CANCARE RESEARCH
Explore previously published research highlights by topic, study type or publication date.
An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Postoperative Atrial Fibrillation and Long-Term Outcomes After Isolated Coronary Artery Bypass Grafting.
Clinical takeaway Postoperative atrial fibrillation may mark increased perioperative and long-term risk after isolated coronary bypass surgery. These associations do not establish that preventing the arrhythmia improves outcomes.
Summary & abstract
Study summary
This retrospective cohort included 5,170 adults undergoing isolated coronary artery bypass grafting; 652 (13%) developed postoperative atrial fibrillation. After propensity-score inverse probability weighting, atrial fibrillation was associated with perioperative stroke (odds ratio 2.59, 95% confidence interval 1.19-5.64) and prolonged mechanical ventilation (odds ratio 1.73, 95% confidence interval 1.22-2.45). Hospital stay was longer by 2.4 days (95% confidence interval 1.6-3.3). Over a median 12.8-year follow-up, postoperative atrial fibrillation was associated with higher all-cause mortality (hazard ratio 1.31, 95% confidence interval 1.23-1.51).
Study limitation: The retrospective, single-centre design leaves potential residual confounding despite propensity-score weighting.
Published abstract
OBJECTIVES: New-onset postoperative atrial fibrillation is the most common complication after cardiac surgery. This study aimed to evaluate the association between postoperative atrial fibrillation and short-term and long-term clinical outcomes after isolated coronary artery bypass grafting. METHODS: We conducted a retrospective cohort study of adults who underwent isolated coronary artery bypass grafting between 2000 and 2015 at a tertiary care centre. Baseline differences between patients who developed postoperative atrial fibrillation and those who did not were adjusted using inverse probability weighting based on propensity scores derived from demographic, clinical and procedural variables. In-hospital outcomes were analysed using weighted regression models, and long-term all-cause mortality was assessed using weighted Cox proportional hazards regression. RESULTS: Among 5,170 included patients, postoperative atrial fibrillation occurred in 652 (13%). After inverse probability weighting, postoperative atrial fibrillation was associated with a higher risk of perioperative stroke (odds ratio 2.59, 95% confidence interval 1.19-5.64), prolonged mechanical ventilation (odds ratio 1.73, 95% confidence interval 1.22-2.45) and longer hospital stay (mean difference 2.4 days, 95% confidence interval 1.6-3.3). During a median follow-up of 12.8 years, postoperative atrial fibrillation was also associated with higher long-term all-cause mortality (hazard ratio 1.31, 95% confidence interval 1.23-1.51). CONCLUSIONS: In patients undergoing isolated coronary artery bypass grafting, postoperative atrial fibrillation was associated, after inverse probability weighting, with major perioperative complications and reduced long-term survival. These findings suggest that postoperative atrial fibrillation may represent a marker of increased postoperative and long-term risk.
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Mechanical circulatory support in hypertrophic cardiomyopathy with cardiogenic shock: A National Inpatient Sample analysis.
Clinical takeaway Temporary MCS use identified a high-mortality subgroup of obstructive HCM hospitalizations with cardiogenic shock. These observational findings do not establish that MCS caused harm or determine its comparative benefit.
Summary & abstract
Study summary
This retrospective National Inpatient Sample study examined adult obstructive hypertrophic cardiomyopathy hospitalizations complicated by cardiogenic shock during 2016–2022. Of 4,610 hospitalizations, 280 (6.1%) received temporary mechanical circulatory support, most commonly VA-ECMO. In-hospital mortality was 42.9% with support versus 22.0% without support; the adjusted association remained significant (adjusted odds ratio 2.88, 95% confidence interval 1.46–5.69). Support was also associated with higher hospital charges, but not significantly longer stays. The authors interpreted these associations as likely reflecting greater illness severity among patients selected for support rather than treatment-related harm.
Study limitation: Selection of more severely ill patients for MCS limits causal interpretation despite multivariable adjustment.
