In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway

Langhelle, Audun; Tyvold, Stig Sverre; Lexow, Kristian; Hapnes, SA; Sunde, Kjetil; Steen, Petter Andreas

doi:10.1016/s0300-9572(02)00409-4

Cited by 297 publications

(196 citation statements)

References 45 publications

Supporting

Mentioning

178

Contrasting

Unclassified

Order By: Relevance

“…A set of potential confounders was chosen a priori based on biological plausibility and a priori knowledge 12, 15, 24, 30, 31, 32, 33, 34, 35, 36, 37, 38. These selected variables included the following: age, sex, hospital category (to adjust for the difference in the frequency of mCPR device use between each institution, hospitals were categorized on the basis of the numbers of patients on whom mCPR devices were used: low volume, <20 per year; moderate volume, 20–100 per year; and high volume, >100 per year), witnessed status, bystander CPR, first documented rhythm, presumed cardiac cause, airway management by EMS, prehospital administration of epinephrine by EMS, tracheal intubation during advanced cardiovascular life support, administration of epinephrine, defibrillation attempt, extracorporeal CPR performed in the ED, and time from call to EMS arrival at scene, time from EMS arrival at scene to EMS arrival at the patient's side, time from EMS arrival at the patient's side to CPR initiation, and time from CPR initiation to hospital arrival (while also adjusting for within‐institution clustering effects using a generalized estimating equation,36, 37, 38, 39 because several articles have suggested the existence of hospital‐related differences in survival after OHCA) 40, 41, 42, 43, 44. All covariates included the selected variables above and location at which the cardiac arrest occurred, observational period, time of cardiac arrest, prehospital mCPR by EMS, number of defibrillations by EMS, time from call to the first epinephrine dose, and laboratory data, including blood ammonia, pH, and Pa co 2 on ED arrival (while also adjusting for within‐institutional clustering effects).…”

Section: Methodsmentioning

confidence: 99%

Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study)

Hayashida

Tagami

Fukuda

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundMechanical cardiopulmonary resuscitation (mCPR) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the mCPR in the emergency department and clinical outcomes.Methods and ResultsIn a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the mCPR with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual CPR group and 918 patients (14.0%) in the mCPR group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that mCPR was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78; P=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94; P=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80; P=0.001).ConclusionsAfter accounting for potential confounders, the mCPR in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which mCPR may benefit these patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study)

Hayashida

Tagami

Fukuda

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…Rebound hyperthermia should be avoided. 59,60 Recommendation: We recommend that MTH be initiated as early as possible after the decision has been made (GOR E), and be maintained for 24 h (GOR A-E).…”

Section: When and For How Long?mentioning

confidence: 99%

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Castrèn¹,

Silfvast²,

Rubertsson³

et al. 2009

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background and aim: Sudden cardiac arrest survivors suffer from ischaemic brain injury that may lead to poor neurological outcome and death. The reperfusion injury that occurs is associated with damaging biochemical reactions, which are suppressed by mild therapeutic hypothermia (MTH). In several studies MTH has been proven to be safe, with few complications and improved survival, and is recommended by the International Liaison of Committee on Resuscitation. The aim of this paper is to recommend clinical practice guidelines for MTH treatment after cardiac arrest from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Methods: Relevant studies were identified after two consensus meetings of the SSAI Task Force on Therapeutic Hypothermia (SSAITFTH) and via literature search of the Cochrane Central Register of Controlled Trials and Medline. Evidence was assessed and consensus opinion was used when high‐grade evidence (Grade of Recommendation, GOR) was unavailable. A management strategy was developed as a consensus from the evidence and the protocols in the participating countries.Results and conclusion: Although proven beneficial only for patients with initial ventricular fibrillation (GOR A), the SSAITFTH also recommend MTH after restored spontaneous circulation, if active treatment is chosen, in patients with initial pulseless electrical activity and asystole (GOR D). Normal ethical considerations, premorbid status, total anoxia time and general condition should decide whether active treatment is required or not. MTH should be part of a standardized treatment protocol, and initiated as early as possible after indication and treatment have been decided (GOR E). There is insufficient evidence to make definitive recommendations among techniques to induce MTH, and we do not know the optimal target temperature, duration of cooling and rewarming time. New studies are needed to address the question as to how MTH affects, for example, prognostic factors.

show abstract

“…Despite CPR after OHCA and post-resuscitation care mortality remains high at 44-66 % (Langhelle et al 2003). Survival from cardiac arrest depends on a sequence of interventions, all of which have to be optimised to maximize survival (Cummins et al 1991).…”

Section: Out-of-hospital Cardiac Arrestmentioning

confidence: 99%

“…In Sweden and Norway the outcome after OHCA varies between different hospitals. Optimised in-hospital factors are associated with improved outcome after OHCA , Langhelle et al 2003.…”

Section: Out-of-hospital Cardiac Arrestmentioning

confidence: 99%

See 1 more Smart Citation

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Virkkunen¹

2009

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway

Cited by 297 publications

References 45 publications

Scandinavian Clinical practice guidelines for therapeutic hypothermia and post‐resuscitation care after cardiac arrest

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

Contact Info

Product

Resources

About