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Abdelazeem B, Awad AK, Manasrah N, Elbadawy MA, Ahmad S, Savarapu P, Abbas KS, Kunadi A. The Effect of Vasopressin and Methylprednisolone on Return of Spontaneous Circulation in Patients with In-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs 2022; 22:523-533. [PMID: 35314927 DOI: 10.1007/s40256-022-00522-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Cardiac arrest is often fatal if not treated immediately by cardiopulmonary resuscitation to restore a normal heart rhythm and spontaneous circulation. We aim to evaluate the clinical benefits of vasopressin and methylprednisolone versus placebo for patients with in-hospital cardiac arrest. DATA SOURCES We searched PubMed, EMBASE, Scopus, Web of Science, Cochrane Central, and Google Scholar from inception to October 17, 2021, by using search terms included "Vasopressin" AND "Methylprednisolone" AND "Cardiac arrest". STUDY SELECTION AND DATA EXTRACTION We included randomized controlled trials (RCTs) that compared vasopressin and methylprednisolone to placebo. The main outcomes were the return of spontaneous circulation (ROSC) and survival to hospital discharge. DATA SYNTHESIS A total of three RCTs, with a total of 869 patients, were included. The pooled risk ratios (RRs) were calculated along with their 95% confidence intervals (CIs). Our result showed an increase in ROSC in patients who received vasopressin and methylprednisolone (RR = 1.32; 95% CI = [1.18, 1.47], p < 0.00001) when compared with the placebo group. However, there was no difference between both groups regarding survival to hospital discharge (RR = 1.76; 95% CI = [0.68, 4.56], p= 0.25). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The current guidelines recommend epinephrine for patients with in-hospital cardiac arrest. Our meta-analysis updates clinicians about using vasopressin and methylprednisolone besides epinephrine, providing them with the best available evidence in managing patients with in-hospital cardiac arrest. CONCLUSION Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone besides epinephrine is associated with increased ROSC compared with placebo and epinephrine. However, high-quality RCTs are necessary before drawing a firm conclusion regarding the efficacy of vasopressin and methylprednisolone for patients with in-hospital cardiac arrest.
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Erdoes G, Weber D, Bloch A, Heinisch PP, Huber M, Friess JO. The impact of on-site cardiac rhythm on mortality in patients supported with extracorporeal cardiopulmonary resuscitation: A retrospective cohort study. Artif Organs 2022; 46:1649-1658. [PMID: 35318673 DOI: 10.1111/aor.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used in patients with out-of-hospital or in-hospital cardiac arrest in whom conventional cardiopulmonary resuscitation remains unsuccessful. The aim of this study was to analyze the impact of initial cardiac rhythm-detected on-site of the cardiac arrest-on mortality. METHODS We performed a retrospective cohort study of patients who received ECPR in our tertiary care cardiac arrest center. Patients were divided into three groups depending on their cardiac rhythm: shockable rhythm, pulseless electrical activity, and asystole. The primary endpoint was mortality within the first 7 days after ECPR deployment. Secondary endpoints were mortality within 28 days and the impact of pre-ECPR potassium, serum lactate, pH, and pCO2 on mortality. The association of the initial cardiac rhythm and the location of arrhythmia detection (patient monitored in hospital [category: monitored], not monitored but hospitalized [in-hospital], not monitored, not hospitalized [out-of hospital]) with the primary and secondary outcome was examined by means of univariable and multivariable logistic regression. RESULTS Sixty-five patients could be included in the final analysis. Thirty-two patients (49.2%, 95%CI 36.6%-61.9%) died within the first 7 days. In terms of 7-day-mortality patients differed in the initial cardiac rhythm (p = 0.040) and with respect to the location of arrhythmia detection (p = 0.002). Shockable cardiac rhythm (crude OR 0.21; 95%CI 0.03-0.98) and pulseless electrical activity (0.13; 0.02-0.61) as the initial rhythm on-site showed better odds for survival compared to asystole. However, this association did neither persist in adjusted analysis nor pairwise comparison. DISCUSSION The study could not demonstrate a better outcome with shockable rhythm after ECPR. More homogeneous and adequately powered cohorts are needed to better understand the impact of cardiac rhythm on patient outcomes after ECPR.
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Affiliation(s)
- Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Weber
- Department of Anaesthesiology and Intensive Care Medicine, Spital Limmattal, Schlieren, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Kantonsspital Lucerne, Lucerne, Switzerland.,Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paul Philipp Heinisch
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Oliver Friess
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Allencherril J, Yong Kyu Lee P, Khan K, Loya A, Pally A. Etiologies of In-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2022; 175:88-95. [PMID: 35278525 DOI: 10.1016/j.resuscitation.2022.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Etiologies of in-hospital cardiac arrest (IHCA) in general wards may differ from etiologies of out-of-hospital cardiac arrest (OHCA) given the different clinical characteristics of these patient populations. An appreciation for the causes of IHCA may allow the clinician to appropriately target root causes of arrest. METHODS MEDLINE/PubMed, EMBASE, and Google Scholar were queried from inception until May 31, 2021. Studies reporting etiologies of IHCA were included. A random effects meta-analysis of extracted data was performed using Review Manager 5.4. RESULTS Of 12,451 citations retrieved from the initial literature search, 9 were included in the meta-analysis. The most frequent etiologies of cardiac arrest were hypoxia (26.46%, 95% confidence interval [CI] 14.19% to 38.74%), acute coronary syndrome (ACS) (18.23%, 95% CI 13.91% to 22.55%), arrhythmias (14.95%, 95% CI 0% to 34.92%), hypovolemia (14.81%, 95% CI 6.98% to 22.65%), infection (14.36%, 95% CI 9.46% to 19.25%), and heart failure (12.64%, 95% CI 6.47% to 18.80%). Cardiac tamponade, electrolyte disturbances, pulmonary embolism, neurological causes, toxins, and pneumothorax were less frequent causes of IHCA. Initial rhythm was unshockable (pulseless electrical activity or asystole) in 69.83% of cases and shockable (ventricular tachycardia or ventricular fibrillation) in 21.75%. CONCLUSION The most prevalent causes of IHCA among the general wards population are hypoxia, ACS, hypovolemia, arrythmias, infection, heart failure, three of which (arrhythmia, infection, heart failure) are not part of the traditional "H's and T's" of cardiac arrest. Other causes noted in the "H's and T's" of advanced cardiac life support do not appear to be important causes of IHCA.
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Affiliation(s)
- Joseph Allencherril
- Texas Heart Institute, Houston, Texas, USA; Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA; Joseph Allencherril and Paul Yong Kyu Lee contributed equally
| | - Paul Yong Kyu Lee
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; Joseph Allencherril and Paul Yong Kyu Lee contributed equally.
| | - Khurrum Khan
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Asad Loya
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Annie Pally
- University of Texas at Austin- Dell Medical School, Austin, TX
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Yang PS, Kim D, Sung JH, Joung B. The effect of age, gender, economic state, and urbanization on the temporal trend in sudden cardiac arrest: a nationwide population-based cohort study. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-021-00058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Sudden cardiac arrest (SCA) has not been well studied in Asian countries. This study investigated the temporal trends in the incidence and outcomes of SCA and the impact of age, gender, economic state, and urbanization on SCA using a nationwide population-based sample cohort of South Korea.
Methods
In the Korean National Health Insurance Service—Sample Cohort consisting of one million persons from 2003 through 2013, we identified 5,675 (0.56%) patients with SCA using ICD-10 code I46 and I49.0. We evaluated the impact of the age, gender, household income, and urbanization level on the incidence and outcome of SCA.
Results
During the study period, the overall age- and gender-adjusted annual incidence of SCA increased by 46.9% from 30.9 in 2003 to 45.4 in 2013 (per 100,000 person-years, p < 0.001 for trend). The medical cost per 100,000 person-years also greatly increased about four times (p < 0.001 for trend). The overall adjusted survival to hospital discharge rate increased from 8.9% in 2003 to 13.2% in 2013 (adjusted rate ratio per year 1.05; p < 0.001 for trend). Old age and low household incomes of the population was related to increased SCA and poor survival to hospital discharge rate. The proportion of patients with intensive or advanced therapeutic modalities after SCA greatly increased from 1.6% in 2003 to 10.0% in 2013 (p < 0.001 for trend). This increase was consistent regardless of age, gender, economic state, and urbanization level.
Conclusions
Although the incidence of SCA was increased, the outcome was improved for the decade. However, in the elderly and low-income population, the incidence of SCA continued to rise and survival outcome was not improved.
