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Considine J, Eastwood K, Webster H, Smyth M, Nation K, Greif R, Dainty K, Finn J, Bray J. Family presence during adult resuscitation from cardiac arrest: A systematic review. Resuscitation 2022; 180:11-23. [PMID: 36087636 DOI: 10.1016/j.resuscitation.2022.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/20/2022]
Abstract
AIM Objective: To conduct a systematic review of the published evidence related to family presence during adult resuscitation from cardiac arrest. METHODS This review, registered with PROSPERO (CRD42021242384) and reported according to PRISMA guidelines, included studies of adult cardiac arrest with family presence during resuscitation that reported one or more patient, family or provider outcomes. Three databases (Medline, CINAHL and EMBASE) were searched from inception to 10/05/2022. Two investigators screened the studies, extracted data, and assessed risks of bias using the Mixed Method Appraisal Tool (MMAT). The synthesis approach was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines and a narrative synthesis method. RESULTS The search retrieved 9,459 citations of which 31 were included: 18 quantitative studies (including two RCTs), 12 qualitative studies, and one mixed methods study. The evidence was of very low or low certainty. There were four major findings. High-certainty evidence regarding the effect of family presence during resuscitation on patient outcomes is lacking. Family members had mixed outcomes in terms of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and experience of witnessing resuscitation. Provider experience was variable and resuscitation setting, provider education, and provider experience were major influences on family presence during resuscitation. Finally, providers reported that a family support person and organisational guidelines were important for facilitating family presence during resuscitation. CONCLUSION The effect of family presence during resuscitation varies between individuals. There was variability in the effect of family presence during resuscitation on patient outcomes, family and provider outcomes and perceptions.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Australia.
| | - Kathryn Eastwood
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Victoria, Australia
| | - Hannah Webster
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Michael Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Kevin Nation
- New Zealand Resuscitation Council, Wellington, New Zealand
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna Austria
| | - Katie Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; North York General Hospital, North York, Ontario, Canada
| | - Judith Finn
- Prehospital, Resuscitation & Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia; St John Western Australia, Australia
| | - Janet Bray
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
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Dadon Z, Fridel T, Einav S. The association between CPR quality of In-hospital resuscitation and sex: A hypothesis generating, prospective observational study. Resusc Plus 2022; 11:100280. [PMID: 35935175 PMCID: PMC9352447 DOI: 10.1016/j.resplu.2022.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the quality of chest compression delivered to men and women. Methods Prospective study of observational data recorded during consecutive resuscitations occurring in a single tertiary center (Feb-1-2015 to Dec-31-2018) with real-time follow-up to hospital discharge. The studied variables included time in CPR, no-flow-time and fraction, compression rate and depth and release velocity. The primary study endpoint was the unadjusted association between patient sex and the chest compression quality (depth and rate). The secondary endpoint was the association between the various components of chest compression quality, sex, and survival to hospital discharge/neurologically intact survival. Results Overall 260 in-hospital resuscitations (57.7% male patients) were included. Among these 100 (38.5%) achieved return of spontaneous circulation (ROSC) and 35 (13.5%) survived to hospital discharge. Female patients were significantly older. Ischemic heart disease and ventricular arrhythmias were more prevalent among males. Compression depth was greater in female vs male patients (54.9 ± 11.3 vs 51.7 ± 10.9 mm; p = 0.024). Other CPR quality-metrics were similar. The rates of ROSC, survival to hospital discharge and neurologically intact survival did not differ between males and females. Univariate analysis revealed no association between sex, quality metrics and outcomes. Discussion Women received deeper chest compressions during in-hospital CPR. Our findings require corroboration in larger cohorts but nonetheless underscore the need to maintain high-quality CPR in all patients using real-time feedback devices. Future studies should also include data on ventilation rates and volumes which may contribute to survival outcomes.
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Baldor DJ, Smyrnios NA, Faris K, Guilarte-Walker Y, Celik U, Torres U. A Controlled Study in CPR-Survival in Propensity Score Matched Full-Code and Do-Not-Resuscitate ICU Patients. J Intensive Care Med 2022; 37:1363-1369. [PMID: 35815880 DOI: 10.1177/08850666221114052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiopulmonary Resuscitation (CPR) causes significant injuries and increased cost among transiently resuscitated patients that do not survive their hospitalizations. Descriptive studies show zero and near-zero percent survival for CPR recipients with high Apache II scores. Despite these factors, no controlled studies exist in CPR to guide patient selection for CPR candidacy. Our objective was therefore to perform a controlled study in CPR to inform recommendations for CPR candidacy. We hypothesize that the protective effects of CPR decrease as illness severity increases, and that Full-Code status provides no survival benefit over Do-Not-Resuscitate (DNR) status for patients with the highest predicted mortality by Apache IV score. METHODS We performed propensity-score matched survival analyzes between Full-Code and DNR patients after stratifying by predicted mortality quartiles using Apache IV scores. Primary outcomes were mortality hazard ratios. Secondary outcomes were Median Survival Differences, ICU LOS, and tracheostomy rates. RESULTS Among 17,710 propensity-score matched ICU encounters, DNR status was associated with greater mortality in the first through third predicted mortality quartiles. There was no difference in survival outcomes in the fourth quartile (HR 0.99, p = .96). There was a stepwise decrease in the mortality hazard ratio for DNR patients as quartiles increased. CONCLUSION Full-Code status provides no survival benefit over DNR status in individuals with greater than 75% predicted mortality by Apache IV score. There is a stepwise decrease in survival benefit for Full-Code patients as predicted mortality increases. We propose that it is reasonable to consider a very high predicted mortality by Apache IV score a contraindication to CPR given the lack of survival benefit seen in these patients. Larger studies with similar methods should be performed to reinforce or refute these findings.
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Affiliation(s)
- Daniel J Baldor
- Department of General Surgery, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Nicholas A Smyrnios
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Khaldoun Faris
- Division of Anesthesiology Critical Care Medicine, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Yurima Guilarte-Walker
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Ugur Celik
- Center for Clinical and Translational Science, Research Informatics Core, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Ulises Torres
- George Washington University School of Medicine, Washington, DC, USA
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Skogvoll E, Skrifvars MB. To what extent do cardiopulmonary resuscitation outcomes vary between hospitals? Acta Anaesthesiol Scand 2022; 66:430-431. [PMID: 35067919 DOI: 10.1111/aas.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Eirik Skogvoll
- Clinic of Anaesthesia and Intensive Care St. Olav University Hospital and Norwegian University of Science and Technology Trondheim Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services Helsinki University Hospital and University of Helsinki Finland
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Hsu SH, Kao PH, Lu TC, Wang CH, Fang CC, Chang WT, Huang CH, Tsai CL. Serum Lactate for Predicting Cardiac Arrest in the Emergency Department. J Clin Med 2022; 11:jcm11020403. [PMID: 35054097 PMCID: PMC8778773 DOI: 10.3390/jcm11020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Early recognition and prevention of in-hospital cardiac arrest (IHCA) play an increasingly important role in the Chain of Survival. However, clinical tools for predicting IHCA in the emergency department (ED) are scanty. We sought to evaluate the role of serum lactate in predicting ED-based IHCA. Methods: Data were retrieved from 733,398 ED visits over a 7-year period in a tertiary medical centre. We selected one ED visit per person and excluded out-of-hospital cardiac arrest, children, or those without lactate measurements. Patient demographics, computerised triage information, and serum lactate levels were extracted. The initial serum lactate levels were grouped into normal (≤2 mmol/L), moderately elevated (2 < lactate ≤ 4), and highly elevated (>4 mmol/L) categories. The primary outcome was ED-based IHCA. Results: A total of 17,392 adult patients were included. Of them, 342 (2%) developed IHCA. About 50% of the lactate levels were normal, 30% were moderately elevated, and 20% were highly elevated. In multivariable analysis, the group with highly elevated lactate had an 18-fold increased risk of IHCA (adjusted odds ratio [OR], 18.0; 95% confidence interval [CI], 11.5-28.2), compared with the normal lactate group. In subgroup analysis, the poor lactate-clearance group (<2.5%/h) was associated with a 7.5-fold higher risk of IHCA (adjusted OR, 7.5; 95%CI, 3.7-15.1) compared with the normal clearance group. Conclusions: Elevated lactate levels and poor lactate clearance were strongly associated with a higher risk of ED-based IHCA. Clinicians may consider a more liberal sampling of lactate in patients at higher risk of IHCA with follow-up of abnormal levels.
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Affiliation(s)
- Shu-Hsien Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
| | - Po-Hsuan Kao
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
| | - Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Cheng-Chung Fang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, 7 Zhongshan S. Rd, Taipei 100, Taiwan; (S.-H.H.); (P.-H.K.); (T.-C.L.); (C.-H.W.); (C.-C.F.); (W.-T.C.); (C.-H.H.)
- Department of Emergency Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, Taipei 100, Taiwan
- Correspondence:
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Alzayer H, Geraghty AM, Sebastian KK, Panesar H, Reddan DN. Dialysis Patients’ Preferences on Resuscitation: A Cross-Sectional Study Design. Can J Kidney Health Dis 2022; 9:20543581221113383. [PMID: 35923181 PMCID: PMC9340425 DOI: 10.1177/20543581221113383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background: End-stage kidney disease is associated with a 10- to 100-fold increase in
cardiovascular mortality compared with age-, sex-, and race-matched
population. Cardiopulmonary resuscitation (CPR) in this cohort has poor
outcomes and leads to increased functional morbidity. Objective: The aim of this study is to assess patients’ preferences toward CPR and
advance care planning (ACP). Design: cross-sectional study design. Setting: Two outpatient dialysis units. Patients: Adults undergoing dialysis for more than 3 months were included. Exclusion
criteria were severe cognitive impairment or non-English-speaking
patients. Measurements: A structured interview with the use of Willingness to Accept Life-Sustaining
Treatment (WALT) tool. Methods: Demographic data were collected, and baseline Montreal Cognitive Assessment,
Patient Health Questionnaire–9, Duke Activity Status Index, Charlson
comorbidity index, and WALT instruments were used. Descriptive analysis,
chi-square, and t test were performed along with
probability plot for testing hypotheses. Results: Seventy participants were included in this analysis representing a 62.5%
response rate. There was a clear association between treatment burden,
anticipated clinical outcome, and the likelihood of that outcome with
patient preferences. Low-burden treatment with expected return to baseline
was associated with 98.5% willingness to accept treatment, whereas
high-burden treatment with expected return to baseline was associated with
94.2% willingness. When the outcome was severe functional or cognitive
impairment, then 45.7% and 28.5% would accept low-burden treatment,
respectively. The response changed based on the likelihood of the outcome.
