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Ashine TM, Heliso AZ, Babore GO, Ezo E, Saliya SA, Birehanu Muluneh B, Alaro MG, Adeba TS, Sebro SF, Hailu AG, Abdisa EN. Incidence and Predictors of Cardiac Arrest Among Patients Admitted to the Intensive Care Units of a Comprehensive Specialized Hospital in Central Ethiopia. Patient Relat Outcome Meas 2024; 15:31-43. [PMID: 38375416 PMCID: PMC10875971 DOI: 10.2147/prom.s452338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cardiac arrest (CA) is a common public health problem. Worldwide, cardiac arrest ranks highly among hospitalised patients' public health concerns, particularly in low-income nations. Data on cardiac arrest in intensive care units in low-income countries are relatively scarce. Determining the incidence and predictors of cardiac arrest among ICU patients will be a very crucial and fruitful clinical practice in resource-limited areas like Ethiopia. Methods A retrospective cohort study was conducted by reviewing charts of 422 systematically selected patients admitted to the ICU from 2018 to 2022 in Wachemo University Comprehensive Specialized Hospital. The extraction tool was used for the data collection, Epi-data version 4.6.0 for data entry, and STATA version 14 for data cleaning and analysis. Kaplan-Meier, log rank test, and life table were used to describe the data. The Cox proportional hazard regression model was used for analysis. Results The findings of this study revealed that the overall occurrence of cardiac arrest among critically ill ICU patients was 27% (95% CI: 23, 32). The incidence density rate of cardiac arrest among intensive care unit patients was 19.6 per 1000 person-days of observation. In a multivariable analysis, patients with chronic kidney disease, oxygen saturation <90%, delirium, intubation, and patients admitted to the ICU with cardiovascular disease were found to be independent predictors of cardiac arrest in the Intensive Care Unit. Conclusion The incidence density rate of cardiac arrest among intensive care unit patients was high. This study also revealed that chronic kidney disease, delirium, intubation, oxygen saturation level below 90% and patients admitted with cardiovascular disease were independent predictors of the occurrence of cardiac arrest among intensive care unit patients. Finally, we recommend that clinician pays attention to those identified as preventable risk factors for early interventions to improve the recovery process of patients in the ICU.
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Affiliation(s)
- Taye Mezgebu Ashine
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Getachew Ossabo Babore
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Ezo
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Sentayehu Admasu Saliya
- Department of Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Bethelhem Birehanu Muluneh
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Michael Geletu Alaro
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Tadesse Sahle Adeba
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Sisay Foga Sebro
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Awoke Girma Hailu
- Emergency medicine and Critical Care nursing, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
| | - Elias Nigusu Abdisa
- Department of Psychiatry and Mental Health, College of Medicine and Health Science, Wachemo University, Hosanna, Ethiopia
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Neamjun S, Phinyo P, Wittayachamnankul B, Wongtanasarasin W. Early endotracheal intubation is not associated with the rate of return of spontaneous circulation following cardiac arrest at the emergency department: an exploratory analysis. World J Emerg Med 2024; 15:297-300. [PMID: 39050216 PMCID: PMC11265638 DOI: 10.5847/wjem.j.1920-8642.2024.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/18/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Siwat Neamjun
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Borwon Wittayachamnankul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento 95817, USA
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Li Z, Xing J. A model for predicting return of spontaneous circulation and neurological outcomes in adults after in-hospital cardiac arrest: development and evaluation. Front Neurol 2023; 14:1323721. [PMID: 38046585 PMCID: PMC10693474 DOI: 10.3389/fneur.2023.1323721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction In-hospital CA (IHCA) is associated with rates of high incidence, low return of spontaneous circulation (ROSC), low survival to discharge, and poor neurological outcomes. We aimed to construct and evaluate prediction models for non-return of spontaneous circulation (non-ROSC) and poor neurological outcomes 12 months after ROSC (PNO-12). Methods We retrospectively analyzed baseline and clinical data from patients experiencing cardiac arrest (CA) in a big academic hospital of Jilin University in China. Patients experiencing CA between September 1, 2019 and December 31, 2020 were categorized into the ROSC and non-ROSC groups. Patients maintaining ROSC >20 min were divided into the good and PNO-12 subgroups. Results Univariate and multivariate logistic regression identified independent factors associated with non-ROSC and PNO-12. Two nomogram prediction models were constructed and evaluated. Of 2,129 patients with IHCA, 851 were included in the study. Multivariate logistic regression analysis revealed that male sex, age >80 years, CPR duration >23 min, and total dose of adrenaline >3 mg were significant risk factors for non-ROSC. Before CA, combined arrhythmia, initial defibrillation rhythm, and advanced airway management (mainly as endotracheal intubation) also influenced outcomes. The area under the receiver operating characteristic curve in the prediction model was 0.904 (C-index: 0.901). Respiratory failure, shock, CA in the monitoring area, advanced airway management, and noradrenaline administration were independent risk factors for PNO-12. The AUC was 0.912 (C-index: 0.918). Conclusions Prediction models based on IHCA data could be helpful to reduce mortality rates and improve prognosis.
