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Veettil ST, Anodiyil MS, Khudadad H, Kalathingal MA, Hamza AH, Ummer FP, Alnuaimi AS. Knowledge, attitude, and proficiency of healthcare providers in cardiopulmonary resuscitation in a public primary healthcare setting in Qatar. Front Cardiovasc Med 2023; 10:1207918. [PMID: 37534275 PMCID: PMC10390828 DOI: 10.3389/fcvm.2023.1207918] [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: 04/18/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Early and effective cardiopulmonary resuscitation (CPR) increases both survival rate and post-cardiac arrest quality of life. This study aims to assess the current knowledge and ability of physicians and nurses in health centers (HCs) operated by the Primary Health Care Corporation (PHCC) in Doha, Qatar, to perform CPR. Methodology This study consists of two parts. The first part is a descriptive cross-sectional survey using an online form targeting physicians and nurses working in all HCs to assess their CPR knowledge and attitude. The second part is a direct observation of CPR drills to evaluate the skills and competencies of code blue team members in a convenient sample of 14 HCs. A multivariate model was employed to test the independent effect of explanatory variables on the total knowledge score. Results A total of 569 physicians and nurses responded to the survey. Only one-half (48.7%) formally received training on basic life support within the last year. Furthermore, 62.7% have tried to revive a dying person with no pulse. All the participants recognize the importance of knowing how to revive a dying adult or child as part of their job. The study showed that being a nurse was the most important predictor of a higher knowledge score in both components. Attending more resuscitation courses (3-6 courses in the last 3 years) ranked second in importance, and a longer experience in clinical practice (5-10 and >10 years) ranked third in predictive power. In addition, the direct observation of CPR drill performance revealed a satisfactory outcome. Conclusion The level of CPR knowledge and skills practice among healthcare providers in PHCC is deemed satisfactory as most providers reported having performed CPR in the past. Considering that PHCC is the first step to people's healthcare in Qatar, clinical staff should be certified and assessed regularly to ensure retention of resuscitation knowledge and skills.
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Affiliation(s)
| | | | - Hanan Khudadad
- Clinical Research Department, Primary Health Care Corporation, Doha, Qatar
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Alum RA, Kiwanuka JK, Nakku D, Kakande ER, Nyaiteera V, Ttendo SS. Factors Associated With In-Hospital Post-Cardiac Arrest Survival in a Referral Level Hospital in Uganda. Anesth Analg 2022; 135:1073-1081. [PMID: 35877819 DOI: 10.1213/ane.0000000000006132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiac arrest (CA) is still associated with high mortality and morbidity across all practice settings despite resuscitation attempts and advancements in its management. Patient outcomes vary and are affected by multiple factors. Nonetheless, there is a paucity of information on survival after CA and associated factors in low-resource settings such as East Africa where Uganda is located. This study set out to describe post-CA survival, associated factors, and neurological outcome at a hospital in Southwestern Uganda. METHODS This was a descriptive study in which we followed up with resuscitated CA patients from any of the selected hospital locations at Mbarara Regional Referral Hospital in Southwestern Uganda. We included all patients who were resuscitated after an index CA in the operating room (OR), intensive care unit (ICU), the pediatric ward, or accident and emergency (A&E) wards. Details of resuscitation were obtained from resuscitation team leader interviews and patient medical records. We followed up with patients with return of spontaneous circulation (ROSC) for up to 7 days after CA when neurological outcomes were measured using the age-appropriate Cerebral Performance Category (CPC) score. Factors affecting survival were then determined. RESULTS A total of 74 participants were enrolled over 8 months. Seven-day survival was 14.86%. Eight of the 11 survivors had a CPC score of 1 seven days after CA. Admission with trauma was associated with increased mortality with an adjusted hazard ratio (HR) of 4.06; 95% confidence interval (CI), 1.19-13.82. Compared to the A&E ward, HR for index CA in OR, ICU, and pediatric ward was 0.15; 95% CI, 0.05-0.45; 0.67; 95% CI, 0.32-1.40, and 0.65; 95% CI, 0.25-1.69, respectively. Compared to cardiopulmonary resuscitation (CPR) <10 minutes, the HR for CPR duration between 10 and 20 minutes was 2.26; 95% CI, 0.78-3.24 and for >20 minutes was 2.26; 95% CI, 1.12-4.56. Prevention of hypotension after ROSC was associated with decreased mortality with an HR of 0.23; 95% CI, 0.08-0.58. CONCLUSIONS Whereas 7-day survival of resuscitated CA patients at Mbarara Regional Referral Hospital (MRRH) was low, survivors had a good neurologic outcome. CA in the OR, CPR <20 minutes, and prevention of hypotension postarrest seemed to be associated with survival.
