期刊,Resuscitation. 2022年176卷期_国家学术搜索

期刊信息/Journal information

Resuscitation.

Middlesex Pub. Co.

主办单位：Middlesex Pub. Co.

国际刊号：0300-9572

Resuscitation./Journal Resuscitation.

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Clinical paper Race and ethnicity disparities in post-arrest care in Texas

Huebinger, RyanChavez, SummerAbella, Benjamin S.Al-Araji, Rabab...

8页

查看更多>>摘要：Introduction: Post-arrest care is essential to the chain of survival after out-of-hospital cardiac arrest (OHCA). Sparse literature evaluates disparities in post-arrest care. We sought to measure post-arrest care disparities using a statewide OHCA registry. Methods: We evaluated 2014???2020 data in the Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) and included adult OHCAs surviving to hospital admission. We stratified subjects by race/ethnicity. Outcomes were targeted temperature management (TTM), percutaneous intervention (PCI), early withdrawal of life-sustaining therapies (WLST), survival to discharge, and survival with cerebral performance category (CPC) of 1???2 (considered favorable). We used both multivariable and mixed-effects, logistic regression models to evaluate the association between race/ethnicity and outcomes, adjusting for confounders. We modeled receiving hospital as a random intercept for the mixed-models analysis. Results: We included 8,363 OHCAs; 3,916 White, 2,251 Black, 2,196 Hispanic/Latino. On multivariable analysis, Black patients had a lower PCI (aOR 0.4, 95% CI 0.3???0.5) and survival with good CPC (aOR 0.6, 95% CI 0.6???0.7). Hispanic/Latino patients had lower TTM (aOR 0.8, 95% CI 0.7??? 0.9), PCI (aOR 0.6, 95% CI 0.5???0.8), survival (aOR 0.8, 95% CI 0.7???0.9), and survival with good CPC (aOR 0.7, 95% CI 0.6???0.7). However, after adjusting for clustering by receiving hospital, most of the post-arrest care relationships were negated, and Black patients actually had a higher rate of Conclusions: Minority OHCA victims experienced disparities in post-arrest care and outcomes. However, adjusting for receiving hospital randomeffect largely diminished these findings. Inter-hospital, post-arrest care disparities may exist.

原文链接:

NSTL
Elsevier

Socioeconomic status and post-arrest care after out-of-hospital cardiac arrest in Texas

Al-Araji, RababPanczyk, MicahWaller-Delarosa, JohnVilla, Normandy...

10页

查看更多>>摘要：Introduction: Post-arrest care after out-of-hospital cardiac arrest (OHCA) is critical to optimizing outcomes, but little is known about socioeconomic disparities in post-arrest care. We evaluated the association of socioeconomic status (SES) with post-arrest care and outcomes. Methods: We included adult OHCAs surviving to hospital admission from the 2014 & ndash;2020 Texas Cardiac Arrest Registry to Enhance Survival (CARES) and stratified cases into SES quartiles based on census tract data. Outcomes were targeted temperature management (TTM), percutaneous coronary intervention (PCI), survival to discharge, and survival with a Cerebral Performance Category (CPC) 1 & ndash;2. We applied both a multi variable logistic regression and a mixed effects logistic regression, comparing lower quartiles to top quartile for outcomes. We modeled receiving hospital as a random intercept. Results: We included 9,936 OHCAs. Using multivariable logistic regression and ignoring the receiving hospital, lower income had lower TTM (Q3 aOR 0.6, 95% CI 0.5 & ndash;0.7; Q4 aOR 0.5, 95% CI 0.5 & ndash;0.6), lower PCI (Q4 aOR 0.6, 95% CI 0.4 & ndash;0.8), and lower survival with good CPC. Lower education had lower TTM (Q2 aOR 0.7, 95% CI 0.7 & ndash;0.8; Q3 aOR, 0.6 95% CI 0.5 & ndash;0.7; Q4 aOR 0.6, 95% CI 0.5 & ndash;0.7), lower survival, and lower survival with good CPC. Lower employment had lower TTM (Q3 aOR 0.7, 95% CI 0.6 & ndash;0.9; Q4 aOR 0.7, 95% CI 0.6 & ndash;0.9) and survival with good CPC. These relationships for post-arrest care were not significant on mixed model analyses though. Conclusion: Lower SES was linked to lower rates of post-arrest care and outcomes, but many of the associations diminished when adjusting for receiving hospital random effect. Further study is needed to evaluate for inter-hospital disparities in care.

