Thursday, July 28, 2016

Can we identify termination of resuscitation criteria in cardiac arrest due to drowning



Article: Can we identify termination of resuscitation criteria in cardiac arrest due to drowning: results from the French national out- of-hospital cardiac arrest registry

Authors: Hubert H, Escutnaire J, Michelet P, et al

Journal: Journal of Evaluation in Clinical Practice


The authors of this article set out to "identify prognostic factors for survival in order to determine advances cardiac life support (ACLS) termination criteria." They used  a French cardiac arrest registry which captures data from the country's EMS system, and evaluated multiple factors to produce a predictive model.

Design: Prospective, multi-center. Data from 7/1/2011 to 11/30/2014
Primary endpoint: patients' vital status at hospital admission

Results

  • 32, 182 cardiac arrests recorded during study period
    • 291 cardiac arrests due to drowning (CAD)
    • 234 CADs analyzed for study
  • Patient and scene factors
    • median age 53
    • majority in rivers
    • median water temp 18 C (64 F)
    • 1/3 witnessed
    • 10% bystander BLS
  • Treatment factors
    • median "no-flow" time (cardiac arrest to first CPR): 10 minutes
    • only 1 patient received defibrillation
    • Majority of first recorded rhythms non-shockable
    • 6% had spontaneous circulation on EMS arrival
  • Prognostic Model
    • Five criteria with best prognostic power
      • Bystander ventilation
        • Those who receive it do better
      • EMS response time
        • Ther shorter, the better
      • Age
        • The younger, the better
      • No flow time
        • The shorter, the better
      • Location
        • Home (vs outside) did better
Discussion
While I found the results of the study a little confusing, and the significance of the proposed criteria wasn't great, there are 2 things I like about this study:

1) A standardized, country-wide database was prospectively used to gather high quality data

2) Bystander BLS (primarily ventilation) far and away had the best prognostic effect. This further supports the fact that cardiac arrest from drowning is a problem of oxygen and its treatment must include reversal of hypoxia.

Reference

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