Database : MEDLINE
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[PMID]: 29476890
[Au] Autor:Kitamura T; Kiyohara K; Nishiyama C; Kiguchi T; Kobayashi D; Kawamura T; Iwami T
[Ad] Address:Division of Environmental Medicine and Population Sciences, Osaka University, Suita, Osaka, Japan.
[Ti] Title:Chest compression-only versus conventional cardiopulmonary resuscitation for bystander-witnessed out-of-hospital cardiac arrest of medical origin: A propensity score-matched cohort from 143,500 patients.
[So] Source:Resuscitation;126:29-35, 2018 Feb 21.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Current cardiopulmonary resuscitation (CPR) guidelines do not define the optimal type of CPR (chest compression-only CPR [CCCPR] or conventional CPR with rescue breathing [CCRB]) to be performed by bystanders when they witness someone collapse. METHODS: Using a nationwide database of 1.17 million patients who underwent out-of-hospital cardiac arrest (OHCA) in Japan, we enrolled consecutive bystander-witnessed OHCAs of medical origin with resuscitation attempts from January 2005 through December 2014. Multivariable logistic regression analysis was used to assess the association between the type of bystander CPR and the OHCA outcome after one-to-one propensity score matching for CCCPR versus CCRB. The primary outcome measure was one-month survival with a favorable neurological outcome, defined as a cerebral performance category of 1 or 2. RESULTS: Among 143,500 eligible patients with bystander-witnessed OHCAs receiving bystander-initiated CPR, 71.4% received CCCPR and 28.6% received CCRB. In the univariate analysis, the proportion of one-month survival cases with favorable neurological outcome was lower in the CCCPR group than the CCRB group (5.6% [5749/102,487] vs. 6.5% [2682/41,013], odds ratio [OR]; 0.85 [95% confidence interval {CI}; 0.81-0.89]). However, in the multivariate analysis, the CCCPR group showed a more favorable neurological outcome than the CCRB group (adjusted OR 1.12, 95% CI; 1.06-1.19). In the propensity-matched cohort, the CCCPR group also showed a more favorable neurological outcome than the CCRB group (7.2% [2894/40,096] vs. 6.5% [2610/40,096], adjusted OR 1.14, 95% CI; 1.09-1.22). CONCLUSIONS: CCCPR is an acceptable resuscitation technique for lay-rescuers responding to bystander witnessed OHCA of presumed medical origin.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 5666 MEDLINE  
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[PMID]: 29474879
[Au] Autor:Moon HK; Jang J; Park KN; Kim SH; Lee BK; Oh SH; Jeung KW; Choi SP; Cho IS; Youn CS
[Ad] Address:Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
[Ti] Title:Quantitative analysis of relative volume of low apparent diffusion coefficient value can predict neurologic outcome after cardiac arrest.
[So] Source:Resuscitation;126:36-42, 2018 Feb 21.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Predicting neurologic outcomes after cardiac arrest (CA) is challenging. This study tested the hypothesis that a quantitative analysis of diffusion weighted imaging (DWI) using the FMRIB Software Library (FSL) can predict neurologic outcomes after CA and can clarify the optimal apparent diffusion coefficient (ADC) thresholds for predicting poor neurologic outcomes. METHODS: Out-of-hospital CA patients treated with targeted temperature management (TTM) who underwent DWI were included in this study. Voxel-based analysis was performed to calculate the mean ADC value. ADC thresholds (750, 700, 650, 600, 550, 500, 450 and 400) and brain volumes below each threshold were also analyzed for their correlation with outcomes. The patients were divided into early (within 48 h after return of spontaneous circulation (ROSC)) and late group (between 48 h and 7 days after ROSC) according to the DWI scan time. The primary outcome was a poor neurologic outcome at 6 months after CA, defined as a cerebral performance category (CPC) of 3-5. RESULTS: One hundred ten DWIs were analyzed. The mean ADC values were 789.0 (761.5-826.5)  10 mm /s for the good neurologic outcome group and 715.2 (663.1-778.4)  10 mm /s for the poor neurologic outcome group (p < 0.001). All the ADC thresholds could differentiate patients with good versus poor outcomes. The ADC threshold of 400  10 mm /s had the highest odds ratio (4.648 in the early group and 11.283 in the late group) after adjusting for initial rhythm and anoxic time. To achieve 100% specificity using an ADC threshold of 400  10 mm /s, the sensitivity was 64% (cutoff value; >2.5% ADC threshold of 400  10 mm /s) in the early group and 79.2% (cutoff value; >1.66% ADC threshold of 400  10 mm /s) in the late group. CONCLUSIONS: Voxel-based analysis using FSL software can predict neurologic outcomes after CA. The ADC threshold of 400  10 mm /s had the highest OR for predicting a poor neurologic outcome.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 5666 MEDLINE  
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[PMID]: 29462642
[Au] Autor:rbo MC; Vangberg TR; Tande PM; Anke A; Aslaksen PM
[Ad] Address:Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Troms, Norway. Electronic address: marte.orbo@hotmail.com.