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Affiliation(s)
| | - Jihong Xing
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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Robinson AE, Driver BE, Prekker ME, Reardon RF, Horton G, Stang JL, Collins JD, Carlson JN. First attempt success with continued versus paused chest compressions during cardiac arrest in the emergency department. Resuscitation 2023; 186:109726. [PMID: 36764570 DOI: 10.1016/j.resuscitation.2023.109726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIM Tracheal intubation is associated with interruption in cardiopulmonary resuscitation (CPR). Current knowledge of tracheal intubation during active CPR focuses on the out-of-hospital environment. We aim to describe characteristics of tracheal intubation during active CPR in the emergency department (ED) and determine whether first attempt success was associated with CPR being continued vs paused. MEASUREMENTS We reviewed overhead video from adult ED patients receiving chest compressions at the start of the orotracheal intubation attempt. We recorded procedural detail including method of CPR, whether CPR was continued vs paused, and first attempt intubation success (primary outcome). We performed logistic regression to determine whether continuing CPR was associated with first attempt success. RESULTS We reviewed 169 instances of tracheal intubation, including 143 patients with continued CPR and 26 patients with paused CPR. Those with paused CPR were more likely to be receiving manual rather than mechanical chest compressions. Video laryngoscopy and bougie use were common. First attempt success was higher in the continued CPR group (87%, 95% CI 81% to 92%) than the interrupted CPR group (65%, 95% CI 44% to 83%, difference 22% [95% CI 3% to 41%]). The multivariable model demonstrated an adjusted odds ratio of 0.67 (95% CI 0.17 to 2.60) for first attempt intubation success when CPR was interrupted vs continued. CONCLUSIONS It was common to continue CPR during tracheal intubation, with success comparable to that achieved in patients without cardiac arrest. It is reasonable to attempt tracheal intubation without interrupting CPR, pausing only if necessary.
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Affiliation(s)
- Aaron E Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Robert F Reardon
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Gabriella Horton
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States
| | - Jamie L Stang
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - Jacob D Collins
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55404, United States
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
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Outcomes of Early versus Late Endotracheal Intubation in Patients with Initial Non-Shockable Rhythm Cardiopulmonary Arrest in the Emergency Department. Emerg Med Int 2022; 2021:2112629. [PMID: 34992885 PMCID: PMC8727158 DOI: 10.1155/2021/2112629] [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: 06/20/2021] [Revised: 09/01/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Sudden cardiac arrest is a critical condition in the emergency department (ED). Currently, there is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm. Objectives To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED. Methods We conducted a retrospective cohort study involving the ED cardiac arrest patients who presented with initial non-shockable rhythm in ED. Multivariable logistic regression analysis was used to evaluate the independent effect of early AAM on outcomes. The outcomes included the survival to hospital discharge and discharge with favorable neurological outcome. Results There were 416 eligible participants: 209 in the early AAM group and 207 participants in the late AAM group. The early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, p = 0.524). Discharge with favorable neurological outcome is also higher in the early AAM group (aOR: 1.68, 95% CI, 0.52 -5.45, p = 0.387). Conclusion This study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival.
