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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Cardiol Clin 2024; 42:289-306. [PMID: 38631796 DOI: 10.1016/j.ccl.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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Nassal MM, Wang HE, Benoit JL, Kuhn A, Powell JR, Keseg D, Sauto J, Panchal AR. Statewide implementation of the cardiac arrest registry to enhance survival in Ohio. Resusc Plus 2024; 17:100528. [PMID: 38178963 PMCID: PMC10765104 DOI: 10.1016/j.resplu.2023.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Public health surveillance is essential for improving community health. The Cardiac Arrest Registry to Enhance Survival (CARES) is a surveillance system for out-of-hospital cardiac arrest (OHCA). We describe results of the organized statewide implementation of Ohio CARES. Methods We performed a retrospective analysis of CARES enactment in Ohio. Key elements included: establishment of statewide leadership, appointment of a dedicated coordinator, conversion to a statewide subscription, statewide dissemination of information, fundraising from internal and external stakeholders, and conduct of resuscitation academies. We identified all adult (≥18 years) OHCA reported in the registry during 2013-2020. We evaluated OHCA characteristics before (2013-2015) and after (2016-2019) statewide implementation using chi-square test. We evaluated trends in OHCA outcomes using the Cochran-Armitage test of trend. Results Statewide CARES promotion increased participation from 2 (urban) to 136 (129 urban, 7 rural) EMS agencies. Covered population increased from 1.2 M (10% of state) to 4.8 M (41% of state). After statewide implementation, OHCA populations increased male (58.1% vs 60.8%, p < 0.01), white (50.1% vs 63.7%, p < 0.01), bystander witnessed (26.9% vs 32.9%, p < 0.01) OHCAs. Bystander CPR (34.7% vs 33.2%, p = 0.22), bystander AED (13.5% vs 12.3%, p = 0.55) and initial rhythm (shockable 18.0% vs 18.3%, p = 0.32) did not change. From 2013 to 2019 there were temporal increases in ROSC (29.7% to 31.9%, p-trend = 0.028), survival (7.4% to 12.3%, p-trend < 0.001) and survival with good neurologic outcome (5.6% to 8.6%, p-trend = 0.047). Conclusion The organized statewide implementation of CARES in Ohio was associated with marked increases in community uptake and concurrent observed improvements in patient outcomes. These results highlight key lessons for community-wide fostering of OHCA surveillance.
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Affiliation(s)
- Michelle M.J. Nassal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Henry E. Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Justin L. Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | | | - Jonathan R. Powell
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - David Keseg
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - James Sauto
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
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Pu Y, Yang G, Chai X. Racial and ethnic disparities in bystander resuscitation for out-of-hospital cardiac arrests. Heart Lung 2024; 64:100-106. [PMID: 38071862 DOI: 10.1016/j.hrtlng.2023.12.004] [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: 08/20/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Bystander-provided cardiopulmonary resuscitation (CRP) influences the survival rates of out-of-hospital cardiac arrests (OHCAs). Disparities on bystander resuscitation measures between Black, Hispanic, Asians and Non-Hispanic White OHCAs is unclear. Examining racial and ethnic differences in bystander resuscitations is essential to better target interventions. METHODS 15,542 witnessed OHCAs were identified between April 1, 2011, and June 30, 2015 using the Resuscitation Outcomes Consortium Epidemiologic Registry 3, a multi-center, controlled trial about OHCAs in the United States and Canada. Multivariable logistic regression model was used to analyze the differences in bystander resuscitation (bystander CRP [B-CPR], CPR plus ventilation, automated external defibrillators/defibrillator application [B-AED/D], or delivery of shocks) and clinical outcomes (death at the scene or en route, return of spontaneous circulation upon first arrival at the emergency department [ROSC-ED], survival until ED discharge [S-ED], survival until hospital discharge [S-HOS], and favorable neurological outcome at discharge) between Black, Hispanic, or Asian victims and Non-Hispanic White victims. RESULTS Compared to OHCA victims in Non-Hispanic Whites, Black, Hispanic, and Asians were less likely to receive B-CPR (adjusted OR: 0.79; 95 % CI: 0.63-0.99), and B-AED/D (adjusted OR: 0.80; 95 % CI: 0.65-0.98) in public locations. And, Black, Hispanic, and Asian OHCAs were less likely to receive bystander resuscitation in street/highway locations and public buildings, and less likely to have better clinical outcomes, including ROSC-ED, S-ED and S-HOS. CONCLUSION Black, Hispanic and Asian victims with witnessed OHCAs are less likely to receive bystander resuscitation and more likely to get worse outcomes than Non-Hispanic White victims.
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Affiliation(s)
- Yuting Pu
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guifang Yang
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiangping Chai
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Emergency Medicine and Difficult Disease Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Emerg Med Clin North Am 2023; 41:485-508. [PMID: 37391246 DOI: 10.1016/j.emc.2023.05.001] [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: 07/02/2023]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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Peri F, De Nardi L, Canuto A, Gaiero A, Noli S, Ferretti M, Vergine G, Falcioni A, Copponi E, Tagliabue B, Massart F, Fabiani E, Stringhi C, Rubini M, Zamagni G, Amaddeo A, Genovese MR, Norbedo S. Drowning in Children and Predictive Parameters: A 15-Year Multicenter Retrospective Analysis. Pediatr Emerg Care 2023; 39:516-523. [PMID: 37335544 DOI: 10.1097/pec.0000000000002987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors. METHODS This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning. RESULTS One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3-10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel ( P = 0.388 vs 0.390). CONCLUSIONS This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention.
