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Original Research

Open Access

Successful resuscitation of out of hospital cardiac arrest patients in the emergency department

  • SHOU-YEN CHEN1
  • SHIH-HAO WANG2
  • YI-MING WENG3
  • YU-CHE CHANG1
  • YU-JR LIN3
  • KO-CHEN CHANG1
  • JIUN-HAO YU4

1,Department of Emergency Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine

2nstitute of Environmental and Occupational Health Science, National Yang-Ming University

3 Department of Emergency Medicine Chang Gung Memorial Hospital and Chang Gung University College of Medicine,Department of Emergency Medicine Chang Gung Memorial Hospital

4Institute of Environmental and Occupational Health Science, National Yang-Ming University

5, Biostatistical Center for clinical Research Chang Gung Memorial Hospital

DOI: 10.22514/SV61.052011.3 Vol.6,Issue 1,May 2011 pp.20-26

Published: 02 May 2011

*Corresponding Author(s): YI-MING WENG E-mail: wengym33@gmail.com

Abstract

Background. We examined factors associated with the successful resuscitation, in the emergency department (ED), of adult, out-of-hospital cardiac arrest (OHCA) patients.

Methods. The study cohort consisted of adult patients (over 18 years of age) who presented to the ED in 2009 with a dia-gnosis of cardiac arrest. Data were retrieved from the institutional database. 

Results. A total of 122 adult, non-traumatic, OHCA patients were enrolled in the study. There were no significant differences between the sustained return of spontaneous circulation (ROSC) and non-sustained ROSC groups in initial body tempe-rature (P = 0.420), time to successful intubation (P = 0.524), time to first intravenous epinephrine injection (P = 0.108), blood sugar levels (P = 0.122), hematocrit (P = 0.977), cardiac enzymes (P = 0.116) and serum sodium level (P = 0.429). Leukocytosis (P = 0.047) and cardiac rhythm of pulseless ventricular tachycardia/ ventricular fibrillation and pulseless electrical activity (P = 0.022), were significantly associated with sustained ROSC. In contrast, patients with more severe acidosis (P = 0.003) and hyperkalemia (P < 0.001) had a reduced likelihood of achieving sustained ROSC. After multiple variable logistic regression analysis adjusting for variables, the correlation between sustained ROSC and leukocytosis and hyperkalemia remained high (leukocytosis, P = 0.007, odds ratio [OR] 3.655, 95% CI 1.422-9.395; hyperkalemia, P = 0.001, OR 0.169, 95% CI 0.057-0.500)

Conclusion. Patients suffering an OHCA were appropriately resuscitated after arriving at the ED. Successful resuscitation in adult OHCA victims was determined by the patient’s status, in particular their white blood cell count and potassium level.

Keywords

adult out of hospital car-diac arrest, return of spontaneous circulation, in-hospital phase, hyper-kalemia, leukocytosis

Cite and Share

SHOU-YEN CHEN,SHIH-HAO WANG,YI-MING WENG,YU-CHE CHANG,YU-JR LIN,KO-CHEN CHANG,JIUN-HAO YU. Successful resuscitation of out of hospital cardiac arrest patients in the emergency department. Signa Vitae. 2011. 6(1);20-26.

References

1. Herlitz J, Engdahl J, Svensson L, Angquist KA, Young M, Holmberg S. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J 2005;149:61-6.

2. Becker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area: where are the survivors? Ann Emerg Med (1991) 20: pp 355

3. Holmberg M, Holmberg S, Herlitz J, Gårdelöv B. Survival after cardiac arrest outside hospital in Sweden. Resuscitation 1998;36:29-36.

4. Soo LH, Gray D, Young T, Huff N, Skene A, Hampton JR. Resuscitation from out of- hospital cardiac arrest: is survival dependent on who is available at the scene? Heart 1999;81:47-52.

5. Bunch TJ, West CP, Packer DL, Panutich MS, White RD. Admission predictors of in-hospital mortality and subsequent long-term outcome in survivors of ventricular fibrillation out-of-hospital cardiac arrest: a population-based study. Cardiology 2004;102:41-7.

6. Jacobs IG, Finn JC, Oxer HF, Jelinek GA. CPR before defibrillation in out-of-hospital cardiac arrest: a randomized trial. Emerg Med Aus-tralas 2005;17:39-45.

