Volume : 09, Issue : 10, October – 2022

Title:

84.EVALUATE THE FEATURES OF OHCA PATIENTS LIVING IN PAKISTAN BOTH BEFORE AND AFTER THE COVID-19 EPIDEMIC IN ORDER TO DETERMINE THEIR OUTCOMES

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Authors :

Dr Faiza Sher, Dr Kashaf Javed, Dr Rida Batool

Abstract :

Aim: Bystander cardiopulmonary resuscitation (CPR) combined with public-access defibrillation has been shown to enhance overall survival for out-of-hospital cardiac arrest. This is one of top reasons of mortality across the globe. The COVID-19 global epidemic has modeled numerous problems for emergency medical services, along with reference of compression-only resuscitation also guidelines for comprehensive protective equipment. These suggestions and advice have created shortcomings and protracted fast response. On the other hand, the risk variables that determine the results of OHCA while the pandemic is ongoing are not well established. The main aim of our research remained to explore medical features in addition results of OHCA individuals in Pakistan both before and after the COVID-19 epidemic.
Methods: The electronic medical records and paper records kept by EMS were utilized to compile the data for this single-center, retrospective observational analysis. The number of emergency hospital returns based on varying qualities in Pakistan institute of Medical Sciences (PIMS), Islamabad Hospitalized patients during and prior to the COVID-19 pandemic in Pakistan were collected. Patients with OHCA who went to the emergency department at PIMS, Islamabad before the COVID-19 pandemic (April 2019 to March 2020) were identified.
Results: Here were a total of 145 patients who participated in this study (80 males, or 58.2% of the total; mean [SD] age, 64.7 years); 64 among those individuals contributed in our current research during the COVID-19 era, and 75 among those individuals contributed in our current research before COVID-19 period. Bystander witnessing and method of chest compression was always the two general baseline features that were found to be substantially different between the two groups (p-values of less than 0.002 and less than 0.002, accordingly). During the COVID-19 era, the ED ROSC was substantially lower than it had been before the COVID-19 period (25.68 percent vs 45.04 percent; adjusted odds ratio of 0.22; p-value less than 0.002) Survival to admission remained suggestively inferior throughout COVID-19 phase compared to the previous time period (26.01 percent vs 41.78 percent, accustomed odds ratio of 0.27, p-value of 0.006). On the other hand, there was no important statistically substantial difference in the 28-day survival rates (4.5% throughout COVID-19 era also 11.54% earlier COVID-19 period).
Conclusion: Patients who had cardiac arrest outside of a hospital in Pakistan had a much lower chance of surviving long enough to be admitted during the COVID-19 epidemic that occurred there. In addition, the two groups’ witness reactions and methods of cardiopulmonary resuscitation couldn’t have been more different from one another.
Keywords: Bystander cardiopulmonary resuscitation, OHCA, Covid-19 pandemic, EMS.

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References:

