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Awad E, Klapthor B, Morgan MH, Youngquist ST. The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. Resuscitation 2024; 201:110286. [PMID: 38901663 DOI: 10.1016/j.resuscitation.2024.110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/26/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms. METHODS We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC). RESULTS Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%. CONCLUSION Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery.
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Affiliation(s)
- Emad Awad
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA; BC RESURECT: Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Brent Klapthor
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael H Morgan
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Scott T Youngquist
- Department of Emergency Medicine, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA; Salt Lake City Fire Department (SLCFD), Salt Lake City, UT, USA
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Ploch M, Ahmed T, Reyes S, Irizarry-Caro JA, Fossas-Espinosa JE, Shoar S, Amatullah A, Jogimahanti A, Antonioli M, Iliescu CA, Balan P, Naeini PS, Madjid M. Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit. Resuscitation 2022; 181:190-196. [PMID: 36174763 DOI: 10.1016/j.resuscitation.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood. METHODS This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities. RESULTS We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status. CONCLUSIONS In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.
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Affiliation(s)
- Michelle Ploch
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Talha Ahmed
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Stephan Reyes
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jorge A Irizarry-Caro
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose E Fossas-Espinosa
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saeed Shoar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Atia Amatullah
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arjun Jogimahanti
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew Antonioli
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cesar A Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prakash Balan
- Department of Cardiology, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Payam Safavi Naeini
- Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute, Houston, TX, United States
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
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3
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Wada T, Hagiwara-Nagasawa M, Kambayashi R, Goto A, Chiba K, Nunoi Y, Izumi-Nakaseko H, Koga T, Matsumoto A, Nakazato Y, Lurie KG, Sugiyama A. Effects of Cardiac Massage and β-Blocker Pretreatment on the Success Rate of Cardiopulmonary Resuscitation Assessed by the Canine Ischemia/Reperfusion-Induced Ventricular Fibrillation Model. Circ J 2021; 85:1885-1891. [PMID: 33762525 DOI: 10.1253/circj.cj-20-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Effects of rapid electrical defibrillation and β-blockade on coronary ischemia/reperfusion-induced ventricular fibrillation (VF) during cardiopulmonary resuscitation (CPR) remain unknown. METHODS AND RESULTS After induction of VF by 30 min of ischemia followed by reperfusion, animals were treated with defibrillation alone (Group A, n=13), 2 min of open-chest cardiac massage followed by defibrillation (Group B, n=11), or the same therapy to Group B with propranolol (1 mg/kg, i.v.) treatment before ischemia/reperfusion (Group C, n=11). If return of spontaneous circulation (ROSC) was not attained, each therapy was repeated ≤3 times (Set-1). When ROSC was not obtained within Set-1, cardiac massage was applied to all animals followed by defibrillation, which was repeated ≤3 times (Set-2). ROSC after Set-1 was 8% in Group A, 82% in Group B and 82% in Group C, whereas that after Set-2 was 62% in Group A, 100% in Group B and 82% in Group C. Each animal with ROSC in Groups A (n=8) and B (n=11) showed sinus rhythm, whereas those in Group C (n=9) had sinus rhythm (n=5), atrial fibrillation (n=1), accelerated idioventricular rhythm (n=2) and atrioventricular block (n=1). Post ROSC heart rate and mean arterial pressure were significantly lower in Group C. CONCLUSIONS Cardiac massage increased the likelihood of ROSC vs. rapid defibrillation, but β-blocker pretreatment may worsen hemodynamics and electrical stability after ROSC.
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Affiliation(s)
- Takeshi Wada
- Department of Pharmacology, Faculty of Medicine, Toho University
- Department of Cardiology, Juntendo University Urayasu Hospital
| | | | | | - Ai Goto
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Koki Chiba
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Yoshio Nunoi
- Department of Pharmacology, Faculty of Medicine, Toho University
| | | | - Tadashi Koga
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Akio Matsumoto
- Department of Aging Pharmacology, Faculty of Medicine, Toho University
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Keith G Lurie
- Department of Emergency Medicine, University of Minnesota Medical School
| | - Atsushi Sugiyama
- Department of Pharmacology, Faculty of Medicine, Toho University
- Department of Aging Pharmacology, Faculty of Medicine, Toho University
- Yamanashi Research Center of Clinical Pharmacology, University of Yamanashi
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Medical Tourism in Aesthetic Breast Surgery: A Systematic Review. Aesthetic Plast Surg 2021; 45:1895-1909. [PMID: 33876284 PMCID: PMC8054849 DOI: 10.1007/s00266-021-02251-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
Introduction Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery. The majority of the literature involves retrospective case series with no defined comparator. We aimed to amalgamate the published data to date to ascertain the risks involved and the outcomes of cosmetic tourism for aesthetic breast surgery on a global basis.
