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Steroid use during cardiopulmonary resuscitation benefits hospital admission in out-of-hospital cardiac arrest victims
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Abstracts / Resuscitation 96S (2015) 43–157
defibrillation again. Sinus rhythm obtained. In ICU burn was noticed between knee to ankle on right leg.
Drugs AP096 Effects of graded-dose 2,3-butanedione monoxime administration on resuscitation outcomes in a prolonged out-of-hospital cardiac arrest model Byung Kook Lee 1,∗ , Kyung Woon Jeung 1 , Sung Min Lee 1 , Kyoung Hwan Song 1 , Sung Soo Choi 2 1 Chonnam National University, Gwangju, Republic of Korea 2 Howon University, Gunsan, Republic of Korea
Case 2: 78-year-old woman had mitral valve repair 4-year-ago. She had severe mitral insufficiency, high rate atrial fibrillation. Echocardiography showed pulmonary hypertension, tricuspid insufficiency, mitral stenosis. She was euroscore 9 high risk patient. Gel pad was replaced externally on right sternum-apex. She needed 3 times of defibrillations before surgery. Mitral valve was replaced. After weaning form bypass machine she was defibrillated 3 times more with gel pads. It was noticed there was burn wound between toe to mid-plantar area of right foot.
Purpose: Previous studies have shown that 2,3-butanedione monoxime (BDM) administered during cardiopulmonary resuscitation reversed ischemic contracture. Here, we aimed to investigate the effect of graded-dose BDM on resuscitation outcomes in a prolonged out-of-hospital cardiac arrest pig model. Methods: After 16 min of untreated ventricular fibrillation (VF) followed by 8 min of basic life support, thirty-six pigs were randomized to receive either 2 ml kg−1 of BDM solution (25 g l−1 ; standard-dose BDM [SDBDM group], 2 ml kg−1 of BDM solution (50 g l−1 ; high-dose BDM [HDBDM] group), or 2 ml kg−1 of saline (control group) during advanced cardiac life support (ACLS). ACLS was continued until restoration of spontaneous circulation (ROSC) or until 12 min had lapsed from the start of ACLS. Echocardiography was performed using a transoesophageal echocardiography probe inserted into a pocket created underneath the xiphoid process. The primary outcome was sustained ROSC over 1 min, and the secondary outcomes were re-arrest after achieving ROSC, LV wall thickness (LVWT), and LV area (LVA). Results: There was no difference in the ROSC rate (control, 10/12; SDBDM, 11/12; HDBDM, 12/12). However, the SDBDM (3/11 vs. 8/10, p = 0.030) and HDBDM (2/12 vs. 8/10, p = 0.008) groups showed lower incidences of re-arrest than the control group. During ACLS, the control group showed an increase in LVWT. However, the SDBDM and HDBDM groups showed no changes in LVWT over time (group-time interaction, p = 0.002). The LVWTs of the control group at 28, 29, and 30 min after induction of VF were significantly higher than those of both BDM groups. The HDBDM group showed significantly higher LVA at 28, 29, and 30 min after induction of VF than the control group. Conclusions: HDBDM and SDBDM administered during cardiopulmonary resuscitation inhibited ischemic contracture; furthermore, HDBDM suppressed the development of re-arrest after achieving ROSC. http://dx.doi.org/10.1016/j.resuscitation.2015.09.193
Conclusion: Increased use of electrical equipments may cause risk of burns despite improved safety. There was no faulty application of the grounding pad of electrocautery with good contact with the patients skin. To reduce burns related to defibrillation, using gel pads, lower energy, force equally to paddles are recommended. Our cases are unique because burn area were at distance place. http://dx.doi.org/10.1016/j.resuscitation.2015.09.192
