Special Issue "Prognostic Performance and Management of Post-Cardiac Arrest Care Patients"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 15 December 2020.

Special Issue Editor

Prof. Won Young Kim
Website
Guest Editor
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan MedicalCenter, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Interests: post-cardiac arrest care; sepsis; septic shock; critical care; ultrasonography; pulmonary embolism

Special Issue Information

Dear Colleagues,

Significant improvements have been achieved in both resuscitation for cardiac arrest and post-cardiac arrest care, but mortality remains high. One of the most pressing issues for relatives and healthcare workers is to quickly obtain reliable information on the probability of obtaining a satisfactory neurological outcome. Neurological prognostication is based on clinical examinations and additional tools to assess the structural (neuroimaging), functional (neurophysiology), and quantitative (biochemical markers) aspects of brain injury. In the absence of perfect predictors of prognosis, current guidelines recommend the timely application of multimodal approaches for these patients. Although assessing the likelihood of poor neurological outcome and minimizing false-positive rates seems reasonable, tools to predict early a good neurological outcome would be very helpful to tailor medical therapies to the appropriate patients. Given a broader knowledge of the outcomes, physicians could introduce more or less aggressive treatment and address specific treatment.

This Special Issue, “Prognostic Performance and Management of Post-Cardiac Arrest Care Patients”, welcomes clinical manuscripts on studies about a multimodal approach, stepwise approach, patient-centric outcomes (quality-of-life, cognitive, or psychosocial), and tools for predicting good neurologic outcome. We also welcome all research which aims to extend our knowledge of the management of post-cardiac arrest care.

Prof. Won Young Kim
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

  • post-cardiac arrest care
  • prognosis
  • biomarker
  • scoring system
  • out-of-hospital cardiac arrest
  • in-hospital cardiac arrest

Published Papers (4 papers)

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Research

Open AccessArticle
Prolonged Length of Stay in the Emergency Department and Increased Risk of In-Hospital Cardiac Arrest: A nationwide Population-Based Study in South Korea, 2016–2017
J. Clin. Med. 2020, 9(7), 2284; https://doi.org/10.3390/jcm9072284 - 18 Jul 2020
Abstract
This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between [...] Read more.
This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between January 2016 and December 2017 was performed. A total of 18,217,034 patients visited an ED during the study period. The median ED LOS was 2.5 h. IHCA occurred in 9,180 patients (0.2%). IHCA was associated with longer ED LOS (4.2 vs. 2.5 h), and higher rates of intensive care unit (ICU) admission (58.6% vs. 4.7%) and in-hospital mortality (35.7% vs. 1.5%). The ED LOS correlated positively with the development of IHCA (Spearman ρ = 0.91; p < 0.01) and was an independent risk factor for IHCA (odds ratio (OR) 1.10; 95% confidence interval (CI), 1.10–1.10). The development of IHCA increased in a stepwise fashion across increasing quartiles of ED LOS, with ORs for the second, third, and fourth relative to the first being 3.35 (95% CI, 3.26–3.44), 3.974 (95% CI, 3.89–4.06), and 4.97 (95% CI, 4.89–5.05), respectively. ED LOS should be reduced to prevent adverse events in patients visiting the ED. Full article
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Open AccessArticle
Inter-Hospital Transfer after Return of Spontaneous Circulation Shows no Correlation with Neurological Outcomes in Cardiac Arrest Patients Undergoing Targeted Temperature Management in Cardiac Arrest Centers
J. Clin. Med. 2020, 9(6), 1979; https://doi.org/10.3390/jcm9061979 - 24 Jun 2020
Abstract
This study evaluated whether inter-hospital transfer (IHT) after the return of spontaneous circulation (ROSC) was associated with poor neurological outcomes after 6 months in post-cardiac-arrest patients treated with targeted temperature management (TTM). We used data from the Korean Hypothermia Network prospective registry from [...] Read more.
This study evaluated whether inter-hospital transfer (IHT) after the return of spontaneous circulation (ROSC) was associated with poor neurological outcomes after 6 months in post-cardiac-arrest patients treated with targeted temperature management (TTM). We used data from the Korean Hypothermia Network prospective registry from November 2015 to December 2018. These out-of-hospital cardiac arrest (OHCA) patients had either received post-cardiac arrest syndrome (PCAS) care at the same hospital or had been transferred from another hospital after ROSC. The primary endpoint was the neurological outcome 6 months after cardiac arrest. Subgroup analyses were performed to determine differences in the time from ROSC to TTM induction according to the electrocardiography results after ROSC. We enrolled 1326 patients. There were no significant differences in neurological outcomes between the direct visit and IHT groups. In patients without ST elevation, the mean time to TTM was significantly shorter in the direct visit group than in the IHT group. IHT after achieving ROSC was not associated with neurologic outcomes after 6 months in post-OHCA patients treated with TTM, even though TTM induction was delayed in transferred patients. Full article
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Open AccessArticle
Prognostic Value of Early Intermittent Electroencephalography in Patients after Extracorporeal Cardiopulmonary Resuscitation
J. Clin. Med. 2020, 9(6), 1745; https://doi.org/10.3390/jcm9061745 - 04 Jun 2020
Abstract
The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG [...] Read more.
The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG scan within 96 h after ECPR. The primary endpoint was neurological status upon discharge from the hospital assessed with a Cerebral Performance Categories (CPC) scale. Among 69 adult cardiac arrest patients who underwent ECPR, 17 (24.6%) patients had favorable neurological outcomes (CPC score of 1 or 2). Malignant EEG patterns were more common in patients with poor neurological outcomes (CPC score of 3, 4 or 5) than in patients with favorable neurological outcomes (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcomes. In multivariable analysis, malignant EEG patterns and duration of cardiopulmonary resuscitation were significantly associated with poor neurological outcomes. In this study, malignant EEG patterns within 96 h after cardiac arrest were significantly associated with poor neurological outcomes. Therefore, an early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR. Full article
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Open AccessArticle
Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management
J. Clin. Med. 2020, 9(4), 1113; https://doi.org/10.3390/jcm9041113 - 13 Apr 2020
Abstract
We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac [...] Read more.
We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors. Full article
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