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1.
J Formos Med Assoc ; 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32299653

RESUMO

BACKGROUND/PURPOSE: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown. METHODS: This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrest patients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge. RESULTS: Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1-2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3-5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296-165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963-21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075-19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764-120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004-236.836, p = 0.011). CONCLUSION: In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.

3.
Sci Rep ; 10(1): 4604, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32165678

RESUMO

To investigate the association between central obesity and outcomes following in-hospital cardiac arrest (IHCA). A single-centred retrospective study was conducted. Adult patients that experienced IHCA during 2006-2015 were screened. Body mass index (BMI) was calculated at hospital admission. Central obesity-related anthropometric parameters were measured by analysing computed tomography images. A total of 648 patients were included, with mean BMI of 23.0 kg/m2. The proportions of BMI-defined obesity in this cohort were underweight (13.1%), normal weight (41.4%), overweight (31.5%) and obesity (14.0%). The mean waist circumference was 85.9 cm with mean waist-to-height ratio (WHtR) of 0.53. The mean sagittal abdominal diameter was 21.2 cm with mean anterior and posterior abdominal subcutaneous adipose tissue (SAT) depths of 1.6 and 2.0 cm, respectively. Multivariate logistic regression analyses indicated BMI of 11.7-23.3 kg/m2 (odds ratio [OR]: 2.53, 95% confidence interval [CI]: 1.10-5.85; p-value = 0.03), WHtR of 0.49-0.59 (OR: 3.45, 95% CI: 1.56-7.65; p-value = 0.002) and anterior abdominal SAT depth <1.9 cm (OR: 2.84, 95% CI: 1.05-7.74; p-value = 0.04) were positively associated with the favourable neurological outcome. Central obesity was associated with poor IHCA outcomes, after adjusting for the effects of BMI.

4.
Ann Emerg Med ; 75(5): 627-636, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31983493

RESUMO

STUDY OBJECTIVE: We compare effectiveness of different airway interventions during cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest. METHODS: We systematically searched the PubMed and EMBASE databases from their inception through August 2018 and selected randomized controlled trials or quasi randomized controlled trials comparing intubation, supraglottic airways, or bag-valve-mask ventilation for treating adult out-of-hospital cardiac arrest patients. We performed a network meta-analysis along with sensitivity analyses to investigate the influence of high intubation success rate on meta-analytic results. RESULTS: A total of 8 randomized controlled trials and 3 quasi randomized controlled trials were included in the network meta-analysis: 7,361 patients received intubation, 7,475 received supraglottic airway, and 1,201 received bag-valve-mask ventilation. The network meta-analysis indicated no differences among these interventions for survival or neurologic outcomes at hospital discharge. Rather, network meta-analysis suggested that supraglottic airway improved the rate of return of spontaneous circulation compared with intubation (odds ratio 1.11; 95% confidence interval 1.03 to 1.20) or bag-valve-mask ventilation (odds ratio 1.35; 95% confidence interval 1.11 to 1.63). Furthermore, intubation improved the rate of return of spontaneous circulation compared with bag-valve-mask ventilation (odds ratio 1.21; 95% confidence interval 1.01 to 1.44). The sensitivity analyses revealed that the meta-analytic results were sensitive to the intubation success rates across different out-of-hospital care systems. CONCLUSION: Although there were no differences in long-term survival or neurologic outcome among these airway interventions, these system-based comparisons demonstrated that supraglottic airway was better than intubation or bag-valve-mask ventilation and intubation was better than bag-valve-mask ventilation in improving return of spontaneous circulation. The intubation success rate greatly influenced the meta-analytic results, and therefore these comparison results should be interpreted with these system differences in mind.