Published abstract
BACKGROUND: Cardiogenic shock in patients with obstructive hypertrophic cardiomyopathy (HCM) is highly lethal. Temporary mechanical circulatory support (MCS), including percutaneous ventricular assist devices such as Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), is increasingly used in refractory cardiogenic shock. However, data regarding outcomes in this population remain limited. METHODS: We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2022. All adult patients with obstructive HCM complicated by cardiogenic shock were included and stratified by temporary MCS use. Survey-weighted multivariable regression evaluated the association between MCS use and in-hospital mortality, length of stay, and total hospital charges. RESULTS: A total of 4610 obstructive HCM hospitalizations with cardiogenic shock were identified; 280 (6.1%) underwent temporary MCS, most commonly VA-ECMO. MCS recipients were younger (58.2 vs 64.6 years, p < 0.01) and less frequently female (46.4% vs 61.0%, p = 0.03). In-hospital mortality was higher with MCS (42.9% vs 22.0%, p < 0.01). After multivariable adjustment, MCS remained independently associated with in-hospital death (aOR 2.88, 95% CI 1.46-5.69) and with higher total hospital charges (adjusted β $391,783, 95% CI $173,936-$609,631), but not with length of stay (β 5.5 days, 95% CI -1.3 to 12.2). CONCLUSIONS: In obstructive HCM complicated by cardiogenic shock, temporary MCS was associated with higher in-hospital mortality and substantially higher resource utilization. These findings likely reflect the greater severity of illness among patients selected for MCS rather than treatment-related harm.
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Associations of preoperative pan-immune inflammation value with postoperative acute kidney injury following open-heart surgery: a retrospective analysis.
Clinical takeaway Preoperative PIV was associated with postoperative acute kidney injury, but its incremental predictive contribution was clinically modest. These findings do not establish that PIV-guided care improves outcomes.
Summary & abstract
Study summary
This retrospective cohort included 725 patients undergoing open-chest cardiac surgery with cardiopulmonary bypass and evaluated preoperative pan-immune inflammation value (PIV) against KDIGO-defined postoperative acute kidney injury. Acute kidney injury occurred in 256 patients (35.3%). Each 50-unit higher PIV was associated with greater adjusted odds of acute kidney injury (odds ratio 1.04; 95% confidence interval 1.02–1.06). Adding PIV produced statistically significant but clinically modest improvements in integrated discrimination improvement and continuous net reclassification improvement, suggesting limited incremental predictive value despite the observed association.
Study limitation: The retrospective observational design cannot establish causality, and the abstract does not report external validation of predictive performance.
Published abstract
BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is prevalent and results in significant morbidity. The pan-immune inflammation value (PIV), derived from routine blood counts, captures innate, adaptive, and coagulation-inflammation pathways; however, its preoperative association with CSA-AKI remains unclear. METHODS: This retrospective cohort study encompassed 725 patients undergoing open-chest cardiac surgery with cardiopulmonary bypass. CSA-AKI was defined according to KDIGO criteria. The relationship between PIV and CSA-AKI was evaluated using multivariable logistic regression. A nonlinear relationship was investigated through restricted cubic spline (RCS) analysis. Subsequent subgroup analysis and interaction effect tests were conducted. The incremental predictive value of PIV was assessed using integrated discrimination improvement (IDI) and net reclassification improvement (NRI). RESULTS: CSA-AKI was identified in 256 (35.3%) patients. Elevated preoperative PIV exhibited a dose-dependent association with increased CSA-AKI incidence (adjusted odds ratio per 50-unit increase: 1.04; 95% confidence interval: 1.02-1.06; p = 0.005). The preoperative PIV demonstrated a monotonic yet attenuating association with CSA-AKI incidence (p-non-linear = 0.087). Results were consistent across subgroups, with no significant interaction effect detected. PIV demonstrated a statistically significant yet clinically modest improvement in IDI and continuous NRI. CONCLUSION: An elevated preoperative PIV correlates with a heightened risk of CSA-AKI. Integrating PIV into preoperative risk algorithms may enhance risk stratification and facilitate targeted preventive measures.