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Abstract
OBJECTIVES Airway management during in-hospital cardiac arrest represents a fundamental component of resuscitative efforts, yet little is known about temporal trends in intubation during in-hospital cardiac arrest. Our objective was to investigate changes in in-hospital cardiac arrest airway management over time and in response to national guideline updates. DESIGN Observational cohort study of a prospectively collected database. SETTING Multicenter study of hospitals participating in the "Get With The Guidelines-Resuscitation" registry from January 1, 2001, to December 31, 2018. SUBJECTS Adult patients who experienced an in-hospital cardiac arrest and did not have an invasive airway in place prior to the arrest. INTERVENTIONS The primary outcome was the rate of intra-arrest intubation from 2001 to 2018. We constructed multivariable regression models with generalized estimating equations to determine the annual adjusted odds of intubation. We also assessed the timing of intubation relative to the onset of pulselessness and other arrest measures. We used an interrupted time-series analysis to assess the association between the 2010 Advanced Cardiac Life Support guideline update and intubation rates. MEASUREMENTS AND MAIN RESULTS One thousand sixty-six eight hundred patients from 797 hospitals were included. From 2001 to 2018, the percentage of patients intubated during an arrest decreased from 69% to 55% for all rhythms, 73% to 60% for nonshockable rhythms, and 58% to 36% for shockable rhythms (p < 0.001 for trend for all 3 groups). The median time from onset of pulselessness to intubation increased from 5 minutes in 2001 (interquartile range, 2-8 min) to 6 minutes in 2018 (interquartile range, 4-10 min) (p < 0.001 for trend). Following the 2010 guideline update, there was a downward step change and a steeper decrease over time in the rate of intubation as compared to the preintervention period (p < 0.001). CONCLUSIONS Endotracheal intubation rates during in-hospital cardiac arrest have decreased significantly over time, with a more substantial decline following the updated 2010 guideline that prioritized chest compressions over airway management.
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First pass success of tracheal intubation using the C-MAC PM videolaryngoscope as first-line device in prehospital cardiac arrest compared with other emergencies: An observational study. Eur J Anaesthesiol 2021; 38:806-812. [PMID: 32833853 DOI: 10.1097/eja.0000000000001286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Successful airway management is a priority in the resuscitation of critically ill or traumatised patients. Several studies have demonstrated the importance of achieving maximum first pass success, particularly in prehospital advanced airway management. OBJECTIVE To compare success rates of emergency intubations between patients requiring cardiopulmonary resuscitation (CPR) for cardiac arrest (CPR group) and other emergencies (non-CPR group) using the C-MAC PM videolaryngoscope. DESIGN Ongoing analysis of prospective collected prehospital advanced airway management core variables. SETTING Single helicopter emergency medical service (HEMS) 'Christoph 22', Ulm Military Hospital, Germany, May 2009 to July 2018. PATIENTS We included all 1006 HEMS patients on whom prehospital advanced airway management was performed by board-certified anaesthesiologists on call at HEMS 'Christoph 22'. INTERVENTIONS The C-MAC PM was used as the first-line device. The initial direct laryngoscopy was carried out using the C-MAC PM without the monitor in sight. After scoring the direct laryngoscopic view according to the Cormack and Lehane grade, the monitor was folded within the sight of the physician and tracheal intubation was performed using the videolaryngoscopic view without removing the blade. MAIN OUTCOME MEASURES The primary outcome was successful airway management. Secondary outcomes were the patient's position during airway management, necessity for suction, direct and videolaryngoscopic view according to Cormack and Lehane grading, as well as number of attempts needed for successful intubation. RESULTS A patent airway was achieved in all patients including rescue techniques. There was a lower first pass success rate in the CPR group compared with the non-CPR group (84.4 vs. 91.4%, P = 0.01). In the CPR group, direct laryngoscopy resulted more often in a clinically unfavourable (Cormack and Lehane grade 3 or 4) glottic view (CPR vs. non-CPR-group 37.2 vs. 26.7%, P = 0.0071). Using videolaryngoscopy reduced the clinically unfavourable grading to Cormack and Lehane 1 or 2 (P < 0.0001). The odds of achieving first pass success were approximately 12-fold higher with a favourable glottic view than with an unfavourable glottic view (OR 12.6, CI, 6.70 to 23.65). CONCLUSION Airway management in an anaesthesiologist-staffed HEMS is associated with a high first pass success rate but even with skilled providers using the C-MAC PM videolaryngoscope routinely, patients who require CPR offer more difficulties for successful prehospital advanced airway management at the first attempt. TRIAL REGISTRATION German Clinical trials register (drks.de) DRKS00020484.
