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Catalisano G, Milazzo M, Simone B, Campanella S, Romana Catalanotto F, Ippolito M, Giarratano A, Baldi E, Cortegiani A. Intentional interruptions during compression only CPR: A scoping review. Resusc Plus 2024; 18:100623. [PMID: 38590448 PMCID: PMC11000192 DOI: 10.1016/j.resplu.2024.100623] [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: 03/13/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Out of hospital cardiac arrest (OHCA) remains one of the main causes of death among industrialized countries. The initiation of cardiopulmonary resuscitation (CPR) by laypeople before the arrival of emergency medical services improves survival. Mouth-to-mouth ventilation may constitute a hindering factor to start bystander CPR, while during continuous chest compressions (CCC) CPR quality decreases rapidly. The aim of this scoping review is to examine the existing literature on strategies that investigate the inclusion of intentional pauses during compression-only resuscitation (CO-CPR) to improve the performance in the context of single lay rescuer OHCA. Methods The protocol of this Scoping review was prospectively registered in Open Science Framework (https://osf.io/rvn8j). A systematic search of PubMed, Scopus, EMBASE, CINAHL was performed. Results Six articles were included. All studies were carried out on simulation manikins and involved a total of 1214 subjects. One study had a multicenter design. Three studies were randomized controlled simulation trials, the rest were prospective randomized crossover studies. The tested protocols were heterogeneous and compared CCC to CO-CPR with intentional interruptions of various length. The most common primary outcome was compressions depth. Compression rate, rescuers' perceived exertion and composite outcomes were also evaluated. Compressions depth and perceived exertion improved in most study groups while compression rate and chest compression fraction remained within guidelines indications. Conclusions In simulation studies, the inclusion of intentional interruptions during CO-CPR within the specific scenario of single rescuer bystander CPR during OHCA may improve the rate of compressions with correct depth and lower rate of perceived exertion. Further high-quality research and feasibility and safety of protocols incorporating intentional interruptions during CO-CPR may be justified.
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Affiliation(s)
- Giulia Catalisano
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ‘Paolo Giaccone’, Palermo, Italy
| | - Marta Milazzo
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
| | - Barbara Simone
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
| | - Salvatore Campanella
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
| | - Francesca Romana Catalanotto
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
| | - Mariachiara Ippolito
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ‘Paolo Giaccone’, Palermo, Italy
| | - Antonino Giarratano
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ‘Paolo Giaccone’, Palermo, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency. University Hospital Policlinico ‘Paolo Giaccone’, Palermo, Italy
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Bharmal M, DiGrande K, Patel A, Shavelle DM, Bosson N. Impact of Coronavirus Disease 2019 Pandemic on Cardiac Arrest and Emergency Care. Cardiol Clin 2024; 42:307-316. [PMID: 38631797 DOI: 10.1016/j.ccl.2024.02.015] [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
The incidence of both out-of-hospital and in-hospital cardiac arrest increased during the coronavirus disease 2019 (COVID-19) pandemic. Patient survival and neurologic outcome after both out-of-hospital and in-hospital cardiac arrest were reduced. Direct effects of the COVID-19 illness combined with indirect effects of the pandemic on patient's behavior and health care systems contributed to these changes. Understanding the potential factors offers the opportunity to improve future response and save lives.
