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Bruckel JT, Wong SL, Chan PS, Bradley SM, Nallamothu BK. Patterns of Resuscitation Care and Survival After In-Hospital Cardiac Arrest in Patients With Advanced Cancer. J Oncol Pract 2017; 13:e821-e830. [PMID: 28763260 DOI: 10.1200/jop.2016.020404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Little is known regarding patterns of resuscitation care in patients with advanced cancer who suffer in-hospital cardiac arrest (IHCA). METHODS In the Get With The Guidelines - Resuscitation registry, 47,157 adults with IHCA with and without advanced cancer (defined as the presence of metastatic or hematologic malignancy) were identified at 369 hospitals from April 2006 through June 2010. We compared rates of return of spontaneous circulation (ROSC) and survival to discharge between groups using multivariable models. We also compared duration of resuscitation effort and resuscitation quality measures. RESULTS Overall, 6,585 patients with IHCA (14.0%) had advanced cancer. Patients with advanced cancer had lower multivariable-adjusted rates of ROSC (52.3% [95% CI, 49.5% to 55.3%] v 56.6% [95% CI, 53.8% to 59.5%]; P < .001) and survival to discharge (7.4% [95% CI, 6.6% to 8.4%] v 13.4% [95% CI, 12.1% to 14.8%]; P < .001). Among nonsurvivors who died during resuscitation, patients with advanced cancer had better performance on most resuscitation quality measures. Among patients with ROSC, patients with advanced cancer were made Do Not Attempt Resuscitation (DNAR) more frequently within 48 hours (adjusted relative risk, 1.30 [95% CI, 1.24 to 1.37]; P < .001). Adjustment for DNAR status explained some of the immediate effect of advanced cancer on survival; however, survival remained significantly lower in patients with cancer. CONCLUSION Patients with advanced cancer can expect lower survival rates after IHCA compared with those without advanced cancer, and they are more frequently made DNAR within 48 hours of ROSC. These findings have important implications for discussions of resuscitation care wishes with patients and can better inform end-of-life discussions.
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Affiliation(s)
- Jeffrey T Bruckel
- University of Rochester Medical Center, Rochester, NY; Dartmouth-Hitchcock Medical Center; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; St Luke's Mid-America Heart Institute; University of Missouri-Kansas City, Kansas City, MO; Minneapolis Heart Institute, Minneapolis, MN; University of Michigan Health System; Michigan Integrated Center for Health Analytics and Medical Prediction; and Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI
| | - Sandra L Wong
- University of Rochester Medical Center, Rochester, NY; Dartmouth-Hitchcock Medical Center; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; St Luke's Mid-America Heart Institute; University of Missouri-Kansas City, Kansas City, MO; Minneapolis Heart Institute, Minneapolis, MN; University of Michigan Health System; Michigan Integrated Center for Health Analytics and Medical Prediction; and Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI
| | - Paul S Chan
- University of Rochester Medical Center, Rochester, NY; Dartmouth-Hitchcock Medical Center; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; St Luke's Mid-America Heart Institute; University of Missouri-Kansas City, Kansas City, MO; Minneapolis Heart Institute, Minneapolis, MN; University of Michigan Health System; Michigan Integrated Center for Health Analytics and Medical Prediction; and Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI
| | - Steven M Bradley
- University of Rochester Medical Center, Rochester, NY; Dartmouth-Hitchcock Medical Center; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; St Luke's Mid-America Heart Institute; University of Missouri-Kansas City, Kansas City, MO; Minneapolis Heart Institute, Minneapolis, MN; University of Michigan Health System; Michigan Integrated Center for Health Analytics and Medical Prediction; and Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- University of Rochester Medical Center, Rochester, NY; Dartmouth-Hitchcock Medical Center; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; St Luke's Mid-America Heart Institute; University of Missouri-Kansas City, Kansas City, MO; Minneapolis Heart Institute, Minneapolis, MN; University of Michigan Health System; Michigan Integrated Center for Health Analytics and Medical Prediction; and Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI
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Ohlsson MA, Kennedy LMA, Juhlin T, Melander O. Midlife risk factor exposure and incidence of cardiac arrest depending on cardiac or non-cardiac origin. Int J Cardiol 2017; 240:398-402. [PMID: 28487155 DOI: 10.1016/j.ijcard.2017.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/07/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Little is known about midlife risk factors of future cardiac arrest. Our objective was to evaluate cardiovascular risk factors in midlife in relation to the risk of cardiac arrest (CA) of cardiac and non-cardiac origin later in life. METHODS We cross-matched individuals of the population based Malmö Diet and Cancer study (n=30,447) with the local CA registry of the city of Malmö. Baseline exposures were related to incident CA. RESULTS During a mean follow-up of 17.6±4.6years, 378 CA occurred, of whom 17.2% survived to discharge. Independent midlife risk factors for CA of cardiac origin included coronary artery disease {HR 2.84 (1.86-4.34) (p<0.001)}, diabetes mellitus {HR 2.37 (1.61-3.51) (p<0.001)} and smoking {HR 1.95 (1.49-2.55) (p<0.001)}. Dyslipidemia and history of stroke were also significantly associated with an elevated risk for CA of cardiac origin. Independent midlife risk factors for CA of non-cardiac origin included obesity (BMI>30kg/m2) {HR 2.37 (1.51-3.71) (p<0.001)}, smoking {HR 2.05 (1.33-3.15) (p<0.001)} and being on antihypertensive treatment {HR 2.25 (1.46-3.46) (p<0.001)}. CONCLUSION Apart from smoking, which increases the risk of CA in general, the midlife risk factor pattern differs between CA of cardiac and non-cardiac origin. Whereas CA of cardiac origin is predicted by history of cardiovascular disease, dyslipidemia and diabetes mellitus, the main risk factors for CA of non-cardiac origin are obesity and hypertension. In addition to control of classical cardiovascular risk factors for prevention of CA, our results suggest that prevention of midlife obesity may reduce the risk of CA of non-cardiac origin.
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Affiliation(s)
- Marcus Andreas Ohlsson
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Linn Maria Anna Kennedy
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tord Juhlin
- Department of Cardiology, Lund University, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
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203
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Barbosa V, Gomes E, Vaz S, Azevedo G, Fernandes G, Ferreira A, Araujo R. Failure to activate the in-hospital emergency team: causes and outcomes. Rev Bras Ter Intensiva 2017; 28:420-426. [PMID: 28099639 PMCID: PMC5225917 DOI: 10.5935/0103-507x.20160075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022] Open
Abstract
Objective To determine the incidence of afferent limb failure of the in-hospital
Medical Emergency Team, characterizing it and comparing the mortality
between the population experiencing afferent limb failure and the population
not experiencing afferent limb failure. Methods A total of 478 activations of the Medical Emergency Team of Hospital
Pedro Hispano occurred from January 2013 to July 2015. A sample
of 285 activations was obtained after excluding incomplete records and
activations for patients with less than 6 hours of hospitalization. The
sample was divided into two groups: the group experiencing afferent limb
failure and the group not experiencing afferent limb failure of the Medical
Emergency Team. Both populations were characterized and compared.
