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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Ong CA, Nadarajan GD, Fook-Chong S, Shahidah N, Arulanandam S, Ng YY, Chia MYC, Tiah L, Mao DR, Ng WM, Leong BSH, Doctor N, Ong MEH, Siddiqui FJ. Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience. Resusc Plus 2024; 17:100573. [PMID: 38370311 PMCID: PMC10869923 DOI: 10.1016/j.resplu.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS. Methods All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS. Results 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR. Conclusions Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.
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Affiliation(s)
- Chloe Alexis Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
| | | | | | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Shalini Arulanandam
- Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore
| | - Yih Yng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | - Desmond R Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Nausheen Doctor
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Fahad J Siddiqui
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
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Alm-Kruse K, Gjerset GM, Tjelmeland IB, Isern CB, Kramer-Johansen J, Garratt AM. How do survivors after out-of-hospital cardiac arrest perceive their health compared to the norm population? A nationwide registry study from Norway. Resusc Plus 2024; 17:100549. [PMID: 38292469 PMCID: PMC10825523 DOI: 10.1016/j.resplu.2023.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Self-perceived health status data is usually collected using patient-reported outcome measures. Information from the patients' perspective is one of the important components in planning person-centred care. The study aimed to compare EQ-5D-5L in survivors after out-of-hospital cardiac arrest (OHCA) with data for Norwegian population controls. Secondary aim included comparing characteristics of respondents and non-respondents from the OHCA population. Methods In this cross-sectional survey, 714 OHCA survivors received an electronic EQ-5D-5L questionnaire 3-6 months following OHCA. EQ-5D-5L assesses for five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with five-point descriptive scales and overall health on a visual analogue scale from 0 (worst) to 100 (best) (EQ VAS). Results are used to calculate the EQ index ranging from -0.59 (worst) to 1 (best). Patient responses were matched for age and sex with existing data from controls, collected through a postal survey (response rate 26%), and compared with Chi-square tests or t-tests as appropriate. Results Of 784 OHCA survivors, 714 received the EQ-5D-5L, and 445 (62%) responded. Respondents had higher rates of shockable first rhythm and better cerebral performance category scores than the non-respondents. OHCA survivors reported poorer health compared to controls as assessed by EQ-5D-5L dimensions, the EQ index (0.76 ± 0.24 vs 0.82 ± 0.18), and EQ VAS (69 ± 21 vs 79 ± 17), except for the pain/discomfort dimension. Conclusions Norwegian OHCA survivors reported poorer health than the general population as assessed by the EQ-5D-5L. PROMs use in this population can be used to inform follow-up and health care delivery.
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Affiliation(s)
- Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunhild M. Gjerset
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology and Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B.M. Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Cecilie B. Isern
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Andrew M. Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
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Günther A, Schmid S, Weidlich-Wichmann U, Czaputa E, Hasseler M, Weber J. Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018-2021. Resusc Plus 2023; 16:100508. [PMID: 38026139 PMCID: PMC10679822 DOI: 10.1016/j.resplu.2023.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Aim The realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital. Methods A full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021. Results Over the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min-max: 36-292); number of beds: 102 (±39; 34-210); deaths per bed per year 0.27 (±0.07; 0.15-0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0-21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0-12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably. Conclusion Resuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.
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Affiliation(s)
- Andreas Günther
- Institute for General Practice and Palliative Care, Hannover Medical School, Hanover, Germany
- Fire Department, City of Braunschweig, Eisenbütteler Straße 2, 38122 Braunschweig, Germany
| | - Sybille Schmid
- Fire Department, City of Braunschweig, Eisenbütteler Straße 2, 38122 Braunschweig, Germany
| | - Uta Weidlich-Wichmann
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Eileen Czaputa
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Martina Hasseler
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Jan Weber
- Social Services Department, City of Braunschweig, Braunschweig, Germany
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Talikowska M, Ball S, Majewski D, Belcher J, Brits R, Gallant S, Finn L, Finn J. Out-of-hospital cardiac arrest in residential aged care facilities is independently associated with lower survival in Perth, Australia. Resusc Plus 2023; 16:100495. [PMID: 38033345 PMCID: PMC10685000 DOI: 10.1016/j.resplu.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Aim To compare out-of-hospital cardiac arrest (OHCA) characteristics and outcomes between people aged ≥ 65 years who arrested in a residential aged care facility (RACF) versus a private residence in Perth, Australia. Methods We undertook a retrospective cohort study of OHCA cases attended by emergency medical services (EMS) in Perth, January 2018-December 2021. OHCA patient and event characteristics and survival outcomes were compared via univariate analysis. Multivariable logistic regression was used to investigate the relationship between residency type and (i) return of spontaneous circulation (ROSC) at emergency department (ED) and (ii) 30-day survival. Results A total of 435 OHCA occurred in RACFs versus 3,395 in private residences. RACF patients were significantly older (median age: 86 [IQR 79, 91] vs 78 [71, 85] years; p < 0.001), more commonly female (50.1% vs 36.8%; p < 0.001), bystander-witnessed arrests (34.9% vs 21.5%; p < 0.001), received bystander cardiopulmonary resuscitation (42.1% vs 28.6%; p < 0.001), had less shockable first monitored rhythms (4.0% vs 8.1%; p = 0.002) and more frequently had a "do not resuscitate" order identified (46.0% vs 13.6%; <0.001). Among those with EMS-attempted resuscitation or with defibrillation before EMS arrival, ROSC at ED and 30-day survival were significantly lower in the RACF group (6.2% vs 18.9%; p < 0.001 and 1.9% vs 7.7%; p < 0.001). The adjusted odds of ROSC at ED (aOR: 0.22 [95%CI: 0.10, 0.46]) and 30-day survival (aOR: 0.20 [95%CI 0.05, 0.92]) were significantly lower for RACF residents. Conclusion RACF residency was an independent predictor of lower survival from OHCA, highlighting the importance of end-of-life planning for RACF residents.