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Affiliation(s)
- Murtaza Bharmal
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - Kyle DiGrande
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - Akash Patel
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - David M Shavelle
- MemorialCare Heart and Vascular Institute, Long Beach Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90807, USA
| | - Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard Ste 200, Santa Fe Springs, CA 90670, USA; Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA, 90509, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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3
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Piscitello GM, Parker WF. Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the COVID-19 Pandemic. Chest 2024; 165:601-609. [PMID: 37778695 PMCID: PMC10925541 DOI: 10.1016/j.chest.2023.09.024] [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: 06/24/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic, whether performing CPR on patients with COVID-19 would be effective or increase COVID-19 transmission to health care workers was unclear. RESEARCH QUESTION Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to health care workers improved? STUDY DESIGN AND METHODS This cross-sectional study assessed DNR orders for all adult patients admitted to ICUs at two academic medical centers in Chicago, IL, between April 2020 and April 2021. DNR orders by COVID-19 status were assessed using risk-adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness. RESULTS The study population of 3,070 critically ill patients were 46% Black, 53% male, with median age (interquartile range [IQR]) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs 29% vs 23%; P = .006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in patients with COVID-19 in the nonpropensity score-matched (n = 3,070; aOR, 2.01; 95% CI, 1.64-2.38) and propensity score-matched (n = 1,118; aOR, 1.91; 95% CI, 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for patients with COVID-19 than patients without COVID-19 during all months of the study period (difference in prevalence over time, P = .751). INTERPRETATION In this multihospital study, DNR orders remained persistently higher for patients with COVID-19 vs patients without COVID-19 with similar severity of illness during the first year of the pandemic. The specific reasons why DNR orders remained persistently elevated for patients with COVID-19 should be assessed in future studies, because these changes may continue to affect COVID-19 patient care and outcomes.
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Affiliation(s)
- Gina M Piscitello
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA; Palliative Research Center, University of Pittsburgh, Pittsburgh, PA.
| | - William F Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
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4
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Lloyd A, Thomas E, Scaife J, Leopold N. Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic. Clin Med (Lond) 2024; 24:100001. [PMID: 38387206 PMCID: PMC11024814 DOI: 10.1016/j.clinme.2023.100001] [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] [Indexed: 02/24/2024]
Abstract
Coronavirus 2019 (COVID-19)-era resuscitation guidelines advised personal protective equipment before chest compressions and proactive advanced care planning. We investigated the impact of COVID-19 on cardiopulmonary resuscitation (CPR) outcomes according to scoring of frailty and of multiple health conditions. A retrospective single-centre analysis of clinical and electronic records for all adult cardiac arrest calls on wards between June 2020 and June 2021 was performed. Data were compared with a cohort pre-COVID (March 2017-March 2018). In total, 62 patients received CPR in 2020-21 compared with 113 in 2017-18. Similar rates of return of spontaneous circulation (ROSC) and a statistically insignificant survival increase from 23.8% to 32.2% (p=0.210). There were linear relationships between Clinical Frailty Scale (CFS) or Charlson Comorbidity Index (CCI) and diminished survival in the pooled data (both p<0.001). Both increasing frailty (measured by CFS) and comorbidity (measured by CCI) were associated with reduced survival from CPR. However, survival and ROSC during COVID-19 were no worse than before the pandemic.
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Affiliation(s)
- Aled Lloyd
- Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
| | - Elin Thomas
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Julia Scaife
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Nicky Leopold
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
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5
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Jacobson E, Troost JP, Epler K, Lenhan B, Rodgers L, O'Callaghan T, Painter N, Barrett J. Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study. J Palliat Med 2023; 26:1188-1197. [PMID: 37022771 PMCID: PMC10623069 DOI: 10.1089/jpm.2022.0578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 04/07/2023] Open
Abstract
Aim: Our aim was to examine how code status orders for patients hospitalized with COVID-19 changed over time as the pandemic progressed and outcomes improved. Methods: This retrospective cohort study was performed at a single academic center in the United States. Adults admitted between March 1, 2020, and December 31, 2021, who tested positive for COVID-19, were included. The study period included four institutional hospitalization surges. Demographic and outcome data were collected and code status orders during admission were trended. Data were analyzed with multivariable analysis to identify predictors of code status. Results: A total of 3615 patients were included with full code (62.7%) being the most common final code status order followed by do-not-attempt-resuscitation (DNAR) (18.1%). Time of admission (per every six months) was an independent predictor of final full compared to DNAR/partial code status (p = 0.04). Limited resuscitation preference (DNAR or partial) decreased from over 20% in the first two surges to 10.8% and 15.6% of patients in the last two surges. Other independent predictors of final code status included body mass index (p < 0.05), Black versus White race (0.64, p = 0.01), time spent in the intensive care unit (4.28, p = <0.001), age (2.11, p = <0.001), and Charlson comorbidity index (1.05, p = <0.001). Conclusions: Over time, adults admitted to the hospital with COVID-19 were less likely to have a DNAR or partial code status order with persistent decrease occurring after March 2021. A trend toward decreased code status documentation as the pandemic progressed was observed.
