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@#BACKGROUND:To evaluate the outcome of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests (OHCA) in India and factors influencing the outcome. METHODS:The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation (ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference. RESULTS: The survival rate to hospital admission was 32.5％, the survival rate to hospital discharge was 8.8％and with good cerebral performance category (CPC1) neurological status was 3.8％. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests (56.5％) with 1.3％bystander CPR rate, 92.5％arrests occurred at home, 96％presented with initial non-shockable rhythm and 92.5％with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was≤20 minutes. CONCLUSION: Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system (EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.
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Objective To evaluate the prognostic value of the first documented rhythm in patients with in-hospital cardiac arrest.Methods The clinical data of 62 in-hospital cardiac arrest patients collected from May 2011 to April 2016 were reviewed.Multiple regression analysis was performed for determination of the factors relevant to ROSC.The patients were divided into defibrillative rhythm group [ventricular fibrillation (VF) /ventricular tachycardia (VT)] and non-defibrillative rhythm group [pulseless electrical activity (PEA) /asystole] according to the first documented rhythm after cardiac arrest.The differences in rate of restoration of spontaneous circulation,number of survival at hospital discharge and those discharged with favorable neurological outcome were compared between groups.Results Logistic regression analysis showed that non-defibrillative rhythm was related to low rate of ROSC.Rate of ROSC (x2 =6.90,P =0.01),number of survival at hospital discharge (x2 =10.49,P =0.00) and those discharged with favorable neurological outcome (x2 =14.70,P =0.00) were higher in the defibrillative rhythm group,while there was no difference in outcomes between the VF and VT groups.There was no difference in consequence found between the PEA and asystole groups.Conclusion Rate of restoration of spontaneous circulation,number of survival at hospital discharge and those discharged with favorable neurological consequence were higher with defibrillative initial rhythm.
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<p><b>INTRODUCTION</b>Early use of mechanical cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) may improve survival outcomes. Current evidence for such devices uses outcomes from an intention-to-treat (ITT) perspective. We aimed to determine whether early use of mechanical CPR using a LUCAS 2 device results in better outcomes.</p><p><b>METHODS</b>A prospective, randomised, multicentre study was conducted over one year with LUCAS 2 devices in 14 ambulances and manual CPR in 32 ambulances to manage OHCA. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were survival at 24 hours, discharge from hospital and 30 days.</p><p><b>RESULTS</b>Of the 1,274 patients recruited, 1,191 were eligible for analysis. 889 had manual CPR and 302 had LUCAS CPR. From an ITT perspective, outcomes for manual and LUCAS CPR were: ROSC 29.2% and 31.1% (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.82-1.45; p = 0.537); 24-hour survival 11.2% and 13.2% (OR 1.20, 95% CI 0.81-1.78; p = 0.352); survival to discharge 3.6% and 4.3% (OR 1.20, 95% CI 0.62-2.33; p = 0.579); and 30-day survival 3.0% and 4.0% (OR 1.32, 95% CI 0.66-2.64; p = 0.430), respectively. By as-treated analysis, outcomes for manual, early LUCAS and late LUCAS CPR were: ROSC 28.0%, 36.9% and 24.5%; 24-hour survival 10.6%, 15.5% and 8.2%; survival to discharge 2.9%, 5.8% and 2.0%; and 30-day survival 2.4%, 5.8% and 0.0%, respectively. Adjusted OR for survival with early LUCAS vs. manual CPR was 1.47 after adjustment for other variables (p = 0.026).</p><p><b>CONCLUSION</b>This study showed a survival benefit with LUCAS CPR as compared to manual CPR only, when the device was applied early on-site.</p>
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Objective To investigate the usefulness of Utstein template to guide the assessment and study of cardiopulmonary resuscitation (CPR) in our medical practice because it has been popularized in many countries since 1991.Methods A prospective observational study using Utstein CPR registry form to evaluate the epidemiological features and outcomes of 511 patients resuscitated in the emergency department.Results Of 511 CPR patients registered,higher cardiac arrest rates were observed in the group of patients aged 40- 70 years. In 511 CPR patients registered,preexisting chronic diseases were common including cardiovascular diseases ( 190,37.2％ ) cerebrovascular diseases (48,9.4％ ) and respiratory diseases (39,7.6％ ).Of them,173 cardiac arrest patients (33.9％) had underlying cardiac causes,such as acute myocardial infarction (AMI) found in 109 (21.3％) patients,and ventricular fibrillation witnessed during first cardiac monitoring in eighty ( 15.7％ ) patients.The restoration of spontaneous circulation (ROSC) rate and survival rate at discharge of in - hospital cardiac arrest (IHCA) patients were 47.0％ and 13.5％respectively,but 16.7％ and 4.7％ respectively in the out - hospital cardiac arrest (OHCA) patients (P ＜0.01,both ). Conclusions This study indicated that the cardiovascular diseases, cerebrovascular diseases,and respiratory diseases were the most common preexisting chronic diseases found in cardiac arrest patients.Myocardial infarct,stroke and trauma were the most common precipitation causes of cardiac arrest in the recruited patients.The rates of ROSC and survival at discharge were significantly higher in statistics in patients with IHCA than those in ones with OHCA.
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Objective To study the Hainan Utstein templates used for cardiac arrest and resuscitation registries to evaluate the epidemiological characteristics and outcomes of the patients with CPR by multi-center study. Methodsccording to the Utstein templates for cardiac arrest and CPR set by International Liaison Committee on resuscitation in 2004, a Hainan Utstein CPR registry chart was designed and a prospective descriptive study was carried out to evaluate the epidemiological characteristics, impact factors and outcomes of the patients with resuscitation attempt in emergency departments of thirteen hospitals in Hainan Island between January 2007 and December 2010.Results Of 1125 patients with cardiac arrest, male accounted for 73. 8％ and female was 26. 2％. The mean ( ± S. D) age of the cardiac arrest patients was 53.9 ± 13. 1 years old.Coronary heart diseases and hypertension were the most common preexisting chronic diseases in the studied patients. The ROSC rate and discharge rates after survival in 1125 patients with CPR were 23. 8％ and 7.4％ respectively. The ROSC rate and discharge rates after survival were 36. 3％ and 11.6％ in the in-hospital cardiac arrest (IHCA) group, respectively whereas 11.5％ and 3. 3％ in out-hospital cardiac arrest (OHCA) group. Of 188 patients with ventricular fibrillation/Pulseless ventricular tachycardia, the ROSC rate and discharge rate after survival were 58.0％and 21.8％,respectively. Of them, 448 (39. 8％ ) of the cardiac arrest patients had underlying cardiac causes, and the ROSC rate and discharge rate after survival were 36. 3％ and 11.5％ respectively in IHCA group whereas 11.6％ and 3. 3％ in OHCA group. The ROSC rate and discharge rate after survival were 69. 8％ and 7. 4％respectively in the tertiary hospitals whereas 30. 2％ and 7. 3％ in the secondary hospitals. Conclusions Patients experienced cardiac arrest were predominantly male. Coronary heart disease and hypertension were the two most common preexisting chronic diseases. The ROSC rate and discharge rate of patients with IHCA were higher than those with OHCA. ROSC rate and discharge rate after survival were higher in the ventriculat fibrillation/Pulseless ventricular tachycardia group than the other cardiac rhythms first witnessed groups. The time delayed of starting CPR after onset of cardiac arrest had a critical impact on survival and discharge rate in both IHCA and OHCA groups.