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The Association of the Systemic Oxygen Delivery to Oxygen Consumption Ratio With Mortality, Heart Transplantation, and Mechanical Circulatory Support.
Clinical takeaway Continuous DO2/VO2 measurements may identify a higher-risk cardiac ICU phenotype, but the nonlinear association does not establish a clinically actionable threshold or a causal relationship.
Summary & abstract
Study summary
This retrospective cohort examined systemic oxygen delivery relative to consumption (DO2/VO2) in adults undergoing invasive haemodynamic assessment in medical and surgical cardiac intensive care units. Mortality showed a nonlinear association with DO2/VO2: relative to the median of 4.73, values around 2 were associated with the highest mortality likelihood. A prespecified cut-point of 5 showed no significant mortality association in Kaplan-Meier analysis. The ratio was also not significantly associated with mechanical circulatory support or heart transplantation; the abstract reported no numerical effect estimates or uncertainty intervals.
Study limitation: The retrospective design limits causal interpretation, and the abstract omits sample size, mortality follow-up duration, and numerical effect estimates.
Published abstract
OBJECTIVES: To identify if the delivery of oxygen over consumption of oxygen (DO2/VO2) ratio is significantly associated with clinical outcomes such as mortality, need for heart transplantation, or need for a mechanical circulatory support device. DESIGN: Retrospective cohort study. SETTING: Medical and surgical cardiac intensive care units of the Mayo Clinic. PARTICIPANTS: Adult patients (≥18 years old) admitted to the cardiothoracic surgical or cardiac intensive care units between January 2012 and December 2025 were included if they underwent invasive hemodynamic assessment with simultaneous arterial blood gas, mixed venous blood gas, hemoglobin, and mean arterial pressure. Patients were excluded if they had their venous oxygen saturations drawn from a central line or a peripherally inserted central catheter, as well as those admitted for sepsis/septic shock. INTERVENTIONS: No interventions were performed on patients. MEASUREMENTS AND MAIN RESULTS: DO2/VO2 demonstrated a nonlinear association with mortality. Using the median value of 4.73 as a reference point, patients with a DO2/VO2 value of ∼2 had the highest likelihood of mortality. Kaplan-Meier analysis using a prespecified cut-point of 5 did not demonstrate any significant relationship with mortality, likely because of the underlying nonlinear relationship. There was no significant association between DO2/VO2 ratio and the need for mechanical circulatory support or heart transplantation. CONCLUSIONS: DO₂/VO₂ is a marker of systemic oxygen balance that complements conventional hemodynamic indices. A categorical threshold of 5 did not show an association with clinical outcomes, but continuous analyses did suggest that a low DO₂/VO₂ may identify a high-risk phenotype.
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Association of Preexisting Atrial Fibrillation or Flutter With 30-Day Outcomes After Septic Shock: A Propensity-Matched Federated Database Study.
Clinical takeaway Preexisting AF/flutter was associated with modestly higher mortality and greater organ-support use in septic shock. These findings support prognostic relevance, not a causal effect or treatment change.
Summary & abstract
Study summary
This federated database study compared adults with septic shock with versus without preexisting atrial fibrillation or flutter, matching 76,295 patients per group. Preexisting arrhythmia was associated with higher 30-day mortality (RR 1.07, 95% CI 1.06–1.09). Associations were also observed for renal replacement therapy (RR 1.30, 95% CI 1.25–1.35), invasive mechanical ventilation (RR 1.14, 95% CI 1.12–1.16), and vasopressor/inotrope use (RR 1.09, 95% CI 1.08–1.10). Cerebral infarction did not differ significantly (RR 1.11, 95% CI 1.00–1.24; P=0.054), which does not establish equivalent risk.