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Affiliation(s)
- Emily Jacobson
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Katharine Epler
- Department of Internal Medicine, University of California San Diego, San Diego, California, USA
| | - Blair Lenhan
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lily Rodgers
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Thomas O'Callaghan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Natalia Painter
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie Barrett
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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Barros AJ, Enfield KB. In-Hospital Cardiac Arrest. Emerg Med Clin North Am 2023; 41:455-464. [PMID: 37391244 PMCID: PMC10549775 DOI: 10.1016/j.emc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
This article reviews the epidemiology and management of in-hospital cardiac arrest.
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Affiliation(s)
- Andrew Julio Barros
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA.
| | - Kyle B Enfield
- Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia School of Medicine, PO Box 800546, Charlottesville, VA 22908, USA. https://twitter.com/KBEnfieldMD
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Kim JH, Ahn C, Park Y, Won M. Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis. Front Public Health 2023; 11:1180511. [PMID: 37234770 PMCID: PMC10208072 DOI: 10.3389/fpubh.2023.1180511] [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: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).
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Affiliation(s)
- Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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8
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Shrestha DB, Sedhai YR, Dawadi S, Dhakal B, Shtembari J, Singh K, Acharya R, Basnyat S, Waheed I, Khan MS, Kazimuddin M, Patel NK, Kalahasty G, Bhave PD, Whalen P, Shantha G. Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12082796. [PMID: 37109134 PMCID: PMC10144838 DOI: 10.3390/jcm12082796] [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: 02/14/2023] [Revised: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19 have been reported by several small single-institutional studies; however, there are no large studies contrasting COVID-19 IHCA with non-COVID-19 IHCA. The objective of this study was to compare the outcomes following IHCA between COVID-19 and non-COVID-19 patients. METHODS We searched databases using predefined search terms and appropriate Boolean operators. All the relevant articles published till August 2022 were included in the analyses. The systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An odds ratio with a 95% confidence interval (CI) was used to measure effects. RESULTS Among 855 studies screened, 6 studies with 27,453 IHCA patients (63.84% male) with COVID-19 and 20,766 (59.7% male) without COVID-19 were included in the analysis. IHCA among patients with COVID-19 has lower odds of achieving return of spontaneous circulation (ROSC) (OR: 0.66, 95% CI: 0.62-0.70). Similarly, patients with COVID-19 have higher odds of 30-day mortality following IHCA (OR: 2.26, 95% CI: 2.08-2.45) and have 45% lower odds of cardiac arrest because of a shockable rhythm (OR: 0.55, 95% CI: 0.50-0.60) (9.59% vs. 16.39%). COVID-19 patients less commonly underwent targeted temperature management (TTM) or coronary angiography; however, they were more commonly intubated and on vasopressor therapy as compared to patients who did not have a COVID-19 infection. CONCLUSIONS This meta-analysis showed that IHCA with COVID-19 has a higher mortality and lower rates of ROSC compared with non-COVID-19 IHCA. COVID-19 is an independent risk factor for poor outcomes in IHCA patients.
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Affiliation(s)
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
| | - Bishal Dhakal
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Karan Singh
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Roshan Acharya
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24014, USA
| | - Soney Basnyat
- Department of Internal Medicine, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Irfan Waheed
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Mohammad Saud Khan
- Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Mohammed Kazimuddin
- Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Gautham Kalahasty
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Prashant Dattatraya Bhave
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Patrick Whalen
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Bharmal M, DiGrande K, Patel A, Shavelle DM, Bosson N. Impact of Coronavirus Disease 2019 Pandemic on Cardiac Arrest and Emergency Care. Heart Fail Clin 2023; 19:231-240. [PMID: 36863815 PMCID: PMC9973546 DOI: 10.1016/j.hfc.2022.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The incidence of both out-of-hospital and in-hospital cardiac arrest increased during the coronavirus disease 2019 (COVID-19) pandemic. Patient survival and neurologic outcome after both out-of-hospital and in-hospital cardiac arrest were reduced. Direct effects of the COVID-19 illness combined with indirect effects of the pandemic on patient's behavior and health care systems contributed to these changes. Understanding the potential factors offers the opportunity to improve future response and save lives.
