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Fishe JN, Crisp AM, Riney L, Bertrand A, Burcham S, Hendry P, Semenova O, Blake KV, Salloum RG. Evaluation of the implementation of evidence-based pediatric asthma exacerbation treatments in a regional consortium of emergency medical Services Agencies. J Asthma 2024; 61:405-416. [PMID: 37930329 PMCID: PMC11035098 DOI: 10.1080/02770903.2023.2280917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Asthma exacerbations are a frequent reason for pediatric emergency medical services (EMS) encounters. The objective of this study was to examine the implementation of evidence-based treatments for pediatric asthma in a regional consortium of EMS agencies. METHODS This retrospective study applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework to data from an EMS agency consortium in the Cincinnati, Ohio region. The study analyzed one year before an oral systemic corticosteroid (OCS) option was added to the agencies' protocol, and five years after the protocol change. We constructed logistic regression models for the primary outcome of Reach, defined as the proportion of pediatric asthma patients who received a systemic corticosteroid. We modeled Maintenance (Reach measured monthly over time) using time series models. RESULTS A total of 713 patients were included, 133 pre- and 580 post-protocol change. In terms of Reach, 3% (n = 4) of eligible patients received a systemic corticosteroid pre-OCS versus 20% (n = 116) post-OCS. Multivariable modeling of Reach revealed the study period, EMS transport time, months since implementation of OCS, and number of bronchodilators administered by EMS as significant covariates for the administration of a systemic corticosteroid. For Maintenance, it took approximately two years to reach maximal administration of systemic corticosteroids. CONCLUSIONS Indicators of asthma severity and time since the protocol change were significantly associated with EMS administration of systemic corticosteroids to pediatric asthma patients. The two-year time for maximal Reach suggests further work is required to understand how to best implement evidence-based pediatric asthma treatments in EMS.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Amy M Crisp
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Lauren Riney
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Bertrand
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Shannon Burcham
- Department of Pediatrics, University of Florida College of Medicine, Cincinnati, OH, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Olga Semenova
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kathryn V Blake
- Nemours Center for Pharmacogenomics and Translational Research, Nemours Children's Clinic, Pensacola, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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2
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Chen X, Li D, He L, Yang W, Dai M, Lan L, Diao D, Zou L, Yao P, Cao Y. The prevalence of anxiety and depression in cardiac arrest survivors: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 83:8-19. [PMID: 37028095 DOI: 10.1016/j.genhosppsych.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE This systematic review aimed to identify the prevalence of anxiety and depression in cardiac arrest (CA) survivors. METHODS A systematic review and network meta-analysis was performed on observational studies in adult cardiac arrest survivors with psychiatric disorders from PubMed, Embase, Cochrane Library and Web of Science. In the meta-analysis, we combined the prevalence quantitatively and analyzed the subgroup based on the classification indexes. RESULTS We identified 32 articles that met the inclusion criteria. Regarding anxiety,the pooled prevalence was 24% (95% CI, 17-31%) and 22% (95% CI, 13-26%) in short-term and long-term respectively. The subgroup analysis showed that the pooled incidence in in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrests (OHCA) survivors was 14.0% (95%CI, 9.0-20.0%) and 28.0% (95%CI, 20.0-36.0%) for short-term anxiety.The incidence of anxiety measured by, Hamilton Anxiety Rating Scale(HAM-A) and State-Trait Anxiety Inventory(STAI) was higher than other tools(P < 0.01). Regarding depression,the data analysis showed that the pooled incidence of short-term and long-term depression was 19% (95% CI, 13-26%) and 19% (95% CI, 16-25%), respectively. The subgroup analysis showed that the incidence of short-term and long-term depression was 8% (95% CI, 1-19%) and 30% (95% CI, 5-64%) for IHCA survivors, and was 18% (95% CI, 11-26%) and 17% (95% CI, 11-25%) for OHCA survivors. The incidence of depression measured by Hamilton Depression Rating Scale(HDRS) and Symptom check list-90(SCL-90) was higher than other assessment tools(P < 0.01). CONCLUSIONS The meta-analysis indicated a high prevalence of anxiety and depression in CA survivors, and those symptoms persisted 1 year or more after CA. Evaluation tool is an important factor affecting the measurement results.
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Affiliation(s)
- Xiaoli Chen
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Min Dai
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Lin Lan
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Dongmei Diao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Peng Yao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China; Disaster Medical Center, Sichuan University, Chengdu, China.
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3
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Wu SN, Tsai MS, Huang CH, Chen WJ. Omecamtiv mecarbil treatment improves post-resuscitation cardiac function and neurological outcome in a rat model. PLoS One 2022; 17:e0264165. [PMID: 35176110 PMCID: PMC8853579 DOI: 10.1371/journal.pone.0264165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Myocardial dysfunction is a major cause of poor outcomes in the post-cardiac arrest period. Omecamtiv mecarbil (OM) is a selective small molecule activator of cardiac myosin that prolongs myocardial systole and increases stroke volume without apparent effects on myocardial oxygen demand. OM administration is safe and improves cardiac function in patients with acute heart failure. Whether OM improves post-resuscitation myocardial dysfunction remains unclear. This study investigated the effect of OM treatment on post-resuscitation myocardial dysfunction and outcomes. Methods and results Adult male rats were resuscitated after 9.5 min of asphyxia-induced cardiac arrest. OM and normal saline was continuously intravenously infused after return of spontaneous circulation (ROSC) at 0.25 mg/kg/h for 4 h in the experimental group and control group, respectively (n = 20 in each group). Hemodynamic parameters were measured hourly and monitored for 4 h after cardiac arrest. Recovery of neurological function was evaluated by neurological functioning scores (0–12; favorable: 11–12) for rats 72 h after cardiac arrest. OM treatment prolonged left ventricular ejection time and improved post-resuscitation cardiac output. Post-resuscitation heart rate and left ventricular systolic function (dp/dt40) were not different between groups. Kaplan-Meier analysis showed non-statistically higher 72-h survival in the OM group (72.2% [13/18] and 58.8% [10/17], p = 0.386). The OM group had a higher chance of having favorable neurological outcomes in surviving rats 72 h after cardiac arrest (84.6% [11/13] vs. 40% [4/10], p = 0.026). The percentage of damaged neurons was lower in the OM group in a histology study at 72 h after cardiac arrest (55.5±2.3% vs. 76.2±10.2%, p = 0.004). Conclusions OM treatment improved post-resuscitation myocardial dysfunction and neurological outcome in an animal model. These findings support further pre-clinical studies to improve outcomes in post-cardiac arrest care.
