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Jerry P Nolan - One of the best experts on this subject based on the ideXlab platform.
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incidence and outcome of in hospital Cardiac Arrest in the united kingdom national Cardiac Arrest audit
Resuscitation, 2014Co-Authors: Jerry P Nolan, Jasmeet Soar, Gary B Smith, Carl Gwinnutt, Francesca Parrott, Sarah Power, David A Harrison, Edel Nixon, Kathryn M RowanAbstract:Abstract Objective To report the incidence, characteristics and outcome of adult in-hospital Cardiac Arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. Methods A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital Cardiac Arrest and survival to hospital discharge. Results The overall incidence of adult in-hospital Cardiac Arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2–2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. Conclusions These first results from the NCAA database describing the current incidence and outcome of adult in-hospital Cardiac Arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital Cardiac Arrest.
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post Cardiac Arrest syndrome
Circulation, 2008Co-Authors: Robert W Neumar, Clifton W Callaway, Jerry P Nolan, Christophe Adrie, Mayuki Aibiki, Robert A Berg, Bernd W Bottiger, Robert S B Clark, Romergryko G Geocadin, Edward C JauchAbstract:The contributors to this statement were selected to ensure expertise in all the disciplines relevant to post–Cardiac Arrest care. In an attempt to make this document universally applicable and generalizable, the authorship comprised clinicians and scientists who represent many specialties in many regions of the world. Several major professional groups whose practice is relevant to post–Cardiac Arrest care were asked and agreed to provide representative contributors. Planning and invitations took place initially by e-mail, followed a series of telephone conferences and face-to-face meetings of the cochairs and writing group members. International writing teams were formed to generate the content of each section, which corresponded to the major subheadings of the final document. Two team leaders from different countries led each writing team. Individual contributors were assigned by the writing group cochairs to work on 1 or more writing teams, which generally reflected their areas of expertise. Relevant articles were identified with PubMed, EMBASE, and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Drafts of each section were written and agreed on by the writing team authors and then sent to the cochairs for editing and amalgamation into a single document. The first draft of the complete document was circulated among writing team leaders for initial comment and editing. A revised version of the document was circulated among all contributors, and consensus was achieved before submission of the final version for independent peer review and approval for publication. This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after Cardiac Arrest. The purpose is to provide a resource for optimization of post–Cardiac Arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes …
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mode of death after admission to an intensive care unit following Cardiac Arrest
Intensive Care Medicine, 2004Co-Authors: S R Laver, Catherine Farrow, Duncan Turner, Jerry P NolanAbstract:To determine the mode of death in patients admitted to an intensive care unit (ICU) after Cardiac Arrest who died before hospital discharge. Prospectively defined retrospective review of a database and individual patient medical records and ICU charts. Eleven-bed multidisciplinary intensive care unit in a general hospital in the United Kingdom. All patients admitted to ICU between February 1998 and July 2003 after a Cardiac Arrest in the previous 24 h. The outcome at hospital discharge and mode of death in non-survivors were recorded. Based on the mode of death, non-survivors were placed in one of three groups: multiple organ failure death, neurological death or cardiovascular death. Two hundred and five patients were admitted to ICU after a Cardiac Arrest; 113 (55.1%) after out-of-hospital Cardiac Arrest and 92 (44.9%) after in-hospital Cardiac Arrest. One hundred and twenty-six (61.5%) patients died before hospital discharge and of these 58 (46.0%) died due to neurological injury. After Cardiac Arrest, 22.9% of the in-hospital patients and 67.7% of the out-of-hospital patients died due to neurological injury, irrespective of the primary Cardiac Arrest arrhythmia. Two-thirds of the patients dying after out-of-hospital Cardiac Arrest died due to neurological injury and this proportion was approximately the same for ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole. Approximately a quarter of the patients dying after in-hospital Cardiac Arrest died due to neurological injury.