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Affiliation(s)
- Murtaza Bharmal
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - Kyle DiGrande
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - Akash Patel
- Department of Cardiology, University of California Irvine Medical Center, 510 E Peltason Drive, Irvine, CA 92697, USA
| | - David M Shavelle
- MemorialCare Heart and Vascular Institute, Long Beach Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90807, USA
| | - Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard Ste 200, Santa Fe Springs, CA 90670, USA; Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA, 90509, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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10
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Kacha AK, Hicks MH, Mahrous C, Dalton A, Ben-Jacob TK. Management of Intraoperative Cardiac Arrest. Anesthesiol Clin 2023; 41:103-119. [PMID: 36871994 DOI: 10.1016/j.anclin.2022.10.002] [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: 03/07/2023]
Abstract
Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology ultimately leading to better outcomes. This article reviews the most probable causes of intraoperative arrest and their management.
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Affiliation(s)
- Aalok K Kacha
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA; Department of Surgery, Section of Transplant Surgery, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
| | - Megan Henley Hicks
- Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Christopher Mahrous
- Department of Anesthesiology, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
| | - Allison Dalton
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Talia K Ben-Jacob
- Department of Anesthesiology, Division of Critical Care, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
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11
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Ploch M, Ahmed T, Reyes S, Irizarry-Caro JA, Fossas-Espinosa JE, Shoar S, Amatullah A, Jogimahanti A, Antonioli M, Iliescu CA, Balan P, Naeini PS, Madjid M. Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit. Resuscitation 2022; 181:190-196. [PMID: 36174763 DOI: 10.1016/j.resuscitation.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood. METHODS This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities. RESULTS We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status. CONCLUSIONS In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.
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Affiliation(s)
- Michelle Ploch
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Talha Ahmed
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Stephan Reyes
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jorge A Irizarry-Caro
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose E Fossas-Espinosa
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saeed Shoar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States
| | - Atia Amatullah
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arjun Jogimahanti
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew Antonioli
- Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cesar A Iliescu
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Prakash Balan
- Department of Cardiology, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Payam Safavi Naeini
- Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute, Houston, TX, United States
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States; Heart and Vascular Institute, Memorial Hermann Hospital, Houston, TX, United States; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.
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12
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Wang W, Wang CY, Wang SI, Wei JCC. Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: A retrospective cohort study from the TriNetX US collaborative networks. EClinicalMedicine 2022; 53:101619. [PMID: 35971425 PMCID: PMC9366236 DOI: 10.1016/j.eclinm.2022.101619] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The long-term cardiovascular outcomes in COVID-19 survivors remain largely unclear. The aim of this study was to investigate the long-term cardiovascular outcomes in COVID-19 survivors. METHODS This study used the data from the US Collaborative Network in TriNetX. From a cohort of more than 42 million records between 1 January 2019 and 31 March 2022, a total of 4,131,717 participants who underwent SARS-CoV-2 testing were recruited. Study