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Epidemiology, etiology, and outcomes of in-hospital cardiac arrest in Lebanon. J Geriatr Cardiol 2021; 18:416-425. [PMID: 34220971 PMCID: PMC8220382 DOI: 10.11909/j.issn.1671-5411.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) constitutes a significant cause of morbidity and mortality. As data is scarce in the Middle East and Lebanon, we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon. METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1, 2016 and May 2, 2019. Sociodemographic variables included age and sex, in addition to the comorbidities listed in the Charlson comorbidity index. IHCA event variables were day, event location, time from activation to arrival, initial cardiac rhythm, and the total number of IHCA events. We also looked at the months and years. We considered the return of spontaneous circulation (ROSC) and survival to discharge (StD) to be our outcomes of interest. RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions (95% CI: 6.09-7.08). Non-shockable rhythms were 90.7% of IHCAs. Most IHCA cases occurred in the closed units (87.9%) (intensive care unit, respiratory care unit, neurology care unit, and cardiology care unit) and on weekdays (76.5%). ROSC followed more than half the IHCA events (56%). However, only 5.4% of IHCA events achieved StD. Both ROSC and StD were higher in cases with a shockable rhythm. Survival outcomes were not significantly different between day, evening, and nightshifts. ROSC was not significantly different between weekdays and weekends; however, StD was higher in events that happened during weekdays than weekends (6.7%vs. 1.9%, P = 0.002). CONCLUSIONS The incidence of IHCA was high, and its outcomes were lower compared to other developed countries. Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week. These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
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Miller AC, Scissum K, McConnell L, East N, Vahedian-Azimi A, Sewell KA, Zehtabchi S. Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis. Int J Crit Illn Inj Sci 2020; 10:109-122. [PMID: 33409125 PMCID: PMC7771623 DOI: 10.4103/ijciis.ijciis_155_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: Restoring cardiopulmonary circulation with effective chest compression remains the cornerstone of resuscitation, yet real-time compressions may be suboptimal. This project aims to determine whether in patients with in-hospital cardiac arrest (IHCA; population), chest compressions performed with free-standing audiovisual feedback (AVF) device as compared to standard manual chest compression (comparison) results in improved outcomes, including the sustained return of spontaneous circulation (ROSC), and survival to the intensive care unit (ICU) and hospital discharge (outcomes). Methods: Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Clinical randomized controlled trials (RCT) were included that enrolled adults (age ≥ 18 years) with IHCA and assessed real-time chest compressions delivered with either the standard manual technique or with AVF from a freestanding device not linked to an automated external defibrillator (AED) or automated compressor. Results: Four clinical trials met inclusion criteria and were included. No ongoing trials were identified. One RCT assessed the Ambu CardioPump (Ambu Inc., Columbia, MD, USA), whereas three assessed Cardio First Angel™ (Inotech, Nubberg, Germany). No clinical RCTs compared AVF devices head-to-head. Three RCTs were multi-center. Sustained ROSC (4 studies, n = 1064) was improved with AVF use (Relative risk [RR] 1.68, 95% confidence interval [CI] 1.39–2.04), as was survival to hospital discharge (2 studies, n = 922; RR 1.78, 95% CI 1.54–2.06) and survival to hospital discharge (3 studies, n = 984; RR 1.91, 95% CI 1.62–2.25). Conclusion: The moderate-quality evidence suggests that chest compressions performed using a non-AED free-standing AVF device during resuscitation for IHCA improves sustained ROSC and survival to ICU and hospital discharge. Trial Registration: PROSPERO (CRD42020157536).
