A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study

Romolo Gaspari, Anthony Weekes, Srikar Adhikari, Vicki Noble, Jason T. Nomura, Daniel Theodoro, Michael Woo, Paul Atkinson, David Blehar, Samuel Brown, Terrell Caffery, Emily Douglass, Jacqueline Fraser, Christine Haines, Samuel Lam, Michael Lanspa, Margaret Lewis, Otto Liebmann, Alexander Limkakeng, Fernando LopezElke Platz, Michelle Mendoza, Hal Minnigan, Christopher Moore, Joseph Novik, Louise Rang, Will Scruggs, Christopher Raio

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. Methods This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks. Only cases with visible cardiac activity on ultrasound were included in the present analysis. Cardiac activity was categorized as disorganized (agonal twitching) or organized (contractions with changes in ventricular dimensions). Patients were categorized as receiving either standard bolus ACLS medications or alternative medications during the resuscitation (continuous adrenergic agents, thrombolytics, others). The primary outcome was survival to hospital admission. The secondary outcome was return of spontaneous circulation (ROSC). Multivariate modeling was performed to assess association between survival to hospital admission in patients with intravenous adrenergic agents and cardiac activity. Results In our cohort of 225 patients in PEA cardiac arrest with cardiac activity on ultrasound, the overall survival rate was higher in patients with organized cardiac activity than with disorganized cardiac activity. PEA cardiac arrest patients with organized cardiac activity treated with standard ACLS interventions demonstrated improved survival to hospital admission compared to those with disorganized activity (37.7% (95%CI 24.8–50.2%) versus 17.9% (95%CI 10.9–28%). PEA cardiac arrest patients with organized cardiac activity who received continuous adrenergic agents during the resuscitation and prior to ROSC demonstrated higher survival to hospital admission 45.5% (95%CI 26.9–65.4%) and ROSC 90.9% (95%CI 71.0–98.7%) compared to those with disorganized cardiac activity who received continuous adrenergic agents during the resuscitation 0% (95%CI 0–23.0%) and 47.1% (95%CI 26–69%). Regression analysis demonstrates an association between increased survival in patients receiving intravenous adrenergic agents and organized cardiac activity. Conclusion Survival in patients following PEA arrest is higher in patients with organized cardiac activity. The initiation of continuous adrenergic agents during PEA was associated with improved survival to hospital admission in patients with organized cardiac activity on bedside ultrasound, but this improvement was not seen in patients in PEA with disorganized cardiac activity. Bedside ultrasound may identify a subset of patients that respond differently to ACLS interventions.

Original languageEnglish (US)
Pages (from-to)103-107
Number of pages5
JournalResuscitation
Volume120
DOIs
StatePublished - Nov 1 2017

Fingerprint

Resuscitation
Retrospective Studies
Advanced Cardiac Life Support
Survival
Adrenergic Agents
Heart Arrest
Patient Admission
Observational Studies
Survival Rate
Regression Analysis

Keywords

  • Bedside ultrasound
  • Cardiac arrest
  • Point-of-care ultrasound
  • Pulseless electrical activity
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. / Gaspari, Romolo; Weekes, Anthony; Adhikari, Srikar; Noble, Vicki; Nomura, Jason T.; Theodoro, Daniel; Woo, Michael; Atkinson, Paul; Blehar, David; Brown, Samuel; Caffery, Terrell; Douglass, Emily; Fraser, Jacqueline; Haines, Christine; Lam, Samuel; Lanspa, Michael; Lewis, Margaret; Liebmann, Otto; Limkakeng, Alexander; Lopez, Fernando; Platz, Elke; Mendoza, Michelle; Minnigan, Hal; Moore, Christopher; Novik, Joseph; Rang, Louise; Scruggs, Will; Raio, Christopher.

In: Resuscitation, Vol. 120, 01.11.2017, p. 103-107.