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Affiliation(s)
- Milena Talikowska
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
| | - David Majewski
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Jason Belcher
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
| | | | - Sheryl Gallant
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Lyndall Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
- Medical School (Emergency Medicine), The University of Western Australia, Nedlands, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Paratz ED, Nehme E, Heriot N, Bissland K, Rowe S, Fahy L, Anderson D, Stub D, La Gerche A, Nehme Z. A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest. Resuscitation 2023; 191:109962. [PMID: 37683995 DOI: 10.1016/j.resuscitation.2023.109962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. METHODS The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021. Predictors of survival to discharge were defined and a prognostic score derived from this cohort. RESULTS 77,628 patients experienced OHCA of whom 25,269 (32.6%) were ≥80 years (80-90 years = 18,956; 90-100 years = 6,148; >100 years = 209). The number of patients ≥80 years increased over time both absolutely (p = 0.002) and proportionally (p = 0.028). 619 (2.4%) patients survived to discharge without change over time. Older ages had no difference in witnessed OHCA status but were less likely to have shockable rhythm (OR 0.50 (95% CI 0.44-0.57) for 90-100-year-olds, OR 0.28 (95% CI 0.12-0.63) for 90-100-year-olds). If OHCA was witnessed and there was a shockable rhythm then survival was 14%; if one factor was present survival was 5-6% and if neither factor was present, survival was 0.09%. These survival rates enabled derivation of a simplified prognostic assessment score - the '15/5/0' score - highly comparable to a previously-published American cohort. CONCLUSIONS Elderly OHCA rates have increased to one-third of caseload. The most important factors predicting survival were whether the OHCA was witnessed and there was a shockable rhythm. We present a simple two-point '15/5/0' prognostic score defining which patients will gain most from advanced resuscitative measures.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia; Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia. https://twitter.com/@pretzeldr
| | - Emily Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia
| | - Kenneth Bissland
- Department of Geriatric Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Louise Fahy
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Dion Stub
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Cardiology, Alfred Health, 55 Commercial Rd, Prahran, VIC 3181, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia
| | - Ziad Nehme
- Ambulance Victoria, Centre for Research and Evaluation, 31 Joseph St, Blackburn, North VIC 3130, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
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Harring AKV, Kramer-Johansen J, Tjelmeland IBM. Resuscitation of older adults in Norway; a comparison of survival and outcome after out-of-hospital cardiac arrest in healthcare institutions and at home. Resuscitation 2023; 189:109871. [PMID: 37327851 DOI: 10.1016/j.resuscitation.2023.109871] [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: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Perceptions about expected outcome after out-of-hospital cardiac arrest (OHCA) influence treatment decisions, and there is a need for updated evidence about outcomes for the elderly. METHOD We conducted a cross-sectional study of cases reported to the Norwegian Cardiac Arrest Registry from 2015 through 2021 of patients 60 years and older, suffering cardiac arrest in healthcare institutions or at home. We examined reasons for emergency medical service (EMS) withholding or withdrawing resuscitation. We compared survival and neurological outcome for EMS-treated patients and explored factors associated with survival using multivariate logistic regression. RESULT We included 12,191 cases and the EMS started resuscitation in 10,340 (85%). The incidence per capita of OHCA the EMS were alerted to was 267/100,000 in healthcare institutions and 134/100,000 at home. Resuscitation was most frequently withdrawn due to medical history (n = 1251). In healthcare institutions, 72 of 1503 (4.8%) patients survived to 30 days compared to 752 of 8837 (8.5%) at home (P <.001). We found survivors in all age cohorts both in healthcare institutions and at home, and most of the 824 survivors had a good neurological outcome with a Cerebral Performance Category ≤2 (88%). CONCLUSION Medical history was the most frequent reason for EMS not to start or continue resuscitation, indicating a need for a discussion about, and documentation of, advance directives in this age group. When EMS attempted resuscitation, most survivors had a good neurological outcome, both in healthcare institutions and at home.