In terms of resuscitation, more than 75% of the participants would be in
favor of receiving CPR and mechanical ventilation at their current health
state. Over 94% of patients stated they had never discussed ACP, whereas
59.4% expressed their wish to discuss this with their primary
nephrologist. Limitations: Limited generalizability due to lack of diversity. Unclear decision stability
due to changes in health status and patients’ priorities. Conclusions: ACP should be incorporated in managing chronic kidney disease (CKD) to
improve communication and encourage patient involvement.
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Affiliation(s)
- Husam Alzayer
- Department of Nephrology, University Hospital Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin
| | | | - Kuruvilla K. Sebastian
- Department of Renal Medicine, Cork University Hospital, Ireland
- Department of Medicine, National University of Ireland, Galway
- Royal College of Physicians of Ireland, Dublin
| | - Hardarsh Panesar
- Department of Renal Medicine, Cork University Hospital, Ireland
- Western University, London, ON, Canada
| | - Donal N. Reddan
- Department of Nephrology, University Hospital Galway, Ireland
- Royal College of Physicians of Ireland, Dublin
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Cheruku SR, Barina A, Kershaw CD, Goff K, Reisch J, Hynan LS, Ahmed F, Armaignac DL, Patel L, Belden KA, Kaufman M, Christie AB, Deo N, Bansal V, Boman K, Kumar VK, Walkey A, Kashyap R, Gajic O, Fox AA. Palliative care consultation and end-of-life outcomes in hospitalized COVID-19 patients. Resuscitation 2021; 170:230-237. [PMID: 34920014 PMCID: PMC8669976 DOI: 10.1016/j.resuscitation.2021.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023]
Abstract
Rationale The impact of palliative care consultation on end-of-life care has not previously been evaluated in a multi-center study. Objectives To evaluate the impact of palliative care consultation on the incidence of cardiopulmonary resuscitation (CPR) performed and comfort care received at the end-of-life in hospitalized patients with COVID-19. Methods We used the Society of Critical Care Medicine’s COVID-19 registry to extract clinical data on patients hospitalized with COVID-19 between March 31st, 2020 to March 17th, 2021 and died during their hospitalization. The proportion of patients who received palliative care consultation was assessed in patients who did and did not receive CPR (primary outcome) and comfort care (secondary outcome). Propensity matching was used to account for potential confounding variables. Measurements and Main Results 3,227 patients were included in the analysis. There was no significant difference in the incidence of palliative care consultation between the CPR and no-CPR groups (19.9% vs. 19.4%, p = 0.8334). Patients who received comfort care at the end-of-life were significantly more likely to have received palliative care consultation (43.3% vs. 7.7%, p < 0.0001). After propensity matching for comfort care on demographic characteristics and comorbidities, this relationship was still significant (43.2% vs. 8.5%; p < 0.0001). Conclusion Palliative care consultation was not associated with CPR performed at the end-of-life but was associated with increased incidence of comfort care being utilized. These results suggest that utilizing palliative care consultation at the end-of-life may better align the needs and values of patients with the care they receive.
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Affiliation(s)
- Sreekanth R Cheruku
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Alexis Barina
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Corey D Kershaw
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, United States
| | - Joan Reisch
- Department of Population and Data Sciences and Department of Family Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Linda S Hynan
- Department of Population and Data Sciences and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Farzin Ahmed
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, United States
| | - Katherine A Belden
- Division of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Amy B Christie
- Department of Critical Care, Atrium Health Navicent, Macon, GA, United States
| | - Neha Deo
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Vikas Bansal
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Vishakha K Kumar
- Society of Critical Care Medicine, Mount Prospect, IL, United States
| | - Allan Walkey
- Department of Medicine, Evans Center of Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ognjen Gajic
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Amanda A Fox
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, United States; McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, United States
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Hong SI, Kim KW, Ko Y, Kim YJ, Huh JW, Hong SB, Kim WY. Long-Term Outcomes After In-Hospital Cardiac Arrest: Does Pre-arrest Skeletal Muscle Depletion Matter? Front Physiol 2021; 12:692757. [PMID: 34393817 PMCID: PMC8359293 DOI: 10.3389/fphys.2021.692757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Skeletal muscle depletion is prevalent in elderly patients and is associated with unfavorable outcomes in patients with chronic diseases. However, the relationship between skeletal muscle mass and neurological outcomes following in-hospital cardiac arrest (IHCA) has not been evaluated. The aim of this study was to investigate whether skeletal muscle status before cardiac arrest is an independent factor affecting neurological outcomes in patients with IHCA. Methods: We reviewed a prospectively enrolled registry of IHCA patients. Consecutive adult patients (>18 years) admitted to a tertiary care hospital from 2013 to 2019 were included in the study. Of these, 421 patients who underwent abdominopelvic computed tomography within 3 months of cardiac arrest were included. Skeletal muscle index (SMI) was measured at the third lumbar vertebra, and skeletal muscle depletion was defined using sex- and body mass index-specific cutoffs of SMI. The primary outcome was a Cerebral Performance Category score of 1 or 2 at 6 months after cardiac arrest, which was considered a good neurological outcome. Results: Of the 421 patients, 248 (58.9%) had skeletal muscle depletion before IHCA. The patients without skeletal muscle depletion showed significantly better neurological outcomes at 6 months after cardiac arrest than those with pre-arrest muscle depletion (20.8 vs. 10.9%, p = 0.004). The absence of skeletal muscle depletion was significantly associated with good neurological outcomes in a multivariable logistic analysis (OR = 3.49, 95% confidence intervals: 1.83-6.65, p < 0.001), along with the absence of diabetes, presence of active cancer, shockable rhythm, and short resuscitation duration. Conclusion: Pre-arrest skeletal muscle depletion was associated with long-term mortality and poor neurological outcomes after IHCA. Skeletal muscle depletion may be used as a tool to identify at-risk patients who may benefit from aggressive treatments.
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Affiliation(s)
- Seok-In Hong
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Barssoum K, Patel H, Rai D, Kumar A, Hassib M, Othman HF, Thakkar S, El Karyoni A, Idemudia O, Ibrahim F, Salem T, Shariff M, Jabri A, ElBadawi A, Khodjaev S, Bandyopadhyay D, Aronow WS, Parikh V, Rao M, Soon P. Outcomes of Cardiac Arrest and Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Device; an Insight From a National Inpatient Sample. Heart Lung Circ 2021; 31:246-254. [PMID: 34226105 DOI: 10.1016/j.hlc.2021.05.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Outcomes of patients with implanted left ventricular assist device (LVAD) implantation experiencing a cardiac arrest (CA) are not well reported. We aimed at defining the in-hospital outcomes of patients with implanted LVAD experiencing a CA. METHODS The national inpatient sample (NIS) was queried using ICD9/ICD10 codes for patients older than 18 years with implanted LVAD and CA between 2010-2018. We excluded patients with orthotropic heart transplantation, biventricular assist device (BiVAD) implantation and do not resuscitate (DNR) status. RESULTS A total of 93,153 hospitalisations between 2010 and 2018 with implanted LVAD were identified. Only 578 of these hospitalisations had experienced CA and of those, 173 (33%) hospitalisations underwent cardiopulmonary resuscitation (CPR). The mean age of hospitalisations that experienced a CA was 60.61±14.85 for non-survivors and 56.23±17.33 for survivors (p=0.14). The in-hospital mortality was 60.8 % in hospitalisations with CA and 74.33% in hospitalisations in whom CPR was performed. In an analysis comparing survivors with non-survivors, non-survivors had more diabetes mellitus (DM) (p=0.01), and ischaemic heart disease (IHD) (p=0.04). Age, female sex, peripheral vascular disease and history of coronary artery bypass graft (CABG) were independently associated with increased mortality in our cohort. Also, ventricular tachycardia (VT) and CPR were independently associated with in-hospital mortality. During the study period, there was a significantly decreasing trend in performing CPR in LVAD hospitalisations with CA. CONCLUSION In conclusion, age, female sex, peripheral vascular disease, history of CABG, VT and CPR were independently associated with in-hospital mortality in LVAD hospitalisations who experienced CA.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA.
| | - Harsh Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - Hasan F Othman
- Michigan State University/Sparrow Health System, Lansing, MI, USA
| | | | - Ahmed El Karyoni
- Cardiovascular Department, Loyola University Medical Center, IL, USA
| | - Osarenren Idemudia
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Fadi Ibrahim
- American University of Antigua, Antigua and Barbuda
| | - Tala Salem
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Jabri
- Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA
| | - Ayman ElBadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Soidjon Khodjaev
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | | | - Wilbert S Aronow
- Department of Cardiology, New York Medical College at Westchester Medical Center, New York, NY, USA
| | - Vishal Parikh
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mohan Rao
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Park Soon
- Department of Advanced Heart Failure and Transplant, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
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10
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Hong SI, Kim YJ, Cho YJ, Huh JW, Hong SB, Kim WY. Predictive value of pre-arrest albumin level with GO-FAR score in patients with in-hospital cardiac arrest. Sci Rep 2021; 11:10631. [PMID: 34017041 PMCID: PMC8138001 DOI: 10.1038/s41598-021-90203-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
We investigated whether combining the pre-arrest serum albumin level could improve the performance of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for predicting neurologic outcomes in in-hospital cardiac arrest patients. Adult patients who were admitted to a tertiary care hospital between 2013 and 2017 were assessed. Their pre-arrest serum albumin levels were measured within 24 h before the cardiac arrest. According to albumin levels, the patients were divided into quartiles and were assigned 1, 0, 0, and, - 2 points. Patients were allocated to the derivation (n = 419) and validation (n = 444) cohorts. The proportion of favorable outcome increased in a stepwise manner across increasing quartiles (p for trend < 0.018). Area under receiver operating characteristic curve (AUROC) of the albumin-added model was significantly higher than that of the original GO-FAR model (0.848 vs. 0.839; p = 0.033). The results were consistent in the validation cohort (AUROC 0.799 vs. 0.791; p = 0.034). Net reclassification indices of the albumin-added model were 0.059 (95% confidence interval [CI] - 0.037 to 0.094) and 0.072 (95% CI 0.013-0.132) in the derivation and validation cohorts, respectively. An improvement in predictive performance was found by adding the ordinal scale of pre-arrest albumin levels to the original GO-FAR score.