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therapeutic hypothermia after Cardiac Arrest
Resuscitation, 2003Co-Authors: Jerry P Nolan, Peter T Morley, Terry L Vanden Hoek, Robert W HickeyAbstract:On the basis of the published evidence to date, the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) made the following recommendations in October 2002: Induction of moderate hypothermia (28°C to 32°C) before Cardiac Arrest has been used successfully since the 1950s to protect the brain against the global ischemia that occurs during some open-heart surgeries. Successful use of therapeutic hypothermia after Cardiac Arrest in humans was also described in the late 1950s1–3 but was subsequently abandoned because of uncertain benefit and difficulties with its use.4 Since then, induction of hypothermia after return of spontaneous circulation (ROSC) has been associated with improved functional recovery and reduced cerebral histological deficits in various animal models of Cardiac Arrest.5–8 Additional promising preliminary human studies have been completed.9–16 At the time of publication of the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care , the evidence was insufficient to recommend use of therapeutic hypothermia after resuscitation from Cardiac Arrest.17 In 2002 the results of 2 prospective randomized trials were published that compared mild hypothermia with normothermia in comatose survivors of out-of-hospital Cardiac Arrest.18,19 One study was undertaken in 9 centers in 5 European countries19; the other was conducted in 4 hospitals in Melbourne, Australia.18 The criteria for entry into these trials were similar: ROSC, patients remaining intubated and ventilated, with persistent coma after out-of-hospital Cardiac Arrest due to VF. In the European study, the median Glasgow Coma Scale score on hospital admission in both groups …
B M Graf - One of the best experts on this subject based on the ideXlab platform.
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lipid emulsion improves recovery from bupivacaine induced Cardiac Arrest but not from ropivacaine or mepivacaine induced Cardiac Arrest
Anesthesia & Analgesia, 2009Co-Authors: York A Zausig, Wolfgang Zink, Meike Keil, Barbara Sinner, Juergen Barwing, Christoph H R Wiese, B M GrafAbstract:BACKGROUND: Cardiac toxicity significantly correlates with the lipophilicity of local anesthetics (LAs). Recently, the infusion of lipid emulsions has been shown to be a promising approach to treat LA-induced Cardiac Arrest. As the postulated mechanism of action, the so-called "lipid sink" effect may depend on the lipophilicity of LAs. In this study, we investigated whether lipid effects differ with regard to the administered LAs. METHODS: In the isolated rat heart, Cardiac Arrest was induced by administration of equipotent doses of bupivacaine, ropivacaine, and mepivacaine, respectively, followed by Cardiac perfusion with or without lipid emulsion (0.25 mL · kg -1 · min -1 ). Subsequently, the times from the start of perfusion to return of first heart activity and to recovery of heart rate and rate-pressure product (to 90% of baseline values) were assessed. RESULTS: In all groups, lipid infusion had no effects on the time to the return of any Cardiac activity. However, recovery times of heart rate and rate-pressure product (to 90% of baseline values) were significantly shorter with the administration of lipids in bupivacaine-induced Cardiac toxicity, but not in ropivacaine- or mepivacaine-induced Cardiac toxicity. CONCLUSIONS: These data show that the effects of lipid infusion on LA-induced Cardiac Arrest are strongly dependent on the administered LAs itself. We conclude that lipophilicity of LAs has a marked impact on the efficacy of lipid infusions to treat Cardiac Arrest induced by these drugs.
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lipid emulsion improves recovery from bupivacaine induced Cardiac Arrest but not from ropivacaine or mepivacaine induced Cardiac Arrest
Anesthesia & Analgesia, 2009Co-Authors: York A Zausig, Wolfgang Zink, Meike Keil, Barbara Sinner, Juergen Barwing, Christoph H R Wiese, B M GrafAbstract:BACKGROUND: Cardiac toxicity significantly correlates with the lipophilicity of local anesthetics (LAs). Recently, the infusion of lipid emulsions has been shown to be a promising approach to treat LA-induced Cardiac Arrest. As the postulated mechanism of action, the so-called "lipid sink" effect may depend on the lipophilicity of LAs. In this study, we investigated whether lipid effects differ with regard to the administered LAs. METHODS: In the isolated rat heart, Cardiac Arrest was induced by administration of equipotent doses of bupivacaine, ropivacaine, and mepivacaine, respectively, followed by Cardiac perfusion with or without lipid emulsion (0.25 mL · kg -1 · min -1 ). Subsequently, the times from the start of perfusion to return of first heart activity and to recovery of heart rate and rate-pressure product (to 90% of baseline values) were assessed. RESULTS: In all groups, lipid infusion had no effects on the time to the return of any Cardiac activity. However, recovery times of heart rate and rate-pressure product (to 90% of baseline values) were significantly shorter with the administration of lipids in bupivacaine-induced Cardiac toxicity, but not in ropivacaine- or mepivacaine-induced Cardiac toxicity. CONCLUSIONS: These data show that the effects of lipid infusion on LA-induced Cardiac Arrest are strongly dependent on the administered LAs itself. We conclude that lipophilicity of LAs has a marked impact on the efficacy of lipid infusions to treat Cardiac Arrest induced by these drugs.
