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Yonsei Medical Journal Dec 2022To evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and meta-analysis.
MATERIALS AND METHODS
MEDLINE, Embase, KoreaMed, and Korean Information Service System databases were searched up to June 2022. We included observational studies and letters on OHCA during the COVID-19 pandemic and compared them to those before the pandemic. Epidemiologic characteristics, including at-home OHCA, bystander cardiopulmonary resuscitation, unwitnessed arrest, use of an automated external defibrillator (AED), shockable cardiac rhythm, and airway management, were evaluated. Survival and favorable neurological outcomes were extracted. We conducted a meta-analysis of each characteristic and outcome.
RESULTS
Six studies including 4628 OHCA patients were included in this study. The incidence of at-home OHCA significantly increased and the AED use decreased during the COVID-19 pandemic compared to before the pandemic [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.08-1.55; I²=0% and OR, 0.74; 95% CI, 0.57-0.97; I²=0%, respectively]. Return of spontaneous circulation after OHCA, survival, and favorable neurological outcomes during and before the pandemic did not differ significantly (OR, 0.90; 95% CI, 0.71-1.13; I²=37%; OR, 0.74; 95% CI, 0.43-1.26; I²=72%; OR, 0.77; 95% CI, 0.43-1.37; I²=70%, respectively).
CONCLUSION
During the COVID-19 pandemic in South Korea, the incidence of at-home OHCA increased and AED use decreased among OHCA patients. However, survival and favorable neurological outcomes did not significantly differ from before the pandemic. This insignificant effect of the pandemic on OHCA in South Korea could be attributed to the slow increase in patient count in the early days of the pandemic. OSF Registry (DOI: 10.17605/OSF.IO/UGE9D).
Topics: Humans; Pandemics; COVID-19; Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; Republic of Korea
PubMed: 36444548
DOI: 10.3349/ymj.2022.0339 -
Resuscitation Apr 2022Sudden cardiac arrest survivors with a reversible cause are not eligible for implantable cardioverter defibrillator (ICD) implantation. This study aims to evaluate the... (Review)
Review
Recurrent ventricular arrhythmias and mortality in cardiac arrest survivors with a reversible cause with and without an implantable cardioverter defibrillator: A systematic review.
BACKGROUND
Sudden cardiac arrest survivors with a reversible cause are not eligible for implantable cardioverter defibrillator (ICD) implantation. This study aims to evaluate the risk of recurrent ventricular arrhythmia in sudden cardiac arrest survivors with a reversible cause and evaluate if ICD implantation increases survival.
METHODS
We conducted a systematic review to identify studies evaluating ICD implantation in sudden cardiac arrest survivors with a reversible cause. Outcomes were mortality and appropriate device therapy. Sudden cardiac arrest patients were divided into 4 subgroups: due to acute myocardial infarction; due to coronary artery spasm; due to takotsubo cardiomyopathy; and studies with various reversible causes of cardiac arrest.
RESULTS
27 studies were included, evaluating 11,402 patients. A total of 2570 patients received an ICD. Studies evaluating coronary artery spasm and with various reversible causes showed a relatively high rate of appropriate device therapy (17% and 20%) and described an increased survival in ICD patients. Takotsubo cardiomyopathy was associated with a low mortality and none of the ICD patients received appropriate device therapy. Studies evaluating acute myocardial infarction survivors reported inconsistent results, with high numbers of appropriate device therapy (12-66%), but the mortality-rate of patients with and without an ICD varied.