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Affiliation(s)
- Francesca Peri
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Laura De Nardi
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Arianna Canuto
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Gaiero
- Pediatric and Neonatology Unit, Ospedale San Paolo Savona, Savona, Italy
| | - Serena Noli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini Institute, University of Genova, Genova, Italy
| | - Marta Ferretti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini Institute, University of Genova, Genova, Italy
| | - Gianluca Vergine
- Department of Pediatrics, Infermi Hospital Rimini, ASL Romagna, Italy
| | - Alice Falcioni
- Department of Pediatrics, Infermi Hospital Rimini, ASL Romagna, Italy
| | | | - Bruna Tagliabue
- Department of Pediatrics, University of Brescia, Brescia, Italy
| | - Francesco Massart
- Pediatric Unit, Maternal and Infant Department, Santa Chiara's University Hospital of Pisa, Pisa, Italy
| | - Elisabetta Fabiani
- Department of Pediatric Emergency, Gaspare Salesi Hospital, Azienda Ospedaliera Ospedali Riuniti, Ancona, Italy
| | | | - Monica Rubini
- Department of Pediatric Emergency, Parma Children's Hospital, Parma, Italy
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Rita Genovese
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Norbedo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Bierens J, Bray J, Abelairas-Gomez C, Barcala-Furelos R, Beerman S, Claesson A, Dunne C, Fukuda T, Jayashree M, T Lagina A, Li L, Mecrow T, Morgan P, Schmidt A, Seesink J, Sempsrott J, Szpilman D, Thom O, Tobin J, Webber J, Johnson S, Perkins GD. A systematic review of interventions for resuscitation following drowning. Resusc Plus 2023; 14:100406. [PMID: 37424769 PMCID: PMC10323217 DOI: 10.1016/j.resplu.2023.100406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023] Open
Abstract
Objectives The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.
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Affiliation(s)
- Joost Bierens
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group and Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo. Pontevedra, Spain
| | | | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Cody Dunne
- Department of Emergency Medicine, University of Calgary, Canada
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Toranomon Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Muralidharan Jayashree
- Department of Pediatrics. Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anthony T Lagina
- School of Emergency Medicine, Wayne State University, Detroit, USA
| | - Lei Li
- School of Emergency Medicine, Wayne State University, Detroit, USA
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tom Mecrow
- Royal National Lifeboat Institution, West Quay Road, Poole, Dorset, UK
| | - Patrick Morgan
- Extreme Environments Laboratory, University of Portsmouth, Portsmouth, UK
| | - Andrew Schmidt
- Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, USA
| | - Jeroen Seesink
- Erasmus MC University Medical Center, Department of Anaesthesiology, Rotterdam, the Netherlands
| | | | - David Szpilman
- Brazilian Lifesaving Society, SOBRASA, Rio de Janeiro, Brazil
| | - Ogilvie Thom
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Joshua Tobin
- UT Health San Antonio, Dept of Anesthesiology, San Antonio, USA
| | - Jonathon Webber
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
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Ryan K, Bui MD, Johnson B, Eddens KS, Schmidt A, Ramos WD. Drowning in the United States: Patient and Scene Characteristics using the novel CARES Drowning Variables. Resuscitation 2023; 187:109788. [PMID: 37030551 DOI: 10.1016/j.resuscitation.2023.109788] [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: 01/13/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies examining drowning internationally have reviewed factors surrounding drowning however in the U.S. limited data exists. This study evaluated the novel drowning elements collected in the Cardiac Arrest Registry to Enhance Survival (CARES) during the first 2 years of data collection. METHODS A retrospective analysis of the CARES database identified cases of drowning etiology for the two years 2020 and 2021. Demographics and incident characteristics were collected. Characteristics included items such as body of water, precipitating event, and who extracted patients. Survival to hospital discharge and neurological outcomes were compared between groups based on who initiated CPR using Pearson's Chi-Squared tests. RESULTS Among 1,767 drowning cases, 69.7% were male, 47.1% white and 11.9% survived to hospital discharge. Body of water was often natural body (36.2%) or swimming pool (25.9%) and bystanders removed the patient in 42.7% of incidents. Swimming was the most common activity at time of submersion (18.6%) however in 50.2% of cases, activity was unknown or missing. When compared to EMS/First Responder initiating CPR, odds of neurologically favorable survival were significantly higher in the Bystander initiated CPR group (OR=2.85, 95% confidence interval [CI] 2.02-4.01). CONCLUSION In this national cohort of drowning patients in cardiac arrest, the novel CARES drowning elements provide additional detail of epidemiological factors. Bystander CPR was associated with improved neurological outcomes. Future studies utilizing the drowning elements can inform injury prevention strategies.