AP097 Steroid use during cardiopulmonary resuscitation benefits hospital admission in out-of-hospital cardiac arrest victims Min-Shan Tsai 1,∗ , Chien-Hua Huang 1 , Ping-Hsun Yu 2 , Po-Ya Chuang 3 , Chao-Hsiun Tang 3 , Wei-Tien Chang 1 , Wen-Jone Chen 1 1 National Taiwan University Medical College and Hospital, Taipei, Taiwan 2 Taipei Hospital, Taipei, Taiwan 3 Taipei Medical University, Taipei, Taiwan
Background: Several studies indicated steroid supplement in combination with vasopressors during resuscitation may improve
Abstracts / Resuscitation 96S (2015) 43–157
outcomes of cardiac arrest victims. However, whether steroid use benefits resuscitation outcome in cardiac arrest needs further population-based analysis. Methods: A total of 145,644 adult patients with non-traumatic, out-of-hospital cardiac arrest (OHCA) during 2004–2011 were identified from the Taiwan National Health Insurance Research database. These patients were classified into steroid group and nonsteroid group according to steroid use or not during resuscitation, and matched with underlying characteristics, previous steroid use, the drugs and electric shock during cardiopulmonary resuscitation, medical center or not, socioeconomic status and the year when cardiac arrest occurred by using propensity score. Logistic regression analysis was used to determine the effect of steroid on hospital admission, hospital discharge and 1-year overall survival. Results: There are 2912 patients in the steroid group and 8685 patients in the matched non-steroid group. The steroid group had a higher hospital admission rate (38.38%) as compared with the non-steroid group (14.58%) (adjusted OR, 3.83; 95% CI, 3.46–4.24; P < 0.0001). The hospital discharge rate (14.68% vs. 4.08%; adjusted OR, 4.11; 95% CI, 3.48–4.86; P < 0.0001) and 1-year overall survival rate (10.92% vs. 3.49%; adjusted OR, 3.25; 95% CI, 2.71–3.89; P < 0.0001) were also significantly higher in the steroid group than in the non-steroid group. Conclusion: Steroid use during resuscitation benefits hospital admission and survival in OHCA victims. http://dx.doi.org/10.1016/j.resuscitation.2015.09.194 AP098 Post-cardiac arrest steroid use improves survival in out-of-hospital cardiac arrest survivors Min-Shan Tsai 1,∗ , Chien-Hua Huang 1 , Ping-Hsun Yu 2 , Po-Ya Chuang 3 , Chao-Hsiun Tang 3 , Wei-Tien Chang 1 , Wen-Jone Chen 1 1 National Taiwan University Medical College and Hospital, Taipei, Taiwan 2 Taipei Hospital, Taipei, Taiwan 3 Taipei Medical University, Taipei, Taiwan
Background: Several studies showed steroid use following cardiac arrest may improve outcomes in cardiac arrest survivors. However, the population-based analysis evaluating the effect of steroid during hospitalization on outcomes in cardiac arrest survivors is lacking. Methods: There were 22,768 adult patients with non-traumatic, out-of-cardiac arrest (OHCA) survivors during 2005–2011 identified from the Taiwan National Health Insurance Research database. Patients with steroid use during (cardiopulmonary resuscitation (CPR) (N = 1118) were excluded. These patients were classified into steroid group and non-steroid group based on whether steroid was used or not during hospitalization. Propensity score was used to match underlying diseases, prior steroid use, the drugs and electric shock during CPR, hospital classification, socioeconomic status and years. The effect of steroid on hospital discharge and 1-year overall survival was determined by using the logistic regression analysis. Results: There are 7638 patients in both the steroid group and the non-steroid group. 2611 patients (34.18%) out of the steroid group survived to hospital discharge when compared with 1469 patients (19.23%) in the non-steroid group (adjusted OR, 2.46; 95% CI, 2.27–2.67; P < 0.0001). The 1-year overall survival rate (21.55% vs. 12.61%; adjusted OR, 2.19; 95% CI, 1.99–2.41; P < 0.0001) was also significantly higher in the steroid group than in the non-steroid group.
