AIM: Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA). METHODS: Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites. Highly malignant patterns were defined as burst-suppression or suppression with or without superimposed periodic discharges. Multimodal prognostication was performed 96 h after CA. Good outcome at 6 months was defined as a modified Rankin Scale score of 0-3. RESULTS: 873 comatose patients at 59 sites had an EEG assessment during the hospital stay. Of these, 283 (32%) had good outcome. EEG was recorded at a median of 69 h (IQR 47-91) after CA. Absence of highly malignant EEG patterns was seen in 543 patients of whom 255 (29% of the cohort) had preserved EEG reactivity. A non-highly malignant and reactive EEG had 56% (CI 50-61) sensitivity and 83% (CI 80-86) specificity to predict good outcome. Presence of EEG reactivity contributed (p < 0.001) to the specificity of EEG to predict good outcome compared to only assessing background pattern without taking reactivity into account. CONCLUSION: Nearly one-third of comatose patients resuscitated after CA had a non-highly malignant and reactive EEG that was associated with a good long-term outcome. Reactivity testing should be routinely performed since preserved EEG reactivity contributed to prognostic performance.
- MeSH
- elektroencefalografie * metody MeSH
- kardiopulmonální resuscitace metody MeSH
- kóma etiologie patofyziologie diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- terapeutická hypotermie * metody MeSH
- zástava srdce mimo nemocnici * terapie patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- MeSH
- lidé MeSH
- zástava srdce mimo nemocnici * komplikace patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Targeted temperature management (TTM) in comatose survivors of out-of-hospital cardiac arrest has been associated with improved neurological outcomes. However, the optimal temperature target for TTM remains unclear. OBJECTIVES: To compare a TTM protocol targeted at 34-36 °C with a protocol targeted at 32-34 °C with reference to both clinical outcomes and acute complications. METHODS: We analyzed a prospective registry of consecutive out-of-hospital cardiac arrest survivors who underwent TTM. We compared patients on a TTM protocol targeted at 34-36 °C (n = 59) with a historical cohort of patients treated at 32-34 °C (n = 116) according to the following parameters: six-month survival, cerebral performance category (CPC) scores, and acute complications. RESULTS: Survival and favorable neurological outcomes (CPC ≤ 2) at six months were 56% and 49%, respectively, in the higher target temperature group vs. 66% and 61%, respectively, in the lower target temperature group (p = 0.18 and 0.13). Acute clinical complications occurred in 1.5% vs. 12% of patients treated at the higher vs. the lower temperature range (p = 0.02). CONCLUSIONS: Patients treated with TTM at 34-36 °C had similar mid-term survival and neurological outcomes as patients treated with TTM at 32-34 °C. However, patients treated within the higher temperature range had fewer acute complications.
- MeSH
- časové faktory MeSH
- kardiopulmonální resuscitace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- registrace * MeSH
- tělesná teplota fyziologie MeSH
- terapeutická hypotermie metody MeSH
- výsledek terapie MeSH
- zástava srdce mimo nemocnici patofyziologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The concept of personalized cardiopulmonary resuscitation (CPR) requires a parameter that reflects its hemodynamic efficiency. While intra-arrest ultrasound is increasingly implemented into the advanced life support, we realized a pre-hospital clinical study to evaluate whether the degree of compression of the right ventricle (RV) and left ventricle (LV) induced by chest compressions during CPR for out-of-hospital cardiac arrest (OHCA) and measured by transthoracic echocardiography correlates with the levels of end-tidal carbon dioxide (EtCO2) measured at the time of echocardiographic investigation. METHODS: Thirty consecutive patients resuscitated for OHCA were included in the study. Transthoracic echocardiography was performed from a subcostal view during ongoing chest compressions in all of them. This was repeated three times during CPR in each patient, and EtCO2 levels were registered. From each investigation, a video loop was recorded. Afterwards, maximal and minimal diameters of LV and RV were obtained from the recorded loops and the compression index of LV (LVCI) and RV (RVCI) was calculated as (maximal - minimal/maximal diameter) × 100. Maximal compression index (CImax) defined as the value of LVCI or RVCI, whichever was greater was also assessed. Correlations between EtCO2 and LVCI, RVCI, and CImax were expressed as Spearman's correlation coefficient (r). RESULTS: Evaluable echocardiographic records were found in 18 patients, and a total of 52 measurements of all parameters were obtained. Chest compressions induced significant compressions of all observed cardiac cavities (LVCI = 20.6 ± 13.8%, RVCI = 34.5 ± 21.6%, CImax = 37.4 ± 20.2%). We identified positive correlation of EtCO2 with LVCI (r = 0.672, p < 0.001) and RVCI (r = 0.778, p < 0.001). The strongest correlation was between EtCO2 and CImax (r = 0.859, p < 0.001). We identified that a CImax cut-off level of 17.35% predicted to reach an EtCO2 level > 20 mmHg with 100% sensitivity and specificity. CONCLUSIONS: Evaluable echocardiographic records were reached in most of the patients. EtCO2 positively correlated with all parameters under consideration, while the strongest correlation was found between CImax and EtCO2. Therefore, CImax is a candidate parameter for the guidance of hemodynamic-directed CPR. TRIAL REGISTRATION: ClinicalTrial.gov, NCT03852225 . Registered 21 February 2019 - Retrospectively registered.