Assuntos
Manuseio das Vias Aéreas , Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal , Parada Cardíaca Extra-Hospitalar/terapia , Manuseio das Vias Aéreas/métodos , Serviços Médicos de Emergência , Humanos , Intubação Intratraqueal/métodos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Resuscitation ; 148: 83-89, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31945424

RESUMO

INTRODUCTION: Following cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients. METHODS: A total of 540 patients with ROSC were retrospectively enrolled in this single-center observational study. The patients' motor responses were documented immediately and at 3 h following ROSC. Predictors of spontaneous neurological recovery were assessed by multiple logistic regression analysis. RESULTS: A total of 221 patients (41%) showed a change in their GCS (Glasgow Coma Score) M score (motor score) during the 3-h interval following ROSC, with improvement evident in 215 patients. Among 96 patients with GCS M6 at 3 h, 83 (86%) were discharged with a favorable neurological outcome. GCS M6 at 3 h post ROSC, was an independent predictor for a favorable neurological outcome, but GCS M6 at ROSC was not. There were four factors predicting the GCS M6 at 3 h; including in-hospital cardiac arrest (OR 3.057; 95% CI: 1.370-6.824, P = 0.006); bystander CPR (OR 13.311; 95% CI: 6.455-27.447, P < 0.0001); the CPR duration (OR, 0.941; 95% CI: 0.91-0.974; P < 0.0001), and the initial shockable rhythm (OR, 4.41; 95% CI: 2.44-7.95; P < 0.0001). CONCLUSIONS: A significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 h post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.

6.
Resuscitation ; 148: 108-117, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31978453

RESUMO

AIM: To summarise and compare the prognostic accuracy of the blood biomarkers of brain injury, including NSE and S-100B, for neurological outcomes in adult post-cardiac arrest patients. METHODS: We systematically searched PubMed and Embase databases from their inception to March 2019. We selected studies providing sufficient data of prognostic values of NSE or S-100B to predict neurological outcomes in adult post-cardiac arrest patients. We adopted QUADAS-2 to assess risk of bias and a Bayesian bivariate random-effects meta-analysis model to synthesise the prognostic data. The study protocol was registered with PROSPERO (CRD42018084933). RESULTS: We included 42 studies involving 4806 patients in the meta-analysis. The NSE was associated with a pooled sensitivity of 0.56 (95% credible interval [CrI], 0.47-0.65) and pooled specificity of 0.99 (95% CrI, 0.98-1.00). The S-100B was associated with a pooled sensitivity of 0.63 (95% CrI, 0.46-0.78) and pooled specificity of 0.97 (95% CrI, 0.92-1.00). The heterogeneity for NSE (I2, 22.4%) and S-100B (I2, 16.1%) was low and publication bias was not significant. In subgroup analyses, both biomarkers were associated with high specificity across all subgroups with regard to different populations (i.e. whether patients were out-of-hospital cardiac arrest or whether patients received targeted temperature management), different timings of measurement, and different timings of outcome assessment. CONCLUSIONS: The prognostic performance was comparable between NSE and S-100B. Both biomarkers may be integrated into a multimodal neuroprognostication algorithm for post-cardiac arrest patients and institution-specific cut-off points for both biomarkers should be established.

