PURPOSE: Coronary artery disease is the most common cause of out-of-hospital cardiac arrest (OHCA). However, there are no definite indications of coronary angiography (CAG) followed by percutaneous coronary intervention (PCI) in patients with OHCA for diagnosis and treatment. The aim of this study was to determine correlation between ECG findings and results of CAG of patients with return of spontaneous circulation after OHCA. METHODS: We collected data from January 2010 until April 2014. CAG was performed in patients with ROSC after OHCA in whom ST-elevation or left bundle branch block (LBBB) was detected on ECG. If ECG showed another rhythm and no obvious non-cardiac cause of cardiac arrest, CAG was performed as an agreement between the emergency physician and cardiologist following by Samsung Medical Center OHCA protocol. RESULTS: CAG was performed in 75 patients among 131 patients who were successfully resuscitated from OHCA. We divided patients into two groups, ST-elevation or LBBB group and other group. Twenty nine patients in the ST-elevation or LBBB group had coronary lesion and nine patients in the other group had coronary lesion on CAG (p<0.01); 15 patients and five patients, respectively, had undergone PCI (p=0.02). CONCLUSION: ECG findings of ST-elevation or LBBB were highly associated with coronary lesions in successfully resuscitated patients from OHCA. However, these ECG findings were not an absolute indication for performing CAG because coronary artery lesions were also observed in patients in the other group.
Bundle-Branch Block ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography* ; Emergencies ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest* ; Percutaneous Coronary Intervention

OBJECTIVE: To investigate the prognostic value of hemoglobin-to-red cell distribution width ratio (HRR) in patients with cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA). METHODS: A retrospective study was conducted. Patients aged ≥ 18 years with OHCA who were transferred to intensive care unit (ICU) after successful CPR from the emergency room of the First Affiliated Hospital of Zhengzhou University from August 2016 to February 2022 were enrolled. General clinical data, initial vital signs, acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), first laboratory indicators after admission to ICU [including white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), pH value, lactic acid (Lac), 6-hour lactic acid clearance (LCR), red cell distribution width (RDW), HRR], length of ICU stay were collected. According to whether the patients died in hospital, the patients were divided into survival group and death group. Binary Logistic regression was used to analyze the independent factors influencing the prognosis of patients after CPR. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of independent influencing factors for the prognosis of patients after CPR. RESULTS: A total of 122 patients were enrolled after OHCA CPR, of which 88 died in hospital, the in-hospital mortality was 72.13%. There were no significant differences in age, past medical history, initial vital signs and WBC in ICU between the two groups. Compared with the death group, the survival group had higher GCS score, RBC, Hb, pH value, 6-hour LCR, HRR, lower APACHE II score, Lac, RDW level, and longer length of ICU stay. Multivariate Logistic regression analysis showed that APACHE II score, GCS score, 6-hour LCR, HRR, length of ICU stay were independent factors influencing the prognosis of patients after CPR [APACHE II score: odds ratio (OR) = 0.784, 95% confidence interval (95%CI) was 0.683-0.901, P = 0.001; GCS score: OR = 1.390, 95%CI was 1.059-1.823, P = 0.018; 6-hour LCR: OR = 1.039, 95%CI was 1.015-1.064, P = 0.001; HRR: OR = 2.047, 95%CI was 1.383-3.029, P < 0.001; length of ICU stay: OR = 1.128, 95%CI was 1.046-1.216, P = 0.002]. ROC curve analysis showed that HRR, 6-hour LCR and APACHE II score could predict the prognosis of patients after CPR. The sensitivity was 85.3% and the specificity was 54.5% when the area under the ROC curve (AUC) of HRR was 0.731, and the cut-off value was 8.555. The sensitivity was 88.2% and the specificity was 46.6%, when the AUC of 6-hour LCR was 0.701, and the cut-off value was 28.947%. The sensitivity was 73.9% and the specificity was 79.4% when the AUC of APACHE II score was 0.848, the cut-off value was 22.000. The predictive value of the combination of HRR and 6-hour LCR was higher than that of a single index. The sensitivity was 79.3% and the specificity was 76.1%, when the AUC was 0.796, the cut-off value was 0.296. CONCLUSIONS HRR, 6-hour LCR and APACHE II score have high prognostic value in patients with OHCA after CPR. HRR < 8.555, 6-hour LCR < 28.947% and APACHE II score > 22.000 indicated poor prognosis.
Humans ; Erythrocyte Indices ; Prognosis ; Retrospective Studies ; Out-of-Hospital Cardiac Arrest/therapy* ; ROC Curve ; Intensive Care Units ; Hemoglobins ; Lactic Acid ; Cardiopulmonary Resuscitation ; Sepsis/diagnosis*

PURPOSE: Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS: Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS: We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION: In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.
Aged ; Biomarkers/*blood ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease/blood/*diagnosis/epidemiology ; Echocardiography/*methods ; Electrocardiography/*methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood/*diagnosis/epidemiology ; Out-of-Hospital Cardiac Arrest/*diagnosis ; Sensitivity and Specificity ; Troponin T

INTRODUCTIONPrompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore.