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Affiliation(s)
- Andrew C Miller
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Kiyoshi Scissum
- Department of Emergency Medicine, East Carolina University, Greenville, NC, USA
| | - Lorena McConnell
- Department of Emergency Medicine, East Carolina University, Greenville, NC, USA
| | - Nathaniel East
- Department of East Carolina University Brody School of Medicin, East Carolina University, Greenville, NC, USA
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kerry A Sewell
- William E. Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - Shahriar Zehtabchi
- Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
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Penketh JA, Nolan JP, Skrifvars MB, Rylander C, Frenell I, Tirkkonen J, Reynolds EC, Parr MJA, Aneman A. Airway management during in-hospital cardiac arrest: An international, multicentre, retrospective, observational cohort study. Resuscitation 2020; 153:143-148. [PMID: 32479867 DOI: 10.1016/j.resuscitation.2020.05.028] [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: 02/07/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
AIM To determine the type of airway devices used during in-hospital cardiac arrest (IHCA) resuscitation attempts. METHODS International multicentre retrospective observational study of in-patients aged over 18 years who received chest compressions for cardiac arrest from April 2016 to September 2018. Patients were identified from resuscitation registries and rapid response system databases. Data were collected through review of resuscitation records and hospital notes. Airway devices used during cardiac arrest were recorded as basic (adjuncts or bag-mask), or advanced, including supraglottic airway devices, tracheal tubes or tracheostomies. Descriptive statistics and multivariable regression modelling were used for data analysis. RESULTS The final analysis included 598 patients. No airway management occurred in 36 (6%), basic airway device use occurred at any time in 562 (94%), basic airway device use without an advanced airway device in 182 (30%), tracheal intubation in 301 (50%), supraglottic airway in 102 (17%), and tracheostomy in 1 (0.2%). There was significant variation in airway device use between centres. The intubation rate ranged between 21% and 90% while supraglottic airway use varied between 1% and 45%. The choice of tracheal intubation vs. supraglottic airway as the second advanced airway device was not associated with immediate survival from the resuscitation attempt (odds ratio 0.81; 95% confidence interval 0.35-1.8). CONCLUSION There is wide variation in airway device use during resuscitation after IHCA. Only half of patients are intubated before return of spontaneous circulation and many are managed without an advanced airway. Further investigation is needed to determine optimal airway device management strategies during resuscitation following IHCA.
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Affiliation(s)
- J A Penketh
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; Intensive Care Unit, Royal United Hospital, Bath, United Kingdom.
| | - J P Nolan
- Intensive Care Unit, Royal United Hospital, Bath, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom.
| | - M B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - C Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - I Frenell
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - J Tirkkonen
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; Intensive Care Unit, Tampere University Hospital, Finland.
| | - E C Reynolds
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; Intensive Care Unit, Royal United Hospital, Bath, United Kingdom.
| | - M J A Parr
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
| | - A Aneman
- Intensive Care Unit, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
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Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest-the PERSEUS resuscitation protocol. Heart Fail Rev 2020; 24:473-480. [PMID: 30741366 DOI: 10.1007/s10741-019-09772-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Resuscitation guidelines remain uniform across all cardiac arrest patients, focusing on the delivery of chest compressions to a standardized rate and depth and algorithmic vasopressor dosing. However, individualizing resuscitation to the appropriate hemodynamic and ventilatory goals rather than a standard "one-size-fits-all" treatment seems a promising new therapeutic strategy. In this article, we present a new physiology-guided treatment strategy to titrate the resuscitation efforts to patient's physiologic response after cardiac arrest. This approach can be applied during resuscitation attempts in highly monitored patients, such as those in the operating room or the intensive care unit, and could serve as a method for improving tissue perfusion and oxygenation while decreasing post-resuscitation adverse effects.
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12
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Wang CH, Chang WT, Huang CH, Tsai MS, Yu PH, Wu YW, Chen WJ. Associations between early intra-arrest blood acidaemia and outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. J Formos Med Assoc 2020; 119:644-651. [PMID: 31493983 DOI: 10.1016/j.jfma.2019.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022] Open
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Benoit JL, McMullan JT, Wang HE, Xie C, Xu P, Hart KW, Stolz U, Lindsell CJ. Timing of Advanced Airway Placement after Witnessed Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2019; 23:838-846. [DOI: 10.1080/10903127.2019.1595236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Granfeldt A, Avis SR, Nicholson TC, Holmberg MJ, Moskowitz A, Coker A, Berg KM, Parr MJ, Donnino MW, Soar J, Nation K, Andersen LW. Advanced airway management during adult cardiac arrest: A systematic review. Resuscitation 2019; 139:133-143. [PMID: 30981882 DOI: 10.1016/j.resuscitation.2019.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 01/10/2023]
Abstract
AIM To systematically review the literature on advanced airway management during adult cardiac arrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations. METHODS The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials and observational studies published before October 30, 2018. The population included adult patients with cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies. RESULTS We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiac arrest. The risk of bias for individual observational studies was overall assessed as critical or serious, with confounding and selection bias being the primary sources of bias. Three of the controlled trials, all published in 2018, were powered for clinical outcomes with two comparing a supraglottic airway to tracheal intubation and one comparing bag-mask ventilation to tracheal intubation. All three trials had some concerns regarding risk of bias primarily due to lack of blinding and variable adherence to the protocol. Clinical and methodological heterogeneity across studies, for both the observational studies and the controlled trials, precluded any meaningful meta-analyses. CONCLUSIONS We identified a large number of studies related to advanced airway management in adult cardiac arrest. Three recently published, large randomized trials in out-of-hospital cardiac arrest will help to inform future guidelines. Trials of advanced airway management during in-hospital cardiac arrest are lacking.
