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Modifiable factors associated with survival for out-of-hospital cardiac arrest: Pan Asian resuscitation outcomes study (PAROS)
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Abstracts / Resuscitation 96S (2015) 43–157
AP149 Breathing difficulties entails high mortality in 112-callers – A register based follow-up study Morten Thingemann Bøtker 1,∗ , Christian Juhl Terkelsen 2 , Jan Nørtved Sørensen 3 , Søren Bruun Jepsen 4 , Søren Paaske Johnsen 5 , Erika Frischknecht Christensen 1 , Mikkel Strømgaard Andersen 1 1
Department for Research and Development, Prehospital Emergency Medical Services, Aarhus, Central Denmark Region, Denmark 2 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark 3 Emergency Medical Communication Center, Capital Region of Denmark, Denmark 4 Mobile Emergency Care Unit, Department Anaesthesiology Intensive Care Medicine, Odense University Hospital, Odense, Denmark 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Purpose of the study: Difficulty in breathing is a frequent symptom in 112-callers. The aim of this study was to compare mortality in 112-callers with breathing difficulties and other symptoms. Materials and methods: Register based follow-up study in 112-callers from the Central Denmark Region, Southern Denmark Region and Capital Region of Denmark from June 1, 2011 to December 31, 2012. We divided patients into groups according to cause of 112-call and used a generalized linear regression model to compare mortality 30 days and 1 year from index event adjusted for age and comorbidity. Results: 142,043 112-callers were included in the study and 9644 (6.8%) suffered from breathing difficulties. The overall mortality in 112-callers was 6.0% (95% CI 5.9–6.1%) at 30 days and 13.0% (95% CI 12.8–13.1%) at 1 year. The mortality in patients with breathing difficulties was 12.4 (95% CI 11.7–13.0%) at 30 days and 27.7 (95% CI 26.7–28.6%) at 1 year. Patients with breathing difficulties had a higher mortality than patients suffering other symptoms at day 30 (p < 0.001), except for patients with cardiac arrest. This difference was consistent at 1-year follow-up (p < 0.001). Kaplan–Meier cumulative mortality curves for selected symptom groups among 112 callers are displayed in Fig. 1.
Fig. 1. Kaplan–Meier cumulative mortality curves for selected causes of 112-calls.
Conclusions: 112-callers with breathing difficulties have very high mortality compared to patients suffering other symptoms.
Future research should focus on improving outcome in this patient group. http://dx.doi.org/10.1016/j.resuscitation.2015.09.246 AP150 Modifiable factors associated with survival for out-of-hospital cardiac arrest: Pan Asian resuscitation outcomes study (PAROS) Marcus Ong 1,∗ , Hideharu Tanaka 2 , Pyrseley Assam 3 , Matthew Ma 4 , Kaneko Hiroshi 5 , Kyung Won Lee 6 , Kentaro Kajino 7 , Chih-Hao Lin 8 , Han Nee Gan 9 , Pairoj Khruekarnchana 10 , Omer Alsakaf 11 , Nik Hisamuddin 12 , Nausheen Doctor 1 , Sang Do Shin 13 1
Singapore General Hospital, Singapore, Singapore Graduate School of Sport System, Kokushikan University, Tokyo, Japan 3 Singapore Clinical Research Institute, Singapore, Singapore 4 National Taiwan University, Taipei, Taiwan 5 Nagoya City Fire Department, Nagoya, Japan 6 Keimyung University Dongsan Hospital, Daegu, Republic of Korea 7 National Ministry of Health, Labor and Welfare, Osaka, Japan 8 National Cheng Kung University Hospital, Tainan, Taiwan 9 Changi General Hospital, Singapore, Singapore 10 Rajavithi Hospital, Bangkok, Thailand 11 Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates 12 University Sains Malaysia, Kelantan, Malaysia 13 Seoul National University, Seoul, Republic of Korea 2
Aim: The study aims to identify the factors that contribute to out-of-hospital cardiac arrest (OHCA) survival across countries participating in the Pan Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network (CRN) namely Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand and UAE-Dubai. Methods: Modifiable factors and rates of OHCA survival were compared between the participating countries for all OHCA presenting to emergency medical services (EMS) and participating public hospitals. A multivariate logistic regression model for survival to discharge was developed to identify important factors with significant impact. Results: A total of 66,780 OHCA cases were contributed by the PAROS CRN between January 2009 and December 2012. The univariate model showed that various resuscitation factors such as initial shockable rhythm, bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED), response times <8 min, pre-hospital defibrillation, pre-hospital drug administration and hypothermia therapy were significantly associated with survival to discharge. In the multivariate regression model, important non-modifiable factors included age 65 years and below (adjusted odds ratio (OR) 1.97 [1.83–2.13]), witnessed arrest by bystanders (OR 3.56 [3.25–3.90]) and initial shockable rhythm (OR 2.82 [2.42–3.28]). As for modifiable factors, bystander CPR (OR 1.55 [1.43–1.68]), response time < 8 min (OR 1.29 [1.16–1.43]) and pre-hospital defibrillation (OR 2.73 [2.35–3.16]) had positive impact on survival. Conversely, pre-hospital advanced airway (OR 0.73 [0.67–0.79]) and pre-hospital drug administration (OR 088 [0.78–0.99]) were negatively associated with survival.