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Affiliation(s)
- Kevin Ryan
- Assistant Professor of Emergency Medicine, Boston Medical Center/Chobanian and Avedisian School of Medicine, 785 Albany Street, 5(th) Floor, Boston, MA 02118
| | - Matthew D Bui
- Boston Medical Center/Chobanian and Avedisian School of Medicine, Department of Emergency Medicine, BCD Building, 800 Harrison Ave, Boston, MA 02118
| | - Brett Johnson
- University of Massachusetts Medical Center/UMASS Chan School of Medicine, Department of Emergency Medicine, 55 Lake Ave North, Worcester, MA 01655
| | - Katherine S Eddens
- Associate Research Scientist, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, 1025 E 7th St, C101, Bloomington, IN 47405
| | - Andrew Schmidt
- Associate Professor of Emergency Medicine, University of Florida College of Medicine -Jacksonville, 655 W 8TH ST C506, Jacksonville, FL 32209
| | - William D Ramos
- Associate Professor, Director - Aquatics Institute, Indiana University School of Public Health-Bloomington, Dept. of Health & Wellness Design, 1025 E 7th St, Bloomington, IN 47405
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Reizine F, Delbove A, Tattevin P, Santos AD, Bodenes L, Bouju P, Fillâtre P, Frérou A, Halley G, Lesieur O, Courouble P, Berteau F, Morin J, Delamaire F, Marnai R, Le Meur A, Aubron C, Reignier J, Gacouin A, Tadié JM. Clinical and microbiological features of drowning-associated pneumonia: a retrospective multicentre cohort study. Clin Microbiol Infect 2023; 29:108.e7-108.e13. [PMID: 35944877 DOI: 10.1016/j.cmi.2022.07.027] [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: 05/02/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pneumonia is the most frequent infectious complication in patients who have experienced drowning that requires intensive care unit (ICU) admission. We aimed to describe clinical, microbiological, and therapeutic data as well as predictors and impacts of such pneumonia on patients' outcomes. METHODS We conducted a retrospective, multicentre study (2013-2020) of 270 consecutive patients admitted for drowning to 14 ICUs in Western France. Their baseline characteristics and outcomes were compared according to the occurrence of drowning-associated pneumonia (DAP), defined as pneumonia diagnosed within 48 hours of ICU admission. A Cox regression model was used to compare survival on day 28, and logistic regression was used to identify risk factors for DAP. Microbiological characteristics and empirical antibacterial treatment were also analysed. RESULTS Among the 270 patients admitted to the ICU for drowning, 101 (37.4%) and 33 (12.2%) experienced pneumonia and microbiologically proven DAP, respectively. The occurrence of pneumonia was associated with higher severity scores at ICU admission (median Simplified Acute Physiology Score II, 34 [interquartile range {IQR}, 25-55] vs. 45 [IQR, 28-67]; p 0.006) and longer ICU length of stay (2 days [IQR, 1-3] vs. 4 days [IQR, 2-7]; p < 0.001). The 28-day mortality rate was higher among these patients (29/101 [28.7%] vs. 26/169 [15.4%]; p 0.013). Microbiologically proven DAP remained associated with higher 28-day mortality after adjustments for cardiac arrest and water salinity (adjusted hazard ratio, 1.86 [95% CI, 1.06-3.28]; p 0.03). A microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli (23/56; 41.1%), with a high prevalence of amoxicillin-clavulanate resistance (12/33; 36.4%). CONCLUSIONS Pneumonia is a common complication in patients admitted in the ICU for drowning and is associated with increased mortality.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France.
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, Vannes, France
| | - Pierre Tattevin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Alexandre Dos Santos
- CH La Roche sur Yon, Service de Réanimation Polyvalente, La Roche sur Yon, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, Lorient, France
| | - Pierre Fillâtre
- CH Saint-Brieuc, Service de Réanimation Polyvalente, Saint-Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, Saint Malo, France
| | | | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, La Rochelle, France
| | - Patricia Courouble
- CH Saint Nazaire, Service de Réanimation Polyvalente, Saint Nazaire, France
| | - Florian Berteau
- CH Morlaix, Service de Réanimation Polyvalente, Morlaix, France
| | - Jean Morin
- CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Flora Delamaire
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Rémy Marnai
- CH Le Mans, Service de Réanimation Polyvalente, Le Mans, France
| | - Anthony Le Meur
- CH Cholet, Service de Réanimation Polyvalente, Cholet, France
| | - Cécile Aubron
- CHU Brest, Médecine Intensive Réanimation, Brest, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, Nantes, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
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Zhou P, Xu H, Li B, Yang C, Zhou Z, Shi J, Li Z. Neurological outcomes in adult drowning patients in China. Ann Saudi Med 2022; 42:127-138. [PMID: 35380055 PMCID: PMC8982001 DOI: 10.5144/0256-4947.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drowning is the third leading cause of unintentional death worldwide. The epidemiological characteristics of adult drownings are rarely reported. OBJECTIVE Investigate factors associated with neurological prognosis in adult drowning inpatients. DESIGN Multicenter medical record review. SETTING Tertiary health care institutions. PATIENTS AND METHODS We collected demographic and clinical data on patients who drowned but survived between September 2006 and January 2020. Neurological prognosis was compared in patients with and without cardiac arrest. MAIN OUTCOME MEASURES Neurological outcomes. SAMPLE SIZE AND CHARACTERISTICS 142 patients with mean age of 50.6 (19.8) years, male/female ratio of 1.54:1. RESULT Forty-five patients (31.7%) received CPR, 90 patients (63.4%) experienced unconsciousness, and 59 patients (41.5%) received endotracheal intubation and mechanical ventilation. Multivariate logistic regression analysis showed that the initial blood lactic acid level (OR: 7.67, 95%CI: 1.23-47.82, P=.029) was associated with a poor neurological prognosis in patients without cardiac arrest. The incidence of ICU admission (OR: 16.604, 95%CI: 1.15-239.49, P=.039) was associated with a poor neurologic prognosis in patients with cardiac arrest. CONCLUSIONS For the drowning patients with cardiac arrest, ICU admission was associated with neurological function prognosis in these patients. Among the patients without cardiac arrest, the initial lactate value was associated with neurological function prognosis of these patients. LIMITATIONS Retrospective. CONFLICT OF INTEREST None.