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Conclusion: Post-cardiac arrest steroid use improves hospital discharge and survival in OHCA survivors. http://dx.doi.org/10.1016/j.resuscitation.2015.09.195 AP099 The effect of the adrenaline administration in OHCA patients – Part 2: Evaluation with the prefecture differences Hiroki Ueta ∗ , Hideharu Tanaka, Hiroshi Takyu, Soh Gotoh, Etsuko Sone, Shuji Shimazaki Graduate School of Kokushikan Univ., Tokyo, Japan Objectives: Administration of adrenaline to out-of-hospital cardiac arrest patients by emergency medical technician (EMT) has been recommended by ALS protocol as a part of cardiac resuscitation. However, there is a little evidence for its effectiveness. In this study, we evaluated that the influence of the time between initial EMT contacts to the administration of adrenaline (as pre-adrenaline time) on favorable neurological outcome and prefectures differences. Method: Nationwide retrospective cohort study was performed using Utstein data of 822,550 OHCA patients between 2006 and 2012. The following patients were excluded from the study: (1) Children below the age of eight, (2) Patients who had ROSC before the initial patient contact, (3) Patients who had high probability of ROSC by defibrillation, and (4) Patients whose administration of adrenaline was not documented. Coloration between the initial EMT contacts time to the administration of adrenaline (as pre-adrenaline time) on favorable neurological outcome and prefectures differences. Results: Average time to adrenaline administration was 17.6 min from the patients contact in all prefectures. Shortest prefecture was 11.9 min (CPC1-2 = 3.3%) whereas longest was 26.7 min (CPC1-2 = 2.1%). Prefectures had carried out an early adrenaline administration was higher CPC1-2. This study indicated that adrenaline time and favorable neurological outcome strongly correlated. We speculated that those prefecture differences were generated by ALS protocol, EMS training with medical oversight in individual area. Conclusion: In conclusion, early administration of adrenalin strongly correlated with favorable neurological outcome. For future improve the use of adrenaline, the following studies are necessary: (1) Review and revision of present protocol of pre-hospital adrenaline administration and (2) Early a venous access by EMT with implied consent of the local medical control. http://dx.doi.org/10.1016/j.resuscitation.2015.09.196 AP100 Comparison of two feedback devices for training Basic Life Support Skills M. Montserrat Tió ∗ , Francisco Javier Tercero, Marta Magaldi, Jaime Fontanals, Angel Caballero, Montserrat Fontanals, Enrique Carrero Hospital Clínic de Barcelona, Barcelona, Spain Purpose of the study: The use of feedback devices for cardiopulmonary resuscitation (CPR) training seems to improve skill acquisition and retention. We compared the effectiveness of two CPR feedback devices for acquisition of basic life support (BLS) skills.
Abstracts / Resuscitation 96S (2015) 43–157
defibrillation again. Sinus rhythm obtained. In ICU burn was noticed between knee to ankle on right leg.
Drugs AP096 Effects of graded-dose 2,3-butanedione monoxime administration on resuscitation outcomes in a prolonged out-of-hospital cardiac arrest model Byung Kook Lee 1,∗ , Kyung Woon Jeung 1 , Sung Min Lee 1 , Kyoung Hwan Song 1 , Sung Soo Choi 2 1 Chonnam National University, Gwangju, Republic of Korea 2 Howon University, Gunsan, Republic of Korea
Case 2: 78-year-old woman had mitral valve repair 4-year-ago. She had severe mitral insufficiency, high rate atrial fibrillation. Echocardiography showed pulmonary hypertension, tricuspid insufficiency, mitral stenosis. She was euroscore 9 high risk patient. Gel pad was replaced externally on right sternum-apex. She needed 3 times of defibrillations before surgery. Mitral valve was replaced. After weaning form bypass machine she was defibrillated 3 times more with gel pads. It was noticed there was burn wound between toe to mid-plantar area of right foot.
