Search Results (7)

Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. Results: ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. Conclusions: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies. Full article

Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994–2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade. We retrospectively investigated data of 47 inpatients aged 0–18 admitted to Leipzig University Department of Pediatrics who matched ICD-10 code T75.1 from 2008 to 2020 and compared them to a preceding study at the same institution. We also examined the prognostic value of parameters regarding the patients’ outcomes. There were three median incidents per annum. The median age was 2.75 years; 76% of incidents happened in males. An accumulation was seen during the summer months and weekends. Most drowning incidents occurred in private ponds or pools (48.9%). Thirty-nine children were discharged without resulting morbidity, four showed neurological impairment, and three died. Risk factors concerning age, sex, and incident characteristics were confirmed. Special supervision needs still apply to 1–3-year-old male children or children with pre-existing health conditions around private pools and ponds. Hospitalization duration shortened, and morbidity and lethality decreased since the previous study. There was structural improvement in primary care and medical documentation. Parameters suggesting good outcomes include a submersion time < 5 min, GCS > 3 points, spontaneous movement upon admission, remaining pupillary light response, the absence of cardiovascular arrest, body temperature ≥ 32 °C, pH > 7, blood glucose < 15 mmol/L, lactate < 14 mmol/L, base excess ≥ −15 mmol/L, and the absence of ARDS. Clear legislation can contribute to improved private home water safety. Further studies should include a broad in- and outpatient spectrum and standardized incident documentation presupposing Utstein-style reporting. Regular reinvestigation of consistent geographical regions facilitates process evaluations of drowning epidemiology and therapy evolution. Full article

Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. Materials and Methods: This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. Results: A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5–8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9–29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3–11.9)] with better survival. Conclusions: Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm. Full article

Background: This study was conducted to identify the predictive factors for survival and favorable neurological outcome in patients with emergency department cardiac arrest (EDCA). Methods: ED patients who suffered from in-hospital cardiac arrest (IHCA) from July 2014 to June 2019 were enrolled. The electronic medical records were retrieved and data were extracted according to the IHCA Utstein-style guidelines. Results: The cardiac arrest survival post-resuscitation in-hospital (CASPRI) score was associated with survival, and the CASPRI scores were lower in the survival group. Three components of the CASPRI score were associated with favorable neurological survival, and the CASPRI scores were lower in the favorable neurological survival group of patients who were successfully resuscitated. The independent predictors of survival were presence of hypotension/shock, metabolic illnesses, short resuscitation time, receiving coronary angiography, and TTM. Receiving coronary angiography and low CASPRI score independently predicted favorable neurological survival in resuscitated patients. The performance of a low CASPRI score for predicting favorable neurological survival was fair, with an AUROCC of 0.77. Conclusions: The CASPRI score can be used to predict survival and neurological status of patients with EDCA. Post-cardiac arrest care may be beneficial for IHCA, especially in patients with EDCA. Full article

Few studies have investigated the association between dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance and the outcomes of out-of-hospital cardiac arrest (OHCA) among communities with different socioeconomic statuses (SES). A retrospective cohort study was conducted using an Utstein-style population OHCA database in Tainan, Taiwan, between January 2014 and December 2015. SES was defined based on real estate prices. The outcome measures included the achievement of return of spontaneous circulation (ROSC) and the performance of DA-CPR. Statistical significance was set at a two-tailed p-value of less than 0.05. A total of 2928 OHCA cases were enrolled in the high SES (n = 1656, 56.6%), middle SES (n = 1025, 35.0%), and low SES (n = 247, 8.4%) groups. The high SES group had a significantly higher prehospital ROSC rate, ever ROSC rate, and sustained ROSC rate and good neurologic outcomes at discharge (all p < 0.005). The low SES group, compared to the high and middle SES groups, had a significantly longer dispatcher recognition time (p = 0.004) and lower early (≤60 s) recognition rate (p = 0.029). The high SES group, but none of the DA-CPR measures, had significant associations with sustained ROSC in the multivariate regression model. The low SES group was associated with a longer time to dispatcher recognition of cardiac arrest and worse outcomes of OHCA. Strategies to promote public awareness of cardiac arrest could be tailored to neighborhood SES. Full article

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes. Full article

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city.
Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360 627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients.
Results. The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole.
Conclusions. Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation. Full article