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Sumeet S Chugh - One of the best experts on this subject based on the ideXlab platform.
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abstract 17732 Pulseless Electrical Activity in middle age is there a connection to obesity
Circulation, 2015Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: Sudden cardiac arrest (SCA) presenting with Pulseless Electrical Activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). Due to the lack of data in middle aged SCA cases, we evaluated predictors of PEA in in this age group. Methods: Out-of-hospital SCA cases were identified from a large ongoing population-based study in a Northwest US metro area (population approx. 1 million), and confirmed by a process of in-house adjudication. Presenting rhythms were identified from review of first responder reports and electrocardiographic recordings. Pearson’s x2 test and independent samples t-test were used for univariate comparisons of middle-aged (35.0-59.9 years) vs. older adults among PEA and VF/VT groups. Logistic regression was used to evaluate significant factors associated with middle-aged vs. older group. Results: A total of 151 middle-aged and 398 older adults presented with PEA. Middle-aged cases were more likely to be male (72.9% vs. 56.0%, p=0....
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abstract 117 menopause and Pulseless Electrical Activity
Circulation, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: There are significant sex differences in the presentation of out-of-hospital sudden cardiac arrest (SCA) and women are more likely to present with Pulseless Electrical Activity (PEA)....
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antipsychotic drugs are associated with Pulseless Electrical Activity the oregon sudden unexpected death study
Heart Rhythm, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Karen Gunson, Jonathan Jui, Harpriya Chugh, Sumeet S ChughAbstract:Background There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of Pulseless Electrical Activity (PEA) and asystole. Objective Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA. Methods Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002–2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ 2 tests and logistic regression. Results PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P P P Conclusions When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.
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survival advantage from ventricular fibrillation and Pulseless Electrical Activity in women compared to men the oregon sudden unexpected death study
Journal of Interventional Cardiac Electrophysiology, 2012Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Jo Ayala, Lynn Wittwer, Sumeet S ChughAbstract:Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival. Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson’s chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival. A total of 1,296 cases had resuscitation attempted (2002–2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with Pulseless Electrical Activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12–3.04)]. Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and Pulseless Electrical Activity.
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abstract 16266 lifetime clinical history of syncope is associated with future Pulseless Electrical Activity vs ventricular fibrillation
Circulation, 2010Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Harpriya Chugh, Celia Dervan, Mershed Samara, Sumeet S ChughAbstract:Introduction: There has been a significant and unexplained rise in prevalence of sudden cardiac arrest (SCA) cases presenting as Pulseless Electrical Activity (PEA), with corresponding decrease in ventricular fibrillation (VF) rates. Given significantly lower survival from PEA vs. VF, we comprehensively investigated PEA determinants by incorporating first responder data with lifetime clinical history information. Hypothesis: We hypothesized that subjects manifesting with PEA have distinctive lifetime clinical characteristics from VF. Methods: In the Northwest US (population approximately one million), cases of out of hospital SCA that underwent attempted resuscitation were identified prospectively (2002 – 2007). Those presenting with PEA vs. VF were compared using chi-square tests and t- tests, as well as logistic regression. Results: A total of 1277cases age ≥18 years underwent resuscitation by first responders (mean age 65 ± 16 years, 67% male). Presenting arrhythmia was VF in 48%, PEA in 25% and asysto...
Norman A Paradis - One of the best experts on this subject based on the ideXlab platform.