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Affiliation(s)
- Shih-Ni Wu
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
- * E-mail:
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
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4
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Granfeldt A, Holmberg MJ, Donnino MW, Andersen LW. 2015 Guidelines for Cardiopulmonary Resuscitation and survival after adult and paediatric out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:407-415. [PMID: 32232441 DOI: 10.1093/ehjqcco/qcaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate whether the introduction of the 2015 Guidelines for Cardiopulmonary Resuscitation were associated with a change in outcomes after out-of-hospital cardiac arrest (OHCA). METHODS AND RESULTS Patients with OHCA were divided into adults (≥18 years) and paediatric cases (<18 years). An interrupted time-series analysis was used to compare survival before (pre-guidelines 1 January 2013 to 31 October 2015) and after (post-guidelines 1 May 2016 to 31 December 2018) introduction of the 2015 guidelines. We fitted a regression model after dividing the time-period into segments with separate intercept and slope estimates. We included 309 499 adults and 8668 children with OHCA. There was no difference in the change in survival to hospital discharge with a favourable functional outcome per year between the two periods for adults {slope difference: -0.07% [95% confidence interval (CI) -0.30 to 0.16], P = 0.55} and paediatric cases [slope difference: -0.01% (95% CI -1.35 to 1.32), P = 0.98]. Likewise, we found no immediate change in survival to hospital discharge with a favourable functional outcome between the two periods for adults [0.20% (95% CI -0.21 to 0.61), P = 0.33] and paediatric cases [-1.08 (95% CI -3.44 to 1.27), P = 0.37]. CONCLUSION Publication of the 2015 Guidelines for Cardiopulmonary Resuscitation was not associated with an increase in survival to hospital discharge with a favourable functional outcome after OHCA. Outcomes for OHCA have not improved the last 6 years in the USA.
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Affiliation(s)
- Asger Granfeldt
- Department of Anesthesiology and Intensive Care Medicine, Randers Regional Hospital, Randers, Skovlyvej 15, 8930 Randers, Denmark.,Department of Intensive Care, Aarhus University Hospital, Palle Juul Jensens Blvd. 99 G304, 8200 Aarhus, Denmark
| | - Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Palle Juul Jensens Blvd. J301, 8200 Aarhus, Denmark.,Department of Emergency Medicine, Horsens Regional Hospital, Horsens, Sundvej 30, 8700 Horsens, Denmark.,Department of Emergency Medicine, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Road Boston, MA 02115, USA
| | - Michael W Donnino
- Department of Emergency Medicine, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Road Boston, MA 02115, USA.,Division of Pulmonary and Critical Care, Department of Internal Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road Boston, MA 02115, USA
| | - Lars W Andersen
- Department of Anesthesiology and Intensive Care Medicine, Randers Regional Hospital, Randers, Skovlyvej 15, 8930 Randers, Denmark.,Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Palle Juul Jensens Blvd. J301, 8200 Aarhus, Denmark.,Department of Emergency Medicine, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Road Boston, MA 02115, USA
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Meta-Analysis Comparing Cardiac Arrest Outcomes Before and After Resuscitation Guideline Updates. Am J Cardiol 2020; 125:618-629. [PMID: 31858970 DOI: 10.1016/j.amjcard.2019.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/22/2022]
Abstract
Updates of resuscitation guidelines have limited high-level supporting evidence. Moreover, the overall effect of such bundled practice changes depends not only on the impact of the individual interventions but also on their interplay and swift functioning of the entire chain of survival. Therefore, real-world data monitoring is essential. We performed a meta-analysis of comparative studies on outcomes before and after successive guideline updates. On January 16, 2019, we searched for comparative studies (PubMed, Web-of-Science, Embase, and the Cochrane Libraries) reporting outcomes before and after resuscitation guidelines 2005, 2010, and 2015. We followed PRISMA, Cochrane, and Moose-recommendations. Studies on outcomes during the 2005 versus 2000 guideline period (n = 23; 40,859 patients) reported significantly higher ROSC (odds ratio [OR] 1.21 [1.04 to 1.42], p = 0.014), survival to admission (OR 1.34 [1.09 to 1.65], p = 0.005), survival to discharge (OR 1.46 [1.25 to 1.70], p <0.001), and favorable neurologic outcome (OR 1.35 [1.01 to 1.81], p = 0.040). Studies on outcomes during the 2010 versus 2005 guideline period (n = 11; 1,048,112 patients) indicated no difference in ROSC (OR 1.25 [95% confidence interval 0.95 to 1.63], p = 0.11), whereas survival to discharge improved significantly (OR 1.30 [1.17 to 1.45], p <0.001). Only 2 studies reported on neurologic outcomes, both showing improved outcome after the 2010 guideline update. No data on the 2015 guidelines were available. This meta-analysis on real-world data of >1 million patients demonstrates improved outcomes after the 2005 and 2010 resuscitation guideline updates, and a lack of data on the 2015 guideline. In conclusion, although limited in terms of causality, this study suggests that the sum of all efforts to improve outcomes, including updated CPR guidelines, contributed to increased survival after cardiac arrest.