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Affiliation(s)
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Pin Pek P, Cheng Fan K, Eng Hock Ong M, Luo N, Østbye T, Lynn Lim S, Fuwah Ho A. Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review. Resuscitation 2023; 188:109794. [PMID: 37059353 DOI: 10.1016/j.resuscitation.2023.109794] [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: 01/25/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE With a growing number of out-of-hospital cardiac arrest (OHCA) survivors globally, the focus of OHCA management has now broadened to survivorship. An outcome central to survivorship is health-related quality of life (HRQoL). This systematic review aimed to synthesise evidence related to the determinants of HRQoL of OHCA survivors. METHODS We systematically searched MEDLINE, Embase, and Scopus from inception to 15 August 2022 to identify studies investigating the association of at least one determinant and HRQoL in adult OHCA survivors. All articles were independently reviewed by two investigators. We abstracted data pertaining to determinants and classified them using a well-established HRQoL theoretical framework - the Wilson and Cleary (revised) model. RESULTS 31 articles assessing a total of 35 determinants were included. Determinants were classified into the five domains in the HRQoL model. 26 studies assessed determinants related to individual characteristics (n=3), 12 studied biological function (n=7), nine studied symptoms (n=3), 16 studied functioning (n=5), and 35 studied characteristics of the environment (n=17). In studies that included multivariable analyses, most reported that individual characteristics (older age, female sex), symptoms (anxiety, depression), and functioning (impaired neurocognitive function) were significantly associated with poorer HRQoL. CONCLUSIONS Individual characteristics, symptoms, and functioning played significant roles in explaining the variability in HRQoL. Significant non-modifiable determinants such as age and sex could be used to identify populations at risk of poorer HRQoL, while significant modifiable determinants such as psychological health and neurocognitive functioning could serve as targets for post-discharge screening and rehabilitation plans. PROSPERO registration number: CRD42022359303.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai Cheng Fan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Marcus Eng Hock Ong
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Truls Østbye
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fuwah Ho
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Nakajima S, Matsuyama T, Okada N, Kandori K, Okada A, Okada Y, Kitamura T, Ohta B. Targeted temperature management on outcome of older adult patients after out-of-hospital cardiac arrest. Am J Emerg Med 2023; 66:61-66. [PMID: 36706483 DOI: 10.1016/j.ajem.2023.01.027] [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: 08/31/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Targeted temperature management (TTM) can potentially improve the prognosis of patients with out-of-hospital cardiac arrest (OHCA). However, the effectiveness of TTM in older adults remains unknown. Therefore, this study aimed to assess the outcomes of older adult patients with OHCA who underwent TTM. METHODS This study was a multicenter, retrospective, nationwide observational analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest (JAAM-OHCA) registry. We included patients aged ≥18 years who had experienced OHCA and underwent TTM from June 1, 2014, to December 31, 2017, in Japan. The primary outcome was a 1-month neurological favorable outcome, and the secondary outcome was 1-month survival. RESULTS A total of 1847 patients were included in the analysis. 79 of 389 patients aged ≥75 years (20.3%) had a 1-month neurological favorable outcome compared with 369 of 959 patients aged 18-64 years (38.5%) (adjusted odds ratios, 0.31; 95% confidence interval [CI], 0.21-0.45; P for trend <0.001). With increasing age, 1-month mortality showed an increasing trend; however, there was no significant difference. CONCLUSION In this retrospective nationwide observational study in Japan, neurological outcomes worsened as age increased in patients with OHCA who underwent TTM.
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Affiliation(s)
- Satoshi Nakajima
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan.
