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Abstract
Already the major cause of mortality in the United States, cardio-vascular emergencies will become increasingly prevalent in the future as the geriatric population doubles. This article discusses five cardiovascular emergencies: acute coronary syndrome, congestive heart failure, dysrythmias, aortic dissection, and ruptured abdominal aortic aneurysm. The discussion focuses on the differences in presentation, management, and outcomes that characterize each disease amongst the elderly. As a rule, the elderly have significantly worse outcomes than younger patients.
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Affiliation(s)
- Rohit Gupta
- Department of Emergency Medicine, Advocate Christ Medical Center, 4440 West 95(th) Street, Oak Lawn, IL 60453, USA.
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Woolley DC, Medvene LJ, Kellerman RD, Base M, Mosack V. Do residents want automated external defibrillators in their retirement home? J Am Med Dir Assoc 2006; 7:135-40. [PMID: 16503305 DOI: 10.1016/j.jamda.2005.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The administration of a continuing care retirement community (CCRC), while weighing practical and ethical questions surrounding installation of automated external defibrillators (AEDs), wanted to consider resident opinions. No databased studies on this subject were found. DESIGN AND METHODS After an information session about AEDs, CCRC residents were surveyed concerning their opinions on AED installation, their beliefs and concerns regarding AEDs, their advance directive status, and their demographic characteristics. Correlations were sought between choices about AED installation and beliefs, advance directives, and demographics. RESULTS Seventy-eight percent of 107 eligible residents participated. Twenty-seven percent wanted AEDs installed, 37% were not sure, 23% were opposed, and 11% did not answer this question. Univariate analysis showed that women, the widowed or single, and those with a college degree were more likely to oppose AEDs. In the best logistic regression (LR) model the hope that "AED use could be life saving" and the fears that "AED use might lead to a very poor quality of life" and that "AEDs might be misused" were more important than any demographic variables and only education remained in the model. Those opposing AEDs supplied powerful written comments to support their choice. CONCLUSIONS There is no consensus and great indecision about AED installation among the residents of this CCRC. The subjects were somewhat older and more affluent than the typical retirement home population, pointing to the need for replicating the investigation with a larger and more diverse study population. However, these findings suggest that AED installation in a retirement home would be premature without engaging the entire community in discussions and education in a process considerate of the wishes of all residents, which are likely to be quite diverse.
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Affiliation(s)
- Douglas C Woolley
- Department of Family and Community Medicine, Kansas University School of Medicine, Wichita, KS 67214-3199, USA.
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53
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Herlitz J, Engdahl J, Svensson L, Angquist KA, Young M, Holmberg S. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J 2005; 149:61-6. [PMID: 15660035 DOI: 10.1016/j.ahj.2004.07.014] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To describe factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in Sweden. PATIENTS AND METHODS All patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom cardiopulmonary resuscitation (CPR) was attempted and who were registered in the Swedish Cardiac Arrest Registry. This registry covers about 85% of the Swedish population and has been running since 1990. RESULTS In all, 33,453 patients, 71% of whom had a cardiac etiology, were included in the survey. The following were independent predictors for an increased chance of survival in order of magnitude: (1) patients found in ventricular fibrillation (odds ratio [OR] 5.3, 95% confidence limits [CL] 4.2-6.8), (2) the interval between call for and arrival of the ambulance less than or equal to the median (OR 3.6, 95% CL 2.9-4.6), (3) cardiac arrest occurred outside the home (OR 2.2, 95% CL 1.9-2.7), (4) cardiac arrest was witnessed (OR 2.0, 95% CL 1.6-2.7), (5) bystanders performing CPR before the arrival of the ambulance (OR 2.0, 95% CL 1.7-2.4), and (6) age less than or equal to the median (OR 1.6, 95% CL 1.4-2.0). When none of these factors were present, survival to 1 m was 0.4%; when all factors were present, survival was 23.8%. CONCLUSION Among patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom CPR was attempted, 6 factors for an increased chance of survival could be defined. These include (1) initial rhythm, (2) delay to arrival of the rescue team, (3) place of arrest, (4) witnessed status, (5) bystander CPR, and (6) age.