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Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
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7
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Tahsili-Fahadan P, Farrokh S, Geocadin RG. Hypothermia and brain inflammation after cardiac arrest. Brain Circ 2018; 4:1-13. [PMID: 30276330 PMCID: PMC6057700 DOI: 10.4103/bc.bc_4_18] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 03/17/2018] [Accepted: 03/18/2018] [Indexed: 12/14/2022] Open
Abstract
The cessation (ischemia) and restoration (reperfusion) of cerebral blood flow after cardiac arrest (CA) induce inflammatory processes that can result in additional brain injury. Therapeutic hypothermia (TH) has been proven as a brain protective strategy after CA. In this article, the underlying pathophysiology of ischemia-reperfusion brain injury with emphasis on the role of inflammatory mechanisms is reviewed. Potential targets for immunomodulatory treatments and relevant effects of TH are also discussed. Further studies are needed to delineate the complex pathophysiology and interactions among different components of immune response after CA and identify appropriate targets for clinical investigations.
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Affiliation(s)
- Pouya Tahsili-Fahadan
- Department of Medicine, Virginia Commonwealth University, Falls Church, Virginia, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salia Farrokh
- Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Romergryko G Geocadin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fishe JN, Crowe RP, Cash RE, Nudell NG, Martin-Gill C, Richards CT. Implementing Prehospital Evidence-Based Guidelines: A Systematic Literature Review. PREHOSP EMERG CARE 2018; 22:511-519. [PMID: 29351495 DOI: 10.1080/10903127.2017.1413466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE As prehospital research advances, more evidence-based guidelines (EBGs) are implemented into emergency medical services (EMS) practice. However, incomplete or suboptimal prehospital EBG implementation may hinder improvement in patient outcomes. To inform future efforts, this study's objective was to review existing evidence pertaining to prehospital EBG implementation methods. METHODS This study was a systematic literature review and evaluation following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. PubMed, EMBASE, Scopus, and Google Advanced Search were searched without language or publication date filters for articles addressing prehospital EBG implementation. Conference proceedings, textbooks, and non-English articles were excluded. GRADE was applied to the remaining articles independently by three of five study investigators. Study characteristics and salient findings from the included articles are reported. RESULTS The systematic literature review identified 1,367 articles, with 41 meeting inclusion criteria. Most articles described prehospital EBG implementation (n = 24, 59%), or implementation barriers (n = 13, 32%). Common study designs were statement documents (n = 12, 29%), retrospective cohort studies (n = 12, 29%), and cross-sectional studies (n = 9, 22%). Using GRADE, evidence quality was rated low (n = 18, 44%), or very low (n = 23, 56%). Salient findings from the articles included: (i) EBG adherence and patient outcomes depend upon successful implementation, (ii) published studies generally lack detailed implementation methods, (iii) EBG implementation takes longer than planned (mostly for EMS education), (iv) EMS systems' heterogeneity affects EBG implementation, and (v) multiple barriers limit successful implementation (e.g., financial constraints, equipment purchasing, coordination with hospitals, and regulatory agencies). This review found no direct evidence for best prehospital EBG implementation practices. There were no studies comparing implementation methods or implementation in different prehospital settings (e.g., urban vs. rural, advanced vs. basic life support). CONCLUSIONS While prehospital EBG implementation barriers are well described, there is a paucity of evidence for optimal implementation methods. For scientific advances to reach prehospital patients, EBG development efforts must translate into EMS practice. Future research should consider comparing implementation methodologies in different prehospital settings, with a goal of defining detailed, reproducible best practices.
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What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada. CAN J EMERG MED 2017; 18:223-9. [PMID: 27138217 DOI: 10.1017/cem.2016.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Geocadin RG, Wijdicks E, Armstrong MJ, Damian M, Mayer SA, Ornato JP, Rabinstein A, Suarez JI, Torbey MT, Dubinsky RM, Lazarou J. Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 88:2141-2149. [PMID: 28490655 DOI: 10.1212/wnl.0000000000003966] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/01/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the evidence and make evidence-based recommendations for acute interventions to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation. METHODS Published literature from 1966 to August 29, 2016, was reviewed with evidence-based classification of relevant articles. RESULTS AND RECOMMENDATIONS For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-34°C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A). For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (36°C for 24 hours, followed by 8 hours of rewarming to 37°C, and temperature maintenance below 37.5°C until 72 hours) is likely as effective as TH and is an acceptable alternative (Level B). For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered (Level C). Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered (Level A). Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed.