CONCLUSION
This study shows that the recurrence risk of ventricular arrhythmia varies between different reversible causes of sudden cardiac arrest and should not be evaluated as one entity. Cardiac arrest survivors with a reversible cause can be at risk of recurrent ventricular arrhythmia and selected patients may benefit from ICD implantation.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Heart Arrest; Humans; Risk Factors; Survivors; Time Factors; Treatment Outcome
PubMed: 35227821
DOI: 10.1016/j.resuscitation.2022.02.019 -
Cureus Oct 2023Out-of-hospital cardiac arrest (OHCA) remains a significant cause of death. The chance of survival significantly increases when immediate defibrillation with an... (Review)
Review
Out-of-hospital cardiac arrest (OHCA) remains a significant cause of death. The chance of survival significantly increases when immediate defibrillation with an on-site automated external defibrillator (AED) is available. Our aim is to systematically evaluate the impact of public access defibrillators (PAD) on the outcomes of outpatient cardiac arrest. We conducted a systematic review of the data from global studies on the role of bystander and emergency medical service (EMS) interventions, primarily focusing on the usage of AEDs, during OHCA events. The results highlight the critical significance of PADs in improving survival outcomes in OHCA settings. The majority of OHCA incidents occurred in private residences, but public spaces such as schools and airports had better outcomes, likely due to AED accessibility and trained individuals. Placing AEDs in public areas, especially high-risk zones, can boost survival chances. Timely defibrillation, particularly by bystanders, correlated with better survival and neurological conditions. The review emphasizes the importance of widespread cardiopulmonary resuscitation (CPR) and AED training, strategic AED placement, and continuous monitoring of interventions and outcomes to enhance survival rates and neurological recovery after OHCAs. This systematic review showed that bystander interventions, including CPR and AED usage, significantly increased the survival rate. Overall, immediate response and accessibility to AEDs in public areas can significantly improve outcomes in OHCA events.
PubMed: 38021997
DOI: 10.7759/cureus.47721 -
Resuscitation Dec 2020The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA.
METHODS
A systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale.
RESULTS
Ten studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p = 0.036). While mortality (OR = 0.67, 95%-CI 0.49-0.91) and supraglottic airway use (OR = 0.36, 95%-CI 0.27-0.46) was higher during the pandemic, automated external defibrillator use (OR = 1.78 95%-CI 1.06-2.98), return of spontaneous circulation (OR = 1.63, 95%CI 1.18-2.26) and intubation (OR = 1.87, 95%-CI 1.12--3.13) was more common before the pandemic. More patients survived to hospital admission (OR = 1.75, 95%-CI 1.42-2.17) and discharge (OR = 1.65, 95%-CI 1.28-2.12) before the pandemic. Bystander CPR (OR = 1.18, 95%-CI 0.95-1.46), unwitnessed OHCA (OR = 0.84, 95%-CI 0.66-1.07), paramedic-resuscitation attempts (OR = 1.19 95%-CI 1.00-1.42) and mechanical CPR device use (OR = 1.57 95%-CI 0.55-4.55) did not defer significantly.
CONCLUSIONS
The incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required.
REVIEW REGISTRATION
PROSPERO (CRD42020203371).
Topics: COVID-19; Cardiopulmonary Resuscitation; Emergency Medical Services; Global Health; Humans; Incidence; Out-of-Hospital Cardiac Arrest; Pandemics; Registries; SARS-CoV-2
PubMed: 33137418
DOI: 10.1016/j.resuscitation.2020.10.025 -
Heart Rhythm O2 Apr 2023Late gadolinium enhancement (LGE) on cardiac magnetic resonance is a predictor of adverse events in patients with nonischemic cardiomyopathy (NICM).
Association of late gadolinium enhancement in cardiac magnetic resonance with mortality, ventricular arrhythmias, and heart failure in patients with nonischemic cardiomyopathy: A systematic review and meta-analysis.
BACKGROUND
Late gadolinium enhancement (LGE) on cardiac magnetic resonance is a predictor of adverse events in patients with nonischemic cardiomyopathy (NICM).
OBJECTIVE
This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VAs) and sudden cardiac death (SCD), and heart failure (HF) outcomes.
METHODS
A literature search was conducted for studies reporting the association between LGE in NICM and the study endpoints. The primary endpoint was mortality. Secondary endpoints included VA and SCD, HF hospitalization, improvement in left ventricular ejection fraction (LVEF) to >35%, and heart transplantation referral. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year.
RESULTS
A total of 46 studies and 10,548 NICM patients (4610 with LGE, 5938 without LGE) were included; mean follow-up was 3 years (range 13-71 months). LGE was associated with increased mortality (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.3-3.8; < .01) and VA and SCD (OR 4.6; 95% CI 3.5-6.0; < .01). LGE was associated with an increased risk of HF hospitalization (OR 3.4; 95% CI 2.3-5.0; < .01), referral for transplantation (OR 5.1; 95% CI 2.5-10.4; < .01), and decreased incidence of LVEF improvement to >35% (OR 0.2; 95% CI 0.03-0.85; = .03).
