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Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study
AIMS: Emergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outco...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502955/ https://www.ncbi.nlm.nih.gov/pubmed/34661179 http://dx.doi.org/10.1016/j.resplu.2021.100168 |
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author | Murasaka, Kenshi Takada, Kohei Yamashita, Akira Ushimoto, Tomoyuki Wato, Yukihiro Inaba, Hideo |
author_facet | Murasaka, Kenshi Takada, Kohei Yamashita, Akira Ushimoto, Tomoyuki Wato, Yukihiro Inaba, Hideo |
author_sort | Murasaka, Kenshi |
collection | PubMed |
description | AIMS: Emergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outcomes. METHODS: This prospective study explored EMS-recorded concomitant signs/symptoms that lead to the requirement of advanced life support in patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity includes abnormal/tonic movements and eyeball deviation. Sudden OHCA was defined by the absence of signs/symptoms of impending cardiac arrest at EMS contact or progressive circulatory/respiratory depressions after the EMS contact. Neurologically favorable outcomes were defined as the cerebral performance category score of 1 or 2 at discharge. RESULTS: From April 2012 to March 2020, 465 patients were studied. The incidence of seizure-like activity at cardiac arrest onset was 12.7% (59/465) in all patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity was common during shockable initial rhythm; in patients with “sudden” OHCA; and in patients who were younger, male, or had a presumed cardiac etiology. In a boosting tree, shockable initial rhythm, “sudden” OHCA, and presumed cardiac etiology were major factors that predicted the incidence of seizure-like activity. Multivariate logistic regression models including and excluding OHCA characteristics revealed that both seizure-like activity and agonal breathing recorded during EMS-witnessed OHCA were associated with favorable outcomes. CONCLUSIONS: Seizure-like activity is a major sign/symptom of the onset of “sudden” cardiac arrest of presumed cardiac etiology, particularly in patients with shockable initial rhythms. Such activity were significantly associated with neurologically favorable outcomes. |
format | Online Article Text |
id | pubmed-8502955 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-85029552021-10-15 Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study Murasaka, Kenshi Takada, Kohei Yamashita, Akira Ushimoto, Tomoyuki Wato, Yukihiro Inaba, Hideo Resusc Plus Clinical Paper AIMS: Emergency medical service (EMS) may detect seizure-like activity in addition to agonal breathing in out-of-hospital cardiac arrest (OHCA). This study investigates the incidence and predictors of seizure-like activity in nontraumatic, EMS-witnessed OHCA and their association with clinical outcomes. METHODS: This prospective study explored EMS-recorded concomitant signs/symptoms that lead to the requirement of advanced life support in patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity includes abnormal/tonic movements and eyeball deviation. Sudden OHCA was defined by the absence of signs/symptoms of impending cardiac arrest at EMS contact or progressive circulatory/respiratory depressions after the EMS contact. Neurologically favorable outcomes were defined as the cerebral performance category score of 1 or 2 at discharge. RESULTS: From April 2012 to March 2020, 465 patients were studied. The incidence of seizure-like activity at cardiac arrest onset was 12.7% (59/465) in all patients with nontraumatic, EMS-witnessed OHCA. Seizure-like activity was common during shockable initial rhythm; in patients with “sudden” OHCA; and in patients who were younger, male, or had a presumed cardiac etiology. In a boosting tree, shockable initial rhythm, “sudden” OHCA, and presumed cardiac etiology were major factors that predicted the incidence of seizure-like activity. Multivariate logistic regression models including and excluding OHCA characteristics revealed that both seizure-like activity and agonal breathing recorded during EMS-witnessed OHCA were associated with favorable outcomes. CONCLUSIONS: Seizure-like activity is a major sign/symptom of the onset of “sudden” cardiac arrest of presumed cardiac etiology, particularly in patients with shockable initial rhythms. Such activity were significantly associated with neurologically favorable outcomes. Elsevier 2021-10-05 /pmc/articles/PMC8502955/ /pubmed/34661179 http://dx.doi.org/10.1016/j.resplu.2021.100168 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Paper Murasaka, Kenshi Takada, Kohei Yamashita, Akira Ushimoto, Tomoyuki Wato, Yukihiro Inaba, Hideo Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title | Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title_full | Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title_fullStr | Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title_full_unstemmed | Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title_short | Seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: An observational study |
title_sort | seizure-like activity at the onset of emergency medical service-witnessed out-of-hospital cardiac arrest: an observational study |
topic | Clinical Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502955/ https://www.ncbi.nlm.nih.gov/pubmed/34661179 http://dx.doi.org/10.1016/j.resplu.2021.100168 |
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