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Suzuki T, Mizuno A, Yoneoka D, Nakashima T, Matoba T, Node K, Yonemoto N, Tahara Y, Kobayashi Y, Ikeda T. Left-digit bias in out-hospital cardiac arrest: The JCS-ReSS study. PLoS One 2024; 19:e0305577. [PMID: 39178172 PMCID: PMC11343399 DOI: 10.1371/journal.pone.0305577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/02/2024] [Indexed: 08/25/2024] Open
Abstract
INTRODUCTION The left-digit bias (LDB), a numerical-related cognitive bias, not only potentially influences decision-making among the general public but also that of medical practitioners. Few studies have investigated its role in out-of-hospital cardiac arrest (OHCA). METHODS We retrospectively included all consecutive patients with OHCA witnessed by family members registered in the All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2005, and December 31, 2020. Target outcomes were the percentage of bystander cardiopulmonary resuscitation (BCPR) performed by family members or paramedics and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). Using a nonparametric regression discontinuity methodology, we examined whether a significant change occurred in the percentages of BCPR and ACLS at the age thresholds of 60, 70, 80, and 90 years, which would indicate the presence of LDB. RESULTS Of the 1,930,273 OHCA cases in the All-Japan Utstein Registry, 384,200 (19.9%) cases witnessed by family members were analyzed. The mean age was 75.8 years (±SD 13.7), with 38.0% (n = 146,137) female. We identified no discontinuities in the percentages of chest compressions, mouth-to-mouth ventilation, or automated external defibrillator (AED) usage by family members for the age thresholds of 60, 70, 80, and 90 years. Moreover, no discontinuities existed in the percentages of chest compressions, advanced airway management, and AED usage by paramedics or prehospital ACLS by physicians for any of the age thresholds. CONCLUSIONS In conclusion, our study did not find any evidence that age-related LDB affects medical decision-making in patients with OHCA.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke’s International Hospital, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takahiro Nakashima
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Naohiro Yonemoto
- The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| | - Yoshio Tahara
- The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| | - Yoshio Kobayashi
- The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| | - Takanori Ikeda
- The Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
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Ishihara T, Sasaki R, Enomoto Y, Amagasa S, Yasuda M, Ohnishi S. Changes in pre- and in-hospital management and outcomes among children with out-of-hospital cardiac arrest between 2012 and 2017 in Kanto, Japan. Sci Rep 2023; 13:10092. [PMID: 37344630 DOI: 10.1038/s41598-023-37201-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/17/2023] [Indexed: 06/23/2023] Open
Abstract
Previously, the SOS-KANTO 2012 studies, conducted in the Kanto area of Japan, reported a summary of outcomes in patients with out-of-hospital cardiac arrest (OHCA). This sub-analysis of the SOS-KANTO study 2017 aimed to evaluate the neurological outcomes of paediatric OHCA patients, by comparing the SOS-KANTO 2012 and 2017 studies. All OHCA patients, aged < 18 years, who were transported to the participating hospitals by EMS personnel were included in both SOS-KANTO studies (2012 and 2017). The number of survival patients with favourable neurological outcomes (paediatric cerebral performance category 1 or 2) at 1 month did not improve between 2012 and 2017. There was no significant difference in achievement of pre-hospital return of spontaneous circulation (ROSC) [odds ratio (OR): 2.00, 95% confidence interval (95% CI): 0.50-7.99, p = 0.50] and favourable outcome at 1 month [OR: 0.67, 95% CI: 0.11-3.99, p = 1] between the two studies, matched by age, witnessed arrest, bystander CPR, aetiology of OHCA, and time from call to EMS arrival. Multivariable logistic regression showed no significant difference in the achievement of pre-hospital ROSC and favourable outcomes at 1 month between the two studies.
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Affiliation(s)
- Tadashi Ishihara
- Department of Emergency and Critical Care Medicine, Urayasu Hospital, Juntendo University, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Ryuji Sasaki
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaragi, Japan
| | - Shunsuke Amagasa
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Masato Yasuda
- Division of Emergency Medicine, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shima Ohnishi
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
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Factors influencing prehospital physicians' decisions to initiate advanced resuscitation for asystolic out-of-hospital cardiac arrest patients. Resuscitation 2022; 177:19-27. [PMID: 35760227 DOI: 10.1016/j.resuscitation.2022.06.015] [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: 04/27/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The decision to initiate or continue advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) could be difficult due to the lack of information and contextual elements, especially in non-shockable rhythms. This study aims to explore factors associated with clinicians' decision to initiate or continue ALS and the conditions associated with higher variability in asystolic patients. METHODS This retrospective observational study enrolled 2653 asystolic patients on whom either ALS was attempted or not by the emergency medical services (EMS) physician. A multivariable logistic regression analysis was performed to find the factors associated with the decision to access ALS. A subgroup analysis was performed on patients with a predicted probability of ALS between 35% and 65%. The single physicians' behaviour was compared to that predicted by the model taking into account the entire agency. RESULTS Age, location of event, bystander CPR and EMS-witnessed event were independent factors influencing physicians' choices about ALS. Non-medical OHCA, younger patients, less experienced physicians, presence of breath activity at the emergency call and a longer time for ALS arrival were more frequent among cases with an expected higher variability in behaviours with ALS. Significant variability was detected between physicians. CONCLUSIONS Significant inter-physician variability in access to ALS could be present within the same EMS, especially among less experienced physicians, non-medical OHCA and in presence of signs of life during emergency call. This arbitrariness has been observed and should be properly addressed by EMS team members as it raises ethical issues regarding the disparity in treatment.
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Gamberini L, Tartivita CN, Guarnera M, Allegri D, Baroncini S, Scquizzato T, Tartaglione M, Alberto Mazzoli C, Chiarini V, Picoco C, Coniglio C, Semeraro F, Gordini G. External validation and insights about the calibration of the return of spontaneous circulation after cardiac arrest (RACA) score. Resusc Plus 2022; 10:100225. [PMID: 35403069 PMCID: PMC8983431 DOI: 10.1016/j.resplu.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background The return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score was developed as a tool to predict ROSC probability (pROSC) based on easily available information and it could be useful to compare the performances of different EMS agencies or the effects of eventual interventions. We performed an external validation of the RACA score in a cohort of out of hospital cardiac arrest (OHCA) patients managed by the EMS of the metropolitan city of Bologna, Italy. Methods We analyzed data from 2,310 OHCA events prospectively collected between January 2009 and June 2021. Discrimination was assessed with the area under the ROC curve (AUROC), while the calibration belts were used for the comparison of observed versus expected ROSC rates. The AUROCs from our cohort and other validation cohorts were compared using a studentized range test. Results The AUROC for the study population was 0.691, comparable to that described by previous validation studies. Despite an acceptable overall calibration, we found a poor calibration for asystole and low pROSC ranges in PEA and shockable rhythms. The model showed a good calibration for patients aged over 80, while no differences in performance were found when evaluating events before and after the implementation of 2015 ERC guidelines. Conclusions Despite AUROC values being similar in different validation studies for RACA score, we suggest separating the different rhythms when assessing ROSC probability with the RACA score, especially for asystole.
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Botto GL, Mantovani LG, Cortesi PA, De Ponti R, D'Onofrio A, Biffi M, Capucci A, Casu G, Notarstefano P, Scaglione M, Zanotto G, Boriani G. The value of wearable cardioverter defibrillator in adult patients with recent myocardial infarction: Economic and clinical implications from a health technology assessment perspective. Int J Cardiol 2022; 356:12-18. [PMID: 35395289 DOI: 10.1016/j.ijcard.2022.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023]
Abstract
AIMS Sudden cardiac death (SCD) causes high mortality and substantial societal burdens for healthcare systems (HSs). The risk of SCD is significantly increased in patients with reduced left ventricular ejection fraction after myocardial infarction (MI). Current guidelines recommend re-evaluation of cardioverter-defibrillator implantation 40 days post-MI, earliest. Medical therapy alone does not provide sufficient protection against SCD, especially in the first month post-MI, and needs time. Consequently, there is a gap in care of high-risk patients upon hospital discharge. The wearable cardioverter defibrillator (WCD) is a proven safe, effective therapy, which temporarily protects from SCD. Little information on WCD cost-effectiveness exists. We conducted this research to demonstrate the medical need of the device in the post-MI setting defining WCD cost-effectiveness. METHODS & RESULTS Based on a randomized clinical trials (RCTs) and Italian and international data, we developed a Markov-model comparing costs, patient survival, and quality-of-life, and calculated the Incremental Cost-Effectiveness Ratio (ICER) of a WCD vs. current standard of care in post-MI patients. The rather conservative base case analysis - based on the RCT intention-to-treat results - produced an ICER of €47,709 per Quality Adjusted Life Year (QALY) gained, which is far lower than the accepted threshold of €60,000 in the Italian National HS. The ICER per Life Year (LY) gained was €38,276. CONCLUSION WCD utilization in post-MI patients is clinically beneficial and cost-effective. While improving guideline directed patient care, the WCD can also contribute to a more efficient use of resources in the Italian HS, and potentially other HSs as well.
