- Email: [email protected]
TOPIC 06-4 – Hypothermia, cardiac arrest
32
Archives of Cardiovascular Diseases Supplements (2011) 2, 1-91
(1) CHU RENNES, Département de Cardiologie, Rennes, France – (2) SAMU, Rennes, France
TOPIC 06-4 – Hypothermia, cardiac arrest
Background: recent improvements in the management of out-of-hospital cardiac arrest (OHCA) should allow a better prognosis. This study aims at determining the actual characteristics and prognosis of patients treated by hypothermia for an OHCA.
May 12th, Thursday 2011
Methods: We analyzed data of patients admitted to our Cardiac Intensive Care Unit during the 3 last years (2008-10) for management of an OHCA related to a ventricular arrhythmia, by therapeutic hypothermia. Main characteristics were compared according to the intra hospital outcome.
0450 Initial management of out-of-hospital cardiac arrest: analysis of indications and results of coronary angiography Florence Boissier [Orateur] (1,2), Nicolas Weiss (2), Jean-Marc Tadié (2), Christophe Faisy (2), Jean-Luc Diehl (2), Emmanuel Guerot (2) (1) APHP, HEGP, cardiologie, Paris, France – (2) APHP HEGP, réanimation médicale, Paris, France Background: Systematic coronary angiography (CA) in emergency after out-of-hospital cardiac arrest (OHCA) is still controversial. Recommendations advise to perform CA for suspected acute coronary syndrom. As this clinical or electrocardiographic diagnosis is difficult in this setting, some teams have proposed to perform a CA for all patients with OHCA without obvious extra-cardiac cause. This attitude is debated, as those studies are not randomized, in a selected population. The aim of this study was to evaluate the indications and results of CA in a center that does not perform systematic CA after OHCA without obvious extracardiac cause. Methods: This monocentric retrospective observational study concerned 204 patients admitted for OHCA in a universitary hospital between 2003 and 2008. General characteristics of patients, initial CPR, initial ECG after return of spontaneous circulation, results of CA were recorded. Results: Mean age was 61+/-16 years. Severity score IGS 2 was 82+/18. Survival was 19%. Cardiac causes were found in 99 cases (49%). The initial ECG found a ST elevation in 54 cases (26%). CA was performed in 70 patients (34%). Significant coronary lesions were found in 47 cases (67%). Angioplasty was performed in 34 of these cases (72%), with success in 82%. In multivariate analysis, factors associated with CA were initial ventricular or supraventricular arrhythmia, chest pain, and ST elevation or depression on initial ECG. Factors associated with survival were male gender, external cardiac massage by a witness, initial ventricular arrhythmia and angioplasty.
Results: During the inclusion time, 53 patients (mean age: 58±15; male: 48 (90%)) were enrolled, included 18 STEMI (34%). Mean resuscitation delays were: “no Àow” 4.4±6, “low Àow” 23.2±16 minutes. Comparison of main data according to the intra hospital outcome (“Good outcome” group are patient discharged with good cerebral performance or moderate cerebral disability, “poor outcome” group are others) is presented in table 1. Conclusion: Despite recent improvement in the management of out-of-hospital cardiac arrest, its prognosis is still poor. Factors associated with good prognosis are: male gender, short delays of resuscitation (“no Àow” and “low Àow”), low lactate blood, coronary artery disease on the admission angiography and angioplasty.
Clinical
Anamnesis of the cardiac arrest and management
Conclusion: The bene¿t of angioplasty on survival, found in studies of more selected populations is con¿rmed here in a more severe population. It raises the problem of early identi¿cation of patients in whom angioplasty is indicated, and the interest of precise description of coronary lesions in order to uniform angioplasty decision in this speci¿c setting.
0314 Characteristics and prognosis of patients treated by hypothermia for an out-of-hospital cardiac arrest related to a ventricular arrhythmia in a French Cardiac Intensive Care Unit
▼
Caroline Vaillant [Orateur] (1), Guillaume Leurent (1), Frédéric Schnell (1), Isabelle Coudert (2), Dominique Boulmier (1), Hervé Le Breton (1), Philippe Mabo (1), Marc Bedossa (1)
© Elsevier Masson SAS. All rights reserved.
Biological a the admission
Good outcome Group n=22
Poor outcome Group n=31
p
Male
22 (100)
26 (83)
0.04
Age
55 ±13
60±16
0.27
Diabetes mellitus
3 (13)
4 (13)
0.93
Current smoker
6 (27)
9 (29)
0.88
Known cardiopathy
9 (41)
21 (67)
0.052
Time of occurring (6 am-6 pm)
16 (72)
22 (71)
0.28
“No Àow” delay (minutes)
2.0±3
5 ±6
0.039
“Low Àow” delay (minutes)
15 ±14
29 ±16
0.003
STEMI
10 (45)
9 (29)
0.21
Coronary artery disease on the admission angiography
18 (81)
16 (51)
0.02
Angioplasty
13 (59)
4 (13)
<0.001
Delay between OHCA and beginning of hypothermia (minutes)
181 ±78
233 ±113
0.08
Troponin (ng/ml)
12.7±30
3.1 ±4
0.09
Lactate blood (mmol/l)
2.4 ±1
4.0 ±2
0.009
pH
7.33 ±0.1
7.29 ±0.1
0.18
Archives of Cardiovascular Diseases Supplements (2011) 2, 1-91
(1) CHU RENNES, Département de Cardiologie, Rennes, France – (2) SAMU, Rennes, France
TOPIC 06-4 – Hypothermia, cardiac arrest
Background: recent improvements in the management of out-of-hospital cardiac arrest (OHCA) should allow a better prognosis. This study aims at determining the actual characteristics and prognosis of patients treated by hypothermia for an OHCA.
