scholarly journals The Outcomes of Endotracheal Intubation versus Non-Endotracheal Intubation during Cardiopulmonary Arrest in the Emergency Department

2019 ◽  
Vol 26 (1) ◽  
pp. 3-10
Author(s):  
Abdullah A. Bakhsh ◽  
Daniah S. Allali ◽  
Ahmad H. Bakhribah ◽  
Ali A. Faydhi
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Neurological Outcome ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Return Of Spontaneous Circulation ◽  
Management Techniques

Airway management techniques during cardiopulmonary arrest in the emergency department may impact short and long-term outcomes of these patients. Prior studies addressing airway management of patients in cardiopulmonary arrest in the emergency department are limited. We aimed to evaluate the one-month neurological outcomes post cardiac arrest as a primary endpoint. Our secondary endpoint was to look at return of spontaneous circulation rates and survival to discharge. We retrospectively reviewed cardiac arrest flow sheets of patients sustaining in-emergency department cardiopulmonary arrest between January 2017 and September 2017. We looked at the different types of airway management techniques and their effect on patient outcomes. Patients who received non-endotracheal intubation during cardiopulmonary arrest had higher rates of good neurological outcome (GCS > 9) at one month when compared with patients who received endotracheal intubation: 8 (32%) vs. 2 (5.3%), respectively. Our results revealed a significant association of non-endotracheal intubation (bag-valve mask or laryngeal mask airway) with return of spontaneous circulation rates (p 0.044), survival to discharge (p < 0.001), and good neurological outcome (GCS > 9) (p 0.008). Although non-endotracheal intubation during cardiopulmonary arrest is not common, we encourage the increased use of bag-valve mask and laryngeal mask airways during cardiopulmonary arrest as they are associated with better outcomes.

scholarly journals Differences in Return of Spontaneous Circulation in Early vs Late Endotracheal Intubation among Patients in Hospital Cardiac Arrest

2018 ◽  
Vol 15 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Battu Kumar Shrestha ◽  
Apurb Sharma ◽  
Parbesh Kumar Gyawali
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Management Strategies ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Early Intubation ◽  
Tertiary Center ◽  
Mean Time

Background: Common airway management strategies during cardiopulmonary resuscitation are bag- mask-valve ventilation followed by endotracheal intubation. Timing of endotracheal intubation is controversial. This study was designed to compare the effect of early vs late endotracheal intubation in terms of return of spontaneous circulation.Methods: This is an observational retrospective study done at tertiary center for the period of two years. The study population was inpatient, adult and pediatric with witnessed cardiac arrest in whom airway management was initially done with bag-valve-mask ventilation followed by endotracheal intubation. Timing of intubations were grouped into early and late with cut off time of five minutes and the groups were compared in terms of return of spontaneous circulation.Results: There were total of 193 patients included in the study. Early intubation was done in 114 patients (59.06%) and late intubation was done in 79 patients (40.94%). Mean time for early intubation was 3.11 minutes. Mean time for late intubation was 7.89 minutes. Seventy three patients (37.8%) attained sustained ROSC. Thirty five patients (30.7%) achieved ROSC in early intubation group while 38 patients (48.1%) attained sustained ROSC in late intubation group(p = 0.016). Conclusions: Early intubation during cardiopulmonary resuscitation was associated with lower rate of return of spontaneous circulation.

scholarly journals Prediction of Neurologically Intact Survival in Cardiac Arrest Patients without Pre-Hospital Return of Spontaneous Circulation: Machine Learning Approach

2021 ◽  
Vol 10 (5) ◽  
pp. 1089
Author(s):  
Dong-Woo Seo ◽  
Hahn Yi ◽  
Hyun-Jin Bae ◽  
Youn-Jung Kim ◽  
Chang-Hwan Sohn ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Neurologically Intact

Current multimodal approaches for the prognostication of out-of-hospital cardiac arrest (OHCA) are based mainly on the prediction of poor neurological outcomes; however, it is challenging to identify patients expected to have a favorable outcome, especially before the return of spontaneous circulation (ROSC). We developed and validated a machine learning-based system to predict good outcome in OHCA patients before ROSC. This prospective, multicenter, registry-based study analyzed non-traumatic OHCA data collected between October 2015 and June 2017. We used information available before ROSC as predictor variables, and the primary outcome was neurologically intact survival at discharge, defined as cerebral performance category 1 or 2. The developed models’ robustness were evaluated and compared with various score metrics to confirm their performance. The model using a voting classifier had the best performance in predicting good neurological outcome (area under the curve = 0.926). We confirmed that the six top-weighted variables predicting neurological outcomes, such as several duration variables after the instant of OHCA and several electrocardiogram variables in the voting classifier model, showed significant differences between the two neurological outcome groups. These findings demonstrate the potential utility of a machine learning model to predict good neurological outcome of OHCA patients before ROSC.

scholarly journals The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support

2019 ◽  
Vol 27 (5) ◽  
pp. 286-292
Author(s):  
Choung Ah Lee ◽  
Gi Woon Kim ◽  
Yu Jin Kim ◽  
Hyung Jun Moon ◽  
Yong Jin Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Epinephrine Administration ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest. Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics. Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group. Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

scholarly journals Outcomes of Early versus Late Endotracheal Intubation in Patients with Initial Non-Shockable Rhythm Cardiopulmonary Arrest in the Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kiattichai Daorattanachai ◽  
Winchana Srivilaithon ◽  
Vitchapon Phakawan ◽  
Intanon Imsuwan
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Airway Management ◽  
Hospital Discharge ◽  
Endotracheal Intubation ◽  
Neurological Outcome ◽  
Independent Effect ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Favorable Neurological Outcome

Background. Sudden cardiac arrest is a critical condition in the emergency department (ED). Currently, there is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm. Objectives. To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED. Methods. We conducted a retrospective cohort study involving the ED cardiac arrest patients who presented with initial non-shockable rhythm in ED. Multivariable logistic regression analysis was used to evaluate the independent effect of early AAM on outcomes. The outcomes included the survival to hospital discharge and discharge with favorable neurological outcome. Results. There were 416 eligible participants: 209 in the early AAM group and 207 participants in the late AAM group. The early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, p = 0.524 ). Discharge with favorable neurological outcome is also higher in the early AAM group (aOR: 1.68, 95% CI, 0.52 -5.45, p = 0.387 ). Conclusion. This study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival.

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 Bag-Valve Mask versus Endotracheal Intubation in Out-of-Hospital Cardiac Arrest on Return of Spontaneous Circulation: A National Database Study

2020 ◽  
Vol Volume 12 ◽  
pp. 43-46 ◽  
Author(s):  
Chaiyaporn Yuksen ◽  
Phatthranit Phattharapornjaroen ◽  
Woranee Kreethep ◽  
Chonnakarn Suwanmano ◽  
Chestsadakon Jenpanitpong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Spontaneous Circulation ◽  
National Database ◽  
Return Of Spontaneous Circulation ◽  
Database Study ◽  
Hospital Cardiac Arrest
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