MATERIALS AND METHODSThis is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied.

RESULTSEighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%).

CONCLUSIONWe found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.

Aged ; Aged, 80 and over ; Ambulances ; Cardiopulmonary Resuscitation ; standards ; Electric Countershock ; standards ; Emergency Medical Services ; standards ; Female ; Humans ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest ; diagnosis ; therapy ; Retrospective Studies ; Singapore ; Transportation of Patients ; standards

We described two patients who were successfully resuscitated from out-of-hospital cardiac arrest. Their ECGs showed ST elevations in V1 and aVR, as well as diffuse ST depression. Their ST elevation in V1 was noted to be greater than in aVR. While one patient was found to have an occlusion of the right ventricular (RV) branch of the right coronary artery, the other was found to have an occlusion of a proximal non-dominant right coronary artery supplying the RV branch. Successful primary percutaneous coronary intervention was performed for each patient with angioplasty and implantation of a drug-eluting stent. Both patients made good physical and neurological recovery.
Adult ; Angioplasty ; Angioplasty, Balloon, Coronary ; Cardiopulmonary Resuscitation ; Coronary Vessels ; physiopathology ; Defibrillators ; Drug-Eluting Stents ; Electrocardiography ; Heart Ventricles ; physiopathology ; Hepatitis B ; complications ; Humans ; Male ; Myocardial Infarction ; diagnosis ; physiopathology ; Out-of-Hospital Cardiac Arrest ; therapy ; Percutaneous Coronary Intervention ; Resuscitation ; Singapore

PURPOSE: Sudden cardiac death is still a major cause of death and a burden to national public health. Out-of-hospital cardiac arrest (OHCA) patients achieving field Return of spontaneous circulation (ROSC) have better survival rates and good neurological outcomes. The study was designed for analysis of prehospital and hospital clinical characteristics of Heartsaver patients surviving OHCA of cardiac origin. METHODS: A retrospective study was conducted on 31 Heartsaver patients surviving OHCA by Emergency Medical Service (EMS) from March, 2011 to May, 2014; 24 cardiogenic-Heartsaver patients were enrolled in this study. They were divided into the myocardial infarction group (MI group) and the non-myocardial infarction group (Non-MI group) by final diagnosis for comparison of prehospital and in-hospital characteristics. RESULTS: The etiology of cardiac arrest cause of cardiogenic-Heartsaver was categorized according to five groups, including myocardial infarction (29.2%), Brugada syndrome (25.0%), idiopathic ventricular fibrillation (25.0%), idiopathic ventricular tachycardia (8.3%), and coronary spasm (12.5%). Most patients had good neurological outcomes, Cerebral Performance Categories scale (CPC) median was 1.0(1.0-1.0). The MI group showed higher average age (57.1+/-6.49 vs 52.3+/-13.0, p=0.036), high incidence of ST-segment elevation (42.9%), and nonspecific-ST or T-wave change (24.9%) in electrocardiogram (ECG) after ROSC, higher incidence of regional wall motion abnormality in Echocardiography (85.7% vs 23.5%, p=0.009), and higher peak level of CK-MB, troponin I within 12 hours (p=0.005, p=0.014). Some Non-MI patients had undergone an electrophysiologic study and received an implantable cardioverter defibrillator. CONCLUSION: Cardiogenic OHCA patients should be examined by cardiac enzyme, ECG, echocardiography, and coronary angiography in order to differentiate etiology. Besides, to prevent sudden cardiac death from fatal arrhythmia, electrophysiologic study and implantable cardioverter defibrillator insertion therapy must be considered.
Arrhythmias, Cardiac ; Brugada Syndrome ; Cause of Death ; Coronary Angiography ; Death, Sudden, Cardiac ; Defibrillators ; Diagnosis ; Echocardiography ; Electrocardiography ; Emergency Medical Services ; Heart Arrest ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Out-of-Hospital Cardiac Arrest* ; Public Health ; Retrospective Studies ; Spasm ; Survival Rate ; Tachycardia, Ventricular ; Troponin I ; Ventricular Fibrillation