原文链接:

NSTL
Elsevier

Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions

Norvik, A.Unneland, E.Bergum, D.Buckler, D. G....

8页

查看更多>>摘要：Background: PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore and quantify the evolution from primary/secondary PEA to ROSC in adults during in-hospital cardiac arrest (IHCA). Methods: We analyzed 700 IHCA episodes at one Norwegian hospital and three U.S. hospitals at different time periods between 2002 and 2021. During resuscitation ECG, chest compressions, and ventilations were recorded by defibrillators. Each event was manually annotated using a graphical application. We quantified the transition intensities, i.e., the propensity to change from PEA to another clinical state using time-to-event statistical methods. Results: Most patients experienced PEA at least once before achieving ROSC or being declared dead. Time average transition intensities to ROSC from primary PEA (n = 230) and secondary PEA after ASY (n = 72) were 0.1 per min, peaking at 4 and 7 minutes, respectively; thus, a patient in these types of PEA showed a 10% chance of achieving ROSC in one minute. Much higher transition intensities to ROSC, average of 0.15 per min, were observed for secondary PEA after VF/VT (n = 83) or after ROSC (n = 134). Discussion: PEA is a crossroad in which the subsequent course is determined. The four distinct presentations of PEA behave differently on important characteristics. A transition to PEA during resuscitation should encourage the resuscitation team to continue resuscitative efforts.& nbsp;

原文链接:

NSTL
Elsevier

Pain pupillary index to prognosticate unfavorable outcome in comatose cardiac arrest patients

Macchini, ElisabettaBertelli, AlessandraBogossian, Elisa GouveaAnnoni, Filippo...

7页

查看更多>>摘要：Background: The prognostic role of the Pupillary Pain Index (PPI), derived from automated pupillometry, remains unknown in post-anoxic brain injury. Methods: Single-center retrospective study in adult comatose cardiac arrest (CA) patients. Quantitative PPI and Neurologic Pupil Index (NPi) were concomitantly recorded on day 1 and day 2 after CA. The primary outcome was to assess the prognostic value of PPI to predict 3-month unfavourable outcome (UO, defined as Cerebral Performance Category of 3 & ndash;5). Secondary outcome was the agreement between PPI and NPi to predict unfavourable outcome. Results: A total of 102 patients were included; patients with UO (n = 69, 68%) showed a lower NPi (4.2 [3.5 & ndash;4.5] vs. 4.6 [4.3 & ndash;4.7]; p < 0.01 on day 1 & ndash;4.3 [3.8 & ndash;4.7] vs 4.6 [4.3 & ndash;4.8] on day 2), and PPI (3 [1 & ndash;6] vs. 6 [3 & ndash;7]; p < 0.01 on day 1 & ndash;3 [1 & ndash;6] vs 6 [4 & ndash;8]; p < 0.01 on day 2) than others. A PPI =1 on day 2 showed a sensitivity of 26 [95% CI 16 & ndash;38]% and a specificity of 100 [95% CI 89 & ndash;100]% to predict UO (p = 0.003 vs. NPi < 2). On day 2, a total of 6 patients had concomitant PPI = 1 and NPi < 2, while 12 showed NPi > 2 and PPI = 1; the coefficient of agreement was 0.42. Moreover, NPi and PPI values showed a moderate correlation both on day 1 and day 2. Conclusions: In this study, PPI = 1 on day 2 could predict UO in comatose CA patients with 100% specificity, but with a low sensitivity (yet higher than NPi). The agreement between PPI and NPi values was moderate.