[Ti] Title:Memory performance, global cerebral volumes and hippocampal subfield volumes in long-term survivors of Out-of-Hospital Cardiac Arrest.
[So] Source:Resuscitation;126:21-28, 2018 Feb 17.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:AIM: We explored the associations between global brain volumes, hippocampal subfield volumes and verbal memory performance in long-term survivors of out-of-hospital cardiac arrest (OHCA). METHODS: Three months after OHCA, survivors and healthy, age-matched controls were assessed with cerebral MRI and the California Verbal Learning Test-II (CVLT-II). Volumetric brain segmentation was performed automatically by FreeSurfer. RESULTS: Twenty-six OHCA survivors who were living independently in regular homes at the time of assessment and 19 controls participated in the study. Thirteen of the survivors had been conscious upon arrival to the emergency department. The other 13 survivors had 0.5-7 days of inpatient coma before recovery. Memory was poorer in the OHCA group that had been comatose beyond initial hospital admission compared to both other groups. Total cortical volumes, total hippocampus volumes and several hippocampal subfield volumes were significantly smaller in the OHCA group comatose beyond initial hospital admission compared to controls. No significant differences between the OHCA group conscious upon emergency department arrival and the other two groups were found for brain volumes. No significant differences were observed between any groups for white matter or total subcortical volumes. In OHCA survivors with recovery from inpatient coma, the various CVLT-II trials were significantly, but differentially, correlated to total gray matter volume, cortical volume and the hippocampal subfield subiculum. CONCLUSION: In this small, single-site study, both hippocampal volume and cortical volume were smaller in good outcome OHCA survivors 3 months after resuscitation in comparison to healthy controls. Smaller cerebral volumes were correlated with poorer memory performance.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  4 / 5666 MEDLINE  
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[PMID]: 29438721
[Au] Autor:Jentzer JC; Anavekar NS; Mankad SV; White RD; Kashani KB; Barsness GW; Rabinstein AA; Pislaru SV
[Ad] Address:Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester MN 55905, United states; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester MN 55905, United states. Electronic address: jentzer.jacob@mayo.e
[Ti] Title:Changes in left ventricular systolic and diastolic function on serial echocardiography after out-of-hospital cardiac arrest.
[So] Source:Resuscitation;126:1-6, 2018 Feb 10.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:AIM: Reversible myocardial dysfunction is common after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine if changes on serial transthoracic echocardiography (TTE) can predict long-term mortality in OHCA subjects. METHODS: This is a single-center historical cohort study of OHCA subjects undergoing targeted temperature management who received >1 TTE during hospitalization. Two-dimensional and Doppler parameters of systolic and diastolic function were compared between paired TTE. Univariate analysis was used to determine associations between TTE parameters and all-cause mortality. RESULTS: Fifty-nine patients were included; mean age was 59.4  11.2 years (75% male). Initial rhythm was shockable in 90%. Initial TTE was done a median of 10.4 h after admission and repeat TTE was done 5.7  4.1 days later. Between TTE studies, there were significant increases in left ventricular ejection fraction (LVEF, from 32% to 43%), cardiac output, stroke volume, and other Doppler-derived hemodynamic parameters, while systemic vascular resistance decreased (all p < 0.001). Systolic function and hemodynamic parameters on initial TTE were not associated with follow-up mortality. Patients who died during follow-up (n = 16, 27%) had smaller increases in LVEF and cardiac output-derived hemodynamic parameters than long-term survivors (p < 0.05). CONCLUSIONS: Significant changes in systolic function and hemodynamic parameters occur on serial Doppler TTE after OHCA, consistent with reversible post-arrest myocardial dysfunction. The magnitude of those changes is greater in long-term survivors, emphasizing that the degree of recovery from post-arrest myocardial dysfunction may be more important than its initial severity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  5 / 5666 MEDLINE  
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[PMID]: 28453817
[Au] Autor:Bonny A; Tibazarwa K; Mbouh S; Wa J; Fonga R; Saka C; Ngantcha M; Pan African Society of Cardiology (PASCAR) Task Force on Sudden Cardiac Death
[Ad] Address:Cameroon Cardiovascular Research Network, Douala, Cameroon.
[Ti] Title:Epidemiology of sudden cardiac death in Cameroon: the first population-based cohort survey in sub-Saharan Africa.
[So] Source:Int J Epidemiol;46(4):1230-1238, 2017 Aug 01.