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Ohbe H, Tagami T, Uda K, Matsui H, Yasunaga H. Incidence and outcomes of in-hospital cardiac arrest in Japan 2011-2017: a nationwide inpatient database study. J Intensive Care 2022; 10:10. [PMID: 35241166 PMCID: PMC8895772 DOI: 10.1186/s40560-022-00601-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although numerous studies have investigated out-of-hospital cardiac arrest, few studies have been conducted on in-hospital cardiac arrest (IHCA). Knowledge of the nationwide epidemiology of IHCA in Japan, with its super-aging society, is important to understand the current situation of IHCA and to establish evidenced-based medicine in the future. The present study aimed to determine the incidence and outcomes of IHCA and their trends in Japan. Methods This observational cohort study was performed using a national administrative inpatient database for more than 1600 acute-care hospitals covering about 50% of all acute-care hospital beds in Japan from April 2011 to March 2018. We defined cardiac arrest patients who received cardiopulmonary resuscitation (chest compression) during hospitalization as IHCA. We excluded out-of-hospital cardiac arrest patients from the source population. The incidence of IHCA per 1000 hospital admissions and survival to discharge rate was reported with trend analyses by calendar year 2011–2017. Results Among 53,871,101 hospitalized patients without out-of-hospital cardiac arrest patients in 1626 hospitals, 2,136,038 (4.0%) had cardiac arrest. Of them, 274,664 (12.9%) received cardiopulmonary resuscitation at least once during hospitalization and were identified as IHCA, and 1,861,374 (87.1%) did not receive cardiopulmonary resuscitation. The incidence of IHCA per 1000 hospital admissions was 5.1, with a significant decreasing trend from 6.1 in 2011 to 4.6 in 2017 (P for trend = 0.033). Our estimated incidence can be translated to approximately 87,000 IHCA cases in Japan each year. The percentage of IHCA patients among cardiac arrest patients was 12.9%, with a significant decreasing trend from 14.0% in 2011 to 12.2% in 2017 (P for trend = 0.006). The overall rate of survival to discharge was 12.7%, with a significant increasing trend from 10.5% in 2011 to 14.0% in 2017 (P for trend < 0.001). Conclusions We found substantial associations between mortality and loss of health and IHCA in Japan. The incidence of IHCA showed a decreasing trend over time, the percentage of treated cardiac arrest patients also had a decreasing trend, and the overall survival to discharge rate improved over time. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00601-y.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
| | - Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Musashi-Kosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 2118533, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 3058575, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
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Stærk M, Lauridsen KG, Krogh K, Løfgren B. Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals. Resusc Plus 2022; 9:100211. [PMID: 35199074 PMCID: PMC8842076 DOI: 10.1016/j.resplu.2022.100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Automated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. However, the effect of AEDs for in-hospital cardiac arrest (IHCA) remains uncertain. This study aims to describe the distribution and use of AEDs in Danish hospitals and investigate whether early rhythm analysis is associated with return of spontaneous circulation (ROSC). Methods All Danish public hospitals with a cardiac arrest team were included and sent a questionnaire on the in-hospital distribution of AEDs and manual defibrillators. Further, we collected data on IHCAs including rhythm analysis, device type, cardiac arrest team arrival, and ROSC from the national database on IHCA (DANARREST). Results Of 46 hospitals, 93% had AEDs and 93% had manual defibrillators. AEDs were often placed in wards or non-clinical areas, whereas manual defibrillators were often placed in areas with high-risk patients. We identified 3,204 IHCAs. AEDs were used in 13% of IHCAs. After adjustment for confounders, chance of ROSC was higher if the first rhythm analysis was performed before the arrival of the cardiac arrest team (RR: 1.28 (95% CI: 1.12–1.46)). The relative risk of ROSC was 1.09 (0.84–1.41) when analyzing with an AED before cardiac arrest team arrival and 1.19 (1.00–1.41) when using a manual defibrillator. However, there was no significant effect modification for AED vs manual defibrillator (p = 0.26). Conclusion AEDs are widely distributed in Danish hospitals but less commonly used for IHCAs compared to manual defibrillators. Rhythm analysis before arrival of the cardiac arrest team was associated with ROSC without significant effect modification of device type.
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Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Denmark
- Education and Research, Randers Regional Hospital, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Emergency Department, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark.
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Song MJ, Lee DS, Choi YY, Lee DY, Jo HM, Lim SY, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT, Lee YJ. Incidence of preventable cardiopulmonary arrest in a mature part-time rapid response system: A prospective cohort study. PLoS One 2022; 17:e0264272. [PMID: 35213617 PMCID: PMC8880884 DOI: 10.1371/journal.pone.0264272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of a rapid response system (RRS) is to reduce the incidence of preventable cardiopulmonary arrests (CPAs) and patient deterioration in general wards. The objective of this study is to investigate the incidence and temporal trends of preventable CPAs and determine factors associated with preventable CPAs in a hospital with a mature RRS. Methods This was a single-center prospective cohort study of all CPAs occurring in the general ward between March 2017 and June 2020. The RRS operates from 07:00 to 23:00 on weekdays and from 07:00 to 12:00 on Saturdays. All CPAs were reviewed upon biweekly conference, and a panel of intensivists judged their preventability. Trends of preventable CPAs were analyzed using Poisson regression models and factors associated with preventable CPAs were analyzed using multivariable logistic regression. Results There were 253 CPAs over 40 months, and 64 (25.3%) of these were preventable. The incidence rate of CPAs was 1.07 per 1000 admissions and that of preventable CPAs was 0.27 per 1000 admissions. The number of preventable CPAs decreased by 24% each year (incidence rate ratio = 0.76; p = 0.039) without a change in the total CPA incidence. The most common contributor to the preventability was delayed response from physicians (n = 41, 64.1%). A predictable CPA with a pre-alarm sign had increased odds in the occurrence of preventable CPAs, while a cardiac cause of CPAs and RRS operating hours had decreased odds in terms of occurrence of preventable CPA. Conclusion Our study showed that one-fourth of all CPAs occurring in the general wards were preventable, and these arrests decreased each year. A mature RRS can evolve to reduce preventable CPAs with regular self-evaluation. Efforts should be directed at improving physicians’ response time since a delay in their response was the most common cause of preventable CPAs.
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Affiliation(s)
- Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Seon Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yun-Young Choi
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Da-Yun Lee
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye-min Jo
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- * E-mail:
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Wang J, Hu Y, Kuang Z, Chen Y, Xing L, Wei W, Xue M, Mu S, Tong C, Yang Y, Song Z. GPR174 mRNA Acts as a Novel Prognostic Biomarker for Patients With Sepsis via Regulating the Inflammatory Response. Front Immunol 2022; 12:789141. [PMID: 35173706 PMCID: PMC8841418 DOI: 10.3389/fimmu.2021.789141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/08/2021] [Indexed: 01/26/2023] Open
Abstract
Previous studies indicated that G-protein coupled receptor 174 (GPR174) is involved in the dysregulated immune response of sepsis, however, the clinical value and effects of GPR174 in septic patients are still unknown. This study is aimed to evaluate the potential value of GPR174 as a prognostic biomarker for sepsis and explore the pathological function of GPR174 in cecal ligation and puncture (CLP)-induced septic mice. In this prospective longitudinal study, the expressions of peripheral GPR174 mRNA were measured in 101 septic patients, 104 non-septic ICU controls, and 46 healthy volunteers at Day 1, 7 after ICU (Intensive Care Unit) admission, respectively. Then, the clinical values of GPR174 for the diagnosis, severity assessment, and prognosis of sepsis were analyzed. Moreover, the expressions of GPR174 mRNA in CLP-induced septic mice were detected, and Gpr174-knockout (KO) mice were used to explore its effects on inflammation. The results showed that the levels of GPR174 mRNA were significantly decreased in septic patients compared with non-septic ICU and healthy controls. In addition, the expressions of GPR174 mRNA were correlated with the lymphocyte (Lym) counts, C-reactive protein (CRP), and APACHE II and SOFA scores. The levels of GPR174 mRNA at Day 7 had a high AUC in predicting the death of sepsis (0.83). Further, we divided the septic patients into the higher and lower GPR174 mRNA expression groups by the ROC cut-off point, and the lower group was significantly associated with poor survival rate (P = 0.00139). Similarly, the expressions of peripheral Gpr174 mRNA in CLP-induced septic mice were also significantly decreased, and recovered after 72 h. Intriguingly, Gpr174-deficient could successfully improve the outcome with less multi-organ damage, which was mainly due to an increased level of IL-10, and decreased levels of IL-1β and TNF-α. Further, RNA-seq showed that Gpr174 deficiency significantly induced a phenotypic shift toward multiple immune response pathways in septic mice. In summary, our results indicated that the expressions of GPR174 mRNA were associated with the severity of sepsis, suggesting that GPR174 could be a potential prognosis biomarker for sepsis. In addition, GPR174 plays an important role in the development of sepsis by regulating the inflammatory response.
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Affiliation(s)
- Jianli Wang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanyan Hu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongshu Kuang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Chen
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingyu Xing
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wei
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingming Xue
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sucheng Mu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chaoyang Tong
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Zhenju Song, ; Yilin Yang, ; Chaoyang Tong,
| | - Yilin Yang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Zhenju Song, ; Yilin Yang, ; Chaoyang Tong,
| | - Zhenju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- *Correspondence: Zhenju Song, ; Yilin Yang, ; Chaoyang Tong,
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Cheng Y, Peng H, Zhang J, Zhu J, Xu L, Cao X, Qin L. Associations between red cell distribution width and outcomes of adults with in-hospital cardiac arrest: A retrospective study. Medicine (Baltimore) 2022; 101:e28750. [PMID: 35089252 PMCID: PMC8797596 DOI: 10.1097/md.0000000000028750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
Previous studies found that high red cell distribution width (RDW) value is associated with poor outcomes among out-of-hospital cardiac arrest survivors. The aim of this study was to investigate whether post-ROSC RDW value was associated with survival and neurological outcomes of in-hospital cardiac arrest (IHCA) patients achieving return of spontaneous circulation (ROSC) but remaining critically ill.This retrospective single-center observational study included IHCA adults with sustained ROSC between January 1, 2017 and January 1, 2021 at an academic medical center in China. PostROSC RDW values were measured within 1 hour after sustained ROSC. The primary outcome was survival to hospital discharge and the secondary outcome was favorable neurological outcome at hospital discharge. The associations between postROSC RDW value and outcomes among IHCA patients with ROSC were evaluated by using multivariate logistic regression.A total of 730 patients with sustained ROSC following IHCA were ultimately included in this study. Of whom 194 (26.6%) survived to hospital discharge and 116 (15.9%) had a favorable neurological outcome at hospital discharge. In multivariable logistic regression analysis, lower postROSC RDW value was independently associated with survival to hospital discharge (odds ratio 0.19, 95% confidence interval 0.15-0.63, P = .017, cut-off value: 15.5%) and favorable neurological outcome at hospital discharge (odds ratio 0.23, 95% confidence interval 0.07-0.87, P < .001, cut-off value: 14.6%). Other independent factors including younger age, initial shockable rhythm, shorter total cardiopulmonary resuscitation duration and post-ROSC percutaneous coronary intervention were also associated with survival to hospital discharge. Regarding favorable neurological outcome at hospital discharge, significant variables other than the aforementioned factors included postROSC targeted temperature management and absence of pre-existing neurological insufficiency.Low postROSC RDW value was associated with survival to hospital discharge and favorable neurological outcome at hospital discharge.
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Affiliation(s)
- Yanwei Cheng
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Hailin Peng
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Jiange Zhang
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Juan Zhu
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Lijun Xu
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Xue Cao
- Department of Rheumatology and Immunology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Lijie Qin
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
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Amien N, Bresick G, Evans K. Preparedness for paediatric cardiopulmonary resuscitation amongst medical doctors working in primary health care facilities in Cape Town, South Africa. S Afr Fam Pract (2004) 2022; 64:e1-e8. [PMID: 35144468 PMCID: PMC8832027 DOI: 10.4102/safp.v64i1.5323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) is the principal medical intervention used to reduce the high mortality associated with the cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric cardiopulmonary resuscitation (pCPR) amongst doctors in Cape Town. This study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary health care facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors’ knowledge of equipment availability. Methods A cross-sectional study using a questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs. Results The questionnaire was completed by 173 doctors (84% response rate). The majority (81.8%) had not undergone pCPR training (Paediatric Advanced Life Support or Advanced Paediatric Life Support). Basic life support was done by 88.3%: 28% greater than two years ago. The average pCPR knowledge score was 61% (standard deviation [s.d.]: 20.3, range: 8.3% – 100%). Doctors in their community service and internship years had significantly higher knowledge scores compared to grade 3 Medical officers (p = 0.001 and p = 0.010, respectively). Eleven per cent had performed pCPR > 10 times in the past year; 20% had never performed pCPR and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility. Conclusion Doctors working in Cape Town PHCFs have poor knowledge, have low confidence levels and are poorly prepared to perform pCPR. Urgent attention needs to be given to ensuring formal pCPR training and acquaintance with equipment availability and location in Cape Town PHCFs.
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Affiliation(s)
- Nabeela Amien
- Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town.
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61
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An Overview of Therapy Guidelines for Cardiac Arrest and the Potential Benefits of Hemoglobin-Based Oxygen Carriers. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] Open
Abstract
Currently, there is an unmet therapeutic need for the medical management of cardiac arrest, as is evident from the high mortality rate associated with this condition. These dire outcomes can be attributed to the severe nature and poor prognosis of this disorder. However, the current treatment modalities, while helping to augment survival, are limited and do not offer adequate improvements to outcomes. Treatment modalities are particularly lacking when considering the underlying pathophysiology of the metabolic phase of cardiac arrest. In this study, we explore the three phases of cardiac arrest and assess the factors related to positive clinical outcomes and survival for these events. Furthermore, we evaluate the present guidelines for resuscitation and recovery, the issues related to ischemia and tissue reperfusion, and the benefit of oxygen-delivery therapeutic methods including blood transfusion therapy and synthetic hemoglobins (HBOCs). The current therapy protocols are limited specifically by the lack of an efficient method of oxygen delivery to address the metabolic phase of cardiac arrest. In this article, we investigate the next generation of HBOCs and review their properties that make them attractive for their potential application in the treatment of cardiac arrest. These products may be a viable solution to address complications associated with ischemia, reperfusion injury, and organ damage.
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Hsu SH, Kao PH, Lu TC, Wang CH, Fang CC, Chang WT, Huang CH, Tsai CL. Serum Lactate for Predicting Cardiac Arrest in the Emergency Department. J Clin Med 2022; 11:jcm11020403. [PMID: 35054097 PMCID: PMC8778773 DOI: 10.3390/jcm11020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Early recognition and prevention of in-hospital cardiac arrest (IHCA) play an increasingly important role in the Chain of Survival. However, clinical tools for predicting IHCA in the emergency department (ED) are scanty. We sought to evaluate the role of serum lactate in predicting ED-based IHCA. Methods: Data were retrieved from 733,398 ED visits over a 7-year period in a tertiary medical centre. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, children, or those without lactate measurements. Patient demographics, computerised triage information, and serum lactate levels were extracted. The initial serum lactate levels were grouped into normal (≤2 mmol/L), moderately elevated (2 < lactate ≤ 4), and highly elevated (>4 mmol/L) categories. The primary outcome was ED-based IHCA. Results: A total of 17,392 adult patients were included. Of them, 342 (2%) developed IHCA. About 50% of the lactate levels were normal, 30% were moderately elevated, and 20% were highly elevated. In multivariable analysis, the group with highly elevated lactate had an 18-fold increased risk of IHCA (adjusted odds ratio [OR], 18.0; 95% confidence interval [CI], 11.5-28.2), compared with the normal lactate group. In subgroup analysis, the poor lactate-clearance group (<2.5%/h) was associated with a 7.5-fold higher risk of IHCA (adjusted OR, 7.5; 95%CI, 3.7-15.1) compared with the normal clearance group. Conclusions: Elevated lactate levels and poor lactate clearance were strongly associated with a higher risk of ED-based IHCA. Clinicians may consider a more liberal sampling of lactate in patients at higher risk of IHCA with follow-up of abnormal levels.
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Affiliation(s)
- Shu-Hsien Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
| | - Po-Hsuan Kao
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Cheng-Chung Fang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
- Correspondence:
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Bourcier S, Desnos C, Clément M, Hékimian G, Bréchot N, Taccone FS, Belliato M, Pappalardo F, Broman LM, Malfertheiner MV, Lunz D, Schmidt M, Leprince P, Combes A, Lebreton G, Luyt CE. Extracorporeal cardiopulmonary resuscitation for refractory in-hospital cardiac arrest: A retrospective cohort study. Int J Cardiol 2022; 350:48-54. [PMID: 34995699 DOI: 10.1016/j.ijcard.2021.12.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a rescue therapy for refractory cardiac arrest, but its high mortality has raised questions about patient selection. No selection criteria have been proposed for patients experiencing in-hospital cardiac arrest. We aimed to identify selection criteria available at the time ECPR was considered for patients with in-hospital cardiac arrest. We analyzed data of in-hospital cardiac arrest patients undergoing ECPR in our extracorporeal membrane oxygenation (ECMO) center (March 2007 to March 2019). Intensive care unit (ICU) and 1-year survival post-hospital discharge were assessed. Factors associated with ICU survival before ECPR were investigated. An external validation cohort from a previous multicenter study was used to validate our results. RESULTS Among the 137 patients (67.9% men; median [IQR] age, 54 [43-62] years; low-flow duration, 45 [30-70] min) requiring ECPR, 32.1% were weaned-off ECMO. Their respective ICU- and 1-year survival rates were 21.9% and 19%. Most 1-year survivors had favorable neurological outcomes (cerebral performance category score 1 or 2). ICU survivors compared to nonsurvivors, respectively, were more likely to have a shockable initial rhythm (53.3% versus 24.3%; P < 0.01), a shorter median (IQR) low-flow time (30 (25-53) versus 50 (35-80) min, P < 0.01) and they more frequently underwent a subsequent intervention (63.3% versus 26.2%, P < 0.01). The algorithm obtained by combining age, initial rhythm and low-flow duration discriminated between patient groups with very different survival probabilities in the derivation and validation cohorts. CONCLUSION Survival of ECPR-managed in-hospital cardiac arrest patients in this cohort was poor but hospital survivors' 1-year neurological outcomes were favorable. When deciding whether or not to use ECPR, the combination of age, initial rhythm and low-flow duration can improve patient selection.
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Affiliation(s)
- Simon Bourcier
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Cyrielle Desnos
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Marina Clément
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France
| | - Guillaume Hékimian
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France
| | - Nicolas Bréchot
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Cliniques Universitaires de Bruxelles (CUB) Erasme, Brussels, Belgium
| | - Mirko Belliato
- UOS Advanced Respiratory Intensive Care Unit, UOC Anestesia e Rianimazione 2 Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian Valentin Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, Intensive Care, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Pascal Leprince
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alain Combes
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Guillaume Lebreton
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Cardiovascular and Thoracic Surgery, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Médecine Intensive Réanimation, Paris, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.
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64
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Michels G, Bauersachs J, Böttiger BW, Busch HJ, Dirks B, Frey N, Lott C, Rott N, Schöls W, Schulze PC, Thiele H. Leitlinien des European Resuscitation Council (ERC) zur kardiopulmonalen Reanimation 2021: Update und Kommentar. Anaesthesist 2022; 71:129-140. [DOI: 10.1007/s00101-021-01084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fukuyama K, Sugiyama O, Chin K, Satou S, Matsumoto S, Muto M. Identification of Respiratory Sounds Collected from Microphones Embedded in Mobile Phones. ADVANCED BIOMEDICAL ENGINEERING 2022. [DOI: 10.14326/abe.11.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keita Fukuyama
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University
| | - Osamu Sugiyama
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University
| | - Kazuo Chin
- Division of Sleep Medicine, Department of Internal Medicine, Department of Sleep Medicine and Respiratory Care, Nihon University of Medicine
| | - Susumu Satou
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University
| | - Shigemi Matsumoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital
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66
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Disparities in cardiac arrest and failure to rescue after major elective noncardiac operations. Surgery 2022; 171:1358-1364. [DOI: 10.1016/j.surg.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 01/30/2023]
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67
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Zachar JJ, Reher P. Frequency and characteristics of medical emergencies in an Australian dental school: A retrospective study. J Dent Educ 2021; 86:574-580. [PMID: 34962657 DOI: 10.1002/jdd.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE/OBJECTIVES The frequency of medical emergencies in a dental setting is relatively low. However, most dental treatment occurs outside of a hospital setting; thus the time to respond to a life-threatening situation is crucial. The aim of this study was to determine the frequency and characteristics of medical emergencies that occurred at the Griffith University Dental Clinic over a 6-year period. METHODS Data involving medical emergencies was collected at a dental school between January 2014 and December 2019. Data was obtained from the risk incident reporting system (GSafe), and descriptive statistics were analyzed using IBM SPSS. RESULTS The frequency of medical emergencies in a dental setting over the 6-year retrospective period based on the number of dental services provided was 0.037% (n = 108). The three most common medical emergencies were syncope (25.0%), hypoglycemia (16.7%), and foreign body ingestion (13.9%). These happened more often during dental extractions (26.9%), followed by local anesthesia (16.7%) and restorative procedures (13.0%). A larger portion of these incidents occurred during dental treatment (62.0%) as opposed to before (12.0%) or after (26.0%). Most medical emergencies happened within the dental student clinic (72.2%) followed by the dental waiting room (19.5%) and dental private clinic (8.3%). CONCLUSION Overall, the number of medical emergencies at the Griffith University Dental Clinic was low. The most common medical emergencies were syncope, hypoglycemia, and foreign body ingestion. Dental education in preventative strategies and training in basic life support is necessary to ensure dental practitioners can manage the acute deterioration of a patient promptly.
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Affiliation(s)
| | - Peter Reher
- School of Dentistry and Oral Health, Griffith University, Southport, Queensland, Australia
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68
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Vestergaard LD, Lauridsen KG, Krarup NHV, Kristensen JU, Andersen LK, Løfgren B. Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest. Open Access Emerg Med 2021; 13:553-560. [PMID: 34938129 PMCID: PMC8687881 DOI: 10.2147/oaem.s341479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes. Patients and Methods This was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported. Results The study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70-201) seconds and median (IQR) time to first defibrillation was 133 (82-264) seconds. Median (IQR) chest compression rate was 126 (119-131) per minute and chest compression fraction (CCF) was 78% (69-86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03). Conclusion We established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.
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Affiliation(s)
| | - Kasper Glerup Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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69
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Lauridsen KG, Højbjerg R, Schmidt AS, Løfgren B. Why Do Not Physicians Attend Hospital Cardiopulmonary Resuscitation Training? Open Access Emerg Med 2021; 13:543-551. [PMID: 34938128 PMCID: PMC8685550 DOI: 10.2147/oaem.s332739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiopulmonary resuscitation (CPR) training is mandatory in most hospitals. Despite this, some hospital staff do not attend CPR training on a regular basis, but the barriers to training attendance are sparsely investigated. This study aimed to investigate CPR course attendance, barriers to participation, and possible initiatives to increase CPR course attendance. Methods Physicians from one university hospital and one regional hospital in the Central Denmark Region were included. Questionnaires were handed out at daily staff meetings at departments of internal medicine and surgery. Results In total, 233 physicians responded (response rate: 92%, male: 54%). Overall, 32% of physicians had not attended CPR training at the hospital. Mean (±standard deviation) time since the last CPR course participation was 17 (±3) months. Frequent barriers to attending courses included not knowing when courses are conducted (70%) and where to sign up for training (45%). The majority (60%) of physicians responded that the reason why they prioritize course participation is to be professionally updated. In contrast, 16% stated that they had sufficient CPR skills and therefore CPR training was unnecessary. Physicians stated that the following factors would improve CPR training participation: an annual day protected (no clinical work) for course attendance (72%), use of short booster sessions (49%), shorter courses combined with e-learning (51%) and shorter courses held over 2 days (46%). Conclusion One-third of physicians did not attend hospital CPR training at two Danish hospitals. Several barriers to course participation exist, of which course registration seems to be a crucial factor. Alternative CPR training methods may help improve training participation.
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Affiliation(s)
- Kasper G Lauridsen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Emergency Department, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Højbjerg
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Anders S Schmidt
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Paul RA, Beaman C, West DA, Duke GJ. CoBRA: COde Blue Retrospective Audit in a Metropolitan Hospital. Intern Med J 2021; 53:745-752. [PMID: 34865306 DOI: 10.1111/imj.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/28/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is an uncommon but challenging problem. This study aims to investigate the management and outcomes of IHCA, and investigate the effect of introducing a Medical Emergency Team (MET) on IHCA prevalence. METHODS Retrospective medical record review of 176 adult IHCA episodes at Box Hill Hospital, a university-affiliated public hospital in metropolitan Melbourne, from July 2012 to June 2017. Inpatients receiving cardiopulmonary resuscitation for IHCA, in inpatient wards, intensive care unit, cardiac catheterisation laboratory, and operating theatres, were included. Data collected included demographics, resuscitation management, and outcomes. Average treatment effect (ATE) was derived from margins estimates and linear regression fitted to hospital outcome, adjusted for IHCA factors. An exponentially-weighed moving average control chart was used to explore IHCA prevalence over time. RESULTS 65.3% of IHCA patients died in hospital. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with higher likelihood of survival to discharge were initial cardiac of rhythm ventricular tachycardia (VT) (ATE 0.10 (95%CI = -0.03-0.25)) or ventricular fibrillation (VF) (ATE 0.28 (95% CI=0.11-0.46)), cardiac monitoring at time of arrest (ATE 0.06 (95%CI = -0.04-0.16)), and time to return of spontaneous circulation (ATE 0.023 (95%CI=0.015-0.031)). CONCLUSION IHCA is uncommon and is associated with high mortality. IHCA prevalence was unchanged after the introduction of a dedicated MET service. Factors associated with improved survival to hospital discharge were initial rhythm VT or VF, cardiac monitoring, and shorter resuscitation times. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Robert A Paul
- Intensive Care Senior Registrar, Alfred Health, Eastern Health Intensive Care Services, Box Hill, VIC
| | - Craig Beaman
- Anaesthetics Registrar, St Vincent's Hospital, Melbourne, VIC, Eastern Health Intensive Care Services, Box Hill, VIC
| | - David A West
- Intensive Care Registrar, Eastern Health Intensive Care Services, Box Hill, VIC
| | - Graeme J Duke
- Deputy Director, Eastern Health Intensive Care Services, Box Hill, VIC, Eastern Health Clinical School, Monash University, Clayton, VIC
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Survival and Factors Associated with Survival with Extracorporeal Life Support During Cardiac Arrest: A Systematic Review and Meta-Analysis. ASAIO J 2021; 68:987-995. [PMID: 34860714 DOI: 10.1097/mat.0000000000001613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The survival rate after cardiac arrest (CA) remains low. The utilization of extracorporeal life support is proposed to improve management. However, this resource-intensive tool is associated with complications and must be used in selected patients. We performed a meta-analysis to determine predictive factors of survival. Among the 81 studies included, involving 9256 patients, survival was 26.2% at discharge and 20.4% with a good neurologic outcome. Meta-regressions identified an association between survival at discharge and lower lactate values, intrahospital CA, and lower cardio pulmonary resuscitation (CPR) duration. After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only remaining factor associated with survival to discharge (β = 0.02, 95% CI: 0.007-0.02; p = 0.0004).
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Mir T, Qureshi WT, Uddin M, Soubani A, Saydain G, Rab T, Kakouros N. Predictors and outcomes of cardiac arrest in the emergency department and in-patient settings in the United States (2016-2018). Resuscitation 2021; 170:100-106. [PMID: 34801637 DOI: 10.1016/j.resuscitation.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Outcomes of cardiac arrest (CA) remain dismal despite therapeutic advances. Literature is limited regarding outcomes of CA in emergency departments (ED). OBJECTIVE To study the possible causes, predictors, and outcomes of CA in ED and in-patient settings throughout the United States (US). METHODS Data from the US national emergency department sample (NEDS) was analyzed for the episodes of CA for 2016-2018. In-hospital CA was divided into in-patient (IPCA) and in the ED (EDCA). Only patients who had cardiopulmonary resuscitation (CPR) within the hospital were included in the study (out-of-hospital were excluded). RESULTS A total of 1,068,847 CA (mean age 63.7 ± 19.4 years, 24%females), of whom 325,062 (30.4%) EDCA and 177,104 (16.6%) IPCA were included in the study. Patients without CPR, 743,785 (69.6%), were excluded. Survival was higher among IPCA 55,821 (31.6%) than the EDCA 32,516 (10%). IPCA encounters had multifactorial associated etiologies including respiratory failure (73%), acidosis (38.7%) sepsis (36.8%) and ST-elevated myocardial infarction (STEMI) (7.3%). Majority of ED arrests (67.1%) had no possible identifiable cause. The predominant known causes include intoxication (7.5%), trauma (6.4%), respiratory failure (5%), and STEMI (2.7%). Cardiovascular interventions had significant survival benefits in IPCA on univariate logistic regression after coarsened exact matching for comorbidities. IPCA had higher intervention rates than EDCA. For all live discharges, a total of 40% of patients were discharged to hospice. CONCLUSION Survival remains dismal among CA patients especially those occurring in the ED. Given that there are considerable variations in the etiology between the two studied cohorts, more research is required to improve the understanding of these factors, which may improve survival outcomes.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA.
| | - Mohammed Uddin
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Ayman Soubani
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
| | - Ghulam Saydain
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
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Müller J, Behnes M, Schupp T, Reiser L, Taton G, Reichelt T, Ellguth D, Borggrefe M, Engelke N, Bollow A, Kim SH, Weidner K, Ansari U, Mashayekhi K, Akin M, Halbfass P, Meininghaus DG, Akin I, Rusnak J. Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias. Heart Vessels 2021; 37:828-839. [PMID: 34783873 PMCID: PMC8986738 DOI: 10.1007/s00380-021-01976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
Limited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002-2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.
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Affiliation(s)
- Julian Müller
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Halbfass
- Department of Interventional Electrophysiology, Heart Centre Bad, Neustadt, Germany
| | | | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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[ERC guidelines 2021 on cardiopulmonary resuscitation]. Herz 2021; 47:4-11. [PMID: 34779865 DOI: 10.1007/s00059-021-05082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
The current European guidelines on cardiopulmonary resuscitation were published in 2021. The guidelines, which are structured in 12 chapters, were supplemented with the chapters on epidemiology and life-saving systems. In the following article, the recommendations on basic life support, advanced measures for resuscitation in adults and postresuscitation treatment are discussed.
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75
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Loftus TJ, Ruppert MM, Ozrazgat-Baslanti T, Balch JA, Efron PA, Tighe PJ, Hogan WR, Rashidi P, Upchurch GR, Bihorac A. Association of Postoperative Undertriage to Hospital Wards With Mortality and Morbidity. JAMA Netw Open 2021; 4:e2131669. [PMID: 34757412 PMCID: PMC8581722 DOI: 10.1001/jamanetworkopen.2021.31669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Undertriaging patients who are at increased risk for postoperative complications after surgical procedures to low-acuity hospital wards (ie, floors) rather than highly vigilant intensive care units (ICUs) may be associated with risk of unrecognized decompensation and worse patient outcomes, but evidence for these associations is lacking. OBJECTIVE To test the hypothesis that postoperative undertriage is associated with increased mortality and morbidity compared with risk-matched ICU admission. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional study was conducted using data from the University of Florida Integrated Data Repository on admissions to a university hospital. Included patients were individuals aged 18 years or older who were admitted after a surgical procedure from June 1, 2014, to August 20, 2020. Data were analyzed from April through August 2021. EXPOSURES Ward admissions were considered undertriaged if their estimated risk for hospital mortality or prolonged ICU stay (ie, ≥48 hours) was in the top quartile among all inpatient surgical procedures according to a validated machine-learning model using preoperative and intraoperative electronic health record features available at surgical procedure end time. A nearest neighbors algorithm was used to identify a risk-matched control group of ICU admissions. MAIN OUTCOMES AND MEASURES The primary outcomes of hospital mortality and morbidity were compared among appropriately triaged ward admissions, undertriaged wards admissions, and a risk-matched control group of ICU admissions. RESULTS Among 12 348 postoperative ward admissions, 11 042 admissions (89.4%) were appropriately triaged (5927 [53.7%] women; median [IQR] age, 59 [44-70] years) and 1306 admissions (10.6%) were undertriaged and matched with a control group of 2452 ICU admissions. The undertriaged group, compared with the control group, had increased median [IQR] age (64 [54-74] years vs 62 [50-73] years; P = .001) and increased proportions of women (649 [49.7%] women vs 1080 [44.0%] women; P < .001) and admitted patients with do not resuscitate orders before first surgical procedure (53 admissions [4.1%] vs 27 admissions [1.1%]); P < .001); 207 admissions that were undertriaged (15.8%) had subsequent ICU admission. In the validation cohort, hospital mortality and prolonged ICU stay estimations had areas under the receiver operating characteristic curve of 0.92 (95% CI, 0.91-0.93) and 0.92 (95% CI, 0.92-0.92), respectively. The undertriaged group, compared with the control group, had similar incidence of prolonged mechanical ventilation (32 admissions [2.5%] vs 53 admissions [2.2%]; P = .60), decreased median (IQR) total costs for admission ($26 900 [$18 400-$42 300] vs $32 700 [$22 700-$48 500]; P < .001), increased median (IQR) hospital length of stay (8.1 [5.1-13.6] days vs 6.0 [3.3-9.3] days, P < .001), and increased incidence of hospital mortality (19 admissions [1.5%] vs 17 admissions [0.7%]; P = .04), discharge to hospice (23 admissions [1.8%] vs 14 admissions [0.6%]; P < .001), unplanned intubation (45 admissions [3.4%] vs 49 admissions [2.0%]; P = .01), and acute kidney injury (341 admissions [26.1%] vs 477 admissions [19.5%]; P < .001). CONCLUSIONS AND RELEVANCE This study found that admitted patients at increased risk for postoperative complications who were undertriaged to hospital wards had increased mortality and morbidity compared with a risk-matched control group of admissions to ICUs. Postoperative undertriage was identifiable using automated preoperative and intraoperative data as features in real-time machine-learning models.
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Affiliation(s)
- Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
| | - Matthew M. Ruppert
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
| | - Tezcan Ozrazgat-Baslanti
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
| | - Jeremy A. Balch
- Department of Surgery, University of Florida Health, Gainesville
| | - Philip A. Efron
- Department of Surgery, University of Florida Health, Gainesville
| | - Patrick J. Tighe
- Department of Anesthesiology, University of Florida Health, Gainesville
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida Health, Gainesville
- Department of Information Systems and Operations Management, University of Florida Health, Gainesville
| | - William R. Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
| | - Parisa Rashidi
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Biomedical Engineering, University of Florida, Gainesville
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | | | - Azra Bihorac
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
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76
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Huang L, Peng J, Wang X, Li F. High platelet-lymphocyte ratio is a risk factor for 30-day mortality in in-hospital cardiac arrest patients: a case-control study. Expert Rev Clin Immunol 2021; 17:1231-1239. [PMID: 34696670 DOI: 10.1080/1744666x.2021.1994389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study explored the association of early dynamic changes in inflammatory markers with 30-day mortality in in-hospital cardiac arrest (IHCA) patients. METHODS This study retrospectively enrolled 85 IHCA patients. The outcome was 30-day mortality. A linear mixed model was used to analyze the dynamic changes in laboratory indicators within 72 h after recovery of spontaneous circulation(ROSC). RESULTS Within 72 h after ROSC, the absolute monocyte count (AMC) showed no significant change trend, and the absolute lymphocyte count (ALC) showed an overall upward trend, while the absolute neutral count (ANC), white blood cell (WBC) count, platelet (PLT) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) showed overall downward trends. Cox multivariate analysis showed that the Charlson comorbidity index (CCI) (HR = 2.37, 95%CI (1.08, 5.17)), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (HR = 2.55, 95% CI (1.00, 6.50)), abnormal creatinine level before IHCA (HR = 3.42, 95% CI (1.44, 8.10)) and PLR within 72 h after ROSC (HR = 2.99, 95% CI (1.44, 6.21)) were independent risk factors for 30-day mortality. CONCLUSIONS The PLR can be used as a predictor of 30-day mortality in IHCA patients.
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Affiliation(s)
- Lihong Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jingjing Peng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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77
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Tygesen GB, Lisby M, Raaber N, Rask MT, Kirkegaard H. A new situation awareness model decreases clinical deterioration in the emergency departments-A controlled intervention study. Acta Anaesthesiol Scand 2021; 65:1337-1344. [PMID: 34028009 DOI: 10.1111/aas.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have suggested that adding subjective parameters to early warning score (EWS) systems might prompt more proactive treatment and positively affect clinical outcomes. Hence, the study aimed to investigate effect of a situation awareness model consisting of objective and subjective parameters on clinical deterioration in adult emergency department (ED) patients. METHODS This controlled pre-and-post interventional study was carried out in July-December 2016 and November 2017-April 2018. In ED patients ≥ 18 years, we examined if a situation awareness model compared with a conventional EWS system could reduce clinical deterioration. The new model consisted of a regional EWS, combined with skin observation, clinical concern and patients' and relatives' concerns, pain, dyspnea, and team risk assessment. Clinical deterioration was defined as change in vital signs requiring increased observation or physician assessment, that is, increase in early warning score from either 0 or 1 to score ≥2 or an increase from score ≥2 and above. Secondary outcomes were mortality, intensive care unit (ICU) admissions, and readmissions. RESULTS We included 34 556 patients. Patients with two or more registered EWS were included in the primary analysis (N = 21 839). Using difference-in-difference regression, we found a reduced odds of clinical deterioration of 21% (OR 0.79 95% CI [0.69; 0.90]) in the intervention groups compared with controls. No impact on mortality, ICU, or readmissions was found. CONCLUSION The situation awareness model reduces odds of clinical deterioration, defined as a clinically relevant increase in EWS, in an unselected adult population of ED patients. However, there was no effect on secondary outcomes.
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Affiliation(s)
- Gitte B. Tygesen
- Department of Emergency Medicine Horsens Regional Hospital Horsens Denmark
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
| | - Marianne Lisby
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
- Department of Emergency Medicine Aarhus University Hospital Aarhus Denmark
| | - Nikolaj Raaber
- Department of Emergency Medicine Aarhus University Hospital Aarhus Denmark
| | - Mette T. Rask
- The Research Clinic for Functional Disorders and Psychosomatics Aarhus University Hospital Aarhus Denmark
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
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Tezel O, Bilge S, Acar YA, Özkan G. Do carboxyhaemoglobin and methaemoglobin levels predict the return of spontaneous circulation and prognosis of cardiac arrest patients? Int J Clin Pract 2021; 75:e14686. [PMID: 34331728 DOI: 10.1111/ijcp.14686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study's goal was to investigate the value of the carboxyhaemoglobin (COHb) and methaemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. METHODS A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups: survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. RESULTS COHb levels were significantly lower in the non-ROSC group than in the ROSC group (P = .002). Urea, creatinine, potassium and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (P < .001, .001, .014, and .005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (P = .022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (P = .001, .005, .001, .010 and .008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (P = .769 and .668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (P ˂ .001). CONCLUSION COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.
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Affiliation(s)
- Onur Tezel
- Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Sedat Bilge
- Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yahya Ayhan Acar
- Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gökhan Özkan
- Department of Anesthesiology and Reanimation, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
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Gravesteijn BY, Schluep M, Lingsma HF, Stolker RJ, Endeman H, Hoeks SE. Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study. Crit Care 2021; 25:329. [PMID: 34507601 PMCID: PMC8431928 DOI: 10.1186/s13054-021-03754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.
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Affiliation(s)
- B Y Gravesteijn
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands.
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Stasiowski M, Głowacki Ł, Gąsiorek J, Majer D, Niewiadomska E, Król S, Żak J, Missir A, Prof LK, Prof PJ, Grabarek BO. General health condition of patients hospitalized after an incident of in-hospital or out-of hospital sudden cardiac arrest with return of spontaneous circulation. Clin Cardiol 2021; 44:1256-1262. [PMID: 34312887 PMCID: PMC8428004 DOI: 10.1002/clc.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) is one of the main reasons for admission to the intensive care unit (ICU), which influences discharge in a good neurological state. Hypothesis To analyze patients who had recovery of spontaneous circulation (ROSC) during hospitalization in the ICU using the Glasgow Outcome Scale (GOS). Methods The study group comprised 78 patients after SCA (35 after out‐of‐hospital cardiac arrest [OHCA] and 43 after in‐hospital cardiac arrest [IHCA]) with ROSC who were admitted to the ICU of Regional Hospital No. 5 in Sosnowiec from January 1, 2016 to December 31, 2016. GOS was used to assess neurological status. Basic anthropological data, with, arterial blood pH, lactate concentration (LAC), and catecholamine treatment were also collected. Results In the study group, 32.1% (n = 25/78) of patients survived until ICU discharge and 30.8% (n = 24/78) until discharge from the hospital. SCA in cardiac mechanism was more common in OHCA than in the IHCA group (OHCA vs. IHCA: 85.7% vs. 62.8%, p = .02). There was no statistically significant difference between the two groups for neurological status assessed using GOS. There was no statistically significant difference between LAC or arterial blood pH and survival to ICU discharge, survival to hospital discharge, or mortality. The need for using catecholamines increased the mortality rate (GOS 1) (p < .001). Conclusions Most patients after RSOC were assigned to a group other than GOS 1, and 25% of all subjects belonged to GOS 4–5. Treatment with catecholamines was more common in patients who do not survive hospital or ICU discharge.
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Affiliation(s)
- Michał Stasiowski
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Łukasz Głowacki
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland
| | - Jakub Gąsiorek
- Students Scientific Society by Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dominika Majer
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Seweryn Król
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jakub Żak
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Anna Missir
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Lech Krawczyk Prof
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Przemysław Jałowiecki Prof
- Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, The University of Technology in Katowice, Katowice, Poland
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Bauer A, Dixon J, Knapp M, Wittenberg R. Exploring the cost-effectiveness of advance care planning (by taking a family carer perspective): Findings of an economic modelling study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:967-981. [PMID: 32783319 DOI: 10.1111/hsc.13131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/15/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Advance care planning is considered an important part of high-quality end-of-life care. Its cost-effectiveness is currently unknown. In this study, we explore the cost-effectiveness of a strategy, in which advance care planning is offered systematically to older people at the end-of-life compared with standard care. We conducted decision-analytic modelling. The perspective was health and social care and the time horizon was 1 year. Outcomes included were quality-adjusted life years as they referred to the surviving carers. Data sources included published studies, national statistics and expert views. Average total cost in the advance care planning versus standard care group was £3,739 versus £3,069. The quality-adjusted life year gain to carers was 0.03 for the intervention in comparison with the standard care group. Based on carer's health-related quality-of-life, the average cost per quality-adjusted life year was £18,965. The probability that the intervention was cost-effective was 55% (70%) at a cost per quality-adjusted life year threshold of £20,000 (£30,000). Conducting cost-effectiveness analysis for advance care planning is challenging due to uncertainties in practice and research, such as a lack of agreement on how advance care planning should be provided and by whom (which influences its costs), and about relevant beneficiary groups (which influences its outcomes). However, even when assuming relatively high costs for the delivery of advance care planning and only one beneficiary group, namely, family carers, our analysis showed that advance care planning was probably cost-effective.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
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82
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Epidemiology, etiology, and outcomes of in-hospital cardiac arrest in Lebanon. J Geriatr Cardiol 2021; 18:416-425. [PMID: 34220971 PMCID: PMC8220382 DOI: 10.11909/j.issn.1671-5411.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) constitutes a significant cause of morbidity and mortality. As data is scarce in the Middle East and Lebanon, we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon. METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1, 2016 and May 2, 2019. Sociodemographic variables included age and sex, in addition to the comorbidities listed in the Charlson comorbidity index. IHCA event variables were day, event location, time from activation to arrival, initial cardiac rhythm, and the total number of IHCA events. We also looked at the months and years. We considered the return of spontaneous circulation (ROSC) and survival to discharge (StD) to be our outcomes of interest. RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions (95% CI: 6.09-7.08). Non-shockable rhythms were 90.7% of IHCAs. Most IHCA cases occurred in the closed units (87.9%) (intensive care unit, respiratory care unit, neurology care unit, and cardiology care unit) and on weekdays (76.5%). ROSC followed more than half the IHCA events (56%). However, only 5.4% of IHCA events achieved StD. Both ROSC and StD were higher in cases with a shockable rhythm. Survival outcomes were not significantly different between day, evening, and nightshifts. ROSC was not significantly different between weekdays and weekends; however, StD was higher in events that happened during weekdays than weekends (6.7%vs. 1.9%, P = 0.002). CONCLUSIONS The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
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Agerström J, Carlsson M, Bremer A, Herlitz J, Israelsson J, Årestedt K. Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest. Eur Heart J 2021; 42:861-869. [PMID: 33345270 PMCID: PMC7897462 DOI: 10.1093/eurheartj/ehaa954] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/03/2020] [Accepted: 11/05/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors. METHODS AND RESULTS In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay. CONCLUSION There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.
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Affiliation(s)
- Jens Agerström
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, SE-39132, Kalmar/Växjö, Sweden
| | - Magnus Carlsson
- Department of Economics and Statistics, School of Business and Economics, Linnaeus University, Pedalstråket 13, SE-39132, Kalmar/Växjö, Sweden
| | - Anders Bremer
- Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, SE-39132, Kalmar/Växjö, Sweden
| | - Johan Herlitz
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 5, SE-41345 Göteborg, Gothenburg, Sweden.,PreHospen - Centre for Prehospital Research, University of Borås, Allegatan 1, SE-50332 Borås, Sweden
| | - Johan Israelsson
- Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, SE-39132, Kalmar/Växjö, Sweden.,Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Lasarettsvägen, SE-39185, Kalmar, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University, Pedalstråket 13, SE-39132, Kalmar/Växjö, Sweden.,The Research Section, Region Kalmar County, Lasarettsvägen 8, SE-39244, Kalmar, Sweden
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84
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 34187632 DOI: 10.1016/j.repce.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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85
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Silva D. Surviving a cardiac arrest: need for action now! Rev Port Cardiol 2021; 40:327-328. [PMID: 34187633 DOI: 10.1016/j.repce.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Doroteia Silva
- Intensive Care Department, Santa Maria University Hospital, Lisbon North Hospital Centre, CCUL, Lisbon, Portugal; Academic Medical Center, Faculty of Medicine of Lisbon, Lisbon, Portugal.
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86
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Torsy T, Deswarte W, Karlberg Traav M, Beeckman D. Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation. Nurs Crit Care 2021; 27:275-281. [PMID: 33884701 DOI: 10.1111/nicc.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In-hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in-hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR). High-quality CPR is essential for patient survival and good neurological outcome. AIMS AND OBJECTIVES To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. DESIGN Manikin-based single-blinded randomised controlled trial. METHODS Nursing students (N = 70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2-minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference. RESULTS The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P = .043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P = .004). CONCLUSIONS CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable. Mattress type, body weight and hand positioning appear to be significant predictors for adequate chest compression depth. RELEVANCE TO CLINICAL PRACTICE A firm surface under the patient is needed during CPR. Special attention must be paid to correct hand positioning during CPR.
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Affiliation(s)
- Tim Torsy
- Department of Nursing, Odisee University College, Brussels, Belgium.,Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Wim Deswarte
- Department of Nursing, Odisee University College, Brussels, Belgium
| | - Malin Karlberg Traav
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health Science, School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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87
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Silva D. Surviving a cardiac arrest: need for action now! Rev Port Cardiol 2021; 40:327-328. [PMID: 33879378 DOI: 10.1016/j.repc.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Doroteia Silva
- Intensive Care Department, Santa Maria University Hospital, Lisbon North Hospital Centre, CCUL, Lisbon, Portugal; Academic Medical Center, Faculty of Medicine of Lisbon, Lisbon, Portugal.
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88
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Robbins AJ, Ingraham NE, Sheka AC, Pendleton KM, Morris R, Rix A, Vakayil V, Chipman JG, Charles A, Tignanelli CJ. Discordant Cardiopulmonary Resuscitation and Code Status at Death. J Pain Symptom Manage 2021; 61:770-780.e1. [PMID: 32949762 PMCID: PMC8052631 DOI: 10.1016/j.jpainsymman.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT One fundamental way to honor patient autonomy is to establish and enact their wishes for end-of-life care. Limited research exists regarding adherence with code status. OBJECTIVES This study aimed to characterize cardiopulmonary resuscitation (CPR) attempts discordant with documented code status at the time of death in the U.S. and to elucidate potential contributing factors. METHODS The Cerner Acute Physiology and Chronic Health Evaluation (APACHE) outcomes database, which includes 237 U.S. hospitals that collect manually abstracted data from all critical care patients, was queried for adults admitted to intensive care units with a documented code status at the time of death from January 2008 to December 2016. The primary outcome was discordant CPR at death. Multivariable logistic regression models were used to identify patient-level and hospital-level associated factors after adjustment for age, hospital, and illness severity (APACHE III score). RESULTS A total of 21,537 patients from 56 hospitals were included. Of patients with a do-not-resuscitate code status, 149 (0.8%) received CPR at death, and associated factors included black race, higher APACHE III score, or treatment in small or nonteaching hospitals. Of patients with a full code status, 203 (9.0%) did not receive CPR at death, and associated factors included higher APACHE III score, primary neurologic or trauma diagnosis, or admission in a more recent year. CONCLUSION At the time of death, 1.6% of patients received or did not undergo CPR in a manner discordant with their documented code statuses. Race and institutional factors were associated with discordant resuscitation, and addressing these disparities may promote concordant end-of-life care in all patients.
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Affiliation(s)
- Alexandria J Robbins
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Nicholas E Ingraham
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Adam C Sheka
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kathryn M Pendleton
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Rachel Morris
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexander Rix
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Victor Vakayil
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA; Institute for Health Informatics, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA
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Jang K, Kim SH, Oh JY, Mun JY. Effectiveness of self-re-learning using video recordings of advanced life support on nursing students' knowledge, self-efficacy, and skills performance. BMC Nurs 2021; 20:52. [PMID: 33789625 PMCID: PMC8011152 DOI: 10.1186/s12912-021-00573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nurses are presumably the first to see an in-hospital cardiac arrest patient. This study proposed measuring nursing students’ knowledge, self-efficacy, and skills performance in advanced life support (ALS), 6 months after training, by sending videos taken during their final skills test after the ALS training. Methods This is an experimental study using a randomised control group design. This study was conducted from June to December 2018, and the subjects of the study were 4th year students, recruited through a bulletin board at a nursing university. The participants’ knowledge, self-efficacy, and skill performance in ALS were evaluated immediately after the training, and participants were videotaped during the final skills test. Thereafter, the videos were sent to the experimental group through a mobile phone messenger application, once a month, from the third month after training. Approximately six months after training day, a follow-up test was conducted for the measured variables using a blinded method. The paired t-test and Wilcoxon signed-rank test were used to compare the two groups pre-and post-intervention. The statistical significance level was set at p < .05. Results Six months after the ALS training, knowledge scores decreased significantly in both groups (p < 0.001). Self-efficacy decreased by about 3 points from 50.55 to 47.18 in the experimental group (p = 0.089), while it decreased by 10 points in the control group, from 50.67 to 39 (p < 0.001). The skills performance decreased from 27.5 to 26.68 in the experimental group, while it decreased significantly from 27.95 to 16.9 in the control group (p < 0.001). Conclusion Self-study with videos taken during an ALS skills test helps enhance the sustainable effects of training such as knowledge, self-efficacy, and skills performance.
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Affiliation(s)
- Kyeongmin Jang
- Department of Nursing, SMG-SNU Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea.,Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea
| | - Sung Hwan Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Ja Young Oh
- Department of Nursing Science, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Wuwon, Republic of Korea
| | - Ji Yeon Mun
- Department of Nursing Science, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Wuwon, Republic of Korea
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Neuromonitoring After Cardiac Arrest: Can Twenty-First Century Medicine Personalize Post Cardiac Arrest Care? Neurol Clin 2021; 39:273-292. [PMID: 33896519 DOI: 10.1016/j.ncl.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac arrest survivors comprise a heterogeneous population, in which the etiology of arrest, systemic and neurologic comorbidities, and sequelae of post-cardiac arrest syndrome influence the severity of secondary brain injury. The degree of secondary neurologic injury can be modifiable and is influenced by factors that alter cerebral physiology. Neuromonitoring techniques provide tools for evaluating the evolution of physiologic variables over time. This article reviews the pathophysiology of hypoxic-ischemic brain injury, provides an overview of the neuromonitoring tools available to identify risk profiles for secondary brain injury, and highlights the importance of an individualized approach to post cardiac arrest care.
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91
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Menezes Fernandes R, Nuñez D, Marques N, Dias CC, Granja C. Surviving cardiac arrest: What happens after admission to the intensive care unit? Rev Port Cardiol 2021; 40:317-325. [PMID: 33812706 DOI: 10.1016/j.repc.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Patients successfully resuscitated from cardiac arrest (CA) are admitted to the intensive care unit (ICU) for post-resuscitation care. These patients' prognosis remains dismal, with only a minority surviving to hospital discharge. Understanding the clinical factors involved in the management of these patients is essential to improve their prognosis. OBJECTIVES To characterize the population admitted after successful reanimation from CA, and to analyze the factors associated with their outcomes. METHODS We performed a retrospective descriptive study of patients admitted to an ICU after CA over a five-year period from January 2014 to December 2018. Demographic factors, CA characteristics, early management, mortality and neurologic outcomes were analyzed. RESULTS A total of 187 patients, median age 67 years, were admitted after CA, of whom 39% suffered out-of-hospital CA; 87% had an initial non-shockable rhythm and the most frequent presumed cause was cardiac (31%). In-hospital mortality was 63%. Significant neurologic dysfunction (cerebral performance category 3 or 4) was seen in 31% of survivors at hospital discharge. Non-immediate initiation of basic life support (BLS), higher Simplified Acute Physiology Score II score and longer relative duration of vasopressor support were independent predictors of in-hospital mortality, while shockable rhythms were associated with improved survival. Higher Glasgow coma scale at ICU discharge and shorter length of ICU stay were predictors of better neurologic outcome. CONCLUSION This study highlights the positive prognostic impact of shockable rhythms, and confirms the importance of immediate initiation of BLS and prompt defibrillation, supporting the need for better training both outside and inside hospitals.
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Affiliation(s)
- Raquel Menezes Fernandes
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
| | - Daniel Nuñez
- Intensive Care Department, Centro Hospitalar Universitário do Algarve, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Nuno Marques
- Cardiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal; Medical and Biomedical Department, University of Algarve, Portugal; Algarve Biomedical Center, Faro, Portugal
| | - Cláudia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision, Faculty of Medicine of Porto, Portugal
| | - Cristina Granja
- CINTESIS - Center for Health Technology and Services Research, Portugal; Anesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine of Porto, Porto, Portugal
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Kim YM, Park JE, Hwang SY, Lee SU, Kim T, Yoon H, Sim MS, Jo IJ, Lee GT, Shin TG. Association between wide QRS pulseless electrical activity and hyperkalemia in cardiac arrest patients. Am J Emerg Med 2021; 45:86-91. [PMID: 33677265 DOI: 10.1016/j.ajem.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/14/2023] Open
Abstract
AIM We evaluated the relationship between hyperkalemia and wide QRS complex in patients with pulseless electrical activity (PEA) cardiac arrest. METHODS This was a single-center, retrospective observational study of patients over the age of 18 treated for cardiac arrest at a tertiary referral hospital whose initial electrocardiogram rhythm was PEA from February 2010 to December 2019. Wide QRS PEA was defined as a QRS interval of 120 ms or more. Hyperkalemia was defined as serum potassium level > 5.5 mmol/L. The primary outcome was hyperkalemia. Multivariable logistic regression analysis was used to evaluate the relationship between wide QRS and hyperkalemia. RESULTS Among 617 patients, we analyzed 111 episodes in the wide QRS group and 506 episodes in the narrow QRS group. The potassium level in the wide QRS group was significantly higher than in the narrow QRS group (5.4 mmol/L, IQR 4.4-6.7 vs. 4.6 mmol/L, IQR 4.0-5.6, P < 0.001). Among all patients, 49.6% (n = 55/111) in the wide QRS group had hyperkalemia, which was significantly higher than the 26.7% (n = 135/506) in the narrow QRS group (P < 0.001). In multivariable logistic regression analysis, wide QRS PEA was significantly associated with hyperkalemia (odds ratio = 2.86, 95% confidence interval: 1.80-4.53, P < 0.001). CONCLUSIONS Wide QRS PEA as an initial cardiac rhythm was significantly associated with hyperkalemia in cardiac arrest patients.
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Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongju, Chungcheongbuk-do, Republic of Korea.
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea.
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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93
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Al-Subu AM, Hacker TA, Eickhoff JC, Ofori-Amanfo G, Eldridge MW. Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest. J Pediatr Intensive Care 2021; 10:31-37. [PMID: 33585059 PMCID: PMC7870341 DOI: 10.1055/s-0040-1712531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO 2 ) and the volume of CO 2 elimination (VCO 2 ) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO 2 and VCO 2 had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 ( p < 0.001) and 0.53 ( p = 0.018), respectively. However, both EtCO 2 and VCO 2 had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 ( p = 0.484) (95% confidence interval [CI], -0.51-0.83) and 0.25 ( p = 0.566) (95% CI, -0.55-0.81), respectively. EtCO 2 and VCO 2 increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO 2 and VCO 2 and CO were weak 0.20 ( p = 0.646) (95% CI, -0.59-0.79), and 0.27 ( p = 0.543) (95% CI, -0.54-0.82) following epinephrine boluses. Continuous EtCO 2 and VCO 2 monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO 2 and VCO 2 to guide chest compression.
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Affiliation(s)
- Awni M. Al-Subu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Timothy A. Hacker
- Cardiovascular Research Center, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Jens C. Eickhoff
- Department of Biostatistics, University of Wisconsin, Madison, Wisconsin, United States
| | - George Ofori-Amanfo
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, United States
| | - Marlowe W. Eldridge
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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94
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Abstract
OBJECTIVES The objective of this systematic review was to evaluate the impact of intraarrest corticosteroids on neurologic outcomes and mortality in patients with cardiac arrest. DATA SOURCES We conducted a systematic search using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE databases. STUDY SELECTION We included all randomized controlled trials and comparative observational studies. We excluded single arm studies, case reports/series, narrative reviews, and studies irrelevant to the focus of this article. DATA EXTRACTION Two reviewers independently assessed trial eligibility. Data were collected for the following outcomes: primary outcomes included good neurologic outcome, survival to hospital discharge, and survival at greater than or equal to 1 year. Secondary outcomes included incidence of return of spontaneous circulation, ICU and hospital length of stay, duration of vasopressor and inotropic treatment, and blood pressure during cardiopulmonary resuscitation and after return of spontaneous circulation. DATA SYNTHESIS The pooled estimates from randomized controlled trials for the following subgroups were analyzed using random-effects models: 1) patients with in-hospital cardiac arrest who received vasopressin, steroids, and epinephrine; 2) patients with in-hospital cardiac arrest who used corticosteroids only (i.e., no vasopressin); and 3) patients with out-of-hospital cardiac arrest who used corticosteroids only. Results included an increase in good neurologic outcomes (relative risk, 2.84; 95% CI, 1.36-5.94) and survival to hospital discharge (relative risk, 2.58; 95% CI, 1.36-4.91) in in-hospital cardiac arrest patients receiving vasopressin, steroids, and epinephrine followed by corticosteroids for postresuscitation shock. This was further supported by an increase in return of spontaneous circulation (relative risk, 1.35; 95% CI, 1.12-1.64) and hemodynamics in this population. There was no benefit observed in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids alone. CONCLUSIONS Our study found that there are limited high-quality data to analyze the association between corticosteroids and reducing mortality in cardiac arrest, but the available data do support future randomized controlled trials. We did find that corticosteroids given as part of a vasopressin, steroids, and epinephrine regimen in in-hospital cardiac arrest patients and for postresuscitation shock did improve neurologic outcomes, survival to hospital discharge, and surrogate outcomes that include return of spontaneous circulation and hemodynamics. We found no benefit in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids only; however, a difference cannot be ruled out due to imprecision and lack of available data.
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95
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Cardiopulmonary arrest after cardiac surgery: A retrospective cohort of 142 patients with nine year follow up. Heart Lung 2021; 50:382-385. [PMID: 33621835 DOI: 10.1016/j.hrtlng.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the techniques and perioperative management in modern cardiac surgeries has improved, and mortality and morbidity have decreased dramatically, postoperative cardiac arrest after heart surgery (POCHS) is a life-threatening condition that should be assessed and managed precisely. OBJECTIVE To determine the mortality rate and causes of death in postoperative cardiac arrest after heart surgery (POCHS). METHODS A total of 3342 patients underwent cardiac surgery from 2010 to 2018 in Isfahan, Iran .142 of them experienced POCHS . POCHS patients were investigated for characteristics, causes of cardiopulmonary arrest, first-line treatment, and mortality. These items were compared between survived and deceased patients to find possible prognostic factors. RESULTS The incidence rate of cardiac arrest was 4.2% (142 ones from total of 3342). Success rate of cardiac arrest is 28.8% (41 from 142). Bradycardia was the most common cause of cardiorespiratory arrest (37.3%), followed by cardiogenic shock (30.3%) and ventricular fibrillation (23.2%). Younger patients (58±11.5 versus 62.9±11.3) and those who developed cardiopulmonary arrest due to ventricular fibrillation (42.4% versus 22.2%), bradycardia (21.2% versus 8.8%), and apnea (15.1% versus 6.6%) were more likely to survive, while, those with shock had the worst prognosis (P<0.05). The best response to resuscitation was found among those treated with defibrillator plus ECM (External Cardiac Massage) as compared to the other approaches (P-value=0.003). CONCLUSION Based on the current report, CPR success was found in 28.6% among whom respiratory etiology led to better outcomes than cardiac etiology. The second cause of cardiac arrest is ventricular fibrillation which immediate defibrillation has the best outcome. The highest numerical success in POCHS is combination of ECM with defibrillator.
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96
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Madsen JL, Lauridsen KG, Løfgren B. In-hospital cardiac arrest call procedures and delays of the cardiac arrest team: A nationwide study. Resusc Plus 2021; 5:100087. [PMID: 34223353 PMCID: PMC8244312 DOI: 10.1016/j.resplu.2021.100087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023] Open
Abstract
Aim Fast arrival of the cardiac arrest team (CAT) is associated with improved survival after in-hospital cardiac arrest however little is known about how we can minimize delays in CAT arrival. This study aimed to investigate differences in the cardiac arrest call procedures in Danish hospitals and identify causes for adverse events delaying the CAT arrival. Methods This nationwide study surveyed all public somatic hospitals in Denmark with a CAT. We searched for all patient safety incidences related to the cardiac arrest call procedure during a two-year period. Two researchers reviewed all incidents and categorized the cause as either human, technical, or not possible to classify, and whether the incident caused a delay of the CAT arrival. Results In total, 36 hospitals (78%) responded and all hospitals used a telephone number, a CAT activation button or both for activation of the CAT. We found 131 reports describing an event related to activation of the CAT of which 87 incidents (66%) caused a definite delay in CAT arrival. The most common were human errors (43%) followed by technical errors (32%) and errors not possible to classify (25%). Almost half of the incidents (47%) could have been avoided if the hospitals used a CAT activation button with direct activation of the CAT. Conclusion There are major differences on the in-hospital cardiac arrest call procedure in Danish hospitals. Human errors are the most frequent cause of safety incidents and may be avoided by simplifying the cardiac arrest call procedure with CAT activation buttons.
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Affiliation(s)
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Medicine, Randers Regional Hospital, Denmark
- Clinical Research Unit, Randers Regional Hospital, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Medicine, Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Medicine, Randers Regional Hospital. Skovlyvej 15, 8930 Randers NE, Denmark.
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97
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Roedl K, Söffker G, Fischer D, Müller J, Westermann D, Issleib M, Kluge S, Jarczak D. Effects of COVID-19 on in-hospital cardiac arrest: incidence, causes, and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2021; 29:30. [PMID: 33557923 PMCID: PMC7868866 DOI: 10.1186/s13049-021-00846-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period. Methods This was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed. Results During the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (− 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1–9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p < 0.01); shockable rhythm (VT/VF) (18% vs 29%, p = 0.05) and defibrillation were more frequent in the pandemic period (20% vs 35%, p < 0.05). Resuscitation times, rates of ROSC and post-CA characteristics were comparable in both periods. The severity of illness (SAPS II/SOFA), frequency of mechanical ventilation and frequency of vasopressor therapy after IHCA were higher during the 2020 period. Overall, 43 patients (12 with & 31 without COVID-19), presented with respiratory failure at the time of IHCA. The Horowitz index and resuscitation time were significantly lower in patients with COVID-19 (each p < 0.01). Favourable outcomes were observed in 42 and 10% of patients with and without COVID-19-related respiratory failure, respectively. Conclusion Hospital admissions declined during the pandemic, but a higher incidence of IHCA was observed. IHCA in patients with COVID-19 was a common finding. Compared to patients with non-COVID-19-related respiratory failure, the outcome was improved. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00846-w.
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Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Gerold Söffker
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Fischer
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Müller
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Anaesthesia, Tabea Hospital, Hamburg, Germany
| | - Dirk Westermann
- Department of Interventional and General Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Malte Issleib
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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98
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Shi Y, Liu G, Cao D, Lu G, Yuan L, Qian Y, Xu J, Sun C, Ge M, Lai L, Wang X, Lu Y, Huang G, Zhai X. Improvement of the functioning and efficiency of a Code Blue system after training in a children's hospital in China. Transl Pediatr 2021; 10:236-243. [PMID: 33708509 PMCID: PMC7944164 DOI: 10.21037/tp-20-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Code Blue is a popular hospital emergency code that is used to alert the emergency response team to any medical emergency requiring critical care. By retrospectively studying Code Blue cases in a children's hospital, we looked for high-risk factors associated with survival and how to improve the effectiveness of Code Blue systems through training. METHODS Data were collected on age, gender, department, diagnosis, time of Code Blue call activation, time between call and arrival of the Code Blue team, treatment details and outcome before and after the training process from January 2016 to December 2019. Chi-square test and logistic regression analysis were used to analyze the data. RESULTS A total of 139 Code Blue cases from the period of January 2016 to December 2019 were retrospectively studied. The wards where Code Blues occurred most frequently were the infectious diseases ward (n=31, 22.3%), the hematology and oncology ward (n=30, 21.6%), and the cardiology ward (n=15, 10.8%). Age, inpatient status, time of arrival, the time of cardiopulmonary resuscitation (CPR), and the cause of shock were all risk factors for death. After the training, the arrival time and recovery time were significantly reduced (P<0.01). The proportion of patients who were transferred to the ICU had increased (P<0.05), and the proportion of deaths had decreased (P<0.01). The survival curve improved (P<0.05). CONCLUSIONS It is very important to summarize the risk factors related to Code Blue. It is clear that the efficacy of the Code Blue events improved after training of the hospital staff in the Children's Hospital.
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Affiliation(s)
- Yu Shi
- Division of Medical Administration, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Gongbao Liu
- Division of Medical Administration, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Di Cao
- Division of Medical Administration, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Intensive Care Unit, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yuan
- President's Office, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Yuping Qian
- President's Office, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Jie Xu
- President's Office, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Chengjun Sun
- Department of Endocrinology and Inborn Metabolic Diseases, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Mengmeng Ge
- Department of Neonatology, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Lingyu Lai
- Department of General Medicine, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Xuan Wang
- Department of Anesthesiology, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Yiqun Lu
- Department of Urology Surgery, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Guoying Huang
- Cardiovascular Center, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
| | - Xiaowen Zhai
- Department of Hematology/Oncology, National Children's Medical Center Children's Hospital of Fudan University, Shanghai, China
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99
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Covino M, De Matteis G, Burzo ML, Santoro M, Fuorlo M, Sabia L, Sandroni C, Gasbarrini A, Franceschi F, Gambassi G. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and prognosis of hypertensive patients hospitalised with COVID-19. Intern Med J 2021; 50:1483-1491. [PMID: 33022124 PMCID: PMC7675354 DOI: 10.1111/imj.15078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Among hypertensive patients, the association between treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) and the clinical severity of COVID-19, remains uncertain. AIMS To determine whether hypertensive patients hospitalised with COVID-19 are at risk of worse outcomes if on treatment with ACEI or ARB compared to other anti-hypertensive medications. METHODS This is a retrospective study conducted at a single academic medical centre (Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy) from 1 to 31 March 2020. We compared patients on treatment with an ACEI/ARB (ACEI/ARB group) to patients receiving other anti-hypertensive medications (No-ACEI/ARB group). The end-points of the study were the all-cause in-hospital death and the combination of in-hospital death or need for intensive care unit (ICU) admission. RESULTS The sample included 166 COVID-19 patients; median age was 74 years and 109 (66%) were men. Overall, 111 (67%) patients were taking an ACEI or ARB. Twenty-nine (17%) patients died during the hospital stay, and 51 (31%) met the combined end-point. After adjustment for comorbidities, age and degree of severity at the presentation, ACEI or ARB treatment was an independent predictor neither of in-hospital death nor of the combination of in-hospital death/need for ICU. No differences were documented between treatment with ACEI compared to ARB. CONCLUSIONS Among hypertensive patients hospitalised for COVID-19, treatment with ACEI or ARB is not associated with an increased risk of in-hospital death.
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Affiliation(s)
- Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Livia Burzo
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Santoro
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariella Fuorlo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Sabia
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Sandroni
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Giovanni Gambassi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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100
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Panagides V, Vase H, Shah SP, Basir MB, Mancini J, Kamran H, Batra S, Laine M, Eiskjær H, Christensen S, Karami M, Paganelli F, Henriques JPS, Bonello L. Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience. J Clin Med 2021; 10:jcm10020339. [PMID: 33477532 PMCID: PMC7831079 DOI: 10.3390/jcm10020339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. METHODS We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. RESULTS Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). CONCLUSIONS In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
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Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Sachin P. Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, INSERM, IRD, APHM, UMR1252, SESSTIM, Hôpital de la Timone, 13005 Marseille, France;
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Supria Batra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Steffen Christensen
- Department of Intensive Care Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Mina Karami
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Jose P. S. Henriques
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
- Correspondence: ; Tel.: +33-4-9196-7487
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