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Affiliation(s)
| | | | - Doreen Nakku
- Otorhinolaryngology (ENT), Mbarara University of Science and Technology
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Ngaruiya C, Kawira A, Mali F, Kambua F, Mwangi B, Wambua M, Hersey D, Obare L, Leff R, Wachira B. Systematic review on epidemiology, interventions and management of noncommunicable diseases in acute and emergency care settings in Kenya. Afr J Emerg Med 2021; 11:264-276. [PMID: 33859931 PMCID: PMC8027527 DOI: 10.1016/j.afjem.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Mortality and morbidity from Non-Communicable Diseases (NCDs) in Africa are expected to worsen if the status quo is maintained. Emergency care settings act as a primary point of entry into the health system for a spectrum of NCD-related illnesses, however, there is a dearth of literature on this population. We conducted a systematic review assessing available evidence on epidemiology, interventions and management of NCDs in acute and emergency care settings in Kenya, the largest economy in East Africa and a medical hub for the continent. Methods All searches were run on July 15, 2015 and updated on December 11, 2020, capturing concepts of NCDs, and acute and emergency care. The study is registered at PROSPERO (CRD42018088621). Results We retrieved a total of 461 references, and an additional 23 articles in grey literature. 391 studies were excluded by title or abstract, and 93 articles read in full. We included 10 articles in final thematic analysis. The majority of studies were conducted in tertiary referral or private/mission hospitals. Cancer, diabetes, cardiovascular disease and renal disease were addressed. Majority of the studies were retrospective, cross-sectional in design; no interventions or clinical trials were identified. There was a lack of access to basic diagnostic tools, and management of NCDs and their complications was limited. Conclusion There is a paucity of literature on NCDs in Kenyan emergency care settings, with particular gaps on interventions and management. Opportunities include nationally representative, longitudinal research such as surveillance and registries, as well as clinical trials and implementation science to advance evidence-based, context-specific care.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
- Corresponding author.
| | - Annrita Kawira
- Department of Surgery, Mwingi Level 4 Hospital, Kitui County, Kenya
| | - Florence Mali
- Department of Medicine, Mwingi Level 4 Hospital, Kitui County, Kenya
| | - Faith Kambua
- Department of Pharmacy, Kileleshwa Medical Plaza, Nairobi, Kenya
| | - Beatrice Mwangi
- Department of Paediatrics and Child Health, Nanyuki Teaching and Referral Hospital, Nanyuki, Kenya
| | - Mbatha Wambua
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Denise Hersey
- Science Libraries, Princeton University, Princeton, NJ, USA
| | | | - Rebecca Leff
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
- School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benjamin Wachira
- Accident and Emergency Department, The Aga Khan University, Nairobi, Kenya
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Voruganti DC, Chennamadhavuni A, Garje R, Shantha GPS, Schweizer ML, Girotra S, Giudici M. Association between diabetes mellitus and poor patient outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Sci Rep 2018; 8:17921. [PMID: 30560897 PMCID: PMC6298970 DOI: 10.1038/s41598-018-36288-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 12/23/2022] Open
Abstract
Diabetes mellitus (DM) serves as an important prognostic indicator in patients with cardiac-related illness. Our objective is to compare survival and neurological outcomes among diabetic and non-diabetic patients who were admitted to the hospital after an out-of-hospital cardiac arrest (OHCA). We searched MEDLINE and EMBASE for relevant articles from database inception to July 2018 without any language restriction. Studies were included if they evaluated patients who presented with OHCA, included mortality and neurological outcome data separately for DM patients and Non-DM patients and reported crude data, odds ratio (OR), relative risk (RR) or hazard ratio (HR). Two investigators independently reviewed the retrieved citations and assessed eligibility. The quality of included studies was evaluated using Newcastle-Ottawa quality assessment scale for cohort studies. Random-effect models using the generic variance