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Affiliation(s)
- Peisen Zhou
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Huaqing Xu
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Bingccan Li
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Chenbing Yang
- From the Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zhiliang Zhou
- From the Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jincun Shi
- From the Department of Emergency Medicine, Wenzhou Central Hospital, Zhejiang, China
| | - Zhangping Li
- From the The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Zhejiang, China
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Resuscitation 2021; 169:229-311. [PMID: 34933747 PMCID: PMC8581280 DOI: 10.1016/j.resuscitation.2021.10.040] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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11
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Circulation 2021; 145:e645-e721. [PMID: 34813356 DOI: 10.1161/cir.0000000000001017] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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12
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Reizine F, Delbove A, Dos Santos A, Bodenes L, Bouju P, Fillâtre P, Frérou A, Halley G, Lesieur O, Jonas M, Berteau F, Morin J, Luque-Paz D, Marnai R, Le Meur A, Aubron C, Reignier J, Tadié JM, Gacouin A. Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:372. [PMID: 34689813 PMCID: PMC8543920 DOI: 10.1186/s13054-021-03792-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
Background Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients’ prognosis remains poorly explored in Intensive Care Units (ICUs) patients. Methods We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. Results Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03–3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51–52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03–1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11–1.3], p < 0.0001). Conclusions In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03792-2.
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Affiliation(s)
- Florian Reizine
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France.
| | - Agathe Delbove
- CH Vannes, Service de Réanimation Polyvalente, 56000, Vannes, France
| | - Alexandre Dos Santos
- CH La Roche Sur Yon, Service de Réanimation Polyvalente, 85191, La Roche sur Yon, France
| | | | - Pierre Bouju
- CH Lorient, Service de Réanimation Polyvalente, 56100, Lorient, France
| | - Pierre Fillâtre
- CH Saint Brieuc, Service de Réanimation Polyvalente, 22000, Saint-Brieuc, France
| | - Aurélien Frérou
- CH Saint Malo, Service de Réanimation Polyvalente, 35400, Saint Malo, France
| | - Guillaume Halley
- CH Quimper, Service de Réanimation Polyvalente, 29000, Quimper, France
| | - Olivier Lesieur
- CH La Rochelle, Service de Réanimation Polyvalente, 17000, La Rochelle, France
| | - Maud Jonas
- CH Saint Nazaire, Service de Réanimation Polyvalente, 44600, Saint Nazaire, France
| | - Florian Berteau
- CH Morlaix, Service de Réanimation Polyvalente, 29600, Morlaix, France
| | - Jean Morin
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - David Luque-Paz
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Rémy Marnai
- CH Le Mans, Service de Réanimation Polyvalente, 72000, Le Mans, France
| | - Anthony Le Meur
- CH Cholet, Service de Réanimation Polyvalente, 49300, Cholet, France
| | - Cécile Aubron
- CHU Brest, Médecine Intensive Réanimation, 29200, Brest, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, 44000, Nantes, France
| | - Jean-Marc Tadié
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
| | - Arnaud Gacouin
- CHU Rennes, Maladies Infectieuses Et Réanimation Médicale, 35033, Rennes, France
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13
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Naim MY, Griffis HM, Berg RA, Bradley RN, Burke RV, Markenson D, McNally BF, Nadkarni VM, Song L, Vellano K, Vetter V, Rossano JW. Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2021; 78:1042-1052. [PMID: 34474737 DOI: 10.1016/j.jacc.2021.06.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA). OBJECTIVES This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR). METHODS Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). The primary outcome was neurologically favorable survival at hospital discharge. RESULTS Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants. CONCLUSIONS CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.
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Affiliation(s)
- Maryam Y Naim
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard N Bradley
- Division of Emergency Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Rita V Burke
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Bryan F McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lihai Song
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kimberly Vellano
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Victoria Vetter
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph W Rossano
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Denny SA, Quan L, Gilchrist J, McCallin T, Shenoi R, Yusuf S, Weiss J, Hoffman B. Prevention of Drowning. Pediatrics 2021; 148:peds.2021-052227. [PMID: 34253571 DOI: 10.1542/peds.2021-052227] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.
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Affiliation(s)
- Sarah A Denny
- Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio;
| | - Linda Quan
- Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | | | - Tracy McCallin
- Children's Hospital of San Antonio, San Antonio, Texas.,Baylor College of Medicine, Houston, Texas
| | - Rohit Shenoi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Shabana Yusuf
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jeffrey Weiss
- Phoenix Children's Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; and
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Koon W, Clemens T, Bierens J, Quan L. Studying outcome predictors of drowning at the scene: Why do we have so few answers? Am J Emerg Med 2021; 46:361-366. [DOI: 10.1016/j.ajem.2020.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023] Open
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Roberts K, Thom O, Devine S, Leggat PA, Peden AE, Franklin RC. A scoping review of female drowning: an underexplored issue in five high-income countries. BMC Public Health 2021; 21:1072. [PMID: 34090385 PMCID: PMC8178917 DOI: 10.1186/s12889-021-10920-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. METHODS A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. RESULTS The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). CONCLUSION Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.
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Affiliation(s)
- Kym Roberts
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Ogilvie Thom
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Peter A. Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Amy E. Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
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17
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Bierens JJLM. Drowning survival: Do differences in EMT airway management matter? Resuscitation 2021; 163:186-188. [PMID: 33864875 DOI: 10.1016/j.resuscitation.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Joost J L M Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussel, Belgium.