Research output: Contribution to journalArticle

Gaspari, R, Weekes, A, Adhikari, S, Noble, V, Nomura, JT, Theodoro, D, Woo, M, Atkinson, P, Blehar, D, Brown, S, Caffery, T, Douglass, E, Fraser, J, Haines, C, Lam, S, Lanspa, M, Lewis, M, Liebmann, O, Limkakeng, A, Lopez, F, Platz, E, Mendoza, M, Minnigan, H, Moore, C, Novik, J, Rang, L, Scruggs, W & Raio, C 2017, 'A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study', Resuscitation, vol. 120, pp. 103-107. https://doi.org/10.1016/j.resuscitation.2017.09.008
Gaspari, Romolo ; Weekes, Anthony ; Adhikari, Srikar ; Noble, Vicki ; Nomura, Jason T. ; Theodoro, Daniel ; Woo, Michael ; Atkinson, Paul ; Blehar, David ; Brown, Samuel ; Caffery, Terrell ; Douglass, Emily ; Fraser, Jacqueline ; Haines, Christine ; Lam, Samuel ; Lanspa, Michael ; Lewis, Margaret ; Liebmann, Otto ; Limkakeng, Alexander ; Lopez, Fernando ; Platz, Elke ; Mendoza, Michelle ; Minnigan, Hal ; Moore, Christopher ; Novik, Joseph ; Rang, Louise ; Scruggs, Will ; Raio, Christopher. / A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. In: Resuscitation. 2017 ; Vol. 120. pp. 103-107.
@article{87d74b50b28b40569f09abdc953caeaa,
title = "A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study",
abstract = "Objective Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. Methods This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks. Only cases with visible cardiac activity on ultrasound were included in the present analysis. Cardiac activity was categorized as disorganized (agonal twitching) or organized (contractions with changes in ventricular dimensions). Patients were categorized as receiving either standard bolus ACLS medications or alternative medications during the resuscitation (continuous adrenergic agents, thrombolytics, others). The primary outcome was survival to hospital admission. The secondary outcome was return of spontaneous circulation (ROSC). Multivariate modeling was performed to assess association between survival to hospital admission in patients with intravenous adrenergic agents and cardiac activity. Results In our cohort of 225 patients in PEA cardiac arrest with cardiac activity on ultrasound, the overall survival rate was higher in patients with organized cardiac activity than with disorganized cardiac activity. PEA cardiac arrest patients with organized cardiac activity treated with standard ACLS interventions demonstrated improved survival to hospital admission compared to those with disorganized activity (37.7{\%} (95{\%}CI 24.8–50.2{\%}) versus 17.9{\%} (95{\%}CI 10.9–28{\%}). PEA cardiac arrest patients with organized cardiac activity who received continuous adrenergic agents during the resuscitation and prior to ROSC demonstrated higher survival to hospital admission 45.5{\%} (95{\%}CI 26.9–65.4{\%}) and ROSC 90.9{\%} (95{\%}CI 71.0–98.7{\%}) compared to those with disorganized cardiac activity who received continuous adrenergic agents during the resuscitation 0{\%} (95{\%}CI 0–23.0{\%}) and 47.1{\%} (95{\%}CI 26–69{\%}). Regression analysis demonstrates an association between increased survival in patients receiving intravenous adrenergic agents and organized cardiac activity. Conclusion Survival in patients following PEA arrest is higher in patients with organized cardiac activity. The initiation of continuous adrenergic agents during PEA was associated with improved survival to hospital admission in patients with organized cardiac activity on bedside ultrasound, but this improvement was not seen in patients in PEA with disorganized cardiac activity. Bedside ultrasound may identify a subset of patients that respond differently to ACLS interventions.",
keywords = "Bedside ultrasound, Cardiac arrest, Point-of-care ultrasound, Pulseless electrical activity, Ultrasound",
author = "Romolo Gaspari and Anthony Weekes and Srikar Adhikari and Vicki Noble and Nomura, {Jason T.} and Daniel Theodoro and Michael Woo and Paul Atkinson and David Blehar and Samuel Brown and Terrell Caffery and Emily Douglass and Jacqueline Fraser and Christine Haines and Samuel Lam and Michael Lanspa and Margaret Lewis and Otto Liebmann and Alexander Limkakeng and Fernando Lopez and Elke Platz and Michelle Mendoza and Hal Minnigan and Christopher Moore and Joseph Novik and Louise Rang and Will Scruggs and Christopher Raio",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/j.resuscitation.2017.09.008",
language = "English (US)",
volume = "120",
pages = "103--107",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study

AU - Gaspari, Romolo

AU - Weekes, Anthony

AU - Adhikari, Srikar

AU - Noble, Vicki

AU - Nomura, Jason T.

