• Humans
• Out-of-Hospital Cardiac Arrest/therapy
• Out-of-Hospital Cardiac Arrest/mortality
• Male
• Female
• Retrospective Studies
• Middle Aged
• Hypothermia, Induced/methods
• Aged
• Time-to-Treatment
• Treatment Outcome
• Cardiopulmonary Resuscitation/methods
• Time Factors
• Logistic Models

• Cardiac arrest
• Cooling method
• Hypoxic ischemic brain injury
• Post-arrest care
• Quality
• Targeted temperature management
• Temperature control

• Humans
• Hypothermia, Induced/methods
• Cross-Sectional Studies
• Heart Arrest/therapy
• Cardiopulmonary Resuscitation/methods
• Time Factors
• Surveys and Questionnaires
• Out-of-Hospital Cardiac Arrest/therapy

• U24 NS100659 NINDS NIH HHS
• UG3 HL145269 NHLBI NIH HHS
• U24 NS100655 NINDS NIH HHS
• U24 HL145272 NHLBI NIH HHS
• UH3 HL145269 NHLBI NIH HHS

• cell biology
• cell growth

• Animals
• RNA-Binding Proteins/metabolism
• RNA-Binding Proteins/genetics
• Mice
• Cell Differentiation
• Myoblasts/metabolism
• Mitochondria/metabolism
• Proteome/metabolism
• Cold-Shock Response
• Cell Line

• NA Department of Biotechnology, Ministry of Science and Technology (DBT)

• AHA scientific statements
• Critical care
• Heart arrest
• Hypoxia–ischemia, brain
• Resuscitation
• Shock, cardiogenic

• United States
• Humans
• Cardiopulmonary Resuscitation/methods
• American Heart Association
• Heart Arrest/therapy
• Emergency Medical Services
• Critical Care/methods

• UL1 TR001863 NCATS NIH HHS

• AHA Scientific Statements
• critical care
• heart arrest
• hypoxia-ischemia, brain
• resuscitation
• shock, cardiogenic

• Humans
• Cardiopulmonary Resuscitation
• American Heart Association
• Heart Arrest/diagnosis
• Heart Arrest/therapy
• Emergency Medical Services
• Critical Care/methods

• P20 GM139745 NIGMS NIH HHS

• application effect
• automatic extracorporeal defibrillation
• cardiac arrest
• cardiopulmomary resuscitation
• case guidance
• training

• Cardiogenic shock
• Cardiogenic shock outcomes
• Shock team

• Humans
• Shock, Cardiogenic/therapy
• Patient Care Team

• Cardiac arrest
• Hypothermia
• In-hospital cardiac arrest
• Neuroprotection
• Non-shockable rhythm
• Out-of-hospital cardiac arrest
• Shockable rhythm
• Targeted temperature management

We evaluated the characteristics of patients with intracerebral hemorrhage in nontraumatic out-of-hospital cardiac arrests (OHCA) after return of spontaneous circulation (ROSC) to identify patients who required brain computed tomography as the next diagnostic workup.

We conducted a retrospective cohort study on 1303 consecutive patients with nontraumatic OHCA who were admitted to Miyazaki Prefectural Nobeoka Hospital between 2008 and 2020. Among these, 454 patients achieved sustained ROSC. We excluded 126 patients with obvious extracardiac causes. Clinical and demographic characteristics of patients and post-resuscitation 12-lead electrocardiogram were compared. Patients were categorized into the intracerebral hemorrhage (n = 32, 10%) and no intracerebral hemorrhage group (n = 296). All causes of intracerebral hemorrhage were diagnosed based on brain computed tomography images by board-certified radiologists.

We included 328 patients (mean age, 74 years; women, 36%) who achieved ROSC. Logistic regression analyses showed that female sex, younger age (<75 years), no shockable rhythm changes, tachycardia (≥100 bpm), lateral ST-segment elevation, and inferior ST-segment depression on post-resuscitation electrocardiogram were independently associated with intracerebral hemorrhage. We developed a new predictive model for intracerebral hemorrhage by considering 1 point for each of the six factors. The odds ratio for intracerebral hemorrhage increased 2.36 for each 1-point increase (P < 0.001). A score ≥ 4 had 43.7% sensitivity, 90.8% specificity, 34.1% positive predictive value, and 93.7% negative predictive value.

Our new predictive model might be useful for risk stratification of intracerebral hemorrhage in patients with OHCA who achieved ROSC.