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18
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Gässler H, Helm M, Hossfeld B, Fischer M. Survival Following Lay Resuscitation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:871-877. [PMID: 33637167 DOI: 10.3238/arztebl.2020.0871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/10/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Resuscitation by laypersons is important in bridging the time between the occurrence of an out-of-hospital cardiac arrest (OHCA) and the arrival of emergency rescue service personnel. Depending on the reason for the cardiac arrest, however, the effectiveness of chest compressions is uncertain. The aim of this study was to explore the impact of lay resuscitation on survival following OHCA of different causes. METHODS The data set for analysis comprised all cases of cardiac arrest before the arrival of emergency rescue service personnel that were fully documented in the German Resuscitation Registry in the period 2007-2019. The following endpoints related to resuscitation by bystanders were evaluated-separately for each cause-descriptively and by means of multivariate logistic regression analysis: return of spontaneous circulation (ROSC), 30 days' survival/discharged alive from the hospital, and good neurological function at discharge. RESULTS Altogether, 40 604 cases of cardiac arrest were included. Resuscitation by laypersons was carried out in 35.1% of these cases. The rate of ROSC was statistically significantly higher after lay resuscitation for OHCA caused by cardiac events, drowning, intoxication, or central nervous system disorders (overall 48.1% versus 41.0%). For all causes-with the exception of trauma/bleeding to death and sepsis- the endpoint 30 days' survival/discharged alive was better with lay resuscitation (overall 17.0% versus 9.5%). In multivariate regression analysis, lay resuscitation was associated with improvement of the endpoint 30 days' survival/discharged alive only for OHCA caused by cardiac events (odds ratio [OR] 1.16) or intoxication (OR 1.81). For all other causes-except hypoxia-lay resuscitation tended to yield better results. Neurological function at discharge was also significantly better (overall 11.5% versus 6.1%) after lay resuscitation for OHCA of all causes except trauma/ bleeding to death, hypoxia, and sepsis. CONCLUSION Resuscitation by laypersons is associated with an improved result regarding the endpoint 30 days' survival/discharged alive in cases of OHCA caused by cardiac events and intoxication. These two groups account for 81% of the resuscitation patients in the study. Because there was also a tendency towards higher survival rates following OHCA of other causes (except hypoxia), laypersons should continue to be encouraged to attempt resuscitation in all cases of OHCA, whatever the cause.
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Affiliation(s)
- Holger Gässler
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, German Armed Forces Hospital Ulm; Department of Anesthesiology and Intensive Care Medicine, Alb-Fils Hospitals, Göppingen
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19
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Affiliation(s)
- Tracy E McCallin
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, TX
| | - Mickinzie Morgan
- Department of Pediatrics, Texas Tech Health Sciences Center, Lubbock, TX
| | | | - Shabana Yusuf
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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20
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Resuscitation and emergency care in drowning: A scoping review. Resuscitation 2021; 162:205-217. [PMID: 33549689 DOI: 10.1016/j.resuscitation.2021.01.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The ILCOR Basic Life Support Task Force and the international drowning research community considered it timely to undertake a scoping review of the literature to identify evidence relating to the initial resuscitation, hospital-based interventions and criteria for safe discharge related to drowning. METHODS Medline, PreMedline, Embase, Cochrane Reviews and Cochrane CENTRAL were searched from 2000 to June 2020 to identify relevant literature. Titles and abstracts and if necessary full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on the population (adults and children who are submerged in water), interventions (resuscitation in water/boats, airway management, oxygen administration, AED use, bystander CPR, ventilation strategies, ECMO, protocols for hospital discharge (I), comparator (standard care) and outcomes (O) survival, survival with a favourable neurological outcome, CPR quality, physiological end-points). RESULTS The database search yielded 3242 references (Medline 1104, Pre-Medline 202, Embase 1722, Cochrane reviews 12, Cochrane CENTRAL 202). After removal of duplicates 2377 papers were left for screening titles and abstracts. In total 65 unique papers were included. The evidence identified was from predominantly high-income countries and lacked consistency in the populations, interventions and outcomes reported. Clinical studies were exclusively observational in nature. CONCLUSION This scoping review found that there is very limited evidence from observational studies to inform evidence based clinical practice guidelines for drowning. The review highlights an urgent need for high quality research in drowning.
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21
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Ryan KM, Bui MD, Dugas JN, Zvonar I, Tobin JM. Impact of prehospital airway interventions on outcome in cardiac arrest following drowning: A study from the CARES Surveillance Group. Resuscitation 2021; 163:130-135. [PMID: 33482267 DOI: 10.1016/j.resuscitation.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies have examined airway interventions affecting patient outcomes in cardiac arrest, but less is known about drowning patients in arrest. This study evaluated the outcomes of drowning patients in the Cardiac Arrest Registry to Enhance Survival (CARES) who received advanced airway management. METHODS A retrospective analysis of the CARES database identified cases of drowning etiology between 2013 and 2018. Patients were stratified by airway intervention performed by EMS personnel. Demographics, sustained return of spontaneous circulation [ROSC], survival to hospital admission, survival to hospital discharge, and neurological outcomes were compared between airway groups using chi-squared tests and logistic regression. RESULTS Among 2388 drowning patients, 70.4% were male, 41.8% white, and 13.1% survived to hospital discharge. Patients that received supraglottic airways [SGA] had statistically significantly lower odds of survival to hospital admission compared to endotracheal tube [ETT] use (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] 0.42-0.76) as well as lower odds of survival to discharge compared to bag valve mask [BVM] use (aOR = 0.40, 95% CI 0.19-0.86) when accounting for relative ROSC timing. CONCLUSION In this national cohort of drowning patients in cardiac arrest, SGA use was associated with significantly lower odds of survival to hospital admission and discharge. However, survival to discharge with favorable neurological outcome did not differ significantly between airway management techniques. Further studies will need to examine if airway intervention order or time to intervention affects outcomes.