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Affiliation(s)
- Johan Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S. Can we define patients with no chance of survival after out-of-hospital cardiac arrest? Heart 2004; 90:1114-8. [PMID: 15367502 PMCID: PMC1768510 DOI: 10.1136/hrt.2003.029348] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. PATIENTS Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. SETTING Various ambulance organisations in Sweden. DESIGN Prospective observational study. RESULTS Among the 16,712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. CONCLUSION Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.
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Affiliation(s)
- J Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg Sweden.
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Zafari AM, Zarter SK, Heggen V, Wilson P, Taylor RA, Reddy K, Backscheider AG, Dudley SC. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 2004; 44:846-52. [PMID: 15312869 DOI: 10.1016/j.jacc.2004.04.054] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 03/25/2004] [Accepted: 04/06/2004] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether survival to discharge after in-hospital cardiopulmonary arrest could be improved by a program encouraging early defibrillation that included switching from monophasic to biphasic devices. BACKGROUND In-hospital resuscitation continues to have a low success rate. Biphasic waveform devices have demonstrated characteristics that might improve survival, and outside the hospital, automated external defibrillators (AEDs) have shown promise in improving survival of patients suffering cardiopulmonary arrest. METHODS A program including education and replacement of all manual monophasic defibrillators with a combination of manual biphasic defibrillators used in AED mode and AEDs in all outpatient clinics and chronic care units was implemented. RESULTS With program implementation, the percentage survival of all patients with resuscitation events improved 2.6-fold, from 4.9% to 12.8%. Factors independently predicting survival included event location outside an intensive care unit, younger age, an initial rhythm of pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF), pre-arrest beta-blocker, and program initiation. The outcome was independent of gender, race, work shift, number of previous resuscitation attempts, body mass index, comorbidity index, presence of diabetes, presence of hypertension, or use of angiotensin-converting enzyme inhibitors. The improvement in mortality was attributable solely to an effect on patients presenting with VT/VF. Patients with these initial rhythms were 14-fold (odds ratio = 0.07 of death, confidence interval = 0.02 to 0.3) more likely to survive to discharge after program initiation. Automated external defibrillators performed similarly to biphasic manual defibrillators in AED mode. CONCLUSIONS A program including education and use of biphasic manual defibrillators in AED mode and selective use of AEDs improved survival to discharge in hospitalized patients suffering from cardiopulmonary arrest.
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Affiliation(s)
- A Maziar Zafari
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
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Bendjelid K. Resuscitation of the elderly after out-of-hospital cardiac arrest: Toward the end of the controversy? *. Crit Care Med 2004; 32:1081-3. [PMID: 15071411 DOI: 10.1097/01.ccm.0000119931.11136.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bunch TJ, White RD, Khan AH, Packer DL. Impact of age on long-term survival and quality of life following out-of-hospital cardiac arrest*. Crit Care Med 2004; 32:963-7. [PMID: 15071386 DOI: 10.1097/01.ccm.0000119421.73520.b6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Early defibrillation programs have improved long-term outcomes following out-of-hospital cardiac arrest from ventricular fibrillation. Although long-term collective quality of life and survival are favorable, there are subsets of these patients who may be predisposed to worse outcomes. In particular, elderly patients may present with more comorbid medical conditions affecting their outcome. However, the impact of age on mortality rate and quality of life after rapid defibrillation is unknown. DESIGN Observational study. SETTING Hospital. SUBJECTS All patients with an out-of-hospital cardiac arrest between November 1990 and January 2001 who received rapid defibrillation for ventricular fibrillation in Olmsted County, Minnesota. All patients received treatment at one hospital. INTERVENTIONS Long-term