Survival after out-of-hospital cardiac arrest, Viet Nam: multicentre prospective cohort study

Ngoc, Son; Luong, Chinh Quoc; Pham, Duy Khanh; Nguyen, Chi Van; Ton, Tra T; Pham, Thao T; Hoang, Quoc T; Hoang, Hue Thi; Nguyen, Duong; Khuong, Dai Q; Nguyen, Quan Huu; Nguyen, Tuan Anh; Pham, Hanh M; Nguyen, My Ha; McNally, Bryan; Ong, Marcus Eh; Nguyen, Anh Dat

doi:10.2471/blt.20.269837

Cited by 14 publications

(26 citation statements)

References 36 publications

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“…The mortality rates of our patients at 30 and 90 days of ictus were lower than the rates reported in previous studies (22-25% and 25-29%, respectively) [5,38]. These differences might be because our cohort is likely to be selected, as many patients with aneurysmal SAH in Vietnam are not transferred to the central hospital and might die in the local hospital, as well as die outside of the hospital [39], and might also be attributed to our study only including patients presenting to the participating hospitals within 4 days of ictus and excluding patients for whom admission GCS was unable to score (e.g., in the intubated patients). Therefore, our cohort may not reflect all aneurysmal SAHs in the region.…”

Section: Discussioncontrasting

confidence: 56%

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

et al. 2021

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Background The prevalence of risk factors for poor outcomes from aneurysmal subarachnoid hemorrhage (SAH) varies widely and has not been fully elucidated to date in Vietnam. Understanding the risk and prognosis of aneurysmal SAH is important to reduce poor outcomes in Vietnam. The aim of this study, therefore, was to investigate the rate of poor outcome at 90 days of ictus and associated factors from aneurysmal SAH in the country. Methods We performed a multicenter prospective cohort study of patients (≥18 years) presenting with aneurysmal SAH to three central hospitals in Hanoi, Vietnam, from August 2019 to August 2020. We collected data on the characteristics, management, and outcomes of patients with aneurysmal SAH and compared these data between good (defined as modified Rankin Scale (mRS) of 0 to 3) and poor (mRS, 4–6) outcomes at 90 days of ictus. We assessed factors associated with poor outcomes using logistic regression analysis. Results Of 168 patients with aneurysmal SAH, 77/168 (45.8%) were men, and the median age was 57 years (IQR: 48–67). Up to 57/168 (33.9%) of these patients had poor outcomes at 90 days of ictus. Most patients underwent sudden-onset and severe headache (87.5%; 147/168) and were transferred from local to participating central hospitals (80.4%, 135/168), over half (57.1%, 92/161) of whom arrived in central hospitals after 24 hours of ictus, and the initial median World Federation of Neurological Surgeons (WFNS) grading score was 2 (IQR: 1–4). Nearly half of the patients (47.0%; 79/168) were treated with endovascular coiling, 37.5% (63/168) were treated with surgical clipping, the remaining patients (15.5%; 26/168) did not receive aneurysm repair, and late rebleeding and delayed cerebral ischemia (DCI) occurred in 6.1% (10/164) and 10.4% (17/163) of patients, respectively. An initial WFNS grade of IV (odds ratio, OR: 15.285; 95% confidence interval, CI: 3.096–75.466) and a grade of V (OR: 162.965; 95% CI: 9.975–2662.318) were independently associated with poor outcomes. Additionally, both endovascular coiling (OR: 0.033; 95% CI: 0.005–0.235) and surgical clipping (OR: 0.046; 95% CI: 0.006–0.370) were inversely and independently associated with poor outcome. Late rebleeding (OR: 97.624; 95% CI: 5.653–1686.010) and DCI (OR: 15.209; 95% CI: 2.321–99.673) were also independently associated with poor outcome. Conclusions Improvements are needed in the management of aneurysmal SAH in Vietnam, such as increasing the number of aneurysm repairs, performing earlier aneurysm treatment by surgical clipping or endovascular coiling, and improving both aneurysm repairs and neurocritical care.