George Klein - One of the best experts on this subject based on the ideXlab platform.
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genetic testing in the evaluation of unexplained Cardiac Arrest from the casper Cardiac Arrest survivors with preserved ejection fraction registry
Circulation-cardiovascular Genetics, 2017Co-Authors: Greg Mellor, Zachary Laksman, Rafik Tadros, Jason D Roberts, Brenda Gerull, Christopher S Simpson, George Klein, Jean Champagne, Mario Talajic, Martin J GardnerAbstract:Background— Unexplained Cardiac Arrest may be because of an inherited arrhythmia syndrome. The role of genetic testing in Cardiac Arrest survivors without a definite clinical phenotype is unclear. Methods and Results— The CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) is a large registry of Cardiac Arrest survivors where initial assessment reveals normal coronary arteries, left ventricular function, and resting ECG. Of 375 Cardiac Arrest survivors in CASPER from 2006 to 2015, 174 underwent genetic testing. Patients were classified as phenotype-positive (n=72) or phenotype-negative (n=102). Genetic testing was performed at treating physicians’ discretion in line with contemporary guidelines and availability. All genetic variants identified from original laboratory reports were reassessed by the investigators in line with modern criteria. Pathogenic variants were identified in 29 (17%) patients (60% channelopathy-associated and 40% cardiomyopathy-associated genes) and 70 variants of unknown significance were identified in 32 (18%) patients. Prior syncope (odds ratio, 4.0; 95% confidence interval, 1.6–9.7) and a family history of sudden death (odds ratio, 3.2; 95% confidence interval, 1.1–9.4) were independently associated with the presence of a pathogenic variant. In phenotype-negative patients, broad multiphenotype genetic testing led to higher yields (21% versus 8%; P =0.04) but was associated with more variants of unknown significance (55% versus 5%; P Conclusions— Genetic testing identifies a pathogenic variant in a significant proportion of unexplained Cardiac Arrest survivors. Prior syncope and family history of sudden death are predictors of a positive genetic test. Both arrhythmia and cardiomyopathy genes are implicated. Broad, multiphenotype testing revealed the highest frequency of pathogenic variants in phenotype-negative patients. Clinical Trial Registration— https://www.clinicaltrials.gov. Unique Identifier: NCT00292032
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systematic assessment of patients with unexplained Cardiac Arrest Cardiac Arrest survivors with preserved ejection fraction registry casper
Circulation, 2009Co-Authors: Andrew D Krahn, Christopher S Simpson, Jean Champagne, Martin J Gardner, Jeff S Healey, Vijay S Chauhan, David H Birnie, Shubhayan Sanatani, Derek V Exner, George KleinAbstract:Background— Cardiac Arrest without evident Cardiac disease may be caused by subclinical genetic conditions. Provocative testing to unmask a phenotype is often necessary to detect primary electrical disease, direct genetic testing, and perform family screening. Methods and Results— Patients with apparently unexplained Cardiac Arrest and no evident Cardiac disease (normal Cardiac function on echocardiogram, no evidence of coronary artery disease, and a normal ECG) underwent systematic evaluation that included Cardiac magnetic resonance imaging, signal-averaged ECG, exercise testing, drug challenge, and selective electrophysiological testing. Diagnostic criteria were based on accepted criteria or provocation of the characteristic clinical features for long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, early repolarization, arrhythmogenic right ventricular cardiomyopathy, coronary spasm, and myocarditis. Sixty-three patients in 9 centers were enrolled (age 43.0±13.4 yea...
Karen Smith - One of the best experts on this subject based on the ideXlab platform.