Purpose: Previous studies have shown that 2,3-butanedione monoxime (BDM) administered during cardiopulmonary resuscitation reversed ischemic contracture. Here, we aimed to investigate the effect of graded-dose BDM on resuscitation outcomes in a prolonged out-of-hospital cardiac arrest pig model. Methods: After 16 min of untreated ventricular fibrillation (VF) followed by 8 min of basic life support, thirty-six pigs were randomized to receive either 2 ml kg−1 of BDM solution (25 g l−1 ; standard-dose BDM [SDBDM group], 2 ml kg−1 of BDM solution (50 g l−1 ; high-dose BDM [HDBDM] group), or 2 ml kg−1 of saline (control group) during advanced cardiac life support (ACLS). ACLS was continued until restoration of spontaneous circulation (ROSC) or until 12 min had lapsed from the start of ACLS. Echocardiography was performed using a transoesophageal echocardiography probe inserted into a pocket created underneath the xiphoid process. The primary outcome was sustained ROSC over 1 min, and the secondary outcomes were re-arrest after achieving ROSC, LV wall thickness (LVWT), and LV area (LVA). Results: There was no difference in the ROSC rate (control, 10/12; SDBDM, 11/12; HDBDM, 12/12). However, the SDBDM (3/11 vs. 8/10, p = 0.030) and HDBDM (2/12 vs. 8/10, p = 0.008) groups showed lower incidences of re-arrest than the control group. During ACLS, the control group showed an increase in LVWT. However, the SDBDM and HDBDM groups showed no changes in LVWT over time (group-time interaction, p = 0.002). The LVWTs of the control group at 28, 29, and 30 min after induction of VF were significantly higher than those of both BDM groups. The HDBDM group showed significantly higher LVA at 28, 29, and 30 min after induction of VF than the control group. Conclusions: HDBDM and SDBDM administered during cardiopulmonary resuscitation inhibited ischemic contracture; furthermore, HDBDM suppressed the development of re-arrest after achieving ROSC. http://dx.doi.org/10.1016/j.resuscitation.2015.09.193
Conclusion: Increased use of electrical equipments may cause risk of burns despite improved safety. There was no faulty application of the grounding pad of electrocautery with good contact with the patients skin. To reduce burns related to defibrillation, using gel pads, lower energy, force equally to paddles are recommended. Our cases are unique because burn area were at distance place. http://dx.doi.org/10.1016/j.resuscitation.2015.09.192
AP097 Steroid use during cardiopulmonary resuscitation benefits hospital admission in out-of-hospital cardiac arrest victims Min-Shan Tsai 1,∗ , Chien-Hua Huang 1 , Ping-Hsun Yu 2 , Po-Ya Chuang 3 , Chao-Hsiun Tang 3 , Wei-Tien Chang 1 , Wen-Jone Chen 1 1 National Taiwan University Medical College and Hospital, Taipei, Taiwan 2 Taipei Hospital, Taipei, Taiwan 3 Taipei Medical University, Taipei, Taiwan
Background: Several studies indicated steroid supplement in combination with vasopressors during resuscitation may improve
Abstracts / Resuscitation 96S (2015) 43–157
outcomes of cardiac arrest victims. However, whether steroid use benefits resuscitation outcome in cardiac arrest needs further population-based analysis. Methods: A total of 145,644 adult patients with non-traumatic, out-of-hospital cardiac arrest (OHCA) during 2004–2011 were identified from the Taiwan National Health Insurance Research database. These patients were classified into steroid group and nonsteroid group according to steroid use or not during resuscitation, and matched with underlying characteristics, previous steroid use, the drugs and electric shock during cardiopulmonary resuscitation, medical center or not, socioeconomic status and the year when cardiac arrest occurred by using propensity score. Logistic regression analysis was used to determine the effect of steroid on hospital admission, hospital discharge and 1-year overall survival. Results: There are 2912 patients in the steroid group and 8685 patients in the matched non-steroid group. The steroid group had a higher hospital admission rate (38.38%) as compared with the non-steroid group (14.58%) (adjusted OR, 3.83; 95% CI, 3.46–4.24; P < 0.0001). The hospital discharge rate (14.68% vs. 4.08%; adjusted OR, 4.11; 95% CI, 3.48–4.86; P < 0.0001) and 1-year overall survival rate (10.92% vs. 3.49%; adjusted OR, 3.25; 95% CI, 2.71–3.89; P < 0.0001) were also significantly higher in the steroid group than in the non-steroid group. Conclusion: Steroid use during resuscitation benefits hospital admission and survival in OHCA victims. http://dx.doi.org/10.1016/j.resuscitation.2015.09.194 AP098 Post-cardiac arrest steroid use improves survival in out-of-hospital cardiac arrest survivors Min-Shan Tsai 1,∗ , Chien-Hua Huang 1 , Ping-Hsun Yu 2 , Po-Ya Chuang 3 , Chao-Hsiun Tang 3 , Wei-Tien Chang 1 , Wen-Jone Chen 1 1 National Taiwan University Medical College and Hospital, Taipei, Taiwan 2 Taipei Hospital, Taipei, Taiwan 3 Taipei Medical University, Taipei, Taiwan