| | - Nobunaga Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Honmachi 15-749, Higashiyama-ku, Kyoto 6050981, Japan
| | - Kenji Kandori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Haruobi-cho 355-5, Kamigyo-ku, Kyoto 6020826, Japan
| | - Asami Okada
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, Haruobi-cho 355-5, Kamigyo-ku, Kyoto 6020826, Japan
| | - Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan
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10
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Lemoyne SEE, Van Bogaert P, Calle P, Wouters K, Deblick D, Herbots H, Monsieurs K. Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care? Acta Clin Belg 2023; 78:3-10. [PMID: 35234573 DOI: 10.1080/17843286.2022.2042644] [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: 01/18/2023]
Abstract
BACKGROUND The decision to transfer a nursing home (NH) resident to an emergency department (ED) is multifactorial and challenging but many of the emergency physician-staffed emergency medical service (EP-EMS) interventions and ED transfers are probably inappropriate. METHODS We conducted a retrospective, cross-sectional study in three EP-EMSs in Belgium over a period of three years. We registered indicators that are potentially associated with inappropriate transfers: patient characteristics, availability of written do not resuscitate (DNR) orders or treatment restrictions, involvement of a general practitioner (GP) and availability of transfer notes. We also explored the association between age, the Charlson Comordity Index (CCI), polypharmacy, dementia, and the availability of DNR documents. RESULTS We registered 308 EP-EMS interventions in NH residents. In 98% the caller was a health-care professional. In 75% there was no GP present and 40% had no transfer note. Thirty-two percentage of the patients had dementia, 45% had more than two comorbidities and 68% took five medications or more. In 6% cardiopulmonary resuscitation was performed. DNR orders were available in 25%. Eighty-eight percentage of the NH residents were transferred to the ED. Forty-four percent had a CCI >5. In patients of ≥90 years, with a CCI >5, with dementia and with polypharmacy, DNR orders were not available in 81%, 67%%,and 69%, respectively. CONCLUSIONS Improved EMS dispatch centre-NH caller interaction, more involvement of GP's, higher availability of DNR orders and better communication between GPs/NHs and EP-EMS could prevent inappropriate interventions, futile prehospital aactions,and ED transfers.
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Affiliation(s)
- Sabine E E Lemoyne
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, University of Antwerp, Edegem, Belgium
| | - Paul Calle
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Dennis Deblick
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hanne Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kg Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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11
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Harring AKV, Tjelmeland IB, Andenæs R, Kramer-Johansen J. Blir beslutninger om behandlingsbegrensninger respektert utenfor sykehus når man har ringt 113? TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Mercier E, Mowbray FI. Patient-important outcomes following in-hospital cardiac arrest: Using frailty to move beyond prediction of immediate survival. Resuscitation 2022; 179:38-40. [PMID: 35933058 DOI: 10.1016/j.resuscitation.2022.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Eric Mercier
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé, Unité de recherche en Traumatologie - Urgence - Soins Intensifs, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada; Département de médecine familiale et médecine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.
| | - Fabrice I Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
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13
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Screening for neurocognitive impairment following out-of-hospital cardiac arrest: anyone for a MoCA? Resuscitation 2022; 172:137-138. [DOI: 10.1016/j.resuscitation.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
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14
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Boriani G, Mantovani LG, Cortesi PA, De Ponti R, D'Onofrio A, Arena G, Curnis A, Forleo G, Guerra F, Porcu M, Sgarito G, Botto GL. Cost-minimization analysis of a wearable cardioverter defibrillator in adult patients undergoing ICD explant procedures: Clinical and economic implications. Clin Cardiol 2021; 44:1497-1505. [PMID: 34427926 PMCID: PMC8571546 DOI: 10.1002/clc.23709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Aims Patients with permanently increased risk of sudden cardiac death (SCD) can be protected by implantable cardioverter defibrillators (ICD). If an ICD must be removed due to infection, for example, immediate reimplantation might not be possible or indicated. The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution to protect patients from SCD during this high‐risk bridging period. Very few economic evaluations on WCD use are currently available. Methods We conducted a systematic review to evaluate the available evidence of WCD in patients undergoing ICD explant/lead extraction. Additionally, a decision model was developed to compare use and costs of the WCD with standard therapy (in‐hospital stay). For this purpose, a cost‐minimization analysis was conducted, and complemented by a one‐way sensitivity analysis. Results In the base case scenario, the WCD was less expensive compared to standard therapy. The cost‐minimization analysis showed a cost reduction of €1782 per patient using the WCD. If costs of standard care were changed, cost savings associated with the WCD varied from €3500 to €0, assuming costs for standard care of €6800 to €3600. Conclusion After ICD explantation, patients can be safely and effectively protected from SCD after hospital discharge through WCD utilization. Furthermore, the use of a WCD for this patient group is cost saving when compared to standard therapy.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaPoliclinico di ModenaItaly
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
- Value‐Based Healthcare UnitIRCCS MultimedicaSesto San GiovanniItaly
| | | | - Roberto De Ponti