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Affiliation(s)
- Seok-In Hong
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Yeon Joo Cho
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, 41404, South Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 05505, South Korea.
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11
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Swindell WR, Gibson CG. A simple ABCD score to stratify patients with respect to the probability of survival following in-hospital cardiopulmonary resuscitation. J Community Hosp Intern Med Perspect 2021; 11:334-342. [PMID: 34234902 PMCID: PMC8118500 DOI: 10.1080/20009666.2020.1866251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is occurring more frequently at community hospitals but most patients undergoing CPR do not survive to discharge. Tools to predict CPR survival can be improved by the identification of high-yield clinical indicators. OBJECTIVE To identify variables associated with survival to discharge following in-hospital cardiac arrest. METHODS Retrospective cohort study of 463,530 hospital admissions from the Nationwide Inpatient Sample (2012-2016). The analysis includes adults (age ≥50) who underwent in-hospital CPR at US community hospitals. RESULTS Overall survival to discharge was 29.8% (95% CI: 29.5-30.1%). Age was the strongest predictor of survival and had greater prognostic value than the Charlson comorbidity index. Obesity was associated with improved survival (35.9%, 95% CI: 35.1-36.7%), whereas underweight patients had decreased survival (24.0%, 95% CI: 22.2-25.7%). Acute indicators of poor survival included hyperkalemia, hypercalcemia, and sepsis. We generated an ABCD index based upon four high-yield variables (age, body habitus, comorbidity, day of hospital admission). An ABCD score of 2 or less was a sensitive but non-specific predictor of post-CPR survival (96.8% sensitivity, 95% CI: 96.6-97.0), and those with extreme scores differed 3.8-fold with respect to post-CPR survival probability (46.0% versus 12.1%). CONCLUSION Age is the strongest predictor of post-CPR survival, but body habitus is also an important indicator that may currently be underutilized. Our results support improved post-CPR survival of obese patients, consistent with an 'obesity paradox'. The ABCD score provides an efficient means of risk-stratifying patients and can be calculated in less than 1 minute.
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Affiliation(s)
- William R Swindell
- Department of Internal Medicine, The Jewish Hospital, Cincinnati, Ohio, USA
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12
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Yang WS, Kim YJ, Ryoo SM, Kim WY. Independent Risk Factors for Sepsis-Associated Cardiac Arrest in Patients with Septic Shock. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094971. [PMID: 34067038 PMCID: PMC8124653 DOI: 10.3390/ijerph18094971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022]
Abstract
The clinical characteristics and laboratory values of patients with septic shock who experience in-hospital cardiac arrest (IHCA) have not been well studied. This study aimed to evaluate the prevalence of IHCA after admission into the emergency department and to identify the factors that increase the risk of IHCA in septic shock patients. This observational cohort study used a prospective registry of septic shock patients and was conducted at the emergency department of a university-affiliated hospital. The data of 887 adult (age ≥ 18 years) septic shock (defined using the Sepsis-3 criteria) patients who were treated with a protocol-driven resuscitation bundle therapy and were admitted to the intensive care unit between January 2010 and September 2018 were analyzed. The primary endpoint was the occurrence of sepsis-associated cardiac arrest. The patient mean age was 65 years, and 61.8% were men. Sepsis-associated cardiac arrest occurred in 25.3% of patients (n = 224). The 28-day survival rate after cardiac arrest was 6.7%. Multivariate logistic regression identified chronic pulmonary disease (odds ratio (OR) 2.06), hypertension (OR 0.48), unknown infection source (OR 1.82), a hepatobiliary infection source (OR 0.25), C-reactive protein (OR 1.03), and serum lactate level 6 h from shock (OR 1.34). Considering the high mortality rate of sepsis-associated cardiac arrest after cardiopulmonary resuscitation, appropriate monitoring is required in septic shock patients with major risk factors for IHCA.
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Affiliation(s)
- Won Soek Yang
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 24252, Korea;
| | - Youn-Jung Kim
- Asan Medical Center, Department of Emergency Medicine, University of Ulsan College of Medicine, Seoul 44610, Korea; (Y.-J.K.); (S.M.R.)
| | - Seung Mok Ryoo
- Asan Medical Center, Department of Emergency Medicine, University of Ulsan College of Medicine, Seoul 44610, Korea; (Y.-J.K.); (S.M.R.)
| | - Won Young Kim
- Asan Medical Center, Department of Emergency Medicine, University of Ulsan College of Medicine, Seoul 44610, Korea; (Y.-J.K.); (S.M.R.)
- Correspondence:
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13
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A narrative inquiry of survivors’ experiences of the time just before and after a cardiac arrest. Collegian 2021. [DOI: 10.1016/j.colegn.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med 2021; 12:695-723. [PMID: 33683679 PMCID: PMC7938035 DOI: 10.1007/s41999-021-00454-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Aim We aimed to collect the available evidence on outcome regarding survival and quality of life after CPR following both IHCA and OHCA in the older population. Findings Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Message Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y. Purpose We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population. Methods A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL). Results The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0–11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7–25.0% and 0–10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1–2 was found in 11.5–23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1–2 among patients surviving until hospital discharge was 82–93% (IHCA) and 77–91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies. Conclusions Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y.
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Affiliation(s)
- Rina Zanders
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
| | - Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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15
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Dai C, Wang J, Li J, Wang J, Zhang L, Yin C, Li Y. Repetitive anodal transcranial direct current stimulation improves neurological recovery by preserving the neuroplasticity in an asphyxial rat model of cardiac arrest. Brain Stimul 2021; 14:407-416. [PMID: 33618015 DOI: 10.1016/j.brs.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-shockable rhythms present an increasing proportion of out-of-hospital cardiac arrest (CA) patients, but are associated with poor prognosis and received limited therapeutic effect of targeted temperature management (TTM). Previous study showed repetitive anodal transcranial direct current stimulation (tDCS) improved neurological outcomes in animals with ventricular fibrillation. Here, we examine the effectiveness of tDCS on neurological recovery and the potential mechanisms in a rat model of asphyxial CA. METHOD Cardiopulmonary resuscitation was initiated after 5 min of untreated asphyxial CA. Animals were randomized to three experimental groups immediately after successful resuscitation (n = 12/group, 6 males): no-treatment control (NTC) group, TTM group, and tDCS group. Post resuscitation hemodynamics, quantitative electroencephalogram (EEG), neurological deficit score, and 96-h survival were evaluated. Brain tissues of additional animals undergoing same experimental procedure was harvested for enzyme-linked immunoassay-based quantification assays of neuroplasticity-related biomarkers and compared with the sham-operated rats (n = 6/group). RESULTS We observed that after resuscitation tDCS-treated animals exhibited significantly higher mean arterial pressure and left ventricular ejection fraction than NTC group and showed greatly improved EEG characteristics including weighted-permutation entropy and gamma band power, and neurologic deficit scores and 96-h survival rates compared to NTC and TTM groups. Furthermore, neuroplastic biomarkers including microtubule-associated protein 2, growth-associated protein 43, postsynaptic density protein 95 and synaptophysin, were significantly higher in tDCS group when compared with NTC and TTM groups. CONCLUSION In this rat model of asphyxial CA, repetitive anodal tDCS commenced after resuscitation improved neurological recovery, and it may exert a neuroprotective effect by preserving the neuroplasticity.
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Affiliation(s)
- Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Jianjie Wang
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Jingru Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Juan Wang
- Department of Emergency, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lei Zhang
- Department of Emergency, Southwest Hospital, Army Medical University, Chongqing, China
| | - Changlin Yin
- Department of Critical Care, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China.
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16
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Luth EA, Pan CX, Viola M, Prigerson HG. Dementia and Early Do-Not-Resuscitate Orders Associated With Less Intensive of End-of-Life Care: A Retrospective Cohort Study. Am J Hosp Palliat Care 2021; 38:1417-1425. [PMID: 33467864 DOI: 10.1177/1049909121989020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia is a leading cause of death among US older adults. Little is known about end-of-life care intensity and do-not-resuscitate orders (DNRs) among patients with dementia who die in hospital. AIM Examine the relationship between dementia, DNR timing, and end-of-life care intensity. DESIGN Observational cohort study. SETTING/PARTICIPANTS Inpatient electronic health record extraction for 2,566 persons age 65 and older who died in 2 New York City hospitals in the United States from 2015 to 2017. RESULTS Multivariable logistic regression analyses modeled associations between dementia diagnosis, DNR timing, and 6 end-of-life care outcomes. 31% of subjects had a dementia diagnosis; 23% had a DNR on day of hospital admission. Patients with dementia were 18%-40% less likely to have received 4 of 6 types of intensive care (mechanical ventilation AOR: 0.82, 95%CI: 0.67 -1.00; intensive care unit admission AOR: 0.60, 95%CI: 0.49-0.83). Having a DNR on file was inversely associated with staying in the intensive care unit (AOR: 0.57, 95%CI: 0.47-0.70) and avoiding other intensive care measures. DNR placement later during the hospitalization and not having a DNR were associated with more intensive care compared to having a DNR upon admission. CONCLUSIONS Having dementia and a do-not resuscitate order upon hospital admission are associated with less intensive end-of-life care. Additional research is needed to understand why persons with dementia receive less intensive care. In clinical practice, encouraging advance care planning prior to and at hospital admission may be particularly important for patients wishing to avoid intensive end-of-life care, including patients with dementia.