Study limitation: Propensity matching cannot exclude residual confounding, and this observational comparison does not establish causation.
Published abstract
Preexisting atrial fibrillation (AF) or atrial flutter may impair cardiovascular reserve during septic shock, potentially leading to worse clinical outcomes; however, its independent association with short-term outcomes remains uncertain. Using the TriNetX U.S. Collaborative Network, we identified adults with septic shock and compared patients with preexisting AF/flutter, documented at least 1 month before the index event, with those without prior AF/flutter. Clinical outcomes were compared after 1:1 propensity score matching for demographic characteristics, comorbidities, and baseline cardiovascular medication use. Outcomes included 30-day all-cause mortality, cerebral infarction, renal replacement therapy, invasive mechanical ventilation, acute-care utilization, and vasopressor/inotrope use. Effect estimates were reported as relative risks (RRs) with 95% confidence intervals. After propensity score matching, 76,295 patients were included in each cohort. Preexisting AF/flutter was associated with significantly higher risks of all-cause mortality (RR 1.07, 95% CI, 1.06-1.09; P<0.001), renal replacement therapy (RR 1.30, 95% CI, 1.25-1.35; P<0.001), invasive mechanical ventilation (RR 1.14, 95% CI, 1.12-1.16; P<0.001), acute-care utilization (RR 1.06, 95% CI, 1.05-1.06; P<0.001), and vasopressor/inotrope use (RR 1.09, 95% CI, 1.08-1.10; P<0.001). There was no significant difference in cerebral infarction (RR 1.11, 95% CI, 1.00-1.24; P=0.054). Among patients with septic shock, preexisting AF/flutter was associated with higher mortality and greater use of organ-supportive therapies, including renal replacement therapy, invasive mechanical ventilation, and vasopressor/inotrope use, but not with a significant increase in cerebral infarction. Preexisting AF/flutter may serve as an important prognostic marker for early risk stratification in septic shock.
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Planned Versus Standby V-A ECMO Strategy During High-Risk PCI: A Retrospective Cohort Study.
Clinical takeaway This cohort suggests an association between planned ECMO and fewer in-hospital adverse events during elective high-risk PCI. The findings are hypothesis-generating rather than evidence establishing the superiority of either strategy.
Summary & abstract
Study summary
This single-center retrospective study compared planned versus standby V-A ECMO strategies in 74 patients undergoing elective high-risk PCI. Planned ECMO began before PCI; standby support was initiated only after predefined intraprocedural haemodynamic deterioration. In-hospital major adverse cardiac and cerebrovascular events occurred in 48.4% with standby versus 14.0% with planned support (p=0.002). Standby strategy remained associated with higher event odds after adjustment (adjusted OR 4.20; 95% CI 1.35–13.10) and longer ICU stays (8 versus 6 days). These associations do not establish a causal benefit from planned ECMO.
Study limitation: Nonrandomized allocation and few events limit causal inference; the abstract also reports inconsistent standby-group denominators.