method were used to create pooled odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the I2 value. Survival and neurological outcomes (using modified rankin scale and cerebral performance category scale) after OHCA in hospitalized patients with DM compared with patients without DM. Out of 57 studies identified, six cohort studies met the inclusion criteria. In an analysis of unadjusted data, patients with DM had lower odds of survival, pooled OR 0.64; 95% CI, 0.52-0.78, [I2 = 90%]. When adjusted ORs were pooled, the association between DM and survival after OHCA was still significantly reduced, pooled OR 0.78, 95% CI, 0.68-0.89 [I2 = 55%]. Unadjusted pooled OR revealed poor neurological outcomes in patients with DM, pooled OR 0.55, 95% CI, 0.38-0.80 [I2 = 90%]. The result demonstrates significant poor outcomes of in-hospital survival and neurological outcomes among DM patients after OHCA.
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Affiliation(s)
- Dinesh Chandra Voruganti
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - Adithya Chennamadhavuni
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rohan Garje
- Division of Hematology and Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Saket Girotra
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Michael Giudici
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, USA
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Kaihula WT, Sawe HR, Runyon MS, Murray BL. Assessment of cardiopulmonary resuscitation knowledge and skills among healthcare providers at an urban tertiary referral hospital in Tanzania. BMC Health Serv Res 2018; 18:935. [PMID: 30514275 PMCID: PMC6278030 DOI: 10.1186/s12913-018-3725-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Early and effective CPR increases both survival rate and post-arrest quality of life. In limited resource countries like Tanzania, there is scarce data describing the basic knowledge of CPR among Healthcare providers (HCP). This study aimed to determine the current level of knowledge on, and ability to perform, CPR among HCP at Muhimbili National Hospital (MNH). Methods This was a descriptive cross sectional study of a random sample of 350 HCP from all cadres and departments at MNH from October 2015 to March 2016. Each participant completed a with 25 question multiple choice and fill-in-the-blank CPR test and a practical test using a CPR manikin where the participant was videotaped for 1–2 min. Two expert observers independently viewed the videos and rated participant performance on a structured data form. The primary outcome of interest was staff member overall performance on the written and practical CPR testing. Results We enrolled 350 HCPs from all 12 MNH clinical departments. The median participant age was 35 (IQR 29–43) years, 225 (64%) were female and 138 (39%) had clinical experience of less than 5 years. Only 57 (16%) and 88 (25%) scored above 50% in written and practical tests, respectively according to local minimum passing test score and 13(4%) and 30 (9%) scored above 75% in written and practical tests, respectively according to international minimum passing test score on CPR. The 233(67%) HCP who reported prior experience performing CPR on an adult patient scored higher on testing than those without; 40% (IQR 28–54) versus 26% (IQR 16–42) respectively, but both groups had median scores <50%. Conclusion The level of CPR knowledge and skills displayed by all cadres and in all departments was poor despite the fact that most providers reported having performed CPR in the past. Since MNH is a tertiary referral hospital, it may reflect the performance of resuscitation status of other local health centers in Tanzania and other low-income countries to employ a formal system of training every HCP in CPR. Staff should be certified and assessed regularly to ensure retention of resuscitation knowledge and skills. Electronic supplementary material The online version of this article (10.1186/s12913-018-3725-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Winfrida T Kaihula
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Brittany L Murray
- Division of Paediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Clinical presentation, management and outcome of cardiopulmonary resuscitation at Tenwek hospital: The oCPRTen Study. Resuscitation 2016; 106:e15-6. [DOI: 10.1016/j.resuscitation.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/20/2022]
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