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Affiliation(s)
- Giovanni Luca Botto
- Cardiology - Electrophysiology Division, Department of Medicine, Ospedale di Circolo Rho, Ospedale Salvini Garbagnate M.se, ASST Rhodense, Milan, Italy.
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy; Value-Based Healthcare Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Cardiology Division - Electrophysiology Department - AORN dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Mauro Biffi
- Cardiology Division - Electrophysiology Department, Policlinico S.Orsola Malpighi, Bologna, Italy
| | - Alessandro Capucci
- Cardiology and Arrhytmology Clinic, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Gavino Casu
- Cardiology and Intensive Care Unit, Ospedale "San Francesco" Nuoro, Italy
| | | | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Lin YY, Lai YY, Chang HC, Lu CH, Chiu PW, Kuo YS, Huang SP, Chang YH, Lin CH. Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols. BMC Emerg Med 2022; 22:53. [PMID: 35346055 PMCID: PMC8958476 DOI: 10.1186/s12873-022-00606-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). METHODS A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. RESULTS Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. CONCLUSIONS Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.
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Affiliation(s)
- Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yin-Yu Lai
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Ying-Hsin Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.
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Shibahashi K, Sakurai S, Sugiyama K, Ishida T, Hamabe Y. Nursing Home Versus Community Resuscitation After Cardiac Arrest: Comparative Outcomes and Risk Factors. J Am Med Dir Assoc 2021; 23:1316-1321. [PMID: 34627752 DOI: 10.1016/j.jamda.2021.09.009] [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: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the characteristics and outcomes of patients who experienced cardiac arrest in nursing homes compared with those in private residences and determine prognostic factors for survival. DESIGN This was a retrospective study that analyzed data from an Utstein-style registry of the Tokyo Fire Department. SETTING AND PARTICIPANTS We identified patients aged ≥65 years who experienced cardiac arrest in a nursing home or private residence from the population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan, from 2014 to 2018. METHODS Patients were grouped into the nursing home or the private residence groups according to their cardiac arrest location. We compared the characteristics and outcomes between the 2 groups and determined prognostic factors for survival in the nursing home group. The primary outcome was 1-month survival after cardiac arrest. RESULTS In total, 37,550 patient records (nursing home group = 6271; private residence group = 31,279) were analyzed. Patients in the nursing home group were significantly older and more often had witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and shock delivery using an automated external defibrillator. The 1-month survival rate was significantly higher in the nursing home group (2.6% vs 1.8%, P < .001). In the best scenario (daytime emergency call, witnessed cardiac arrest, bystander CPR provided), the 1-month survival rate after cardiac arrest in the nursing home group was 8.0% (95% confidence interval 6.4-9.9%), while none survived if they had neither witness nor bystander CPR. CONCLUSIONS AND IMPLICATIONS Survival outcome was significantly better in the nursing home group than in the private residence group and was well stratified by 3 prognostic factors: emergency call timing, witnessed status, and bystander CPR provision. Our results suggest that a decision to withhold vigorous treatment solely based on nursing home residential status is not justified, while termination of resuscitation may be determined by considering significant prognostic factors.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
| | | | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Erogul M, Likourezos A, Meddy J, Terentiev V, Davydkina D, Monfort R, Pushkar I, Vu T, Achalla M, Fromm C, Marshall J. Post-traumatic Stress Disorder in Family-witnessed Resuscitation of Emergency Department Patients. West J Emerg Med 2020; 21:1182-1187. [PMID: 32970573 PMCID: PMC7514396 DOI: 10.5811/westjem.2020.6.46300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Family presence during emergency resuscitations is increasingly common, but the question remains whether the practice results in psychological harm to the witness. We examine whether family members who witness resuscitations have increased post-traumatic stress disorder (PTSD) symptoms at one month following the event. Methods We identified family members of critically ill patients via our emergency department (ED) electronic health record. Patients were selected based on their geographic triage to an ED critical care room. Family members were called a median of one month post-event and administered the Impact of Event Scale-Revised (IES-R), a 22-item validated scale that measures post-traumatic distress symptoms and correlates closely with Diagnostic and Statistical Manual of Mental Disorders-IV criteria for post-traumatic stress disorder (PTSD). Family members were placed into two groups based on whether they stated they had witnessed the resuscitation (FWR group) or not witnessed the resuscitation (FNWR group). Data analyses included chi-square test, independent sample t-test, and linear regression controlling for gender and age. Results A convenience sample of 423 family members responded to the phone interview: 250 FWR and 173 FNWR. The FWR group had significantly higher mean total IES-R scores: 30.4 vs 25.6 (95% confidence interval [CI], −8.73 to −0.75; P<.05). Additionally, the FWR group had significantly higher mean score for the subscales of avoidance (10.6 vs 8.1; 95% CI, −4.25 to −0.94; P<.005) and a trend toward higher score for the subscale of intrusion (13.0 vs 11.4; 95% CI, −3.38 to .028; P = .054). No statistical significant difference was noted between the groups in the subscale of hyperarousal (6.95 vs 6.02; 95% CI, −2.08 to 0.22; P=.121). All findings were consistent after controlling for age, gender, and immediate family member (spouse, parent, children, and grandchildren). Conclusion Our results suggest that family members who witness ED resuscitations may be at increased risk of PTSD symptoms at one month. This is the first study that examines the effects of family visitation for an unsorted population of very sick patients who would typically be seen in the critical care section of a busy ED.
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Affiliation(s)
- Mert Erogul
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Antonios Likourezos
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Jodee Meddy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Victoria Terentiev
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - D'anna Davydkina
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Ralph Monfort
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Illya Pushkar
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Thomas Vu
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Madhu Achalla
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Christian Fromm
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - John Marshall
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
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Tíscar-González V, Gea-Sánchez M, Blanco-Blanco J, Pastells-Peiró R, De Ríos-Briz N, Moreno-Casbas MT. Witnessed resuscitation of adult and paediatric hospital patients: An umbrella review of the evidence. Int J Nurs Stud 2020; 113:103740. [PMID: 33099179 DOI: 10.1016/j.ijnurstu.2020.103740] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the research evidence about whether families were allowed to witness cardiopulmonary resuscitation on hospitalised adult and paediatric patients; and the views of patients, families and health professionals, about witnessed cardiopulmonary resuscitation. DESIGN An umbrella review methodology of systematic reviews with sufficient methodological quality. REVIEW METHODS Papers published in Spanish and English between, 1 January 2009 and 31 December 2018 were considered. The following databases were searched: PubMed, CINAHL, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, PsycInfo, Embase, the Central Supplier Database and the Joanna Briggs Institute, Evidence-based Practice Database. Two independent reviewers assessed the papers for methodological quality employing instruments from the Joanna Briggs Institute. Critical appraisal, extraction and synthesis were carried out, employing the established methods for umbrella reviews and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO number CRD42019145610). RESULTS The search identified 12 systematic reviews with moderate-to-high quality, which covered 110 original papers. Habitually, health professionals expressed controversial views and showed some reluctance to let families be present during cardiopulmonary resuscitation. In contrast, family members felt strongly that they should be present and patients agreed. Key factors that facilitated witnessed cardiopulmonary were a formal institutional policy, educating health professionals, and designating a health professional to support the family. Educational and cultural backgrounds influenced healthcare professionals' experiences and their attitudes towards witnessed cardiopulmonary resuscitation. In general, Anglo-Saxon countries showed greater support for this practice. These included the United States, which was the country that dominated the literature on this subject. CONCLUSIONS The best available evidence supports allowing the family to be present during cardiopulmonary resuscitation. It is necessary to include this practice in educational curricula and to train emergency personnel in its implementation. Culturally sensitive policies need to be designed, and the public to be aware of their right to be present.
