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  • 1
    Online Resource
    Online Resource
    Abstract 10522: Early Lactate Clearance is Associated With Survival in a National Cohort of Refractory Out-of-Hospital Cardiac Arrest Patients Managed With Extracorporeal Cardiopulmonary Resuscitation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Introduction: In refractory out-of-hospital cardiac arrest (OHCA), prolonged whole-body ischemia with global tissue injury proceeds even after achievement of reperfusion with extracorporeal cardiopulmonary resuscitation (eCPR). Hypothesis: Biomarkers reflecting ischemia and inflammation may be used for prognostication of refractory OHCA managed with eCPR. Methods: This nationwide retrospective study included patients (≥18 years) with refractory OHCA managed with eCPR in Denmark (2011 to 2020). Biomarker levels at admission, at 24 hours (lactate, leukocytes, and platelets), and repeated measures of lactate after eCPR initiation were analyzed. Lactate clearance was calculated as (admission lactate - post eCPR lactate) / admission lactate x100%. Results: Two hundred eighteen patients (80% male; age 52±12yrs) were included. Primary cause of OHCA was acute myocardial infarction (63%), 69% had shockable primary rhythm and 86% witnessed OHCA with a median low-flow time of 105 minutes (Q1-Q3: 86-124 min.). Fifty-three (24%) survived to hospital discharge. Survivors had a significantly lower lactate level at admission (13.1 vs. 15.4 mmol/l, p=0.004) and after 24 hours (2.8 vs. 5.0, p=0.001), and a significantly higher admission platelet level (181 vs. 153 x10 9 /l, p=0.03). No difference in admission levels of leukocytes nor leukocytes and platelets after 24 hours were found between survivors and non-survivors. Lactate clearance was available for 68% and 79% of patients alive after 8 and 24 hours, respectively. All survivors had a lactate level less than admission lactate at 8 hours (lactate clearance 〉 0%) and had cleared 〉 25% of admission lactate at 24 hours after eCPR initiation. There was a significant difference in survival between quartiles of lactate clearance at 8 hours after eCPR initiation (Figure 1). Conclusion: In conclusion, early lactate clearance after eCPR initiation was associated with survival to discharge in refractory OHCA-patients.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.10522
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Abstract 12497: Long Transport Distances to a Tertiary Cardiac Arrest Center Does Not Affect Survival in Patients With Out-of-Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Introduction: Patients with out-of-hospital cardiac arrest (OHCA) are increasingly transported to tertiary cardiac arrest centers, when the arrest is presumed to be of cardiac origin. For some patients, centralization has led to longer transport distances to advanced care resulting in prolonged prehospital system delays, which may affect outcome. Hypothesis: Longer transport distance to center for patients with OHCA reduces 30-day survival. Methods: Central Denmark Region covers rural and urban areas of 13 000 square kilometers and has a population of approximately 1.3 million inhabitants. Aarhus University Hospital functions as the tertiary cardiac care hospital with access to 24/7 cardiac catherization service and extracorporeal cardiopulmonary resuscitation. Distance to center varies greatly among citizens in the region; with longest distance exceeding 170 km. This observational retrospective study included all patients with OHCA referred to Aarhus University Hospital from 2015 to 2018. Kaplan-Meier curves were conducted to evaluate association between distance and mortality. The odds of 30-day mortality were generated using logistic regression. Results: A total of 807 patients with OHCA were referred to center. Distance to center was 〈 25km (22%), 25 to 50km (40%), 50 to 100km (20%) and 〉 100km (18%), respectively. The median prehospital system delay from collapse to arrival at center was 70 minutes [IQR, 55-90 minutes]. Logistic regression did not demonstrate an association between 30-day mortality and increasing distance to center (distance 〈 25 km as reference, 25 to 50km: OR 0.83, 95% CI [0.58-1.20], 50 to 100km: OR 0.96, 95% CI [0.62-1.47] and 〉 100km: OR 1.20, 95% CI [0.77-1.88]). Conclusions: In OHCA patients with long transport distances to a tertiary cardiac center, survival was similar in patients with short distance to center. Centralization of post cardiac care is feasible in the setting of long transport distances.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.12497
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Abstract 12464: Signs of Life as a Predictor of Survival in Patients With Out-of-Hospital Cardiac Arrest and Long Low-Flow Times
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Introduction: Long low-flow times in patients with out-of-hospital cardiac arrest (OHCA) are associated with poor outcome. Signs of life during cardiopulmonary resuscitation (CPR) is a simple method to evaluate in the field, but little is known about its impact on survival in patients with long low-flow times. Hypothesis: Thirty-day survival in OHCA patients with long prehospital low-flow times is higher in patients with signs of life during CPR than in patients with no signs of life during CPR. Methods: Observational, retrospective, single center study of OHCA patients referred to a tertiary cardiac arrest center in the Central Demark Region from 2015-2018. Risk factors were assessed by univariate logistic regression. Comparisons were made by Kaplan-Meier survival curves and log-rank test. Results: In a cohort of 807 patients with OHCA, 30-day survival was seen in 364 (45%). Among patients discharged from hospital, favorable neurological outcome with CPC 1-2 was observed in 93%. Signs of life during CPR was present in 315 (39%) patients. Risk of 30-day mortality was significantly reduced in patients presenting signs of life during CPR (RR 0.25, 95% CI [0.20-0.30]). Poor survival was seen in patients with low-flow times exceeding 30 minutes compared to patients with shorter low-flow times, (11% versus 66%, p 〈 0.001). In patients with low-flow times 〉 30 min, the survival rate increased to 33 % in the presence of signs of life during CPR compared to only 3% in patients without signs of life during CPR, p 〈 0.001. Conclusions: In OHCA patients, low-flow times 〉 30 minutes were highly associated with poor survival, however signs of life during CPR predicts higher survival both in the overall population and in patients with long low-flow times. Thus, resuscitation efforts may not be futile in patients with long low-flow times presenting signs of life during CPR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.12464
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
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    Online Resource
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