Published abstract
BACKGROUND: The role of mechanical circulatory support (MCS) in high-risk percutaneous coronary intervention (HR-PCI) remains controversial, and the optimal timing of its initiation is not well defined. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides full hemodynamic support; however, comparative data on planned versus standby strategies are limited. AIM: To compare clinical outcomes of planned versus standby V-A ECMO support in patients undergoing elective HR-PCI, with a focus on the impact of timing of ECMO initiation. METHODS: This single-center retrospective observational study included 74 consecutive patients who underwent high-risk PCI between 2019 and 2025 and were managed according to a preprocedurally determined V-A ECMO strategy. Before PCI, the multidisciplinary Heart Team selected either a planned strategy (n = 43), in which V-A ECMO was initiated before PCI, or a standby strategy (n = 31), in which ECMO equipment and vascular access were prepared in advance, but ECMO was initiated only in response to predefined intraprocedural hemodynamic deterioration. The primary endpoint was in-hospital major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, myocardial infarction, stroke, and repeat revascularization. RESULTS: No statistically significant differences were observed in the measured baseline variables. ECMO support during PCI was required in 19/32 (61.3%) of patients in the standby-strategy group. The incidence of in-hospital MACCE was significantly higher in the standby-strategy group compared with the planned-strategy group (48.4% vs. 14.0%, p = 0.002). The standby-strategy group also had longer ICU stay (8 [5-12] vs. 6 [4-9] days, p = 0.03) and hospital stay (15 [11-20] vs. 12 [9-16] days, p = 0.02), as well as higher vasoactive-inotropic scores (p = 0.033). In multivariable analysis, the standby strategy was associated with higher odds of in-hospital MACCE after adjustment (adjusted OR, 4.20; 95% CI, 1.35-13.10; p = 0.013). CONCLUSIONS: In this single-center retrospective cohort of patients undergoing elective HR-PCI, a planned V-A ECMO strategy was associated with a lower incidence of in-hospital MACCE than a standby strategy. Given the nonrandomized treatment allocation, inclusion of standby patients who did not ultimately require ECMO, and limited number of events, these findings are hypothesis-generating and do not establish a causal benefit of planned ECMO or harm from rescue initiation.
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Venous Thromboembolism in Severe Renal Insufficiency: 20 Years of Contemporary Management and Clinical Outcomes.
Clinical takeaway This registry highlights high short-term mortality and differing timing of fatal pulmonary embolism and bleeding in severe renal insufficiency. It does not establish which anticoagulant strategy offers better outcomes.
Summary & abstract
Study summary
This registry analysis examined 5,763 patients with acute venous thromboembolism and creatinine clearance below 30 mL/min enrolled during 2005–2024. Mean age was 81 years, 69% were women, and 56% presented with pulmonary embolism. At 90 days, recurrent venous thromboembolism occurred in 1.3%, major bleeding in 5.1%, and death in 20%. Fatal pulmonary embolism exceeded fatal bleeding during days 0–10 (2.0% versus 0.3%), while fatal bleeding exceeded fatal pulmonary embolism during days 11–90 (0.7% versus 0.3%), describing a changing pattern of fatal events over follow-up.
Study limitation: The observational cohort combines pulmonary embolism and other venous thromboembolism; reported outcomes are not restricted to critically ill patients.
Published abstract
BACKGROUND: Patients with severe renal insufficiency have been systematically excluded from randomized trials of anticoagulation for venous thromboembolism (VTE), leaving uncertainty regarding their management in clinical practice. OBJECTIVES: The purpose of this study was to describe the clinical profile, temporal trends in management, and phase-specific outcomes of patients with acute VTE and severe renal insufficiency. METHODS: We analyzed 5,763 patients with acute VTE and creatinine clearance < 30 mL/min enrolled in Registro Informatizado de Enfermedad TromboEmbólica (2005-2024). Baseline characteristics, anticoagulant strategies, and 90-day outcomes were evaluated across 4 calendar periods and during the early (days 0-10) and late (days 11-90) treatment phases. RESULTS: Mean age was 81 years; 69% were women, 56% presented with pulmonary embolism (PE), 16% had creatinine clearance <15 mL/min, and 3.6% were receiving hemodialysis. Over time, severe renal dysfunction and hemodialysis became more frequent. Initial treatment remained predominantly low-molecular-weight heparin, whereas vitamin K antagonist use declined and direct oral anticoagulant use increased. At 90 days, recurrent VTE occurred in 1.3% of patients, major bleeding in 5.1%, and 20% died. During the first 10 days, fatal PE exceeded fatal bleeding (2.0% vs 0.3%), whereas during days 11 to 90 fatal bleeding exceeded fatal PE (0.7% vs 0.3%). CONCLUSIONS: Patients with VTE and severe renal insufficiency are elderly, medically complex, and experience high short-term mortality. The relative balance between fatal PE and fatal bleeding changes over time, with fatal PE predominating early and fatal bleeding thereafter, while real-world management frequently differs from product labels and guideline recommendations.