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Affiliation(s)
- Verónica Tíscar-González
- Nursing teaching Unit, OSI Araba (Osakidetza), Vitoria, Spain; Clinical nursing and community health group. BioAraba Health Research Institute, Vitoria, Spain
| | - Montserrat Gea-Sánchez
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Group for the Study of Society Health Education and Culture (GESEC), University of Lleida, Lleida, Spain; Health Care Research Group (GRECS) Biomedical Research Institute of Lleida, IRBLleida, Lleida, Spain
| | - Joan Blanco-Blanco
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Group for the Study of Society Health Education and Culture (GESEC), University of Lleida, Lleida, Spain; Health Care Research Group (GRECS) Biomedical Research Institute of Lleida, IRBLleida, Lleida, Spain.
| | - Roland Pastells-Peiró
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Group for the Study of Society Health Education and Culture (GESEC), University of Lleida, Lleida, Spain; Health Care Research Group (GRECS) Biomedical Research Institute of Lleida, IRBLleida, Lleida, Spain
| | - Nuria De Ríos-Briz
- OSI Ezkerraldea-Enkarterri-Cruces (Osakidetza), Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Maria Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain; CIBERFES, Institute of Health Carlos III, Madrid, Spain
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Winther-Jensen M, Christiansen MN, Hassager C, Køber L, Torp-Pedersen C, Hansen SM, Lippert F, Christensen EF, Kjaergaard J, Andersson C. Age-specific trends in incidence and survival of out-of-hospital cardiac arrest from presumed cardiac cause in Denmark 2002-2014. Resuscitation 2020; 152:77-85. [PMID: 32417269 DOI: 10.1016/j.resuscitation.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The general cardiovascular health has improved throughout the last few decades for middle-aged and older individuals, but the incidence of several cardiovascular diseases is reported to increase in younger people. We aimed to assess the age-specific incidence and mortality rates associated with out-of-hospital-cardiac-arrest (OHCA) between 2002 and 2014. METHODS We used the Danish Cardiac Arrest Register to identify patients with OHCA of presumed cardiac etiology. We calculated the annual incidence rates (IR) and 30-day mortality rates (MR) in 7 age groups (18-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years and ≥85 years, and ≤50 vs. >50 years). RESULTS Between 2002 and 2014, IR of OHCA decreased in individuals aged 65-74 and 75-84 years (158.08 to 111.2 and 237.5 to 217.09 per 100,000 person-years) and increased in the oldest from 201.01 to 325.4 pr. 100.000 person-years. In 18-34-years incidence of OHCA increased from 1.7 to 2.6 per 100.000 person-years. When stratifying into age ≤50 vs. >50 years, the IR deviated in those >50 years (from 117.8 in 2002 to 91 in 2008 to 117.4 in 2014100,000 person-years). The prevalence of acute myocardial infarction and heart failure prior to OHCA increased in the younger patient group in contrast to the older segment (AMI: ≤50 years: 10% to 16%, vs. >50 years: 25% to 23%, heart failure: ≤50 years 6% to 14%, vs. >50 years: 21% to 24%). CONCLUSION Over the last decades, incidence rates of OHCA decreased in individuals aged 65-84, but increased in individuals older than 85. An increase was also observed in younger individuals, potentially indicating a need for better cardiovascular disease prevention in younger adults.
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Affiliation(s)
- Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Epidemiology, Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Mia Nielsen Christiansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Erika Frischknecht Christensen
- Center for Prehospital and Emergency Research, Department of Clinical Medicine Aalborg University, Clinic for Internal and Emergency Medicine Aalborg University Hospital, and EMS North Denmark Region, Aalborg, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Charlotte Andersson
- Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Medicine, Section of Cardiovascular Medicine Boston Medical Center, Boston University Boston, MA, USA
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11
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Campwala RT, Schmidt AR, Chang TP, Nager AL. Factors influencing termination of resuscitation in children: a qualitative analysis. Int J Emerg Med 2020; 13:12. [PMID: 32171233 PMCID: PMC7071657 DOI: 10.1186/s12245-020-0263-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians' attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital "non-medical" considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians. METHODS A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children's hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors. RESULTS Coding yielded 5 broad categories of "non-medical" factors that influenced physicians' decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept. CONCLUSION Physicians consider numerous "non-medical" factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.
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Affiliation(s)
- Rashida T Campwala
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mail Stop 113, Los Angeles, CA, 90027, USA. .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Anita R Schmidt
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mail Stop 113, Los Angeles, CA, 90027, USA
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mail Stop 113, Los Angeles, CA, 90027, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alan L Nager
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mail Stop 113, Los Angeles, CA, 90027, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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12
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Fridh I, Åkerman E. Family‐centred end‐of‐life care and bereavement services in Swedish intensive care units: A cross‐sectional study. Nurs Crit Care 2019; 25:291-298. [DOI: 10.1111/nicc.12480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Isabell Fridh
- Faculty of Caring Science, Work Life and Social WelfareUniversity of Borås Borås Sweden
- Department of Anesthesiology and Intensive CareSahlgrenska University Hospital Gothenburg Sweden
| | - Eva Åkerman
- Intensive Care Unit, Department of Perioperative Medicine and Intensive CareKarolinska University Hospital Stockholm Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and SocietyKarolinska Institutet Stockholm Sweden
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Georgiou L, Georgiou A. A critical review of the factors leading to cardiopulmonary resuscitation as the default position of hospitalized patients in the USA regardless of severity of illness. Int J Emerg Med 2019; 12:9. [PMID: 31179942 PMCID: PMC6416939 DOI: 10.1186/s12245-019-0225-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Physicians are occasionally faced with patients requesting full resuscitation against medical advice. More commonly, neither patients nor their family members make such a request, but physicians simply presume that providing cardiopulmonary resuscitation comports with the patient's wishes. In the USA, in contrast to other countries, a unilateral Do-Not-Resuscitate order by the physician is either forbidden by State Statute or not enforced by hospital policy. Unless otherwise specified, performing cardiopulmonary resuscitation on all hospitalized patients, regardless of the severity of the underlying illness, is the default position. Unlike other medical interventions, no deference is given to the medical judgment of the physician even when a patient is in the last days of a terminal illness. We examine the factors that have led to cardiopulmonary resuscitation having this unique status. MAIN BODY A review of the historical factors leading to cardiopulmonary resuscitation as the default position was undertaken. Articles published in the medical literature, lay-press articles, legislative enactments of law, and judicial opinions involving the issue of Do-Not-Resuscitate and cardiopulmonary resuscitation were reviewed regarding their impact on physician and hospital practice in the USA. CONCLUSION A critical review of the historical factors reveals that the rapid dissemination of cardiopulmonary training for the public, inaccuracies in the media regarding successful cardiopulmonary resuscitation, well-meaning legislative efforts with inadvertent consequences, and judicial interpretation outside the generally accepted concept of malpractice law have contributed to the situation faced by today's physicians and hospitals in the USA.
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Affiliation(s)
- Loukas Georgiou
- Rhodes College, 2000 North Parkway, Box 1641, Memphis, TN 38112 USA
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14
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Tíscar-González V, Blanco-Blanco J, Gea-Sánchez M, Rodriguez Molinuevo A, Moreno-Casbas T. Nursing knowledge of and attitude in cardiopulmonary arrest: cross-sectional survey analysis. PeerJ 2019; 7:e6410. [PMID: 30746310 PMCID: PMC6368968 DOI: 10.7717/peerj.6410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/07/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. That is why it is crucial that they keep their knowledge and skills up-to-date and their attitudes to resuscitation are very important. The main aim of this study was to analyse whether the level of theoretical and practical understanding affected the attitudes of nursing staff. METHODS A questionnaire was designed using the Delphi technique (three rounds). The questionnaire was adjusted and it was piloted on a test-retest basis with a convenience sample of 30 registered nurses. The psychometric characteristics were evaluated using a sample of 347 nurses using Cronbach's alpha. Descriptive analysis was performed to describe the sociodemographic variables and Spearman's correlation coefficient to assess the relationship between two scale variables. Pearson's chi-squared test has been used to study the relationship between two categorical variables. Wilcoxon Mann Whitney test and the Kruskal-Wallis test were performed to establish relationships between the demographic/work related characteristics and the level of understanding. RESULTS The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic information, theoretical and practical understanding, and attitudes of ethical issues. Cronbach's alpha for the internal consistency of the attitudes questionnaire was 0.621. The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly affected their attitudes. Their responses raised a number of bioethical issues. CONCLUSIONS CAEPCR questionnaire is the first one which successfully linked knowledge of cardiopulmonary resuscitation to the attitudes towards ethical issues Health policies should ensure that CPR training is mandatory for nurses and all healthcare workers, and this training should include the ethical aspects.
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Affiliation(s)
| | - Joan Blanco-Blanco
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Group for the Study of Society Health Education and Culture, GESEC, University of Lleida, Faculty of Nursing and Physiotherapy, Lleida, Spain
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
| | - Montserrat Gea-Sánchez
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Group for the Study of Society Health Education and Culture, GESEC, University of Lleida, Faculty of Nursing and Physiotherapy, Lleida, Spain
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
| | | | - Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit, Institute of Health Carlos III, Madrid, Spain
- CIBERFES, Institute of Health Carlos III, Madrid, Spain
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Hansen C, Lauridsen KG, Schmidt AS, Løfgren B. Decision-making in cardiac arrest: physicians' and nurses' knowledge and views on terminating resuscitation. Open Access Emerg Med 2018; 11:1-8. [PMID: 30588135 PMCID: PMC6305156 DOI: 10.2147/oaem.s183248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Many cardiopulmonary resuscitation (CPR) attempts are unsuccessful and must be terminated. On the contrary, premature termination results in a self-fulfilling prophecy. This study aimed to investigate 1) physicians’ self-assessed competence in terminating CPR, 2) physicians’ and nurses’ knowledge of the European Resuscitation Council guidelines on termination, and 3) single factors leading to termination. Methods Questionnaires were distributed at advanced cardiac life support (ACLS) courses at a university hospital in Denmark. Participants included ACLS health care providers, ie, physicians and nurses from cardiac arrest teams, intensive care and anesthetic units or medical wards with a duty to provide ACLS. Physicians were divided into junior physicians (house officers) and experienced physicians (specialist registrars and consultants). Results Overall, 308 participants responded (104 physicians and 204 nurses, response rate: 98%). Among physicians, 37 (36%) did not feel competent to decide when to terminate CPR (junior physicians: n=16, 64%, compared with experienced physicians: n=21, 28%, P=0.002). Two (2%) physicians and one (0.5%) nurse were able to state the contents of termination guidelines. Several factors were reported to impact termination, including absence of a pupillary light reflex (physicians: 17%, nurses: 22%) and cardiac standstill on echocardiography (physicians: 18%, nurses: 20%). Moreover, nine (9%) physicians and 35 (17%) nurses would terminate prolonged CPR despite a shockable rhythm present. Conclusion One-third of all physicians did not feel competent to decide when to terminate CPR. Physicians’ and nurses’ knowledge of termination guidelines was poor, and both professions reported unvalidated or controversial factors as a single reason for terminating CPR.