7.
J Formos Med Assoc ; 119(2): 644-651, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31493983

RESUMO

BACKGROUND: Resuscitation guidelines list acidaemia as a potentially reversible cause of cardiac arrest without specifying the threshold defining acidaemia. We examined the association between early intra-arrest arterial blood gas (ABG) data and outcomes of in-hospital cardiac arrest (IHCA). METHODS: This single-centred retrospective study reviewed patients with IHCA between 2006 and 2015. Early intra-arrest ABG data were measured within 10 min of initiating cardiopulmonary resuscitation. The ABG analysis included measurements of blood pH, PaCO2, and HCO3-. RESULTS: Among the 1065 included patients, 60 (5.6%) achieved neurologically intact survival. Mean blood pH was 7.2. Mean PaCO2 and HCO3- levels were 59.7 mmHg and 22.1 mmol/L, respectively. A blood pH of 7.2 was identified by a generalised additive models plot to define severe acidaemia. The PaCO2 level was higher in patients with severe acidaemia (mean: 74.5 vs. 44.1 mmHg) than in those without. Multivariable logistic regression analyses indicated that blood pH > 7.2 was associated with a favourable neurological recovery (odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.43-5.46; p-value = 0.003) and blood pH was positively associated with survival at hospital discharge (OR: 5.80, 95% CI: 1.62-20.69; p-value = 0.007). CONCLUSION: Early intra-arrest blood pH was associated with IHCA outcomes, while levels of PaCO2 and HCO3- were not. A blood pH of 7.2 could be used as the threshold defining severe acidaemia during arrest and help profile patients with IHCA. Innovative interventions should be developed to improve the outcomes of patients with severe acidaemia, such as novel ventilation methods.

8.
J Formos Med Assoc ; 119(1 Pt 2): 327-334, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31255419

RESUMO

BACKGROUND: To determine the association between amiodarone or lidocaine and outcomes in adult in-hospital cardiac arrest (IHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). METHODS: A retrospective study in a single medical centre was conducted. Patients experiencing an IHCA between 2006 and 2015 were screened. Shock-refractory ventricular tachyarrhythmias were defined as VF/pVT requiring more than one defibrillation attempt. A multivariate logistic regression analysis was used to study the associations between the independent variables and outcomes. RESULTS: A total of 130 patients were included. Among these, 113 patients (86.9%) were administered amiodarone as the first antiarrhythmic agent (amiodarone first) following VF/pVT, and the other patients were administered lidocaine (lidocaine first). The median time to the first defibrillation and first antiarrhythmic drug administration were 2 and 9 min, respectively. The analysis demonstrated that the amiodarone-first group experienced a higher likelihood of terminating the VF/pVT within three shocks (odds ratio: 11.61, 95% confidence interval: 1.34-100.84; p-value = 0.03), as compared with the lidocaine-first group. However, there were no significant differences between the amiodarone- and lidocaine-first groups in sustained return of spontaneous circulation, survival for 24 h, survival, or favourable neurological outcomes at hospital discharge. CONCLUSION: For patients with IHCA and shock-refractory VF/pVT, the adoption of an amiodarone-first strategy seemed to be associated with the termination of VF/pVT using fewer shocks. Nonetheless, because of the small sample size, additional large-scale studies should be conducted to investigate whether this advantage could be translated into a long-term benefit in survival or neurological outcomes.

9.
Resuscitation ; 146: 103-110, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786236

RESUMO

AIM: We attempted to examine the association between intra-arrest blood glucose (BG) level and outcomes of in-hospital cardiac arrest (IHCA). The interaction between diabetes mellitus (DM) and BG level as well as between dextrose administration and BG level were investigated. METHODS: This single-centred retrospective study reviewed IHCA patients between 2006 and 2015. Patients with measured intra-arrest BG levels were included. Multivariable logistic regression analyses were conducted. Generalised additive models were used to identify appropriate cut-off points for continuous variables. Interactions between independent variables were assessed during the model-fitting process. RESULTS: Among the 580 included patients, 34 (5.9%) achieved neurologically intact survival. There were 197 DM patients (34.0%). The mean intra-arrest BG level was 191.5 mg/dl, with 57 patients (9.8%) experiencing hypoglycaemia (BG level ≤ 70 mg/dl). A total of 165 patients (28.4%) received a dextrose injection. An intra-arrest BG level ≤ 150 mg/dl was inversely associated with favourable neurological outcomes at hospital discharge (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.11-0.73; p-value = 0.01). In analyses of interactions, non-DM × BG level ≤ 168 mg/dl was inversely associated with favourable neurological outcomes (OR: 0.30, 95% CI: 0.11-0.80; p-value = 0.02). There were no significant interactions between BG level and dextrose administration. CONCLUSION: IHCA patients with intra-arrest BG level ≤ 150 mg/dl had worse neurological recovery. Intra-arrest hypoglycaemia might be a marker of critical illness. Dextrose administration was not shown to improve outcomes of IHCA patients with intra-arrest BG level ≤ 150 mg/dl, indicating the need to develop new therapeutics other than dextrose administration for these patients.