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17
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Patel R, Mathew P. An Ethically Justified Approach That Integrates Advance Directives Discussions With Care of the Patient With Cancer. Am J Hosp Palliat Care 2021; 38:1433-1440. [PMID: 33464116 DOI: 10.1177/1049909120988507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although the frequency of advance directives discussions may be increasing, there is a need to improve the quality of these discussions. In a range of advanced medical illnesses, including cancer, poor outcomes with advanced cardiopulmonary life support (ACLS) have been well documented. However, when speaking to patients at the end-of-life, physicians frequently withhold evidence-based information and guidance about prognosis or outcomes of ACLS. Tools and models developed to facilitate communication at the end-of-life do not explicitly include recommendations on advance directives and specifically do not discuss the available evidence on ACLS outcomes in the seriously ill. Here, we review the current literature on outcomes of ACLS and current tools and communications for end-of-life discussions. A majority of patients have a preference for truth-telling and guidance. We advocate an approach that integrates individual goals and preferences with a shared understanding of prognosis and appropriate management options, as judged and recommended by the disease experts, in order to reach an evidence-based decision on advance directives. This pragmatic and ethically justified approach emphasizes active empathic communication to prioritize the care of the patient over the mechanical details of ACLS, thereby aligning end-of-life discussions with current practices in other domains of medicine.
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Affiliation(s)
- Rima Patel
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.,Division of Hematology/Oncology, Mount Sinai Hospital, New York, NY, USA
| | - Paul Mathew
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
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18
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Ngo DQ, Vu C, Nguyen T, Sotolongo P, Talati M, Zahabi N, Platt K. The Effect of Mock Code Blue Simulations and Dedicated Advanced Cardiac Life Support Didactics on Resident Perceived Competency. Cureus 2020; 12:e11705. [PMID: 33391938 PMCID: PMC7769772 DOI: 10.7759/cureus.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In-hospital cardiac or pulmonary arrest is associated with high mortality. In the USA, approximately 200,000 of these events occur and are associated with overall survival rates of 18%-20%. Despite advances in resuscitative methods, the probability of intact survival also remains unfavorable. Though many factors play a role, we believe a large portion of a patient’s survival is dependent on the competency of the leader of the code blue or resuscitative team’s efforts. Newly minted physicians who enter medical training in their respective residencies are equipped with a wide range of clinical competency in regards to hands-on experience and aptitude with handling code blue scenarios. Through the use of mock code blue simulations along with dedicated didactics over a seven-month time span, we were able to demonstrate success in improving clinical competency and patient survival outcomes.
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Affiliation(s)
- Dallis Q Ngo
- Pulmonary Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Christina Vu
- Infectious Diseases, University of Southern California, Los Angeles, USA
| | - Thien Nguyen
- Internal Medicine, Desert Regional Medical Center, Palm Springs, USA
| | | | | | - Nikki Zahabi
- Internal Medicine, Hoag Medical Group, Newport Beach, USA
| | - Katrina Platt
- Internal Medicine, Desert Regional Medical Center, Palm Springs, USA
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19
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Donaldson L, Stevenson MA, Fletcher DJ, Gillespie Í, Kellett-Gregory L, Boller M. Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada. J Vet Emerg Crit Care (San Antonio) 2020; 30:615-631. [PMID: 32975359 DOI: 10.1111/vec.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/24/2019] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012. DESIGN Internet-based survey. SETTING Academia and referral practice. SUBJECTS Four hundred and ninety-one small animal veterinarians in clinical practice in the United States and Canada. INTERVENTIONS An internet-based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board-certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320). MEASUREMENTS AND MAIN RESULTS Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey. Being a BCS was associated with significantly higher compliance with the RECOVER recommendations than GPE in the domains of preparedness (P = 0.02), BLS (P < 0.01), and ALS (P < 0.01). Increases in age of the respondent had a negative effect on compliance with the BLS guidelines (P < 0.01), while gender had no effect. CONCLUSIONS Compared to 2008, current practices in small animal CPR in the North American emergency and critical care community shifted toward those recommended in the RECOVER guidelines across all CPR domains. This supports the notion that uptake of the RECOVER guidelines among veterinary emergency or critical care clinicians was sufficient to lead to a change in the practice of CPR.
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Affiliation(s)
- Liam Donaldson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Mark A Stevenson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - Daniel J Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences, Cornell University, Ithaca, New York
| | - Íde Gillespie
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | | | - Manuel Boller
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia.,Translational Research and Clinical Trials (TRACTs), Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
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20
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Chiang CC, Chang SC, Fan SY. The Concerns and Experience of Decision-Making Regarding Do-Not-Resuscitate Orders Among Caregivers in Hospice Palliative Care. Am J Hosp Palliat Care 2020; 38:123-129. [DOI: 10.1177/1049909120933535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A do-not-resuscitate (DNR) order is an important end-of-life decision. In Taiwan, family caregivers are also involved in this decision-making process. This study aimed to explore the concerns and experiences regarding DNR decisions among caregivers in Taiwan. Qualitative study was conducted. Convenience sampling was used, and 26 caregivers were recruited whose patients had a DNR order and had received hospice care or hospice home care. Semi-structured interviews were used for data collection, including the previous experiences of DNR discussions with the patients and medical staff and their concerns and difficulties in decision-making. The data analysis was based on the principle of thematic analysis. Four themes were identified: (1) Patients: The caregivers respected the patients’ willingness and did not want to make them feel like “giving up.” (2) Caregivers’ self: They did not want to intensify the patients’ suffering but sometimes found it emotionally difficult to accept death. (3) Other family members: They were concerned about the other family members’ opinions on DNR orders, their blame, and their views on filial impiety. (4) Medical staff: The information and suggestions from the medical staff were foundational to their decision-making. The caregivers needed the health care professionals’ supports to deal with the concerns from patients and other family members as well as their emotional reactions.
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Affiliation(s)
- Ching-Chun Chiang
- Heart Lotus palliative ward, Tzu Chi Medical Foundation, Hualien Tzu Chi Hospital, Hualien
| | - Shu-Chuan Chang
- The Nursing Committee, Buddhist Tzu Chi Medical Foundation, Hualien
- School of Nursing, Tzu Chi University, Hualien
| | - Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan
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21
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Oud L. In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes. J Clin Med Res 2020; 12:233-242. [PMID: 32362971 PMCID: PMC7188366 DOI: 10.14740/jocmr4108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background Marked improvements were realized in both short-term and long-term outcomes of human immunodeficiency virus (HIV)-infected patients following the introduction of combination antiretroviral therapy. However, the contemporary population-level patterns of in-hospital cardiopulmonary resuscitation (CPR) and the outcomes of HIV-infected patients were not systematically examined. Methods We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without HIV during 2009 - 2014, and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of HIV infection following in-hospital CPR and predictors of short-term survival among HIV hospitalizations. Results In-hospital CPR was reported in 437 and 54,135 hospitalizations with and without HIV, respectively. The rates of in-hospital CPR (per 1,000 hospitalizations) were 4.4 and 4.1 among hospitalizations with and without HIV, respectively (P = 0.1659). The corresponding rates of in-hospital CPR among decedents were 11% and 11.8%, respectively (P = 0.1531). Crude short-term survival following in-hospital CPR among hospitalizations with and without HIV was 19% and 26.8%, respectively (P = 0.0003). The corresponding adjusted short-term survival between 2009 and 2014 rose from 14.2% to 27% (P = 0.0009 for trend) and from 25.5% to 28% (P < 0.0001 for trend). HIV infection was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio (aOR): 0.50, 95% confidence interval (95% CI): 0.39 - 0.65). Select comorbid conditions (congestive heart failure, aOR: 2.03, 95% CI: 1.20 - 2.46; cerebrovascular disease, aOR: 2.08, 95% CI: 1.15 - 3.75; and diabetes, aOR: 1.53, 95% CI 1.31 - 4.71) were the only independent predictors of short-term survival following in-hospital CPR among HIV hospitalizations. Conclusions The rates of in-hospital CPR were similar among hospitalizations with and without HIV infection, with similar level of selectivity among decedents. Although HIV infection was associated with lower short-term survival following in-hospital CPR for the whole cohort, a dramatic improvement was observed during the study period among affected patients, with short-term survival rates becoming near-similar to those without HIV. Further studies are needed to identify modifiable factors to further improve the outcomes following in-hospital CPR among patients with HIV infection.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th St., Odessa, TX 79763, USA.
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22
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Cho YJ, Kim YJ, Kim MY, Shin YJ, Lee J, Choi E, Hong SB, Huh JW, Yang WS, Kim WY. Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in an East Asian population. Resuscitation 2020; 150:36-40. [PMID: 32194163 DOI: 10.1016/j.resuscitation.2020.02.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 11/18/2022]
Abstract
AIM The Good Outcome Following Attempted Resuscitation (GO-FAR) score is useful for identifying patients post-arrest with very poor neurologic outcomes and may thus be utilized when counseling family members on do-not-attempt-resuscitation (DNAR) order. We validated the GO-FAR score for neurologically intact survival in patients with in-hospital cardiac arrest (IHCA) in an East Asian country in which DNAR order not common. METHODS Retrospective study about patients who experienced IHCA from 2013 to 2017 with a primary outcome of neurologically intact survival, defined as a CPC score 1 or 2 at discharge. GO-FAR score categorizes the patients into 4 groups: a very low (<1%), low (1%-3%), average (>3%-15%), or higher than average (>15%) likelihood of neurologically intact survival. RESULTS Of the 1011 included patients, the rates of survival discharge and neurologically intact survival at discharge were 25.4% and 16.0%, respectively. The area under the receiver operating characteristics curve of GO-FAR score for good neurological outcome was 0.81 (95% CI, 0.78-0.84). Patients with low or very low probability of survival had a likelihood of 0.9% (95% CI, 0.0-2.0), but for those under 40 years old, it was increased to 4.2% (95% CI, 0.0-12.2). Patients with average or above-average probabilities had likelihoods of of 18.5% (95% CI, 15.3-21.6) and 50.5% (95% CI, 40.6-60.5), respectively. CONCLUSIONS The GO-FAR score well-predicted the neurologically intact survival of East Asian patients with IHCA. This tool may be used as part of a shared decision regarding DNAR orders.
