Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out-of-Hospital Cardiac Arrest Victims.

Head computed tomography (HCT) is often performed postcardiac arrest to assess for hypoxic-ischemic brain injury. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome after out-of-hospital cardiac arrest (OHCA).We included subjects from a prospectively collected database of OHCA adults who received targeted temperature management at two hospitals from July 2009 to July 2018. We included cases if an emergency department (ED) HCT was performed. Patient demographics and cardiac arrest variables were collected. HCT results were abstracted from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, and stroke). Outcomes were survival to discharge or dichotomized discharge cerebral performance category (CPC) of 1-2 (good neurologic outcome) versus 3-5 (poor neurologic outcome). Univariate and multivariate analyses were performed. There were 425 OHCA, of which 315 had ED HCT with 277 cases included. Patients were predominately male (65.0%), average age of 60.9 years and average body mass index of 30.5. Of all cases, 44 (15.9%) showed CE on computed tomography. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (odds ratio [OR]: 9.23; 95% confidence interval [CI] 1.73-49.2) and 9.1-fold greater odds of death (OR: 9.09, 95% CI 2.4-33.9). In adjusted analysis, CE was associated with a poor CPC outcome (adjusted odds ratios [AOR]: 14.9, 95% CI 2.49-88.4), and death (AOR: 13.7, 95% CI 3.26-57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (hazard ratios 3.56, 95% CI 2.34-5.41). The results identify that CE on HCTs early in the postarrest period in OHCA patients is strongly associated with poor rates of survival and neurologic outcome. Prospective work is needed to further define the role of early HCT in postarrest neuroprognostication.

Time to Awakening Is Often Delayed in Patients Who Receive Targeted Temperature Management After Cardiac Arrest.

Post cardiac arrest, neuroprognostication remains a complex and clinically challenging issue for critical care providers. For this reason, our primary objective in this study was to determine the frequency of survival and favorable neurological outcomes in post-cardiac arrest patients with delayed time to awakening. To assess whether early withdrawal of care may adversely impact survival, we also sought to describe the time to withdrawal of care of non-surviving patients. We performed a retrospective study of patients resuscitated after cardiac arrest in two large academic community hospitals. We performed a structured chart review of patients treated with therapeutic hypothermia (TH) at one hospital from 2009 to 2015 and at a second hospital from 2013 to 2015. Demographics and Utstein style variables were recorded on all patients, as well as temporal variables to characterize the time interval from Return of Spontaneous Circulation (ROSC) to awakening as recorded by ICU nurses and defined as Glasgow Coma Scale (GCS) of >8. Descriptive data were also captured regarding time to withdrawal of care. We pre-hoc defined delayed awakening as >72 hours post ROSC or >72 hours post rewarming. Our primary outcome was survival to hospital discharge with a secondary outcome of a favorable cerebral performance category of 1 or 2. During this study period, 321 patients received TH, with 111 (34.6%) discharged alive and, of these, 67 (68.5%) experienced a good neurological outcome. Awakening more than 72 hours after return of circulation was common with 31 patients surviving to discharge. Of these, 16 of 31 (51.6%) were found to have a good neurological outcome on hospital discharge. Of the patients who died before discharge, 54 (29.5%) had care withdrawn less than 72 hours after ROSC. A delayed time to awakening is not infrequently associated with a good neurological outcome after TH in patients resuscitated from cardiac arrest.

Care for Cardiac Arrest on Golf Courses: Still Not up to Par?

Abstract Introduction. Early CPR and use of automated external defibrillators (AEDs) have been shown to improve cardiac arrest (CA) outcomes. Placement of AEDs on golf courses has been advocated for more than a decade, with many trade golf publications calling for their use. Objective. To describe the incidence and treatment of CAs at Michigan golf courses and assess the response readiness of their staff. Methods. We performed a retrospective study of CA on Michigan golf courses from 2010 to 2012. Cases were identified from the Michigan EMS Information (MI-EMSIS) database. Cases with "golf" or "country club" were manually reviewed and location type was confirmed using Google Maps. We conducted a structured telephone survey capturing demographics, course preparedness, including CPR training and AED placement, and a description of events, including whether CPR was performed and if an AED was used. Our primary area of interest was the process of care. We also recorded return of spontaneous circulation (ROSC) as an outcome measure. EMS Utstein data were collected from MI-EMSIS. Descriptive data are presented. Results. During the study period, there were 14,666 CAs, of which 40 (0.18%) occurred on 39 golf courses (1 arrest/64 courses/year). Of these, 38 occurred between May and October, yielding a rate of 1 arrest/33.5 courses/golf season. Almost all (96.2%) patients were male, mean age 66.3 (range 45-85), 68% had VT/VF, and 7 arrested after EMS arrival. Mean interval from 9-1-1 call to EMS arrival at the patient was 9:45 minutes (range 3-20). Of all cases, 24 (72.3%) patients received CPR with 2 patients having CPR performed by course staff. Although AEDs were available at 9 (22.5%) courses, they were only placed on 2 patients prior to EMS arrival. Sustained ROSC was obtained in 12 (30.0%) patients. Only 7, (17.9%) courses required CPR/AED training of staff. Conclusion. When seasonally adjusted, the rate of cardiac arrest on Michigan golf courses is similar to that of other public locations. AED use was rare even when available. Preparedness for and response during a CA is suboptimal. Despite more than a decade of advocacy, response to golf course cardiac arrest is still not up to par.