Insights into the epidemiology of cardiopulmonary resuscitation‐induced consciousness in out‐of‐hospital cardiac arrest

Doan, Tan; Adams, Luke A.; Schultz, Brendan V; Bunting, Denise; Parker, Lachlan; Rashford, Stephen; Bosley, Emma

doi:10.1111/1742-6723.13505

Cited by 23 publications

(24 citation statements)

References 14 publications

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“…The database contains more than 140 variables, including the Utstein‐style descriptors. Detailed description of the QAS OHCA database can be found in our previous publications 1,12 . Survival to hospital discharge and 30‐day survival data are obtained from the Queensland Hospital Admitted Patient Data Collection and the Queensland Registry of Deaths.…”

Section: Methodsmentioning

confidence: 99%

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Wissa

Schultz

Wilson

et al. 2021

Emerg Medicine Australasia

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Objective International guidelines recommend amiodarone for out‐of‐hospital cardiac arrest (OHCA) in refractory ventricular fibrillation (VF). While early appropriate interventions have been shown to improve OHCA survival, the association between time to amiodarone and survival remains to be established. Methods Included were adult OHCA in refractory VF, between January 2015 and December 2019, who received a resuscitation attempt with amiodarone from Queensland Ambulance Service paramedics. Patient characteristics and survival outcomes were described. Factors associated with survival were investigated, with a focus on time from arrest to amiodarone administration. Optimal time window for amiodarone administration was determined, and factors influencing whether amiodarone was given within the optimal time window were examined. Results A total of 502 patients were included. The average (range) time from arrest to amiodarone was 25 (4–83) min. Time to amiodarone was negatively associated with survival (adjusted odds ratio 0.93 for event survival; 95% confidence interval 0.89–0.97). The optimal time window for amiodarone was within 23 min following arrest. Patients receiving amiodarone within the optimal time had significantly better survival than those receiving it outside this window (event survival 38.3% vs 20.6%, P < 0.001; discharge survival 25.5% vs 9.7%, P < 0.001; 30‐day survival 25.1% vs 9.7%, P < 0.001). Paramedic response time (adjusted odds ratio 0.96; 95% confidence interval 0.92–0.99) and time from arrest to intravenous access (0.71; 0.67–0.76) were independent factors determining whether patients received amiodarone within the optimal time. Conclusions Earlier amiodarone administration was associated with improved survival. Strategies aimed at reducing delay to amiodarone administration have the potential to improve outcome.

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Section: Methodsmentioning

confidence: 99%

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Wissa

Schultz

Wilson

et al. 2021

Emerg Medicine Australasia

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“…Detailed description of the database can be found in our previous publications. 18 19 Briefly, it is a statewide, population-based database that prospectively collects data of all OHCA patients who are attended by QAS paramedics. 18 19 The present study included all OHCA cases that occurred in Brisbane and attended by paramedics between 1 January 2007 and 31 December 2019.…”

Section: Ohca Datamentioning

confidence: 99%

Ambient temperatures, heatwaves and out-of-hospital cardiac arrest in Brisbane, Australia

Doan¹,

Wilson

Rashford

et al. 2021

Occup Environ Med

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BackgroundThe health impacts of temperatures are gaining attention in Australia and worldwide. While a number of studies have investigated the association of temperatures with the risk of cardiovascular diseases, few examined out-of-hospital cardiac arrest (OHCA) and none have done so in Australia. This study examined the exposure–response relationship between temperatures, including heatwaves and OHCA in Brisbane, Australia.MethodsA quasi-Poisson regression model coupled with a distributed lag non-linear model was employed, using OHCA and meteorological data between 1 January 2007 and 31 December 2019. Reference temperature was chosen to be the temperature of minimum risk (21.4°C). Heatwaves were defined as daily average temperatures at or above a heat threshold (90th, 95th, 98th, 99th percentile of the yearly temperature distribution) for at least two consecutive days.ResultsThe effect of any temperature above the reference temperature was not statistically significant; whereas low temperatures (below reference temperature) increased OHCA risk. The effect of low temperatures was delayed for 1 day, sustained up to 3 days, peaking at 2 days following exposures. Heatwaves significantly increased OHCA risk across the operational definitions. When a threshold of 95th percentile of yearly temperature distribution was used to define heatwaves, OHCA risk increased 1.25 (95% CI 1.04 to 1.50) times. When the heat threshold for defining heatwaves increased to 99th percentile, the relative risk increased to 1.48 (1.11 to 1.96).ConclusionsLow temperatures and defined heatwaves increase OHCA risk. The findings of this study have important public health implications for mitigating strategies aimed at minimising temperature-related OHCA.