Statistical significance was set at p ≤ 0.05. Result Afferent limb failure was observed in 22.1% of activations. The causal
analysis revealed significant differences in Medical Emergency Team
activation criteria (p = 0.003) in the group experiencing afferent limb
failure, with higher rates of Medical Emergency Team activation for cardiac
arrest and cardiovascular dysfunction. Regarding patient outcomes, the group
experiencing afferent limb failure had higher immediate mortality rates and
higher mortality rates at hospital discharge, with no significant
differences. No significant differences were found for the other
parameters. Conclusion The incidence of cardiac arrest and the mortality rate were higher in
patients experiencing failure of the afferent limb of the Medical Emergency
Team. This study highlights the need for health units to invest in the
training of all healthcare professionals regarding the Medical Emergency
Team activation criteria and emergency medical response system
operations.
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Affiliation(s)
- Vera Barbosa
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Ernestina Gomes
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Senio Vaz
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Gustavo Azevedo
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Gonçalo Fernandes
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Amélia Ferreira
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
| | - Rui Araujo
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE - Senhora da Hora, Portugal
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204
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Lin HL, Lin MH, Ho CC, Fu CH, Koo M. Psychometric properties of the Chinese version of the attitudes towards cardiopulmonary resuscitation with defibrillation (ACPRD-C) among female hospital nurses in Taiwan. Int Emerg Nurs 2017; 33:7-13. [DOI: 10.1016/j.ienj.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
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Hogan H, Carver C, Zipfel R, Hutchings A, Welch J, Harrison D, Black N. Effectiveness of ways to improve detection and rescue of deteriorating patients. Br J Hosp Med (Lond) 2017; 78:150-159. [PMID: 28277760 DOI: 10.12968/hmed.2017.78.3.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A number of interventions has been introduced to improve recognition of and response to deterioration, but evidence for improved outcomes is mixed. Future evaluations need better articulation of intervention components and outcomes, longer run-in times and consideration of the interplay between concurrent interventions.
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Affiliation(s)
- Helen Hogan
- Clinical Senior Lecturer, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH
| | - Catherine Carver
- Clinical Research Fellow, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | - Rebecca Zipfel
- Research Assistant, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | - Andrew Hutchings
- Lecturer in Statistics, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | - John Welch
- Consultant Nurse in Critical Care, University College London Hospital, London
| | - David Harrison
- Senior Statistician, Intensive Care National Audit and Research Centre, London
| | - Nick Black
- Professor of Health Services Research, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
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Neurologic Recovery After Cardiac Arrest: a Multifaceted Puzzle Requiring Comprehensive Coordinated Care. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:52. [PMID: 28536893 DOI: 10.1007/s11936-017-0548-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Surviving cardiac arrest (CA) requires a longitudinal approach with multiple levels of responsibility, including fostering a culture of action by increasing public awareness and training, optimization of resuscitation measures including frequent updates of guidelines and their timely implementation into practice, and optimization of post-CA care. This clearly goes beyond resuscitation and targeted temperature management. Brain-directed physiologic goals should dictate the post-CA management, as accumulating evidence suggests that the degree of hypoxic brain injury is the main determinant of survival, regardless of the etiology of arrest. Early assessment of the need for further hemodynamic and electrophysiologic cardiac interventions, adjusting ventilator settings to avoid hyperoxia/hypoxia while targeting high-normal to mildly elevated PaCO2, maintaining mean arterial blood pressures >65 mmHg, evaluating for and treating seizures, maintaining euglycemia, and aggressively pursuing normothermia are key steps in reducing the bioenergetic failure that underlies secondary brain injury. Accurate neuroprognostication requires a multimodal approach with standardized assessments accounting for confounders while recognizing the importance of a delayed prognostication when there is any uncertainty regarding outcome. The concept of a highly specialized post-CA team with expertise in the management of post-CA syndrome (mindful of the brain-directed physiologic goals during the early post-resuscitation phase), TTM, and neuroprognostication, guiding the comprehensive care to the CA survivor, is likely cost-effective and should be explored by institutions that frequently care for these patients. Finally, providing tailored rehabilitation care with systematic reassessment of the needs and overall goals is key for increasing independence and improving quality-of-life in survivors, thereby also alleviating the burden on families. Emerging evidence from multicenter collaborations advances the field of resuscitation at an incredible pace, challenging previously well-established paradigms. There is no more room for "conventional wisdom" in saving the survivors of cardiac arrest.
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208
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Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30–60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists). Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.
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Affiliation(s)
- Steven A Conrad
- Division of Critical Care Medicine, Louisiana State University Health Sciences Center; University Health Shreveport, Extracorporeal Life Support Program, Shreveport, Louisiana, USA
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, Michigan, USA
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209
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Hickey TR, Cooper Z, Urman RD, Hepner DL, Bader AM. An Agenda for Improving Perioperative Code Status Discussion. ACTA ACUST UNITED AC 2017; 6:411-5. [PMID: 27301059 DOI: 10.1213/xaa.0000000000000327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD.
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Affiliation(s)
- Thomas R Hickey
- From the *Yale University School of Medicine, Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, Connecticut; †Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, and the Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; ‡Ariadne Labs, Boston, Massachusetts; §Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; and ‖Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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210
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Gueret RM, Bailitz JM, Sahni AS, Tulaimat A. Therapeutic hypothermia at an urban public hospital: Development, implementation, experience and outcomes. Heart Lung 2017; 46:40-45. [DOI: 10.1016/j.hrtlng.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 01/10/2023]
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211
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Bhatnagar V, Tandon U, Jinjil K, Dwivedi D, Kiran S, Verma R. Cardiopulmonary Resuscitation: Evaluation of Knowledge, Efficacy, and Retention in Young Doctors Joining Postgraduation Program. Anesth Essays Res 2017; 11:842-846. [PMID: 29284836 PMCID: PMC5735475 DOI: 10.4103/aer.aer_239_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. Aims: The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. Design: The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. Methods: A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical Analysis: Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. Results: The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. Conclusion: The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.
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Affiliation(s)
- Vidhu Bhatnagar
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Urvashi Tandon
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Kavitha Jinjil
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - S Kiran
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Rohit Verma
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
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212
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Lee JS, Hong SK. Aortic Dissection in a Survivor after Cardiopulmonary Resuscitation. Korean J Crit Care Med 2016; 32:218-222. [PMID: 31723637 PMCID: PMC6786706 DOI: 10.4266/kjccm.2016.00416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 05/30/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022] Open
Abstract
We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 minutes, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography (TTE). Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.
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Affiliation(s)
- Jeong-Sun Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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213
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Morales-Cané I, Valverde-León MDR, Rodríguez-Borrego MA. Epinephrine in cardiac arrest: systematic review and meta-analysis. Rev Lat Am Enfermagem 2016; 24:e2821. [PMID: 27982306 PMCID: PMC5171778 DOI: 10.1590/1518-8345.1317.2821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/07/2016] [Indexed: 02/06/2023] Open
Abstract
Objective evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.