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Affiliation(s)
- Camilla Hansen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark, .,Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark, .,Clinical Research Unit, Randers Regional Hospital, Randers, Denmark
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark, .,Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark, .,Clinical Research Unit, Randers Regional Hospital, Randers, Denmark
| | - Anders S Schmidt
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark, .,Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark, .,Clinical Research Unit, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark, .,Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark, .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark, .,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,
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Fitzgibbon JB, Lovallo E, Escajeda J, Radomski MA, Martin-Gill C. Feasibility of Out-of-Hospital Cardiac Arrest Ultrasound by EMS Physicians. PREHOSP EMERG CARE 2018; 23:297-303. [PMID: 30192687 DOI: 10.1080/10903127.2018.1518505] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) has been suggested as a useful tool to predict survival and guide interventions in out-of-hospital cardiac arrest (OHCA). While POCUS has been deployed in prehospital settings, a minimal amount of data exists on prehospital use, particularly by personnel with limited ultrasound experience. We aimed to characterize the feasibility and barriers to prehospital POCUS during OHCA by emergency medicine services (EMS) physicians in training. METHODS We deployed the SonoSite iViz portable ultrasound device for use by EMS physicians for OHCA in an urban EMS system. All physicians received POCUS education as part of their graduate medical training and were provided an instructional video on use of the SonoSite iViz device. POCUS use was limited to identifying cardiac motion during pulse checks, without interrupting resuscitation, and the results could be used to supplement management at the physicians' discretion. Data were recorded prospectively by saving images on the device and through a custom electronic form within the patient care report. The primary measure was the frequency of use of POCUS during OHCA. Secondarily, we characterized agreement by expert (ultrasound fellowship trained) faculty (using a kappa statistic) and identified reported barriers to the use of prehospital POCUS. RESULTS From November 2016 to March 2017, 348 physician field responses were reviewed, including 127 cases of OHCA. There were 106 patients remaining in arrest on physician arrival, with 56 (52.8%) cases of POCUS use. Still or video images were recorded in 48 cases; video in 34 cases. From video images, agreement in identifying cardiac motion between the EMS physician and expert reviewer occurred in 91% of cases (K = 0.82). Reasons cited for not using POCUS included return of circulation soon before or after arrival, prioritizing clinical interventions, not having the ultrasound device, mechanical failure, and cessation of resuscitation per advanced directives. CONCLUSION Use of POCUS by EMS physicians to detect cardiac activity in OHCA is feasible and correlates with expert interpretation. Several avoidable barriers were identified and should be considered in the future implementation of prehospital POCUS. Larger studies are needed to determine what role POCUS may play in prehospital cardiac arrest management.
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Haugaard SF, Jeppesen AN, Troldborg A, Kirkegaard H, Thiel S, Hvas AM. The complement lectin pathway after cardiac arrest. Scand J Immunol 2018; 88:e12680. [PMID: 29885250 DOI: 10.1111/sji.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/05/2018] [Indexed: 02/06/2023]
Abstract
The lectin pathway (LP) of the complement system may initiate inflammatory reactions when body tissue is altered. We aimed to investigate the levels of the LP proteins in out-of-hospital cardiac arrest patients, and to compare these with healthy individuals. Furthermore, we aimed to clarify whether the duration of targeted temperature management influenced LP protein levels, and we further examined whether LP proteins were associated with 30-day mortality. We included 82 patients resuscitated from out-of-hospital cardiac arrest. The patients were randomly assigned to 24 or 48 hours of targeted temperature management at 33 ± 1°C. Blood samples were obtained 22, 46 and 70 hours after target temperature was reached. Levels of the LP proteins (mannan-binding lectin [MBL], M-ficolin, H-ficolin, collectin liver 1 [CL-L1], MBL-associated serine protease 1 [MASP-1], MASP-2, MASP-3 and MBL-associated protein of 44 kDa [MAp44]) were measured using time-resolved immunofluorometric assays. Data from 82 gender matched healthy individuals were used for comparison. Levels of CL-L1, MASP-1, MASP-2 and MAp44 were significantly higher, whereas M-ficolin levels were significantly lower in cardiac arrest patients compared with healthy individuals. MASP-2, MASP-3 and M-ficolin levels changed significantly when comparing 24 and 48 hours of targeted temperature management. The LP protein levels were not different between 30-day survivors and non-survivors after cardiac arrest. The differences in LP protein levels between patients and healthy individuals may indicate that cardiac arrest patients have an activated LP. Overall, the LP protein levels were not influenced by the duration of targeted temperature management, and the levels were not associated with 30-day mortality.
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Affiliation(s)
- S F Haugaard
- Department of Clinical Biochemistry, Centre for Hemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - A N Jeppesen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - A Troldborg
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - H Kirkegaard
- Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - A-M Hvas
- Department of Clinical Biochemistry, Centre for Hemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
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Malek MM, Abdul Rahman NN, Hasan MS, Haji Abdullah L. Islamic Considerations on the Application of Patient's Autonomy in End-of-Life Decision. JOURNAL OF RELIGION AND HEALTH 2018; 57:1524-1537. [PMID: 29417395 DOI: 10.1007/s10943-018-0575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In end-of-life situation, the need for patient's preference comes into the picture with the intention of guiding physicians in the direction of patient care. Preference in medical directive is made by a person with full mental capacity outlining what actions should be taken for his health should he loses his competency. This is based on the reality of universal paradigm in medical practice that emphasises patient's autonomy. A specific directive is produced according to a patient's wish that might include some ethically and religiously controversial directives such as mercy killing, physician-assisted suicide, forgoing life-supporting treatments and do-not-resuscitate. In the future, patient autonomy is expected to become prevalent. The extent of patient autonomy has not been widely discussed among Muslim scholars. In Islam, there are certain considerations that must be adhered to.
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Affiliation(s)
- Mohammad Mustaqim Malek
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Centre for Science and Environment Studies, Institute of Islamic Understanding Malaysia, No. 2, Langgak Tunku, Off Jalan Tuanku Abdul Halim, 50480, Kuala Lumpur, Malaysia.
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Luqman Haji Abdullah
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Factors associated with nurses' perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: A cross-sectional survey. Int J Nurs Stud 2018; 87:103-112. [PMID: 30096577 DOI: 10.1016/j.ijnurstu.2018.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Family presence during resuscitation is not widely implemented in clinical practice. Prior research about nurse factors that may influence their decision to invite family members to remain in the room during resuscitation is contradictory and inconclusive. OBJECTIVES To describe intensive care unit nurses' perceptions, self-confidence, and invitations of family presence during resuscitation, and to evaluate differences according to nurse factors. DESIGN A cross-sectional survey design was used for descriptive and correlational analyses. SETTING Data collection occurred online. PARTICIPANTS A convenience sample of 395 nurses working in intensive care units across the United States was obtained. METHODS Participants completed a survey to collect personal, professional, and workplace information. The Family Presence Risk-Benefit Scale and Family Presence Self-confidence Scale were administered, and frequency of inviting family members to be in the room during resuscitation was collected by self-report. Following descriptive analysis of univariate distributions, a series of hierarchical OLS regression analyses was used to identify which personal, professional, or workplace factors yielded the largest unique impact on nurse perceptions, self-confidence, and invitations of family presence during resuscitation. RESULTS Despite high frequency of performing resuscitative care, one-third of participants had never invited family members to be in the room during resuscitation during their careers, and another 33% had invited family members to be present just 1-5 times. Having had clinical experience with family presence during resuscitation was the strongest predictor of positive perceptions, higher self-confidence, and increased invitations. In addition, having received education on family presence during resuscitation and a written facility policy were found to be key professional and workplace predictors of perceptions and invitations. CONCLUSIONS Nurses who work in a facility with a policy on family presence during resuscitation, are educated on it, and have experienced it in the clinical setting are more likely to have positive perceptions and higher self-confidence, and to invite family members to be in the room during resuscitation with increased frequency. Nurses in leadership roles should create policies for their units and provide education to nurses and other healthcare providers. Due to the apparent importance of clinical experience with family presence during resuscitation, it is recommended to initially provide this experience using simulation and role modeling.