population then divided into two groups based on COVID-19 test results. To avoid reverse causality, the follow-up initiated 30 days after the test, and continued until 12 months. Hazard ratios (HRs) and 95% Confidence intervals (CIs) of the incidental cardiovascular outcomes were calculated between propensity score-matched patients with versus without SARS-CoV-2 infection. Subgroup analyses on sex, and age group were also conducted. Sensitivity analyses were performed using different network, or stratified by hospitalization to explore the difference of geography and severity of COVID-19 infection. FINDINGS The COVID-19 survivors were associated with increased risks of cerebrovascular diseases, such as stroke (HR [95% CI] = 1.618 [1.545-1.694]), arrhythmia related disorders, such as atrial fibrillation (HR [95% CI] = 2.407 [2.296-2.523]), inflammatory heart disease, such as myocarditis (HR [95% CI] =4.406 [2.890-6.716]), ischemic heart disease(IHD), like ischemic cardiomyopathy (HR [95% CI] = 2.811 [2.477-3.190]), other cardiac disorders, such as heart failure (HR [95% CI] =2.296 [2.200-2.396]) and thromboembolic disorders (e.g. pulmonary embolism: HR [95% CI] =2.648 [2.443-2.870]). The risks of two composite endpoints, major adverse cardiovascular event (HR [95% CI] = 1.871 [1.816-1.927]) and any cardiovascular outcome (HR [95% CI] = 1.552 [1.526-1.578]), were also higher in the COVID-19 survivors than in the controls. Moreover, the survival probability of the COVID-19 survivors dramatically decreased in all the cardiovascular outcomes. The risks of cardiovascular outcomes were evident in both male and female COVID-19 survivors. Furthermore, the risk of mortality was higher in the elderly COVID-19 survivors (age ≥ 65 years) than in the young ones. Sensitivity analyses presented roughly similar results globally. Furthermore, the impact of COVID-19 on cardio-related outcomes appeared to be more pronounced in inpatients than in outpatients. INTERPRETATION The 12-month risk of incidental cardiovascular diseases is substantially higher in the COVID-19 survivors than the non-COVID-19 controls. Clinicians and patients with a history of COVID-19 should pay attention to their cardiovascular health in long term. FUNDING The Fundamental Research Funds for the Central public welfare research institutes and Young Elite Scientists Sponsorship Program by CACM.
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Affiliation(s)
- Weijie Wang
- Department of Rheumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Institue of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Science, Beijing, China
| | - Chi-Yen Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shiow-Ing Wang
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Corresponding author at: No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan.
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Characteristics and mortality of 561,379 hospitalized COVID-19 patients in Germany until December 2021 based on real-life data. Sci Rep 2022; 12:11116. [PMID: 35778464 PMCID: PMC9247915 DOI: 10.1038/s41598-022-15287-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023] Open
Abstract
The ongoing SARS-CoV-2 pandemic is characterized by poor outcome and a high mortality especially in the older patient cohort. Up to this point there is a lack of data characterising COVID-19 patients in Germany admitted to intensive care (ICU) vs. non-ICU patients. German Reimbursement inpatient data covering the period in Germany from January 1st, 2020 to December 31th, 2021 were analyzed. 561,379 patients were hospitalized with COVID-19. 24.54% (n = 137,750) were admitted to ICU. Overall hospital mortality was 16.69% (n = 93,668) and 33.36% (n = 45,947) in the ICU group. 28.66% (n = 160,881) of all patients suffer from Cardiac arrhythmia and 17.98% (n = 100,926) developed renal failure. Obesity showed an odds-ratio ranging from 0.83 (0.79-0.87) for WHO grade I to 1.13 (1.08-1.19) for grade III. Mortality-rates peaked in April 2020 and January 2021 being 21.23% (n = 4539) and 22.99% (n = 15,724). A third peak was observed November and December 2021 (16.82%, n = 7173 and 16.54%, n = 9416). Hospitalized COVID-19 patient mortality in Germany is lower than previously shown in other studies. 24.54% of all patients had to be treated in the ICU with a mortality rate of 33.36%. Congestive heart failure was associated with a higher risk of death whereas low grade obesity might have a protective effect on patient survival. High admission numbers are accompanied by a higher mortality rate.
