Christopher Hahn1, Martin Breil2, Jens Christian Schewe2, Martin Messelken1, Stefan Rauch1, Jan Thorsten Gräsner3, Jan Wnent4, Stephan Seewald4, Andreas Bohn5, Matthias Fischer6. 1. Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany. 2. Department of Anaesthesiology and Intensive Care Medicine, Bonn University Hospital, Bonn, Germany. 3. Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Kiel Campus, Kiel, Germany. 4. Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Lübeck Campus, Lübeck, Germany. 5. City of Münster Fire Department, Münster, Germany. 6. Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany. Electronic address: Matthias.Fischer@af-k.de.
Abstract
AIM: Survival rates after out-of-hospital-cardiac-arrest (OHCA) differ widely between EMS systems. Since hypertonic saline appears to improve long-term outcome after OHCA, some local EMS systems have included it in their treatment protocols for OHCA. Our first aim was to give a quality review of one of these protocols. Our second aim was to assess whether short-term survival improves when hypertonic saline is used in resuscitation after OHCA. METHODS: Matched pairs were identified for the independent "return of spontaneous circulation (ROSC) after cardiac arrest" (RACA) score variables and for use of ACD-CPR, adrenaline, and amiodarone from the German Resuscitation Registry (GRR) for January 2000 to March 2011. Patients received either 2mlkg(-1) hypertonic saline with hydroxyethyl starch (7.2% NaCl with 6% hydroxyethyl starch 200,000/0.5, HyperHAES® [HHS]) infused intravenously within 10min during CPR according to local treatment protocols or standard of care CPR (NON-HHS). The primary endpoint was admission to hospital rate (with spontaneous circulation); secondary endpoint was ROSC rate in relation to RACA score. RESULTS: 322 matched pairs were defined for 14 variables. Predicted ROSC-rate using RACA-score was similar in HHS (44.63%) and NON-HHS (43.63%; p=0.440). In contrast, 190 (59.0%) HHS patients achieved ROSC compared with only 136 NON-HHS patients (42.2%; χ(2): p<0.0001). Short term survival measured as rate of "admission to hospital with spontaneous circulation" was achieved in 169 HHS patients (52.5%) versus 108 NON-HHS patients (33.5%) (OR 2.19; 95%CI: 1.592-3.009; χ(2): p<0.0001). CONCLUSION: Locally implemented treatment protocols using hypertonic saline/HES after OHCA are safe and effective. Also, we verified that short-term survival rates were better in patients receiving HHS.
AIM: Survival rates after out-of-hospital-cardiac-arrest (OHCA) differ widely between EMS systems. Since hypertonicsaline appears to improve long-term outcome after OHCA, some local EMS systems have included it in their treatment protocols for OHCA. Our first aim was to give a quality review of one of these protocols. Our second aim was to assess whether short-term survival improves when hypertonicsaline is used in resuscitation after OHCA. METHODS: Matched pairs were identified for the independent "return of spontaneous circulation (ROSC) after cardiac arrest" (RACA) score variables and for use of ACD-CPR, adrenaline, and amiodarone from the German Resuscitation Registry (GRR) for January 2000 to March 2011. Patients received either 2mlkg(-1) hypertonicsaline with hydroxyethyl starch (7.2% NaCl with 6% hydroxyethyl starch 200,000/0.5, HyperHAES® [HHS]) infused intravenously within 10min during CPR according to local treatment protocols or standard of care CPR (NON-HHS). The primary endpoint was admission to hospital rate (with spontaneous circulation); secondary endpoint was ROSC rate in relation to RACA score. RESULTS: 322 matched pairs were defined for 14 variables. Predicted ROSC-rate using RACA-score was similar in HHS (44.63%) and NON-HHS (43.63%; p=0.440). In contrast, 190 (59.0%) HHSpatients achieved ROSC compared with only 136 NON-HHSpatients (42.2%; χ(2): p<0.0001). Short term survival measured as rate of "admission to hospital with spontaneous circulation" was achieved in 169 HHSpatients (52.5%) versus 108 NON-HHSpatients (33.5%) (OR 2.19; 95%CI: 1.592-3.009; χ(2): p<0.0001). CONCLUSION: Locally implemented treatment protocols using hypertonicsaline/HES after OHCA are safe and effective. Also, we verified that short-term survival rates were better in patients receiving HHS.
Keywords:
Case control clinical trial; Hospital admittance rate; Hypertonic saline; Out-of-hospital-cardiac-arrest; RACA-score; Small volume resuscitation
Authors: C Jayson Esdaille; Patrick J Coppler; John W Faro; Zachary M Weisner; Joseph P Condle; Jonathan Elmer; Clifton W Callaway Journal: Resuscitation Date: 2020-06-23 Impact factor: 5.262