac arrest of presumed heart disease etiology, with ventricular fibrillation as the initial identified rhythm. Proposed definitions for the data emergency medical services systems should report as they examine their cardiac arrest survival rates are presented.

Emergency Medical Services↗
PubMed1974

Relation of neurological findings after cardiac arrest to outcome.

Routine neurological examination of patients one hour after cardiac arrest seems to be of value in determining the prognosis for life and likelihood of intellectual impairment.In 48 patients 53 episodes of cardiac arrest were followed by serial neurological examinations. Patients were divided into two groups according to neurological findings one hour after cardiac arrest. Patients in group 1 were unresponsive or at most responded in a reflex fashion to painful stimuli at one hour; these patients died or survived with intellectual damage. Patients in group 2 responded purposefully at one hour and survived without neurological damage. These patients commonly showed transient confusional states and a variety of other non-focal abnormalities, and focal signs were seen occasionally.

Adult↗