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Affiliation(s)
- Kevin M Ryan
- Boston University School of Medicine, 785 Albany Street, 5th Floor, Boston, MA 02118, United States.
| | - Matthew D Bui
- Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, United States
| | - Julianne N Dugas
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02118, United States
| | - Ivan Zvonar
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02118, United States
| | - Joshua M Tobin
- American Red Cross Scientific Advisory Council, 431 18th Street, NW, Washington, DC 20006, United States
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Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A35-A79. [PMID: 33098921 PMCID: PMC7576327 DOI: 10.1016/j.resuscitation.2020.09.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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23
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Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KK, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Svavarsdóttir H, Raffay V, Kuzovlev A, Grasner JT, Dee R, Smith M, Rajendran K. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S41-S91. [DOI: 10.1161/cir.0000000000000892] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning. Prehosp Disaster Med 2020; 35:141-147. [PMID: 31973778 DOI: 10.1017/s1049023x20000060] [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] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning. HYPOTHESIS/PROBLEM The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only. METHODS The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC). RESULTS Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10-6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01-2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86-2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91-1.84; P = .157). CONCLUSION In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.
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Griffis H, Wu L, Naim MY, Bradley R, Tobin J, McNally B, Vellano K, Quan L, Markenson D, Rossano JW. Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics. Resuscitation 2019; 146:126-131. [PMID: 31785372 DOI: 10.1016/j.resuscitation.2019.09.038] [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: 02/01/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA. METHODS Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes. RESULTS Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics. CONCLUSIONS Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.
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Affiliation(s)
- H Griffis
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, United States; Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States; Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States.
| | - L Wu
- The Children's Hospital of Philadelphia, United States
| | - M Y Naim
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
| | - R Bradley
- Division of Emergency Medical Services and Disaster Medicine, University of Texas Health Science Center, United States
| | - J Tobin
- Division of Trauma Anesthesiology, University of Southern California, United States
| | - B McNally
- Department of Emergency Medicine, Emory University, United States
| | - K Vellano
- Department of Emergency Medicine, Emory University, United States
| | - L Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, United States
| | | | - J W Rossano
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
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Fukuda T, Ohashi-Fukuda N, Hayashida K, Kondo Y, Kukita I. Bystander-initiated conventional vs compression-only cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest due to drowning. Resuscitation 2019; 145:166-174. [PMID: 31639461 DOI: 10.1016/j.resuscitation.2019.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/30/2019] [Accepted: 08/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Great emphasis has been placed on rescue breathing in out-of-hospital cardiac arrest (OHCA) due to drowning. However, there is no evidence about the effect of rescue breathing on neurologically favorable survival after OHCA due to drowning. The aim of this study is to examine the effect of bystander-initiated conventional (with rescue breathing) versus compression-only (without rescue breathing) cardiopulmonary resuscitation (CPR) in OHCA due to drowning. METHODS This nationwide population-based observational study using prospectively collected government-led registry data included patients with OHCA due to drowning who were transported to an emergency hospital in Japan between 2013 and 2016. The primary outcome was one-month neurologically favorable survival. RESULTS The full cohort (n = 5121) comprised 2486 (48.5%) male patients, and the mean age was 72.4 years (standard deviation, 21.6). Of these, 968 (18.9%) received conventional CPR, and 4153 (81.1%) received compression-only CPR. 928 patients receiving conventional CPR were propensity-matched with 928 patients receiving compression-only CPR. In the propensity score-matched cohort, one-month neurologically favorable survival was not significantly different between the two groups (7.5% in the conventional CPR group vs. 6.6% in the compression-only CPR group; risk ratio, 1.15; 95% confidence interval, 0.82-1.60; P = 0.4147). This association was consistent across a variety of subgroup analyses. CONCLUSIONS Among patients with OHCA due to drowning, there were no differences in one-month neurologically favorable survival between bystander-initiated conventional and compression-only CPR groups, although several important data (e.g., water temperature, submersion duration, or body of water) could not be addressed. Further study is warranted to confirm our findings.
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Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Naoko Ohashi-Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
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Yanagawa Y, Onitsuka M, Nozawa Y, Nagasawa H, Ikuto T, Jitsuiki K, Madokoro S, Ohsaka H, Ishikawa K, Omori K. The Significance of a Cooperative Medical System for Treating Decompression Illness on the Izu Peninsula in Japan. Wilderness Environ Med 2019; 30:268-273. [PMID: 31345722 DOI: 10.1016/j.wem.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In 2011, our hospital on the Izu peninsula began to hold meetings to discuss how to manage patients with decompression illness (DCI) to establish a cooperative medical system. We retrospectively investigated the influence of these meetings and the changes subsequently effected. METHODS A medical chart review was retrospectively performed to investigate all cases between January 2005 and December 2017 in which the transport of patients with DCI via a physician-staffed helicopter emergency medical service (HEMS) was attempted. The patients were divided into 2 groups: the preprogram group and the postprogram group. RESULTS There were 63 patients in the preprogram group and 65 in the postprogram group. There were no cases in which a patient's symptoms deteriorated during transportation by the HEMS. The frequency of dispatch to the scene for direct evacuation in the postprogram group (86%) was greater than that in the preprogram group (74%), but the difference was not statistically significant (P=0.09). In the postprogram group, the duration of activities at the scene or the first aid hospital was significantly shorter in comparison to the preprogram group (P=0.01). CONCLUSIONS This retrospective study revealed simultaneity between the introduction of the yearly meetings and a reduced duration of the HEMS staff's activity at either the scene or the first aid hospital.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan.