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Affiliation(s)
- Ignacio Morales-Cané
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Universidad de Córdoba, Córdoba, Spain
| | | | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Universidad de Córdoba, Córdoba, Spain. Hospital Universitario Reina Sofía, Córdoba, Spain
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214
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Moffat S, Skinner J, Fritz Z. Does resuscitation status affect decision making in a deteriorating patient? Results from a randomised vignette study. J Eval Clin Pract 2016; 22:917-923. [PMID: 27237130 PMCID: PMC5111586 DOI: 10.1111/jep.12559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES The aim of this paper is to determine the influence of do not attempt cardiopulmonary resuscitation (DNACPR) orders and the Universal Form of Treatment Options ('UFTO': an alternative approach that contextualizes the resuscitation decision within an overall treatment plan) on nurses' decision making about a deteriorating patient. METHODS An online survey with a developing case scenario across three timeframes was used on 231 nurses from 10 National Health Service Trusts. Nurses were randomised into three groups: DNACPR, the UFTO and no-form. Statements were pooled into four subcategories: Increasing Monitoring, Escalating Concern, Initiating Treatments and Comfort Measures. RESULTS Reported decisions were different across the three groups. Nurses in the DNACPR group agreed or strongly agreed to initiate fewer intense nursing interventions than the UFTO and no-form groups (P < 0.001) overall and across subcategories of Increase Monitoring, Escalate Concern and Initiate Treatments (all P < 0.001). There was no difference between the UFTO and no-form groups overall (P = 0.795) or in the subcategories. No difference in Comfort Measures were observed (P = 0.201) between the three groups. CONCLUSION The presence of a DNACPR order appears to influence nurse decision making in a deteriorating patient vignette. Differences were not observed in the UFTO and no-form group. The UFTO may improve the way nurses modulate their behaviours towards critically ill patients with DNACPR status. More hospitals should consider adopting an approach where the resuscitation decisions are contextualised within overall goals of care.
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Affiliation(s)
- Suzanne Moffat
- Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Jane Skinner
- Department of Medicine, University of East Anglia, Norwich, Norfolk, UK
| | - Zoë Fritz
- Acute Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
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215
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Farrell TW, Widera E, Rosenberg L, Rubin CD, Naik AD, Braun U, Torke A, Li I, Vitale C, Shega J. AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults. J Am Geriatr Soc 2016; 65:14-15. [PMID: 27874181 DOI: 10.1111/jgs.14586] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision-making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf. The process of arriving at a treatment decision for an unbefriended older adult should be conducted according to standards of procedural fairness and include capacity assessment, a search for potentially unidentified surrogate decision makers (including non-traditional surrogates) and a team-based effort to ascertain the unbefriended older adult's preferences by synthesizing all available evidence. A concerted national effort is needed to help reduce the significant state-to-state variability in legal approaches to unbefriended patients. Proactive efforts are also needed to identify older adults, including "adult orphans," at risk for becoming unbefriended and to develop alternative approaches to medical decision making for unbefriended older adults. This document updates the 1996 AGS position statement on unbefriended older adults.
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Affiliation(s)
- Timothy W Farrell
- University of Utah School of Medicine, Salt Lake City, UT.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT
| | - Eric Widera
- University of California San Francisco, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Craig D Rubin
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Aanand D Naik
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | - Ursula Braun
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | | | - Ina Li
- Christiana Care Health System, Wilmington, DE
| | - Caroline Vitale
- University of Michigan, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Joseph Shega
- VITAS Hospice Care Healthcare, Gotha, FL.,University of Central Florida, Gotha, FL
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Engsig M, Søholm H, Folke F, Gadegaard PJ, Wiis JT, Molin R, Mohr T, Engsig FN. Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management. Clin Epidemiol 2016; 8:761-768. [PMID: 27877067 PMCID: PMC5108475 DOI: 10.2147/clep.s114946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. Design, setting, and patients Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. Measurements Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological outcome assessed using the Pittsburgh cerebral performance category (CPC). Results A total of 282 patients were included in this study; 233 (83%) OHCA and 49 (17%) IHCA. The IHCA group presented more often with asystole, received bystander cardiopulmonary resuscitation (CPR) in all cases, and had shorter time to return of spontaneous circulation (ROSC). Survival to hospital discharge was 54% for OHCA and 53% for IHCA (adjusted odds ratio 0.98 [95% confidence interval {CI}; 0.43–2.24]). Age ≤60 years, bystander CPR, time to ROSC ≤10 min, and shockable rhythm at presentation were associated with survival to hospital discharge. Good neurologic outcome among survivors was achieved by 86% of OHCA and 92% of IHCA (P=0.83). After a median follow-up time of >5 years, 83% of OHCA and 77% of IHCA were alive (adjusted hazard ratio [HR] 1.51 [95% CI; 0.59–3.91]). Age ≤60 years was the only factor associated with long-term survival (adjusted HR 2.73 [95% CI; 1.36–5.52]). Conclusion There was no difference in short- and long-term survival and no difference in neurologic outcome to hospital discharge between IHCA and OHCA patients treated with TTM despite higher frequency of asystole in IHCA.
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Affiliation(s)
- Magaly Engsig
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Hellerup
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital, Herlev
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital, Hellerup; Pre-Hospital Emergency Medical Services, Capital Region of Denmark, Ballerup
| | - Peter J Gadegaard
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Hellerup
| | - Julie Therese Wiis
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen
| | - Rune Molin
- Department of Anaesthesiology, Copenhagen University Hospital, Hillerød
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Hellerup
| | - Frederik N Engsig
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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217
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Choi Y, Kwon IH, Jeong J, Chung J, Roh Y. Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea. Healthc Inform Res 2016; 22:277-284. [PMID: 27895959 PMCID: PMC5116539 DOI: 10.4258/hir.2016.22.4.277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study analyzed the incidence and characteristics of in-hospital cardiac arrest (IHCA) in Korea based on a sample group of patients that is representative of the population. METHODS The incidence of IHCA in adults was extracted from HIRA-NIS-2009, a sample of all patients using medical services in Korea. IHCA patients were analyzed according to gender, age, type of medical institute, and classification under the 6th revision of the Korean Standard Classification of Diseases (KCD-6). In addition, to assess the differences arising from the size of medical institutes, the IHCA incidence was analyzed in relation to the number of inpatient beds. RESULTS Based on the sample data, the total incidence of IHCA in Korea was found to be 2.46 per 1,000 admissions (95% confidence interval [CI], 2.37-2.55). A higher incidence was found among men at 3.18 (95% CI, 3.03-3.33), compared to women at 1.84 (95% CI, 1.74-1.94). The incidence of IHCA was also higher in hospitals that had more than 600 inpatients beds at 5.40 (95% CI, 5.16-5.66) in comparison to those that had less than 600 inpatients beds at 4.09 (95% CI, 3.76-4.36) (p < 0.001). By primary disease, the incidence was the highest for infectious diseases. CONCLUSIONS We demonstrated that the IHCA incidence based on gender, age, diagnostic group, and number of beds could be analyzed using the insurance claim data from a national representative sample.
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Affiliation(s)
- Yuri Choi
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea.; Department of Medicine, Graduate School of Dong-A University, Busan, Korea
| | - In Ho Kwon
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Junyoung Chung
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Younghoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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DeVoe B, Roth A, Maurer G, Tamuz M, Lesser M, Pekmezaris R, Makaryus AN, Hartman A, DiMarzio P. Correlation of the predictive ability of early warning metrics and mortality for cardiac arrest patients receiving in-hospital Advanced Cardiovascular Life Support. Heart Lung 2016; 45:497-502. [PMID: 27697395 DOI: 10.1016/j.hrtlng.2016.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Modified Early Warning Score (MEWS) helps identify patients experiencing a decline in physiological parameters that indicate risk for cardiac arrest (CA). OBJECTIVES To assess the association between MEWS values and patient survival following in-hospital CA. METHODS Retrospective cohort study of patients who experienced in-hospital CA. The relationship between CA survival and MEWS values as well as other risk factors such as age, gender and type of electrographic cardiac rhythms was analyzed using logistic regression. RESULTS Survival rate to hospital discharge was 21%. Strong predictors for survival were MEWS values at hospital admission (p < .002), younger age (p < .005), ventricular fibrillation (p < .0001), and ventricular tachycardia (p < .0001). Gender and MEWS 4 hours prior to CA were not significantly associated with survival. CONCLUSIONS Survival following CA was significantly associated with MEWS at hospital admission but not 4 hours prior to CA. The type of cardiac rhythm and age were also predictive of survival.