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Section: Discussioncontrasting

confidence: 56%

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

et al. 2021

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“…The lower rate of CPR success rate among patients with out-ofhospital CA in the present study may also be due to the fact that only 12.5% of them had been taken to hospital by emergency medical services and the others had been taken by private vehicles or taxi and hence, had not received out-of-hospital CPR. A former study also reported the same nding (44).…”

Section: Discussionsupporting

confidence: 55%

Cardiopulmonary Resuscitation of Patients with Coronavirus Disease 2019: A One-Year Survey in The West of Iran

Goodarzi

Khodaveisi

Abdi

et al. 2021

Preprint

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Background The coronavirus disease 2019 (COVID-19) is associated with high risk of cardiac arrest (CA). Therefore, assessing cardiopulmonary resuscitation (CPR) success among patients with COVID-19 and employing effective strategies for its improvement are essential. The present study aimed at assessing the one-year epidemiology and outcomes of CPR among patients with COVID-19. Methods This cross-sectional descriptive-analytical study was conducted in January 2021 in the emergency departments of two hospitals in Hamadan and Kermanshah, Iran. Participants were 487 patients with confirmed COVID-19 and CA who had undergone CPR during the one-year period between January 20, 2020 and January 20, 2021. Data were collected using the available CPR documentation forms developed based on the Utstein Style. Data analysis was performed via the Chi-square, Fisher’s exact, and Mann-Whitney U tests and the logistic regression analysis. Results Participants’ age was 69.31 ± 14.73 years and most of them were male (61.8%) and suffered from at least one underlying disease (58.1%). The rate of total and in-hospital CA was 9.67% and 9.39%, respectively. The most prevalent first documented rhythm was asystole and the highest responsivity to CPR was for shockable rhythms. The rate of the return of spontaneous circulation was 9% and the rate of survival to hospital discharge was 2%. The significant predictors of CPR success were age, epinephrine administration time interval, and CPR duration. Conclusion CPR outcomes among patients with COVID-19 are poor, particularly among those with asystole and bradycardia. Old age and high or low doses of epinephrine can reduce CPR success, while CPR prolongation can improve CPR outcomes.

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“…This multicenter prospective observational study is part of the Pan-Asian Resuscitation Outcomes Study (PAROS), Clinical Research Network, which collects data on patients with OHCA admitted to hospital emergency departments (EDs) in countries of Asia [ 31 – 33 ]. In this study, we used only data for Vietnam.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, the ambulances, trained and accredited medical staff, and life-saving equipment available are limited, and medical oversight and regular monitoring of quality indicators are uncommon [ 27 , 29 ]. As a result, the staff of the EMS is often overworked and not able to respond promptly to emergencies [ 27 – 31 ]. Furthermore, although national health insurance was established in 1992 to improve access to health care and mitigate the negative impact of user fees introduced in 1989, neither EMS nor private ambulance services are currently covered by health insurance.…”

Section: Introductionmentioning

confidence: 99%

“…A previous study has shown that only 4% (3/75) of patients with injury were transported to the hospital by ambulances [ 25 ]. Most patients are brought by taxi, private vehicle, or motorbike, usually with no first-aid having been provided [ 21 , 25 , 26 , 30 , 31 ]. Thus, basic (BLS) and advanced life support (ALS) treatment is often delayed for patients with life-threatening illnesses or injuries until they arrive at the hospital.…”

Section: Introductionmentioning

confidence: 99%

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Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study

et al. 2021

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Background Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Methods We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). Conclusion In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

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Survival after out-of-hospital cardiac arrest, Viet Nam: multicentre prospective cohort study

Cited by 14 publications

References 36 publications

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

Cardiopulmonary Resuscitation of Patients with Coronavirus Disease 2019: A One-Year Survey in The West of Iran

Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study

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