- MeSH
- dechové testy metody MeSH
- echokardiografie přístrojové vybavení metody normy MeSH
- kardiopulmonální resuscitace metody normy MeSH
- lidé středního věku MeSH
- lidé MeSH
- oxid uhličitý analýza MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tlak škodlivé účinky MeSH
- urgentní zdravotnické služby normy MeSH
- zástava srdce mimo nemocnici klasifikace patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: The presence of gasping in out-of-hospital cardiac arrest (OHCA) patients predicts short-term prognosis. We performed a retrospective study to evaluate whether the presence of gasping at the time of Emergency Medical Service (EMS) arrival in the case OHCA patients of presumed cardian origin has any impact on six-month survival and/or sustained return of spontaneous circulation (ROSC). METHODS: We collected and analyzed Utstein Style data for all patients resuscitated for OHCA of presumed cardiac origin by the EMS of the Central Bohemian Region from July 1st, 2013 to June 30th, 2014. RESULTS: During the data collection period, 565 cases of OHCA of presumed cardiac origin were reported. Gasping at the time of EMS arrival was identified in 23.9%. The presence of gasping was associated with a significantly increased frequency of sustained ROSC (48.1 versus 20.7%, P<0.001) and six-month survival (40.7 versus 16.7%, P<0.001) than in non-breathing patients. Presence of gasping upon EMS arrival has been found to be an independent positive predictor of sustained ROSC (OR 2.51, CI 95% 1.59-3.98, P<0.001). The occurrence of gasping at the time of EMS arrival at the scene was significantly related to response time from EMS activation to arrival. CONCLUSION: The presence of gasping upon arrival of the EMS for the patient with OHCA of presumed cardiac origin predicts both improves short-term and long-term prognoses.
- MeSH
- časové faktory MeSH
- kardiopulmonální resuscitace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- poruchy dýchání mortalita patofyziologie MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- urgentní zdravotnické služby MeSH
- zástava srdce mimo nemocnici mortalita patofyziologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in developed industrial countries. The global worldwide average of OHCA incidence in adults is 95.9/100,000/year. European incidences vary according to source from 16 to 119/100,000/year. The aim of this study was to provide an overview of current information on OHCA. The incidences in various populations are discussed, along with the factors affecting the prognosis and outcome of these patients. The etiology and pathophysiological mechanisms are also described, especially in relation to the most common causes - acute and chronic forms of coronary artery disease and cardiomyopathies. Measures that could improve survival rates are discussed, with emphasis on the role of the general public and deployment of automatic external defibrillators.
- MeSH
- defibrilátory MeSH
- incidence MeSH
- lidé MeSH
- míra přežití MeSH
- prognóza MeSH
- zástava srdce mimo nemocnici epidemiologie etiologie patofyziologie terapie MeSH
- zdravotní výchova MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVES: Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. DESIGN: Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." SETTING: Thirty-six sites in Europe and Australia. PATIENTS: All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. INTERVENTIONS: Targeted temperature management at 33°C or 36°C. MEASUREMENTS AND MAIN RESULTS: Nonparametric tests as well as multiple logistic regression and mixed effects logistic regression models were used. Median glucose concentrations on hospital admission differed significantly between Cerebral Performance Category outcomes (p < 0.0001). Hyper- and hypoglycemia were associated with poor neurologic outcome (p = 0.001 and p = 0.054). In the multiple logistic regression models, the median glycemic level was an independent predictor of poor Cerebral Performance Category (Cerebral Performance Category, 3-5) with an odds ratio (OR) of 1.13 in the adjusted model (p = 0.008; 95% CI, 1.03-1.24). It was also a predictor in the mixed model, which served as a sensitivity analysis to adjust for the multiple time points. The proportion of hyperglycemia was higher in the 33°C group compared with the 36°C group. CONCLUSION: Higher blood glucose levels at admission and during the first 36 hours, and higher glycemic variability, were associated with poor neurologic outcome and death. More patients in the 33°C treatment arm had hyperglycemia.
- MeSH
- časové faktory MeSH
- Glasgowská stupnice následků MeSH
- hyperglykemie patofyziologie MeSH
- hypoglykemie patofyziologie MeSH
- kardiopulmonální resuscitace metody MeSH
- krevní glukóza fyziologie MeSH
- lidé MeSH
- tělesná teplota * MeSH
- terapeutická hypotermie metody MeSH
- zástava srdce mimo nemocnici mortalita patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- MeSH
- lidé MeSH
- zástava srdce mimo nemocnici * komplikace patofyziologie terapie MeSH
- Check Tag
- lidé MeSH
- Klíčová slova
- mimonemocniční náhlá zástava oběhu, ZZS Moravskoslezského kraje,
- MeSH
- defibrilátory využití zásobování a distribuce MeSH
- kardiocentra MeSH
- kardiopulmonální resuscitace využití MeSH
- koronární jednotky MeSH
- lidé středního věku MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- systolické srdeční selhání diagnóza terapie MeSH
- urgentní zdravotnické služby organizace a řízení statistika a číselné údaje MeSH
- zástava srdce mimo nemocnici * diagnóza epidemiologie klasifikace mortalita patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- elektrostimulační terapie metody MeSH
- fibrilace komor patofyziologie terapie MeSH
- kohortové studie MeSH
- komorová tachykardie patofyziologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- prognóza MeSH
- prospektivní studie MeSH
- registrace MeSH
- resuscitace metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- terapeutická hypotermie metody MeSH
- výsledek terapie MeSH
- zástava srdce mimo nemocnici patofyziologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