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Affiliation(s)
- Barbara DeVoe
- Interprofessional Education Hofstra-Northwell Health, School of Graduate Nursing and Physician Assistant Studies, Science Education, Hofstra Northwell Health School of Medicine, USA
| | - Anita Roth
- Department of Allergy & Immunology, Northwell Health, USA
| | | | - Michal Tamuz
- Research Health Outcomes, Patient Safety Institute, Center for Learning and Innovation, Northwell Health, USA
| | - Martin Lesser
- Biostatistics Unit, The Feinstein Institute for Medical Research, Northwell Health, USA
| | - Renee Pekmezaris
- Department of Medicine, Hofstra Northwell Health School of Medicine, USA; Department of Occupational Medicine Epidemiology and Prevention, Hofstra Northwell Health School of Medicine, USA
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, USA; Department of Cardiology, Hofstra Northwell School of Medicine, USA
| | | | - Paola DiMarzio
- Department of Medicine, Hofstra Northwell Health School of Medicine, USA; Department of Occupational Medicine Epidemiology and Prevention, Hofstra Northwell Health School of Medicine, USA.
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Bonaventura J, Alan D, Vejvoda J, Honek J, Veselka J. History and current use of mild therapeutic hypothermia after cardiac arrest. Arch Med Sci 2016; 12:1135-1141. [PMID: 27695505 PMCID: PMC5016592 DOI: 10.5114/aoms.2016.61917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/05/2015] [Indexed: 11/17/2022] Open
Abstract
In spite of many years of development and implementation of pre-hospital advanced life support programmes, the survival rate of out-of-hospital cardiac arrest (OHCA) used to be very poor. Neurologic injury from cerebral hypoxia is the most common cause of death in patients with OHCA. In the past two decades, post-resuscitation care has developed many new concepts aimed at improving the neurological outcome and survival rate of patients after cardiac arrest. Systematic post-cardiac arrest care after the return of spontaneous circulation, including induced mild therapeutic hypothermia (TH) in selected patients, is aimed at significantly improving rates of long-term neurologically intact survival. This review summarises the history and current knowledge in the field of mild TH after OHCA.
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Affiliation(s)
- Jiří Bonaventura
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - David Alan
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jiri Vejvoda
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jakub Honek
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
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Min MK, Yeom SR, Ryu JH, Kim YI, Park MR, Han SK, Lee SH, Park SW, Park SC. Comparison between an instructor-led course and training using a voice advisory manikin in initial cardiopulmonary resuscitation skill acquisition. Clin Exp Emerg Med 2016; 3:158-164. [PMID: 27752634 PMCID: PMC5065339 DOI: 10.15441/ceem.15.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 12/04/2022] Open
Abstract
Objective We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. Methods This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association’s Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. Results The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). Conclusion Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
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Affiliation(s)
- Mun Ki Min
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seok Ran Yeom
- Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong In Kim
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Maeng Real Park
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Kyoon Han
- Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Seong Hwa Lee
- Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Wook Park
- Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Soon Chang Park
- Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea
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Perman SM, Stanton E, Soar J, Berg RA, Donnino MW, Mikkelsen ME, Edelson DP, Churpek MM, Yang L, Merchant RM. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes. J Am Heart Assoc 2016; 5:JAHA.116.003638. [PMID: 27688235 PMCID: PMC5121474 DOI: 10.1161/jaha.116.003638] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. Methods and Results This is a retrospective study of adult IHCA events in the Get with the Guidelines—Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital‐level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed‐days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed‐days in both locations. Conclusions Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.
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Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Emily Stanton
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Robert A Berg
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dana P Edelson
- Department of Internal Medicine, University of Chicago, Chicago, IL
| | | | - Lin Yang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Raina M Merchant
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Therapeutic hypothermia after cardiac arrest is not associated with favorable neurological outcome: a meta-analysis. J Clin Anesth 2016; 33:225-32. [DOI: 10.1016/j.jclinane.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
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Connell CJ, Endacott R, Jackman JA, Kiprillis NR, Sparkes LM, Cooper SJ. The effectiveness of education in the recognition and management of deteriorating patients: A systematic review. NURSE EDUCATION TODAY 2016; 44:133-145. [PMID: 27429343 DOI: 10.1016/j.nedt.2016.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Survival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown. AIM The aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness. METHODS A mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form. RESULTS Twenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with >87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44h however one of the most educationally effective programs was based upon a 40min simulation program. CONCLUSION Educational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes. In situ simulation has demonstrated sustained positive impact upon the real world implementation of rapid response systems. Outcome measures should include knowledge and skill developments but there are important benefits in understanding patient outcomes.
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Affiliation(s)
- Clifford J Connell
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia.
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia; School of Nursing and Midwifery, Plymouth University, UK.
| | - Jennifer A Jackman
- Monash Health, Dandenong Hospital Emergency Department, 135 David Street, Dandenong, VIC 3175, Australia.
| | - Noelleen R Kiprillis
- School of Nursing and Midwifery, Monash University, 100 Clyde Road, Berwick 3806, Australia.
| | | | - Simon J Cooper
- School of Nursing, Midwifery and Healthcare, Federation University, Gippsland Campus, Northways Road, Churchill, VIC 3842, Australia.
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 926] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Kim DH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Extracorporeal Cardiopulmonary Resuscitation: Predictors of Survival. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:273-9. [PMID: 27525236 PMCID: PMC4981229 DOI: 10.5090/kjtcs.2016.49.4.273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
Background The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). Methods Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. Results Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). Conclusion These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients.
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Affiliation(s)
- Dong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation 2016; 107:19-24. [PMID: 27492850 DOI: 10.1016/j.resuscitation.2016.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/11/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
Abstract
AIM Aetiology of in-hospital cardiac arrests (IHCAs) on general wards has not been studied. We aimed to determine the underlying causes for IHCAs by the means of autopsy records and clinical judgement of the treating consultants. Furthermore, we investigated whether aetiology and preceding vital dysfunctions are associated with long-term survival. DESIGN AND SETTING Prospective observational study between 2009-2011 including 279 adult IHCA patients attended by medical emergency team in a Finnish university hospital's general wards. RESULTS The median age of the patients was 72 (64, 80) years, 185 (66%) were male, 178 (64%) of events were monitored/witnessed, first rhythm was shockable in 42 (15%) cases and 53 (19%) patients survived six months. Aetiology was determined as cardiac in 141 events, 73 of which were due to acute myocardial infarction. There were 138 non-cardiac IHCAs; most common causes were pneumonia (39) and exsanguination (16). No statistical difference was observed in the incidence of objective vital dysfunctions preceding the event between the cardiac and non-cardiac groups (40% vs. 44%, p=0.448). Subjective antecedents were more common in the cardiac cohort (47% vs. 32%, p=0.022), chest pain being an example (11% vs. 0.7%, p<0.001). Reviewing all 279 IHCAs, only shockable primary rhythm, monitored/witnessed event and low comorbidity score were independently associated with 180-day survival. CONCLUSIONS Cardiac aetiology underlies half of the IHCAs on general wards. Both objective and subjective antecedents are common. However, neither the cardiac aetiology nor the absence of preceding deterioration of vital signs were factors independently associated with a favourable outcome.
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Affiliation(s)
- Joonas Tirkkonen
- Tampere University Hospital, Department of Intensive Care Medicine, P.O. Box 2000, FI-33521 Tampere, Finland; Department of Anaesthesiology and Intensive Care Medicine, Seinäjoki Central Hospital, Finland.
| | - Heidi Hellevuo
- Department of Emergency Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.
| | - Klaus T Olkkola
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS Helsinki, Finland.
| | - Sanna Hoppu
- Tampere University Hospital, Department of Intensive Care Medicine, P.O. Box 2000, FI-33521 Tampere, Finland.
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Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing. Resuscitation 2016; 107:13-8. [PMID: 27456394 DOI: 10.1016/j.resuscitation.2016.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Define the frequency and survival pattern of cardiac arrests in relation to the hospital day of event and etiology of arrest. SUBJECT AND METHODS Retrospective cohort study of adult in-hospital cardiac arrests between July 1, 2005, and June 30, 2013, that were classified by etiology of deterioration. Arrests were divided based on hospital day (HD) of event (HD1, HD2-7, HD>7 days), and analysis of frequency was performed. The primary outcome of survival to discharge and secondary outcomes of return of spontaneous circulation (ROSC) and favorable neurological outcomes were compared using multivariable logistic regression analysis. RESULTS A total of 627 cases were included, 193 (30.8%) cases in group HD1, 206 (32.9%) in HD2-7, and 228 (36.4%) in HD>7. Etiology of arrest demonstrated variability across the groups (p<0.001). Arrests due to ventilation issues increased in frequency with longer hospitalization (p<0.001) while arrests due to dysrhythmia had the opposite trend (p=0.014). Rates of survival to discharge (p=0.038) and favorable neurological outcomes (p=0.002) were lower with increasing hospital days while ROSC was not different among the groups (p=0.183). Survival was highest for HD1 (HD1: 38.9% [95% CI, 32.0-45.7%], p=0.002 vs HD2-7: 34.0% [95% CI, 27.5-40.4%], p<0.001 vs HD>7: 27.2% [95% CI, 21.4-33.0%], p<0.001). CONCLUSIONS The etiology of cardiac arrests varies in frequency as length of hospitalization increases. Survival rates and favorable neurological outcomes are lower for in-hospital arrests occurring later in the hospitalization, even when adjusted for age, sex, and location of event. Understanding these issues may help with focusing therapies and accurate prognostication.
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Fontanals J, Magaldi M, Caballero Á, Fontanals M. [Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. Med Clin (Barc) 2016; 147:49-55. [PMID: 27237362 DOI: 10.1016/j.medcli.2016.04.014] [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: 11/05/2015] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.
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Affiliation(s)
- Jaume Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Magaldi
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - Ángel Caballero
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - Montserrat Fontanals
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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231
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Deng Y, He L, Yang J, Wang J. Serum D-dimer as an indicator of immediate mortality in patients with in-hospital cardiac arrest. Thromb Res 2016; 143:161-5. [DOI: 10.1016/j.thromres.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 01/08/2023]
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232
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Which comes first? The chicken or the egg: The association of d-dimer with return of spontaneous circulation following in-hospital cardiac arrest. Thromb Res 2016; 143:159-60. [DOI: 10.1016/j.thromres.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/19/2022]
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234
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Choi S, Lee J, Shin Y, Lee J, Jung J, Han M, Son J, Jung Y, Lee SH, Hong SB, Huh JW. Effects of a medical emergency team follow-up programme on patients discharged from the medical intensive care unit to the general ward: a single-centre experience. J Eval Clin Pract 2016; 22:356-62. [PMID: 26671285 DOI: 10.1111/jep.12485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aim of this study was to analyse the effects of the follow-up programme implemented by the Asan Medical Center Medical Emergency Team (MET). METHOD A quasi-experimental pre-post intervention design was used, retrospectively reviewed. The follow-up programme includes respiratory care, regular visits and communication between the attending doctors and MET nurse for patients discharged from the medical intensive care unit (MICU) to the general ward. This programme has been implemented since February 2013. Outcomes of patients before and at 1 year after the introduction of the programme were retrospectively reviewed. RESULTS A total of 1229 patients were enrolled and divided two groups (Before, n = 624; After the introduction of the programme, n = 625). Forty-six patients (3.7%) were readmitted to the ICU within 72 hours, and there was no significant difference found between the two groups (3.7% versus 3.7%, P = 0.996). Respiratory distress was the most common reason for readmission (67.4%). Cardiac arrest developed in four (0.6%) Before patients; whereas, no cardiac arrest occurred in the After group (0.0%, P = 0.062) cases. A total of 223 patients were discharged to the step-down units. The SOFA (sequential organ failure assessment) score was significantly higher in the step-down unit patients than general ward patients (4.9 ± 2.8 versus 6.2 ± 3.1, P = 0.000). In the analysis restricted to patients discharged to step-down units, unplanned ICU readmissions significantly decreased in the After group (9.3% versus 2.6%, P = 0.034). CONCLUSIONS The implementation of the MET follow-up programme did not change the rate of ICU readmission and cardiac arrest; however, its introduction was associated with the reduced ICU readmission of the high-risk patient populations discharged to the step-down unit.
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Affiliation(s)
- Sunhui Choi
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - Jinmi Lee
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - Yujung Shin
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - JuRy Lee
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - JiYoung Jung
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - Myongja Han
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - JeongSuk Son
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - YounKyung Jung
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - Soon-Haeng Lee
- Department of Intensive Care Nursing, Asan Medical Center, Seoul, South Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jin-Won Huh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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235
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Huschak G, Dünnebier A, Kaisers UX, Bercker S. Automated External Defibrillator Use for In-Hospital Emergency Management. Anaesth Intensive Care 2016; 44:353-8. [DOI: 10.1177/0310057x1604400304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a ‘heart-safe hospital’. We performed a cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital, analysing cardiopulmonary resuscitation (CPR) cases with and without AED use. In total, 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. Only 8% percent of the CPR cases had a shockable rhythm. In three of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available.
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Affiliation(s)
- G. Huschak
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - A. Dünnebier
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - U. X. Kaisers
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - S. Bercker
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
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236
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Grundgeiger T, Albert M, Reinhardt D, Happel O, Steinisch A, Wurmb T. Real-time tablet-based resuscitation documentation by the team leader: evaluating documentation quality and clinical performance. Scand J Trauma Resusc Emerg Med 2016; 24:51. [PMID: 27084746 PMCID: PMC4833944 DOI: 10.1186/s13049-016-0242-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/08/2016] [Indexed: 11/11/2022] Open
Abstract
Background Precise and complete documentation of in-hospital cardiopulmonary resuscitations is important but data quality can be poor. In the present study, we investigated the effect of a tablet-based application for real-time resuscitation documentation used by the emergency team leader on documentation quality and clinical performance of the emergency team. Methods Senior anaesthesiologists either used the tablet-based application during the simulated resuscitation for documentation and also used the application for the final documentation or conducted the full documentation at the end of the scenario using the local hospital information system. The latter procedure represents the current local documentation method. All scenarios were video recorded. To assess the documentation, we compared the precision of intervention delivery times, documentation completeness, and final documentation time. To assess clinical performance, we compared adherence to guidelines for defibrillation and adrenaline administration, the no-flow fraction, and the time to first defibrillation. Results The results showed significant benefits for the tablet-based application compared to the hospital information system for precision of the intervention delivery times, the final documentation time, and the no-flow fraction. We observed no differences between the groups for documentation completeness, adherence to guidelines for defibrillation and adrenaline administration, and the time to first defibrillation. Discussion In the presented study, we observed that a tablet-based application can improve documentation data quality. Furthermore, we demonstrated that a well-designed application can be used in real-time by a member of the emergency team with possible beneficial effects on clinical performance. Conclusion The present evaluation confirms the advantage of tablet-based documentation tools and also shows that the application can be used by an active member of an emergency team without compromising clinical performance.
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Affiliation(s)
- T Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074, Würzburg, Germany
| | - M Albert
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074, Würzburg, Germany
| | - D Reinhardt
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074, Würzburg, Germany
| | - O Happel
- Department of Anaesthesia and Critical Care/Section Emergency Medicine, University Hospital of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - A Steinisch
- Department of Anaesthesia and Critical Care/Section Emergency Medicine, University Hospital of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - T Wurmb
- Department of Anaesthesia and Critical Care/Section Emergency Medicine, University Hospital of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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237
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Evaluation of the effect of the modified early warning system on the nurse-led activation of the rapid response system. J Nurs Care Qual 2016; 29:223-9. [PMID: 24859890 DOI: 10.1097/ncq.0000000000000048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The modified early warning system (MEWS) is a scoring rubric used to detect the earliest signs of a change in a patient's condition. This mixed-methods study used pre- and postintervention data to describe the impact of the MEWS on the frequency of rapid response system activations and cardiopulmonary arrests among patients admitted to medical-surgical units. Focus groups of nursing staff provided insight into the factors that influence how nurses use the MEWS at the bedside as a framework to identify, intervene, and manage patients in need of an advanced level of care.
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238
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Huschak G, Dünnebier A, Kaisers UX, Bercker S. Automated external defibrillator use for in-hospital emergency management. Anaesth Intensive Care 2016. [DOI: 10.1177/0310057x1604400202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a ‘heart-safe hospital’. Methods Cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital. Analysis of cardio-pulmonary resuscitation (CPR) cases with and without AED use. Results A number of 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. 8% percent of the CPR cases had a shockable rhythm. In only three cases of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Conclusion Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available.
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Affiliation(s)
- G. Huschak
- Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - A. Dünnebier
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - U. X. Kaisers
- Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - S. Bercker
- Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
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239
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Overdyk FJ, Dowling O, Marino J, Qiu J, Chien HL, Erslon M, Morrison N, Harrison B, Dahan A, Gan TJ. Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database. PLoS One 2016; 11:e0150214. [PMID: 26913753 PMCID: PMC4767404 DOI: 10.1371/journal.pone.0150214] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives). Methods A retrospective analysis of adult inpatient discharges from 2008–2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives. Results Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40–3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569. Conclusions Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study.
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Affiliation(s)
- Frank J. Overdyk
- Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America
- North American Partners in Anesthesia, Melville, NY, United States of America
- * E-mail:
| | - Oonagh Dowling
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, United States of America
| | - Joseph Marino
- Department of Anesthesiology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, United States of America
- North American Partners in Anesthesia, Melville, NY, United States of America
| | - Jiejing Qiu
- Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America
| | - Hung-Lun Chien
- Covidien Healthcare Economics and Outcomes Research, Mansfield, MA, United States of America
| | - Mary Erslon
- Covidien Respiratory and Monitoring Solutions, Boulder, CO, United States of America
| | | | - Brooke Harrison
- Boulder Medical Writing, Boulder, CO, United States of America
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Tong J. Gan
- Department of Anesthesiology, Stony Brook University (SUNY), Stony Brook, NY, United States of America
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B Skrifvars M, Martin-Loeches I. Finally time for rapid response systems to be well MET in Europe? Intensive Care Med 2016; 42:608-610. [PMID: 26910561 DOI: 10.1007/s00134-016-4271-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Markus B Skrifvars
- Division of Critical Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Wellcome Trust-HRB Clinical Research, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland
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241
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Nishijima I, Oyadomari S, Maedomari S, Toma R, Igei C, Kobata S, Koyama J, Tomori R, Kawamitsu N, Yamamoto Y, Tsuchida M, Tokeshi Y, Ikemura R, Miyagi K, Okiyama K, Iha K. Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest. J Intensive Care 2016; 4:12. [PMID: 26865981 PMCID: PMC4748572 DOI: 10.1186/s40560-016-0134-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022] Open
Abstract
Background Physiological abnormalities are often observed in patients prior to cardiac arrest. A modified early warning score (MEWS) system was introduced, which aims to detect early abnormalities by grading vital signs, and the present study investigated its usefulness. Methods Based on previous reports, the Chubu Tokushukai Hospital-customized MEWS was developed in Okinawa, Japan. The MEWS was calculated among all inpatients, and the rates of in-hospital cardiac arrests (IHCAs) were compared according to the score. The warning zone (WZ) was set as 7 or more because of the high possibility of acute deterioration. The MEWS system was introduced to provide immediate interventions for patients who reached the WZ in accordance with the callout algorithm. The numbers of IHCAs were compared between the 18 months before and after introduction of the MEWS system. Results The numbers of patients who experienced IHCA with each score were as follows: score of 6, 1 of 556 patients (0.18 %); score of 7, 4 of 289 (1.40 %); score of 8, 2 of 114 (1.75 %); and score of 9 or more, 2 of 56 (3.57 %). There was no significant difference in the mean age or sex between before and after the introduction of the MEWS system. The rate of IHCAs per 1000 admissions decreased significantly from 5.21 (79/15,170) to 2.05 (43/17,961) (p < 0.01). Conclusions The Chubu Tokushukai Hospital-customized MEWS was applied to all inpatients, and the rate of IHCA decreased owing to the introduction of the system, as the system enables early interventions for patients who have the possibility of acute deterioration.
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Affiliation(s)
- Isao Nishijima
- Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan
| | - Shouhei Oyadomari
- Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan
| | - Shuuto Maedomari
- Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan
| | - Risa Toma
- Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan
| | - Chisato Igei
- Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan
| | - Shinya Kobata
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Jyun Koyama
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Ryuichiro Tomori
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Natsuki Kawamitsu
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Yoshiki Yamamoto
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | | | - Yoshihiro Tokeshi
- Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Ryo Ikemura
- Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Kazufumi Miyagi
- Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Koichi Okiyama
- Department of Neurosurgery, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Kiyoshi Iha
- Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan
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Miranzadeh S, Adib-Hajbaghery M, Hosseinpour N. A Prospective Study of Survival After In-Hospital Cardiopulmonary Resuscitation and its Related Factors. Trauma Mon 2016; 21:e31796. [PMID: 27218061 PMCID: PMC4869436 DOI: 10.5812/traumamon.31796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 12/01/2022] Open
Abstract
Background Despite several studies, there is no agreement on factors that affect survival after in-hospital cardiopulmonary resuscitation (CPR). Objectives This study aimed to evaluate the survival rate of in-hospital CPR and its related factors at Shahid Beheshti hospital in Kashan, Iran, in 2014. Patients and Methods A descriptive study was conducted on all cases of CPR performed in Kashan Shahid Beheshti hospital during a 6-month period in 2014. Through a consecutive sampling method, 250 cases of CPR were studied. A three-part researcher-made instrument was used. The outcome of CPR was documented as either survival to hospital discharge or unsuccessful (death of the patient). Chi-square test, t test, and logistic regression analysis were used to analyze the data. Results Of all CPR cases, 238 (95.2%) were unsuccessful and 12 (4.8%) survived to hospital discharge. Only 2.6% of patients who were resuscitated in medical units survived to hospital discharge, whereas this rate was 11.4% in the emergency department. Only 45 (18%) patients were defibrillated during resuscitation; in 11 patients, defibrillation was performed between 15 to 45 minutes after the initiation of CPR. The mean time from initiation of CPR to the first DC shock was 13.93 ± 8.88 minutes. Moreover, the mean duration of CPR was 35.11 ± 11.42 minutes. The survival rate was higher in the morning shift and lower during the time of shift change (9.4% vs. 0). The duration of CPR and speed of arrival of the CPR team were identified as factors that predicted the outcome of CPR. Conclusions The survival rate after in-hospital CPR was very low. The duration of CPR and the time of initiating CPR effects patients’ outcomes. These findings highlight the crucial role of an organized, skilled, well-established and timely CPR team.
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Affiliation(s)
- Sedigheh Miranzadeh
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021, Fax: +98-3155546633, E-mail:
| | - Nadimeh Hosseinpour
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Ahmad AS, Mudasser S, Khan MN, Abdoun HNH. Outcomes of Cardiopulmonary Resuscitation and Estimation of Healthcare Costs in Potential 'Do Not Resuscitate' Cases. Sultan Qaboos Univ Med J 2016; 16:e27-34. [PMID: 26909209 PMCID: PMC4746039 DOI: 10.18295/squmj.2016.16.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/28/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cardiopulmonary resuscitation (CPR) is a life-saving procedure which may fail if applied unselectively. 'Do not resuscitate' (DNR) policies can help avoid futile life-saving attempts among terminally-ill patients. This study aimed to assess CPR outcomes and estimate healthcare costs in potential DNR cases. METHODS This retrospective study was carried out between March and June 2014 and included 50 adult cardiac arrest patients who had undergone CPR at Sultan Qaboos Hospital in Salalah, Oman. Medical records were reviewed and treating teams were consulted to determine DNR eligibility. The outcomes, clinical risk categories and associated healthcare costs of the DNR candidates were assessed. RESULTS Two-thirds of the potential DNR candidates were ≥60 years old. Eight patients (16%) were in a vegetative state, 39 (78%) had an irreversible terminal illness and 43 (86%) had a low likelihood of successful CPR. Most patients (72%) met multiple criteria for DNR eligibility. According to clinical risk categories, these patients had terminal malignancies (30%), recent massive strokes (16%), end-stage organ failure (30%) or were bed-bound (50%). Initial CPR was unsuccessful in 30 patients (60%); the remaining 20 patients (40%) were initially resuscitated but subsequently died, with 70% dying within 24 hours. These patients were ventilated for an average of 5.6 days, with four patients (20%) requiring >15 days of ventilation. The average healthcare cost per patient was USD $1,958.9. CONCLUSION With careful assessment, potential DNR patients can be identified and futile CPR efforts avoided. Institutional DNR policies may help to reduce healthcare costs and improve services.
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Affiliation(s)
| | - Sayed Mudasser
- Department of Medicine, Sultan Qaboos Hospital, Salalah, Oman
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244
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Boller M, Fletcher DJ, Brainard BM, Haskins S, Hopper K, Nadkarni VM, Morley PT, McMichael M, Nishimura R, Robben JH, Rozanski E, Rudloff E, Rush J, Shih A, Smarick S, Tello LH. Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement. J Vet Emerg Crit Care (San Antonio) 2016; 26:11-34. [DOI: 10.1111/vec.12436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Manuel Boller
- Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee VIC Australia
| | - Dan J. Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca NY
| | - Benjamin M. Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athens GA
| | - Steve Haskins
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine; University of California at Davis; Davis CA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine; University of California at Davis; Davis CA
| | - Vinay M. Nadkarni
- The Children's Hospital of Philadelphia, Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Peter T. Morley
- The Royal Melbourne Hospital Clinical School; University of Melbourne; Parkville VIC Australia
| | | | - Ryohei Nishimura
- Graduate School of Agricultural and Life Sciences; The University of Tokyo; Tokyo Japan
| | - Joris H. Robben
- Faculty of Veterinary Medicine; Utrecht University; Utrecht the Netherlands
| | - Elizabeth Rozanski
- Cummings School of Veterinary Medicine; Tufts University; North Grafton MA
| | | | - John Rush
- Cummings School of Veterinary Medicine; Tufts University; North Grafton MA
| | - Andre Shih
- College of Veterinary Medicine; University of Florida; Gainesville FL
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245
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Piscator E, Hedberg P, Göransson K, Djärv T. Survival after in-hospital cardiac arrest is highly associated with the Age-combined Charlson Co-morbidity Index in a cohort study from a two-site Swedish University hospital. Resuscitation 2015; 99:79-83. [PMID: 26708451 DOI: 10.1016/j.resuscitation.2015.11.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) has a poor prognosis and clinicians often write "Do-Not-Attempt-Resuscitation" (DNAR) orders based on co-morbidities. AIM To assess the impact of the Age-combined Charlson Co-morbidity Index (ACCI) on 30-days survival after IHCA. MATERIAL AND METHODS All patients suffering IHCA at Karolinska University Hospital between 1st January and 31st December 2014 were included. Data regarding patient characteristics, co-morbidities and survival were drawn from the electronic patient records. Co-morbidities were assessed prior to the IHCA as ICD-10 codes according to the ACCI. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with an ACCI of 0-4 points versus those with 5-7 points, as well as those with ≥8 points. Adjustments included hospital site, heart rhythm, ECG surveillance, witnessed status and place of IHCA. RESULTS In all, 174 patients suffered IHCA, of whom 41 (24%) survived at least 30 days. Patients with an ACCI of 5-7 points had a minor chance and those with an ACCI of ≥8 points had a minimal chance of surviving IHCA compared to those with an ACCI of 0-4 points (adjusted OR 0.10, 95% CI 0.04-0.26 and OR 0.04, 95% CI 0.03-0.42, respectively). CONCLUSION Patients with a moderate or severe burden of ACCI have a minor chance of surviving an IHCA. This information could be used as part of the decision tools during ongoing CPR, and could be an aid for clinicians in planning care and discussing DNAR orders.