10.
J Formos Med Assoc ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31526656

RESUMO

BACKGROUND: The role of body mass index (BMI) in clinical outcomes in patients resuscitated from cardiac arrest (CA) has recently drawn attention. We evaluated the effect of BMI on the prognosis of patients successfully resuscitated from cardiogenic arrest. METHODS: This retrospective cohort study included 273 non-traumatic adult cardiogenic arrest survivors receiving coronary angiography after return of spontaneous circulation in three hospitals from January 2011 to September 2017. These patients were classified as underweight, normal-weight, overweight, and obese, based on BMI (<18.5; 18.5-24.9; 25.0-29.9; and ≥30 kg/m2, respectively). In-hospital mortality and poor neurological outcomes were compared among groups. RESULTS: The obese group had significantly higher rates of in-hospital mortality and poor neurological outcomes (cerebral performance scale = 3-5) than did the other groups (for underweight, normal-weight, overweight, and obese groups, in-hospital mortality rates were 38.5%, 29.8%, 39.0%, and 64.1%, respectively, p = 0.002; poor neurological outcomes were 53.9%, 43.8%, 47.0%, and 71.8%, respectively, p = 0.02). The obese group exhibited higher risks of in-hospital mortality and poor neurological outcomes than did the normal-weight group (in-hospital mortality: adjusted hazard ratio (aHR) = 5.21, 95% confidence interval (CI) 2.16-10.32, p < 0.001; poor neurological outcomes: aHR = 3.77, 95% CI 1.69-8.36, p = 0.002). CONCLUSION: Obesity was associated with higher risks of in-hospital mortality and poor neurological recovery.

11.
Resuscitation ; 143: 42-49, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31422106

RESUMO

AIM: The simplified cardiac arrest hospital prognosis (sCAHP) score is a validated tool for predicting neurological outcomes after out-of-hospital cardiac arrest (OHCA). We used the sCAHP score to evaluate whether the effects of early coronary angiography (CAG) and targeted temperature management (TTM) for OHCA were modulated by immediate neuroprognosis. METHODS: This was a single-centre retrospective observational study. Consecutive OHCA patients were screened between 2011 and 2017. Multivariate logistic regression analysis and generalised additive models (GAMs) were used to examine the associations between independent variables and outcomes. Early CAG was defined as CAG performed within 24 h after return of spontaneous circulation (ROSC). RESULTS: A total of 412 patients were included in the study, and 94 (22.8%) patients had neurologically intact survival. The GAM plot identified a sCAHP score of 185 as the cut-off point to differentiate high-risk (sCAHP score ≧185) from low-risk (sCAHP score <185) patients. Regression models indicated that early CAG was significantly associated with favourable neurological [odds ratio (OR) 4.43, 95% confidence interval (CI) 2.28-8.60, p < 0.001] and survival outcomes (OR 3.47, 95% CI 1.93-6.25, p < 0.001), independent of the sCAHP score. Although TTM was associated with favourable neurological outcome only in low-risk patients (OR 2.13, 95% CI 1.10-4.13, p = 0.02), TTM was associated with improved survival for all patients (OR 2.66, 95% CI 1.54-4.59, p < 0.001), independent of the sCAHP score. CONCLUSIONS: Early CAG and TTM should be considered for all OHCA patients as suggested by guidelines, irrespective of the immediately predicted neuroprognosis after ROSC.