• intracerebral hemorrhage
• cardiac arrest
• return of spontaneous circulation predictive model

• Computed tomography
• Coronary Artery Disease
• Myocardial infarction
• Out-hospital-Arrest
• Sudden Cardiac Arrest

• cardiac arrest
• program evaluation
• return of spontaneous circulation
• targeted temperature management
• temperature
• timing

• brain death
• cardiopulmonary resuscitation
• extracorporeal cardiopulmonary resuscitation
• extracorporeal membrane oxygenation
• neurological prognostication
• neurological recovery

Hypothermia is an important protective strategy against global cerebral ischemia following cardiac arrest. However, the mechanisms of hypothermia underlying the changes in different regions and connections of the brain have not been fully elucidated. This study aims to identify the metabolic nodes and connection integrity of specific brain regions in rats with global cerebral ischemia that are most affected by hypothermia treatment. ¹⁸F-fluorodeoxyglucose positron emission tomography was used to quantitatively determine glucose metabolism in different brain regions in a rat model of global cerebral ischemia established at 31–33°C. Diffusion tensor imaging was also used to reconstruct and explore the brain connections involved. The results showed that, compared with the model rats established at 37–37.5°C, the rat models of global cerebral ischemia established at 31–33°C had smaller hypometabolic regions in the thalamus and primary sensory areas and sustained no obvious thalamic injury. Hypothermia selectively preserved the integrity of the anterior forebrain mesocircuit, exhibiting protective effects on the brain during the global cerebral ischemia. The study was approved by the Institutional Animal Care and Use Committee at Capital Medical University (approval No. XW-AD318-97-019) on December 15, 2019.

• anterior forebrain mesocircuit
• cardiac arrest
• corpus callosum
• global cerebral ischemia
• hypometabolic areas
• hypothermia
• magnetic resonance imaging
• positron emission tomography
• prefrontal cortex
• rats
• thalamus

The role of percutaneous coronary intervention (PCI) after return of spontaneous circulation (ROSC) in patients with acute myocardial infarction (AMI) complicated by cardiac arrest (CA) is controversial. This study aimed to evaluate the effects of PCI on the in-hospital mortality after ROSC in patients with AMI complicated by CA.

The clinical data of 66 consecutive patients with ROSC after CA caused by AMI from January 2006 to December 2015 at the First Affiliated Hospital of Sun Yat-sen University were collected. Among these patients, 21 underwent urgent PCI. We analyzed the clinical characteristics of the patients during hospitalization.

The patients who underwent PCI had a higher rate of ST-segment elevation, and their initial recorded heart rhythms were more likely to have a shockable rhythm. Further, they had a high PCI success rate of 100%. The in-hospital mortality in the patients who did not undergo PCI was significantly higher than that in the patients who underwent PCI (68.9% vs 9.5%, P<0.05). Multivariate logistic regression analysis showed that cardiogenic shock (odds ratio [OR], 3.537; 95% CI, 1.047–11.945; P=0.042) and Glasgow Coma Scale score of ≤8 after ROSC (OR, 14.992; 95% CI, 2.815–79.843; P=0.002) were the independent risk factors for in-hospital mortality among the patients. Meanwhile, PCI was a protective factor against in-hospital mortality (OR, 0.063; 95% CI, 0.012–0.318; P=0.001). After propensity matching analysis, the results still showed that PCI (OR, 0.226; 95% CI, 0.028–1.814; P=0.0162) was a protective factor for in-hospital death.

The patients with ROSC after CA caused by AMI who underwent PCI had a lower in-hospital mortality than those who did not undergo PCI.

• cardiac arrest
• in-hospital mortality
• neurological performance
• percutaneous coronary intervention

• CCL, cardiac catheterization laboratory
• CS, cardiogenic shock
• Cangrelor
• Cardiogenic shock
• Covid-19
• Covid-19, coronavirus disease 2019
• DAPT, dual antiplatelet therapy
• EMS, emergency medical service
• MCS, mechanical circulatory support
• OHCA, out-of-hospital cardiac arrest
• Out-of-hospital cardiac arrest
• PCI, percutaneous coronary intervention
• Regional systems
• SARS-CoV-2, severe acute respiratory syndrome coronavirus-2
• ST-segment elevation myocardial infarction
• STEMI, ST-segment elevation myocardial infarction
• TH, therapeutic hypothermia

