S Bendotti

Bio: S Bendotti is an academic researcher. The author has contributed to research in topics: Medicine & Internal medicine. The author has co-authored 1 publications.

Impact of gender on survival of out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias and role of coronary artery disease

Abstract: Type of funding sources: None. Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distribution and prevalence of coronary artery disease (CAD). The aim of this study was to characterize gender-related outcome, prevalence and severity of CAD in OHCA victims presenting with shockable rhythm and refractory VA. All OHCAs presenting with shockable rhythm occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included. Out of 3592 OHCAs, 685 presented with shockable rhythm and, of them, 212 had a refractory VA. Overall, male gender was independently associated with a lower probability of survival both at hospital admission and at 30-days (OR 0.63, 95% CI 0.58-0.67, p <0.001 and OR 0.82 95% CI 0.74-0.91, p <0.001, respectively) and presented with a more severe CAD. Male gender was 5-times more frequently associated with OHCA presenting with refractory VA. Despite of a more favourable OHCA presentation (i.e. more often OHCA witnessed, public place occurrence and CPR initiated by bystander) male patients with refractory VA had a lower likelihood of survival (OR 0.25, 95% CI 0.21-0.30). A higher prevalence (81%) of CAD was observed in OHCAs presenting with refractory VA but not a higher number of diseased vessels. Male gender is more frequently associated with refractory VA, lower probability of survival and higher prevalence and severity of CAD. CAD severity, however, does not significantly affect refractory VA presentation.

C6 ventricular fibrillation spectral area (amsa) and low–energy shock success prediction in patients with out–of–hospital cardiac arrest

Abstract: In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy level for defibrillation is that which achieves defibrillation and minimize the current–induced myocardial damage. Therefore, it would be reasonable to reduce the energy level as well as the number of shocks. ECG–based VF waveform analysis features such as amplitude spectral area (AMSA) have been recently introduced as predictors of shock success but their predictivity for shock success with low energy level is not known. We aimed to assess whether AMSA of VF is able to predict the efficacy of low energy level for defibrillation in out–of–hospital cardiac arrest (OHCA) patients. All the OHCAs with at least one shockable rhythm occurred from January 2015 to December 2020 in the province of Pavia, Italy, were considered. AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators and by using a 2–second–pre–shock ECG interval. Among 4619 OHCA, AMSA values and energy for defibrillation were documented in 791 shocks, of which 45% received a shock at low energy (<= 150J) and 55% at high energy (>150J). The rate of efficacy between the two groups did not differ significantly (44% vs 38%, p=0.102), however in patients efficaciously treated with low energy, AMSA was higher compared to those efficaciously treated with high energy [13.2 mV·Hz (12.5–14.2) vs 10.8 (10.1–11.5), p<0.001]. Moreover, AMSA was found to be different even when comparing ineffective shock at low energy with effective shock at high energy [(6.6 (4.6–10) vs 10.8 (8.1–13.8), p<0.001] and similar when comparing ineffective shock at low and at high energy [6.6 (4.6–10) vs 6.3 (4.5–8.7), p=0.21]. By dividing AMSA values into three tertiles the rate of shock success at low energy was found to be different: [T1 (0.7–6.2) 4.2%; T2 (6.2–10.8) 13%; T3 (10.8–63.2) 42%, Chi squared p<0.001 and p for trend <0.001]. After correction for age, sex, amiodarone use, call to shock time, AMSA values corresponding to the third and second tertile were associated with higher probability of shock success compared with the values in the lowest tertile [T3 OR 15 (95%CI 7–30), p< 0.001; T2 OR 3 (95%CI 1–7), p= 0.002]. Amplitude spectral area of VF is a predictor of shock success at low energy. This could be useful to optimize the choice of energy limiting the current related myocardial injury.

Mean value of Perfusion Index in patients resuscitated from an out-of-hospital cardiac arrest predict the incidence of lactic acidosis on ICU admission

Abstract: Type of funding sources: None. Regional and general hypoperfusion cause hypoxia, resulting in excess production of lactate secondary to reduced mitochondrial oxidation. Peripheral perfusion index (PI) is the fraction of the pulsatile blood flow to the non-pulsatile blood in peripheral tissue obtained by standard pulse-oximetry. Recent literature has highlighted its association with both survival and ECG reliability in patients resuscitated from an out-of-hospital cardiac arrest (OHCA). We raised the hypothesis that the mean value of PI over 30-minutes monitoring (MPI30) after ROSC in patients resuscitated from an OHCA is associated with the probability of detecting a lactic acidosis (LA) at the first arterial blood gas analysis available after ICU admission. This was a retrospective study, obtaining data from our cardiac arrest registry. Among 172 post-ROSC patients admitted to the ICU (between 1st January 2017 and May 2021) post-ROSC MPI30 was available in 76 patients: 54 (72%) males; median age 70 years (IQR 59-77). PI was automatically and continuously measured by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) once the pulse oximeter was placed, then registered in the report. The population was divided in quartiles according to MPI30 values, then the incidence along the quartiles were compared with chi-squared test. The association between MPI30 and LA incidence was investigated both with univariate and multivariate logistic regression. LA was documented in 57% of the study population. We found a significant trend toward reduction of incidence of LA along the four quartiles (p=0.0386). Univariate logistic regression showed a statistically significant association between MPI30 and LA on admission [OR 0.62 (95%CI 0.44-0.89), p=0.005] which was confirmed after correction for age and sex [OR 0.63 (95%CI 0.43-0.91), p=0.009]. Low perfusion as measured by MPI30 after ROSC predicts a higher incidence of lactic acidosis in patients on admission to the ICU. Our results could help clinicians in identifying patients at risk for metabolic derangements even before a blood gas analysis is obtained.