AU - Theodoro, Daniel

AU - Woo, Michael

AU - Atkinson, Paul

AU - Blehar, David

AU - Brown, Samuel

AU - Caffery, Terrell

AU - Douglass, Emily

AU - Fraser, Jacqueline

AU - Haines, Christine

AU - Lam, Samuel

AU - Lanspa, Michael

AU - Lewis, Margaret

AU - Liebmann, Otto

AU - Limkakeng, Alexander

AU - Lopez, Fernando

AU - Platz, Elke

AU - Mendoza, Michelle

AU - Minnigan, Hal

AU - Moore, Christopher

AU - Novik, Joseph

AU - Rang, Louise

AU - Scruggs, Will

AU - Raio, Christopher

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. Methods This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks. Only cases with visible cardiac activity on ultrasound were included in the present analysis. Cardiac activity was categorized as disorganized (agonal twitching) or organized (contractions with changes in ventricular dimensions). Patients were categorized as receiving either standard bolus ACLS medications or alternative medications during the resuscitation (continuous adrenergic agents, thrombolytics, others). The primary outcome was survival to hospital admission. The secondary outcome was return of spontaneous circulation (ROSC). Multivariate modeling was performed to assess association between survival to hospital admission in patients with intravenous adrenergic agents and cardiac activity. Results In our cohort of 225 patients in PEA cardiac arrest with cardiac activity on ultrasound, the overall survival rate was higher in patients with organized cardiac activity than with disorganized cardiac activity. PEA cardiac arrest patients with organized cardiac activity treated with standard ACLS interventions demonstrated improved survival to hospital admission compared to those with disorganized activity (37.7% (95%CI 24.8–50.2%) versus 17.9% (95%CI 10.9–28%). PEA cardiac arrest patients with organized cardiac activity who received continuous adrenergic agents during the resuscitation and prior to ROSC demonstrated higher survival to hospital admission 45.5% (95%CI 26.9–65.4%) and ROSC 90.9% (95%CI 71.0–98.7%) compared to those with disorganized cardiac activity who received continuous adrenergic agents during the resuscitation 0% (95%CI 0–23.0%) and 47.1% (95%CI 26–69%). Regression analysis demonstrates an association between increased survival in patients receiving intravenous adrenergic agents and organized cardiac activity. Conclusion Survival in patients following PEA arrest is higher in patients with organized cardiac activity. The initiation of continuous adrenergic agents during PEA was associated with improved survival to hospital admission in patients with organized cardiac activity on bedside ultrasound, but this improvement was not seen in patients in PEA with disorganized cardiac activity. Bedside ultrasound may identify a subset of patients that respond differently to ACLS interventions.

AB - Objective Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. Methods This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks. Only cases with visible cardiac activity on ultrasound were included in the present analysis. Cardiac activity was categorized as disorganized (agonal twitching) or organized (contractions with changes in ventricular dimensions). Patients were categorized as receiving either standard bolus ACLS medications or alternative medications during the resuscitation (continuous adrenergic agents, thrombolytics, others). The primary outcome was survival to hospital admission. The secondary outcome was return of spontaneous circulation (ROSC). Multivariate modeling was performed to assess association between survival to hospital admission in patients with intravenous adrenergic agents and cardiac activity. Results In our cohort of 225 patients in PEA cardiac arrest with cardiac activity on ultrasound, the overall survival rate was higher in patients with organized cardiac activity than with disorganized cardiac activity. PEA cardiac arrest patients with organized cardiac activity treated with standard ACLS interventions demonstrated improved survival to hospital admission compared to those with disorganized activity (37.7% (95%CI 24.8–50.2%) versus 17.9% (95%CI 10.9–28%). PEA cardiac arrest patients with organized cardiac activity who received continuous adrenergic agents during the resuscitation and prior to ROSC demonstrated higher survival to hospital admission 45.5% (95%CI 26.9–65.4%) and ROSC 90.9% (95%CI 71.0–98.7%) compared to those with disorganized cardiac activity who received continuous adrenergic agents during the resuscitation 0% (95%CI 0–23.0%) and 47.1% (95%CI 26–69%). Regression analysis demonstrates an association between increased survival in patients receiving intravenous adrenergic agents and organized cardiac activity. Conclusion Survival in patients following PEA arrest is higher in patients with organized cardiac activity. The initiation of continuous adrenergic agents during PEA was associated with improved survival to hospital admission in patients with organized cardiac activity on bedside ultrasound, but this improvement was not seen in patients in PEA with disorganized cardiac activity. Bedside ultrasound may identify a subset of patients that respond differently to ACLS interventions.

KW - Bedside ultrasound

KW - Cardiac arrest

KW - Point-of-care ultrasound

KW - Pulseless electrical activity

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85029706122&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029706122&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2017.09.008

DO - 10.1016/j.resuscitation.2017.09.008

M3 - Article

C2 - 28916478

AN - SCOPUS:85029706122

VL - 120

SP - 103

EP - 107

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -