Pulseless electrical activity and asystole during in-hospital cardiac arrest: Disentangling the ‘nonshockable’ rhythms

Andrea, Luke; Shiloh, Ariel L.; Colvin, Mai; Rahmanian, Marjan; Bangar, Maneesha; Grossestreuer, Anne V.; Berg, Katherine M.; Gong, Michelle N.; Moskowitz, Ari

doi:10.1016/j.resuscitation.2023.109857

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…This includes variations in key prognostic variables such as the type of arrest, rhythm, timeline and patient age of the included populations [ 7 , 10 , 11 ]. Similarly, the cardiac arrest characteristics of in-hospital cardiac arrest (IHCA) may differ greatly from out-of-hospital populations [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of restrictive versus liberal selection criteria on survival in ECPR: a retrospective analysis of a multi-regional dataset

Diehl,

Read,

Southwood

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Extracorporeal cardiopulmonary resuscitation (ECPR) is an established rescue therapy for both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, there remains significant heterogeneity in populations and outcomes across different studies. The primary aim of this study was to compare commonly used selection criteria and their effect on survival and utilisation in an Australian ECPR cohort. Methods We performed a retrospective, observational study of three established ECPR centres in Australia, including cases from 1 January 2013 to 31 December 2020 to establish the baseline cohort. We applied five commonly used ECPR selection criteria, ranging from restrictive to liberal. Results The baseline cohort included 199 ECPR cases: 95 OHCA and 104 IHCA patients. Survival to hospital discharge was 20% for OHCA and 41.4% for IHCA. For OHCA patients, strictly applying the most restrictive criteria would have resulted in the highest survival rate 7/16 (43.8%) compared to the most liberal criteria 16/73 (21.9%). However, only 16/95 (16.8%) in our cohort strictly met the most restrictive criteria versus 73/95 (76.8%) with the most liberal criteria. Similarly, in IHCA, the most restrictive criteria would have resulted in a higher survival rate in eligible patients 10/15 (66.7%) compared to 27/59 (45.8%) with the most liberal criteria. With all criteria a large portion of survivors in IHCA would not have been eligible for ECMO if strictly applying criteria, 33/43 (77%) with restrictive and 16/43 (37%) with the most liberal criteria. Conclusions Adherence to different selection criteria impacts both the ECPR survival rate and the total number of survivors. Commonly used selection criteria may be unsuitable to select IHCA ECPR patients.

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Section: Introductionmentioning

confidence: 99%

The effect of restrictive versus liberal selection criteria on survival in ECPR: a retrospective analysis of a multi-regional dataset

Diehl,

Read,

Southwood

et al. 2023

Scand J Trauma Resusc Emerg Med

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Trends and disparities in arrhythmia-related deaths among older adults in the United States, 1999–2020

Cheema,

Nashwan

2024

Journal of Medicine, Surgery, and Public Health

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Aetiology and predictors of outcome in non‐shockable in‐hospital cardiac arrest: A retrospective cohort study from the Swedish Registry for Cardiopulmonary Resuscitation

Bruchfeld,

Ullemark,

Riva

et al. 2024

Acta Anaesthesiol Scand

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BackgroundNon‐shockable in‐hospital cardiac arrest (IHCA) is a condition with diverse aetiology, predictive factors, and outcome. This study aimed to compare IHCA with initial asystole or pulseless electrical activity (PEA), focusing specifically on their aetiologies and the significance of predictive factors.MethodsUsing the Swedish Registry of Cardiopulmonary Resuscitation, adult non‐shockable IHCA cases from 2018 to 2022 (n = 5788) were analysed. Exposure was initial rhythm, while survival to hospital discharge was the primary outcome. A random forest model with 28 variables was used to generate permutation‐based variable importance for outcome prediction.ResultsOverall, 60% of patients (n = 3486) were male and the median age was 75 years (IQR 67–81). The most frequent arrest location (46%) was on general wards. Comorbidities were present in 79% of cases and the most prevalent comorbidity was heart failure (33%). Initial rhythm was PEA in 47% (n = 2702) of patients, and asystole in 53% (n = 3086). The most frequent aetiologies in both PEA and asystole were cardiac ischemia (24% vs. 19%, absolute difference [AD]: 5.4%; 95% confidence interval [CI] 3.0% to 7.7%), and respiratory failure (14% vs. 13%, no significant difference). Survival was higher in asystole (24%) than in PEA (17%) (AD: 7.3%; 95% CI 5.2% to 9.4%). Cardiopulmonary resuscitation (CPR) durations were longer in PEA, 18 vs 15 min (AD 4.9 min, 95% CI 4.0–5.9 min). The duration of CPR was the single most important predictor of survival across all subgroup and sensitivity analyses. Aetiology ranked as the second most important predictor in most analyses, except in the asystole subgroup where responsiveness at cardiac arrest team arrival took precedence.ConclusionsIn this nationwide registry study of non‐shockable IHCA comparing asystole to PEA, cardiac ischemia and respiratory failure were the predominant aetiologies. Duration of CPR was the most important predictor of survival, followed by aetiology. Asystole was associated with higher survival compared to PEA, possibly due to shorter CPR durations and a larger proportion of reversible aetiologies.

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Pulseless electrical activity and asystole during in-hospital cardiac arrest: Disentangling the ‘nonshockable’ rhythms

Cited by 4 publications

References 25 publications

The effect of restrictive versus liberal selection criteria on survival in ECPR: a retrospective analysis of a multi-regional dataset

The effect of restrictive versus liberal selection criteria on survival in ECPR: a retrospective analysis of a multi-regional dataset

Trends and disparities in arrhythmia-related deaths among older adults in the United States, 1999–2020

Aetiology and predictors of outcome in non‐shockable in‐hospital cardiac arrest: A retrospective cohort study from the Swedish Registry for Cardiopulmonary Resuscitation

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