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using a Cardiac Arrest registry to measure the quality of emergency medical service care decade of findings from the victorian ambulance Cardiac Arrest registry
Circulation-cardiovascular Quality and Outcomes, 2015Co-Authors: Ziad Nehme, Stephen Bernard, Peter Cameron, Janet Bray, Ian T Meredith, Marijana Lijovic, Karen SmithAbstract:Background— Although the value of clinical registries has been well recognized in developed countries, their use for measuring the quality of emergency medical service care remains relatively unknown. We report the methodology and findings of a statewide emergency medical service surveillance initiative, which is used to measure the quality of systems of care for patients with out-of-hospital Cardiac Arrest. Methods and Results— Between July 1, 2002, and June 30, 2012, data for adult out-of-hospital Cardiac Arrest cases of presumed Cardiac cause occurring in the Australian Southeastern state of Victoria were extracted from the Victorian Ambulance Cardiac Arrest Registry. Regional and temporal trends in bystander cardiopulmonary resuscitation, event survival, and survival to hospital discharge were analyzed using logistic regression and multilevel modeling. A total of 32 097 out-of-hospital Cardiac Arrest cases were identified, of whom 14 083 (43.9%) received treatment by the emergency medical service. The risk-adjusted odds of receiving bystander cardiopulmonary resuscitation (odds ratio [OR], 2.96; 95% confidence interval, 2.62–3.33), event survival (OR, 1.55; 95% confidence interval, 1.30–1.85), and survival to hospital discharge (OR, 2.81; 95% confidence interval, 2.07–3.82) were significantly improved by 2011 to 2012 compared with baseline. Significant variation in rates of bystander cardiopulmonary resuscitation and survival were observed across regions, with Arrests in rural regions less likely to survive to hospital discharge. The median OR for interhospital variability in survival to hospital discharge outcome was 70% (median OR, 1.70). Conclusions— Between 2002 and 2012, there have been significant improvements in bystander cardiopulmonary resuscitation and survival outcome for out-of-hospital Cardiac Arrest patients in Victoria, Australia. However, regional survival disparities and interhospital variability in outcomes pose significant challenges for future improvements in care.
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a model of survival following pre hospital Cardiac Arrest based on the victorian ambulance Cardiac Arrest register
Resuscitation, 2007Co-Authors: Masha Fridman, Vanessa Barnes, Andrew Whyman, Alex Currell, Stephen Bernard, Tony Walker, Karen SmithAbstract:Summary Aims This study describes the epidemiology of sudden Cardiac Arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital Cardiac Arrest (OHCA), which was specified in accordance with observed trends. Patients All cases of Cardiac Arrest in Victoria that were attended by Victorian ambulance services during the period of 2002–2005. Results Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult Cardiac Arrests of presumed Cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, Cardiac Arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15 min. Conclusion The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.
Graham Nichol - One of the best experts on this subject based on the ideXlab platform.
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incidence of treated Cardiac Arrest in hospitalized patients in the united states
Critical Care Medicine, 2011Co-Authors: Raina M Merchant, Graham Nichol, Lance B Becker, Robert A Berg, Vinay Nadkarni, Lin Yang, Brendan G Carr, Nandita Mitra, Steven M Bradley, Benjamin S AbellaAbstract:Objective The incidence and incidence over time of Cardiac Arrest in hospitalized patients (IHCA) is unknown. We sought to estimate the event rate and temporal trends of adult inhospital Cardiac Arrest (IHCA) treated with a resuscitation response.
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rationale development and implementation of the resuscitation outcomes consortium epistry Cardiac Arrest
Resuscitation, 2008Co-Authors: Laurie J Morriso, Thomas D. Rea, Graham Nichol, Jim Christenso, Clifto W Callaway, Shanno W Stephens, Ronald G Pirrallo, Dianne L Atkins, Daniel P Davis, Ahamed H IdrisAbstract:Summary Objective To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry—Cardiac Arrest. Methods The ROC Epistry—Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital Cardiac Arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience Cardiac Arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry—Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm Arrests and 4000 and 5000 ventricular fibrillation Arrests annually and approximately 8000 EMS-attended but untreated Arrests. Conclusion We describe the rationale, development, design and future implications of the ROC Epistry—Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry—Cardiac Arrest and the ROC trials.
