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Is there any correlation between the percentage of defibrillable rhythms and witnessed cardiac arrests?
Abstracts / Resuscitation 96S (2015) 43–157
AP169 Survival of patients suffering out-of-hospital cardiac arrest treated by the EMS SUMMA 112, Madrid, Spain Jose Maria Navalpotro Pascual ∗ , Francisco Alfonso Peinado Vallejo, Anselmo Corral Sánchez, Juan Valenciano Rodríguez, Juan Les González, Jesús Bravo Rodríguez-Barbero SUMMA 112, Madrid, Spain The cardiac arrest (CA) is the leading cause of early death in Western countries, including Spain. Therefore, we must know the actual state of out-of-hospital cardiac arrest (OHCA) in our country and the results achieved by our national health system. Purpose: To describe the epidemiological profile of OHCA in Madrid, Spain, and the survival rate to hospital admission. Material and methods: As part of the OHSCAR Project (Out-of-Hospital Spanish Cardiac Arrest Registry), a prospective, observational clinical cohort study including 1,162 OHCA treated by the EMS SUMMA 112, Madrid, Spain, from October 2013 to September 2014 was conducted. Two hundred twenty-five patients were excluded because CPR was futile or was not performed. The following independent endpoints were studied: age, sex, initial rhythm of OHCA, etiology, whether OHCA was or was not witnessed, who was the witness, whether CPR was initiated before the arrival of the EMS and whether OHCA was witnessed by the EMS. Survival to hospital admission was the dependent endpoint. Results: A total of 937 OHCA were analyzed (males 69.6%, median age (RIQ) 65 years old (51.25–78). Significant differences (p < 0.001) in survival were found for OHCA witnessed by the EMS (57.3% versus 29.5% if not witnessed; adjRR 3.2, 95% CI 2.2–4.6), initial defibrillable rhythm (62.4% versus 27.0% if not defibrillable; adjRR 4.5, 95% CI 3.2–6.3) and witnessed OHCA (37.7% versus 19.1% if not witnessed; adjRR 2.5, 95% CI 1.7–3.9). No significant difference was found for the other endpoints. Conclusions: Survival increased if OHCA was witnessed by the EMS and an initial defibrillable rhythm was present. Patients were more likely to survive to hospital admission if OHCA was witnessed. http://dx.doi.org/10.1016/j.resuscitation.2015.09.266 AP170 Is there any correlation between the percentage of defibrillable rhythms and witnessed cardiac arrests? Jose Maria Navalpotro Pascual ∗ , Francisco Alfonso Peinado Vallejo, Juan Valenciano Rodríguez, Anselmo Corral Sánchez, Juan Les González, Jesús Bravo Rodríguez-Barbero SUMMA 112, Madrid, Spain Although many studies have shown that the shorter time from out-of-hospital cardiac arrest (OHCA) to the recording of the initial rhythm, the higher percentage of defibrillable rhythms, does this depends on the presence/absence and type of witness? Purpose: To calculate the percentage and significant differences, if any, of OHCAs presenting with defibrillable rhythms correlated to the presence/absence and type of witness. Material and methods: An observational, prospective clinical cohort study including 1162 OHCAs treated by the EMS SUMMA 112, Madrid, Spain, from October 2013 to September 2014 was conducted. Patients were excluded (225) if cardiopulmonary resuscitation (CPR) was futile or was not performed. As independent
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variables were considered: age, sex, witnessed/unwitnessed OHCA, type of witness and CPR performed prior to arrival of EMS. The dependent variable was the initial rhythm of OHCA. RESULTS: A total of 937 OHCAs were analyzed (male patients, 69.6%) with a median (RIQ) age of 65 years (51.25–78). OHCAs were reported as witnessed in 737 patients, unwitnessed in 152 and unknown in 48. OHCAs were witnessed by bystanders (63.5%), by healthcare professionals not belonging to EMS (15.2%), by EMS staff (19.6%) and by personnel of other departments such as police or fire (1.6%). CPR was initiated before the arrival of EMS in 55.2%. Witnessed OHCAs correlated significantly (p = 0.001) to a higher percentage of defibrillable rhythms (21.7% versus 10.5%; adjRR 2.1, 95% CI 1.3–3.3). No significant differences in defibrillable rhythms were found for the type of witness and CPR performed prior to arrival of EMS. Conclusions: Witnessed OHCAs are more likely to present with defibrillable rhythms. http://dx.doi.org/10.1016/j.resuscitation.2015.09.267 AP171 The obesity paradox is associated with admission to intensive care units, but not with hospital discharge Ioanna Galatianou 1 , George Karlis 1 , Aristotelis Apostolopoulos 1 , Georgios Intas 1 , Nicoletta Iacovidou 1 , Anil Gulati 2 , Theodoros Xanthos 2,∗ 1