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epinephrine plus chest compressions is superior to epinephrine alone in a hypoxia induced porcine model of pseudo Pulseless Electrical Activity
Resuscitation Plus, 2021Co-Authors: Felipe Teran, Alexander L Lindqwister, Karen L Moodie, Benjamin S Abella, William J Hunckler, Claire Centeno, William P Landis, Frances S Shofer, Norman A ParadisAbstract:Abstract Aim Pseudo-Pulseless Electrical Activity (pseudo-PEA) is a global hypotensive ischemic state with retained coordinated myocardial contractile Activity and an organized ECG with no clinically detectable pulses. The role of standard external chest compressions (CPR) and its associated intrinsic hemodynamics remains unclear in the setting of pseudo-PEA. We undertook an experimental trial to compare epinephrine alone versus epinephrine with CPR in the treatment of pseudo-PEA. Methods Using a porcine model of hypoxic pseudo-PEA, we randomized 12 Yorkshire male swine to resuscitation with epinephrine only (control) (0.0015 mg/kg) versus epinephrine plus standard CPR (intervention). Animals who achieved return of spontaneous circulation (ROSC) were stabilized, fully recovered to hemodynamic and respiratory baseline, and rearrested up to 6 times. Primary outcome was ROSC defined as a sustained systolic blood pressure (SBP) of 60 mmHg for 2 min. Secondary outcomes included time to ROSC, coronary perfusion pressure (CoPP), and end-tidal carbon dioxide (ETCO2). Results Among 47 events of pseudo-PEA in 12 animals, we observed significantly higher proportion of ROSC when treatment included CPR (14/21 – 67%) compared to epinephrine alone (4/26 – 15%) (p = 0.0007). CoPP, aortic pressures and ETCO2 were significantly higher, and right atrial pressures were lower in the intervention group. Conclusions In a swine model of hypoxia-induced pseudo-PEA, epinephrine plus CPR was associated with improved intra-arrest hemodynamics and higher probability of ROSC. Thus, epinephrine plus CPR may be superior to epinephrine alone in the treatment of patients with pseudo-PEA.
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abstract 293 detection of pseudo Pulseless Electrical Activity with Electrical impedance tomography
Circulation, 2020Co-Authors: Alexander L Lindqwister, Alexander Ivanov, Ethan K Murphy, Samuel B Klein, Saeed Hassanpour, Karen L Moodie, Alexandra Hamlin, Joseph M Minichiello, Justin Anderson, Norman A ParadisAbstract:Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical Activity without clinically detectable pulses....
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abstract 301 aortic and central venous pressure wave synchronization in pseudo Pulseless Electrical Activity
Circulation, 2020Co-Authors: Alexander L Lindqwister, Samuel B Klein, Karen L Moodie, Colin Raelson, Kevin M Stanko, Norman A ParadisAbstract:Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical Activity without clinically detectable pulses....
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abstract 291 return of spontaneous circulation detection in pseudo Pulseless Electrical Activity using plethysmography
Circulation, 2020Co-Authors: Sylvia M Guerra, Alexander L Lindqwister, Samuel B Klein, Karen L Moodie, Norman A ParadisAbstract:Background: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical Activity without clinically detectable pulses. p...
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abstract 292 detection of return of spontaneous circulation in pseudo Pulseless Electrical Activity using trans thoracic and trans abdominal bioimpedance
Circulation, 2020Co-Authors: William J Hunckler, Alexander L Lindqwister, Ethan K Murphy, Samuel B Klein, Karen L Moodie, Alexandra Hamlin, Joseph M Minichiello, Justin Anderson, Norman A ParadisAbstract:Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical Activity without clinically detectable pulses....
Carmen Teodorescu - One of the best experts on this subject based on the ideXlab platform.
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abstract 17732 Pulseless Electrical Activity in middle age is there a connection to obesity
Circulation, 2015Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: Sudden cardiac arrest (SCA) presenting with Pulseless Electrical Activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). Due to the lack of data in middle aged SCA cases, we evaluated predictors of PEA in in this age group. Methods: Out-of-hospital SCA cases were identified from a large ongoing population-based study in a Northwest US metro area (population approx. 1 million), and confirmed by a process of in-house adjudication. Presenting rhythms were identified from review of first responder reports and electrocardiographic recordings. Pearson’s x2 test and independent samples t-test were used for univariate comparisons of middle-aged (35.0-59.9 years) vs. older adults among PEA and VF/VT groups. Logistic regression was used to evaluate significant factors associated with middle-aged vs. older group. Results: A total of 151 middle-aged and 398 older adults presented with PEA. Middle-aged cases were more likely to be male (72.9% vs. 56.0%, p=0....
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abstract 117 menopause and Pulseless Electrical Activity
Circulation, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: There are significant sex differences in the presentation of out-of-hospital sudden cardiac arrest (SCA) and women are more likely to present with Pulseless Electrical Activity (PEA)....
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antipsychotic drugs are associated with Pulseless Electrical Activity the oregon sudden unexpected death study
Heart Rhythm, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Karen Gunson, Jonathan Jui, Harpriya Chugh, Sumeet S ChughAbstract:Background There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of Pulseless Electrical Activity (PEA) and asystole. Objective Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA. Methods Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002–2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ 2 tests and logistic regression. Results PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P P P Conclusions When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.