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delayed time to defibrillation after in hospital Cardiac Arrest
The New England Journal of Medicine, 2008Co-Authors: Paul S Chan, Harlan M Krumholz, Graham Nichol, Brahmajee K NallamothuAbstract:BACKGROUND Expert guidelines advocate defibrillation within 2 minutes after an in-hospital Cardiac Arrest caused by ventricular arrhythmia. However, empirical data on the prevalence of delayed defibrillation in the United States and its effect on survival are limited. METHODS We identified 6789 patients who had Cardiac Arrest due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. Using multivariable logistic regression, we identified characteristics associated with delayed defibrillation. We then examined the association between delayed defibrillation (more than 2 minutes) and survival to discharge after adjusting for differences in patient and hospital characteristics. RESULTS The overall median time to defibrillation was 1 minute (interquartile range, <1 to 3 minutes); delayed defibrillation occurred in 2045 patients (30.1%). Characteristics associated with delayed defibrillation included black race, nonCardiac admitting diagnosis, and occurrence of Cardiac Arrest at a hospital with fewer than 250 beds, in an unmonitored hospital unit, and during after-hours periods (5 p.m. to 8 a.m. or weekends). Delayed defibrillation was associated with a significantly lower probability of surviving to hospital discharge (22.2%, vs. 39.3% when defibrillation was not delayed; adjusted odds ratio, 0.48; 95% confidence interval, 0.42 to 0.54; P<0.001). In addition, a graded association was seen between increasing time to defibrillation and lower rates of survival to hospital discharge for each minute of delay (P for trend <0.001). CONCLUSIONS Delayed defibrillation is common and is associated with lower rates of survival after in-hospital Cardiac Arrest.
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systematic review of percutaneous cardiopulmonary bypass for Cardiac Arrest or cardiogenic shock states
Resuscitation, 2006Co-Authors: Graham Nichol, Riyad Karmyjones, Chris Salerno, Lisa Cantore, Lance B BeckerAbstract:Summary Background Cardiogenic shock and Cardiac Arrest are common, lethal, debilitating and costly. Percutaneous cardiopulmonary bypass is an innovative strategy for treating these disorders that consists of rapid initiation of cardiopulmonary bypass and extracorporeal maintenance of circulation until restoration of an effective Cardiac output. Multiple case reports suggest that percutaneous bypass is efficacious in patients with these disorders but these experiences have not been collated. Therefore, we have reviewed systematically the published experience with percutaneous bypass in patients with cardiogenic shock or Cardiac Arrest. Objectives The objectives were to describe the proportion of patients with cardiogenic shock or Cardiac Arrest who achieved restoration of spontaneous circulation or survival to discharge with percutaneous bypass. A secondary objective was to describe adverse effects associated with percutaneous bypass, if feasible. Design Articles were identified by using a comprehensive search of English-language MEDLINE from 1966 to September 2005. Patients Individuals in cardiogenic shock or Cardiac Arrest. Interventions Percutaneous cardiopulmonary bypass. Analysis Effects were summarized as inverse-variance weighted means, standard errors, median and interquartile range. Results Included were 85 studies of 1494 patients with cardiogenic shock, Cardiac Arrest or both. Studies were case reports, case-series or case-control studies of heterogeneous interventions in heterogeneous patients. The proportion of patients weaned was mean, 76.8±4.2%, and median, 66.0% (IQR 50%, 100%). The proportion of patients who survived to discharge was mean, 47.4±4.5%, and median 40.0% (IQR 20%, 75%). Fifty-two studies included 533 patients in cardiogenic shock. The proportion of patients who survived to discharge was mean, 51.6±6.5%, and median 38.5% (IQR 23.4%, 76.3%). Fifty-four studies included 675 patients in Cardiac Arrest. The proportion of patients who survived to discharge was mean, 44.9±6.7%, and median, 42.3% (IQR 15.4%, 75%). Five studies with 286 subjects had both patients with cardiogenic shock or Cardiac Arrest. Conclusions Percutaneous bypass is an efficacious intervention in patients with Cardiac Arrest or cardiogenic shock. Adequately-powered experimental studies of current percutaneous bypass technologies are required to demonstrate whether it is safe, effective and cost-effective.