University of Athens, Medical School, Athens, Greece 2 Midwestern University of Chicago, Illinois, USA Purpose: The body mass index (BMI) has been linked with patient outcomes from cardiovascular or other disease. The aim of the present study was to examine the outcome of out-of-hospital cardiac arrest (OHCA) victims in a tertiary Greek hospital and possible associations between Intensive Care Unit (ICU) admission and survival with their BMI. Materials and methods: We performed a prospective observational study including consecutive OHCA victims that were transferred to the Emergency Department (ED) from May 2014 to December 2014. Based on BMI we divided them in two groups: the normal BMI group (BMI < 25) and the elevated BMI group (BMI ≥ 25). Results: The study included 84 patients (61 males and 23 females) with a mean age of 59.3 ± 12.4 years and a mean BMI of 29.8. The transfer time from the site of OHCA to ED was 7.8 ± 4.1 min for normal BMI group and 10.1 ± 8.1 min for elevated BMI group (p = 0.255). At the time of ED admission 72 patients (85.7%) had asystole/pulseless electrical activity (PEA) and 12 (14.3%) had ventricular fibrillation (VF). Between BMI group comparisons revealed statistical significant difference to ICU admission (17.6%) vs. (6.25%), p = 0.049, but no statistical difference to hospital discharge (10.3%) vs. (6.25%), p = 0.125 for the elevated BMI group. Patients who presented with VF, irrespectively of their BMI, had better survival to hospital discharge (33.3%), compared to those with non-shockable presenting rhythms (p = 0.002). The overall survival was 9.5% (8 out of 84 patients). Conclusions: In the present study we observed statistical significant difference to ICU admission in the elevated BMI group. More studies are needed to confirm or refute this “obesity paradox”. The overall survival was close to that reported from large European registries. http://dx.doi.org/10.1016/j.resuscitation.2015.09.268
AP169 Survival of patients suffering out-of-hospital cardiac arrest treated by the EMS SUMMA 112, Madrid, Spain Jose Maria Navalpotro Pascual ∗ , Francisco Alfonso Peinado Vallejo, Anselmo Corral Sánchez, Juan Valenciano Rodríguez, Juan Les González, Jesús Bravo Rodríguez-Barbero SUMMA 112, Madrid, Spain The cardiac arrest (CA) is the leading cause of early death in Western countries, including Spain. Therefore, we must know the actual state of out-of-hospital cardiac arrest (OHCA) in our country and the results achieved by our national health system. Purpose: To describe the epidemiological profile of OHCA in Madrid, Spain, and the survival rate to hospital admission. Material and methods: As part of the OHSCAR Project (Out-of-Hospital Spanish Cardiac Arrest Registry), a prospective, observational clinical cohort study including 1,162 OHCA treated by the EMS SUMMA 112, Madrid, Spain, from October 2013 to September 2014 was conducted. Two hundred twenty-five patients were excluded because CPR was futile or was not performed. The following independent endpoints were studied: age, sex, initial rhythm of OHCA, etiology, whether OHCA was or was not witnessed, who was the witness, whether CPR was initiated before the arrival of the EMS and whether OHCA was witnessed by the EMS. Survival to hospital admission was the dependent endpoint. Results: A total of 937 OHCA were analyzed (males 69.6%, median age (RIQ) 65 years old (51.25–78). Significant differences (p < 0.001) in survival were found for OHCA witnessed by the EMS (57.3% versus 29.5% if not witnessed; adjRR 3.2, 95% CI 2.2–4.6), initial defibrillable rhythm (62.4% versus 27.0% if not defibrillable; adjRR 4.5, 95% CI 3.2–6.3) and witnessed OHCA (37.7% versus 19.1% if not witnessed; adjRR 2.5, 95% CI 1.7–3.9). No significant difference was found for the other endpoints. Conclusions: Survival increased if OHCA was witnessed by the EMS and an initial defibrillable rhythm was present. Patients were more likely to survive to hospital admission if OHCA was witnessed. http://dx.doi.org/10.1016/j.resuscitation.2015.09.266 