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Affiliation(s)
- Asger Granfeldt
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Suzanne R Avis
- School of Medicine, University of Tasmania - SydneyCampus, Sydney, Australia
| | | | - Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Amin Coker
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katherine M Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael J Parr
- Intensive Care Unit, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jasmeet Soar
- Intensive Care Unit, Southmead Hospital, Bristol, United Kingdom
| | - Kevin Nation
- New Zealand Resuscitation Council, Wellington, New Zealand
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Intensive Care Medicine, Randers Regional Hospital, Randers, Denmark.
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15
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Goharani R, Vahedian-Azimi A, Farzanegan B, Bashar FR, Hajiesmaeili M, Shojaei S, Madani SJ, Gohari-Moghaddam K, Hatamian S, Mosavinasab SMM, Khoshfetrat M, Khabiri Khatir MA, Miller AC. Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial. J Intensive Care 2019; 7:5. [PMID: 30693086 PMCID: PMC6341760 DOI: 10.1186/s40560-019-0357-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/03/2019] [Indexed: 01/29/2023] Open
Abstract
Objective To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical–surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge. Results One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P < 0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones. Conclusion Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge. Trial registration The study was registered with Clinicaltrials.gov (NCT02845011), registered retrospectively on July 21, 2016.
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Affiliation(s)
- Reza Goharani
- 1Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- 2Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behrooz Farzanegan
- 3Tracheal Diseases Research Center, Anesthesia and Critical Care Department, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid R Bashar
- 4Anesthesia and Critical Care Department, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Mohammadreza Hajiesmaeili
- 1Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedpouzhia Shojaei
- 1Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed J Madani
- 5Medicine Faculty, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Keivan Gohari-Moghaddam
- 6Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevak Hatamian
- 7Anesthesia and Critical Care Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyed M M Mosavinasab
- 8Anesthesiology Research Center, Anesthesia Care Department, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoum Khoshfetrat
- 9Anesthesiology Research Center, Anesthesia and Critical Care Department, Khatam-o-anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad A Khabiri Khatir
- 10Anesthesiology Research Center, Anesthesia and Critical Care Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andrew C Miller
- 11Department of Emergency Medicine, Vident Medical Center, East Carolina University Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27834 USA
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16
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Smith CM, Yeung J. Airway management in cardiac arrest-Not a question of choice but of quality? Resuscitation 2018; 133:A5-A6. [PMID: 30336234 DOI: 10.1016/j.resuscitation.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Christopher M Smith
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Joyce Yeung
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
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17
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Aziz F, Paulo MS, Dababneh EH, Loney T. Epidemiology of in-hospital cardiac arrest in Abu Dhabi, United Arab Emirates, 2013-2015. HEART ASIA 2018; 10:e011029. [PMID: 30245746 PMCID: PMC6144902 DOI: 10.1136/heartasia-2018-011029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Objective Estimate the incidence and outcomes of in-hospital cardiac arrest (IHCA) in a tertiary-care hospital in Abu Dhabi emirate, United Arab Emirates (UAE). Methods Retrospective data from 685 inpatients who experienced an IHCA at a hospital in Abu Dhabi (UAE) between 1 January 2013 and 31 December 2015 were analysed. Sociodemographic variables were age and gender, and IHCA event variables were shift, day, event location, initial cardiac rhythm and the total number of IHCA events. Outcome variables were the return of spontaneous circulation (ROSC) and survival to discharge (StD). Results The incidence of IHCA was 11.7 (95% CI 10.8 to 12.6) per 1000 hospital admissions. Non-shockable rhythms were 91.1% of the cardiac rhythms at presentation. The majority of IHCA cases occurred in the intensive care unit (46.1%) and on weekdays (74.6%). More than a third (38.3%) of patients who experienced an IHCA achieved ROSC and 7.7% StD. Both ROSC and StD were significantly higher in patients who were younger and presenting with a shockable rhythm (all p’s≤0.05). Survival outcomes were not significantly different between dayshifts and nightshifts or weekdays and weekends. Conclusions The incidence of IHCA was higher and its outcomes were lower compared with other high-income/developed countries. Survival outcomes were better for patients who were younger and had a shockable rhythm, and similar between time of day and days of the week. These findings may help to inform health managers about the magnitude and quality of IHCA care in the UAE.
