Public-Access Defibrillation Leads to Better Neurological Outcome Even in Patients Without Pre-Hospital Return of Spontaneous Circulation: A Population-Based Cohort Study

2019 ◽  
Author(s):  
Takahiro Nakashima ◽  
Teruo Noguchi ◽  
Yoshio Tahara ◽  
Kunihiro Nishimura ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Cohort Study ◽  
Neurological Outcome ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Public Access ◽  
Return Of Spontaneous Circulation ◽  
Public Access Defibrillation ◽  
Defibrillation Leads

Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study

The Lancet ◽  
2019 ◽  
Vol 394 (10216) ◽  
pp. 2255-2262 ◽  
Author(s):  
Takahiro Nakashima ◽  
Teruo Noguchi ◽  
Yoshio Tahara ◽  
Kunihiro Nishimura ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Population Based ◽  
Public Access ◽  
Neurological Outcomes ◽  
Public Access Defibrillation ◽  
Hospital Cardiac Arrest

scholarly journals Infrared pupillometry to help predict neurological outcome for patients achieving return of spontaneous circulation following cardiac arrest: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Alex Monk ◽  
Shashank Patil
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Objective Measure ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Return Of Spontaneous Circulation ◽  
Use Of Resources ◽  
Infrared Pupillometry ◽  
Poor Neurological Outcome

Abstract Background Despite advances in resuscitation care, mortality rates following cardiac arrest (CA) remain high. Between one-quarter (in-hospital CA) and two-thirds (out of hospital CA) of patients admitted comatose to intensive care die of neurological injury. Neuroprognostication determines an informed and timely withdrawal of life sustaining treatment (WLST), sparing the patient unnecessary suffering, alleviating family distress and allowing a more utilitarian use of resources. The latest Resuscitation Council UK (2015) guidance on post-resuscitation care provides the current multi-modal neuroprognostication strategy to predict neurological outcome. Its modalities include neurological examination, neurophysiological tests, biomarkers and radiology. Despite each of the current strategy’s predictive modalities exhibiting limitations, meta-analyses show that three, namely PLR (pupillary light reflex), CR (corneal reflex) and N20 SSEP (somatosensory-evoked potential), accurately predict poor neurological outcome with low false positive rates. However, the quality of evidence is low, reducing confidence in the strategy’s results. While infrared pupillometry (IRP) is not currently used as a prognostication modality, it can provide a quantitative and objective measure of pupillary size and PLR, giving a definitive view of the second and third cranial nerve activity, a predictor of neurological outcome. Methods The proposed study will test the hypothesis, “in those patients who remain comatose following return of spontaneous circulation (ROSC) after CA, IRP can be used early to help predict poor neurological outcome”. A comprehensive review of the evidence using a PRISMA-P (2015) compliant methodology will be underpinned by systematic searching of electronic databases and the two authors selecting and screening eligible studies using the Cochrane data extraction and assessment template. Randomised controlled trials and retrospective and prospective studies will be included, and the quality and strength of evidence will be assessed using the Grading  of Recommendation, Assessment and Evaluation (GRADE) approach. Discussion IRP requires rudimentary skill and is objective and repeatable. As a clinical prognostication modality, it may be utilised early, when the strategy’s other modalities are not recommended. Corroboration in the evidence would promote early use of IRP and a reduction in ICU bed days. Systematic review registration PROSPERO CRD42018118180

scholarly journals Serum potassium level on hospital arrival and survival after out-of-hospital cardiac arrest: The CRITICAL study in Osaka, Japan

2019 ◽  
Vol 9 (4_suppl) ◽  
pp. S175-S183 ◽  
Author(s):  
Haruka Shida ◽  
Tasuku Matsuyama ◽  
Taku Iwami ◽  
Satoe Okabayashi ◽  
Tomoki Yamada ◽  
...  
Keyword(s):  
Serum Potassium ◽  
Neurological Outcome ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
Spontaneous Circulation ◽  
Critical Study ◽  
Hospital Arrival ◽  
Return Of Spontaneous Circulation ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Little is known about the association between serum potassium level on hospital arrival and neurological outcome after out-of-hospital cardiac arrest (OHCA). We investigated whether the serum potassium level on hospital arrival had prognostic indications for patients with OHCA. Methods: This prospective, multicenter observational study conducted in Osaka, Japan (CRITICAL study) enrolled consecutive patients with OHCA transported to 14 participating institutions from 2012 to 2016. We included adult patients aged ⩾18 years with OHCA of cardiac origin who achieved return of spontaneous circulation and whose serum potassium level on hospital arrival was available. Based on the serum potassium level, patients were divided into four quartiles: Q1 (K ⩽3.8 mEq/L), Q2 (3.8< K⩽4.5 mEq/L), Q3 (4.5< K⩽5.6 mEq/L) and Q4 (K >5.6 mEq/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. Results: A total of 9822 patients were registered, and 1516 of these were eligible for analyses. The highest proportion of favorable neurological outcome was 44.8% (189/422) in Q1 group, followed by 30.3% (103/340), 11.7% (44/375) and 4.5% (17/379) in the Q2, Q3 and Q4 groups, respectively ( p<0.001). In the multivariable analysis, the proportion of favorable neurological outcome decreased as the serum potassium level increased ( p<0.001). Conclusions: High serum potassium level was significantly and dose-dependently associated with poor neurological outcome. Serum potassium on hospital arrival would be one of the effective prognostic indications for OHCA achieving return of spontaneous circulation.

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