- Department of Heart and VesselsOspedale di Circolo‐University of InsubriaVareseItaly
| | - Antonio D'Onofrio
- Cardiology Division – Electrophysiology Department – AORN dei Colli – Ospedale MonaldiNapoliItaly
| | - Giuseppe Arena
- Cardiology DepartmentAzienda Usl Toscana Nord OvestMassa CarraraItaly
| | - Antonio Curnis
- Cardiology DepartmentPresidio Ospedaliero di Brescia, ASST Spedali CiviliBresciaItaly
| | - Giovanni Forleo
- Cardiology Department, Electrophysiology and Arrhtymology DivisionOspedale Luigi Sacco ‐ Polo UniversitarioMilanItaly
| | - Federico Guerra
- Cardiology and Arrhytmology ClinicAzienda Ospedaliero Universitaria Ospedali RiunitiAnconaItaly
| | - Maurizio Porcu
- Cardiology DepartmentAzienda Ospedaliera “G. Brotzu”CagliariItaly
| | - Giuseppe Sgarito
- Cardiology Department, Electrophysiology and Arrhtymology DivisionA.R.N.A.S. Ospedali CivicoPalermoItaly
| | - Giovanni Luca Botto
- Cardiology – Electrophysiology Division, Department of MedicineOspedale di Circolo Rho, Ospedale Salvini Garbagnate M.se, ASST RhodenseMilanItaly
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15
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Holmström E, Efendijev I, Raj R, Pekkarinen PT, Litonius E, Skrifvars MB. Intensive care-treated cardiac arrest: a retrospective study on the impact of extended age on mortality, neurological outcome, received treatments and healthcare-associated costs. Scand J Trauma Resusc Emerg Med 2021; 29:103. [PMID: 34321064 PMCID: PMC8317381 DOI: 10.1186/s13049-021-00923-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome. Results This study included a total of 1,285 patients, of which 212 (16 %) were \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24 % of the patients in the elderly group and 47 % of the patients in the younger group had a CPC of 1–2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 2.90, 95 % CI: 1.94–4.31, p < 0.001) and neurological outcome (multivariate OR = 3.15, 95 % CI: 2.04–4.86, p < 0.001). Conclusions The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Elderly received less intense treatment. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00923-0.
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Affiliation(s)
- Ester Holmström
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Ilmar Efendijev
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T Pekkarinen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Erik Litonius
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Mentzelopoulos SD, Couper K, Van de Voorde P, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. [Ethics of resuscitation and end of life decisions]. Notf Rett Med 2021; 24:720-749. [PMID: 34093076 PMCID: PMC8170633 DOI: 10.1007/s10049-021-00888-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Affiliation(s)
- Spyros D. Mentzelopoulos
- Evaggelismos Allgemeines Krankenhaus, Abteilung für Intensivmedizin, Medizinische Fakultät der Nationalen und Kapodistrischen Universität Athen, 45–47 Ipsilandou Street, 10675 Athen, Griechenland
| | - Keith Couper
- Universitätskliniken Birmingham NHS Foundation Trust, UK Critical Care Unit, Birmingham, Großbritannien
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | - Patrick Van de Voorde
- Universitätsklinikum und Universität Gent, Gent, Belgien
- staatliches Gesundheitsministerium, Brüssel, Belgien
| | - Patrick Druwé
- Abteilung für Intensivmedizin, Universitätsklinikum Gent, Gent, Belgien
| | - Marieke Blom
- Medizinisches Zentrum der Universität Amsterdam, Amsterdam, Niederlande
| | - Gavin D. Perkins
- Medizinische Fakultät Warwick, Universität Warwick, Coventry, Großbritannien
| | | | - Jana Djakow
- Intensivstation für Kinder, NH Hospital, Hořovice, Tschechien
- Abteilung für Kinderanästhesiologie und Intensivmedizin, Universitätsklinikum und Medizinische Fakultät der Masaryk-Universität, Brno, Tschechien
| | - Violetta Raffay
- School of Medicine, Europäische Universität Zypern, Nikosia, Zypern
- Serbischer Wiederbelebungsrat, Novi Sad, Serbien
| | - Gisela Lilja
- Universitätsklinikum Skane, Abteilung für klinische Wissenschaften Lund, Neurologie, Universität Lund, Lund, Schweden
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17
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Mentzelopoulos SD, Couper K, Voorde PVD, Druwé P, Blom M, Perkins GD, Lulic I, Djakow J, Raffay V, Lilja G, Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation 2021; 161:408-432. [PMID: 33773832 DOI: 10.1016/j.resuscitation.2021.02.017] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care.
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Affiliation(s)
| | - Keith Couper
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van de Voorde
- University Hospital and University Ghent, Belgium; Federal Department Health, Belgium
| | - Patrick Druwé
- Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium
| | - Marieke Blom
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gavin D Perkins
- UK Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Violetta Raffay
- European University Cyprus, School of Medicine, Nicosia, Cyprus; Serbian Resuscitation Council, Novi Sad, Serbia
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
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18
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Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med 2021; 12:695-723. [PMID: 33683679 PMCID: PMC7938035 DOI: 10.1007/s41999-021-00454-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Aim We aimed to collect the available evidence on outcome regarding survival and quality of life after CPR following both IHCA and OHCA in the older population. Findings Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Message Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y. Purpose We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population. Methods A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL). Results The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0–11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7–25.0% and 0–10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1–2 was found in 11.5–23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1–2 among patients surviving until hospital discharge was 82–93% (IHCA) and 77–91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies. Conclusions Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y.