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Signs of Life and Clinical Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Observational Study.
Clinical takeaway Scene cardiac electrical activity, particularly with spontaneous respiration, was associated descriptively with greater survival beyond the emergency department. These findings do not establish long-term prognosis or a basis for resuscitation decisions.
Summary & abstract
Study summary
A retrospective analysis of a multicenter prospective registry included 462 adults with traumatic out-of-hospital cardiac arrest, excluding patients with a palpable pulse at EMS arrival. Patients were grouped by pupillary light reflex, spontaneous respiration, and cardiac electrical activity at the scene. Overall, 22 patients (4.8%) survived beyond the emergency department, while 318 (68.8%) had no signs of life at the scene. Survival beyond the emergency department was highest with cardiac activity plus spontaneous respiration (4/16; 25%), followed by cardiac activity alone (10/117; 8.5%).
Study limitation: Small descriptive subgroups and an endpoint limited to survival beyond the emergency department constrain prognostic interpretation.
Published abstract
BACKGROUND: The prognostic value of individual signs of life (SOLs) remains unclear in patients experiencing traumatic out-of-hospital cardiac arrest (t-OHCA). OBJECTIVES: To describe clinical outcomes among patients with t-OHCA by the presence of each SOL at the scene. METHODS: Data from the SOS-KANTO 2017 study, a multicenter prospective registry of OHCA cases treated between 2019 and 2021, were retrospectively analyzed. Adult patients diagnosed with t-OHCA were included, excluding those with a palpable pulse upon emergency medical service (EMS) arrival. Patients were categorized into eight subgroups based on the presence of three SOLs at the scene-the pupillary light reflex, spontaneous respiration, and cardiac electrical activity - and descriptive analyses were performed. The primary outcome was survival beyond the emergency department (ED). RESULTS: Of the 462 patients included in the analysis, two (0.4%) exhibited all three SOLs, and 18 (3.9%) exhibited two SOLs; in the latter group, two demonstrated cardiac activity and a pupillary reflex, and 16 had cardiac activity and spontaneous respiration. Among the 124 patients (26.8%) with only one SOL, 117 had cardiac activity, three showed a pupillary reflex, and four exhibited spontaneous respiration. No SOLs were observed in 318 patients (68.8%). Overall, 22 patients (4.8%) survived beyond the ED. The highest survival rate was observed in the subgroup with both cardiac activity and spontaneous respiration (4/16; 25%), followed by the subgroup with cardiac activity alone (10/117; 8.5%). CONCLUSIONS: Among the t-OHCA patients, survival beyond the ED was observed more frequently in those with cardiac electrical activity at the scene.
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The Incidence of Bone Cement Implantation Syndrome Grade 3 in Hip and Knee Arthroplasty: A Retrospective Multicenter Case Series.
Clinical takeaway This series identifies a rare perioperative arrest syndrome with high mortality, concentrated in elderly patients undergoing hip-fracture hemiarthroplasty. It does not establish preventive or resuscitation strategies.
Summary & abstract
Study summary
This retrospective study examined grade 3 bone cement implantation syndrome across hip and knee arthroplasty procedures at four Dutch hospitals. Cases required cardiovascular collapse needing CPR between joint manipulation and skin closure. There were no cases among 25,914 knee arthroplasties, versus 31 among 39,237 hip procedures (0.08%). Of these 31 cases, 27 occurred during hemiarthroplasty for femoral neck fracture. Affected patients had a mean age of 86.2 years, 87.1% underwent cemented procedures, and perioperative mortality was 67.7%, highlighting the severe outcomes accompanying this uncommon perioperative arrest syndrome.
Study limitation: Retrospective case ascertainment and only 31 events limit precision; the abstract does not define the perioperative mortality time window.