Abstracts / Resuscitation 96S (2015) 43–157
Conclusion: This large cohort study showed that bystander CPR, pre-hospital defibrillation and shorter response times were positively associated with survival while pre-hospital advanced airway and drug administration were negatively associated. This emphasizes that developing EMS systems around the world should focus on delivering excellent basic rather than advanced life support. http://dx.doi.org/10.1016/j.resuscitation.2015.09.247 AP151 Incidence and clinical features of subarachnoid hemorrhage in out-of-hospital cardiac arrest: Multicenter retrospective study Jonghwan Shin 1 , Kibong Baek 1,∗ , Joonghee Kim 2 , Kyuseok Kim 2 , Yong Su Lim 3 , Hui Jai Lee 2 , Young Ju Son 2 1
Seoul National University Boramae Medical Center, Seoul, Republic of Korea 2 Seoul National University Bundang Hospital, Gyeongi-do, Republic of Korea 3 Gachon University Gil Hospital, Incheon, Republic of Korea Objective: The prevalence of cases of patients with subarachnoid hemorrhage (SAH) following out-of-hospital cardiac arrest (OHCA) varies between 4 and 18% among those who were admitted. The differences of prehospital and laboratory variables between SAH and non-SAH following OHCA were not known. The main objectives of our study were to describe the incidence of SAH occurring after OHCA in Korea and the differences of clinical variables between SAH and non-SAH groups. Methods: A retrospective-observational registry-based study was conducted in an emergency department (ED) at the three university hospitals. All cases of OHCA were registered in our study over the period of 5 years, from January 2009 to January 2014. Several prehospital, hospital, and laboratory variables were examined for a comparison analysis between SAH and non-SAH groups. Results: A total of 2701 patients who had cardiac arrest were registered in our database. Among them, 1131 patients (42%) had return of spontaneous circulation (ROSC) after the advanced cardiac life support (ACLS). After ROSC, brain computed tomography was performed on 836 patients and the existence of SAH was found in 98 patients (12%). There were no statistical differences between the serum electrolytes, glucose, lactate level, initial pH, PCO2 and PO2 during CPR in ED. However, gender and prehospital ROSC were significantly different between SAH and non-SAH (p = 0.001 and p = 0.006, respectively). Conclusion: The incidence of SAH after ROSC from OHCA was about 12 percent. There were no statistical differences in laboratory findings between SAH and non-SAH. http://dx.doi.org/10.1016/j.resuscitation.2015.09.248
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AP152 The difference in the change of ABGA and VBGA according to the cardiac arrest rat model: Ventricular fibrillation versus asphyxia Chang Je Park ∗ , Jonghwan Shin, Hui Jai Lee, Eunhye Choi, Seo Jin Yoon Boramae Medical Center, Seoul, Republic of Korea Objective: Blood gas analysis can be administered to cardiac arrest patients during cardiopulmonary resuscitation (CPR). However, no study to date has investigated the meaning of the blood gas analysis during CPR. To this end, this study evaluates the changes between ventricular fibrillation and asphyxia in a cardiac arrest rat model through a blood gas analysis. Methods: We analyzed 16 male rats with a weight of between 350 g and 400 g each. Cardiac arrest was induced with ventricular fibrillation (VF) in 8 rats and through asphyxia in the remaining 8 rats. For each type of cardiac arrest, no flow time was maintained for 10 min after the cardiac arrest. The rats were resuscitated through chest compressions and an infusion of epinephrine. Blood was obtained from the femoral artery (ABGA) and the other side of the femoral vein (VBGA) before the cardiac arrest was induced and 30 s and 5 min after resuscitation. Results: The PH of ABGA decreased more in the asphyxia than in the VF (p = 0.101) group, and the PH of VBGA significantly decreased more in the VF than in the asphyxia (p = 0.007) group. Statistically significant changes were observed in the arterial PCO2, PO2, HCO3 in the asphyxia group relative to the VF group. However, there were no significant changes in venous PCO2, PO2 and HCO3 between the VF and asphyxia groups. Conclusion: This study is the first to show the differences in the arterial and venous blood gas analysis between VF and asphyxia in a cardiac arrest rat model. The level of arterial PCO2, PO2 and HCO3, and the venous PH exhibited significant changes between VF and asphyxia during CPR. An additional clinical study is therefore necessary for cardiac arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2015.09.249
Abstracts / Resuscitation 96S (2015) 43–157
AP149 Breathing difficulties entails high mortality in 112-callers – A register based follow-up study Morten Thingemann Bøtker 1,∗ , Christian Juhl Terkelsen 2 , Jan Nørtved Sørensen 3 , Søren Bruun Jepsen 4 , Søren Paaske Johnsen 5 , Erika Frischknecht Christensen 1 , Mikkel Strømgaard Andersen 1 1