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Affiliation(s)
- Rina Zanders
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
| | - Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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19
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Nakajima M, H Kaszynski R, Goto H, Matsui H, Fushimi K, Yamaguchi Y, Yasunaga H. Current trends and outcomes of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Japan: A nationwide observational study. Resusc Plus 2020; 4:100048. [PMID: 34223323 PMCID: PMC8244426 DOI: 10.1016/j.resplu.2020.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM The present study aimed to describe the prevalence, prognosis and annual trends of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients, using a nationwide inpatient database in Japan. METHODS This was a nationwide retrospective cohort study, using the Japanese Diagnosis Procedure Combination inpatient database. We included OHCA patients registered in the database from July 2010 to March 2017 and analyzed the annual prevalence of OHCA patients who received ECPR. The outcomes included survival to hospital discharge and survival with favorable neurologic outcome at hospital discharge. The annual trends on the outcomes were also analyzed. RESULTS We identified 217,907 eligible patients. OHCA patients were divided into patients with ECPR (n = 5,612) and conventional CPR (n = 212,295). The prevalence of ECPR performed in OHCA patients was 2.6%. ECPR prevalence significantly increased from 2.1% in 2010 to 3.0% in 2016 (P < 0.001). Overall survival to hospital discharge was 16.4% and 2.7% in patients with ECPR and conventional CPR, respectively. Prevalence of patients who were discharged from hospital with favorable neurologic outcome was 12.4% and 1.6% in those with ECPR and conventional CPR, respectively.Increasing age was associated with progressively deteriorating outcomes. The trend of survival to hospital discharge significantly increased on an annual basis. CONCLUSIONS The annual prevalence of ECPR significantly increased from 2010 to 2016. Improvements in overall survival to hospital discharge were noted for ECPR in OHCA patients and there was a trend in the tendency for ECPR patients discharged from the hospital to have favorable neurologic outcomes.
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Affiliation(s)
- Mikio Nakajima
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Richard H Kaszynski
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Hideaki Goto
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Hiroki Matsui
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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20
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Druwé P, Monsieurs KG, Gagg J, Nakahara S, Cocchi MN, Élő G, van Schuppen H, Alpert EA, Truhlář A, Huybrechts SA, Mpotos N, Paal P, BjØrshol C, Xanthos T, Joly LM, Roessler M, Deasy C, Svavarsdóttir H, Nurmi J, Owczuk R, Salmeron PP, Cimpoesu D, Fuenzalida PA, Raffay V, Steen J, Decruyenaere J, De Paepe P, Piers R, Benoit DD. Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries. Resuscitation 2020; 158:41-48. [PMID: 33227397 DOI: 10.1016/j.resuscitation.2020.10.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, USA
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, The Netherlands
| | | | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic
| | | | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Austria
| | - Conrad BjØrshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | | | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | | | - Johan Steen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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21
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Günther A, Schildmann J, in der Schmitten J, Schmid S, Weidlich-Wichmann U, Fischer M. Opportunities and Risks of Resuscitation Attempts in Nursing Homes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:757-763. [PMID: 33533330 PMCID: PMC7898050 DOI: 10.3238/arztebl.2020.0757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/19/2020] [Accepted: 06/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Data supporting decision-making regarding cardiopulmonary resuscitation (CPR) in German nursing homes is insufficient. METHODS A retrospective evaluation of pre-hospital CPR was carried out with data from the German Resuscitation Registry (Deutsches Reanimationsregister) for the years 2011-2018. Patients under age 65 were excluded, as were patients from districts in which long-term data was available for less than 60% of patients. Subgroups were analyzed based on age and certain prehospital situations; patients treated outside nursing homes were used for comparison. RESULTS The study group consisted of 2900 patients, whose mean age was 83.7 years (standard deviation, 7.5 years). 1766 (60.9%) were women and 1134 (39.1%) were men. 118 patients (4.0%) were discharged alive, including 64 (2.2%) with a cerebral performance category (CPC) of 1 or 2, 30 (1.0%) with an unknown CPC, and 24 (0.8%) with a CPC of 3 or 4. 902 patients (31.1%) died in the hospital, including five (0.2%) who died more than 30 days after resuscitation, 279 (9.6%) between 24 hours and 30 days, and 618 (21.3%) within 24 hours. 1880 patients (64.8%) died at the site of attempted resuscitation. In 1056 cases (36.4%), CPR was initiated before the arrival of the emergency medical services. In the "initially shockable" subgroup, 13 of 208 patients (6.3%) were discharged alive with a CPC of 1 or 2. CONCLUSION CPR can lead to a good neurological outcome in rare cases even when carried out in a nursing home. The large percentage of CPR attempts that were initiated only after a delay indicates that nursing home staff may often be uncertain how to proceed. Uncertainty among caregivers points to a potential for advance care planning.