outcome and quality of life were followed. Survival was estimated using the Kaplan-Meier method. The quality of life was established by an SF-36 survey. MEASUREMENTS AND MAIN RESULTS Two hundred patients presented in ventricular fibrillation out-of-hospital cardiac arrest; of these, 138 (69%) survived to hospital admission, seven (4%) died in the emergency department, and 79 (39%) were discharged neurologically intact. The average age was 62+/-16 yrs, with 51% (n = 40) of the population > or =65. The average length of follow-up was 4.8+/-3.0 yrs. The 5-yr survival in patients <65 was 94% (confidence interval, 86-100%) and 66% (confidence interval, 52-84%) in patients > or =65 (p <.001). The observed survival in the younger group was not different from that expected in a U.S. age- and gender-matched population. However, in the older group, the expected survival was significantly lower compared with an age- and gender-matched U.S. population (p =.01) but similar to an age-, gender-, and disease-matched cohort of patients from Olmsted County not experiencing an arrest. In both age-dependent cohort populations, the quality of life scores crossed the norm in all categories with exception of vitality in patients >65 yrs old (42.6+/-7.2). In direct comparison between the two patient groups, the older cohort reported lower levels of physical functioning (p =.002), role-emotional score (p =.03), and role-physical score (p =.007). Other SF-36 scores were not different between the groups. Sixty-five percent of patients <65 yrs returned to work compared with 56% of older patients. CONCLUSIONS The survival rate for ventricular fibrillation out-of-hospital cardiac arrest is significantly improved by the presence of a rapid defibrillation program. In patients <65 yrs old, long-term survival is equal to that of normal individuals and quality of life is similar to the general population. The survival, although high, in older patients is less than that in age-matched healthy controls, and physical and emotional quality of life scores are decreased.
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Affiliation(s)
- T Jared Bunch
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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58
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Herlitz J, Eek M, Engdahl J, Holmberg M, Holmberg S. Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age. Resuscitation 2003; 58:309-17. [PMID: 12969609 DOI: 10.1016/s0300-9572(03)00155-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM To describe various factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. PATIENTS All patients included in the Swedish Cardiac Arrest Registry during the period 1990-1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS All patients reached by the ambulance crew and in whom resuscitative efforts were attempted. Crew witnessed cases were excluded. Only patients aged over 18 years were included. Patients were divided into three age groups: less than 65 years (n=7810), 65-75 years (n=7261) and over 75 years (n=8390). RESULTS The proportion of cases with a cardiac aetiology increased with increasing age (P<0.0001). The proportion of witnessed cases increased with increasing age among those with a non-cardiac aetiology (P<0.0001) and decreased with increasing age among cases with a cardiac aetiology (P=0.02). The proportion of patients exposed to bystander CPR decreased with increasing age (P<0.0001). The proportion of patients found in ventricular fibrillation (VF) decreased with increasing age among patients with a cardiac aetiology (P<0.0001) but was not related to age in those with a non-cardiac aetiology. The proportion of patients being alive after 1 month in the three age groups (youngest first) were: 4.5, 3.2 and 2.5% (P<0.0001). The corresponding figures for patients with a cardiac aetiology found in VF were: 10.7, 7.6 and 6.6% (P<0.0001). After multiple regression analysis controlling for other factors increasing age was still associated with decreased survival to 1 month (odds ratio 0.85; 95% confidence limits 0.80-0.91). CONCLUSION Among patients suffering from out-of-hospital cardiac arrest various factors at resuscitation, including initial rhythm, aetiology and bystander CPR, are strongly related to age. The chance of survival diminishes with increasing age. When correcting for the dissimilarities in terms of factors at resuscitation, age is still significantly associated with survival, being lower among the elderly.
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Affiliation(s)
- Johan Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, S-41345 Gothenburg, Sweden.