• Aged
• Body Temperature
• Cause of Death
• Coma/etiology
• Coma/mortality
• Coma/therapy
• Confidence Intervals
• Female
• Humans
• Hypothermia, Induced/adverse effects
• Hypothermia, Induced/methods
• Hypothermia, Induced/mortality
• Intensive Care Units/statistics & numerical data
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Ontario
• Out-of-Hospital Cardiac Arrest/complications
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/therapy
• Persistent Vegetative State/etiology
• Survivors
• Treatment Outcome
• Vena Cava, Inferior
• Venous Thrombosis/epidemiology
• Venous Thrombosis/etiology

• Cardiac arrest
• Coronary angiography
• Percutaneous coronary intervention
• Post resuscitation care
• Return of spontaneous circulation
• ST-segment-elevation
• Shockable
• Without-ST-segment elevation

• coronary reperfusion therapy
• mechanical chest compression device
• out-of-hospital cardiac arrest
• targeted temperature management

• tricyclic antidepressant
• targeted temperature management
• veno-arterial extracorporeal membrane oxygenation

• Antidepressive Agents, Tricyclic/adverse effects
• Electrocardiography
• Extracorporeal Membrane Oxygenation/methods
• Heart Arrest/chemically induced
• Heart Arrest/therapy
• Humans
• Hypothermia, Induced/methods
• Male
• Young Adult

• Anoxic brain injury
• Cardiac arrest
• Cardiopulmonary resuscitation
• Disability
• Neurologic outcomes
• Pathophysiology
• Prognostication
• Targeted temperature management
• Therapeutic hypothermia

• Cardiopulmonary Resuscitation
• Heart Arrest/complications
• Heart Arrest/epidemiology
• Heart Arrest/therapy
• Humans
• Hypothermia, Induced
• Nervous System Diseases/epidemiology
• Nervous System Diseases/etiology
• Nervous System Diseases/therapy

• Coronary angiography
• Extracorporeal membrane oxygenation
• Post-cardiac arrest care
• Respiratory care
• Targeted temperature management

• Cardiopulmonary Resuscitation
• Consensus
• Critical Care
• Emergency Medicine
• Heart Arrest/therapy
• Humans
• Taiwan
• Temperature

Despite the benefits of targeted temperature management (TTM) for out‐of‐hospital cardiac arrest), implementation within the United States remains low. The objective of this study was to evaluate the prevalence and factors associated with TTM use in a large, urban‐suburban regional system of care.

This was a retrospective analysis from the Los Angeles County regional cardiac system of care serving a population of >10 million residents. All adult patients aged ≥18 years with non‐traumatic out‐of‐hospital cardiac arrest transported to a cardiac arrest center from April 2011 to August 2017 were included. Patients awake and alert in the emergency department and patients who died in the emergency department before consideration for TTM were excluded. The primary outcome measure was prevalence of TTM use. The secondary analysis were annual trends in TTM use over the study period and factors associated with TTM use. The study population included 8072 patients; 4154 patients (51.5%) received TTM and 3767 patients (46.7%) did not receive TTM. Median age was 67 years, 4780 patients (59.2%) were men, 4645 patients (57.5%) were non‐White, and the most common arrest location was personal residence in 4841 patients (60.0%). In the adjusted analysis, younger age, male sex, an initial shockable rhythm, witnessed arrest, and receiving coronary angiography were associated with receiving TTM.

Within this regional system of care, use of TTM was higher than previously reported in the literature at just over 50%. Use of integrated systems of care may be a novel method to increase TTM use within the United States.

• cardiac arrest
• out‐of‐hospital cardiac arrest
• targeted temperature management

• coronary angiography
• heart arrest
• out-of-hospital cardiac arrest

• Angioplasty
• Cardiac arrest
• Cardiogenic shock
• Myocardial infarction
• Registry

Targeted temperature management (TTM) is a recommended treatment modality to improve neurological outcomes in patients with out‐of‐hospital cardiac arrest. The impact of the duration from hospital admission to TTM initiation (door‐to‐TTM; DTT) on clinical outcomes has not been well elucidated. We hypothesized that shorter DTT initiation intervals would be associated with improved survival with favorable neurological outcome.

We performed a post hoc analysis of nontraumatic paramedic‐treated out‐of‐hospital cardiac arrests. The primary outcome was favorable neurological status at hospital discharge, with a secondary outcome of survival to discharge. We fit a logistic regression analysis to determine the association of early compared with delayed DTT, dichotomized by the median DTT duration, and outcomes. Of 3805 patients enrolled in the CCC (Continuous Chest Compressions) Trial in British Columbia, 570 were included in this analysis. There was substantial variation in DTT among patients receiving TTM. The median DTT duration was 122 minutes (interquartile range 35‐218). Favorable neurological outcomes in the early and delayed DTT groups were 48% and 38%, respectively. Compared with delayed DTT (interquartile range 167‐319 minutes), early DTT (interquartile range 20‐81 minutes) was associated with survival (adjusted odds ratio 1.56, 95% CI 1.02‐2.38) but not with favorable neurological outcomes (adjusted odds ratio 1.45, 95% CI, 0.94‐2.22) at hospital discharge.

