Sex-related disparities in obstructive coronary artery disease, percutaneous coronary intervention, and mortality in adults with cardiac arrest.

OBJECTIVES: Despite numerous advances in the delivery of resuscitative care, cardiac arrest (CA) continues to be associated with high morbidity and mortality. We sought to examine the association between sex and presence of obstructive coronary artery disease (CAD), percutaneous coronary intervention (PCI), and mortality in adults with CA. METHODS: The study population included 208 consecutive patients hospitalized with CA who underwent resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as >1 coronary artery with >70% stenosis or >1 coronary bypass graft with >70% stenosis. RESULTS: Of the study population, 150 patients (72%) were men and 58 (28%) were women. Women had a trend toward lower rates of obstructive CAD (69% vs 80%, p = 0.09) and lower rates of multivessel CAD compared to their male counterparts, but no significant difference in rates of PCI (62% vs 53%, p = 0.26). While rates of therapeutic hypothermia and vasopressor requirement were similar in men and women, women were less likely to require percutaneous left ventricular support. In-hospital mortality rates were similar in men and women (23% vs 21%, p = 0.68). In multivariate analysis, sex was not independently associated with obstructive CAD or mortality. CONCLUSIONS: In this observational contemporary study of adults with CA undergoing coronary angiogram, although women had a trend toward lower rates of obstructive CAD, no significant difference in rates of PCI and in-hospital mortality were noted between men and women.

Predictors of Obstructive Coronary Disease and Mortality in Adults Having Cardiac Arrest.

Coronary angiography is a key component of systematic, multi-disciplinary post-cardiac arrest (CA) care, however, coronary angiogram is not routinely performed in the setting of CA. We sought to identify the predictors of obstructive coronary artery disease (CAD) and mortality in adults with CA undergoing coronary angiogram. The study population included 208 consecutive patients hospitalized with CA who underwent resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as >1 coronary artery with >70% stenosis or >1 coronary bypass graft with >70% stenosis. The secondary outcome of interest was in-hospital mortality. Of the 208 patients studied, 160 (76.9%) had obstructive CAD while 48 (23.1%) did not. In-hospital mortality occurred in 47 patients (22.6%). In multivariate analysis, ST-elevation myocardial infarction (STEMI) (OR 7.69, 95% CI 2.89 to 20.51), defibrillation (OR 4.90, 95% CI 1.19 to 20.17), vasopressors (OR 3.53, 95% CI 1.15 to 10.81), and absence of therapeutic hypothermia (OR 0.38, 95% CI 0.15 to 0.98) were independently associated with presence of obstructive CAD while STEMI (OR 3.21, 95% CI 1.01 to 10.24), vasopressors (OR 4.92, 95% CI 1.78 to 13.62), therapeutic hypothermia (OR 3.89, 95% CI 1.47 to 10.31), and admission blood urea nitrogen (OR 1.06, 95% CI 1.00 to 1.11) were independently associated with higher rates of in-hospital mortality. In this observational contemporary study, predictors of obstructive CAD and mortality exist in adults with CA undergoing coronary angiogram. Such risk models may aid in identification of CA patients who will benefit from early angiography and percutaneous coronary intervention.

Association between intra- and post-arrest hyperoxia on mortality in adults with cardiac arrest: A systematic review and meta-analysis.

OBJECTIVES: The association between intra-arrest and post-arrest hyperoxia and mortality in adults with cardiac arrest (CA) is widely debated. We therefore conducted a systematic review and meta-analysis to investigate the association between intra-arrest and post-arrest hyperoxia and mortality in adults with CA. METHODS: We systematically searched MEDLINE and Cochrane databases to identify observational studies from January 2008 to December 2017 investigating the relationship between hyperoxia (either intra-arrest or post-arrest) and mortality in adults with CA. RESULTS: We included 16 observational studies with a total of 40,573 adult patients. Six studies included patients only with out-of-hospital CA (OHCA), 2 studies included patients only with in-hospital CA (IHCA), and 8 studies included patients with both OHCA and IHCA. Two studies assessed intra-arrest hyperoxia while 14 studies examined post-arrest hyperoxia. Of the 10 studies included for quantitative analysis, intra-arrest hyperoxia was associated with a significantly lower mortality rate [odds ratio (OR) 0.25, 95% confidence interval (CI) 0.12-0.53, p < 0.001] while post-arrest hyperoxia was associated with higher mortality (OR 1.34, 95%CI 1.08-1.67, p = 0.008). CONCLUSIONS: In adults with CA, intra-arrest hyperoxia is associated with lower mortality while post-arrest hyperoxia is associated with higher mortality.

Reducing bounce effects in the Andersen cascade impactor.

The collection efficiency of the Andersen cascade impactor (ACI) can be affected by particle bounce, overload and re-entrainment (or blow-off), collectively referred to as bounce effects. Reduction of bounce effects in the ACI operated at 60 LPM was investigated for placebo large porous particles. Aerodynamic particle size distributions (aPSDs) obtained with the ACI and multi-stage liquid impinger (MSLI) were compared by observation of modes and statistical comparisons of the mass median aerodynamic diameter (MMAD) and geometric standard deviation (sigmag). Particle bounce effects were prevalent in the ACI with uncoated plates, i.e., bi-modal distribution with statistically significant differences in MMAD and sigmag (P<0.05). Coating the impaction plates with a thin layer of vacuum grease and decreasing the ACI stage jet velocities reduced, but did not minimize bounce effects. Bounce effects were minimized using 20-microm pore glass fiber filters saturated in water placed on inverted impaction plates, with good agreement obtained between the ACI and MSLI aPSDs, i.e., mono-modal with no statistically significant differences in MMAD and sigmag (P>0.05). Selection of the impaction substrate material and solvent must be evaluated with the drug product and analytical methods to minimize bounce effects and obtain an accurate measure of the aPSD.