Department for Research and Development, Prehospital Emergency Medical Services, Aarhus, Central Denmark Region, Denmark 2 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark 3 Emergency Medical Communication Center, Capital Region of Denmark, Denmark 4 Mobile Emergency Care Unit, Department Anaesthesiology Intensive Care Medicine, Odense University Hospital, Odense, Denmark 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Purpose of the study: Difficulty in breathing is a frequent symptom in 112-callers. The aim of this study was to compare mortality in 112-callers with breathing difficulties and other symptoms. Materials and methods: Register based follow-up study in 112-callers from the Central Denmark Region, Southern Denmark Region and Capital Region of Denmark from June 1, 2011 to December 31, 2012. We divided patients into groups according to cause of 112-call and used a generalized linear regression model to compare mortality 30 days and 1 year from index event adjusted for age and comorbidity. Results: 142,043 112-callers were included in the study and 9644 (6.8%) suffered from breathing difficulties. The overall mortality in 112-callers was 6.0% (95% CI 5.9–6.1%) at 30 days and 13.0% (95% CI 12.8–13.1%) at 1 year. The mortality in patients with breathing difficulties was 12.4 (95% CI 11.7–13.0%) at 30 days and 27.7 (95% CI 26.7–28.6%) at 1 year. Patients with breathing difficulties had a higher mortality than patients suffering other symptoms at day 30 (p < 0.001), except for patients with cardiac arrest. This difference was consistent at 1-year follow-up (p < 0.001). Kaplan–Meier cumulative mortality curves for selected symptom groups among 112 callers are displayed in Fig. 1.
Fig. 1. Kaplan–Meier cumulative mortality curves for selected causes of 112-calls.
Conclusions: 112-callers with breathing difficulties have very high mortality compared to patients suffering other symptoms.
Future research should focus on improving outcome in this patient group. http://dx.doi.org/10.1016/j.resuscitation.2015.09.246 AP150 Modifiable factors associated with survival for out-of-hospital cardiac arrest: Pan Asian resuscitation outcomes study (PAROS) Marcus Ong 1,∗ , Hideharu Tanaka 2 , Pyrseley Assam 3 , Matthew Ma 4 , Kaneko Hiroshi 5 , Kyung Won Lee 6 , Kentaro Kajino 7 , Chih-Hao Lin 8 , Han Nee Gan 9 , Pairoj Khruekarnchana 10 , Omer Alsakaf 11 , Nik Hisamuddin 12 , Nausheen Doctor 1 , Sang Do Shin 13 1
Singapore General Hospital, Singapore, Singapore Graduate School of Sport System, Kokushikan University, Tokyo, Japan 3 Singapore Clinical Research Institute, Singapore, Singapore 4 National Taiwan University, Taipei, Taiwan 5 Nagoya City Fire Department, Nagoya, Japan 6 Keimyung University Dongsan Hospital, Daegu, Republic of Korea 7 National Ministry of Health, Labor and Welfare, Osaka, Japan 8 National Cheng Kung University Hospital, Tainan, Taiwan 9 Changi General Hospital, Singapore, Singapore 10 Rajavithi Hospital, Bangkok, Thailand 11 Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates 12 University Sains Malaysia, Kelantan, Malaysia 13 Seoul National University, Seoul, Republic of Korea 2
Aim: The study aims to identify the factors that contribute to out-of-hospital cardiac arrest (OHCA) survival across countries participating in the Pan Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network (CRN) namely Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand and UAE-Dubai. Methods: Modifiable factors and rates of OHCA survival were compared between the participating countries for all OHCA presenting to emergency medical services (EMS) and participating public hospitals. A multivariate logistic regression model for survival to discharge was developed to identify important factors with significant impact. Results: A total of 66,780 OHCA cases were contributed by the PAROS CRN between January 2009 and December 2012. The univariate model showed that various resuscitation factors such as initial shockable rhythm, bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED), response times <8 min, pre-hospital defibrillation, pre-hospital drug administration and hypothermia therapy were significantly associated with survival to discharge. In the multivariate regression model, important non-modifiable factors included age 65 years and below (adjusted odds ratio (OR) 1.97 [1.83–2.13]), witnessed arrest by bystanders (OR 3.56 [3.25–3.90]) and initial shockable rhythm (OR 2.82 [2.42–3.28]). As for modifiable factors, bystander CPR (OR 1.55 [1.43–1.68]), response time < 8 min (OR 1.29 [1.16–1.43]) and pre-hospital defibrillation (OR 2.73 [2.35–3.16]) had positive impact on survival. Conversely, pre-hospital advanced airway (OR 0.73 [0.67–0.79]) and pre-hospital drug administration (OR 088 [0.78–0.99]) were negatively associated with survival.