13.
Crit Care Med ; 47(11): 1549-1556, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356478

RESUMO

OBJECTIVES: Hyperoxia could lead to a worse outcome after cardiac arrest. Few studies have investigated the impact of oxygenation status on patient outcomes following extracorporeal cardiopulmonary resuscitation. We sought to delineate the association between oxygenation status and neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. DESIGN: Retrospective analysis of a prospective extracorporeal cardiopulmonary resuscitation registry database. SETTING: An academic tertiary care hospital. PATIENTS: Patients receiving extracorporeal cardiopulmonary resuscitation between 2000 and 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 291 patients were included, and 80.1% were male. Their mean age was 56.0 years. The arterial blood gas data employed in the primary analysis were recorded from the first sample over the first 24 hours in the ICUs after return of spontaneous circulation. The mean PaO2 after initiation of venoarterial extracorporeal membrane oxygenation was 178.0 mm Hg, and the mean PaO2/FIO2 ratio was 322.0. Only 88 patients (30.2%) demonstrated favorable neurologic status at hospital discharge. Multivariate logistic regression analysis indicated that PaO2 between 77 and 220 mm Hg (odds ratio, 2.29; 95% CI, 1.01-5.22; p = 0.05) and PaO2/FIO2 ratio between 314 and 788 (odds ratio, 5.09; 95% CI, 2.13-12.14; p < 0.001) were both positively associated with favorable neurologic outcomes. CONCLUSIONS: Oxygenation status during extracorporeal membrane oxygenation affects neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. The PaO2 range of 77 to 220 mm Hg, which is slightly narrower than previously defined, seems optimal. The PaO2/FIO2 ratio was also associated with outcomes in our analysis, indicating that both PaO2 and the PaO2/FIO2 ratio should be closely monitored during the early postcardiac arrest phase for postextracorporeal cardiopulmonary resuscitation patients.

14.
PLoS One ; 14(3): e0213168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845157

RESUMO

BACKGROUND: We attempted to identify factors associated with physicians' decisions to terminate CPR and to explore the role of family in the decision-making process. METHODS: We conducted a retrospective observational study in a single center in Taiwan. Patients who experienced in-hospital cardiac arrest (IHCA) between 2006 and 2014 were screened for study inclusion. Multivariate survival analysis was conducted to identify independent variables associated with IHCA outcomes using the Cox proportional hazards model. RESULTS: A total of 1525 patients were included in the study. Family was present at the beginning of CPR during 722 (47.3%) resuscitation events. The median CPR duration was significantly shorter for patients with family present at the beginning of CPR than for those without family present (23.5 mins vs 30 min, p = 0.01). Some factors were associated with shorter time to termination of CPR, including arrest in an intensive care unit, Charlson comorbidity index score greater than 2, age older than 79 years, baseline evidence of motor, cognitive, or functional deficits, and vasopressors in place at time of arrest. After adjusting for confounding effects, family presence was associated with shorter time to termination of CPR (hazard ratio, 1.25; 95% confidence interval, 1.06-1.46; p = 0.008). CONCLUSION: Clinicians' decisions concerning when to terminate CPR seemed to be based on outcome prognosticators. Family presence at the beginning of CPR was associated with shorter duration of CPR. Effective communication, along with outcome prediction tools, may avoid prolonged CPR efforts in an East Asian society.


Assuntos
Reanimação Cardiopulmonar , Família/psicologia , Parada Cardíaca/patologia , Idoso , Feminino , Parada Cardíaca/mortalidade , Hospitais , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Taiwan
15.
Am J Cardiol ; 123(10): 1572-1579, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30851940