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14
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ROMEO I, SKURZAK S. How to tell our grandchildren the tale of cardiac arrest during COVID-19. Minerva Anestesiol 2022; 88:541-543. [DOI: 10.23736/s0375-9393.22.16674-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Johnston C, Subramaniam A, Orosz J, Burrell A, Neto AS, Young M, Bailey M, Pilcher D, Udy A, Jones D. Intensive care admissions following rapid response team reviews in patients with COVID-19 in Australia. CRIT CARE RESUSC 2022; 24:106-115. [PMID: 38045596 PMCID: PMC10692595 DOI: 10.51893/2022.2.oa1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. Design: Multicentre, retrospective cohort study. Setting: 48 public and private ICUs in Australia. Participants: All adults (aged ≥ 16 years) with confirmed COVID-19 admitted to participating ICUs between 25 January and 31 October 2020, as part of SPRINT-SARI (Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection) Australia, which were linked with ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD). Main outcome measures and results: Of the 413 critically ill patients with COVID-19 who were analysed, 48.2% (199/413) were admitted from the ward and 30.5% (126/413) were admitted to the ICU following an RRT review. Patients admitted following an RRT review had higher Acute Physiology and Chronic Health Evaluation (APACHE) scores, fewer days from symptom onset to hospitalisation (median, 5.4 [interquartile range (IQR), 3.2-7.6] v 7.1 days [IQR, 4.1-9.8]; P < 0.001) and longer hospitalisations (median, 18 [IQR, 11-33] v 13 days [IQR, 7-24]; P < 0.001) compared with those not admitted via an RRT review. Admissions following RRT review comprised 60.3% (120/199) of all ward-based admissions. Overall, IHCA occurred in 1.9% (8/413) of ICU patients with COVID-19, and most IHCAs (6/8, 75%) occurred during ICU admission. There were no differences in IHCA rates or in ICU or hospital mortality rates based on whether a patient had a prior RRT review or not. Conclusions: This study found that RRT reviews were a common way for deteriorating ward patients with COVID-19 to be admitted to the ICU, and that IHCA was rare among ICU patients with COVID-19.
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Affiliation(s)
- Craig Johnston
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Intensive Care Unit, Frankston Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Judit Orosz
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Aidan Burrell
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Meredith Young
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- ANZICS Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Daryl Jones
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
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Baldi E, Cortegiani A, Savastano S. Cardiac arrest and coronavirus disease 2019. Curr Opin Crit Care 2022; 28:237-243. [PMID: 35275877 PMCID: PMC9208745 DOI: 10.1097/mcc.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). RECENT FINDINGS An increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SUMMARY Cardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
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Brady WJ, Chavez S, Gottlieb M, Liang SY, Carius B, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings. Am J Emerg Med 2022; 57:114-123. [PMID: 35561501 PMCID: PMC9045864 DOI: 10.1016/j.ajem.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. Objective This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. Discussion COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. Conclusion This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
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El-Zein RS, Chan ML, Su L, Chan PS. Outcomes of pediatric patients with COVID-19 and in-hospital cardiopulmonary resuscitation. Resuscitation 2022; 173:71-75. [PMID: 35227819 PMCID: PMC8875850 DOI: 10.1016/j.resuscitation.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early studies found low survival rates for adults with COVID-19 infection and in-hospital cardiac arrest (IHCA). We evaluated the association of COVID-19 infection on survival outcomes in pediatric patients undergoing cardiopulmonary resuscitation (CPR). METHODS Within Get-With-The-Guidelines®-Resuscitation, we identified pediatric patients who underwent CPR for an IHCA or bradycardia with poor perfusion between March and December, 2020. We compared survival outcomes (survival to discharge and return of spontaneous circulation for ≥20 minutes [ROSC]) between patients with suspected/confirmed COVID-19 infection and non-COVID-19 patients using multivariable hierarchical regression, with hospital site as a random effect and patient and cardiac arrest variables with a significant (p < 0.05) bivariate association as fixed effects. RESULTS Overall, 1328 pediatric in-hospital CPR events were identified (590 IHCA, 738 bradycardia with poor perfusion), of which 46 (32 IHCA, 14 bradycardia) had suspected/confirmed COVID-19 infection. Rates of survival to discharge were similar between those with and without COVID-19 infection (39.1% vs. 44.9%; adjusted RR, 1.14 [95% CI: 0.55-2.36]), and these estimates were similar for those with IHCA and bradycardia with poor perfusion (adjusted RRs of 1.03 and 1.05; interaction p = 0.96). Rates of ROSC were also similar between pediatric patients with and without COVID-19 overall (67.4% vs. 76.9%; adjusted RR, 0.87 [0.43, 1.77]), and for the subgroups with IHCA or bradycardia requiring CPR (adjusted RRs of 0.95 and 0.86, interaction p = 0.26). CONCLUSIONS In a large multicenter national registry of CPR events, COVID-19 infection was not associated with lower rates of ROSC or survival to hospital discharge in pediatric patients undergoing CPR.