Methods A systematic review of PubMed, Google Scholar, EMBASE, the Cochrane library and OVID Medline was conducted using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. Keywords such as “medical tourism”, “cosmetic tourism”, “tourism”, “tourist”, “surgery”, “breast” and “outcomes” were used. Seven hundred and seventy-one titles were screened, and 86 abstracts were reviewed leaving 35 full texts. Twenty-four of these met the inclusion criteria and were used to extract data for this systematic review. Results One hundred and seventy-one patients partook in cosmetic tourism for aesthetic breast surgery. Forty-nine percent of patients had an implant-based procedure. Other procedures included: mastopexy (n=4), bilateral breast reduction (n=11) and silicone injections (n=2). Two-hundred and twenty-two complications were recorded, common complications included: wound infection in 39% (n=67), breast abscess/ collection in 12% (n=21), wound dehiscence in 12% (n= 20) and ruptured implant in 8% (n=13). Clavien–Dindo classification of the complications includes 88 (51%) IIIb complications with 103 returns to theatre, 2 class IV complications (ICU stay) and one class V death of a patient. Explantation occurred in 39% (n=32) of implant-based augmentation patients. Conclusions Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (39%) and return to theatre rates (51%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. The high complication rate not only impacts individual patients, but also the home country healthcare systems. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where health care is already stretched, the burden from cosmetic tourism complications must be minimised. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Oh J, Cha KC, Lee JH, Park S, Kim DH, Lee BK, Park JS, Jung WJ, Lee DK, Roh YI, Kim TY, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support. Clin Exp Emerg Med 2021; 8:S26-S40. [PMID: 34034448 PMCID: PMC8171171 DOI: 10.15441/ceem.21.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Seungmin Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Hyeok Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Keon Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Youn Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Bowman TG, Boergers RJ, Lininger MR, Kilmer AJ, Ardente M, D'Amodio G, Hughes C, Murphy M. The Effect of Lacrosse Protective Equipment on Cardiopulmonary Resuscitation and Automated External Defibrillator Shock. J Athl Train 2020; 57:446991. [PMID: 33150371 PMCID: PMC9661938 DOI: 10.4085/437-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
CONTEXT In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock. OBJECTIVE To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types. DESIGN Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). RESULTS We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P<0.0001; Hitman pads: 53.8±14.5 s, P<0.0001). CONCLUSIONS Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_84-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barry T, Doheny MC, Masterson S, Conroy N, Klimas J, Segurado R, Codd M, Bury G. Community first responders for out-of-hospital cardiac arrest in adults and children. Cochrane Database Syst Rev 2019; 7:CD012764. [PMID: 31323120 PMCID: PMC6641654 DOI: 10.1002/14651858.cd012764.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival. OBJECTIVES To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in adults and children older than four weeks of age, in terms of survival and neurological function. SEARCH METHODS We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation Council. SELECTION CRITERIA We included randomized and quasi-randomized trials (RCTs and q-RCTs) that compared routine emergency medical services (EMS) care versus EMS care plus mobilization of CFRs in instances of OHCA.Trials with randomization by cluster were eligible for inclusion, including cluster-design studies with intervention cross-over.In some communities, the statutory ambulance service/EMS is routinely provided by the local fire service. For the purposes of this review, this group represents the statutory ambulance service/EMS, as distinct from CFRs, and was not included as an eligible intervention.We did not include studies primarily focused on opportunistic bystanders. Individuals who were present at the scene of an OHCA event and who performed CPR according to telephone instruction provided by EMS call takers were not considered to be CFRs.Studies primarily assessing the impact of specific additional interventions such as administration of naloxone in narcotic overdose or adrenaline in anaphylaxis were also excluded.We included adults and children older than four weeks of age who had experienced an OHCA. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed all titles and abstracts received to assess potential eligibility, using set inclusion criteria. We obtained and examined in detail full-text copies of all papers considered potentially eligible, and we approached authors of trials for additional information when necessary. We summarized the process of study selection in a PRISMA flowchart.Three review authors independently extracted relevant data using a standard data extraction form and assessed the validity of each included trial using the Cochrane 'Risk of bias' tool. We resolved disagreements by discussion and consensus.We synthesized findings in narrative fashion due to the heterogeneity of the included studies. We used the principles of the GRADE system to assess the certainty of the body of evidence associated with specific outcomes and to construct a 'Summary of findings' table. MAIN RESULTS We found two completed studies involving a total of 1136 participants that ultimately met our inclusion criteria. We also found one ongoing study and one planned study. We noted significant heterogeneity in the characteristics of interventions and outcomes measured or reported across these studies, thus we could not pool study results.One completed study considered the dispatch of police and fire service CFRs equipped with automatic external defibrillators (AEDs) in an EMS system in Amsterdam and surrounding areas. This study was an RCT with allocation made by cluster according to non-overlapping geographical regions. It was conducted between 5 January 2000 and 5 January 2002. All participants were 18 years of age or older and had experienced witnessed OHCA. The study found no difference in survival at hospital discharge (odds ratio (OR) 1.3, 95% confidence interval (CI) 0.8 to 2.2; 1 RCT; 469 participants; low-certainty evidence), despite the observation that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group (OR and 95% CI - not applicable; 1 RCT; 469 participants; moderate-certainty evidence). This study reported increased survival to hospital admission in the intervention group (OR 1.5, 95% CI 1.1 to 2.0; 1 RCT; 469 participants; moderate-certainty evidence).The second completed study considered the dispatch of nearby lay volunteers in Stockholm, Sweden, who were trained to perform cardiopulmonary resuscitation (CPR). This represented a supplementary CFR intervention in an EMS system where police and fire services were already routinely dispatched to OHCA in addition to EMS ambulances. This study, an RCT, included both witnessed and unwitnessed OHCA and was conducted between 1 April 2012 and 1 December 2013. Participants included adults and children eight years of age and older. Researchers found no difference in 30-day survival (OR 1.34, 95% CI 0.79 to 2.29; 1 RCT; 612 participants; low-certainty evidence), despite a significant increase in CPR performed before EMS arrival (OR 1.49, 95% CI 1.09 to 2.03; 1 RCT; 665 participants; moderate-certainty evidence).Neither of the included completed studies considered neurological function at hospital discharge or at 30 days, measured by cerebral performance category or by any other means. Neither of the included completed studies considered health-related quality of life. The overall certainty of evidence for the outcomes of included studies was low to moderate. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted.The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured.We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types.