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59
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Swor R, Compton S, Farr L, Kokko S, Vining F, Pascual R, Jackson RE. Perceived Self-Efficacy in Performing and Willingness to Learn Cardiopulmonary Resuscitation in an Elderly Population in a Suburban Community. Am J Crit Care 2003. [DOI: 10.4037/ajcc2003.12.1.65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
• Background Older persons are the group most likely to respond to cardiac arrests in private residences.
• Objective To characterize the knowledge about, attitudes toward, and perceived self-efficacy of older persons in learning and providing cardiopulmonary resuscitation.
• Methods A total of 2743 surveys were mailed to adults 55 years and older who resided in a single Michigan suburb. Data were collected on demographics, medical history, training in and willingness to provide cardiopulmonary resuscitation, and concerns about providing this intervention.
• Results The 631 persons (24.6%) who responded were elderly (mean age, 73.5 years) and had a mean of 1.7 occupants per household. More than one third lived alone. Of all respondents, 275 (43.6%) had received training in cardiopulmonary resuscitation, 370 (58.6%) indicated a willingness to learn cardiopulmonary resuscitation, and 412 (65.3%) thought that they had the ability to perform this intervention. Respondents 80 years or younger were significantly more likely than respondents more than 80 years old to be willing to learn cardiopulmonary resuscitation (65.7% vs 19.0%, P < .001) and perceived themselves as able to perform it (73.0% vs 34.0%, P < .001). The absence of mouth-to-mouth ventilation as part of training had minimal impact on the willingness of either age group to receive training (61.2% vs 58.6%, P = .19). Perceived ability to learn and perform cardiopulmonary resuscitation did not vary with the medical history of the respondent or the respondent’s spouse.
• Conclusion Adults 56 to 80 years old perceive themselves as able to perform cardiopulmonary resuscitation and are interested in receiving training.
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Affiliation(s)
- Robert Swor
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Scott Compton
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Lynn Farr
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Sue Kokko
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Fern Vining
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Rebecca Pascual
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
| | - Raymond E. Jackson
- The Department of Emergency Medicine (RS, SC, RP, REJ) and the Department of Nursing Development and Educational Resources (LF, SK, FV), William Beaumont Hospital, Royal Oak, Mich
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Herlitz J, Eek M, Holmberg M, Engdahl J, Holmberg S. Characteristics and outcome among patients having out of hospital cardiac arrest at home compared with elsewhere. Heart 2002; 88:579-82. [PMID: 12433883 PMCID: PMC1767462 DOI: 10.1136/heart.88.6.579] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the characteristics and outcome of patients who have a cardiac arrest at home compared with elsewhere out of hospital. PATIENTS Subjects were patients included in the Swedish cardiac arrest registry between 1990 and 1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS The study sample comprised patients reached by the ambulance crew and in whom resuscitation was attempted out of hospital. There was no age limit. Crew witnessed cases were excluded. The patients were divided into two groups: cardiac arrest at home and cardiac arrest elsewhere. RESULTS Among a study population of 24 630 patients the event took place at home in 16 150 (65.5%). Those in whom the arrest took place at home differed from the remainder in that they were older, were more often women, less often had a witnessed cardiac arrest, were less often exposed to bystander cardiopulmonary resuscitation (CPR), were less often found in ventricular fibrillation, and had a longer interval between collapse and call for ambulance, arrival of ambulance, start of CPR, and first defibrillation. Of patients in whom the arrest took place at home, 11.3% were admitted to hospital alive, v 19.4% in the elsewhere group (p < 0.0001); corresponding figures for survival after one month were 1.7% v 6.2% (p < 0.0001). The adjusted odds ratio for survival after one month (at home v not at home; considering age, sex, initial arrhythmia, bystander CPR, aetiology, and whether the arrest was witnessed) was 0.40 (95% confidence interval 0.33 to 0.49; p < 0.0001). CONCLUSIONS Sixty five per cent of out of hospital cardiac arrests in Sweden occur at home. The patients differed greatly from those with out of hospital cardiac arrests elsewhere, and fewer than 2% were alive after one month. Having an arrest at home was a strong independent predictor of adverse outcome. Further research is needed to identify the reasons for this.