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“…An Australian group report an incidence of 0.23% of CPR-related consciousness in OHCA patients. Of the reported 52 patients with CPR-related consciousness, 18 presented with combativeness/agitation [44].…”

Section: Current Concepts In Cpr -"The Chain Of Survival"mentioning

confidence: 99%

Passive leg raising in out-of-hospital cardiac arrest

et al. 2019

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Background: The chances of survival after an out-of-hospital cardiac arrest (OHCA) are one in ten. The majority of survivors have no or relatively mild neurological sequelae. Interventions are time critical and well-timed management is challenging. All aspects of resuscitation in an OHCA are based on knowledge of clinically important actions and their timing in OHCA management. Randomised trials face ethical and legal barriers. The victim is unable to give informed consent and obtaining consent from a legal surrogate delays resuscitation actions. This highlights the need for observational efforts in cardiac arrest research, together with the further exploration of clinically relevant factors and their importance to survival chances in OHCA. Methods: Study I describes the importance of the number of defibrillations in OHCA and their association with survival chances. It is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). Study II describes the implementation and feasibility of a direct pathway to immediate coronary angiography after OHCA and its outcome. Patients were screened in the field by ambulance crews and referred to the catheterisation laboratory after consultation with the interventionalist. Study III examines the effect of a basic manoeuvre (passive leg-raising, PLR) in cardiopulmonary resuscitation (CPR) in an observation comparing PLR with standard CPR. Study IV determines the association between ambulance response time and survival after an OHCA, based on data reported to the SRCR. Results: Study I: Between 1990 and 2015, 19,519 patients with a shockable rhythm were reported to the SRCR and included in the study. The chances of survival decreased as the number of defibrillations required increased. Among patients found in a shockable rhythm, 7.5% required more than 10 shocks. Among the witnessed cases, we identified 12 factors associated with survival to 30 days, one of which was the number of shocks that were delivered. Study II: Prehospital screening identified 86 OHCA patients, but only 58% fulfilled the given criteria for pathway activation. Among these, the angiography procedure was started within an hour after collapse in half the cases and the majority had a culprit lesion. Thirty per cent of the patients survived to 30 days and 92% of the survivors presented with a shockable rhythm. All survivors had a good cerebral performance or sufficient function to manage activities of daily life independently. Study III: The PLR manoeuvre was performed in 44% of the n=3,554 OHCA patients included in the study. Survival to 30 days was 7.9% among patients who received PLR and 13.5% among those who did not (OR 0.55; 95% CI 0.44-0.69; p < 0.0001). When matching 1:1 on a propensity score, the difference in 30-day survival between the two groups disappeared (OR 1.07; CI 0.80-1.44; p = 0.65). The matched comparison showed a 30-day survival rate of 8.6% in the PLR group versus 8.2% in the control group. Study IV: Survival chances after a witnessed OHCA decreased as ambulance respo...

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Insights into the epidemiology of cardiopulmonary resuscitation‐induced consciousness in out‐of‐hospital cardiac arrest

Cited by 23 publications

References 14 publications

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Ambient temperatures, heatwaves and out-of-hospital cardiac arrest in Brisbane, Australia

Passive leg raising in out-of-hospital cardiac arrest

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