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Affiliation(s)
- Romergryko G Geocadin
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Eelco Wijdicks
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Melissa J Armstrong
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Maxwell Damian
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Stephan A Mayer
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Joseph P Ornato
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Alejandro Rabinstein
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - José I Suarez
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Michel T Torbey
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Richard M Dubinsky
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
| | - Jason Lazarou
- From the Departments of Neurology, Anesthesiology-Critical Care Medicine, and Neurosurgery (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (E.W., A.R.), Mayo Clinic, Rochester, MN; Department of Neurology (M.J.A.), University of Florida-McKnight Brain Institute, Gainesville; Department of Neurology and Neurocritical Care Unit (M.D.), Cambridge University Hospitals; The Ipswich Hospital (M.D.), Cambridge, UK; Departments of Neurology and Neurosurgery (S.A.M.), Mount Sinai-Icahn School of Medicine, New York, NY; Departments of Emergency Medicine and Internal Medicine (Cardiology) (J.P.O.), Virginia Commonwealth University College of Medicine, Richmond; Department of Neurology (J.I.S.), Baylor College of Medicine, Houston, TX; Department of Neurology and Neurosurgery (M.T.T.), Ohio State University, Columbus; Department of Neurology (R.M.D.), Kansas University Medical Center, Kansas City; and Department of Neurology (J.L.), University of Toronto, Canada
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Survival, expenditure and disposition in patients following out-of-hospital cardiac arrest: 1995–2013. Resuscitation 2017; 113:13-20. [DOI: 10.1016/j.resuscitation.2016.12.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/27/2016] [Accepted: 12/26/2016] [Indexed: 11/20/2022]
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Urocortin Treatment Improves Acute Hemodynamic Instability and Reduces Myocardial Damage in Post-Cardiac Arrest Myocardial Dysfunction. PLoS One 2016; 11:e0166324. [PMID: 27832152 PMCID: PMC5104489 DOI: 10.1371/journal.pone.0166324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023] Open
Abstract
Aims Hemodynamic instability occurs following cardiac arrest and is associated with high mortality during the post-cardiac period. Urocortin is a novel peptide and a member of the corticotrophin-releasing factor family. Urocortin has the potential to improve acute cardiac dysfunction, as well as to reduce the myocardial damage sustained after ischemia reperfusion injury. The effects of urocortin in post-cardiac arrest myocardial dysfunction remain unclear. Methods and Results We developed a preclinical cardiac arrest model and investigated the effects of urocortin. After cardiac arrest induced by 6.5 min asphyxia, male Wistar rats were resuscitated and randomized to either the urocortin treatment group or the control group. Urocortin (10 μg/kg) was administrated intravenously upon onset of resuscitation in the experimental group. The rate of return of spontaneous circulation (ROSC) was similar between the urocortin group (76%) and the control group (72%) after resuscitation. The left ventricular systolic (dP/dt40) and diastolic (maximal negative dP/dt) functions, and cardiac output, were ameliorated within 4 h after ROSC in the urocortin-treated group compared to the control group (P<0.01). The neurological function of surviving animals was better at 6 h after ROSC in the urocortin-treated group (p = 0.023). The 72-h survival rate was greater in the urocortin-treated group compared to the control group (p = 0.044 by log-rank test). Cardiomyocyte apoptosis was lower in the urocortin-treated group (39.9±8.6 vs. 17.5±4.6% of TUNEL positive nuclei, P<0.05) with significantly increased Akt, ERK and STAT-3 activation and phosphorylation in the myocardium (P<0.05). Conclusions Urocortin treatment can improve acute hemodynamic instability as well as reducing myocardial damage in post-cardiac arrest myocardial dysfunction.
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Nolan JP, Hazinski MF, Aickin R, Bhanji F, Billi JE, Callaway CW, Castren M, de Caen AR, Ferrer JME, Finn JC, Gent LM, Griffin RE, Iverson S, Lang E, Lim SH, Maconochie IK, Montgomery WH, Morley PT, Nadkarni VM, Neumar RW, Nikolaou NI, Perkins GD, Perlman JM, Singletary EM, Soar J, Travers AH, Welsford M, Wyllie J, Zideman DA. Part 1: Executive summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2016; 95:e1-31. [PMID: 26477703 DOI: 10.1016/j.resuscitation.2015.07.039] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Applying hospital evidence to paramedicine: issues of indirectness, validity and knowledge translation. CAN J EMERG MED 2016; 17:281-5. [PMID: 26034914 DOI: 10.1017/cem.2015.65] [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] [Indexed: 01/22/2023]
Abstract
The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.
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Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, Castren M, de Caen AR, Ferrer JME, Finn JC, Gent LM, Griffin RE, Iverson S, Lang E, Lim SH, Maconochie IK, Montgomery WH, Morley PT, Nadkarni VM, Neumar RW, Nikolaou NI, Perkins GD, Perlman JM, Singletary EM, Soar J, Travers AH, Welsford M, Wyllie J, Zideman DA. Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S2-39. [PMID: 26472854 DOI: 10.1161/cir.0000000000000270] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Blewer AL, Buckler DG, Li J, Leary M, Becker LB, Shea JA, Groeneveld PW, Putt ME, Abella BS. Impact of the 2010 resuscitation guidelines training on layperson chest compressions. World J Emerg Med 2015; 6:270-6. [PMID: 26693261 DOI: 10.5847/wjem.j.1920-8642.2015.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown whether training laypersons using updated guidelines resulted in changed CPR performance. We hypothesized that laypersons taught CPR using the 2010 guidelines performed deeper and faster compressions than those taught using the 2005 materials. METHODS This work represents a secondary analysis of a study conducted at eight hospitals where family members of hospitalized cardiac patients were trained in CPR. An initial cohort was trained using the 2005 guidelines, and a subsequent cohort was trained using the 2010 guideline materials. Post training, CPR skills were quantified using a recording manikin. RESULTS Between May 2009 to August 2013, 338 subjects completed the assessment. Among the subjects, 176 received 2005 training and 162 underwent 2010 training. The mean compression rate in the 2005 cohort was 87 (95%CI 83-90) per minute, and in the 2010 cohort was 86 (95%CI 83-90) per minute (P=ns), while the mean compression depth was 34 (95%CI 32-35) mm in the 2005 cohort and 46 (95%CI 44-47) mm in the 2010 cohort (P<0.01). CONCLUSIONS Training with the 2010 CPR guidelines resulted in a statistically significant increase in trainees' compression depth but there was no change in compression rate. Nevertheless, the majority of CPR performed by trainees in both cohorts was below the guideline recommendation, highlighting an important gap between training goals and trainee performance.