[Is] ISSN:1464-3685
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Incidence estimates of sudden cardiac death (SCD) in sub-Saharan Africa (SSA) are unknown. Method: Over 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala, Cameroon, registered all deaths among 86 188 inhabitants aged >18 years. As part of an extended multi-source surveillance system, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. Results: There were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3-40.6]/100 000 person-years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4-44.9)/100 000 person-years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital sudden cardiac arrest occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed cardiac arrest, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%. Conclusion: The burden of SCD in this African population is heavy with distinct characteristics, whereas awareness of SCD and prompt resuscitation efforts appear suboptimal. Larger epidemiological studies are required in SSA in order to implement preventive measures, especially in women and young people.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1704
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Process
[do] DOI:10.1093/ije/dyx043

  6 / 5666 MEDLINE  
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[PMID]: 29523899
[Au] Autor:Grabmaier U; Rizas KD; Berghof J; Huflaender Y; Wiegers C; Wakili R; Kaspar M; Angstwurm M; Massberg S; Weckbach LT; Brunner S
[Ad] Address:Med. Klinik und Poliklinik I, Klinikum der Universitt Mnchen, Ludwig-Maximilians-University, Munich, Germany. ulrich.grabmaier@med.uni-muenchen.de.
[Ti] Title:Association between survival and non-selective prehospital aspirin and heparin administration in patients with out-of-hospital cardiac arrest: a propensity score-matched analysis.
[So] Source:Intensive Care Med;, 2018 Mar 09.
[Is] ISSN:1432-1238
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00134-018-5111-2

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[PMID]: 29521302
[Au] Autor:Wang K; Shen Y; Li PW; Gu R; Zhang JM; Wang L; Bai J; Xu B
[Ad] Address:Department of Cardiology, Drum Tower Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.
[Ti] Title:ST-Segment Elevation Myocardial Infarction Patients Complicated by Out-of-Hospital Cardiac Arrest May Not Benefit from Emergency Percutaneous Intervention.
[So] Source:Chin Med J (Engl);131(6):746-747, 2018 Mar 20.
[Is] ISSN:0366-6999
[Cp] Country of publication:China
[La] Language:eng
[Pt] Publication type:LETTER
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.4103/0366-6999.226887

  8 / 5666 MEDLINE  
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[PMID]: 29518440
[Au] Autor:Jaeger D; Dumas F; Escutnaire J; Sadoune S; Lauvray A; Elkhoury C; Bassand A; Girerd N; Gueugniaud PY; Tazarourte K; Hubert H; Cariou A; Chouihed T; Reac Group
[Ad] Address:Emergency Department, University Hospital of Nancy, France; INSERM, Clinical Investigation Center - Unit 1433, University Hospital of Nancy, Vandoeuvre les, Nancy, France; INSERM U1116, Universit de Lorraine, Nancy, France. Electronic address: t.chouihed@chu-nancy.fr.
[Ti] Title:Benefit of immediate coronary angiography after out-of-hospital cardiac arrest in France: A nationwide propensity score analysis from the RAC Registry.
[So] Source:Resuscitation;, 2018 Mar 05.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:BACKGROUND: The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low, generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion, may improve this outcome. The main objective of the present study was to determine whether patients with immediate coronary angiography at hospital admission (CAA) had a better outcome than patients without immediate CAA. METHODS: This cohort analysis study was based on data extracted from the French National Cardiac Arrest registry (RAC). To control for attribution bias, patients were matched using a propensity score, which included age clusters, low flow and no flow delays, initial rhythm and bystander cardiopulmonary resuscitation (CPR). The main endpoint was survival at day 30 (D30). Secondary endpoint was neurological recovery of survivors assessed by the Cerebral Performance Category (CPC) scale, with CPC 1 and 2 at D30 considered as a favorable outcome. RESULTS: From July 1st, 2011 to October 1st, 2016, 63394 OHCA were registered in the database, of which 39444 were of an unknown or suspected cardiac origin. After on-site resuscitation by a mobile medical team, 7584 patients were transported to a hospital facility. Among these patients, 4046 were retained in the analysis after matching for the aforementioned factors and constituted into 2 groups: immediate coronary angiography (iCAA) group (n = 2023) and non-immediate coronary angiography (niCAA) group (n = 2023). The survival rate at D30 after matching was 43.3% in the iCAA group versus 34.5% in the niCAA group (OD = 0.66 [0.58; 0.75], p < 0.001). In the iCAA group, (n = 707) 36% of the patients at D30 were CPC 1-2 comparatively to (n = 539) 27.3% in the niCAA group (p < 0.01). CONCLUSIONS: Both the survival and proportion of patients with favorable neurological recovery were significantly higher in patients who underwent an immediate coronary angiography after a resuscitated OHCA. These observational results warrant further exploration of the benefit of this invasive strategy in randomized studies.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  9 / 5666 MEDLINE  
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[PMID]: 29518439
[Au] Autor:Casey SD; Mumma BE
[Ad] Address:Albert Einstein College of Medicine, USA; Department of Emergency Medicine, University of California Davis, USA.