| | - Mika Onitsuka
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Yoko Nozawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Takeuchi Ikuto
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Shunsuke Madokoro
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Japan
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Reynolds JC, Hartley T, Michiels EA, Quan L. Long-Term Survival After Drowning-Related Cardiac Arrest. J Emerg Med 2019; 57:129-139. [PMID: 31262547 DOI: 10.1016/j.jemermed.2019.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Long-term outcomes after drowning-related cardiac arrest are not well characterized. OBJECTIVE Our aims were to estimate long-term survival and identify prognostic factors in a large, population-based cohort of drowning victims with cardiac arrest. METHODS We conducted a population-based prospective cohort study (1974-1996) of Western Washington Drowning Registry (WWDR) subjects with out-of-hospital cardiac arrest and attempted professional resuscitation. The primary outcome was long-term survival through 2012. We tabulated Utstein-style exposure variables, estimated Kaplan-Meier curves, and identified prognostic factors with Cox proportional hazard modeling. RESULTS Of 2824 WWDR cases, 407 subjects (median age 17 years [interquartile range 3-33 years], 81% were male) were included. Only 54 (13%) were still alive after 1663 person-years of follow-up. Most deaths occurred after termination of initial resuscitation or during initial hospitalization. Risk of subsequent death after hospital discharge was 9.6 (95% confidence interval [CI] 5.7-15.9) per 1000 person-years. Long-term survival differed by Utstein variables (older age, illicit substance use, pre-drowning activity, submersion duration, cardiopulmonary resuscitation duration, intubation, defibrillation, and medications) and inpatient markers of illness severity (vital signs, Glasgow Coma Scale, laboratory values, shock). In adjusted analyses, older age (hazard ratio [HR] 1.01; 95% CI 1.01-1.02), epinephrine administration (HR 1.92; 95% CI 1.31-2.80), antiepileptic administration (HR 0.53; 95% CI 0.35-0.81), initial arterial pH (HR 0.49; 95% CI 0.26-0.92), and shock (HR 2.19; 95% CI 1.16-4.15) were associated with higher risk of death. CONCLUSIONS Most cases of drowning-related cardiac arrest were fatal, but survivors to hospital discharge had a low risk of subsequent death that was independently associated with older age and clinical evidence of shock.
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Affiliation(s)
- Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Thomas Hartley
- Department of Emergency Medicine, Sinai-Grace Hospital, Wayne State University, Detroit, Michigan
| | - Erica A Michiels
- Department of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Linda Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Fukuda T, Ohashi-Fukuda N, Hayashida K, Kukita I. Association of bystander cardiopulmonary resuscitation and neurological outcome after out-of-hospital cardiac arrest due to drowning in Japan, 2013-2016. Resuscitation 2019; 141:111-120. [PMID: 31202824 DOI: 10.1016/j.resuscitation.2019.06.005] [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] [Received: 03/12/2019] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Early initiation of cardiopulmonary resuscitation (CPR) performed by bystanders is essential in patients with out-of-hospital cardiac arrest (OHCA) due to primary cardiac cause. However, evidence about the effect of bystander CPR on neurologically favorable survival after OHCA due to drowning is scarce and controversial. METHODS This nationwide population-based observational study using prospectively collected government-led registry data included patients with OHCA due to drowning who were transported to an emergency hospital between 2013 and 2016. The primary outcome was one-month neurologically favorable survival defined as Glasgow-Pittsburgh Cerebral Performance Category score of 1-2. The secondary outcomes were one-month survival and prehospital return of spontaneous circulation (ROSC). RESULTS The full cohort (n = 12,139) comprised 6291 (51.8%) male patients, and the mean age was 73.7 (standard deviation [SD], 18.8). Of these, 5157 (42.5%) received bystander CPR, and 6982 (57.5%) did not. 4345 patients receiving bystander CPR were propensity-matched with 4345 patients not receiving bystander CPR. In the propensity score-matched cohort, bystander CPR was associated with increased chance of one-month neurologically favorable survival (0.4% vs. 0.8%; risk ratio [RR], 2.19; 95%confidence interval [CI], 1.21-3.95; P = 0.0076), one-month survival (1.1% vs. 1.7%; RR, 1.55; 95%CI, 1.09-2.22; P = 0.0150), and prehospital ROSC (2.7% vs. 3.5%; RR, 1.30; 95%CI, 1.03-1.65; P = 0.0296). Similar association was observed across a variety of sensitivity analyses. In subgroup analysis, statistically significant difference was not observed in pediatric OHCA due to drowning, although the sample size was too small (n = 218). CONCLUSIONS Among patients with OHCA due to drowning, bystander CPR was associated with increased chance of neurologically favorable survival.
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Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Naoko Ohashi-Fukuda
- Regional Perinatal Medical Center, Department of Obstetrics and Gynecology, Naha City Hospital, 2-31-1 Furujima, Naha-shi, Okinawa, 902-8511, Japan; Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
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Denny SA, Quan L, Gilchrist J, McCallin T, Shenoi R, Yusuf S, Hoffman B, Weiss J, Agran PF, Hirsh M, Johnston B, Lee LK, Monroe K, Schaechter J, Tenenbein M, Zonfrillo MR, Quinlan K. Prevention of Drowning. Pediatrics 2019; 143:peds.2019-0850. [PMID: 30877146 DOI: 10.1542/peds.2019-0850] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.