CONCLUSION
LGE in NICM patients is associated with increased mortality, VA and SCD, and HF hospitalization and heart transplantation referral during long-term follow up. Given these competing risks of mortality and HF progression, prospective randomized controlled trials are required to determine if LGE is useful for guiding prophylactic implantable cardioverter-defibrillator placement in NICM patients.
PubMed: 37124560
DOI: 10.1016/j.hroo.2023.01.001 -
BMJ Open Sep 2022To systematically review academic literature for studies on any processes, procedures, methods or approaches to purchasing high-cost medical devices and equipment within...
OBJECTIVES
To systematically review academic literature for studies on any processes, procedures, methods or approaches to purchasing high-cost medical devices and equipment within hospitals in high-income countries.
METHODS
On 13 August 2020, we searched the following from inception: Cost-Effectiveness Analysis Registry, EconLit and ProQuest Dissertations & Theses A&I via ProQuest, Embase, MEDLINE, and MEDLINE in Process via Ovid SP, Google and Google Scholar, Health Management and Policy Database via Ovid SP, IEEE Xplore Digital Library, International HTA Database, NHS EED via CRD Web, Science Citation Index-Expanded, Conference Proceedings Citation Index-Science, and Emerging Sources Citation Index via Web of Science, Scopus, and Zetoc conference search. Studies were included if they described the approach to purchasing (also known as procurement or acquisition) of high-cost medical devices and/or equipment conducted within hospitals in high-income countries between 2000 and 2020. Studies were screened, data extracted and results summarised in tables under themes identified.
RESULTS
Of 9437 records, 24 were included, based in 12 different countries and covering equipment types including surgical robots, medical imaging equipment, defibrillators and orthopaedic implants. We found heterogeneity in methods and approaches; including descriptions of processes taking place within or across hospitals (n=14), out of which three reported cost savings; empirical studies in which hospital records or participant data were analysed (n=8), and evaluations or pilots of proposed purchasing processes (n=2). Studies emphasise the importance of balancing technical, financial, safety and clinical requirements for device selection through multidisciplinary involvement (especially clinical engineers and clinicians) in decision-making, and the potential of increasing evidence-based purchasing decisions using approaches such as hospital-based health technology assessments, ergonomics and device 'user trials'.
CONCLUSIONS
We highlight the need for more empirical work that evaluates purchasing approaches or interventions, and greater specificity in study reporting (eg, equipment type, evaluation outcomes) to build the evidence base required to influence policy and practice for medical equipment purchasing.
PROTOCOL REGISTRATION
This review was registered in Open Science Framework: Shokraneh F, Hinrichs-Krapels S, Chalkidou A . Purchasing high-cost medical equipment in hospitals in OECD countries: A systematic review. Open Science Framework 2021; doi:10.17605/OSF.IO/GTXN8. Available at: https://osf.io/gtxn8/ (accessed 12 February 2022).
Topics: Humans; Hospitals
PubMed: 36581959
DOI: 10.1136/bmjopen-2021-057516 -
Resuscitation Jul 2020Involving laypersons in response to out-of-hospital cardiac arrest through mobile-phone technology is becoming widespread in numerous countries, and different solutions... (Review)
Review
INTRODUCTION
Involving laypersons in response to out-of-hospital cardiac arrest through mobile-phone technology is becoming widespread in numerous countries, and different solutions were developed. We performed a systematic review on the impact of alerting citizens as first responders and to provide an overview of different strategies and technologies used.
METHODS
We searched electronic databases up to October 2019. Eligible studies described systems to alert citizens first responders to out-of-hospital cardiac arrest through text messages or apps. We analyzed the implementation and performance of these systems and their impact on patients' outcomes.