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Affiliation(s)
- Andreas Günther
- Fire Department,City of Braunschweig and Department of Anesthesiology, Braunschweig Hospitals gGmbH
| | - Jan Schildmann
- Institute for the History and Ethics of Medicine, Medical Faculty, University of Halle-Wittenberg (Saale)
| | - Jürgen in der Schmitten
- Fire Department,City of Braunschweig and Department of Anesthesiology, Braunschweig Hospitals gGmbH
| | | | - Uta Weidlich-Wichmann
- Faculty of Public Health Services, Ostfalia University of Applied Sciences, Campus Wolfsburg
| | - Matthias Fischer
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Klinik am Eichert, Alb Fils Hospitals, Göppingen
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22
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Kovács E, Pilecky D, Szakál-Tóth Z, Fekete-Győr A, Gyarmathy VA, Gellér L, Hauser B, Gál J, Merkely B, Zima E. The role of age in post-cardiac arrest therapy in an elderly patient population. Physiol Int 2020; 107:319-336. [PMID: 32692712 DOI: 10.1556/2060.2020.00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
Aim We investigated the effect of age on post-cardiac arrest treatment outcomes in an elderly population, based on a local database and a systemic review of the literature. Methods Data were collected retrospectively from medical charts and reports. Sixty-one comatose patients, cooled to 32-34 °C for 24 h, were categorized into three groups: younger group (≤65 years), older group (66-75 years), and very old group (>75 years). Circumstances of cardiopulmonary resuscitation (CPR), patients' characteristics, post-resuscitation treatment, hemodynamic monitoring, neurologic outcome and survival were compared across age groups. Kruskal-Wallis test, Chi-square test and binary logistic regression (BLR) were applied. In addition, a literature search of PubMed/Medline database was performed to provide a background. Results Age was significantly associated with having a cardiac arrest on a monitor and a history of hypertension. No association was found between age and survival or neurologic outcome. Age did not affect hemodynamic parameter changes during target temperature management (TTM), except mean arterial pressure (MAP). Need of catecholamine administration was the highest among very old patients. During the literature review, seven papers were identified. Most studies had a retrospective design and investigated interventions and outcome, but lacked unified age categorization. All studies reported worse survival in the elderly, although old survivors showed a favorable neurologic outcome in most of the cases. Conclusion There is no evidence to support the limitation of post-cardiac arrest therapy in the aging population. Furthermore, additional prospective studies are needed to investigate the characteristics and outcome of post-cardiac arrest therapy in this patient group.
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Affiliation(s)
- E Kovács
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | | | - Z Szakál-Tóth
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - A Fekete-Győr
- 4St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - L Gellér
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - B Hauser
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - J Gál
- 1Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - B Merkely
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - E Zima
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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23
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Druwé P, Benoit DD, Monsieurs KG, Gagg J, Nakahara S, Alpert EA, van Schuppen H, Élő G, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P, Cocchi MN, Bjørshol C, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Cimpoesu D, Raffay V, Pachys G, De Paepe P, Piers R. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians. J Am Geriatr Soc 2019; 68:39-45. [PMID: 31840239 DOI: 10.1111/jgs.16270] [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: 08/12/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | | | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Sofie A Huybrechts
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Salzburg, Austria
| | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Conrad Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | - Gal Pachys
- Emergency Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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24
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Couper K. The quality of quality-of-life outcome data: The challenge of data interpretation. Resuscitation 2019; 146:266-267. [PMID: 31821837 DOI: 10.1016/j.resuscitation.2019.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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25
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Nehme Z, Andrew E, Bernard S, Smith K. Sex differences in the quality-of-life and functional outcome of cardiac arrest survivors. Resuscitation 2019; 137:21-28. [DOI: 10.1016/j.resuscitation.2019.01.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/26/2019] [Indexed: 11/28/2022]
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26
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Hiemstra B, Bergman R, Absalom AR, van der Naalt J, van der Harst P, de Vos R, Nieuwland W, Nijsten MW, van der Horst ICC. Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis 2018; 12:341-349. [PMID: 30231773 PMCID: PMC6266245 DOI: 10.1177/1753944718792420] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population. METHODS: Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (⩾75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population. RESULTS: Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 ± 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% ( p < 0.001). A CPC of 1 was present in 73% of the elderly patients versus 86% of the younger patients ( p = 0.031). In 7.3% of the elderly patients, a CPC >2 was observed versus 2.5% of their younger counterparts ( p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population ( p = 0.019). CONCLUSIONS: The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population.