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Affiliation(s)
- Yeon Joo Cho
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Youn Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Mu Yeol Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yu Jung Shin
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jinmi Lee
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Eunjoo Choi
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won Seok Yang
- Department of Emergency Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Kangwondo, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Mandigers L, Termorshuizen F, de Keizer NF, Gommers D, Dos Reis Miranda D, Rietdijk WJR, den Uil CA. A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in the Netherlands between 2010 and 2016. Resuscitation 2020; 147:88-94. [PMID: 31926259 DOI: 10.1016/j.resuscitation.2019.12.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
AIM Worldwide, cardiac arrest (CA) remains a major cause of death. Most post-CA patients are admitted to the intensive care unit (ICU). The aim of this study is to describe mortality rates and possible changes in mortality rates in patients with CA admitted to the ICU in the Netherlands between 2010 and 2016. METHODS In this study, we included all adult CA patients registered in the National Intensive Care Evaluation (NICE) registry who were admitted to ICUs in the Netherlands between 2010 and 2016. The primary outcome was 1-year mortality which was analysed by Cox regression. The secondary outcomes were ICU mortality and hospital mortality. Hospital mortality was analysed by binary logistic regression analysis. Patients were stratified by whether they experienced in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Finally, the outcome over calendar time was assessed for both groups. RESULTS We included 26,056 CA patients: 10,618 (40.8%) IHCA patients and 14,482 (55.6%) OHCA patients. The 1-year mortality rate was 57.5%: 59% for IHCA and 56.4% for OHCA, p < 0.01. This mortality rate remained stable between 2010 and 2016 for IHCA (p = 0.31) and declined for OHCA patients (p = 0.01). The hospital mortality rate was 50.3%: 50.5% for IHCA and 50.2% for OHCA, p = 0.66. This mortality rate remained stable between 2010-2016 for IHCA (p = 0.21) and decreased for OHCA patients (p < 0.01). An additional analysis with calendar year as a continuous variable showed a mortality decline of 1.56% per calendar year for 1-year mortality. CONCLUSION This nationwide registry cohort study reported a 57.5% 1-year mortality rate for CA patients admitted to the ICU between 2010 and 2016. We reported a decline in 1-year mortality for OHCA patients in these years.
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Affiliation(s)
- Loes Mandigers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Fabian Termorshuizen
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands; Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Predicting the probability of survival with mild or moderate neurological dysfunction after in-hospital cardiopulmonary arrest: The GO-FAR 2 score. Resuscitation 2019; 146:162-169. [PMID: 31821836 DOI: 10.1016/j.resuscitation.2019.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Good Outcome Following Attempted Resuscitation (GO-FAR) Score uses pre-arrest factors to predict survival after In-Hospital Cardiac Arrest (IHCA) with minimal neurological dysfunction, (cerebral performance category (CPC) ≤1). Moderate neurological dysfunction (CPC ≤2) may be a more acceptable outcome. OBJECTIVE To predict survival after IHCA with mild or moderate neurological dysfunction based on pre-arrest factors. METHODS 52,468 patients with IHCA from 2012-2017. Data was divided into training (44%), testing (22%), and validation (34%) sets. Univariate analysis was used to identify variables with >3% difference in survival with CPC ≤2. These variables carried forward to the multivariate logistic regression model. The most parsimonious model that best classified patients as having a very poor (≤5%), below average (≤10%), average (11%-30%), or above average (>30%) likelihood of survival with CPC ≤2 was chosen. RESULTS Age >85, admission CPC <2, and non-surgical admission were strongly association with poor survival (-12.1%, -14.4%, and -18%, respectively). Nine variables were included in the logistic regression analysis. The final updated model, GO FAR 2, categorized 6.2% of patients with a very poor predicted survival, 24.8% of patients with a below average predicted survival, and 11.3% with above average predicted survival. The observed survival among those with very poor predicted survival was 4.5%. CONCLUSION The GO FAR 2 score provides clinicians with a prognostic estimate of the likelihood of a good outcome after IHCA based on pre-arrest patient factors. Future research is required to validate the GO-FAR 2 score.
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Levinson M, Mills A, Barrett J, Sritharan G, Gellie A. 'Why didn't you write a not-for-cardiopulmonary resuscitation order?' Unexpected death or failure of process? AUST HEALTH REV 2019; 42:53-58. [PMID: 27978419 DOI: 10.1071/ah16140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to understand the reasons for the delivery of non-beneficial cardiopulmonary resuscitation (CPR) attempts in a tertiary private hospital over 12 months. We determined doctors' expectations of survival after CPR for their patient, whether they had considered a not-for-resuscitation (NFR) order and the barriers to completion of NFR orders. Methods Anonymous questionnaires were sent to the doctors primarily responsible for a given patient's care in the hospital within 2 weeks of the unsuccessful CPR attempt. The data were analysed quantitatively where appropriate and qualitatively for themes for open-text responses Results Most doctors surveyed in the present study understood the poor outcome after CPR in the older person. Most doctors had an expectation that their own patient had a poor prognosis and a poor likely predicted outcome after CPR. This implied that the patient's death was neither unexpected nor likely to be reversible. Some doctors considered NFR orders, but multiple barriers to completion were cited, including the family's wishes, being time poor and diffusion or deferral of responsibility. Conclusions It is likely that futile CPR is provided contrary to policy and legal documents relating to end-of-life care, with the potential for harms relating to both patient and family, and members of resuscitation teams. The failure appears to relate to process rather than recognition of poor patient outcome. What is known about the topic? Mandatory CPR has been established in Australian hospitals on the premise that it will save lives. The outcome from in-hospital cardiac arrest has not improved despite significant training and resources. The outcome for those acutely hospitalised patients aged over 80 years has been repeatedly demonstrated to be poor with significant morbidity in the survivors. There is emerging literature on the extent of the delivery of non-beneficial treatments at the end of life, including futile CPR, the recognition of harms incurred by patients, families and members of the resuscitation teams and on the opportunity cost of the inappropriate use of resources. What does this paper add? This is the first study, to our knowledge, that has demonstrated that doctors understood the outcomes for CPR, particularly in those aged 80 years and older, and that failure to recognise poor outcome and prognosis in their own patients is not a barrier to writing NFR orders. What are the implications for practitioners? Recognition of the poor outcomes from CPR for the elderly patient for whom the doctor has a duty of care should result in a discussion with the patients, allowing an exploration of values and expectations of treatment. This would promote shared decision making, which includes the use of CPR. Facilitation of these discussions should be the focus of health service review.
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Affiliation(s)
- Michele Levinson
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Amber Mills
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Jonathan Barrett
- Intensive Care Unit, Epworth Healthcare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email
| | - Gaya Sritharan
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
| | - Anthea Gellie
- Cabrini-Monash Department of Medicine, Cabrini Institute for Research and Education, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
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Regional trends in In-hospital Cardiac Arrest following sepsis-related admissions and subsequent mortality. Resuscitation 2019; 143:35-41. [DOI: 10.1016/j.resuscitation.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/19/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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Oud L. In-hospital cardiopulmonary resuscitation of patients with cirrhosis: A population-based analysis. PLoS One 2019; 14:e0222873. [PMID: 31568520 PMCID: PMC6768467 DOI: 10.1371/journal.pone.0222873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/08/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To examine the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) among patients with cirrhosis. Methods We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without cirrhosis during 2009–2014 and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of cirrhosis following in-hospital CPR and predictors of short-term survival among cirrhosis hospitalizations. Results In-hospital CPR was reported in 2,511 and 51,969 hospitalizations with and without cirrhosis, respectively. The rate of in-hospital CPR (per 1,000 hospitalizations) was 7.6 and 4.0 among hospitalizations with and without cirrhosis, respectively. The corresponding rate of in-hospital CPR among decedents was 10.7% and 13.4%, respectively. Short-term survival following in-hospital CPR among hospitalizations with and without cirrhosis was 14.9% and 27.3%, respectively, and remained unchanged over time on adjusted analyses among the former (p = 0.1753), while increasing among the latter (p = 0.0404). Cirrhosis was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio [aOR] 0.55 [95% CI: 0.49–0.62]). Lack of health insurance (vs. Medicare) (aOR] 0.47 [95% CI: 0.34–0.67]) and sepsis ([aOR] 0.67 [95% CI: 0.53–85]) were associated with lower odds of short-term survival following in-hospital CPR among cirrhosis hospitalizations. Conclusions The rate of in-hospital CPR was nearly 2-fold higher among hospitalizations with cirrhosis than among those without it, though it was used more selectively among the former. Short-term survival following in-hospital CPR remained markedly lower among cirrhosis hospitalizations, while progressively improving among those without cirrhosis. Strategies to increase access to health insurance and improve early identification and control of infection should be explored in future preventive and interventional efforts.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, United States of America
- * E-mail:
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Abstract
AIM Cardiac arrest is not a common complication of sepsis, although sepsis has been recognized as one condition behind cardiac arrest. Our aim was to evaluate the prevalence of sepsis among patients with inhospital cardiac arrest (IHCA), and to determine if sepsis is associated with inferior outcome after IHCA. METHODS All consecutive emergency team dispatches in Turku University Hospital in 2011 to 2014 (n = 607) were retrospectively reviewed to identify the patients undergoing cardiopulmonary resuscitation (CPR) for IHCA (n = 301). The patient records were reviewed for the criteria of severe sepsis, organ dysfunction, and chronic comorbidities before IHCA. Outcome was followed for 1 year. RESULTS The criteria for prearrest severe sepsis were met by 83/301 (28%) of the patients, and 93/301 (31%) had multiorgan dysfunction (3 or more organ systems). The patients with severe sepsis had higher mortality than those without severe sepsis, increasing from 30-day mortalities of 63/83 (76%) and 151/218 (69%), respectively (P = 0.256), to 1-year mortalities of 72/83 (87%) and 164/218 (75%), respectively (P = 0.030). Emergency admission, age, immunosuppression, DM, multiorgan dysfunction, and a nonshockable rhythm were independent predictors of 1-year mortality by multivariate logistic regression analysis. Six out of 83 patients with severe sepsis before IHCA (7%) survived 1 year with good neurological outcome (CPC scale 1). CONCLUSIONS A high proportion of patients with IHCA have sepsis and multiorgan dysfunction, and their prognosis is worse than the prognosis of patients with IHCA in general.