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survival advantage from ventricular fibrillation and Pulseless Electrical Activity in women compared to men the oregon sudden unexpected death study
Journal of Interventional Cardiac Electrophysiology, 2012Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Jo Ayala, Lynn Wittwer, Sumeet S ChughAbstract:Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival. Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson’s chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival. A total of 1,296 cases had resuscitation attempted (2002–2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with Pulseless Electrical Activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12–3.04)]. Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and Pulseless Electrical Activity.
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abstract 16266 lifetime clinical history of syncope is associated with future Pulseless Electrical Activity vs ventricular fibrillation
Circulation, 2010Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Harpriya Chugh, Celia Dervan, Mershed Samara, Sumeet S ChughAbstract:Introduction: There has been a significant and unexplained rise in prevalence of sudden cardiac arrest (SCA) cases presenting as Pulseless Electrical Activity (PEA), with corresponding decrease in ventricular fibrillation (VF) rates. Given significantly lower survival from PEA vs. VF, we comprehensively investigated PEA determinants by incorporating first responder data with lifetime clinical history information. Hypothesis: We hypothesized that subjects manifesting with PEA have distinctive lifetime clinical characteristics from VF. Methods: In the Northwest US (population approximately one million), cases of out of hospital SCA that underwent attempted resuscitation were identified prospectively (2002 – 2007). Those presenting with PEA vs. VF were compared using chi-square tests and t- tests, as well as logistic regression. Results: A total of 1277cases age ≥18 years underwent resuscitation by first responders (mean age 65 ± 16 years, 67% male). Presenting arrhythmia was VF in 48%, PEA in 25% and asysto...
Karen Gunson - One of the best experts on this subject based on the ideXlab platform.
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abstract 17732 Pulseless Electrical Activity in middle age is there a connection to obesity
Circulation, 2015Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: Sudden cardiac arrest (SCA) presenting with Pulseless Electrical Activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). Due to the lack of data in middle aged SCA cases, we evaluated predictors of PEA in in this age group. Methods: Out-of-hospital SCA cases were identified from a large ongoing population-based study in a Northwest US metro area (population approx. 1 million), and confirmed by a process of in-house adjudication. Presenting rhythms were identified from review of first responder reports and electrocardiographic recordings. Pearson’s x2 test and independent samples t-test were used for univariate comparisons of middle-aged (35.0-59.9 years) vs. older adults among PEA and VF/VT groups. Logistic regression was used to evaluate significant factors associated with middle-aged vs. older group. Results: A total of 151 middle-aged and 398 older adults presented with PEA. Middle-aged cases were more likely to be male (72.9% vs. 56.0%, p=0....
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abstract 117 menopause and Pulseless Electrical Activity
Circulation, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: There are significant sex differences in the presentation of out-of-hospital sudden cardiac arrest (SCA) and women are more likely to present with Pulseless Electrical Activity (PEA)....
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antipsychotic drugs are associated with Pulseless Electrical Activity the oregon sudden unexpected death study
Heart Rhythm, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Karen Gunson, Jonathan Jui, Harpriya Chugh, Sumeet S ChughAbstract:Background There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of Pulseless Electrical Activity (PEA) and asystole. Objective Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA. Methods Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002–2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ 2 tests and logistic regression. Results PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P P P Conclusions When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.
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survival advantage from ventricular fibrillation and Pulseless Electrical Activity in women compared to men the oregon sudden unexpected death study
Journal of Interventional Cardiac Electrophysiology, 2012Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Jo Ayala, Lynn Wittwer, Sumeet S ChughAbstract:Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival. Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson’s chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival. A total of 1,296 cases had resuscitation attempted (2002–2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with Pulseless Electrical Activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12–3.04)]. Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and Pulseless Electrical Activity.