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Affiliation(s)
- Tomas Barry
- University College DublinSchool of MedicineDublinIreland
| | - Maeve C Doheny
- University College DublinSchool of MedicineDublinIreland
| | - Siobhán Masterson
- National University of Ireland GalwayDiscipline of General Practice, School of MedicineGalwayIreland
| | - Niall Conroy
- University College DublinCentre for Emergency Medical ScienceDublinIreland
| | - Jan Klimas
- BC Centre for Excellence in HIV/AIDSBC Centre on Substance Use611 Powell StreetVancouverBCCanadaV6A 1H2
- School of Medicine, University College DublinHealth Science Centre, Belfield, UCDDublinIrelandD4
| | - Ricardo Segurado
- University College DublinSchool of Public Health, Physiotherapy and Sport ScienceBelfieldDublinIreland4
- University College DublinUCD Centre for Support and Training in Analysis and Research (CSTAR)DublinIreland
| | - Mary Codd
- University College DublinSchool of Public Health, Physiotherapy and Sport ScienceBelfieldDublinIreland4
- University College DublinUCD Centre for Support and Training in Analysis and Research (CSTAR)DublinIreland
| | - Gerard Bury
- University College DublinSchool of MedicineDublinIreland
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Patel VH, Vendittelli P, Garg R, Szpunar S, LaLonde T, Lee J, Rosman H, Mehta RH, Othman H. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8:9-17. [PMID: 30815378 PMCID: PMC6388309 DOI: 10.5492/wjccm.v8.i2.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient’s prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.
AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.
METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.
RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, P = 0.01], older age (OR = 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, P = 0.02) were independent predictors of death.
CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
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Affiliation(s)
- Vishal H Patel
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Philip Vendittelli
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajat Garg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44915, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Thomas LaLonde
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - John Lee
- Department of Critical Care Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Howard Rosman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 22705, United States
| | - Hussein Othman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
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12
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Marton-Popovici M. Review. Regional Networks in Acute Cardiac Care. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In acute cardiac care, the timely initiation of life-saving measures proved to be life-saving and requires many organizational and logistic measures. One of such measures is represented by the development and implementation of a regional network dedicated for the treatment of major cardiovascular emergencies, a strategy that proved to significantly reduce mortality rates on short and long term. This review aims to describe the current status in the development of regional networks in three of the main cardiovascular emergencies: acute myocardial infarction, out-of-hospital cardiac arrest, and acute stroke. The concepts demonstrating the utility of such networks, together with their results in reducing cardiac events, are presented in this paper.
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Affiliation(s)
- Monica Marton-Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington , USA
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13
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Barry T, Conroy N, Masterson S, Klimas J, Segurado R, Codd M, Bury G. Community first responders for out-of-hospital cardiac arrest. Hippokratia 2017. [DOI: 10.1002/14651858.cd012764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tomas Barry
- University College Dublin; Centre for Emergency Medical Science; Dublin Ireland
| | - Niall Conroy
- University College Dublin; Centre for Emergency Medical Science; Dublin Ireland
| | - Siobhán Masterson
- National University of Ireland Galway; Discipline of General Practice, School of Medicine; Galway Ireland
| | - Jan Klimas
- BC Centre for Excellence in HIV/AIDS; BC Centre on Substance Use; 611 Powell Street Vancouver BC Canada V6A 1H2
| | - Ricardo Segurado
- University College Dublin; School of Public Health, Physiotherapy and Sport Science; Belfield Dublin Ireland 4
| | - Mary Codd
- University College Dublin; School of Public Health, Physiotherapy and Sport Science; Belfield Dublin Ireland 4
| | - Gerard Bury
- University College Dublin; School of Medicine; Coombe Healthcare Centre Dolphins Barn Dublin Ireland D8
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14
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Öztürk D, Altinbilek E, Koyuncu M, Sönmez BM, Çaltili Ç, Ikizceli I, Kavalci C, Kavalci G. Successful application of acute cardiopulmonary resuscitation. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/j.joad.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Gutierrez C, Hatamy E. Cardiac Arrhythmias. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_84-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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