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Affiliation(s)
- Rayan S El-Zein
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Maya L Chan
- William College, Williamstown, MA, United States
| | - Lillian Su
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
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Goals of Care Conversations in Long-Term Care during the First Wave of the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11061710. [PMID: 35330035 PMCID: PMC8950529 DOI: 10.3390/jcm11061710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Goals of care discussions typically focus on decision maker preference and underemphasize prognosis and outcomes related to frailty, resulting in poorly informed decisions. Our objective was to determine whether navigated care planning with nursing home residents or their decision makers changed care plans during the first wave of the COVID-19 pandemic. The MED-LTC virtual consultation service, led by internal medicine specialists, conducted care planning conversations that balanced information-giving/physician guidance with resident autonomy. Consultation included (1) the assessment of co-morbidities, frailty, health trajectory, and capacity; (2) in-depth discussion with decision makers about health status and expected outcomes; and (3) co-development of a care plan. Non-parametric tests and logistic regression determined the significance and factors associated with a change in care plan. Sixty-three residents received virtual consultations to review care goals. Consultation resulted in less aggressive care decisions for 52 residents (83%), while 10 (16%) remained the same. One resident escalated their care plan after a mistaken diagnosis of dementia was corrected. Pre-consultation, 50 residents would have accepted intubation compared to 9 post-consultation. The de-escalation of care plans was associated with dementia, COVID-19 positive status, and advanced frailty. We conclude that during the COVID-19 pandemic, a specialist-led consultation service for frail nursing home residents significantly influenced decisions towards less aggressive care.
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Impact of COVID-19 Pandemic on Cardiac Arrest and Emergency Care. Cardiol Clin 2022; 40:355-364. [PMID: 35851459 PMCID: PMC8960232 DOI: 10.1016/j.ccl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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21
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Resuscitation highlights in 2021. Resuscitation 2022; 172:64-73. [PMID: 35077856 DOI: 10.1016/j.resuscitation.2022.01.015] [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: 01/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND This review is the latest in a series of regular annual reviews undertaken by the editors and aims to highlight some of the key papers published in Resuscitation during 2021. METHODS Hand-searching by the editors of all papers published in Resuscitation during 2021. Papers were selected based on then general interest and novelty and were categorised into themes. RESULTS 98 papers were selected for brief mention. CONCLUSIONS Resuscitation science continues to evolve and incorporates all links in the chain of survival.
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22
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Singh Bajwa S, Mehdiratta L. Cardiopulmonary resuscitation during COVID-19 times….Time to recover and emerge stronger! Indian J Anaesth 2022; 66:95-99. [PMID: 35359475 PMCID: PMC8963224 DOI: 10.4103/ija.ija_153_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/04/2022] Open
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Ramadan A, Abella BS, Mitchell OJL. In-hospital cardiac arrest during the COVID-19 pandemic: Where do we go now? Resuscitation 2021; 170:371-372. [PMID: 34920019 PMCID: PMC8668778 DOI: 10.1016/j.resuscitation.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Amina Ramadan
- Department of Emergency Medicine, University of Illinois at Chicago, United States; Department of Internal Medicine, University of Illinois at Chicago, United States
| | - Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, United States; Center for Resuscitation Science, University of Pennsylvania, United States
| | - Oscar J L Mitchell
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, United States; Center for Resuscitation Science, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States.