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Piscator E, Göransson K, Forsberg S, Bottai M, Ebell M, Herlitz J, Djärv T. Prearrest prediction of favourable neurological survival following in-hospital cardiac arrest: The Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. Resuscitation 2019; 143:92-99. [PMID: 31412292 DOI: 10.1016/j.resuscitation.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND A prearrest prediction tool can aid clinicians in consolidating objective findings with clinical judgement and in balance with the values of the patient be a part of the decision process for do-not-attempt-resuscitation (DNAR) orders. A previous prearrest prediction tool for in-hospital cardiac arrest (IHCA) have not performed satisfactory in external validation in a Swedish cohort. Therefore our aim was to develop a prediction model for the Swedish setting. METHODS Model development was based on previous external validation of The Good Outcome Following Attempted Resuscitation (GO-FAR) score, with 717 adult IHCAs. It included redefinition and reduction of predictors, and addition of chronic comorbidity, to create a full model of 9 predictors. Outcome was favourable neurological survival defined as Cerebral Performance Category score 1-2 at discharge. The likelihood of favourable neurological survival was categorised into very low (<1%), low (1-3%) and above low (>3%). RESULTS We called the model the Prediction of outcome for In-Hospital Cardiac Arrest (PIHCA) score. The AUROC was 0.808 (95% CI 0.807-0.810) and calibration was satisfactory. With a cutoff of 3% likelihood of favourable neurological survival sensitivity was 99.4% and specificity 8.4%. Although specificity was limited, predictive value for classification into ≤3% likelihood of favorable neurological survival was high (97.4%) and false classification into ≤3% likelihood of favourable neurological survival was low (0.6%). CONCLUSION The PIHCA score has the potential to be used as an objective tool in prearrest prediction of outcome after IHCA, as part of the decision process for a DNAR order.
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Affiliation(s)
- Eva Piscator
- Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden.
| | - Katarina Göransson
- Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sune Forsberg
- Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Department of Anaesthesiology and Intensive Care, Norrtälje Hospital, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Department of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Mark Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, USA
| | - Johan Herlitz
- Center of Prehospital Research, Faculty of Caring Science, Work-life and Welfare, University of Borås and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Therese Djärv
- Center for Resuscitation Science, Department of Medicine Solna, Karolinska Institutet and Function of Emergency Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
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Duprey MS, Al-Qadheeb NS, O'Donnell N, Hoffman KB, Weinstock J, Madias C, Dimbil M, Devlin JW. Serious Cardiovascular Adverse Events Reported with Intravenous Sedatives: A Retrospective Analysis of the MedWatch Adverse Event Reporting System. Drugs Real World Outcomes 2019; 6:141-149. [PMID: 31399842 PMCID: PMC6702539 DOI: 10.1007/s40801-019-00161-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Serious cardiovascular adverse events (SCAEs) associated with intravenous sedatives remain poorly characterized. OBJECTIVE The objective of this study was to compare SCAE incidence, types, and mortality between intravenous benzodiazepines (i.e., diazepam, lorazepam, and midazolam), dexmedetomidine, and propofol in the USA over 8 years regardless of the clinical setting where it was administered. METHODS The Food and Drug Administration's MedWatch Adverse Event Reporting System was searched between 2004 and 2011 using the Evidex® platform from Advera Health Analytics, Inc. to identify all reports that included one or more of ten different SCAEs (package insert incidence ≥ 1%) and where an intravenous benzodiazepine, dexmedetomidine, or propofol was the primary suspected drug. RESULTS Among the 2326 Food and Drug Administration's MedWatch Adverse Event Reporting System cases reported, 394 (16.9%) were related to a SCAE. The presence of a SCAE (vs. a non-SCAE) is associated with higher mortality (34 vs. 8%, p < 0.001). The percentage of cases with one or more SCAE, the case mortality rate (%), and the incidence of each SCAE (per 106 days of sedative exposure), respectively, were benzodiazepines (14, 26, 13) [diazepam (13, 23, 31); lorazepam (15, 43, 14); midazolam (14, 20, 11)]; dexmedetomidine (40, 15, 13); and propofol (17, 39, 7). Propofol (vs. either a benzodiazepine or dexmedetomidine) was associated with more total SCAEs (268 vs. 126, p < 0.001) but a lower incidence (per 106 days of sedative exposure) of SCAE (7 vs. 13, p = 0.0001) and cardiac arrest [6.3 (benzodiazepine) vs. 6.7 (dexmedetomidine) vs. 1.4 (propofol), p < 0.0001]. CONCLUSIONS Serious cardiac adverse events account for nearly one-fifth of intravenous sedative Food and Drug Administration's MedWatch Adverse Event Reporting System reports. These SCAEs appear to be associated with greater mortality than non-cardiac serious adverse events. Serious cardiac events may be more prevalent with either benzodiazepines or dexmedetomidine than propofol.
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Affiliation(s)
- Matthew S Duprey
- Northeastern University School of Pharmacy, 360 Huntington Ave, 140 TF R216, Boston, MA, 02115, USA
| | - Nada S Al-Qadheeb
- Department of Critical Care, Hafer Al Batin Central Hospital, Qurtubah, Hafar Al Batin, Saudi Arabia
| | | | | | | | | | - Mo Dimbil
- Advera Health Analytics, Inc., Santa Rosa, CA, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, 360 Huntington Ave, 140 TF R216, Boston, MA, 02115, USA. .,Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA, USA.
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Spitzer CR, Evans K, Buehler J, Ali NA, Besecker BY. Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation. Resuscitation 2019; 143:158-164. [PMID: 31299222 DOI: 10.1016/j.resuscitation.2019.06.290] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mortality from in-hospital cardiac arrests remains a large problem world-wide. In an effort to improve in-hospital cardiac arrest mortality, there is a renewed focus on team training and operations. Here, we describe the implementation of a "pit crew" model to provide in-hospital resuscitation care. METHODS In order to improve our institution's code team organization, we implemented a pit crew resuscitation model. The model was introduced through computer-based modules and lectures and was reemphasized at our institution-based ACLS training and mock code events. To assess the effect of our model, we reviewed pre- and post-pit crew implementation data from five sources: defibrillator downloads, a centralized hospital database, mock codes, expert-led debriefings, and confidential surveys. Data with continuous variables and normal distribution were analyzed using a standard two-sample t-test. For yes/no categorical data either a Z-test for difference between proportions or Chi-square test was used. RESULTS There were statistically significant improvements in compression rates post-intervention (mean rate 133.5 pre vs. 127.9 post, two-tailed, p = 0.02) and in adequate team communication (33% pre vs. 100% post; p = 0.05). There were also trends toward a reduction in the number of shockable rhythms that were not defibrillated (32.7% pre vs. 18.4% post), average time to shock (mean 1.96 min pre vs. 1.69 min post), and overall survival to discharge (31% pre vs. 37% post), though these did not reach statistical significance. CONCLUSION Implementation of an in-hospital, pit crew resuscitation model is feasible and can improve both code team communication as well as key ACLS metrics.
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Affiliation(s)
- Carleen R Spitzer
- Division of Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
| | - Kimberly Evans
- Quality & Patient Safety, 630 Ackerman Rd., 2nd Floor, Rm F2050, Columbus, OH 43202, United States.
| | - Jeri Buehler
- Education, Development and Resources, 660 Ackerman Rd., Columbus, OH 43218, United States.
| | - Naeem A Ali
- University Hospital, Division of Pulmonary, Critical Care, and Sleep Medicine, 168 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, United States.
| | - Beth Y Besecker
- Division of Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
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Ufere NN, Brahmania M, Sey M, Teriaky A, El-Jawahri A, Walley KR, Celi LA, Chung RT, Rush B. Outcomes of in-hospital cardiopulmonary resuscitation for patients with end-stage liver disease. Liver Int 2019; 39:1256-1262. [PMID: 30809903 DOI: 10.1111/liv.14079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/29/2018] [Accepted: 02/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS There have been improving survival trends after in-hospital cardiac arrest for the general population, but there is limited information on the outcomes of hospitalized patients with end-stage liver disease (ESLD) who undergo cardiopulmonary resuscitation (CPR). We aimed to examine survival to hospital discharge after receipt of in-hospital CPR in patients with ESLD using a nationally representative sample. METHODS We used the Nationwide Inpatient Sample database from 2006 to 2014 to identify adult patients who underwent in-hospital CPR. Using multivariate modelling, we compared survival to hospital discharge for patients with ESLD to those without ESLD. We also compared outcomes of patients with ESLD to patients with metastatic cancer. RESULTS A total of 177 533 patients underwent in-hospital CPR, of which 1474 (0.8%) had ESLD. Patients with ESLD had lower rates of survival to hospital discharge compared to patients without ESLD (10.7% vs 28.6%, P < 0.01). In multivariate modelling, ESLD was significantly associated with lower odds of survival to hospital discharge after in-hospital CPR (OR 0.35, 95% CI 0.28-0.44, P < 0.01). Among survivors of in-hospital CPR, ESLD patients had a significantly lower chance of discharge to home compared to patients without ESLD (3.2% vs 8.0%, P < 0.05). Patients with ESLD also had lower rates of survival to hospital discharge compared to those with metastatic cancer (10.7% vs 15.5%, P < 0.01). CONCLUSIONS Outcomes are poor after in-hospital CPR in patients with ESLD and are worse than for patients with metastatic cancer. The current analysis can be used to inform goals of care discussions for patients with ESLD.