1. Kim Y-M, Yim H-W, Jeong S-H, Klem ML, Callaway CW (2021) Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms? A systematic review and meta-analysis of randomized and non-randomized studies. Resuscitation 83:188–196
2. Robba C, Siwicka-Gieroba D, Sikter A, Battaglini D, Dąbrowski W, Schultz MJ et al (2020) Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest. Intensive Care Med Exp 8:19
3. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A et al (2019) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788
4. Neto AS, Barbas CSV, Simonis FD, Artigas-Raventós A, Canet J, Determann RM et al (2016) Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med 4:882–893
5. Sutherasan Y, Peñuelas O, Muriel A, Vargas M, Frutos-Vivar F, Brunetti I et al (2015) Management and outcome of mechanically ventilated patients after cardiac arrest. Crit Care 19:215
6. Harmon MBA, van Meenen DMP, van der Veen ALIP, Binnekade JM, Dankiewicz J, Ebner F et al (2018) Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: a substudy of the targeted temperature management trial. Resuscitation 129:29–36
7. EL Costa V, Slutsky AS, Brochard LJ, Brower R, Serpa-Neto A, Cavalcanti AB et al (2021) Ventilatory variables and mechanical power in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 204:303–311
8. Robba C, Nielsen N, Dankiewicz J, Badenes R, Battaglini D, Ball L et al (2022) Ventilation management and outcomes in out-of-hospital cardiac arrest: a protocol for a preplanned secondary analysis of the TTM2 trial. BMJ Open 12:e058001
9. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Bělohlávek J, Callaway C et al (2019) Targeted hypothermia versus targeted Normothermia after out-of-hospital cardiac arrest (TTM2): a randomized clinical trial—rationale and design. Am Heart J 217:23–31
10. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S et al (2021) Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med 384:2283–2294
11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457
12. Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251
13. Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O et al (2016) Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med 42:1567–1575
14. Sinha P, Calfee CS, Beitler JR, Soni N, Ho K, Matthay MA et al (2019) Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome. Am J Respir Crit Care Med 199:333–341
15. Royston P, Saurbrei W (2008) Multivariable model-building: a pragmatic approach to regression anaylsis based on fractional polynomials for modelling continuous variables.
16. Jann B (2020) Relative distribution analysis in Stata. Stata J [Internet] 21:885–951
17. Young PJ, Bailey M, Bellomo R, Bernard S, Bray J, Jakkula P et al (2020) Conservative or liberal oxygen therapy in adults after cardiac arrest. Resuscitation 157:15–22
18. Roberts BW, Kilgannon JH, Chansky ME, Mittal N, Wooden J, Trzeciak S (2019) Association between postresuscitation partial pressure of arterial carbon dioxide and neurological outcome in patients with post–cardiac arrest syndrome. Circulation 127:2107–2113
19. Palmer E, Post B, Klapaukh R, Marra G, MacCallum NS, Brealey D et al (2019) The association between supraphysiologic arterial oxygen levels and mortality in critically ill patients. A multicenter observational cohort study. Am J Respir Crit Care Med 200:1373–1380
20. Pilcher J, Weatherall M, Shirtcliffe P, Bellomo R, Young P, Beasley R (2012) The effect of hyperoxia following cardiac arrest: a systematic review and meta-analysis of animal trials. Resuscitation 83:417–422
21. Roberts BW, Kilgannon J, Chansky ME, Trzeciak S (2014) Association between initial prescribed minute ventilation and post-resuscitation partial pressure of arterial carbon dioxide in patients with post-cardiac arrest syndrome. Ann Intensive Care 4:9
22. Tejerina E, Pelosi P, Muriel A, Peñuelas O, Sutherasan Y, Frutos-Vivar F et al (2017) Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury. J Crit Care 38:341–345
23. Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H et al (2021) European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 47:369–421
24. Lundbye JB, Rai M, Ramu B, Hosseini-Khalili A, Li D, Slim HB et al (2012) Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms. Resuscitation 83:202–207
25. Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H et al (2021) European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: post-resuscitation care. Resuscitation 161:220–26
26. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM et al (2018) Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med 44:1914–1922
27. Coppola S, Caccioppola A, Froio S, Formenti P, De Giorgis V, Galanti V et al (2020) Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care 24:246
28. Bellani G, Grassi A, Sosio S, Gatti S, Kavanagh BP, Pesenti A et al (2019) Driving pressure is associated with outcome during assisted ventilation in acute respiratory distress syndrome. Anesthesiology 131:594–604
29. Toufen Junior C, De Santis Santiago RR, Hirota AS, Carvalho ARS, Gomes S, Amato MBP et al (2018) Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome. Ann Intensive Care 8:119
30. Guo L, Xie J, Huang Y, Pan C, Yang Y, Qiu H et al (2018) Higher PEEP improves outcomes in ARDS patients with clinically objective positive oxygenation response to PEEP: a systematic review and meta-analysis. BMC Anesthesiol 18:172
31. Serpa Neto A, Filho RR, Cherpanath T, Determann R, Dongelmans DA, Paulus F et al (2016) Associations between positive end-expiratory pressure and outcome of patients without ARDS at onset of ventilation: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care 6:109
32. Torres A, Motos A, Riera J, Fernández-Barat L, Ceccato A, Pérez-Arnal R et al (2021) The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients. Crit Care 25:331
33. Amato MBP, Barbas CSV, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G et al (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 338:347–354
34. Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
35. Simonis FD, Serpa Neto A, Binnekade JM, Braber A, Bruin KCM, Determann RM et al (2018) Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS. JAMA 320:1872
36. Tiruvoipati R, Pilcher D, Botha J, Buscher H, Simister R, Bailey M (2018) Association of hypercapnia and hypercapnic acidosis with clinical outcomes in mechanically ventilated patients with cerebral injury. JAMA Neurol 75:818–826
37. Beitler JR, Ghafouri TB, Jinadasa SP, Mueller A, Hsu L, Anderson RJ et al (2017) Favorable neurocognitive outcome with low tidal volume ventilation after cardiac arrest. Am J Respir Crit Care Med 195:1198–1206
38. Eastwood GM, Nichol A (2020) Optimal ventilator settings after return of spontaneous circulation. Curr Opin Crit Care 26:251–258
39. Eastwood GM, Young PJ, Bellomo R (2014) The impact of oxygen and carbon dioxide management on outcome after cardiac arrest. Curr Opin Crit Care 20:266–272
40. Farias LL, Faffe DS, Xisto DG, Santana MCE, Lassance R, Prota LFM et al (2005) Positive end-expiratory pressure prevents lung mechanical stress caused by recruitment/derecruitment. J Appl Physiol 98:53–61
41. Ricard J-D, Dreyfuss D, Saumon G (2003) Ventilator-induced lung injury. Eur Respir J 22:2s–9s
42. Schaefer MS, Serpa Neto A, Pelosi P, de Gama AM, Kienbaum P, Schultz MJ et al (2019) Temporal changes in ventilator settings in patients with uninjured lungs. Anesth Analg 129:129–140
43. Tejerina EE, Pelosi P, Robba C, Peñuelas O, Muriel A, Barrios D et al (2021) Evolution over time of ventilatory management and outcome of patients with neurologic disease. Crit Care Med 49:1095–1106
44. Esteban A (2022) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345