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Affiliation(s)
- Audrey L Blewer
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David G Buckler
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jiaqi Li
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marion Leary
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA ; School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lance B Becker
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter W Groeneveld
- Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mary E Putt
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Benjamin S Abella
- Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA 19104, USA
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hörburger D, Haslinger J, Bickel H, Graf N, Schober A, Testori C, Weiser C, Sterz F, Haugk M. Where no guideline has gone before: retrospective analysis of resuscitation in the 24th century. Resuscitation 2015; 85:1790-4. [PMID: 25457378 DOI: 10.1016/j.resuscitation.2014.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
AIM OF THE STUDY Evaluation of the treatment, epidemiology and outcome of cardiac arrest in the television franchise Star Trek. METHODS Retrospective cohort study of prospective events. Screening of all episodes of Star Trek: The Next Generation, Star Trek: Deep Space Nine and Star Trek: Voyager for cardiac arrest events. Documentation was performed according to the Utstein guidelines for cardiac arrest documentation. All adult, single person cardiac arrests were included. Patients were excluded if cardiac arrest occurred during mass casualties, if the victims were annihilated by energy weapons or were murdered and nobody besides the assassin could provide first aid. Epidemiological data, treatment and outcome of cardiac arrest victims in the 24th century were studied. RESULTS Ninety-six cardiac arrests were included. Twenty-three individuals were female (24%). Cardiac arrest was witnessed in 91 cases (95%), trauma was the leading cause (n = 38; 40%). Resuscitation was initiated in 17 cases (18%) and 12 patients (13%) had return of spontaneous circulation. Favorable neurological outcome and long-term survival was documented in nine patients (9%). Technically diagnosed cardiac arrest was associated with higher rates of favorable neurological outcome and long-term survival. Neurological outcome and survival did not depend on cardiac arrest location. CONCLUSION Cardiac arrest remains a critical event in the 24th century. We observed a change of etiology from cardiac toward traumatic origin. Quick access to medical help and new prognostic tools were established to treat cardiac arrest.
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Greif R, Lockey A, Conaghan P, Lippert A, De Vries W, Monsieurs K. Ausbildung und Implementierung der Reanimation. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0092-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Ballance JH, Barelli A, Biarent D, Bossaert L, Castrén M, Handley AJ, Lott C, Maconochie I, Nolan JP, Perkins G, Raffay V, Ringsted C, Soar J, Schlieber J, Van de Voorde P, Wyllie J, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:288-301. [DOI: 10.1016/j.resuscitation.2015.07.032] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Daya MR, Schmicker RH, Zive DM, Rea TD, Nichol G, Buick JE, Brooks S, Christenson J, MacPhee R, Craig A, Rittenberger JC, Davis DP, May S, Wigginton J, Wang H. Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC). Resuscitation 2015; 91:108-15. [PMID: 25676321 PMCID: PMC4433591 DOI: 10.1016/j.resuscitation.2015.02.003] [Citation(s) in RCA: 347] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/21/2015] [Accepted: 02/02/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death and a 2010 meta-analysis concluded that outcomes have not improved over several decades. However, guidelines have changed to emphasize CPR quality, minimization of interruptions, and standardized post-resuscitation care. We sought to evaluate whether OHCA outcomes have improved over time among agencies participating in the Resuscitation Outcomes Consortium (ROC) cardiac arrest registry (Epistry) and randomized clinical trials (RCTs). METHODS Observational cohort study of 47,148 EMS-treated OHCA cases in Epistry from 139 EMS agencies at 10 ROC sites that participated in at least one RCT between 1/1/2006 and 12/31/2010. We reviewed patient, scene, event characteristics, and outcomes of EMS-treated OHCA over time, including subgroups with initial rhythm of pulseless ventricular tachycardia or ventricular fibrillation (VT/VF). RESULTS Mean response interval, median age and male proportion remained similar over time. Unadjusted survival to discharge increased between 2006 and 2010 for treated OHCA (from 8.2% to 10.4%), as well as for subgroups of VT/VF (21.4% to 29.3%) and bystander witnessed VT/VF (23.5% to 30.3%). Compared with 2006, adjusted survival to discharge was significantly higher in 2010 for treated cases (OR = 1.72; 95% CI 1.53, 1.94), VT/VF cases (OR = 1.69; 95% CI 1.45, 1.98) and bystander witnessed VT/VF cases (OR = 1.65; 95% CI 1.36, 2.00). Tests for trend in each subgroup were significant (p < 0.001). CONCLUSIONS ROC-wide survival increased significantly between 2006 and 2010. Additional research efforts are warranted to identify specific factors associated with this improvement.
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Affiliation(s)
- Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.
| | - Robert H Schmicker
- University of Washington Clinical Trial Center, Seattle, WA, United States
| | - Dana M Zive
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Thomas D Rea
- University of Washington, Seattle, WA, United States
| | - Graham Nichol
- University of Washington Clinical Trial Center, Seattle, WA, United States; University of Washington, Seattle, WA, United States
| | | | | | | | | | - Alan Craig
- University of Toronto, Toronto, ON, Canada
| | | | - Daniel P Davis
- University of California at San Diego, San Diego, CA, United States
| | - Susanne May
- University of Washington Clinical Trial Center, Seattle, WA, United States
| | - Jane Wigginton
- University of Texas Southwestern, Dallas, TX, United States
| | - Henry Wang
- University of Alabama at Birmingham, Birmingham, AL, United States
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Davis DP, Graham PG, Husa RD, Lawrence B, Minokadeh A, Altieri K, Sell RE. A performance improvement-based resuscitation programme reduces arrest incidence and increases survival from in-hospital cardiac arrest. Resuscitation 2015; 92:63-9. [PMID: 25906942 DOI: 10.1016/j.resuscitation.2015.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Traditional resuscitation training models are inadequate to achieving and maintaining resuscitation competency. This analysis evaluates the effectiveness of a novel, performance improvement-based inpatient resuscitation programme. METHODS This was a prospective, before-and-after study conducted in an urban, university-affiliated hospital system. All inpatient adult cardiac arrest victims without an active Do Not Attempt Resuscitation order from July 2005 to June 2012 were included. The advanced resuscitation training (ART) programme was implemented in Spring 2007 and included a unique treatment algorithm constructed around the capabilities of our providers and resuscitation equipment, a training programme with flexible format and content including early recognition concepts, and a comprehensive approach to performance improvement feeding directly back into training. Our inpatient resuscitation registry and electronic patient care record were used to quantify arrest rates and survival-to-hospital discharge before and after ART programme implementation. Multiple logistic regression analysis was used to adjust for age, gender, location of arrest, initial rhythm, and time of day. RESULTS A total of 556 cardiac arrest victims were included (182 pre- and 374 post-ART). Arrest incidence decreased from 2.7 to 1.2 per 1000 patient discharges in non-ICU inpatient units, with no change in ICU arrest rate. An increase in survival-to-hospital discharge from 21 to 45% (p < 0.01) was observed following ART programme implementation. Adjusted odds ratios for survival-to-discharge (OR 2.2, 95% CI 1.4-3.4) and good neurological outcomes (OR 3.0, 95% CI 1.7-5.3) reflected similar improvements. Arrest-related deaths decreased from 2.1 to 0.5 deaths per 1000 patient discharges in non-ICU areas and from 1.5 to 1.3 deaths per 1000 patient discharges in ICU areas, and overall hospital mortality decreased from 2.2% to 1.8%. CONCLUSIONS Implementation of a novel, performance improvement-based inpatient resuscitation programme was associated with a decrease in the incidence of cardiac arrest and improved clinical outcomes.