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Affiliation(s)
- Nneka N Ufere
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Mayur Brahmania
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Anouar Teriaky
- Division of Gastroenterology, Department of Medicine, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Areej El-Jawahri
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith R Walley
- Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Leo A Celi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raymond T Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Barret Rush
- Division of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Young AK, Maniaci MJ, Simon LV, Lowman PE, McKenna RT, Thomas CS, Cochuyt JJ, Vadeboncoeur TF. Use of a simulation-based advanced resuscitation training curriculum: Impact on cardiopulmonary resuscitation quality and patient outcomes. J Intensive Care Soc 2019; 21:57-63. [PMID: 32284719 DOI: 10.1177/1751143719838209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite a continued focus on improved cardiopulmonary resuscitation quality, survival remains low from in-hospital cardiac arrest. Advanced Resuscitation Training has been shown to improve survival to hospital discharge and survival with good neurological outcome following in-hospital cardiac arrest at its home institution. We sought to determine if Advanced Resuscitation Training implementation would improve patient outcomes and cardiopulmonary resuscitation quality at our institution. Methods This was a prospective, before-after study of adult in-hospital cardiac arrest victims who had cardiopulmonary resuscitation performed. During phase 1, standard institution cardiopulmonary resuscitation training was provided. During phase 2, providers received the same quantity of training, but with emphasis on Advanced Resuscitation Training principles. Primary outcomes were return of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Secondary outcomes were cardiopulmonary resuscitation quality parameters. Results A total of 156 adult in-hospital cardiac arrests occurred during the study period. Rates of return of spontaneous circulation improved from 58.1 to 86.3% with an adjusted odds ratios of 5.31 (95% CI: 2.23-14.35, P < 0.001). Survival to discharge increased from 26.7 to 41.2%, adjusted odds ratios 2.17 (95% CI: 1.02-4.67, P < 0.05). Survival with a good neurological outcome increased from 24.8 to 35.3%, but was not statistically significant. Target chest compression rate increased from 30.4% of patients in P1 to 65.6% in P2, adjusted odds ratios 4.27 (95% CI: 1.72-11.12, P = 0.002), and target depth increased from 23.2% in P1 to 46.9% in P2, adjusted odds ratios 2.92 (95% CI: 1.16-7.54, P = 0.024). Conclusions After Advanced Resuscitation Training implementation, there were significant improvements in cardiopulmonary resuscitation quality and rates of return of spontaneous circulation and survival to discharge.
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Affiliation(s)
- Amanda K Young
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Philip E Lowman
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Ryan T McKenna
- Division of Emergency Medicine, University of South Florida Morsani College of Medicine and Team Health, Tampa, FL, USA
| | - Colleen S Thomas
- Department of Health Sciences Research Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Jordan J Cochuyt
- Department of Health Sciences Research Mayo Clinic in Florida, Jacksonville, FL, USA
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Sulzgruber P, Schnaubelt S, Pesce M, Uray T, Niederdöckl J, Domanovits H, Rosenhek R, Binder T, Distelmaier K, Hengstenberg C, Niessner A, Goliasch G. Aortic stenosis is an independent predictor for outcome in patients with in-hospital cardiac arrest. Resuscitation 2019; 137:156-160. [DOI: 10.1016/j.resuscitation.2019.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
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Kim M, Li G. Postoperative Complications Affecting Survival After Cardiac Arrest in General Surgery Patients. Anesth Analg 2018; 126:858-864. [PMID: 28891912 DOI: 10.1213/ane.0000000000002460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative cardiac arrest is uncommon but associated with a high mortality risk in general surgery patients and is often preceded by postoperative complications. The relationships between previous complications and mortality after cardiac arrest in general surgery patients have not been completely evaluated. METHODS A retrospective, observational cohort of general surgery in patients with cardiac arrest occurring after postoperative day (POD) #0 (and up to POD #30) was obtained from the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program. Previous complication was defined as at least one of the following occurring before the POD of cardiac arrest: (1) acute kidney injury; (2) acute respiratory failure; (3) deep vein thrombosis/pulmonary embolus; (4) myocardial infarction; (5) sepsis/septic shock; (6) stroke; and/or (7) transfusion. The associations between previous complications and mortality after cardiac arrest were assessed using Cox proportional hazards models that adjusted for preoperative risk factors. RESULTS Of 1352 patients with postoperative cardiac arrest, 746 patients (55%) developed at least 1 complication before cardiac arrest. Overall 30-day mortality was 71% (958/1352) and was similar among patients with and without a previous complication (71% [533/746] vs 70% [425/606]; P = .60). Patients with previous complications did not have an increased risk of mortality, compared to patients without previous complications, in adjusted Cox models (hazard ratio, 1.03; 95% confidence interval, 0.90-1.18; P = .70). In addition, no previous complication was associated with increased mortality risk in individual analyses. CONCLUSIONS Among general surgery patients with cardiac arrest after POD #0, complications occurring before cardiac arrest are common but are not associated with increased mortality risk.
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Affiliation(s)
- Minjae Kim
- From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Guohua Li
- From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Dai C, Chen G, Chen B, Wang J, Yin C, Wang J, Gong Y, Wei L, Huang Y, Li Y. Repetitive anodal transcranial direct current stimulation improves neurological outcome and survival in a ventricular fibrillation cardiac arrest rat model. Brain Stimul 2018; 12:659-667. [PMID: 30611705 DOI: 10.1016/j.brs.2018.12.974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/15/2018] [Accepted: 12/22/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) modulates neuronal activity and is a potential therapeutic tool for many neurological diseases. However, its beneficial effects on post cardiac arrest syndrome remains uncertain. OBJECTIVE/HYPOTHESIS We investigated the effects of repetitive anodal tDCS on neurological outcome and survival in a ventricular fibrillation (VF) cardiac arrest rat model. METHODS Cardiopulmonary resuscitation was initiated after 6 min of VF in 36 Sprague-Dawley rats. The animals were randomized into three groups immediately after resuscitation (n = 12 each): no-treatment control (NTC) group, targeted temperature management (TTM) group, and tDCS group. For tDCS, 1 mA anodal tDCS was applied on the dorsal scalp for 0.5 h. The stimulation was repeated for four sessions with 1-h resting interval under normothermia. Post-resuscitation hemodynamic, cerebral, and myocardial injuries, 96-h neurological outcome, and survival were evaluated. RESULTS Compared with the NTC group, post-resuscitation serum astroglial protein S100 beta and cardiac troponin T levels and 96-h neuronal and myocardial damage scores were markedly reduced in the tDCS and TTM groups. Myocardial ejection fraction, neurological deficit score, and 96-h survival rate were also significantly better for the tDCS and TTM groups. The period of post-resuscitation arrhythmia with hemodynamic instability was considerably shorter in the tDCS group, but no differences were observed in neurological outcome and survival between the tDCS and TTM groups. CONCLUSIONS In this cardiac arrest rat model, repeated anodal tDCS commenced after resuscitation improves 96-h neurological outcome and survival to an extent comparable to TTM by attenuating post-resuscitation cerebral and cardiac injuries.
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Affiliation(s)
- Chenxi Dai
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Gang Chen
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Bihua Chen
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Juan Wang
- Department of Emergency, Southwest Hospital, Army Medical University, Chongqing, China
| | - Changlin Yin
- Department of Emergency, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianjie Wang
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Yushun Gong
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Liang Wei
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Yuanyuan Huang
- Department of Neurology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongqin Li
- School of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China.
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Peck V, Valiani S, Tanuseputro P, Mulpuru S, Kyeremanteng K, Fitzgibbon E, Forster A, Kobewka D. Advance care planning after hospital discharge: qualitative analysis of facilitators and barriers from patient interviews. BMC Palliat Care 2018; 17:127. [PMID: 30518345 PMCID: PMC6282276 DOI: 10.1186/s12904-018-0379-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Patients who engage in Advance Care Planning (ACP) are more likely to get care consistent with their values. We sought to determine the barriers and facilitators to ACP engagement after discharge from hospital. Methods Prior to discharge from hospital eligible patients received a standardized conversation about prognosis and ACP. Each patient was given an ACP workbook and asked to complete it over the following four weeks. We included frail elderly patients with a high risk of death admitted to general internal medicine wards at a tertiary care academic teaching hospital. Four weeks after discharge we conducted semi-structured interviews with patients. Interviews were transcribed, coded and analysed with thematic analysis. Themes were categorized according to the theoretical domains framework. Results We performed 17 interviews. All Theoretical Domain Framework components except for Social/Professional Identity and Behavioral Regulation were identified in our data. Poor knowledge about ACP and physician communication skills were barriers partially addressed by our intervention. Some patients found it difficult to discuss ACP during an acute illness. For others acute illness made ACP discussions more relevant. Uncertainty about future health motivated some participants to engage in ACP while others found that ACP discussions prevented them from living in the moment and stripped them of hope that better days were ahead. Conclusions For some patients acute illness resulting in admission to hospital can be an opportunity to engage in ACP conversations but for others ACP discussions are antithetical to the goals of hospital care. Electronic supplementary material The online version of this article (10.1186/s12904-018-0379-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vanessa Peck
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward Fitzgibbon
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alan Forster
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Kobewka
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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One-year mortality of patients admitted to the intensive care unit after in-hospital cardiac arrest: a retrospective study. J Crit Care 2018; 48:345-351. [DOI: 10.1016/j.jcrc.2018.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/30/2018] [Accepted: 09/23/2018] [Indexed: 11/23/2022]
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Wang CH, Chang WT, Huang CH, Tsai MS, Yu PH, Wu YW, Chen WJ. Validation of the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score in an East Asian population. PLoS One 2018; 13:e0202938. [PMID: 30138383 PMCID: PMC6107241 DOI: 10.1371/journal.pone.0202938] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score is a useful tool for predicting neurological outcome following in-hospital cardiac arrest (IHCA), and was derived from a cohort selected from the Get With The Guidelines-Resuscitation registry between 2000 and 2009 in the United States. In an East Asian population, we aimed to identify the factors associated with outcomes of resuscitated IHCA patients and assess the validity of the CASPRI score. METHODS A retrospective study was conducted in a single centre in Taiwan. Patients with IHCA between 2006 and 2014 were screened. RESULTS Among the 796 included patients, 94 (11.8%) patients achieved neurologically intact survival. Multivariable logistic regression analyses identified factors significantly associated with neurological outcome. Six of these factors were also components of the CASPRI score, including duration of resuscitation, neurological status before IHCA, malignant disease, initial arrest rhythms, renal insufficiency and age. In univariate logistic regression analysis, the CASPRI score was significantly associated with neurological outcome (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.80-0.87); the area under the receiver operating characteristics curve was 0.79 (95% CI: 0.74-0.84). CONCLUSION In this retrospective study conducted in a single centre at Taiwan, we identified the common prognosticators of IHCA shared by both East Asian and Western societies. As a composite prognosticator, CASPRI score predicts outcomes with excellent accuracy among successfully resuscitated IHCA patients in an East Asian population. This tool allows accurate IHCA prognostication in an East Asian population.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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Survival after in-hospital cardiac arrest among cerebrovascular disease patients. J Clin Neurosci 2018; 54:1-6. [PMID: 29789199 DOI: 10.1016/j.jocn.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 11/20/2022]
Abstract
Stroke is a leading cause of death and disability, and while preferences for cardiopulmonary resuscitation (CPR) are frequently discussed, there is limited evidence detailing outcomes after CPR among acute cerebrovascular neurology (inclusive of stroke, subarachnoid hemorrhage (SAH)) patients. Systematic review and meta-analysis of PubMed and Cochrane libraries from January 1990 to December 2016 was conducted among stroke patients undergoing in-hospital CPR. Primary data from studies meeting inclusion criteria at two levels were extracted: 1) studies reporting survival to hospital discharge after CPR with cerebrovascular primary admitting diagnosis, and 2) studies reporting survival to hospital discharge after CPR with cerebrovascular comorbidity. Meta-analysis generated weighted, pooled survival estimates for each population. Of 818 articles screened, there were 176 articles (22%) that underwent full review. Three articles met primary inclusion criteria, with an estimated 8% (95% Confidence Interval (CI) 0.01, 0.14) rate of survival to hospital discharge from a pooled sample of 561 cerebrovascular patients after in-hospital CPR. Twenty articles met secondary inclusion criteria, listing a cerebrovascular comorbidity, with an estimated rate of survival to hospital discharge of 16% (95% CI 0.14, 0.19). All studies demonstrated wide variability in adherence to Utstein guidelines, and neurological outcomes were detailed in only 6 (26%) studies. Among the few studies reporting survival to hospital discharge after CPR among acute cerebrovascular patients, survival is lower than general inpatient populations. These findings synthesize the limited empirical basis for discussions about resuscitation among stroke patients, and highlight the need for more disease stratified reporting of outcomes after inpatient CPR.