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[Presence of relatives during cardiopulmonary resuscitation: Perspectives of health professionals, patients and family in the Basque Country]. Aten Primaria 2018; 51:269-277. [PMID: 29571750 PMCID: PMC6837081 DOI: 10.1016/j.aprim.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/02/2017] [Accepted: 12/31/2017] [Indexed: 11/29/2022] Open
Abstract
Objetivo Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos. Diseño Se desarrolló un estudio cualitativo exploratorio y un análisis temático. Emplazamiento Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud. Participantes La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos. Método Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1. Resultados Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales. Conclusiones La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones.
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Bossaert L, Perkins G, Askitopoulou H, Raffay V, Greif R, Haywood K, Mentzelopoulos S, Nolan J, Van de Voorde P, Xanthos T. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0329-z] [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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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 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Medical emergency teams (METs) implement do not attempt cardiopulmonary resuscitation (DNACPR) orders and other limitations of medical treatment (LOMTs) in hospitals regularly. However, METs operate in emergency situations with limited or no patient information at the scene. We aimed to study the medical ethics of LOMTs implemented in in-hospital emergency situations. METHODS This was a prospective observational study with retrospect case-note analysis conducted in a single Finnish university hospital over 16 months. Data were collected according to the Utstein-style scientific statement. RESULTS There were 774 reviews on 640 patients without preceding LOMT. During the reviews MET assigned LOMTs (including 55 DNACPR orders) for a group of 59 patients who were older (median 77 vs. 68 years; P<0.001) and had higher cumulative comorbidity (median Charlson comorbidity index 2 vs. 1; P=0.001) compared with patients without LOMTs (no-LOMT). Most reviews (71%) leading to new LOMTs occurred during on-call time. In the majority of LOMT cases at least two physicians (86%) and the patient/relatives (76%) were involved in the decision-making. All but one (98%) of the LOMT reviews were documented in the electronic patient records and included clearly described rationale for the LOMT. The median durations of the MET reviews (31 vs. 31 min, P=0.9) were comparable in the two groups. Age alone was never recorded as a reason for LOMT. CONCLUSION LOMTs were implemented in a decent and ethically justified manner in emergency situations following the code of conduct recommended by guidelines, even though MET operated under highly suboptimal circumstances for end-of-life care planning.
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Szarpak L, Truszewski Z, Vitale J, Glosser L, Ruetzler K, Rodríguez-Núñez A. Exchange of supraglottic airways for endotracheal tube using the Eschmann Introducer during simulated child resuscitation: A randomized study comparing 4 devices. Medicine (Baltimore) 2017; 96:e7177. [PMID: 28658109 PMCID: PMC5500031 DOI: 10.1097/md.0000000000007177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the application of the Eschmann tracheal tube introducer (ETTI) with 4 types of supraglottic airway devices (SADs) using a child-manikin. METHODS A total of 79 paramedics were asked to exchange the 4 SADs for an endotracheal tube with the ETTI in 3 different scenarios using a randomized crossover study format: normal airway without chest compression; normal airway with uninterrupted chest compression; and difficult airway with uninterrupted chest compression. The primary outcome was time to SAD exchange, with the secondary outcome measuring the success of SAD exchange. Each attempt was assessed by a trained assistant. RESULTS The mean exchange times for LMA, Cobra PLA, Air-Q, and SALT were as follows: 21, 23, 21, and 18, respectively for Scenario A; 23, 27, 22.5, and 21 for Scenario B; and 23, 28, 23, and 23 for Scenario C. The percent efficacy of SADs exchange with LMA, Cobra PLA, Air-Q and SALT were 98.7%, 94.9%, 100%, and 100% for scenario A; 98.7%, 88.6%, 98.7%, and 97.5% for scenario B; and 93.7%, 87.3%, 94.9%, and 93.7% for scenario C. CONCLUSIONS In this model of pediatric resuscitation, the SAD exchange using an ETTI has (LMA, Cobra PLA, Air-Q and SALT) proved to be effective in paramedics with no previous experience. Furthermore, experimental findings indicated that SAD exchange can be achieved without interrupting chest compression.
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Affiliation(s)
- Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Kurt Ruetzler
- Department of General Anesthesiology and Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Antonio Rodríguez-Núñez
- Pediatric Emergency and Critical Care Division and Institute of Investigation of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS, CLINURSID Investigation Group, Nursing Department, Universidade de Santiago de Compostela, SAMID Network, Madrid, Spain
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25
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Zali M, Hassankhani H, Powers KA, Dadashzadeh A, Rajaei Ghafouri R. Family presence during resuscitation: A descriptive study with Iranian nurses and patients' family members. Int Emerg Nurs 2017; 34:11-16. [PMID: 28528270 DOI: 10.1016/j.ienj.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family presence during resuscitation (FPDR) has advantages for the patients' family member to be present at the bedside. However, FPDR is not regularly practiced by nurses, especially in low to middle income countries. The purpose of this study was to determine Iranian nurses' and family members' attitudes towards FPDR. METHOD In a descriptive study, data was collected from the random sample of 178 nurses and 136 family members in four hospitals located in Iran. A 27-item questionnaire was used to collect data on attitudes towards FPDR, and descriptive and correlational analyses were conducted. RESULTS Of family members, particularly the women, 57.2% (n=78) felt it is their right to experience FPDR and that it has many advantages for the family; including the ability to see that everything was done and worry less. However, 62.5% (n=111) of the nurses disagreed with an adult implementation of FPDR. Nurses perceived FPDR to have many disadvantages. Family members becoming distressed and interfering with the patient which may prolong the resuscitation effort. Nurses with prior education on FPDR were more willing to implement it. CONCLUSION FPDR was desired by the majority of family members. To meet their needs, it is important to improve Iranian nurses' views about the advantages of the implementation of FPDR. Education on FPDR is recommended to improve Iranian nurses' views about the advantages of the implementation of FPDR.
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Affiliation(s)
- Mahnaz Zali
- Student's Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hadi Hassankhani
- Center of Qualitative Studies, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Kelly A Powers
- School of Nursing, UNC Charlotte, College of Health and Human Services 428, 9201 University City Blvd., Charlotte, NC 28223, United States.
| | - Abbas Dadashzadeh
- Road Traffic Injury Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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26
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Lauridsen KG, Schmidt AS, Caap P, Aagaard R, Løfgren B. Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study. Open Access Emerg Med 2017; 9:37-41. [PMID: 28331374 PMCID: PMC5349502 DOI: 10.2147/oaem.s124149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19–87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2–10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation.
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Affiliation(s)
- Kasper G Lauridsen
- Department of Internal Medicine; Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital
| | - Anders S Schmidt
- Department of Internal Medicine; Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital
| | - Philip Caap
- Research Center for Emergency Medicine, Aarhus University Hospital; Institute of Clinical Medicine, Aarhus University, Aarhus
| | - Rasmus Aagaard
- Clinical Research Unit, Regional Hospital of Randers, Randers; Research Center for Emergency Medicine, Aarhus University Hospital; Department of Anesthesiology, Randers Regional Hospital, Denmark
| | - Bo Løfgren
- Department of Internal Medicine; Research Center for Emergency Medicine, Aarhus University Hospital; Institute of Clinical Medicine, Aarhus University, Aarhus
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27
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Xiong Y, Zhan H, Lu Y, Guan K, Okoro N, Mitchell D, Dwyer M, Leatham A, Salazar G, Liao X, Idris A. Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors? Resuscitation 2017; 112:28-33. [DOI: 10.1016/j.resuscitation.2016.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
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28
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Wagemans AMA, van Schrojenstein Lantman-de Valk HMJ, Proot IM, Bressers AM, Metsemakers J, Tuffrey-Wijne I, Groot M, Curfs LMG. Do-Not-Attempt-Resuscitation orders for people with intellectual disabilities: dilemmas and uncertainties for ID physicians and trainees. The importance of the deliberation process. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:245-254. [PMID: 27561444 DOI: 10.1111/jir.12333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Not much is known about Do-Not-Attempt-Resuscitation (DNAR) decision-making for people with intellectual disabilities (IDs). The aim of this study was to clarify the problems and pitfalls of non-emergency DNAR decision-making for people with IDs, from the perspective of ID physicians. METHODS This qualitative study was based on semi-structured individual interviews, focus group interviews and an expert meeting, all recorded digitally and transcribed verbatim. Forty ID physicians and trainees were interviewed about problems, pitfalls and dilemmas of DNAR decision-making for people with IDs in the Netherlands. Data were analysed using Grounded Theory procedures. RESULTS The core category identified was 'Patient-related considerations when issuing DNAR orders'. Within this category, medical considerations were the main contributory factor for the ID physicians. Evaluation of quality of life was left to the relatives and was sometimes a cause of conflicts between physicians and relatives. The category of 'The decision-maker role' was as important as that of 'The decision procedure in an organisational context'. The procedure of issuing a non-emergency DNAR order and the embedding of this procedure in the health care organisation were important for the ID physicians. CONCLUSION The theory we developed clarifies that DNAR decision-making for people with IDs is complex and causes uncertainties. This theory offers a sound basis for training courses for physicians to deal with uncertainties regarding DNAR decision-making, as well as a method for advance care planning. Health care organisations are strongly advised to implement a procedure regarding DNAR decision-making.