RESULTS
We included 28 manuscripts describing 12 different systems. The first text message system was implemented in 2006 and the first app in 2010. First responders accepted to intervene in median (interquartile) 28.7% (27-29%) of alerts and reached the scene after 4.6 (4.4-5.5) minutes for performing CPR. First responders arrived before ambulance, started CPR and attached a defibrillator in 47% (34-58%), 24% (23-27%) and 9% (6-14%) of cases, respectively. Pooled analysis showed that first responders activation increased layperson-CPR rates (1463/2292 [63.8%] in the intervention group vs. 1094/1989 [55.0%] in the control group; OR = 1.70; 95% CI, 1.11-2.60; p = 0.01) and survival to hospital discharge or at 30 days (327/2273 [14.4%] vs. 184/1955 [9.4%]; OR = 1.51; 95% CI, 1.24-1.84; p < 0.001).
CONCLUSIONS
Alerting citizens as first responders in case of out-of-hospital cardiac arrest may reduce the intervention-free time and improve patients' outcomes.
Topics: Ambulances; Cardiopulmonary Resuscitation; Emergency Medical Services; Emergency Responders; Humans; Out-of-Hospital Cardiac Arrest
PubMed: 32437783
DOI: 10.1016/j.resuscitation.2020.05.006 -
Heart Rhythm O2 Dec 2021Patients with end-stage heart failure are at high risk for sudden cardiac death. However, implantable cardioverter-defibrillator (ICD) is not routinely implanted given...
BACKGROUND
Patients with end-stage heart failure are at high risk for sudden cardiac death. However, implantable cardioverter-defibrillator (ICD) is not routinely implanted given the high competing risk of pump failure. A unique population worth separate consideration are patients with end-stage heart failure awaiting heart transplantation, as prolonged survival improves the chances of receiving transplant.
OBJECTIVE
To compare clinical outcomes of heart failure patients with and without an ICD awaiting heart transplant.
METHODS
We performed an extensive literature search and systematic review of studies that compared end-stage heart failure patients with and without an ICD awaiting heart transplantation. We separately assessed the rates of total mortality, sudden cardiac death, nonsudden cardiac death, and heart transplantation. Risk ratio (RR) and 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used owing to heterogeneity across study cohorts.
RESULTS
Ten studies with a total of 36,112 patients were included. A total of 62.5% of patients had an ICD implanted. Patients with an ICD had decreased total mortality (RR 0.60, 95% CI 0.51-0.71, < .00001) and sudden cardiac death (RR 0.27, 95% CI 0.11-0.66, = .004) and increased rates of heart transplantation (RR 1.09, 95% CI 1.05-1.14, < .0001). There was no difference in prevalence of nonsudden cardiac death (RR 0.68, 95% CI 0.44-1.04, = .07).
CONCLUSION
ICD implantation is associated with improved outcomes in patients awaiting heart transplant, characterized by decreased total mortality and sudden cardiac death as well as higher rates of heart transplantation.
PubMed: 34988520
DOI: 10.1016/j.hroo.2021.09.013 -
Cureus Sep 2023An increase in cardiovascular implantable electronic devices (CIEDs) and undoubtedly the complications brought on by these devices coincide with an increase in... (Review)
Review
An increase in cardiovascular implantable electronic devices (CIEDs) and undoubtedly the complications brought on by these devices coincide with an increase in cardiovascular disorders, particularly heart rhythm abnormalities. The safest procedure to extract these devices is transvenous lead extraction (TLE). Thus, this systematic review aimed to summarize the possibility of success rates and the common complications that could arise during the surgery. Full-text publications in PubMed, MEDLINE, PubMed Central (PMC), and ScienceDirect were used in this study, which was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were reviewed for this systematic review after being screened by title, abstract, full-text availability, and quality appraisal assessment. Heart and vascular tears, along with tricuspid regurgitation (TR), are common adverse events. Pulmonary embolism, hemothorax, hemopericardium, and ghost appearance in echo are less common consequences. In addition, the longer the dwelling time of the leads, the greater the chance of infection due to an increase in lead adhesions and fibrous tissue that has made the procedure unsafe as time passes. However, we concluded that TLE is a successful method across all age groups with an excellent probability of clinical and procedural success in a majority of studies.
PubMed: 37829955
DOI: 10.7759/cureus.45048 -
Journal of Cardiovascular Development... Aug 2022The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the... (Review)
Review
The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.
PubMed: 36005421
DOI: 10.3390/jcdd9080257