Abstracts / Resuscitation 96S (2015) 43–157
Conclusion: This large cohort study showed that bystander CPR, pre-hospital defibrillation and shorter response times were positively associated with survival while pre-hospital advanced airway and drug administration were negatively associated. This emphasizes that developing EMS systems around the world should focus on delivering excellent basic rather than advanced life support. http://dx.doi.org/10.1016/j.resuscitation.2015.09.247 AP151 Incidence and clinical features of subarachnoid hemorrhage in out-of-hospital cardiac arrest: Multicenter retrospective study Jonghwan Shin 1 , Kibong Baek 1,∗ , Joonghee Kim 2 , Kyuseok Kim 2 , Yong Su Lim 3 , Hui Jai Lee 2 , Young Ju Son 2 1
Seoul National University Boramae Medical Center, Seoul, Republic of Korea 2 Seoul National University Bundang Hospital, Gyeongi-do, Republic of Korea 3 Gachon University Gil Hospital, Incheon, Republic of Korea Objective: The prevalence of cases of patients with subarachnoid hemorrhage (SAH) following out-of-hospital cardiac arrest (OHCA) varies between 4 and 18% among those who were admitted. The differences of prehospital and laboratory variables between SAH and non-SAH following OHCA were not known. The main objectives of our study were to describe the incidence of SAH occurring after OHCA in Korea and the differences of clinical variables between SAH and non-SAH groups. Methods: A retrospective-observational registry-based study was conducted in an emergency department (ED) at the three university hospitals. All cases of OHCA were registered in our study over the period of 5 years, from January 2009 to January 2014. Several prehospital, hospital, and laboratory variables were examined for a comparison analysis between SAH and non-SAH groups. Results: A total of 2701 patients who had cardiac arrest were registered in our database. Among them, 1131 patients (42%) had return of spontaneous circulation (ROSC) after the advanced cardiac life support (ACLS). After ROSC, brain computed tomography was performed on 836 patients and the existence of SAH was found in 98 patients (12%). There were no statistical differences between the serum electrolytes, glucose, lactate level, initial pH, PCO2 and PO2 during CPR in ED. However, gender and prehospital ROSC were significantly different between SAH and non-SAH (p = 0.001 and p = 0.006, respectively). Conclusion: The incidence of SAH after ROSC from OHCA was about 12 percent. There were no statistical differences in laboratory findings between SAH and non-SAH. http://dx.doi.org/10.1016/j.resuscitation.2015.09.248
105
AP152 The difference in the change of ABGA and VBGA according to the cardiac arrest rat model: Ventricular fibrillation versus asphyxia Chang Je Park ∗ , Jonghwan Shin, Hui Jai Lee, Eunhye Choi, Seo Jin Yoon Boramae Medical Center, Seoul, Republic of Korea Objective: Blood gas analysis can be administered to cardiac arrest patients during cardiopulmonary resuscitation (CPR). However, no study to date has investigated the meaning of the blood gas analysis during CPR. To this end, this study evaluates the changes between ventricular fibrillation and asphyxia in a cardiac arrest rat model through a blood gas analysis. Methods: We analyzed 16 male rats with a weight of between 350 g and 400 g each. Cardiac arrest was induced with ventricular fibrillation (VF) in 8 rats and through asphyxia in the remaining 8 rats. For each type of cardiac arrest, no flow time was maintained for 10 min after the cardiac arrest. The rats were resuscitated through chest compressions and an infusion of epinephrine. Blood was obtained from the femoral artery (ABGA) and the other side of the femoral vein (VBGA) before the cardiac arrest was induced and 30 s and 5 min after resuscitation. Results: The PH of ABGA decreased more in the asphyxia than in the VF (p = 0.101) group, and the PH of VBGA significantly decreased more in the VF than in the asphyxia (p = 0.007) group. Statistically significant changes were observed in the arterial PCO2, PO2, HCO3 in the asphyxia group relative to the VF group. However, there were no significant changes in venous PCO2, PO2 and HCO3 between the VF and asphyxia groups. Conclusion: This study is the first to show the differences in the arterial and venous blood gas analysis between VF and asphyxia in a cardiac arrest rat model. The level of arterial PCO2, PO2 and HCO3, and the venous PH exhibited significant changes between VF and asphyxia during CPR. An additional clinical study is therefore necessary for cardiac arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2015.09.249