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Affiliation(s)
- A M A Wagemans
- Maasveld, Koraalgroep, Maastricht, The Netherlands
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- CAPHRI (School of Primary Care and Public Health), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H M J van Schrojenstein Lantman-de Valk
- CAPHRI (School of Primary Care and Public Health), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I M Proot
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- CAPHRI (School of Primary Care and Public Health), Maastricht University Medical Centre, Maastricht, The Netherlands
- RVE Patient & Care, University Hospital Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A M Bressers
- Maasveld, Koraalgroep, Maastricht, The Netherlands
| | - J Metsemakers
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- RVE Patient & Care, University Hospital Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - I Tuffrey-Wijne
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom
| | - M Groot
- Radboud University Nijmegen Medical Centre, Department of Anesthesiology, Pain and Palliative Medicine, Nijmegen, The Netherlands
| | - L M G Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- CAPHRI (School of Primary Care and Public Health), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
Sudden cardiac death (SCD) is a major cause of mortality worldwide. Similar to the number of SCDs in western countries including the USA, the number of SCDs in China is ∼544,000 annually. However, there are significant differences in patient characteristics between Chinese primary prevention population and U.S. primary prevention population. In contrast to western countries where implantable cardioverter-defibrillator (ICD) devices have been well adopted as a major effective method for both primary and secondary prevention of SCD, China has a low prevalence of ICD utilization (∼1.5 device per 1 million people). Socioeconomic and political factors, awareness and knowledge of SCD, and the difference in disease patterns have led to the underutilization of ICD in China. China, as the most populated and the second largest economic country in the world, has now taken variable approaches to address this pressing health problem and enhances the delivery of lifesaving therapies, including arrhythmia ablation and medical treatment besides ICD, to patients who are at risk of SCD.
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Affiliation(s)
- Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Clinical EP Lab and Arrhythmic Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Beijing 100037, PR China
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30
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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: 925] [Impact Index Per Article: 115.6] [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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31
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Lederman Z. Family presence during cardiopulmonary resuscitation: Evidence-based guidelines? Resuscitation 2016; 105:e5-6. [DOI: 10.1016/j.resuscitation.2016.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/23/2016] [Accepted: 04/06/2016] [Indexed: 11/26/2022]
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Haydon G, van der Riet P, Maguire J. Survivors' quality of life after cardiopulmonary resuscitation: an integrative review of the literature. Scand J Caring Sci 2016; 31:6-26. [DOI: 10.1111/scs.12323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Gunilla Haydon
- Faculty of Health and Medicine; School of Nursing and Midwifery; University of Newcastle; Newcastle NSW Australia
| | - Pamela van der Riet
- Faculty of Health and Medicine; School of Nursing and Midwifery; University of Newcastle; Newcastle NSW Australia
| | - Jane Maguire
- Faculty of Health and Medicine; School of Nursing and Midwifery; University of Newcastle; Newcastle NSW Australia
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Sauneuf B, Bouffard C, Cornet E, Daubin C, Brunet J, Seguin A, Valette X, Chapuis N, du Cheyron D, Parienti JJ, Terzi N. Immature/total granulocyte ratio improves early prediction of neurological outcome after out-of-hospital cardiac arrest: the MyeloScore study. Ann Intensive Care 2016; 6:65. [PMID: 27422256 PMCID: PMC4947062 DOI: 10.1186/s13613-016-0170-4] [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: 01/22/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA. Methods This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012–2014) after successfully resuscitated OHCA. The I/T-G ratio was determined in blood samples collected at admission. Results We studied 204 patients (77 % male, median age, 58 [48–67] years), of whom 64 % had a suspected cardiac cause of OHCA, 62 % died in the unit, and 31.5 % survived with good cerebral function. Independent outcome predictors by multivariate analysis were age, first shockable rhythm, bystander-initiated resuscitation, and I/T-G ratio. Compared to the model computed without the I/T-G ratio, the model with the ratio performed significantly better [areas under the ROC curves (AUCs), 0.78 vs. 0.83, respectively; P = 0.04]. These items were used to develop the MyeloScore equation: ([0.47 × I/T-G ratio] + [0.023 × age in years]) − 1.26 if initial VF/VT − 1.1 if bystander-initiated CPR. The MyeloScore predicted neurological outcomes with similar accuracy to the previously reported OHCA score (0.83 and 0.85, respectively; P = 0.6). The ROC–AUC was 0.84, providing external validation of the MyeloScore. Conclusions The I/T-G ratio independently predicts neurological outcome after OHCA and, when added to other known risk factors, improves neurological outcome prediction. The clinical performance of the MyeloScore requires evaluation in a prospective study.
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Affiliation(s)
- Bertrand Sauneuf
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France.
| | - Claire Bouffard
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Edouard Cornet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4652 - MILPAT, Université de Caen Basse-Normandie, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Cedric Daubin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Jennifer Brunet
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Amélie Seguin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Xavier Valette
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hôpital Cochin, AP-HP, Paris, France.,Institut Cochin, CNRS (UMR8104), INSERM, U1016, Université Paris Descartes, Paris, France
| | - Damien du Cheyron
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Inserm U 1075 COMETE, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.,HP2, Inserm U1042, Université Grenoble-Alpes, 38000, Grenoble, France.,Service de réanimation médicale, CHU Grenoble Alpes, 38000, Grenoble, France.,Faculté de Médecine, Université Grenoble-Alpes, 38000, Grenoble, France
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Enriquez D, Mastandueno R, Flichtentrei D, Szyld E. Relatives' Presence During Cardiopulmonary Resuscitation. Glob Heart 2016; 12:335-340.e1. [PMID: 27264608 DOI: 10.1016/j.gheart.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The question of whether or not to allow family to be present during resuscitation is relevant to everyday professional health care assistance, but it remains largely unexplored in the medical literature. OBJECTIVES We conducted an online survey with the aim of increasing our knowledge and understanding of this issue. METHODS This is a cross-sectional, multicenter, descriptive, national, and international study using a web-based, voluntary survey. The survey was designed and distributed through a medical website in Spanish, targeting physicians who frequently deal with critical patients. RESULTS A total of 1,286 Argentine physicians and 1,848 physicians from other countries responded to this voluntary survey. Of Argentine respondents, 15.8% (203) treat only children, 68.2% (877) treat adults, and 16% (206) treat patients of any age. The survey found that 23% (296) of Argentine and 20% of other respondents favor the presence of family members during cardiopulmonary resuscitation (p = 0.03). This practice was more common among physicians treating pediatric and neonatal patients than among those who treat adults. The most commonly reported reason (21.8%) for avoiding the presence of relatives was concerns that physicians, communications, and medical practices might be misunderstood or misinterpreted. CONCLUSIONS Avoiding relatives' presence while performing cardiopulmonary resuscitation is the most frequent choice made by the surveyed physicians who treat critical Argentine patients. The main causes for discouraging family presence during cardiopulmonary resuscitation or other critical procedures include the following: risk of misinterpretation of the physician's actions and/or words; risk of a relative's decompensation; uncertainty about possible reactions; and interpretation of the relative's presence as negative.
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Affiliation(s)
- Diego Enriquez
- Simulación Médica Roemmers (SIMMER) Buenos Aires, Argentina
| | | | | | - Edgardo Szyld
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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35
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De Stefano C, Normand D, Jabre P, Azoulay E, Kentish-Barnes N, Lapostolle F, Baubet T, Reuter PG, Javaud N, Borron SW, Vicaut E, Adnet F. Family Presence during Resuscitation: A Qualitative Analysis from a National Multicenter Randomized Clinical Trial. PLoS One 2016; 11:e0156100. [PMID: 27253993 PMCID: PMC4890739 DOI: 10.1371/journal.pone.0156100] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The themes of qualitative assessments that characterize the experience of family members offered the choice of observing cardiopulmonary resuscitation (CPR) of a loved one have not been formally identified. METHODS AND FINDINGS In the context of a multicenter randomized clinical trial offering family members the choice of observing CPR of a patient with sudden cardiac arrest, a qualitative analysis, with a sequential explanatory design, was conducted. The aim of the study was to understand family members' experience during CPR. All participants were interviewed by phone at home three months after cardiac arrest. Saturation was reached after analysis of 30 interviews of a randomly selected sample of 75 family members included in the trial. Four themes were identified: 1- choosing to be actively involved in the resuscitation; 2- communication between the relative and the emergency care team; 3- perception of the reality of the death, promoting acceptance of the loss; 4- experience and reactions of the relatives who did or did not witness the CPR, describing their feelings. Twelve sub-themes further defining these four themes were identified. Transferability of our findings should take into account the country-specific medical system. CONCLUSIONS Family presence can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death and of having participated in this important moment. Our results showed the central role of communication between the family and the emergency care team in facilitating the acceptance of the reality of death.