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Affiliation(s)
- Daniel P Davis
- Department of Emergency Medicine, University of California at San Diego, United States.
| | - Patricia G Graham
- Department of Nursing Education, Development, Research, University of California at San Diego, United States
| | - Ruchika D Husa
- Division of Cardiology, University of California at San Diego, United States; Division of Cardiology, Ohio State University, United States
| | - Brenna Lawrence
- Department of Nursing, University of California at San Diego, United States
| | - Anushirvan Minokadeh
- Department of Anesthesiology, University of California at San Diego, United States
| | - Katherine Altieri
- School of Medicine, University of California at San Diego, United States
| | - Rebecca E Sell
- Division of Pulmonary and Critical Care Medicine, University of California at San Diego, United States
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Savastano S, Klersy C, Raimondi M, Langord K, Vanni V, Rordorf R, Vicentini A, Petracci B, Landolina M, Visconti LO. Positive trend in survival to hospital discharge after out-of-hospital cardiac arrest. J Cardiovasc Med (Hagerstown) 2014; 17:227. [DOI: 10.2459/jcm.0000000000000040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hahn C, Breil M, Schewe JC, Messelken M, Rauch S, Gräsner JT, Wnent J, Seewald S, Bohn A, Fischer M. Hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest: A matched-pair study from the German Resuscitation Registry. Resuscitation 2014; 85:628-36. [DOI: 10.1016/j.resuscitation.2013.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 12/23/2022]
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Wilder Schaaf KP, Artman LK, Peberdy MA, Walker WC, Ornato JP, Gossip MR, Kreutzer JS. Anxiety, depression, and PTSD following cardiac arrest: A systematic review of the literature. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2012.11.021] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berthelot S, Plourde M, Bertrand I, Bourassa A, Couture MM, Berger-Pelletier É, St-Onge M, Leroux R, Le Sage N, Camden S. Push hard, push fast: quasi-experimental study on the capacity of elementary schoolchildren to perform cardiopulmonary resuscitation. Scand J Trauma Resusc Emerg Med 2013; 21:41. [PMID: 23694715 PMCID: PMC3680201 DOI: 10.1186/1757-7241-21-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal age to begin CPR training is a matter of debate. This study aims to determine if elementary schoolchildren have the capacity to administer CPR efficiently. METHODS This quasi-experimental study took place in a Quebec City school. Eighty-two children 10 to 12 years old received a 6-hour CPR course based on the American Heart Association (AHA) Guidelines. A comparison group of 20 adults who had taken the same CPR course was recruited. After training, participants' performance was evaluated using a Skillreporter manikin. The primary outcome was depth of compressions. The secondary outcomes were compression rate, insufflation volume and adherence to the CPR sequence. Children's performance was primarily evaluated based on the 2005 AHA standards and secondarily compared to the adults' performance. RESULTS Schoolchildren did not reach the lower thresholds for depth (28.1 +/- 5.9 vs 38 mm; one-sided p = 1.0). The volume of the recorded insufflations was sufficient (558.6 +/222.8 vs 500 ml; one-sided p = 0.02), but there were a significant number of unsuccessful insufflation attempts not captured by the Skillreporter. The children reached the minimal threshold for rate (113.9 +/-18.3 vs 90/min; one-sided p < 0.001). They did not perform as well as the adults regarding compression depth (p < 0.001), but were comparable for insufflation volume (p = 0.83) and CPR sequence. CONCLUSIONS In this study, schoolchildren aged 10-12 years old did not achieve the standards for compression depth, but achieved adequate compression rate and CPR sequence. When attempts were successful at generating airflow in the Skillreporter, insufflation volume was also adequate.
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Affiliation(s)
- Simon Berthelot
- Department of Emergency Medicine, CHU de Québec - CHUL, 2705 Boul, Laurier, Québec, Qc G1V 4G2, Canada.