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Trends in co-morbidities and survival for in-hospital cardiac arrest –A Swedish cohort study. Resuscitation 2018; 124:29-34. [DOI: 10.1016/j.resuscitation.2017.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 11/23/2022]
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Trethewey SP, Couper K. Comorbidity and cardiac arrest: A continuing conundrum. Resuscitation 2018; 124:A9-A10. [PMID: 29355698 DOI: 10.1016/j.resuscitation.2018.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/18/2022]
Affiliation(s)
| | - Keith Couper
- Heart of England NHS Foundation Trust, Birmingham, UK; Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Risaliti C, Evans K, Buehler J, Besecker B, Ali N. Decoding Code Blue: A process to assess and improve code team function. Resuscitation 2017; 122:e15-e16. [PMID: 29155295 DOI: 10.1016/j.resuscitation.2017.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Carleen Risaliti
- Division of Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
| | - Kimberly Evans
- Quality & Patient Safety, 630 Ackerman Rd, 2nd Floor, Rm F2050, Columbus, OH 43202, United States.
| | - Jeri Buehler
- Education, Development and Resources, 660 Ackerman Rd, Columbus, OH 43218, United States.
| | - Beth Besecker
- Pulmonary, Critical Care, and Sleep Medicine, 201 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, Columbus, OH 43210, United States.
| | - Naeem Ali
- Division of Pulmonary, Critical Care, and Sleep Medicine, 168 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, United States.
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Morgan RW, Fitzgerald JC, Weiss SL, Nadkarni VM, Sutton RM, Berg RA. Sepsis-associated in-hospital cardiac arrest: Epidemiology, pathophysiology, and potential therapies. J Crit Care 2017; 40:128-135. [DOI: 10.1016/j.jcrc.2017.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/19/2017] [Accepted: 03/29/2017] [Indexed: 12/20/2022]
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Long-Term Outcomes in Critically Ill Septic Patients Who Survived Cardiopulmonary Resuscitation. Crit Care Med 2017; 44:1067-74. [PMID: 26807681 DOI: 10.1097/ccm.0000000000001608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale. DESIGN Retrospective and observational cohort study. SETTING Data were extracted from Taiwan's National Health Insurance Research Database. PATIENTS A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled. Post-discharge survival outcomes of ICU sepsis survivors who received cardiopulmonary resuscitation were compared with those of patients who did not experience cardiopulmonary arrest using propensity score matching with a 1:1 ratio. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Only 7% (n = 3,207) of sepsis patients who received cardiopulmonary resuscitation survived to discharge. The overall 1-, 2-, and 5-year postdischarge survival rates following cardiopulmonary resuscitation were 28%, 23%, and 14%, respectively. Compared with sepsis survivors without cardiopulmonary arrest, sepsis survivors who received cardiopulmonary resuscitation had a greater risk of all-cause mortality after discharge (hazard ratio, 1.38; 95% CI, 1.34-1.46). This difference in mortality risk diminished after 2 years (hazard ratio, 1.11; 95% CI, 0.96-1.28). Multivariable analysis showed that independent risk factors for long-term mortality following cardiopulmonary resuscitation were male sex, older age, receipt of care in a nonmedical center, higher Charlson Comorbidity Index score, chronic kidney disease, cancer, respiratory infection, vasoactive agent use, and receipt of renal replacement therapy during ICU stay. CONCLUSION The long-term outcome was worse in ICU survivors of sepsis who received in-hospital cardiopulmonary resuscitation than in those who did not, but this increased risk of mortality diminished at 2 years after discharge.
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Haydon G, van der Riet P, Inder K. A systematic review and meta-synthesis of the qualitative literature exploring the experiences and quality of life of survivors of a cardiac arrest. Eur J Cardiovasc Nurs 2017; 16:475-483. [PMID: 28436244 DOI: 10.1177/1474515117705486] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival following cardiac arrest and subsequent cardiopulmonary resuscitation (CPR) is increasing worldwide, mainly due to greater awareness of the symptoms of cardiac events and an increased attention to CPR training. Although patient outcomes remain unpredictable and quantitative studies suggest that the overall quality of life (QOL) is acceptable, it is valuable to synthesise qualitative studies exploring these phenomena in depth, providing a deeper knowledge of survivors' experiences and QOL. AIMS To critically appraise and synthesise the qualitative literature on survivors' experiences of a cardiac arrest and CPR with the aim of identifying common themes that can inform clinical pathways and thereby improve survivor outcomes and QOL. METHODS A systematic review and meta-synthesis of the qualitative literature, using Thomas and Harden's framework, and confined to peer-reviewed papers published from 2000 to 2015, which were identified through database searches of EBSCO, OVID and ProQuest. RESULTS The search produced 204 papers, and of these, seven relevant papers were identified for review. Data extraction included setting, participants, research design, data collection, analysis and themes. Five qualitative themes were identified and were the subject of this meta-synthesis: multitude of contrasting feelings; disruption in the continuum of time; new reality and psychological challenges; changed body with new limitations; and confrontation with death. CONCLUSION This review provides insights into the experiences of survivors' QOL after CPR. Increased knowledge can improve person-centred care in the immediate and forthcoming care after the event, both in terms of planning for discharge and in the future care of people who survive a cardiac arrest.
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Mulder M, Geocadin RG. Neurology of cardiopulmonary resuscitation. HANDBOOK OF CLINICAL NEUROLOGY 2017; 141:593-617. [PMID: 28190437 DOI: 10.1016/b978-0-444-63599-0.00032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction. Guidance to practice evidence-based clinical care when able and thoughtful, pragmatic suggestions for care where evidence is lacking are also provided. This chapter serves as both a useful clinical guide and an updated, thorough, and state-of-the-art reference on the topic for advanced students and experienced practitioners in the field.
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Affiliation(s)
- M Mulder
- Department of Critical Care and the John Nasseff Neuroscience Institute, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA
| | - R G Geocadin
- Neurosciences Critical Care Division, Department of Anesthesiology and Critical Care Medicine and Departments of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Blumenstein J, Leick J, Liebetrau C, Kempfert J, Gaede L, Groß S, Krug M, Berkowitsch A, Nef H, Rolf A, Arlt M, Walther T, Hamm CW, Möllmann H. Extracorporeal life support in cardiovascular patients with observed refractory in-hospital cardiac arrest is associated with favourable short and long-term outcomes: A propensity-matched analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:13-22. [DOI: 10.1177/2048872615612454] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jürgen Leick
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
| | | | - Joerg Kempfert
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
| | - Sebastian Groß
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
| | - Marcel Krug
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
| | | | - Holger Nef
- Justus Liebig University of Giessen, Department of Internal Medicine I, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
- Justus Liebig University of Giessen, Department of Internal Medicine I, Germany
| | - Matthias Arlt
- Department of Anesthesiology, Kerckhoff Heart and Thorax Center, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
- Justus Liebig University of Giessen, Department of Internal Medicine I, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Germany
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Hydrogen Inhalation is Superior to Mild Hypothermia in Improving Cardiac Function and Neurological Outcome in an Asphyxial Cardiac Arrest Model of Rats. Shock 2016; 46:312-8. [DOI: 10.1097/shk.0000000000000585] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Documentation of cardiopulmonary resuscitation decisions in a New Zealand hospital: A prospective observational study. Intensive Crit Care Nurs 2016; 37:75-81. [PMID: 27575617 DOI: 10.1016/j.iccn.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Documentation of cardiopulmonary resuscitation (CPR) decisions is often poor. Lack of documented decisions risks inappropriate CPR and staff, patient and family distress. OBJECTIVE To examine documented evidence of CPR decisions. METHOD Using a prospective observational design, case notes of current patients in 16 wards were reviewed for documented evidence of CPR decisions. Data were collected over a consecutive two-day period in April 2015. RESULTS 151 patients case notes were reviewed; 41 (27.2%) patients had documented decisions and 110 (72.8%) had no decisions documented. When compared to patients with no documented decisions, those with documented decisions were older (p≤0.001), had a greater number of admission days at time of data collection (p=0.02) and more comorbidities (p≤0.001). In those with documented decisions, advancing age was related to a greater number of comorbidities (p=0.02) but not to an increased number of admission days at time of data collection (p=0.81). In the non-documented group advancing age was related to both an increased number of admission days at time of data collection (p≤0.001) and a greater number of comorbidities (p≤0.001). CONCLUSION Documentation of CPR decisions is suboptimal. Improving documentation reduces staff, patient and family distress and allows appropriate and dignified end of life care.
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