- Email: [email protected]
GW27-e0054 Outcomes of out-of-hospital cardiac arrest with initially shockable rhythm no shock is given
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
OTHERS OTHERS GW27-e0008 Permanent Pacing in a Premature Infant with Isolated Congenital Complete Atrioventricular Block: A Case Report Yuni Twiyartti Pertiwi, Paskah Suciadi Hasan Sadikin Hospital OBJECTIVES Congenital complete atrioventricular block (CCAVB) is a rare and potentially lethal disease with an estimated incidence of 1 in 15.000 to 20.000 live born infants. Most of the patients with CCAVB have structurally normal hearts, referred to as an ’isolated’ CCAVB. METHODS None. RESULTS We present the case of a premature infant with CCAVB who underwent implantation of a permanent pacemaker. The male infant was born at 33 weeks of gestation and weighed 2150 g. Repeat fetal ultrasound assessment before demonstrated fetal cardiomegaly increased at 30 weeks gestation. The decision was made to deliver the baby by cesarean section at 33 0/7 weeks gestation. After birth, the infant showed respiratory distress despite antenatal corticosteroid therapy. There were no clinical signs of hydrops fetalis. The heart rate ranged between 40 and 50 bpm. An electrocardiogram showed that the rate of P wave was 120 bpm and the rate of QRS wave was 50 bpm. The chest x-ray demonstrated dilated heart and echocardiogram showed dilated chambers, small non significant PDA with left to right shunt, no ASD or VSD, and satisfactory contracted ventricles. Respiratory problem was resolved after supportive treatment with temporary pacing. He underwent succesfull implantation of a permanent transepicardial pacemaker (VVIR mode, stimulation rate 120 bpm, output 1,5 mV and sensitivity 2,6 mA). A unipolar epicardial lead was used and the pulse generator was implanted in a pocket made under at the anterior rectus sheath. Surgery was performed without any complications. There was no respiratory problem associated with pacemaker implantations in the abdominal wall. He was discharged at the age of 31 days with a weight of 2350 g. At the 1-year follow up he remains in well condition without any complications. CONCLUSIONS We have reported a case of a CCAVB with succesfull implantation of permanent pacemaker. GW27-e0054 Outcomes of out-of-hospital cardiac arrest with initially shockable rhythm no shock is given Yan Xiong,1,2 Jinli Liao,1 Zhihao Liu,1 Jia Xu,1 Wanwan Zhang,1 Hong Zhan,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yat-sen University; 2University of Texas Southwestern Medical Center OBJECTIVES Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with an initially shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. In this study, we described demographics, prehospital characteristics, field interventions, and outcomes in OHCA patients with an initially shockable rhythm who were and were not shocked in the field in ROC PRIMED study. METHODS We included non-traumatic OHCA cases 18 years old with VF/VT as initial rhythm, who were treated in the field by EMS providers from June 2007 to November 2009 with completed case report of data concerned within PRIMED study. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multivariate regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. RESULTS Included were 2229 adult non-traumatic OHCA cases with VF/VT as initial rhythm; 52.5% (1170) had ROSC in the field, 25.3% (564) survived to hospital discharge; 98.9% (2204) were shocked, while 1.1% (25) were not. Of the 1.1% (25) who were not shocked, 8.0% (2) achieved ROSC in the field and 4.0% (1) survived to hospital discharge. For those
C181
not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.077(95%CI 0.018-0.328, p¼0.001) and 0.070 (95%CI 0.016-0.307, p¼0.001), respectively; and for survival to hospital discharge they were 0.121(95%CI 0.044-0.377, p¼0.039) and 0.066(95%CI 0.008-0.564, p¼0.013), respectively. CONCLUSIONS In PRIMED study, 1.1% of OHCA victims with an initially shockable rhythm did not receive any shock on the scene, which was significantly associated with decreased ROSC in the field and survival to hospital discharge. GW27-e0055 Conversion to shockable rhythms and subsequent reception of shocks is not necessarily a positive survival prognosticator in initially non-shockable out-of-hospital cardiac arrest patients Yan Xiong,1,2 Ruiying Zheng,1 Shengyuan Luo,1 Jinli Liao,1 Wanwan Zhang,1 Jia Xu,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yat-sen University; 2University of Texas Southwestern Medical Center OBJECTIVES The incidence of out-of hospital cardiac arrest (OHCA) with initially non-shockable rhythms, Pulseless Electrical Activity (PEA) and Asystole, is reported to be increased and researchers found that conversion from initially non-shockable rhythms to shockable rhythms may be utilized for prognosis prediction. In this study, we were to determine whether the conversion to