Background: Several studies showed steroid use following cardiac arrest may improve outcomes in cardiac arrest survivors. However, the population-based analysis evaluating the effect of steroid during hospitalization on outcomes in cardiac arrest survivors is lacking. Methods: There were 22,768 adult patients with non-traumatic, out-of-cardiac arrest (OHCA) survivors during 2005–2011 identified from the Taiwan National Health Insurance Research database. Patients with steroid use during (cardiopulmonary resuscitation (CPR) (N = 1118) were excluded. These patients were classified into steroid group and non-steroid group based on whether steroid was used or not during hospitalization. Propensity score was used to match underlying diseases, prior steroid use, the drugs and electric shock during CPR, hospital classification, socioeconomic status and years. The effect of steroid on hospital discharge and 1-year overall survival was determined by using the logistic regression analysis. Results: There are 7638 patients in both the steroid group and the non-steroid group. 2611 patients (34.18%) out of the steroid group survived to hospital discharge when compared with 1469 patients (19.23%) in the non-steroid group (adjusted OR, 2.46; 95% CI, 2.27–2.67; P < 0.0001). The 1-year overall survival rate (21.55% vs. 12.61%; adjusted OR, 2.19; 95% CI, 1.99–2.41; P < 0.0001) was also significantly higher in the steroid group than in the non-steroid group.
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Conclusion: Post-cardiac arrest steroid use improves hospital discharge and survival in OHCA survivors. http://dx.doi.org/10.1016/j.resuscitation.2015.09.195 AP099 The effect of the adrenaline administration in OHCA patients – Part 2: Evaluation with the prefecture differences Hiroki Ueta ∗ , Hideharu Tanaka, Hiroshi Takyu, Soh Gotoh, Etsuko Sone, Shuji Shimazaki Graduate School of Kokushikan Univ., Tokyo, Japan Objectives: Administration of adrenaline to out-of-hospital cardiac arrest patients by emergency medical technician (EMT) has been recommended by ALS protocol as a part of cardiac resuscitation. However, there is a little evidence for its effectiveness. In this study, we evaluated that the influence of the time between initial EMT contacts to the administration of adrenaline (as pre-adrenaline time) on favorable neurological outcome and prefectures differences. Method: Nationwide retrospective cohort study was performed using Utstein data of 822,550 OHCA patients between 2006 and 2012. The following patients were excluded from the study: (1) Children below the age of eight, (2) Patients who had ROSC before the initial patient contact, (3) Patients who had high probability of ROSC by defibrillation, and (4) Patients whose administration of adrenaline was not documented. Coloration between the initial EMT contacts time to the administration of adrenaline (as pre-adrenaline time) on favorable neurological outcome and prefectures differences. Results: Average time to adrenaline administration was 17.6 min from the patients contact in all prefectures. Shortest prefecture was 11.9 min (CPC1-2 = 3.3%) whereas longest was 26.7 min (CPC1-2 = 2.1%). Prefectures had carried out an early adrenaline administration was higher CPC1-2. This study indicated that adrenaline time and favorable neurological outcome strongly correlated. We speculated that those prefecture differences were generated by ALS protocol, EMS training with medical oversight in individual area. Conclusion: In conclusion, early administration of adrenalin strongly correlated with favorable neurological outcome. For future improve the use of adrenaline, the following studies are necessary: (1) Review and revision of present protocol of pre-hospital adrenaline administration and (2) Early a venous access by EMT with implied consent of the local medical control. http://dx.doi.org/10.1016/j.resuscitation.2015.09.196 AP100 Comparison of two feedback devices for training Basic Life Support Skills M. Montserrat Tió ∗ , Francisco Javier Tercero, Marta Magaldi, Jaime Fontanals, Angel Caballero, Montserrat Fontanals, Enrique Carrero Hospital Clínic de Barcelona, Barcelona, Spain Purpose of the study: The use of feedback devices for cardiopulmonary resuscitation (CPR) training seems to improve skill acquisition and retention. We compared the effectiveness of two CPR feedback devices for acquisition of basic life support (BLS) skills.