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Affiliation(s)
- Faisal Aziz
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Emad H Dababneh
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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18
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Timing of advanced airway management by emergency medical services personnel following out-of-hospital cardiac arrest: A population-based cohort study. Resuscitation 2018; 128:16-23. [DOI: 10.1016/j.resuscitation.2018.04.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 01/01/2023]
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19
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ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement. Resuscitation 2018; 127:132-146. [DOI: 10.1016/j.resuscitation.2018.03.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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Kleinman ME, Perkins GD, Bhanji F, Billi JE, Bray JE, Callaway CW, de Caen A, Finn JC, Hazinski MF, Lim SH, Maconochie I, Nadkarni V, Neumar RW, Nikolaou N, Nolan JP, Reis A, Sierra AF, Singletary EM, Soar J, Stanton D, Travers A, Welsford M, Zideman D. ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement. Circulation 2018; 137:e802-e819. [PMID: 29700123 DOI: 10.1161/cir.0000000000000561] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines.
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21
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Jabre P, Penaloza A, Pinero D, Duchateau FX, Borron SW, Javaudin F, Richard O, de Longueville D, Bouilleau G, Devaud ML, Heidet M, Lejeune C, Fauroux S, Greingor JL, Manara A, Hubert JC, Guihard B, Vermylen O, Lievens P, Auffret Y, Maisondieu C, Huet S, Claessens B, Lapostolle F, Javaud N, Reuter PG, Baker E, Vicaut E, Adnet F. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. JAMA 2018; 319:779-787. [PMID: 29486039 PMCID: PMC5838565 DOI: 10.1001/jama.2018.0156] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Bag-mask ventilation (BMV) is a less complex technique than endotracheal intubation (ETI) for airway management during the advanced cardiac life support phase of cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest. It has been reported as superior in terms of survival. OBJECTIVES To assess noninferiority of BMV vs ETI for advanced airway management with regard to survival with favorable neurological function at day 28. DESIGN, SETTINGS, AND PARTICIPANTS Multicenter randomized clinical trial comparing BMV with ETI in 2043 patients with out-of-hospital cardiorespiratory arrest in France and Belgium. Enrollment occurred from March 9, 2015, to January 2, 2017, and follow-up ended January 26, 2017. INTERVENTION Participants were randomized to initial airway management with BMV (n = 1020) or ETI (n = 1023). MAIN OUTCOMES AND MEASURES The primary outcome was favorable neurological outcome at 28 days defined as cerebral performance category 1 or 2. A noninferiority margin of 1% was chosen. Secondary end points included rate of survival to hospital admission, rate of survival at day 28, rate of return of spontaneous circulation, and ETI and BMV difficulty or failure. RESULTS Among 2043 patients who were randomized (mean age, 64.7 years; 665 women [32%]), 2040 (99.8%) completed the trial. In the intention-to-treat population, favorable functional survival at day 28 was 44 of 1018 patients (4.3%) in the BMV group and 43 of 1022 patients (4.2%) in the ETI group (difference, 0.11% [1-sided 97.5% CI, -1.64% to infinity]; P for noninferiority = .11). Survival to hospital admission (294/1018 [28.9%] in the BMV group vs 333/1022 [32.6%] in the ETI group; difference, -3.7% [95% CI, -7.7% to 0.3%]) and global survival at day 28 (55/1018 [5.4%] in the BMV group vs 54/1022 [5.3%] in the ETI group; difference, 0.1% [95% CI, -1.8% to 2.1%]) were not significantly different. Complications included difficult airway management (186/1027 [18.1%] in the BMV group vs 134/996 [13.4%] in the ETI group; difference, 4.7% [95% CI, 1.5% to 7.9%]; P = .004), failure (69/1028 [6.7%] in the BMV group vs 21/996 [2.1%] in the ETI group; difference, 4.6% [95% CI, 2.8% to 6.4%]; P < .001), and regurgitation of gastric content (156/1027 [15.2%] in the BMV group vs 75/999 [7.5%] in the ETI group; difference, 7.7% [95% CI, 4.9% to 10.4%]; P < .001). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiorespiratory arrest, the use of BMV compared with ETI failed to demonstrate noninferiority or inferiority for survival with favorable 28-day neurological function, an inconclusive result. A determination of equivalence or superiority between these techniques requires further research. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02327026.