May 12th, Thursday 2011
Methods: We analyzed data of patients admitted to our Cardiac Intensive Care Unit during the 3 last years (2008-10) for management of an OHCA related to a ventricular arrhythmia, by therapeutic hypothermia. Main characteristics were compared according to the intra hospital outcome.
0450 Initial management of out-of-hospital cardiac arrest: analysis of indications and results of coronary angiography Florence Boissier [Orateur] (1,2), Nicolas Weiss (2), Jean-Marc Tadié (2), Christophe Faisy (2), Jean-Luc Diehl (2), Emmanuel Guerot (2) (1) APHP, HEGP, cardiologie, Paris, France – (2) APHP HEGP, réanimation médicale, Paris, France Background: Systematic coronary angiography (CA) in emergency after out-of-hospital cardiac arrest (OHCA) is still controversial. Recommendations advise to perform CA for suspected acute coronary syndrom. As this clinical or electrocardiographic diagnosis is difficult in this setting, some teams have proposed to perform a CA for all patients with OHCA without obvious extra-cardiac cause. This attitude is debated, as those studies are not randomized, in a selected population. The aim of this study was to evaluate the indications and results of CA in a center that does not perform systematic CA after OHCA without obvious extracardiac cause. Methods: This monocentric retrospective observational study concerned 204 patients admitted for OHCA in a universitary hospital between 2003 and 2008. General characteristics of patients, initial CPR, initial ECG after return of spontaneous circulation, results of CA were recorded. Results: Mean age was 61+/-16 years. Severity score IGS 2 was 82+/18. Survival was 19%. Cardiac causes were found in 99 cases (49%). The initial ECG found a ST elevation in 54 cases (26%). CA was performed in 70 patients (34%). Significant coronary lesions were found in 47 cases (67%). Angioplasty was performed in 34 of these cases (72%), with success in 82%. In multivariate analysis, factors associated with CA were initial ventricular or supraventricular arrhythmia, chest pain, and ST elevation or depression on initial ECG. Factors associated with survival were male gender, external cardiac massage by a witness, initial ventricular arrhythmia and angioplasty.
Results: During the inclusion time, 53 patients (mean age: 58±15; male: 48 (90%)) were enrolled, included 18 STEMI (34%). Mean resuscitation delays were: “no Àow” 4.4±6, “low Àow” 23.2±16 minutes. Comparison of main data according to the intra hospital outcome (“Good outcome” group are patient discharged with good cerebral performance or moderate cerebral disability, “poor outcome” group are others) is presented in table 1. Conclusion: Despite recent improvement in the management of out-of-hospital cardiac arrest, its prognosis is still poor. Factors associated with good prognosis are: male gender, short delays of resuscitation (“no Àow” and “low Àow”), low lactate blood, coronary artery disease on the admission angiography and angioplasty.
Clinical
Anamnesis of the cardiac arrest and management
Conclusion: The bene¿t of angioplasty on survival, found in studies of more selected populations is con¿rmed here in a more severe population. It raises the problem of early identi¿cation of patients in whom angioplasty is indicated, and the interest of precise description of coronary lesions in order to uniform angioplasty decision in this speci¿c setting.
0314 Characteristics and prognosis of patients treated by hypothermia for an out-of-hospital cardiac arrest related to a ventricular arrhythmia in a French Cardiac Intensive Care Unit
▼
Caroline Vaillant [Orateur] (1), Guillaume Leurent (1), Frédéric Schnell (1), Isabelle Coudert (2), Dominique Boulmier (1), Hervé Le Breton (1), Philippe Mabo (1), Marc Bedossa (1)
© Elsevier Masson SAS. All rights reserved.
Biological a the admission
Good outcome Group n=22
Poor outcome Group n=31
p
Male
22 (100)
26 (83)
0.04
Age
55 ±13
60±16
0.27
Diabetes mellitus
3 (13)
4 (13)
0.93
Current smoker
6 (27)
9 (29)
0.88
Known cardiopathy
9 (41)
21 (67)
0.052
Time of occurring (6 am-6 pm)
16 (72)
22 (71)
0.28
“No Àow” delay (minutes)
2.0±3
5 ±6
0.039
“Low Àow” delay (minutes)
15 ±14
29 ±16
0.003
STEMI
10 (45)
9 (29)
0.21
Coronary artery disease on the admission angiography
18 (81)
16 (51)
0.02
Angioplasty
13 (59)
4 (13)
<0.001
Delay between OHCA and beginning of hypothermia (minutes)
181 ±78
233 ±113
0.08
Troponin (ng/ml)
12.7±30
3.1 ±4
0.09
Lactate blood (mmol/l)
2.4 ±1
4.0 ±2
0.009
pH
7.33 ±0.1
7.29 ±0.1
0.18