Visible summary of this examine. Credit score: Junki Ishii, Hiroshima College (Tailored from Ishii et al., JAMA Netw Open. 2024;7(11):e2445543. CC BY 4.0)
Asystole is essentially the most critical type of cardiac arrest. It occurs when the center stops beating and there’s no extra electrical exercise. It’s typically known as “flat-line” or “flat-lining” as a result of the traces on an electrocardiogram turn into flat when electrical exercise ceases.
Administration of asystole cardiac arrest by emergency medical providers (EMS) exterior of a hospital setting varies from nation to nation. In Japan, EMS are required to proceed resuscitative efforts generally, offering a singular alternative to measure the impact of pre-hospital life assist procedures on asystole outcomes.
The outcomes of the massive cohort examine of cardiac arrest sufferers in Japan discovered that pre-hospital life assist procedures didn’t meaningfully enhance outcomes for sufferers with asystole. The outcomes have been revealed in JAMA Community Open.
“Out-of-hospital cardiac arrest is a major public health problem across the world, and outcomes remain poor despite the recent accumulation of scientific knowledge,” mentioned Junki Ishii, an assistant professor at Hiroshima College’s Graduate College of Biomedical and Well being Sciences in Hiroshima, Japan.
“In particular, little is known about the epidemiology of out-of-hospital cardiac arrest with asystole in countries where prehospital resuscitation is not withheld or terminated. We hoped to understand if pre-hospital advanced life support procedures were associated with favorable outcomes.”
In lots of locations, EMS personnel can cease resuscitative efforts on sufferers experiencing asystole. EMS personnel comply with set tips to find out if resuscitation must be stopped. They might think about, for instance, if the affected person did or didn’t obtain a shock with a defibrillator or if CPR was carried out by bystanders.
Research out of North America and Australia, the place prehospital resuscitation efforts will be withheld or terminated, have proven that between 58.3% and 75% of sufferers with asystole didn’t obtain resuscitative makes an attempt or the resuscitative makes an attempt have been stopped within the area.
Temporal tendencies within the affected person outcomes at 30 days. Credit score: Junki Ishii, Hiroshima College (Tailored from Ishii et al., JAMA Netw Open. 2024;7(11):e2445543. CC BY 4.0)
In distinction, Japanese EMS personnel are anticipated to proceed resuscitative efforts generally. This distinction in strategy supplied a chance for scientists to conduct a examine to disclose whether or not persevering with resuscitative efforts and superior life assist on these sufferers with asystole actually contributed to improved outcomes.
Examples of superior life assist embrace superior airway administration and intravenous epinephrine administration, along with primary life assist together with chest compression.
The examine analyzed the outcomes for 60,349 grownup sufferers who had an out-of-hospital cardiac arrest in Japan between June 1, 2014 and December 31, 2020. Sufferers who acquired defibrillation with an automatic exterior defibrillator earlier than EMS personnel arrived and people with out involvement of ALS suppliers within the prehospital resuscitation have been excluded.
There have been 35,843 sufferers (59.4%) who offered with asystole, with a median age of 77 years. Of those, 33,674 (93.9%) underwent superior life assist procedures.
Out of 35,843 sufferers with asystole, 497 survived after 30 days, however solely 67 achieved a good neurological end result. The 2 superior life assist procedures that have been studied, superior airway administration and intravenous epinephrine, weren’t related to favorable neurological outcomes. Nevertheless, they did enhance the percentages of survival after 30 days.
Superior airway administration elevated the percentages of survival after 30 days by 45% and intravenous epinephrine elevated the percentages of survival after 30 days by 81%.
“In this cohort study of patients with out-of-hospital cardiac arrest presenting with asystole, the proportion with a favorable neurological outcome at 30 days was substantially low, and no pre-hospital advanced life support procedure was associated with a favorable neurological outcome,” mentioned Ishii.
Among the many sufferers on this examine with asystole, 35.5% would have been eligible for termination of resuscitation based mostly on particular tips. Solely 0.1% of those sufferers had a good neurological end result at 30 days.
“These findings suggest that discussions regarding implementation of a termination of resuscitation rule for these patients are warranted,” mentioned Ishii.
Extra info:
Junki Ishii et al, Resuscitation Try and Outcomes in Sufferers With Asystole Out-of-Hospital Cardiac Arrest, JAMA Community Open (2024). DOI: 10.1001/jamanetworkopen.2024.45543
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Massive-scale examine reveals ‘flat-line ECG’ signifies poor outcomes for out-of-hospital cardiac arrest (2025, August 29)
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