原文链接:

NSTL
Elsevier

Femoral artery Doppler ultrasound for pulse detection in cardiac arrest - Potential limitations

Putowski, MateuszSanak, Tomasz

2页

原文链接:

NSTL
Elsevier

Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest

Rolston, Daniel M.Cohen, Allison L.

2页

原文链接:

NSTL

Prevalence of intracranial hemorrhage amongst patients presenting with out-of-hospital cardiac arrest: A systematic review and meta-analysis

Lee, Kai YiSo, Wei ZhengHo, Jamie S. Y.Guo, Liang...

14页

查看更多>>摘要：Introduction: An unknown proportion of out-of-hospital cardiac arrest (OHCA) is caused by intracranial hemorrhage (ICH). There is uncertainty over the role of early head computed tomography (CT) in non-traumatic OHCA due to uncertain diagnostic yield and ways to identify high-risk patients. This study aimed to identify the prevalence of ICH in non-traumatic OHCA and possible predictors. Methods: PubMed, EMBASE, and the Cochrane library were searched from inception to January 2022. Data extraction and quality assessment were independently reviewed by two authors. Meta-analyses estimated the prevalence of ICH amongst OHCA patients and pre-specified subgroups and geographical settings. Subgroup analysis were used to explore potential clinical predictors. Results: 23 studies involving 54,349 patients were included. The pooled ICH prevalence was 4.28% (95%CI: 3.31 & ndash;5.24). Asia had a significantly larger risk ratio (RR = 3.93, P value < 0.0001) than Europe. The ICH subgroup was significantly more likely to be female (OR: 2.16; 95%CI: 1.10 & ndash; 4.26), and less likely to experience shockable rhythms compared with non-shockable rhythms (OR: 0.22; 95% CI: 0.04 & ndash;1.22), achieve ROSC prior to arrival (OR: 0.27; 95%CI: 0.10 & ndash;0.77), and survive to discharge compared to those without ICH (OR: 0.26; 95%CI: 0.11 & ndash;0.59). Conclusions: One in twenty OHCA have ICH at the time of presentation. An early head CT scan should be strongly considered after return of spontaneous circulation (ROSC), especially in patients who are female, with non-shockable rhythm and did not attain ROSC prior to arrival. These finding should influence clinical protocols to favor routine scans especially in Asia where prevalence is higher.

原文链接:

NSTL
Elsevier

Bedside monitoring of hypoxic ischemic brain injury using low-field, portable brain magnetic resonance imaging after cardiac arrest

Khosla, AkhilHoniden, ShyokoMiller, P. ElliottWira, Charles...

9页

查看更多>>摘要：Background: Assessment of brain injury severity is critically important after survival from cardiac arrest (CA). Recent advances in low-field MRI technology have permitted the acquisition of clinically useful bedside brain imaging. Our objective was to deploy a novel approach for evaluating brain injury after CA in critically ill patients at high risk for adverse neurological outcome. Methods: This retrospective, single center study involved review of all consecutive portable MRIs performed as part of clinical care for CA patients between September 2020 and January 2022. Portable MR images were retrospectively reviewed by a blinded board-certified neuroradiologist (S.P.). Fluid-inversion recovery (FLAIR) signal intensities were measured in select regions of interest. Results: We performed 22 low-field MRI examinations in 19 patients resuscitated from CA (68.4% male, mean [standard deviation] age, 51.8 [13.1] years). Twelve patients (63.2%) had findings consistent with HIBI on conventional neuroimaging radiology report. Low-field MRI detected findings consistent with HIBI in all of these patients. Low-field MRI was acquired at a median (interquartile range) of 78 (40???136) hours post-arrest. Quantitatively, we measured FLAIR signal intensity in three regions of interest, which were higher amongst patients with confirmed HIBI. Low-field MRI was completed in all patients without disruption of intensive care unit equipment monitoring and no safety events occurred. Conclusion: In a critically ill CA population in whom MR imaging is often not feasible, low-field MRI can be deployed at the bedside to identify HIBI. Low-field MRI provides an opportunity to evaluate the time-dependent nature of MRI findings in CA survivors.

原文链接:

NSTL
Elsevier