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Affiliation(s)
- Carla De Stefano
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, Paris, France
- Paris 13 Sorbonne University, Paris Cité, Laboratoire UTRPP (EA 4403), Inserm 669, France, 93000 Bobigny, France
- * E-mail:
| | - Domitille Normand
- AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, Paris, France
| | - Patricia Jabre
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- Inserm U970, Centre de Recherche Cardiovasculaire de Paris, Université Paris Descartes, Paris, France
- AP-HP, Samu de Paris, hôpital Necker-Enfants Malades, Paris, France
| | - Elie Azoulay
- AP-HP, réanimation médicale, hôpital Saint-Louis, Paris, France
| | | | - Frederic Lapostolle
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- Paris 13 Sorbonne University, Paris Cité, EA 3509, 93000 Bobigny, France
| | - Thierry Baubet
- AP-HP, Department of Child and Adolescent Psychiatry and General Psychiatry, Avicenne Hospital, Paris, France
- Paris 13 Sorbonne University, Paris Cité, Laboratoire UTRPP (EA 4403), Inserm 669, France, 93000 Bobigny, France
| | - Paul-Georges Reuter
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- Paris 13 Sorbonne University, Paris Cité, EA 3509, 93000 Bobigny, France
| | - Nicolas Javaud
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- Paris 13 Sorbonne University, Paris Cité, EA 3509, 93000 Bobigny, France
| | - Stephen W. Borron
- Department of Emergency Medicine, Texas Tech University HSC, El Paso, TX, United States of America
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, hôpital Fernand Widal, Paris, France
| | - Frederic Adnet
- AP-HP, Urgences, Samu 93, hôpital Avicenne, 93000 Bobigny, France
- Paris 13 Sorbonne University, Paris Cité, EA 3509, 93000 Bobigny, France
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Lin BC, Chen CW, Chen CC, Kuo CL, Fan IC, Ho CK, Liu IC, Chan TC. Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA). Int J Health Geogr 2016; 15:17. [PMID: 27225882 PMCID: PMC4881177 DOI: 10.1186/s12942-016-0046-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrence of out-of-hospital cardiac arrest (OHCA) is a critical life-threatening event which frequently warrants early defibrillation with an automated external defibrillator (AED). The optimization of allocating a limited number of AEDs in various types of communities is challenging. We aimed to propose a two-stage modeling framework including spatial accessibility evaluation and priority ranking to identify the highest gaps between demand and supply for allocating AEDs. METHODS In this study, a total of 6135 OHCA patients were defined as demand, and the existing 476 publicly available AEDs locations and 51 emergency medical service (EMS) stations were defined as supply. To identify the demand for AEDs, Bayesian spatial analysis with the integrated nested Laplace approximation (INLA) method is applied to estimate the composite spatial risks from multiple factors. The population density, proportion of elderly people, and land use classifications are identified as risk factors. Then, the multi-criterion two-step floating catchment area (MC2SFCA) method is used to measure spatial accessibility of AEDs between the spatial risks and the supply of AEDs. Priority ranking is utilized for prioritizing deployment of AEDs among communities because of limited resources. RESULTS Among 6135 OHCA patients, 56.85 % were older than 65 years old, and 79.04 % were in a residential area. The spatial distribution of OHCA incidents was found to be concentrated in the metropolitan area of Kaohsiung City, Taiwan. According to the posterior mean estimated by INLA, the spatial effects including population density and proportion of elderly people, and land use classifications are positively associated with the OHCA incidence. Utilizing the MC2SFCA for spatial accessibility, we found that supply of AEDs is less than demand in most areas, especially in rural areas. Under limited resources, we identify priority places for deploying AEDs based on transportation time to the nearest hospital and population size of the communities. CONCLUSION The proposed method will be beneficial for optimizing resource allocation while considering multiple local risks. The optimized deployment of AEDs can broaden EMS coverage and minimize the problems of the disparity in urban areas and the deficiency in rural areas.
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Affiliation(s)
- Bo-Cheng Lin
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
| | - Chao-Wen Chen
- />Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- />Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - Chien-Chou Chen
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
| | - Chiao-Ling Kuo
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
- />Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
| | - I-chun Fan
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
- />Institute of History and Philology, Academia Sinica, Taipei, Taiwan
| | - Chi-Kung Ho
- />Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan
- />Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chuan Liu
- />Fire Bureau, Kaohsiung City Government, Kaohsiung, Taiwan
| | - Ta-Chien Chan
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
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Szarpak L, Truszewski Z, Smereka J, Krajewski P, Fudalej M, Adamczyk P, Czyzewski L. A Randomized Cadaver Study Comparing First-Attempt Success Between Tibial and Humeral Intraosseous Insertions Using NIO Device by Paramedics: A Preliminary Investigation. Medicine (Baltimore) 2016; 95:e3724. [PMID: 27196493 PMCID: PMC4902435 DOI: 10.1097/md.0000000000003724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Medical personnel may encounter difficulties in obtaining intravenous (IV) access during cardiac arrest. The 2015 American Heart Association guidelines and the 2015 European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) suggest that rescuers establish intraosseous (IO) access if an IV line is not easily obtainable.The aim of the study was to compare the success rates of the IO proximal tibia and proximal humerus head access performed by paramedics using the New Intraosseous access device (NIO; Persys Medical, Houston, TX, USA) in an adult cadaver model during simulated CPR.In an interventional, randomized, crossover, single-center cadaver study, a semi-automatic spring-load driven NIO access device was investigated. In total, 84 paramedics with less than 5-year experience in Emergency Medical Service participated in the study. The trial was performed on 42 adult cadavers. In each cadaver, 2 IO accesses to the humerus head, and 2 IO accesses to the proximal tibia were obtained.The success rate of the first IO attempt was 89.3% (75/84) for tibial access, and 73.8% (62/84) for humeral access (P = 0.017). The procedure times were significantly faster for tibial access [16.8 (interquartile range, IQR, 15.1-19.9] s] than humeral access [26.7 (IQR, 22.1-30.9) s] (P < 0.001).Tibial IO access is easier and faster to put in place than humeral IO access. Humeral IO access can be an alternative method to tibial IO access. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02700867.
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Affiliation(s)
- Lukasz Szarpak
- From the Department of Emergency Medicine (LS, ZT), Medical University of Warsaw, Warsaw; Department of Emergency Medical Service (JS), Wroclaw Medical University, Wroclaw; Department of Forensic Medicine (PK, MF); Student Research Circle at the Department of Emergency Medicine (PA); and Department of Nephrologic Nursing (LC), Medical University of Warsaw, Warsaw, Poland
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Pérez Pérez FM. [The suitability of therapeutic effort: An end-of-life strategy]. Semergen 2016; 42:566-574. [PMID: 26811015 DOI: 10.1016/j.semerg.2015.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 01/31/2023]
Abstract
End-of-life treatment and attention to the needs of relatives are not adequate for several reasons: Society denies or hides the death; it is very difficult to predict it accurately; treatment is frequently fragmented between different specialists, and there is insufficient palliative medicine training, including communication skills. There are frequent conflicts with decisions made at the end of life, particularly the suitability of therapeutic effort. The attitude of professionals on the adequacy of therapeutic effort is not homogenous, and varies depending on the specialty, experience, and beliefs. Many doctors are still afraid of inconveniencing patients. Primary care is in a privileged position to approach the life and values of our patients and their families, and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.
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Affiliation(s)
- F M Pérez Pérez
- Servicio Provincial de Cádiz de Emergencias Sanitarias 061 Andalucía, Hospital Clínico de Puerto Real, Puerto Real, Cádiz, España.
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Verhaert DVM, Bonnes JL, Nas J, Keuper W, van Grunsven PM, Smeets JLRM, de Boer MJ, Brouwer MA. Termination of resuscitation in the prehospital setting: A comparison of decisions in clinical practice vs. recommendations of a termination rule. Resuscitation 2016; 100:60-5. [PMID: 26774173 DOI: 10.1016/j.resuscitation.2015.12.014] [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: 09/18/2015] [Revised: 12/08/2015] [Accepted: 12/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Of the proposed algorithms that provide guidance for in-field termination of resuscitation (TOR) decisions, the guidelines for cardiopulmonary resuscitation (CPR) refer to the basic and advanced life support (ALS)-TOR rules. To assess the potential consequences of implementation of the ALS-TOR rule, we performed a case-by-case evaluation of our in-field termination decisions and assessed the corresponding recommendations of the ALS-TOR rule. METHODS Cohort of non-traumatic out-of-hospital cardiac arrest (OHCA)-patients who were resuscitated by the ALS-practising emergency medical service (EMS) in the Nijmegen area (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). RESULTS Of the 598 cases reviewed, resuscitative efforts were terminated in the field in 46% and 15% survived to discharge. The ALS-TOR rule would have recommended in-field termination in only 6% of patients, due to high percentages of witnessed arrests (73%) and bystander CPR (54%). In current practice, absence of ROSC was the most important determinant of termination [aOR 35.6 (95% CI 18.3-69.3)]. Weaker associations were found for: unwitnessed and non-public arrests, non-shockable initial rhythms and longer EMS-response times. CONCLUSION While designed to optimise hospital transportations, application of the ALS-TOR rule would almost double our hospital transportation rate to over 90% of OHCA-cases due to the favourable arrest circumstances in our region. Prior to implementation of the ALS-TOR rule, local evaluation of the potential consequences for the efficiency of triage is to be recommended and initiatives to improve field-triage for ALS-based EMS-systems are eagerly awaited.