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Impact of the 2005 resuscitation guidelines on patient survival after out-of-hospital cardiac arrest: experience from a 20-year registry in a middle-eastern country. Resuscitation 2013; 84:e97-8. [PMID: 23603457 DOI: 10.1016/j.resuscitation.2013.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/21/2022]
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Are the 2010 guidelines on cardiopulmonary resuscitation lost in translation? A call for increased focus on implementation science. Resuscitation 2013; 84:422-5. [DOI: 10.1016/j.resuscitation.2012.08.336] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/12/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
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Goldberg SA, Metzger JC, Pepe PE. Year in review 2011: Critical Care--Out-of-hospital cardiac arrest and trauma. Crit Care 2012; 16:247. [PMID: 23249434 PMCID: PMC3672581 DOI: 10.1186/cc11832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In 2011, numerous studies were published in Critical Care focusing on out-of-hospital cardiac arrest, cardiopulmonary resuscitation, trauma, and some related airway, respiratory, and response time factors. In this review, we summarize several of these studies, including those that brought forth advances in therapies for the post-resuscitative period. These advances involved hypothesis-generating concepts in therapeutic hypothermia as well as the impact of early percutaneous coronary artery interventions and the potential utility of extracorporeal life support after cardiac arrest. There were also articles pertaining to the importance of timing in prehospital airway management, the outcome impact of hyperoxia, and the timing of end-tidal carbon dioxide measurements to predict futility in cardiac arrest resuscitation. In other articles, additional perspectives were provided on the classic correlations between emergency medical service response intervals and outcomes.
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Affiliation(s)
- Scott A Goldberg
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
| | - Jeffery C Metzger
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
| | - Paul E Pepe
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
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Tagami T, Hirata K, Takeshige T, Matsui J, Takinami M, Satake M, Satake S, Yui T, Itabashi K, Sakata T, Tosa R, Kushimoto S, Yokota H, Hirama H. Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation 2012; 126:589-97. [PMID: 22850361 DOI: 10.1161/circulationaha.111.086173] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Heart Association 2010 resuscitation guidelines recommended adding a fifth link (multidisciplinary postresuscitation care in a regional center) to the previous 4 in the chain of survival concept for out-of-hospital cardiac arrest. Our study aimed to determine the effectiveness of this fifth link. METHODS AND RESULTS This multicenter prospective cohort study involved all eligible out-of-hospital cardiac arrest patients in the Aizu region (n=1482, suburban/rural, Fukushima, Japan). Proportions of favorable neurological outcomes were evaluated before (January 2006-April 2008) and after (January 2009-December 2010) the implementation of the fifth link. After implementation, all patients were transported directly from the field to the tertiary-level hospital or secondarily from an outlying hospital to the tertiary-level hospital after restoration of circulation. The tertiary hospital provided intensive postresuscitation care, including appropriate hemodynamic and respiratory management, therapeutic hypothermia, and percutaneous coronary intervention. One-month survival with a favorable neurological outcome among all patients treated by emergency medical services providers improved significantly after implementation (4 of 770 [0.5%] versus 21 of 712 [3.0%]; P<0.001). The adjusted odds ratios of favorable neurological outcome were 0.9 (95% confidence interval, 0.7-1.1) for early access to emergency medical care, 3.1 (95% confidence interval, 0.7-14.2) for bystander resuscitation, 14.7 (95% confidence interval, 3.2-67.0) for early defibrillation, 1.0 (95% confidence interval, 1.0-1.1) for early advanced life support, and 7.8 (95% confidence interval, 1.6-39.0) for the fifth link. CONCLUSION The proportion of out-of-hospital cardiac arrest patients with a favorable neurological outcome improved significantly after the implementation of the fifth link, which may be an independent predictor of outcome. CLINICAL TRIAL REGISTRATION URL: http://www.apps.who.int/trialsearch. Unique identifier: UMIN000001607.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
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Salciccioli JD, Cristia C, Chase M, Giberson T, Graver A, Gautam S, Cocchi MN, Donnino MW. Performance of SAPS II and SAPS III scores in post-cardiac arrest. Minerva Anestesiol 2012; 78:1341-1347. [PMID: 22743785 PMCID: PMC3760015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Cardiac arrest is a major public health issue affecting an estimated 300,000 patients in the United States each year. The American Heart Association has recommended the Simplified Acute Physiology Score II and III (SAPS) to assess severity of illness and to predict outcomes in the post-cardiac arrest population. Our objective was to determine if SAPS II and SAPS III scores predict outcomes in post-cardiac arrest patients. METHODS We performed an observational study of patients suffering cardiac arrest with return of spontaneous circulation. Data were collected prospectively and recorded in the Utstein style. SAPS II and SAPS III scores were calculated for each subject. Logistic regression was used to assess the relationship between the calculated severity of illness score and in-hospital mortality and poor neurologic outcome. RESULTS A total of 274 subjects were identified for analysis. SAPS II was a significant predictor of in-hospital mortality (OR: 1.05, 95% CI: 1.03-1.07) and poor-neurologic outcome (OR: 1.06, 95%CI: 1.04-1.08). SAPS III was a significant predictor of in-hospital mortality (OR: 1.04, 95%CI: 1.02-1.06) and poor neurologic outcome (OR: 1.04, 95%CI: 1.02-1.05). Both scores had moderate ability to discriminate survivors from non-survivors (SAPS II AUC: 0.70; SAPS III AUC: 0.66), and good neurologic outcome from poor neurologic outcome (SAPS II AUC: 0.71; SAPS III AUC: 0.65). CONCLUSION SAPS II and SAPS III scores have only moderate discrimination and are not clinically relevant tools to predict outcome in post-cardiac arrest patients. Further study is needed to identify a more reliable severity of illness score in the post-arrest population.