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Affiliation(s)
- Patricia Jabre
- AP-HP, Service d’Aide Médicale d’Urgence (SAMU) de Paris and Paris Sudden Death Expertise Center, Université Paris Descartes, Paris, France
| | - Andrea Penaloza
- Emergency Department, Cliniques universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - David Pinero
- SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | | | - Stephen W. Borron
- Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso
| | - Francois Javaudin
- SAMU 44, Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Olivier Richard
- SAMU 78, Centre Hospitalier de Versailles, Le Chenay, France
| | - Diane de Longueville
- Service des Urgences et du Service Mobile d’Urgence et de Réanimation (SMUR), CHU Saint-Pierre, Brussels, Belgium
| | | | | | - Matthieu Heidet
- AP-HP, SAMU 94, Hôpital Henri Mondor, Université Paris-Est Créteil, EA-4330, Créteil, France
| | | | | | - Jean-Luc Greingor
- SAMU, The Mercy Regional Hospital Centre (CHR) of Metz-Thionville, Ars-Laquenexy, France
| | - Alessandro Manara
- Emergency Department, Cliniques universitaires Saint Luc, Université Catholique de Louvain, Belgium
| | | | | | | | | | | | | | - Stephanie Huet
- AP-HP, SMUR Hôtel-Dieu, hôpital Hôtel-Dieu, Paris, France
| | - Benoît Claessens
- Service des Urgences et du Service Mobile d’Urgence et de Réanimation (SMUR), CHU Saint-Pierre, Brussels, Belgium
| | | | - Nicolas Javaud
- AP-HP, Urgences, Hôpital Louis Mourier, Colombes, France
| | | | - Elinor Baker
- AP-HP, SAMU 93, Hôpital Avicenne, Inserm U942, Bobigny, France
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, hôpital Fernand Widal, Université Paris-Diderot, Paris, France
| | - Frédéric Adnet
- AP-HP, SAMU 93, Hôpital Avicenne, Inserm U942, Bobigny, France
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Wee S, Chang ZY, Lau YH, Wong Y, Ong C. Cardiopulmonary resuscitation-from the patient's perspective. Anaesth Intensive Care 2017; 45:344-350. [PMID: 28486892 DOI: 10.1177/0310057x1704500309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). This study aims to understand the knowledge and perspectives of the local community regarding resuscitation options and end-of-life decision-making and to explore ways to improve the quality of end-of-life discussions. An interviewer-administered survey was conducted with a prospectively recruited group of surgical patients admitted postoperatively to the day surgery ward of a single tertiary institution in Singapore from April to May 2015. The survey, modelled after two validated questionnaires, measured patients' knowledge, attitudes and preferences regarding CPR in a series of 18 questions. Fifty-one out of 67 (76.1%) patients completed the survey. Results indicated that 80.4% (n=41) of participants correctly understood the purpose of CPR, but 64.7% (n=33) did not know of any possible complications of CPR. Less than half (n=21, 41.2%) of participants had thought about life support measures they wanted for themselves. Most of the participants agreed that they should personally be involved in making end-of-life decisions (n=44, 86.3%). Many patients had a poor knowledge of CPR and other resuscitation measures and the majority overestimated the success rate of CPR. However, a majority were receptive to improving their knowledge and keen to discuss end-of-life issues with physicians.
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Affiliation(s)
- S Wee
- Resident, Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Z Y Chang
- Medical student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y H Lau
- Consultant, Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Yky Wong
- Senior Epidemiologist, Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
| | - Cym Ong
- Consultant, Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
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Chalkias A, Pavlopoulos F, Koutsovasilis A, d'Aloja E, Xanthos T. Airway pressure and outcome of out-of-hospital cardiac arrest: A prospective observational study. Resuscitation 2017; 110:101-106. [DOI: 10.1016/j.resuscitation.2016.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/22/2016] [Accepted: 10/30/2016] [Indexed: 11/29/2022]
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