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Affiliation(s)
- Dominique V M Verhaert
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Judith L Bonnes
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Joris Nas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Wessel Keuper
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Pierre M van Grunsven
- Regional Ambulance Service Gelderland-Zuid, Professor Bellefroidstraat 11, 6525 AG Nijmegen, The Netherlands
| | - Joep L R M Smeets
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Menko Jan de Boer
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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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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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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Bogdański Ł, Truszewski Z, Kurowski A, Czyżewski Ł, Zaśko P, Adamczyk P, Szarpak Ł. Simulated endotracheal intubation of a patient with cervical spine immobilization during resuscitation: a randomized comparison of the Pentax AWS, the Airtraq, and the McCoy Laryngoscopes. Am J Emerg Med 2015; 33:1814-7. [DOI: 10.1016/j.ajem.2015.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/16/2015] [Accepted: 09/17/2015] [Indexed: 11/15/2022] Open
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Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fukuda T, Ohashi-Fukuda N, Matsubara T, Doi K, Kitsuta Y, Nakajima S, Yahagi N. Trends in Outcomes for Out-of-Hospital Cardiac Arrest by Age in Japan: An Observational Study. Medicine (Baltimore) 2015; 94:e2049. [PMID: 26656330 PMCID: PMC5008475 DOI: 10.1097/md.0000000000002049] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022] Open
Abstract
Population aging has rapidly advanced throughout the world and the elderly accounting for out-of-hospital cardiac arrest (OHCA) has increased yearly.We identified all adults who experienced an out-of-hospital cardiac arrest in the All-Japan Utstein Registry of the Fire and Disaster Management Agency, a prospective, population-based clinical registry, between 2005 and 2010. Using multivariable regression, we examined temporal trends in outcomes for OHCA patients by age, as well as the influence of advanced age on outcomes. The primary outcome was a favorable neurological outcome at 1 month after OHCA.Among 605,505 patients, 454,755 (75.1%) were the elderly (≥65 years), and 154,785 (25.6%) were the oldest old (≥85 years). Although neurological outcomes were worse as the age group was older (P < 0.0001 for trend), there was a significant trend toward improved neurological outcomes during the study period by any age group (P < 0.005 for trend). After adjustment for temporal trends in various confounding variables, neurological outcomes improved yearly in all age groups (18-64 years: adjusted OR per year 1.15 [95% CI 1.13-1.18]; 65-84 years: adjusted OR per year 1.12 [95% CI 1.10-1.15]; and ≥85 years: adjusted OR per year 1.08 [95% CI 1.04-1.13]). Similar trends were found in the secondary outcomes.Although neurological outcomes from OHCA ware worse as the age group was older, the rates of favorable neurological outcomes have substantially improved since 2005 even in the elderly, including the oldest old. Careful consideration may be necessary in limiting treatment on OHCA solely for the reason of advanced age.
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Affiliation(s)
- Tatsuma Fukuda
- From the Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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Goto Y, Funada A, Nakatsu-Goto Y. Neurological outcomes in children dead on hospital arrival. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:410. [PMID: 26581332 PMCID: PMC4652393 DOI: 10.1186/s13054-015-1132-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/06/2015] [Indexed: 11/21/2022]
Abstract
Introduction Obtaining favorable neurological outcomes is extremely difficult in children transported to a hospital without a prehospital return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). However, the crucial prehospital factors affecting outcomes in this cohort remain unclear. We aimed to determine the prehospital factors for survival with favorable neurological outcomes (Cerebral Performance Category 1 or 2 (CPC 1–2)) in children without a prehospital ROSC after OHCA. Methods Of 9093 OHCA children, 7332 children (age <18 years) without a prehospital ROSC after attempting resuscitation were eligible for enrollment. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2008 to 2012. The primary endpoint was 1-month CPC 1–2 after OHCA. Results The 1-month survival and 1-month CPC 1–2 rates were 6.92 % (n = 508) and 0.99 % (n = 73), respectively. The proportions of the following prehospital variables were significantly higher in the 1-month CPC 1–2 cohort than in the 1-month CPC 3–5 cohort: age (median, 3 years (interquartile range (IQR), 0–14) versus 1 year (IQR, 0–11), p <0.05), bystander-witnessed arrest (52/73 (71.2 %) versus 1830/7259 (25.2 %), p <0.001), initial ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) rhythm (28/73 (38.3 %) versus 241/7259 (3.3 %), p <0.001), presumed cardiac causes (42/73 (57.5 %) versus 2385/7259 (32.8 %), p <0.001), and actual shock delivery (25/73 (34.2 %) versus 314/7259 (4.3 %), p <0.0001). Multivariate logistic regression analysis indicated that 2 prehospital factors were associated with 1-month CPC 1–2: initial non-asystole rhythm (VF/pulseless VT: adjusted odds ratio ( aOR), 16.0; 95 % confidence interval (CI), 8.05–32.0; pulseless electrical activity (PEA): aOR, 5.19; 95 % CI, 2.77–9.82) and bystander-witnessed arrest (aOR, 3.22; 95 % CI, 1.84–5.79). The rate of 1-month CPC 1–2 in witnessed-arrest children with an initial VF/pulseless VT was significantly higher than that in those with other initial cardiac rhythms (15.6 % versus 2.3 % for PEA and 1.2 % for asystole, p for trend <0.001). Conclusions The crucial prehospital factors for 1-month survival with favorable neurological outcomes after OHCA were initial non-asystole rhythm and bystander-witnessed arrest in children transported to hospitals without a prehospital ROSC.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Yumiko Nakatsu-Goto
- Department of Cardiology, Yawata Medical Center, 12-7 I Yawata, Komatsu, 923-8551, Japan.
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Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. J Formos Med Assoc 2015; 115:628-38. [PMID: 26596689 DOI: 10.1016/j.jfma.2015.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.
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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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Szarpak L, Truszewski Z, Czyzewski L, Kurowski A, Bogdanski L, Zasko P. Child endotracheal intubation with a Clarus Levitan fiberoptic stylet vs Macintosh laryngoscope during resuscitation performed by paramedics: a randomized crossover manikin trial. Am J Emerg Med 2015; 33:1547-51. [DOI: 10.1016/j.ajem.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/27/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022] Open
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Xu J, Li C, Zheng L, Han F, Li Y, Walline J, Fu Y, Yao D, Zhang X, Zhang H, Zhu H, Guo S, Wang Z, Yu X. Pulse Oximetry: A Non-Invasive, Novel Marker for the Quality of Chest Compressions in Porcine Models of Cardiac Arrest. PLoS One 2015; 10:e0139707. [PMID: 26485651 PMCID: PMC4613139 DOI: 10.1371/journal.pone.0139707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/16/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Pulse oximetry, which noninvasively detects the blood flow of peripheral tissue, has achieved widespread clinical use. We have noticed that the better the quality of cardiopulmonary resuscitation (CPR), the better the appearance of pulse oximetry plethysmographic waveform (POP). We investigated whether the area under the curve (AUC) and/or the amplitude (Amp) of POP could be used to monitor the quality of CPR. Design Prospective, randomized controlled study. Setting Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China. Subjects Healthy 3-month-old male domestic swine. Interventions 34 local pigs were enrolled in this study. After 4 minutes of untreated ventricular fibrillation, animals were randomly assigned into two resuscitation groups: a “low quality” group (with a compression depth of 3cm) and a “high quality” group (with a depth of 5cm). All treatments between the two groups were identical except for the depth of chest compressions. Hemodynamic parameters [coronary perfusion pressure (CPP), partial pressure of end-tidal carbon dioxide (PETCO2)] as well as AUC and Amp of POP were all collected and analyzed. Measurements and Findings There were statistical differences between the “high quality” group and the “low quality” group in AUC, Amp, CPP and PETCO2 during CPR (P<0.05). AUC, Amp and CPP were positively correlated with PETCO2, respectively (P<0.01). There was no statistical difference between the heart rate calculated according to the POP (FCPR) and the frequency of mechanical CPR at the 3rd minute of CPR. The FCPR was lower than the frequency of mechanical CPR at the 6th and the 9th minute of CPR. Conclusions Both the AUC and Amp of POP correlated well with CPP and PETCO2 in animal models. The frequency of POP closely matched the CPR heart rate. AUC and Amp of POP might be potential noninvasive quality monitoring markers for CPR.
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Affiliation(s)
- Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Chen Li
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | | | - Fei Han
- Institute of Life Monitoring, Mindray Corporation, Shenzhen, China
| | - Yan Li
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Joseph Walline
- Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Dongqi Yao
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Xiaocui Zhang
- Institute of Life Monitoring, Mindray Corporation, Shenzhen, China
| | - Hui Zhang
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Shubin Guo
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
| | - Zhong Wang
- Emergency Department, Beijing Tsinghua Chang Gung Hospital, Beijing, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China
- * E-mail:
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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