There was wide variability in the initiation of TTM among comatose out‐of‐hospital cardiac arrest survivors. Initiation of TTM within 122 minutes of hospital admission was associated with improved survival. These results support in‐hospital efforts to achieve early DTT among out‐of‐hospital cardiac arrest patients admitted to the hospital.

See Editorial Schenone and Menon

• cardiac arrest
• cardiac arrhythmia
• neurocritical care
• neuroprotectant
• survival

• Acute myocardial infarction
• Guideline
• Taiwan

• acute myocardial infarction
• outcomes
• trends

• catheter-related thrombosis
• endovascular cooling catheter
• inferior vena cava thrombosis
• out-of-hospital cardiac arrest
• targeted temperature management

• Cardiac arrest
• Induced hypothermia
• Intravascular temperature management
• Surface cooling methods
• Targeted temperature management

• Body Temperature
• Cardiopulmonary Resuscitation/adverse effects
• Cardiopulmonary Resuscitation/methods
• Coma/diagnosis
• Coma/etiology
• Coma/physiopathology
• Heart Arrest/complications
• Heart Arrest/therapy
• Humans
• Hypothermia, Induced/adverse effects
• Hypothermia, Induced/methods
• Neuroprotection

• Out-of-hospital cardiac arrest
• mechanical circulatory support
• percutaneous coronary intervention

• cardiac arrest
• head CT
• subarachnoid hemorrhage

• Electrocardiography
• Humans
• Out-of-Hospital Cardiac Arrest
• Resuscitation
• Tomography, X-Ray Computed

Although acute myocardial infarction is a common cause of out-of-hospital cardiac arrest (OHCA), the role of early coronary angiography in OHCA remains uncertain. We conducted a meta-analysis of observational studies to determine the association of early coronary angiography with survival in OHCA.

We searched multiple electronic databases for published studies on early coronary angiography in OHCA between 1 January 1990 and 18 January 2017. Studies were included if (1) restricted to only OHCA, (2) included an exposure group that underwent early coronary angiography within 1  day of arrest onset and a concurrent control group that did not undergo early coronary angiography, and (3) reported survival outcomes. We used a random-effects model to obtain pooled OR. I² statistics and Cochran’s Q test were used to determine between-study heterogeneity.

A total of 17 studies with 14 972 patients were included, of whom 6424 (44%) received early coronary angiography. Early coronary angiography was associated with higher odds of survival (pooled OR 2.54 (95% CI 1.94 to 3.33)) and survival with favourable neurological outcome (pooled OR 2.37 (95%  CI 1.71 to 3.28)). However, there was substantial heterogeneity in our pooled estimate (I²=88%  and p value for Cochran’s test <0.0001 for both outcomes). The large heterogeneity in pooled estimates was reduced after including adjusted estimates when available, and was explained by differences in methodological rigour and characteristics of included studies.

Among patients resuscitated from OHCA, early coronary angiography is associated with increased survival to discharge and favourable neurological outcome.

• coronary angiography
• out-of-hospital cardiac arrest
• survival

Cardiac arrest remains a common and lethal condition associated with high morbidity and mortality. Even with improving survival rates, the successfully resuscitated post cardiac arrest patient is also at risk for poor neurological outcomes, functional status and long- term survival if not managed appropriately. Given that acute coronary occlusion has been found to be the leading cause of cardiac arrest, long-term prognosis is good in selected patients after successful out-of-hospital resuscitation and ST elevation myocardial infarction who are taken for immediate coronary angiography, treated with primary percutaneous coronary intervention and hypothermia when indicated.

A priority should therefore be placed in diagnosing as quickly as possible patients who have an acute coronary occlusion (i.e. ST elevation myocardial infarction) and implementing the appropriate and timely therapeutic strategy, which will require close chain of survival co- ordination and the services of the cardiac catheterization lab. Here we review previous and current guidelines as well as associated evidence.

• Cardiac arrest
• ST elevation myocardial infarction
• cardiac catheterization lab
• hypothermia
• morbidity
• mortality.