RESUMO

Pretreatment with statins is associated with improved outcomes in severe sepsis, acute coronary syndrome, and stroke. Patients with cardiac arrest experience sepsis-like syndrome and ischemia reperfusion injuries in the heart and brain. The objective of this study was to investigate the effects of statin use before cardiac arrest on outcomes in cardiac arrest patients. Medical records of 142,131 adult patients who experienced nontraumatic cardiac arrest and were resuscitated between 2004 and 2011 were analyzed. Patients were grouped into 2 groups: the "statin group" comprised patients who had received statin treatment for at least 30 days before the cardiac arrest event; the "never statin group" comprised patients who had no statin use within 30 days before the event. Patients with previous statin treatment had better chance of survival to hospital discharge (6.1% vs 4.3%, p <0.0001) and 1-year survival (4.8% vs 3.2%, p <0.0001) after propensity score matching. Previous statin use was an independent predictor for 1-year survival (adjusted odds ratio 1.41, 95% confidence interval 1.16 to 1.71; p = 0.001). A favorable outcome effect of statin on 1-year survival was observed in the presence of diabetes mellitus, chronic kidney disease, and Charlson Comorbidity Index score greater than 5 in the subgroup analysis. In conclusion, statin use before cardiac arrest is associated with 1-year survival in a propensity score-matched nationwide cohort study.


Assuntos
Parada Cardíaca/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Isquemia Miocárdica/tratamento farmacológico , Pontuação de Propensão , Sistema de Registros , Idoso , Feminino , Seguimentos , Parada Cardíaca/etiologia , Parada Cardíaca/prevenção & controle , Humanos , Incidência , Masculino , Isquemia Miocárdica/complicações , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Taiwan/epidemiologia
16.
Resuscitation ; 137: 52-60, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30772425

RESUMO

BACKGROUND: The emergent coronary angiography (CAG) is associated with better outcomes in CA survivors. However, the impact of severity and revascularization of coronary artery stenosis on outcomes in cardiac arrest (CA) survivors remains unclear. METHODS: A total of 273 non-traumatic adult CA survivors who underwent emergent CAG from January 2011 to July 2017 were retrospectively recruited. The stenosis and non-revascularization of an individual coronary artery ≥70% were defined as significant in any of the major coronary arteries based on an operator visual estimate. RESULTS: There were 201 patients (73.63%) had ≧1 significant coronary artery stenosis and 58 patients (21.25%) with ≧1 non-revascularized coronary artery. The increased number of stenosed coronary artery was associated with an increased risk for in-hospital mortality [1-vessel: adjusted hazard ration (HR) 2.27, 95% confidence interval (CI) = 1.43-4.04, p = 0.021; 2-vessel: adjusted HR 5.49, 95% CI=2.17-13.89, p < 0.001; 3-vessel: adjusted HR 11.05, 95% CI=4.20-29.04, p < 0.001)] and poor neurological recovery (cerebral performance category = 3-5) [(1-vessel: adjusted odds ration (OR) 1.66, 95% CI 0.67-4.15, =0.275; 2-vessel: adjusted OR 1.81, 95% CI 1.05-3.97, p = 0.045; 3-vessel: adjusted OR 3.19, 95% CI 1.25-8.15, p = 0.001)], which was positively correlated with the number of vessels. The incomplete revascularization were also associated with increased in-hospital mortality and poor neurological function in patients with ≧1vessel stenosis. CONCLUSION: The severity and incomplete revascularization of coronary artery stenosis were associated with increased in-hospital mortality and poor neurological recovery in patients with presumed cardiogenic arrest.

17.
Resuscitation ; 137: 133-139, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797049

RESUMO

AIM: The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. METHODS: This was a single-centre prospective observational study. Consecutive OHCA patients were screened between January 2011 and March 2017. Simplified OHCA and CAHP scores (sOHCA, sCAHP) were calculated as the original scores with the no-flow interval omitted. Association between independent variables and outcomes was examined by multivariate logistic regression analysis, and area under the receiver operating characteristics curve (AUC) values were compared by paired DeLong test. RESULTS: A total of 412 patients were included. An inverse association between sOHCA and sCAHP scores and neurological outcome was confirmed, and most of the variables included in the simplified score calculations were also independently associated with neurological outcomes in our cohort. The AUC values for the simplified scores were similar, and both had excellent discriminatory performance for favourable neurologic outcome (AUC = 0.82, 95% confidence interval 0.77-0.86 for sOHCA and 0.84 with 95% confidence interval 0.80-0.89 for sCAHP, p-value = 0.19). CONCLUSION: The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.

18.
Crit Care Med ; 47(2): 167-175, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30308548

RESUMO

OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.


Assuntos
Parada Cardíaca/tratamento farmacológico , Esteroides/uso terapêutico , Idoso , Feminino , Parada Cardíaca/mortalidade , Humanos , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Sobreviventes , Taiwan/epidemiologia , Resultado do Tratamento
19.
Resuscitation ; 133: 18-24, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30261218

RESUMO

AIM: Resuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. METHODS: This study was a retrospective study in a single medical centre. Patients with an IHCA between 2006 and 2015 were screened. The estimated average glucose (eAG) level was converted from the HbA1c level measured within three months prior to the IHCA. The minimum glycaemic gap was calculated from the post-resuscitation minimum BG level minus the eAG level. RESULTS: A total of 141 patients were included in this study. The mean HbA1c was 7.2% (corresponding eAG: 160.2 mg/dL [8.9 mmol/L]). Multivariable logistic regression analysis indicated an eAG level of less than 196 mg/dL (10.9 mmol/L; corresponding HbA1c: 8.5%) was positively associated with a favourable neurological outcome at hospital discharge (odds ratio [OR]: 5.12, 95% confidence interval [CI]: 1.11-23.70; p-value = 0.04). An absolute minimum glycaemic gap of less than 70 mg/dL (3.9 mmol/L) was also positively associated with a favourable neurological outcome (OR: 5.41, 95% CI: 1.41-20.78; p-value = 0.01). CONCLUSION: For diabetic patients, poor long-term glycaemic control correlated with worse neurological recovery following an IHCA. The HbA1c-derived average BG level could be used as a reference point for glycaemic management during the early stage of post-cardiac arrest syndrome. The glycaemic gap could be used to identify the optimal glycaemic range around the reference point.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/sangue , Hemoglobina A Glicada/metabolismo , Parada Cardíaca/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Estudos de Casos e Controles , Causalidade , Comorbidade , Diabetes Mellitus/mortalidade , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Hiperglicemia/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
PLoS One ; 13(8): e0202938, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30138383

RESUMO

BACKGROUND: The Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score is a useful tool for predicting neurological outcome following in-hospital cardiac arrest (IHCA), and was derived from a cohort selected from the Get With The Guidelines-Resuscitation registry between 2000 and 2009 in the United States. In an East Asian population, we aimed to identify the factors associated with outcomes of resuscitated IHCA patients and assess the validity of the CASPRI score. METHODS: A retrospective study was conducted in a single centre in Taiwan. Patients with IHCA between 2006 and 2014 were screened. RESULTS: Among the 796 included patients, 94 (11.8%) patients achieved neurologically intact survival. Multivariable logistic regression analyses identified factors significantly associated with neurological outcome. Six of these factors were also components of the CASPRI score, including duration of resuscitation, neurological status before IHCA, malignant disease, initial arrest rhythms, renal insufficiency and age. In univariate logistic regression analysis, the CASPRI score was significantly associated with neurological outcome (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.80-0.87); the area under the receiver operating characteristics curve was 0.79 (95% CI: 0.74-0.84). CONCLUSION: In this retrospective study conducted in a single centre at Taiwan, we identified the common prognosticators of IHCA shared by both East Asian and Western societies. As a composite prognosticator, CASPRI score predicts outcomes with excellent accuracy among successfully resuscitated IHCA patients in an East Asian population. This tool allows accurate IHCA prognostication in an East Asian population.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Resultado do Tratamento , Idoso , Tomada de Decisões , Extremo Oriente/epidemiologia , Feminino , Parada Cardíaca/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Taiwan/epidemiologia , Fatores de Tempo
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