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abstract 16266 lifetime clinical history of syncope is associated with future Pulseless Electrical Activity vs ventricular fibrillation
Circulation, 2010Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Harpriya Chugh, Celia Dervan, Mershed Samara, Sumeet S ChughAbstract:Introduction: There has been a significant and unexplained rise in prevalence of sudden cardiac arrest (SCA) cases presenting as Pulseless Electrical Activity (PEA), with corresponding decrease in ventricular fibrillation (VF) rates. Given significantly lower survival from PEA vs. VF, we comprehensively investigated PEA determinants by incorporating first responder data with lifetime clinical history information. Hypothesis: We hypothesized that subjects manifesting with PEA have distinctive lifetime clinical characteristics from VF. Methods: In the Northwest US (population approximately one million), cases of out of hospital SCA that underwent attempted resuscitation were identified prospectively (2002 – 2007). Those presenting with PEA vs. VF were compared using chi-square tests and t- tests, as well as logistic regression. Results: A total of 1277cases age ≥18 years underwent resuscitation by first responders (mean age 65 ± 16 years, 67% male). Presenting arrhythmia was VF in 48%, PEA in 25% and asysto...
Jonathan Jui - One of the best experts on this subject based on the ideXlab platform.
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abstract 17732 Pulseless Electrical Activity in middle age is there a connection to obesity
Circulation, 2015Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: Sudden cardiac arrest (SCA) presenting with Pulseless Electrical Activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). Due to the lack of data in middle aged SCA cases, we evaluated predictors of PEA in in this age group. Methods: Out-of-hospital SCA cases were identified from a large ongoing population-based study in a Northwest US metro area (population approx. 1 million), and confirmed by a process of in-house adjudication. Presenting rhythms were identified from review of first responder reports and electrocardiographic recordings. Pearson’s x2 test and independent samples t-test were used for univariate comparisons of middle-aged (35.0-59.9 years) vs. older adults among PEA and VF/VT groups. Logistic regression was used to evaluate significant factors associated with middle-aged vs. older group. Results: A total of 151 middle-aged and 398 older adults presented with PEA. Middle-aged cases were more likely to be male (72.9% vs. 56.0%, p=0....
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abstract 117 menopause and Pulseless Electrical Activity
Circulation, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S ChughAbstract:Introduction: There are significant sex differences in the presentation of out-of-hospital sudden cardiac arrest (SCA) and women are more likely to present with Pulseless Electrical Activity (PEA)....
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antipsychotic drugs are associated with Pulseless Electrical Activity the oregon sudden unexpected death study
Heart Rhythm, 2013Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Karen Gunson, Jonathan Jui, Harpriya Chugh, Sumeet S ChughAbstract:Background There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of Pulseless Electrical Activity (PEA) and asystole. Objective Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA. Methods Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002–2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ 2 tests and logistic regression. Results PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P P P Conclusions When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.
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survival advantage from ventricular fibrillation and Pulseless Electrical Activity in women compared to men the oregon sudden unexpected death study
Journal of Interventional Cardiac Electrophysiology, 2012Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Jo Ayala, Lynn Wittwer, Sumeet S ChughAbstract:Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival. Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson’s chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival. A total of 1,296 cases had resuscitation attempted (2002–2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with Pulseless Electrical Activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12–3.04)]. Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and Pulseless Electrical Activity.
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abstract 16266 lifetime clinical history of syncope is associated with future Pulseless Electrical Activity vs ventricular fibrillation
Circulation, 2010Co-Authors: Carmen Teodorescu, Kyndaron Reinier, Audrey Uyevanado, Ronald Mariani, Karen Gunson, Jonathan Jui, Harpriya Chugh, Celia Dervan, Mershed Samara, Sumeet S ChughAbstract:Introduction: There has been a significant and unexplained rise in prevalence of sudden cardiac arrest (SCA) cases presenting as Pulseless Electrical Activity (PEA), with corresponding decrease in ventricular fibrillation (VF) rates. Given significantly lower survival from PEA vs. VF, we comprehensively investigated PEA determinants by incorporating first responder data with lifetime clinical history information. Hypothesis: We hypothesized that subjects manifesting with PEA have distinctive lifetime clinical characteristics from VF. Methods: In the Northwest US (population approximately one million), cases of out of hospital SCA that underwent attempted resuscitation were identified prospectively (2002 – 2007). Those presenting with PEA vs. VF were compared using chi-square tests and t- tests, as well as logistic regression. Results: A total of 1277cases age ≥18 years underwent resuscitation by first responders (mean age 65 ± 16 years, 67% male). Presenting arrhythmia was VF in 48%, PEA in 25% and asysto...
