Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial

Havránek, Štěpán; Fingrová, Zdeňka; Rob, Daniel; Šmalcová, Jana; Kaválková, Petra; Franěk, Ondřej; Šmíd, Ondřej; Huptych, Michal; Dusík, Milan; Linhart, Aleš; Bělohlávek, Jan

doi:10.1016/j.resuscitation.2022.10.006

Cited by 27 publications

(29 citation statements)

References 36 publications

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“…In a subsequent post-hoc analysis of the Prague trial, authors reported that in the presence of an initial shockable rhythm, treatment with the invasive approach was associated with a neurologically favorable survival for 180 days [ 28 ]. Indeed, survival with good neurological recovery between shockable and non-shockable initial rhythms was significantly different, i.e., 49% vs. 8% in the invasive strategy and 33% vs. 2% in the standard ALS.…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.

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Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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show abstract

“…Still, in a multicenter cohort study, pre-ECPR and 24-hour lactate levels were identified as a prognostic marker for 1-year survival. 30 Furthermore, in a recent post-hoc analysis of the Prague OHCA trial, 31 serial lactate levels measured during the first 24 h following arrest were significantly correlated with favorable neurological outcome in patients undergoing ECPR. Although our findings seem to contradict this analysis, the first measured lactate levels in the Prague OHCA cohort did not differ significantly either upon admission between survivors and non-survivors (7.8 vs 9.7 mmol/L).…”

Section: Discussionmentioning

confidence: 99%

Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial

Ubben,

Heuts,

Delnoij

et al. 2024

Resuscitation Plus

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“…The prognoses of OHCA patients varied according to their eGFR when the initial CA rhythm at the scene was shockable, possibly because patients with initial shockable rhythm are highly likely to have reversible underlying causes and a cardiac origin for their arrest. 6 Renal dysfunction is reportedly associated with a high incidence of cardiogenic CA and mortality. 3 , 4 The relationship between renal dysfunction and neurological outcomes after CA might be explained by the mechanism of the brain's original vulnerability to ischemia, impaired cerebral autoregulation, and cardiovascular dysfunction in the presence of renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 4 However, determining the cause of CA during resuscitation remains challenging, thus limiting the clinical applicability of such studies. Additionally, while cardiac rhythm is a dominant factor in characterizing the features of OHCAs, 5 , 6 , 7 it was not considered in the previous studies. Therefore, it would be necessary to analyze shockable and non‐shockable rhythm separately, and we categorized patients based on initial rhythm to enhance clinical implications and interpretation.…”

Section: Introductionmentioning

confidence: 99%

Association between eGFR and neurological outcomes among patients with out‐of‐hospital cardiac arrest: A nationwide prospective study in Japan

Kandori,

Okada,

Nakajima

et al. 2024

Acute Medicine & Surgery

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AimWe aimed to investigate the association between estimated glomerular filtration rate and prognosis in out‐of‐hospital cardiac arrest patients and explore the heterogeneity of the association.MethodsPatients experiencing out‐of‐hospital cardiac arrest due to medical causes and registered in the JAAM‐OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1‐month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model.ResultsOf the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1‐month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45–59 mL/min/1.73 m2, 0.61 [0.47–0.79]; 30–44 mL/min/1.73 m2, 0.45 [0.32–0.62]; 15–29 mL/min/1.73 m2, 0.35 [0.20–0.63]; and <15 mL/min/1.73 m2, 0.14 [0.07–0.27]). Estimated glomerular filtration rate was associated with neurological outcomes in patients aged <65 years with initial shockable rhythm but not in those aged >65 years or patients with initial pulseless electrical activity or asystole.ConclusionThe estimated glomerular filtration rate is associated with neurological prognosis in out‐of‐hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non‐shockable rhythm.

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Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial

Cited by 27 publications

References 36 publications

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial

Association between eGFR and neurological outcomes among patients with out‐of‐hospital cardiac arrest: A nationwide prospective study in Japan

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