Published abstract
BACKGROUND: Cardiac arrest during hip or knee arthroplasty (KA) represents the most severe manifestation of bone cement implantation syndrome (BCIS). However, true incidence rates remain uncertain, and data on clinical characteristics and outcomes are limited. The aim of this study was to determine the incidence of BCIS grade 3 in hip and KA and to describe associated clinical characteristics and mortality. METHODS: This retrospective multicenter case series included all hip and KA procedures performed at 4 Dutch hospitals. Potential cases were identified through database queries. Medical records were manually reviewed to confirm BCIS grade 3, defined as cardiovascular collapse requiring cardiopulmonary resuscitation occurring from joint manipulation through skin closure. RESULTS: No cases of BCIS grade 3 occurred during 25,914 knee arthroplasties. Among 39,237 hip procedures, 31 patients experienced BCIS grade 3 (0.08%), of which 27 cases occurred during hemiarthroplasty for femoral neck fracture (FNF). The mean age of patients with BCIS grade 3 was 86.2 ± 7.7 years; 71.0% were female, 93.5% underwent acute surgery for FNF, 87.1% involved cemented procedures, and perioperative mortality was 67.7%. CONCLUSION: BCIS grade 3 is rare but highly lethal, occurring predominantly during hemiarthroplasty for FNF in elderly patients. Individualized risk assessment and informed consent are essential when managing FNF in high-risk patients. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Incidence of refibrillation and shock-resistant ventricular fibrillation during OHCA when treated with a public access defibrillator: implications for CPR timing in lay rescuer-treated OHCA.
Clinical takeaway Refibrillation was more common than three-shock-resistant ventricular fibrillation in this lay-rescuer-treated cohort. The findings support further investigation of CPR-cycle timing, but do not establish an optimal interval or demonstrate a survival benefit.
Summary & abstract
Study summary
This retrospective study analysed ECG recordings from out-of-hospital cardiac arrests treated by lay rescuers using public access defibrillators. Among 1459 patients receiving at least one shock, 498 (34.1%) experienced refibrillation. The median number of refibrillations per patient was 1 (IQR 1–2), and median time to refibrillation was 29.8 seconds. Three consecutive shocks were observed in 231 patients (15.8%); only 11 of these patients (4.8%) had shock-resistant ventricular fibrillation, defined as three consecutive failed shocks. These findings distinguish recurrent fibrillation from persistent failure of defibrillation in this setting.
Study limitation: Retrospective ECG analysis describes rhythm outcomes; the abstract reports neither survival outcomes nor a direct comparison of CPR-cycle durations.
Published abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) treatment often requires multiple defibrillatory shocks due to failed defibrillation or refibrillation. The complete nature of refractory ventricular fibrillation (VF) is unknown, as many studies do not consider shocks delivered by lay rescuers prior to the arrival of basic life support (BLS)/advanced life support (ALS) when quantifying refractory VF. ERC guidelines define refractory VF as continuous VF after three consecutive shocks, not differentiating between patients who refibrillate and those with shock-resistant VF (three consecutive failed shocks) which may contribute to this variation in reported incidence. There are some differences in treatment recommendations for patients who refibrillate and those with shock-resistant VF. Therefore, understanding the number of shocks delivered by lay-rescuers with public access defibrillators (PADs) and the patient's response to them prior to BLS/ALS arrival may inform treatment strategies. METHODS: ECG data collected retrospectively from OHCAs treated by lay-rescuers using PADs were analysed. Cardiac rhythm, shock success, refibrillation, time to refibrillation and presence of shock-resistant VF (three consecutive failed shocks) were determined by two investigators. RESULTS: Data were available for 1459 patients receiving at least one shock. Refibrillation occurred in 498 (34.1%) patients. The median number of refibrillations per patient was 1 (IQR 1, 2). Median time to refibrillation was 29.8 s. Three consecutive shocks were observed in 231 of the 1459 (15.8%) patients, 11 patients (4.8% of 231 patients) had shock-resistant VF. CONCLUSION: When treated by lay-rescuers with PADs, refibrillation occurrence is lower than that reported for patients treated by BLS/ALS. However, aligned with BLS/ALS studies, in lay-rescuer treated OHCA, refibrillation typically occurs within the first 30 s following a successful shock. Therefore, patients who refibrillate are typically in VF for an additional 1.5 min before receiving a subsequent shock for PADs with a 2 min cardiopulmonary resuscitation (CPR) cycle. This finding emphasises the need for investigation into optimal CPR duration for patients requiring multiple shocks.