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Affiliation(s)
- Bart Hiemstra
- Department of Critical Care, University of
Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001,
Groningen, 9700 RB, The Netherlands
| | - Remco Bergman
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Anthony R. Absalom
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Ronald de Vos
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Wybe Nieuwland
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Maarten W. Nijsten
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
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27
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Matsuyama T, Kitamura T, Kiyohara K, Kiguchi T, Kobayashi D, Nishiyama C, Iwami T, Ohta B. Assessment of the 11-year nationwide trend of out-of-hospital cardiac arrest cases among elderly patients in Japan (2005-2015). Resuscitation 2018; 131:83-90. [PMID: 30099119 DOI: 10.1016/j.resuscitation.2018.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/19/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Japan has one of the most rapidly aging societies worldwide. This study aimed to assess the long-term nationwide trend of out-of-hospital cardiac arrest (OHCA) cases among elderly patients in Japan. METHODS This prospective, nationwide observational study in Japan included elderly patients aged ≥65 years who experienced OHCA from January 1, 2005 to December 31, 2015. The patients were classified into three groups: young-old, aged 65-74 years; old-old, aged 75-84 years; and oldest-old, aged ≥85 years. The primary outcome of this study was one-month survival with a favorable neurological outcome, which was defined as a cerebral performance category scale score of 1 or 2. RESULTS A total of 877,009 patients were included in our analysis. The number of elderly patients with OHCA increased from 65,968 in 2005 to 87,339 in 2015, and each age category showed a significantly increasing trend (p value <0.001 for each trend). The proportions of favorable neurological outcomes also increased from 1.2% in 2005 to 2.8% in 2015 in the young-old group; from 0.6% in 2005 to 1.1% in 2015 in the old-old group; and from 0.2% in 2005 to 0.5% in 2014 in the oldest-old group. Furthermore, this improving trend was notable for those with a shockable first documented rhythm. CONCLUSIONS Based on this long-term nationwide observational study in Japan, the number of elderly patients with OHCA increased annually, and a significant improvement in the patients' neurological outcomes was noted regardless of age category, particularly among those with an initially shockable rhythm.
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Affiliation(s)
- Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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28
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Mentzelopoulos SD, Slowther AM, Fritz Z, Sandroni C, Xanthos T, Callaway C, Perkins GD, Newgard C, Ischaki E, Greif R, Kompanje E, Bossaert L. Ethical challenges in resuscitation. Intensive Care Med 2018; 44:703-716. [PMID: 29748717 DOI: 10.1007/s00134-018-5202-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/28/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE A rapidly evolving resuscitation science provides more effective treatments to an aging population with multiple comorbidites. Concurrently, emergency care has become patient-centered. This review aims to describe challenges associated with the application of key principles of bioethics in resuscitation and post-resuscitation care; propose actions to address these challenges; and highlight the need for evidence-based ethics and consensus on ethical principles interpretation. METHODS Following agreement on the article's outline, subgroups of 2-3 authors provided narrative reviews of ethical issues concerning autonomy and honesty, beneficence/nonmaleficence and dignity, justice, specific practices/circumstances such as family presence during resuscitation, and emergency research. Proposals for addressing ethical challenges were also offered. RESULTS Respect for patient autonomy can be realized through honest provision of information, shared decision-making, and advance directives/care planning. Essential prerequisites comprise public and specific healthcare professionals' education, appropriate regulatory provisions, and allocation of adequate resources. Regarding beneficence/nonmaleficence, resuscitation should benefit patients, while avoiding harm from futile interventions; pertinent practice should be based on neurological prognostication and patient/family-reported outcomes. Regarding dignity, aggressive life-sustaining treatments against patients preferences should be avoided. Contrary to the principle of justice, resuscitation quality may be affected by race/income status, age, ethnicity, comorbidity, and location (urban versus rural or country-specific/region-specific). Current evidence supports family presence during resuscitation. Regarding emergency research, autonomy should be respected without hindering scientific progress; furthermore, transparency of research conduct should be promoted and funding increased. CONCLUSIONS Major ethical challenges in resuscitation science need to be addressed through complex/resource-demanding interventions. Such actions require support by ongoing/future research.
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Affiliation(s)
- Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, 10675, Athens, Greece.
| | - Anne-Marie Slowther
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Zoe Fritz
- Acute Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Claudio Sandroni
- Istituto Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Fondazione Policlinico, Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Theodoros Xanthos
- European University, Engomi, Cyprus.,President Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | - Gavin D Perkins
- Division of Health Sciences, Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Craig Newgard
- Department of Emergency Medicine Oregon Health and Science University Portland, Center for Policy and Research in Emergency Medicine, Portland, OR, USA
| | - Eleni Ischaki
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, 10675, Athens, Greece
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, University of Bern, Bern University Hospital, 3010, Bern, Switzerland
| | - Erwin Kompanje
- Department of Intensive Care, Department of Ethics and Philosophy of Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leo Bossaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,European Resuscitation Council, Niel, Belgium
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