[Ti] Title:Sex, Race, and Insurance Status Differences in Hospital Treatment and Outcomes Following Out-of-Hospital Cardiac Arrest.
[So] Source:Resuscitation;, 2018 Mar 05.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Sex, race, and insurance status are associated with treatment and outcomes in several cardiovascular diseases. These disparities, however, have not been well-studied in out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Our objective was to evaluate the association of patient sex, race, and insurance status with hospital treatments and outcomes following OHCA. METHODS: We studied adult patients in the 2011-2015 California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database with a "present on admission" diagnosis of cardiac arrest (ICD-9-CM 427.5). Insurance status was classified as private, Medicare, and Medi-Cal/government/self-pay. Our primary outcome was good neurologic recovery at hospital discharge, which was determined by discharge disposition. Secondary outcomes were survival to hospital discharge, treatment at a 24/7 percutaneous coronary intervention (PCI) center, "do not resuscitate" orders within 24 hours of admission, and cardiac catheterization during hospitalization. Data were analyzed with hierarchical multiple logistic regression models. RESULTS: We studied 38,163 patients in the OSHPD database. Female sex, non-white race, and Medicare insurance status were independently associated with worse neurologic recovery [OR 0.94 (0.89-0.98), 0.93 (0.88-0.98), and 0.85 (0.79-0.91), respectively], lower rates of treatment at a 24/7 PCI center [OR 0.89 (0.85-0.93), 0.88 (0.85-0.93), and 0.87 (0.82-0.94), respectively], and lower rates of cardiac catheterization [OR 0.61 (0.57-0.65), 0.90 (0.84-0.97), and 0.44 (0.40-0.48), respectively]. Female sex, white race, and Medicare insurance were associated with DNR orders within 24 hours of admission [OR 1.16 (1.10-1.23), 1.14 (1.07-1.21), and 1.25 (1.15-1.36), respectively]. CONCLUSIONS: Sex, race, and insurance status were independently associated with post-arrest care interventions, patient outcomes and treatment at a 24/7 PCI center. More studies are needed to fully understand the causes and implications of these disparities.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  10 / 5666 MEDLINE  
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[PMID]: 29518438
[Au] Autor:Granfeldt A; Wissenberg M; Hansen SM; Lippert FK; Torp-Pedersen C; Skaarup SH; Andersen LW; Christensen EF; Christiansen CF
[Ad] Address:Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: granfeldt@gmail.com.
[Ti] Title:Severity of chronic obstructive pulmonary disease and presenting rhythm in patients with out-of-hospital cardiac arrest.
[So] Source:Resuscitation;, 2018 Mar 05.
[Is] ISSN:1873-1570
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with a non-shockable rhythm as presenting rhythm in out-of-hospital cardiac arrest (OHCA). Whether the severity of the underlying disease is related to presenting rhythm is unknown. We hypothesize that increased severity of COPD in OHCA patients is associated with an increased prevalence of non-shockable rhythm. METHODS: This study included OHCA patients ≥40 years from the Danish Cardiac Arrest Registry (2001-2014). Population-based registries were used to identify chronic diseases and drug prescriptions. COPD was defined as a COPD diagnosis or pharmacological therapy for COPD. The severity of COPD was based on either 1) pharmacological therapy (mild/moderate/severe), 2) admission for exacerbation, 3) prescription for corticosteroids, or 4) forced expiratory volume in 1 second (FEV1). For each of these, a multivariable logistic regression model was used to estimate odds ratios (ORs) for a non-shockable rhythm. RESULTS: Of 33,228 patients with OHCA 7,789 (23.4%) had COPD. Of these 6,702 (86.0%) had a non-shockable rhythm. Compared to patients without COPD, mild COPD was associated with a non-shockable rhythm (OR = 1.46, 95%CI 1.29-1.65). This association was more pronounced for moderate (OR = 1.78, 95%CI 1.45-2.19) and severe COPD (OR = 2.01 95%CI 1.82-2.20). Recent admission for exacerbation (OR = 2.12, OR 95%CI 1.81-2.49) or prescription for corticosteroids (OR = 1.82, 95%CI 1.55-2.14) was also associated with a non-shockable rhythm. FEV1 ≤50% was associated with a non-shockable rhythm compared to FEV1 > 50% (OR = 1.74, 95%CI 1.07-2.82, n = 1122). CONCLUSION: Incremental severity of COPD is associated with increasing prevalence of a non-shockable rhythm as presenting rhythm in OHCA patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher


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