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Clinical and Financial Value of Cardiac Point-of-Care Ultrasound During Traumatic Cardiac Arrest.
Clinical takeaway Cardiac activity on POCUS was associated with admission survival, but evidence for discharge survival was inconclusive. These findings do not establish ultrasound findings as a stand-alone basis for resuscitation decisions.
Summary & abstract
Study summary
This single-center retrospective study included 74 patients with presumed traumatic cardiac arrest who underwent cardiac POCUS during initial resuscitation. Two of 17 patients with cardiac activity survived to discharge; both ultimately had medical rather than traumatic etiologies. None of 57 patients without cardiac activity survived to discharge (95% CI, 0–6.3%). Cardiac activity was associated with greater survival to admission (OR, 49.8; 95% CI, 5.5–446.9), but the discharge association was not statistically significant (OR, 18.6; 95% CI, 0.84–406.7); resuscitation duration and hospital charges were also higher.
Study limitation: The small, single-center retrospective cohort included only patients receiving POCUS, and both discharge survivors ultimately had nontraumatic etiologies.
Published abstract
INTRODUCTION: Traumatic cardiac arrest is associated with poor survival and significant consumption of hospital resources. Determining which patients have survivable injuries allows for judicious use of resources. Our aim was to determine whether cardiac activity on point-of-care ultrasound (POCUS) during traumatic cardiac arrest was associated with increased patient survival and the charges of continued resuscitation in patients that do have cardiac activity on POCUS. METHODS: We conducted this single-center retrospective study at an urban, Level I trauma center of consecutive patients arriving in traumatic cardiac arrest from August 2016-December 2023 who had a cardiac POCUS performed during the initial resuscitation efforts. Our primary outcome was to determine whether cardiac activity on POCUS during the arrest was associated with increased patient survival to neurologically intact hospital discharge. Secondary objectives included determining whether there was a correlation between cardiac activity on POCUS during traumatic cardiac arrest and survival to hospital admission. Additionally, we evaluated hospital charges and length of stay associated with continued resuscitation in patients who demonstrated cardiac activity on ultrasound. RESULTS: We identified 134 patients in traumatic cardiac arrest, of whom 74 (55.2%) had a cardiac POCUS performed and met inclusion criteria. A total of 17 patients had cardiac activity noted on the initial POCUS, with two (11%) surviving to hospital discharge (95% CI, 1.3-39.7). The two survivors initially categorized as being in traumatic cardiac arrest were ultimately found to have medical etiologies and not trauma. Of the 57 patients who had no cardiac activity noted on POCUS, none survived to hospital discharge (95% CI, 0-6.3%). More patients survived to hospital admission who had cardiac activity on their initial POCUS compared with those who had no cardiac activity (odds ratio [OR], 49.8; 95% CI, 5.5-446.9; P < .001). More patients survived to hospital discharge as well, but this was not statistically significant (OR, 18.6; 95% CI, 0.84-406.7, P = .06). Traumatic cardiac arrest patients who had present cardiac activity had longer code times prior to terminating efforts (26.6 vs 7.7 minutes, P < .001) and had higher overall charges per patient ($91,321 vs $10,032), P < .001). CONCLUSION: The absence of cardiac activity on POCUS in patients with traumatic cardiac activity is likely to be fatal. The presence of cardiac activity was associated with increased resuscitation times, charges, and survival to hospital admission but not necessarily to hospital discharge.
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