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Affiliation(s)
- Eva Piscator
- Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Hedberg
- Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Katarina Göransson
- Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Therese Djärv
- Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
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246
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Feingold P, Mina MJ, Burke RM, Hashimoto B, Gregg S, Martin GS, Leeper K, Buchman T. Long-term survival following in-hospital cardiac arrest: A matched cohort study. Resuscitation 2015; 99:72-8. [PMID: 26703463 DOI: 10.1016/j.resuscitation.2015.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/05/2015] [Accepted: 12/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Each year, 200,000 patients undergo an in-hospital cardiac arrest (IHCA), with approximately 15-20% surviving to discharge. Little is known, however, about the long-term prognosis of these patients after discharge. Previous efforts to describe out-of-hospital survival of IHCA patients have been limited by small sample sizes and narrow patient populations METHODS A single institution matched cohort study was undertaken to describe mortality following IHCA. Patients surviving to discharge following an IHCA between 2008 and 2010 were matched on age, sex, race and hospital admission criteria with non-IHCA hospital controls and follow-up between 9 and 45 months. Kaplan-Meier curves and Cox PH models assessed differences in survival. RESULTS Of the 1262 IHCAs, 20% survived to hospital discharge. Of those discharged, survival at 1 year post-discharge was 59% for IHCA patients and 82% for controls (p<0.0001). Hazard ratios (IHCA vs. controls) for mortality were greatest within the 90 days following discharge (HR=2.90, p<0.0001) and decreased linearly thereafter, with those surviving to one year post-discharge having an HR for mortality below 1.0. Survival after discharge varied amongst IHCA survivors. When grouped by discharge destination, out of hospital survival varied; in fact, IHCA patients discharged home without services demonstrated no survival difference compared to their non-IHCA controls (HR 1.10, p=0.72). IHCA patients discharged to long-term hospital care or hospice, however, had a significantly higher mortality compared to matched controls (HR 3.91 and 20.3, respectively; p<0.0001). CONCLUSION Among IHCA patients who survive to hospital discharge, the highest risk of death is within the first 90 days after discharge. Additionally, IHCA survivors overall have increased long-term mortality vs. CONTROLS Survival rates were varied widely with different discharge destinations, and those discharged to home, skilled nursing facilities or to rehabilitation services had survival rates no different than controls. Thus, increased mortality was primarily driven by patients discharged to long-term care or hospice.
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Affiliation(s)
- Paul Feingold
- School of Medicine, Emory University, Atlanta, GA, USA.
| | - Michael J Mina
- School of Medicine, Emory University, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Rachel M Burke
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Barry Hashimoto
- Department of Political Science, Emory University, Atlanta, GA, USA.
| | - Sara Gregg
- School of Medicine, Emory University, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Political Science, Emory University, Atlanta, GA, USA; Center for Critical Care, Emory University, Atlanta, GA, USA.
| | - Greg S Martin
- Center for Critical Care, Emory University, Atlanta, GA, USA.
| | - Kenneth Leeper
- Center for Critical Care, Emory University, Atlanta, GA, USA.
| | - Timothy Buchman
- Center for Critical Care, Emory University, Atlanta, GA, USA.
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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248
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Snipelisky D, Ray J, Matcha G, Roy A, Clark B, Dumitrascu A, Bosworth V, Whitman A, Lewis P, Vadeboncoeur T, Kusumoto F, Burton MC. Mayo registry for telemetry efficacy in arrest (MR TEA) study: An assessment of the effect of admission diagnosis on outcomes from in-hospital cardiopulmonary arrest. ACUTE CARDIAC CARE 2015; 17:67-71. [PMID: 27712143 DOI: 10.1080/17482941.2016.1203439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Little data exists evaluating how different risk factors influence outcomes following in-hospital arrests. METHODS A retrospective review of patients that suffered a cardiopulmonary arrest between 1 May 2008 and 30 June 2014 was performed. Patients were stratified into subsets based on cardiac versus non-cardiac reasons for admission. RESULTS 199 patients met inclusion criteria, of which 138 (69.3%) had a non-cardiac reason for admission and 61 (30.7%) a cardiac etiology. No difference in demographics and non-cardiac comorbidities were present. Cardiac-related comorbidities were more prevalent in the cardiac etiology subset. Arrests with a shockable rhythm were more common in the cardiac group (P < 0.0001), yet return of spontaneous circulation from the index event was similar (P = 0.254). More patients in the cardiac group were alive at 24-h post resuscitation (n = 34, 55.7% versus n = 49, 35.5%; P = 0.0085), discharge (n = 21, 34.4% versus n = 19, 13.8%; P = 0.0018), and at last follow-up (n = 13, 21.3% versus n = 14, 10.1%; P = 0.0434). CONCLUSION Although patients with cardiac and non-cardiac etiologies for admission have similar rates of return of spontaneous circulation, those with cardiac etiologies are more likely to survive to hospital discharge and outpatient follow-up.
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Affiliation(s)
- David Snipelisky
- a Department of Medicine , Division of Cardiovascular Diseases, Mayo Clinic , Rochester , MN , USA
| | - Jordan Ray
- b Department of Medicine , Division of Internal Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Gautam Matcha
- b Department of Medicine , Division of Internal Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Archana Roy
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Brooke Clark
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Adrian Dumitrascu
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Veronica Bosworth
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Anastasia Whitman
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Patricia Lewis
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Tyler Vadeboncoeur
- d Department of Emergency Medicine , Mayo Clinic , Jacksonville , FL , USA
| | - Fred Kusumoto
- e Department of Medicine , Division of Cardiovascular Diseases, Mayo Clinic , Jacksonville , FL , USA
| | - M Caroline Burton
- c Department of Medicine , Division of Hospital Medicine, Mayo Clinic , Jacksonville , FL , USA
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249
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Kudenchuk PJ, Sandroni C, Drinhaus HR, Böttiger BW, Cariou A, Sunde K, Dworschak M, Taccone FS, Deye N, Friberg H, Laureys S, Ledoux D, Oddo M, Legriel S, Hantson P, Diehl JL, Laterre PF. Breakthrough in cardiac arrest: reports from the 4th Paris International Conference. Ann Intensive Care 2015; 5:22. [PMID: 26380990 PMCID: PMC4573754 DOI: 10.1186/s13613-015-0064-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023] Open
Abstract
Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th "Paris International Conference in Intensive Care", whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was "Breakthrough in cardiac arrest", with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters: Epidemiology of CA Pre-hospital management Post-resuscitation management: targeted temperature management Post-resuscitation management: optimizing organ perfusion and metabolic parameters Neurological assessment of brain damages Public healthcare.
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Affiliation(s)
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
| | - Hendrik R Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France.
- Paris Descartes University and Sorbonne Paris Cité-Medical School and INSERM U970 (Team 4), Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France.
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Surgical Intensive Care Unit Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Vienna General Hospital, Medical University Vienna, Vienna, Austria.
| | - Fabio Silvio Taccone
- Department of Intensive Care, Laboratoire de Recherche Experimentale, Erasme Hospital, Brussels, Belgium.
| | - Nicolas Deye
- Medical Intensive Care Unit, AP-HP, Lariboisière University Hospital, Inserm U942, Paris, France.
| | - Hans Friberg
- Anaesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège and Liège 2 Department of Neurology, University Hospital of Liège, Liège, Belgium.
| | - Didier Ledoux
- Coma Science Group, Cyclotron Research Centre, University of Liège and Department of Intensive Care Medicine, University Hospital of Liège, Liège, Belgium.
| | - Mauro Oddo
- Department of Intensive Care Medicine, Faculty of Biology and Medicine, CHUV-University Hospital, Lausanne, Switzerland.
| | - Stéphane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France.
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, AP-HP, European Georges Pompidou Hospital, Paris Descartes University and Sorbonne Paris Cité-Medical School, Paris, France.
| | - Pierre-Francois Laterre
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Brussels, Brussels, Belgium.
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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