Background And Aims: Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.
Methods: This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.
Results: Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p = 0.02 and in those with a MIRACLE score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p = 0.005].
Conclusions: The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE score, to a dedicated CAC may improve survival.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.resuscitation.2025.110491 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Trends in Cardiac Arrest Outcomes & Management in Children with Cardiac Illness Category Compared to Non-Cardiac Illness Category: An Analysis from the AHA Get With The Guidelines®-Resuscitation Registry.
Resuscitation
December 2024
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Introduction: Contemporary rates of survival after pediatric in-hospital CPR events and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and rates of survival after in-hospital CPR increased over time in all categories.
Methods: The AHA Get With The Guidelines®-Resuscitation registry was queried for index CPR events in children < 18 years of age from 2000 to 2021.
A case of fatal acute saddle embolism of the terminal aorta after long-term support using Impella CP.
J Artif Organs
March 2025
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan.
A 69-year-old male diagnosed with subacute myocardial infarction was subsequently transferred to our institution. Upon admission, echocardiography revealed ventricular septal rupture (VSR). The patient was promptly supported via venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella CP before surgical VSR repair on the 12th day of admission.
View Article and Find Full Text PDFTrends in Cardiac Arrest Among Heart Failure Patients Aged 25 and Older in the United States: Insights from the CDC WONDER Database: Cardiac Arrest Mortality Trends in Heart Failure.
Am J Cardiol
March 2025
Department of Cardiology, Lahey Hospital and Medical Center, Burlington, MA.
The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest is appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes or massive head trauma.
View Article and Find Full Text PDFComparison of different treatments of out-of-hospital cardiac arrest: A systematic review and network meta-analysis.
Medicine (Baltimore)
March 2025
Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, Henan Province, China.
Background: This study aimed to compare the effectiveness of various treatments for out-of-hospital cardiac arrest (OHCA) patients using a network meta-analysis.
Methods: A systematic search was conducted on Pubmed, Embase, and Cochrane Library databases from their inception to January 2024 to identify randomized controlled trials comparing various treatments (epinephrine (high dose), vasopressin, epinephrine (standard dose), epinephrine + vasopressin) or placebo for OHCA patients. Bayesian network meta-analyses were performed, and data extraction and analysis were carried out using the R software with the gemtc package.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!