AP170 Is there any correlation between the percentage of defibrillable rhythms and witnessed cardiac arrests? Jose Maria Navalpotro Pascual ∗ , Francisco Alfonso Peinado Vallejo, Juan Valenciano Rodríguez, Anselmo Corral Sánchez, Juan Les González, Jesús Bravo Rodríguez-Barbero SUMMA 112, Madrid, Spain Although many studies have shown that the shorter time from out-of-hospital cardiac arrest (OHCA) to the recording of the initial rhythm, the higher percentage of defibrillable rhythms, does this depends on the presence/absence and type of witness? Purpose: To calculate the percentage and significant differences, if any, of OHCAs presenting with defibrillable rhythms correlated to the presence/absence and type of witness. Material and methods: An observational, prospective clinical cohort study including 1162 OHCAs treated by the EMS SUMMA 112, Madrid, Spain, from October 2013 to September 2014 was conducted. Patients were excluded (225) if cardiopulmonary resuscitation (CPR) was futile or was not performed. As independent
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variables were considered: age, sex, witnessed/unwitnessed OHCA, type of witness and CPR performed prior to arrival of EMS. The dependent variable was the initial rhythm of OHCA. RESULTS: A total of 937 OHCAs were analyzed (male patients, 69.6%) with a median (RIQ) age of 65 years (51.25–78). OHCAs were reported as witnessed in 737 patients, unwitnessed in 152 and unknown in 48. OHCAs were witnessed by bystanders (63.5%), by healthcare professionals not belonging to EMS (15.2%), by EMS staff (19.6%) and by personnel of other departments such as police or fire (1.6%). CPR was initiated before the arrival of EMS in 55.2%. Witnessed OHCAs correlated significantly (p = 0.001) to a higher percentage of defibrillable rhythms (21.7% versus 10.5%; adjRR 2.1, 95% CI 1.3–3.3). No significant differences in defibrillable rhythms were found for the type of witness and CPR performed prior to arrival of EMS. Conclusions: Witnessed OHCAs are more likely to present with defibrillable rhythms. http://dx.doi.org/10.1016/j.resuscitation.2015.09.267 AP171 The obesity paradox is associated with admission to intensive care units, but not with hospital discharge Ioanna Galatianou 1 , George Karlis 1 , Aristotelis Apostolopoulos 1 , Georgios Intas 1 , Nicoletta Iacovidou 1 , Anil Gulati 2 , Theodoros Xanthos 2,∗ 1
University of Athens, Medical School, Athens, Greece 2 Midwestern University of Chicago, Illinois, USA Purpose: The body mass index (BMI) has been linked with patient outcomes from cardiovascular or other disease. The aim of the present study was to examine the outcome of out-of-hospital cardiac arrest (OHCA) victims in a tertiary Greek hospital and possible associations between Intensive Care Unit (ICU) admission and survival with their BMI. Materials and methods: We performed a prospective observational study including consecutive OHCA victims that were transferred to the Emergency Department (ED) from May 2014 to December 2014. Based on BMI we divided them in two groups: the normal BMI group (BMI < 25) and the elevated BMI group (BMI ≥ 25). Results: The study included 84 patients (61 males and 23 females) with a mean age of 59.3 ± 12.4 years and a mean BMI of 29.8. The transfer time from the site of OHCA to ED was 7.8 ± 4.1 min for normal BMI group and 10.1 ± 8.1 min for elevated BMI group (p = 0.255). At the time of ED admission 72 patients (85.7%) had asystole/pulseless electrical activity (PEA) and 12 (14.3%) had ventricular fibrillation (VF). Between BMI group comparisons revealed statistical significant difference to ICU admission (17.6%) vs. (6.25%), p = 0.049, but no statistical difference to hospital discharge (10.3%) vs. (6.25%), p = 0.125 for the elevated BMI group. Patients who presented with VF, irrespectively of their BMI, had better survival to hospital discharge (33.3%), compared to those with non-shockable presenting rhythms (p = 0.002). The overall survival was 9.5% (8 out of 84 patients). Conclusions: In the present study we observed statistical significant difference to ICU admission in the elevated BMI group. More studies are needed to confirm or refute this “obesity paradox”. The overall survival was close to that reported from large European registries. http://dx.doi.org/10.1016/j.resuscitation.2015.09.268