shockable rhythms and the subsequent reception of shocks is indeed a reliable indicator towards better survival outcomes in both OHCA patients who initially presented with pulseless electrical activity (PEA) and those presenting with asystole, and whether any differences existed between those two populations. METHODS A secondary analysis on the Resuscitation Outcomes Consortium (ROC) PRIMED dataset was performed. The primary outcome was survival to hospital discharge and the secondary outcome was prehospital return to spontaneous circulation (ROSC) in the field. We compared outcomes using chi-square analysis and univariable logistic analysis and adjusted them for confounders via multivariable logistic regression. RESULTS Of the 9,902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA patients and 1,134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. The adjusted odds ratios (ORs) for prehospital ROSC and survival to discharge were 1.862 (95%CI, 1.5902.180;p¼0.000) and 3.778 (95%CI, 2.374-6.014; p¼0.000) respectively in subsequently shocked asystolic patients, and 1.115 (95%CI 0.7201.726) and 0.951 (95%CI 0.796-1.137) respectively in subsequently shocked PEA patients. CONCLUSIONS The conversion to shockable rhythms and subsequent reception of shocks were associated with higher odds for prehospital ROSC and survival to hospital discharge in initially asystolic OHCA patients, whereas such associations were not observed in patients whose initial rhythms were PEA. GW27-e0056 Outcomes of out-of-hospital cardiac arrest with initially shockable rhythm when no shock is given Yan Xiong,1,2 Jinli Liao,1 Zhihao Liu,1 Jia Xu,1 Wanwan Zhang,1 Hong Zhan,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yatsen University; 2University of Texas, Southwestern Medical Center OBJECTIVES Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with an initially shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. In this study, we described demographics, prehospital characteristics, field interventions, and outcomes in OHCA patients with an initially shockable rhythm who were and were not shocked in the field in ROC PRIMED study. METHODS We included non-traumatic OHCA cases 18 years old with VF/VT as initial rhythm, who were treated in the field by EMS providers from June 2007 to November 2009 with completed case report of data concerned within PRIMED study. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multivariate regression analysis assessed the association between shock delivery and ROSC in the field as well as survival.
OTHERS OTHERS GW27-e0008 Permanent Pacing in a Premature Infant with Isolated Congenital Complete Atrioventricular Block: A Case Report Yuni Twiyartti Pertiwi, Paskah Suciadi Hasan Sadikin Hospital OBJECTIVES Congenital complete atrioventricular block (CCAVB) is a rare and potentially lethal disease with an estimated incidence of 1 in 15.000 to 20.000 live born infants. Most of the patients with CCAVB have structurally normal hearts, referred to as an ’isolated’ CCAVB. METHODS None. RESULTS We present the case of a premature infant with CCAVB who underwent implantation of a permanent pacemaker. The male infant was born at 33 weeks of gestation and weighed 2150 g. Repeat fetal ultrasound assessment before demonstrated fetal cardiomegaly increased at 30 weeks gestation. The decision was made to deliver the baby by cesarean section at 33 0/7 weeks gestation. After birth, the infant showed respiratory distress despite antenatal corticosteroid therapy. There were no clinical signs of hydrops fetalis. The heart rate ranged between 40 and 50 bpm. An electrocardiogram showed that the rate of P wave was 120 bpm and the rate of QRS wave was 50 bpm. The chest x-ray demonstrated dilated heart and echocardiogram showed dilated chambers, small non significant PDA with left to right shunt, no ASD or VSD, and satisfactory contracted ventricles. Respiratory problem was resolved after supportive treatment with temporary pacing. He underwent succesfull implantation of a permanent transepicardial pacemaker (VVIR mode, stimulation rate 120 bpm, output 1,5 mV and sensitivity 2,6 mA). A unipolar epicardial lead was used and the pulse generator was implanted in a pocket made under at the anterior rectus sheath. Surgery was performed without any complications. There was no respiratory problem associated with pacemaker implantations in the abdominal wall. He was discharged at the age of 31 days with a weight of 2350 g. At the 1-year follow up he remains in well condition without any complications. CONCLUSIONS We have reported a case of a CCAVB with succesfull implantation of permanent pacemaker. GW27-e0054 Outcomes of out-of-hospital cardiac arrest with initially shockable rhythm no shock is given Yan Xiong,1,2 Jinli Liao,1 Zhihao Liu,1 Jia Xu,1 Wanwan Zhang,1 Hong Zhan,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yat-sen University; 2University of Texas Southwestern Medical Center OBJECTIVES Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with an initially shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. In this study, we described demographics, prehospital characteristics, field interventions, and outcomes in OHCA patients with an initially shockable rhythm who were and were not shocked in the field in ROC PRIMED study. METHODS We included non-traumatic OHCA cases 18 years old with VF/VT as initial rhythm, who were treated in the field by EMS providers from June 2007 to November 2009 with completed case report of data concerned within PRIMED study. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multivariate regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. RESULTS Included were 2229 adult non-traumatic OHCA cases with VF/VT as initial rhythm; 52.5% (1170) had ROSC in the field, 25.3% (564) survived to hospital discharge; 98.9% (2204) were shocked, while 1.1% (25) were not. Of the 1.1% (25) who were not shocked, 8.0% (2) achieved ROSC in the field and 4.0% (1) survived to hospital discharge. For those
C181
not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.077(95%CI 0.018-0.328, p¼0.001) and 0.070 (95%CI 0.016-0.307, p¼0.001), respectively; and for survival to hospital discharge they were 0.121(95%CI 0.044-0.377, p¼0.039) and 0.066(95%CI 0.008-0.564, p¼0.013), respectively. CONCLUSIONS In PRIMED study, 1.1% of OHCA victims with an initially shockable rhythm did not receive any shock on the scene, which was significantly associated with decreased ROSC in the field and survival to hospital discharge. GW27-e0055 Conversion to shockable rhythms and subsequent reception of shocks is not necessarily a positive survival prognosticator in initially non-shockable out-of-hospital cardiac arrest patients Yan Xiong,1,2 Ruiying Zheng,1 Shengyuan Luo,1 Jinli Liao,1 Wanwan Zhang,1 Jia Xu,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yat-sen University; 2University of Texas Southwestern Medical Center OBJECTIVES The incidence of out-of hospital cardiac arrest (OHCA) with initially non-shockable rhythms, Pulseless Electrical Activity (PEA) and Asystole, is reported to be increased and researchers found that conversion from initially non-shockable rhythms to shockable rhythms may be utilized for prognosis prediction. In this study, we were to determine whether the conversion to shockable rhythms and the subsequent reception of shocks is indeed a reliable indicator towards better survival outcomes in both OHCA patients who initially presented with pulseless electrical activity (PEA) and those presenting with asystole, and whether any differences existed between those two populations. METHODS A secondary analysis on the Resuscitation Outcomes Consortium (ROC) PRIMED dataset was performed. The primary outcome was survival to hospital discharge and the secondary outcome was prehospital return to spontaneous circulation (ROSC) in the field. We compared outcomes using chi-square analysis and univariable logistic analysis and adjusted them for confounders via multivariable logistic regression. RESULTS Of the 9,902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA patients and 1,134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. The adjusted odds ratios (ORs) for prehospital ROSC and survival to discharge were 1.862 (95%CI, 1.5902.180;p¼0.000) and 3.778 (95%CI, 2.374-6.014; p¼0.000) respectively in subsequently shocked asystolic patients, and 1.115 (95%CI 0.7201.726) and 0.951 (95%CI 0.796-1.137) respectively in subsequently shocked PEA patients. CONCLUSIONS The conversion to shockable rhythms and subsequent reception of shocks were associated with higher odds for prehospital ROSC and survival to hospital discharge in initially asystolic OHCA patients, whereas such associations were not observed in patients whose initial rhythms were PEA. GW27-e0056 Outcomes of out-of-hospital cardiac arrest with initially shockable rhythm when no shock is given Yan Xiong,1,2 Jinli Liao,1 Zhihao Liu,1 Jia Xu,1 Wanwan Zhang,1 Hong Zhan,1 Ahamed H. Idris2 1 The First Affiliated Hospital of Sun Yatsen University; 2University of Texas, Southwestern Medical Center OBJECTIVES Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with an initially shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. In this study, we described demographics, prehospital characteristics, field interventions, and outcomes in OHCA patients with an initially shockable rhythm who were and were not shocked in the field in ROC PRIMED study. METHODS We included non-traumatic OHCA cases 18 years old with VF/VT as initial rhythm, who were treated in the field by EMS providers from June 2007 to November 2009 with completed case report of data concerned within PRIMED study. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multivariate regression analysis assessed the association between shock delivery and ROSC in the field as well as survival.