7. Bunch TJ, White RD, Friedman PA, Kottke TE, Wu LA, Packer DL. Trends in treated ventricular fibrillation out-of-hospital cardiac arrest: a

17- year population-based study. Heart Rhythm 2004;1:255-9.

8. Weaver WD, Cobb LA, Hallstrom AP, Fahrenbruch C, Copass MK, Ray R. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol 1986;7:752-7.

9. Herlitz J, Eek M, Engdahl J, Holmberg M, Holmberg S. Factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. Resuscitation 2003;58:309-17.

10. ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:IV1.

11. Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Inter American Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 63 (2004), pp. 233–249

12. Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med 2010; 55(3):249-57.

13. Hu SC, Tsai J, Lu YL, Lan CF. EMS characteristics in an asian metropolis. Am J Emerg Med 1996;14:82-85.

14. Ko PC, Ma MH, Yen ZS, Shih CL, Chen WJ, Lin FY. Impact of community-wide deployment of biphasic waveform automated external defibrillators on out-of-hospital cardiac arrest in Taipei. Resuscitation 2004;63:167-174.

15. Chien KL, Hsu HC, Sung FC, Su TC, Chen MF, Lee YT. Hyperuricemia as a risk factor on cardiovascular events in Taiwan: the Chin-Shan community cardiovascular cohort study. Atherosclerosis 2005;183:147-155.

16. Huang CH, Ma HM, Chen WJ. Out-of-Hospital Cardiac Arrest in Taipei, Taiwan. Acta Cardiol Sin 2006;22:53-7.

17. Martin GB, Carden DL, Nowak RM, Foreback C, Tomlanovich MC. Hyperkalemia during cardiac arrest and resuscitation in the canine model. Crit Care Med 1986;14:300-302.

18. Martin GB, Nowak RM, Cisek JE, Carden DL, Tomlanovich MC. Hyperkalemia during human cardiopulmonary resuscitation: Incidence and ramifications. J Emerg Med 1989;7:109-113.

19. Niemann JT, Cairns CB. Hyperkalemia and Ionized Hypocalcemia During Cardiac Arrest and Resuscitation: Possible Culprits for Postcoun-tershock Arrhythmias? Annals Emerg Med 1999;34(1): 1-7.

20. Jennings RB, Murry CE, Steenbergen C, Reimer KA. Development of cell injury in sustained acute ischemia. Circulation 1990;82(Suppl II):II-2-II-12.

21. Steuven H, Thompson BM, Aprahamian C, Darin JC. Use of calcium in prehospital cardiac arrest. Ann Emerg Med 1983;12:136-139.

22. Thompson BM, Steuven HS, Tonsfeldt DJ, Aprahamian C, Troiano PF, Kastenson GH, et al. Calcium: Limited indications, some danger. Circulation 1986;74(Suppl IV):IV-90-IV-93.

23. Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med 2006; 24:156.

24. Dybvik T, Strand T, Steen P. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation 1995; 29:89.

25. Lin JL, Lim PS, Leu ML, Huang CC. Outcomes of severe hyperkalemia in cardiopulmonary resuscitation with concomitant hemodialysis. Intensive Care Medicine1994; 20(4):287-90

26. Kao KC, Huang CC, Tsai YH, Lin MC, Tsao TC. Hyperkalemic cardiac arrest successfully reversed by hemodialysis during cardiopulmonary resuscitation: case report. Chang Gung Medical Journal, 2000; 23(9):555-9.

27. Friedman GD, Klatsky AL, Siegelaub AB. Leukocyte count as a predictor of myocardial infarction. N Engl J Med 1974;290:1275–8.

28. Haines AP, Howarth D, North WR, Goldenberg E, Stirling Y, Meade TW, et al. Haemostatic variables and the outcome of myocardial infarc-tion. Thromb Haemost 1983;50:800–3.

29. Furman MI, Becker RC, Yarzebski J, Savegeau J, Gore JM, Goldberg RJ. Effect of elevated leukocyte count on in-hospital mortality follow-ing acute myocardial infarction. Am J Cardiol 1996;78:945– 8.

30. Ushay HM, Notterman DA. Pharmacology of pediatric resuscitation. Pediatr Clin North Am 1997; 44:207.

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