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Affiliation(s)
- Sarah A. Denny
- College of Medicine, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio
| | - Linda Quan
- School of Medicine, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | | | - Tracy McCallin
- Children’s Hospital of San Antonio, San Antonio, Texas
- Baylor College of Medicine and
| | - Rohit Shenoi
- Baylor College of Medicine and
- Texas Children’s Hospital, Houston, Texas
| | - Shabana Yusuf
- Baylor College of Medicine and
- Texas Children’s Hospital, Houston, Texas
| | - Benjamin Hoffman
- Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, Oregon; and
| | - Jeffrey Weiss
- College of Medicine, University of Arizona and Phoenix Children’s Hospital, Phoenix, Arizona
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Peden AE, Mahony AJ, Barnsley PD, Scarr J. Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia. BMJ Open 2018; 8:e024868. [PMID: 30473541 PMCID: PMC6254411 DOI: 10.1136/bmjopen-2018-024868] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning. DESIGN A subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates. SETTING Australia, 1 July 2002 to 30 June 2015. PARTICIPANTS Unintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation. RESULTS 2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0-4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65-74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal. CONCLUSIONS This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Alison J Mahony
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
| | - Paul D Barnsley
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
| | - Justin Scarr
- Royal Life Saving Society-Australia, Broadway, New South Wales, Australia
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Peden AE, Franklin RC, Leggat PA. Cardiopulmonary resuscitation and first-aid training of river users in Australia: A strategy for reducing drowning. Health Promot J Austr 2018; 30:258-262. [PMID: 30134008 DOI: 10.1002/hpja.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/19/2018] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Rivers are a leading location for fatal drowning worldwide, often geographically isolated from timely medical assistance. Cardiopulmonary resuscitation (CPR) benefits drowning victims and those who suffer cardiac arrests. This study explored CPR and first-aid training of river users in Australia. METHODS Adult river users (18+ years) were surveyed at four high-risk river drowning sites. Respondents were asked the last time they undertook CPR (responses converted into: "CPR ever undertaken"-yes/no; and "CPR training current"-yes/no (training undertaken ≤12 months ago). Responses were explored by demographics and social determinants of health. RESULTS Of those surveyed (N = 688), 98.4% responded regarding CPR. Seventy-five percent (74.9%) had undertaken CPR training previously. Females and 35- to 44-year-olds were more likely to have undertaken training (P < 0.05). Males and older people (65+ years) were less likely to hold a current qualification (P < 0.05). Major city residents reported a longer mean time (5.4 years) since last trained than remote and very remote locations (2.0 years). People in low socio-economic areas had a shorter time since qualification current (5.8 years) than those in areas deemed high (7.2 years). CONCLUSION Current CPR qualifications are important, particularly among those visiting high-risk river drowning locations. System-level, upstream strategies that should be explored include compulsory CPR training in secondary schools and linking CPR updates to motor vehicle licence renewals. SO WHAT?: Cardiopulmonary resuscitation is a vital component of multifaceted river drowning prevention. Social determinants of health, such as socio-economic disadvantage and geographical isolation, were not barriers to participation or currency of qualification.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Dandona R, Kumar GA, George S, Kumar A, Dandona L. Risk profile for drowning deaths in children in the Indian state of Bihar: results from a population-based study. Inj Prev 2018; 25:364-371. [PMID: 29778993 PMCID: PMC6839727 DOI: 10.1136/injuryprev-2018-042743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND We report on incidence of drowning deaths and related contextual factors in children from a population-based study in the Indian state of Bihar which estimated the causes of death using verbal autopsy (VA). METHODS Interviews were conducted for deaths in 1-14 years population that occurred from January 2012 to March 2014 in 109 689 households (87.1% participation) in 1017 clusters representative of the state. The Population Health Metrics Research Consortium shortened VA questionnaire was used for interview and cause of death was assigned using the SmartVA automated algorithm. The annualised unintentional drowning death incidence, activity prior to drowning, the body of water where drowning death had occurred and contextual information are reported. FINDINGS The survey covered 224 077 children aged 1-14 years. Drowning deaths accounted for 7.2%, 12.5% and 5.8% of all deaths in 1-4, 5-9 and 10-14 years age groups, respectively. The adjusted incidence of drowning deaths was 14.3 (95% CI 14.0 to 14.7) per 100 000 children, with it being higher in urban (16.1, 95% CI 14.8 to 17.3) areas. Nearly half of the children drowned in a river (5.9, 95% CI 5.6 to 6.1) followed by in a pond (2.8, 95% CI 2.6 to 2.9). Drowning death incidence was the highest while playing (5.1, 95% CI 4.9 to 5.4) and bathing (4.0, 95% CI 3.8 to 4.2) with the former accounting for more deaths in 1-4 years age group. Sixty per cent of children were already dead when found. None of these deaths were reported to the civil registration system to obtain death certificate. INTERPRETATION The findings from this large representative sample of children document the magnitude of and variations in unintentional drowning deaths in Bihar. Urgent targeted drowning interventions are needed to address the risk in children. Gross under-reporting of drowning deaths in children in India needs attention.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, India.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Sibin George
- Public Health Foundation of India, Gurugram, India
| | - Amit Kumar
- Public Health Foundation of India, Gurugram, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, India.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Nolan J, Ornato J, Parr M, Perkins G, Soar J. Resuscitation highlights in 2017. Resuscitation 2018; 124:A1-A8. [DOI: 10.1016/j.resuscitation.2018.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
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Perkins GD, Olasveengen TM, Maconochie I, Soar J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2017; 123:43-50. [PMID: 29233740 DOI: 10.1016/j.resuscitation.2017.12.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Gavin D Perkins
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium.
| | | | - Ian Maconochie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jasmeet Soar
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jonathan Wyllie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Robert Greif
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Andrew Lockey
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Federico Semeraro
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | | | - Carsten Lott
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Koenraad G Monsieurs
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jerry P Nolan
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
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