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Affiliation(s)
- J D Salciccioli
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Salmen M, Ewy GA, Sasson C. Use of cardiocerebral resuscitation or AHA/ERC 2005 Guidelines is associated with improved survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. BMJ Open 2012; 2:e001273. [PMID: 23036985 PMCID: PMC4401819 DOI: 10.1136/bmjopen-2012-001273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/28/2012] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To determine whether the use of cardiocerebral resuscitation (CCR) or AHA/ERC 2005 Resuscitation Guidelines improved patient outcomes from out-of-hospital cardiac arrest (OHCA) compared to older guidelines. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, Web of Science and the Cochrane Library databases. We also hand-searched study references and consulted experts. STUDY SELECTION Design: randomised controlled trials and observational studies. POPULATION OHCA patients, age >17 years. COMPARATORS 'Control' protocol versus 'Study' protocol. 'Control' protocol defined as AHA/ERC 2000 Guidelines for cardiopulmonary resuscitation (CPR). 'Study' protocol defined as AHA/ERC 2005 Guidelines for CPR, or a CCR protocol. OUTCOME Survival to hospital discharge. QUALITY High-quality or medium-quality studies, as measured by the Newcastle Ottawa Scale using predefined categories. RESULTS Twelve observational studies met inclusion criteria. All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines. Pooled data demonstrate that use of a CCR protocol has an unadjusted OR of 2.26 (95% CI 1.64 to 3.12) for survival to hospital discharge among all cardiac arrest patients. Among witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) patients, CCR increased survival by an OR of 2.98 (95% CI 1.92 to 4.62). Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies. CONCLUSIONS We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines. In the subgroup of patients with witnessed VF/VT, there was a threefold increase in OHCA survival when CCR was used. CCR appears to be a promising resuscitation protocol for Emergency Medical Services providers in increasing survival from OHCA. Future research will need to be conducted to directly compare AHA/ERC 2010 Guidelines with the CCR approach.
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Affiliation(s)
- Marcus Salmen
- Department of Emergency Medicine & Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Gordon A Ewy
- Department of Medicine, University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Comilla Sasson
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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Henry K, Murphy A, Willis D, Cusack S, Bury G, O'Sullivan I, Deasy C. Out-of-hospital cardiac arrest in Cork, Ireland. Emerg Med J 2012; 30:496-500. [PMID: 22707474 DOI: 10.1136/emermed-2011-200888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) in Ireland accounts for approximately 5000 deaths annually. Little published evidence exists on survival from OHCA in this country to date. We aimed to characterise and describe 'presumed cardiac' OHCA in Cork City and County attended by the Ambulance Service. METHODS Dispatch records, ambulance patient records and hospital records for a 1-year period were examined for patient demographics, OHCA characteristics, interventions and patient outcomes. RESULTS There were 231 'presumed cardiac' OHCAs attended over the study period; 130 (56%) were in urban locations and 101 (44%) in rural. OHCAs were lay-witnessed in 20% (n=46), and 22% (n=50) received bystander CPR. Shockable rhythm was present in 36 cases (16%) on initial assessment, and there was no difference in presence of shockable rhythm between urban and rural OHCAs (18% vs 13%, p=0.31). Resuscitation was attempted in 176 cases (77.5%), of whom 27 (15%) achieved return of spontaneous circulation and 13 (7.4%) survived to leave hospital. Survival when the initial rhythm was shockable was 16.7% (6 of 36 patients). Despite longer response times for rural compared with urban OHCAs (median (IQR) 16.5 (11.0-23.5) vs 9 (7-12) min, p<0.001), survival to leave hospital alive where resuscitation was attempted was similar (7.4% vs 7.4%, p=0.99, respectively). CONCLUSION A survival rate of 16.7% in shockable rhythms indicates scope for improvement which would influence the overall survival rate which was found to be 7.4%. Real-time feedback of performance and quality of the continuum of patient care through a clinical-quality cardiac arrest registry would monitor and incentivise such initiatives.
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Affiliation(s)
- Kieran Henry
- National Ambulance Service, HSE Southern Region, South Link Road, Cork, Ireland.
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Post-cardiac arrest myocardial dysfunction is improved with cyclosporine treatment at onset of resuscitation but not in the reperfusion phase. Resuscitation 2012; 82 Suppl 2:S41-7. [PMID: 22208177 DOI: 10.1016/s0300-9572(11)70150-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM OF STUDY Significant myocardial dysfunction and high mortality occur after whole-body ischaemia-eperfusion injuries in the post-cardiac arrest status. The inhibition of mitochondrial permeability transition pore (mPTP) opening during ischaemia-reperfusion can ameliorate injuries in the specific organs. We investigated the effect and therapeutic window of pharmacological inhibition of mPTP opening in cardiac arrest. METHODS Forty male Wistar rats were resuscitated after cardiac arrest induced by 8.5 min of asphyxia. Cyclosporine (10 mg/kg) was administered intravenously at onset of resuscitation in protocol 1 study and administered 3 min after ROSC in protocol 2 with placebo control in both. RESULTS Left ventricular systolic (dP/dt 40), diastolic (maximal negative dP/dt) functions and cardiac output were improved in the group with cyclosporine treatment at onset of resuscitation compared to control group (p < 0.01, respectively). Seventy-two hour survival was better in the group with cyclosporine treatment at onset of resuscitation compared to control (p = 0.046). Left ventricular systolic and diastolic function, cardiac output and 72 h survival were not improved in the group with cyclosporine treatment 3 min after ROSC. The severity of mitochondrial damage under electronic microscopy, mPTP opening, mitochondrial respiratory control ratio and ADP:O ratio were ameliorated in the group with cyclosporine treatment at onset of resuscitation (p< 0.05, respectively) but not in the group with cyclosporine treatment at 3 min after ROSC. CONCLUSIONS Post-cardiac arrest myocardial dysfunction and survival can be improved by cyclosporine treatment at onset of resuscitation, but not by the cyclosporine treatment at 3 min after ROSC.
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Scholefield BR, Bingham RM. Cardiac arrest in infancy; is it always depressing? Resuscitation 2012; 83:541-2. [DOI: 10.1016/j.resuscitation.2012.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
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Topjian AA, Nadkarni VM, Berg RA. Did the 2005 AHA Guidelines bundle improve outcome following out-of-hospital cardiac arrest? Resuscitation 2011; 82:963-4. [DOI: 10.1016/j.resuscitation.2011.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/29/2022]
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