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Affiliation(s)
- J Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Citerio G, Galli D, Cesana GC, Bosio M, Landriscina M, Raimondi M, Rossi GP, Pesenti A. Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region. Resuscitation 2002; 55:247-54. [PMID: 12458061 DOI: 10.1016/s0300-9572(02)00267-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this research is to evaluate quality of out-of-hospital medical services in our country, using performance indicators and a new computerised database. METHODS (a) EXPERIMENTAL DESIGN Data were collected prospectively in three emergency dispatch centres for 90 days. Follow-up was evaluated at 1 day and 1 month after the event. This paper presents data on the cardiac arrest cohort only. (b) SETTING Three emergency dispatch centres in Lombardia. (c) PATIENTS One hundred and seventy-eight patients in non-traumatic cardiac arrest were enrolled. (d) INTERVENTIONS None. The study was observational only. RESULTS Mean interval between phone call and arrival on scene was 8.5+/-3.5 min. BLS manoeuvres were carried out from bystanders only in 15% of the cohort; this was associated with significant mortality reduction (85.7 versus 95.8%, chi(2) P<0.05). One hundred and thirty-three patients (75%) received assistance from BLS crews while only 45 patients (25%) were assisted by ALS medical personel, with a significant mortality reduction (ALS deaths 86.7%, BLS deaths 97%). Total 24 h survival was 9% and survival at 1 month declined to 6.17%. CONCLUSIONS Quality monitoring produces objective information on interventions and outcomes. Only with this information, is it possible to implement improvement programmes that are planned according to the data presented.
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Affiliation(s)
- G Citerio
- Dipartimento di Anestesia e Rianimazione, Azienda Ospedale San Gerardo di monza, Nuovo Ospedale San Gerardo, Via Donizetti, 106, 20052 Monza (MI), Italy.
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Blaivas M, Fox JC. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med 2001; 8:616-21. [PMID: 11388936 DOI: 10.1111/j.1553-2712.2001.tb00174.x] [Citation(s) in RCA: 194] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
UNLABELLED Patients presenting in cardiac arrest frequently have poor outcomes despite heroic resuscitative measures in the field. Many emergency medical systems have protocols in place to stop resuscitative measures in the field; however, further predictors need to be developed for cardiac arrest patients brought to the emergency department (ED). OBJECTIVE To examine the predictive value of cardiac standstill visualized on bedside ED echocardiograms during the initial presentations of patients receiving cardiopulmonary resuscitation (CPR). METHODS The study took place in a large urban community hospital with an emergency medicine residency program and a high volume of cardiac arrest patients. As part of routine care, all patients arriving with CPR in progress were subject to immediate and brief subxiphoid or parasternal cardiac ultrasound examination. This was followed by brief repeat ultrasound examination during the resuscitation when pulses were checked. A 2.5-MHz phased-array probe was used for imaging. Investigators filled out standardized data sheets. Examinations were taped for review. Statistical analysis included descriptive statistics, positive and negative predictive values, and likelihood ratios. RESULTS One hundred sixty-nine patients were enrolled in the study. One hundred thirty-six patients had cardiac standstill on the initial echocardiogram. Of these, 71 patients had an identifiable rhythm on monitor. No patient with sonographically identified cardiac standstill survived to leave the ED regardless of his or her initial electrical rhythm. Cardiac standstill on echocardiogram resulted in a positive predictive value of 100% for death in the ED, with a negative predictive value of 58%. CONCLUSIONS Patients presenting with cardiac standstill on bedside echocardiogram do not survive to leave the ED regardless of their electrical rhythms. This finding was uniform regardless of downtime. Although larger studies are needed, this may be an additional marker for cessation of resuscitative efforts.
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Affiliation(s)
- M Blaivas
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA.
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