Vasoactive inotropic score (VIS) at ICU admission predicts neurological outcome and survival in patients resuscitated from an out of hospital cardiac arrest

Abstract: Type of funding sources: None. Since its proposal, Vasoactive Inotropic Score (VIS) was applied in different setting of acute critical care (e.g. pediatric population or post-cardiac surgery). It reflects the pharmacological support of the cardiovascular system and higher VIS values in the first 24 hours from ICU admission predict worse outcomes, both in pediatric and adult population. Few data are available regarding patients admitted for an Out of Hospital Cardiac Arrest (OHCA). The aim of this work is to investigate the prognostic role of VIS score in this population. We enrolled 171 consecutive patients who were resuscitated after an OHCA and admitted to ICU at our center from September 2017 to April 2021. VIS score on admission was available for 144 patients. We divided the population in two groups (high vs low VIS score) according to VIS score median values. For every patient neurological outcome at discharge and survival at one year were available. Median VIS score was 10 so we considered low values ≤ 10 (group 1) and high values > 10 (group 2). There were 73 patients in low VIS group (Group 1) and 71 in high VIS group (Group 2). No differences were found in the two groups regarding sex (75% males vs 74%, p=0.88), age [64 (49-70) vs 61 (52-74), p=0.5], SAPS II score at admission [63.61 (53-70) vs 65.46 (61-86), p=0.54], shockable rhythm as first rhythm (60.2% vs 51.51%, p=0.3) and number of shocks delivered [median value 1 (0-13) vs 1 (0-14), p=0.84]. On the contrary, patients with lower VIS values had a shorter arrest duration [26 mins (19-40) vs 41 mins (27-74), p=0.0002] and less adrenaline delivered [2 mg (0-6) vs 3 mg (0 -12), p=0.0012]. Moreover, patients with lower VIS score values on admission showed a better neurological outcome (defined as a CPC < 2) at ICU discharge (44% vs 21%, p=0.08). In addition, patients in group 1 showed a lower mortality rate as compared to group 2 [60% (44/73) vs 76% (54/71),p=0.0048]. in adult patients resuscitated from an out-of-hospital cardiac arrest and admitted to an ICU, lower values of VIS score were associated with higher survival at 1 year. Moreover patients with low VIS showed better neurological outcome at ICU discharge. This could be explained by the fact that VIS express the need for cardiovascular support and is lower in patients with a more stable hemodynamic status after OHCA, reflecting a less compromised clinical condition.

Association Between Postresuscitation 12‐Lead ECG Features and Early Mortality After Out‐of‐Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study

Abstract: Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.

Impact of sex and role of coronary artery disease in out-of-hospital cardiac arrest presenting with refractory ventricular arrhythmias

Abstract: Introduction There are limited data on sex-related differences in out-of hospital cardiac arrests (OHCAs) with refractory ventricular arrhythmias (VA) and, in particular, about their relationship with cardiovascular risk profile and severity of coronary artery disease (CAD). Purpose Aim of this study was to characterize sex-related differences in clinical presentation, cardiovascular risk profile, CAD prevalence, and outcome in OHCA victims presenting with refractory VA. Methods All OHCAs with shockable rhythm that occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included. Results Out of 680 OHCAs with first shockable rhythm, 216 (33%) had a refractory VA. OHCA patients with refractory VA were younger and more often male. Males with refractory VA had more often a history of CAD (37% vs. 21%, p 0.03). In females, refractory VA were less frequent (M : F ratio 5 : 1) and no significant differences in cardiovascular risk factor prevalence or clinical presentation were observed. Male patients with refractory VA had a significantly lower survival at hospital admission and at 30 days as compared to males without refractory VA (45% vs. 64%, p < 0.001 and 24% vs. 49%, p < 0.001, respectively). Whereas in females, no significant survival difference was observed. Conclusions In OHCA patients presenting with refractory VA the prognosis was significantly poorer for male patients. The refractoriness of arrhythmic events in the male population was probably due to a more complex cardiovascular profile and in particular due to a pre-existing CAD. In females, OHCA with refractory VA were less frequent and no correlation with a specific cardiovascular risk profile was observed.