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Cui Y, Jiang S. Influence of Personal Protective Equipment on the Quality of Chest Compressions: A Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:733724. [PMID: 34901055 PMCID: PMC8662528 DOI: 10.3389/fmed.2021.733724] [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: 06/30/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Randomized controlled trials (RCTs) evaluating the influence of personal protective equipment (PPE) on quality of chest compressions during cardiopulmonary resuscitation (CPR) showed inconsistent results. Accordingly, a meta-analysis was performed to provide an overview. Methods: Relevant studies were obtained by search of Medline, Embase, and Cochrane's Library databases. A random-effect model incorporating the potential heterogeneity was used to pool the results. Results: Six simulation-based RCTs were included. Overall, pooled results showed that there was no statistically significant difference between the rate [mean difference (MD): −1.70 time/min, 95% confidence interval (CI): −5.77 to 2.36, P = 0.41, I2 = 80%] or the depth [MD: −1.84 mm, 95% CI: −3.93 to 0.24, P = 0.11, I2 = 73%] of chest compressions performed by medical personnel with and without PPE. Subgroup analyses showed that use of PPE was associated with reduced rate of chest compressions in studies before COVID-19 (MD: −7.02 time/min, 95% CI: −10.46 to −3.57, P < 0.001), but not in studies after COVID-19 (MD: 0.14 time/min, 95% CI: −5.77 to 2.36, P = 0.95). In addition, PPE was not associated with significantly reduced depth of chest compressions in studies before (MD: −3.34 mm, 95% CI: −10.29 to −3.62, P = 0.35) or after (MD: −0.97 mm, 95% CI: −2.62 to 0.68, P = 0.25) COVID-19. No significant difference was found between parallel-group and crossover RCTs (P for subgroup difference both > 0.05). Conclusions: Evidence from simulation-based RCTs showed that use of PPE was not associated with reduced rate or depth of chest compressions in CPR.
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Affiliation(s)
- Ying Cui
- Intensive Care Unit, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Siyi Jiang
- Intensive Care Unit, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
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Jafari D, Cohen AL, Monsieurs K, Becker LB. Changing resuscitation strategies during a pandemic: lessons from the consecutive surges in New York and global challenges. Curr Opin Crit Care 2021; 27:656-662. [PMID: 34581299 DOI: 10.1097/mcc.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW To provide a framework for resuscitation of COVID-19 critical illness for emergency and intensive care clinicians with the most up to date evidence and recommendations in the care of COVID-19 patients in cardiac arrest or in extremis. RECENT FINDINGS Performing cardiopulmonary resuscitation (CPR) on COVID-19 patients requires the clinicians to adopt infection mitigation strategies such as full personal protective equipment, mechanical chest compression devices, and restricting the number of people present during the resuscitation. The time of intubation is a subject of ongoing research and clinicians should use their best judgment for each patient. Clinicians should prepare for CPR in prone position. Particular attention should be given to the psychological well-being of the staff. Point of care ultrasound has proved to be an invaluable diagnostic tool in assessing ventricular dysfunction and parenchymal lung disease. Although novel therapies to supplant the function of diseased lungs have shown promise in select patients the evidence is still being collected. The end-of-life discussions have been negatively impacted by prognostic uncertainty as well as barriers to in person meetings with families. SUMMARY The resuscitation of critically ill COVID-19 patients poses new challenges, but the principles remain largely unchanged.
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Affiliation(s)
- Daniel Jafari
- Department of Emergency Medicine.,Department of Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Hofstra Northwell, Hempstead, New York, USA
| | | | - Koen Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives. J Multidiscip Healthc 2021; 14:2719-2730. [PMID: 34611408 PMCID: PMC8486274 DOI: 10.2147/jmdh.s240563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.
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Affiliation(s)
- Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Marino
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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Perceived challenges during resuscitation of in-hospital cardiac arrests in the COVID-19 era. Resuscitation 2021; 167:89-90. [PMID: 34425154 PMCID: PMC8378041 DOI: 10.1016/j.resuscitation.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
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Baldi E, Cortegiani A. Out-of-hospital cardiac arrest during the COVID-19 era: The importance to fight against fear. Am J Emerg Med 2021; 48:338-339. [PMID: 34420857 PMCID: PMC8176882 DOI: 10.1016/j.ajem.2021.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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Ippolito M, Cortegiani A, Ferraro OE, Borrelli P, Contri E, Burkart R, Baldi E. Physical activity and quality of cardiopulmonary resuscitation: A secondary analysis of the MANI-CPR trial. Am J Emerg Med 2021; 50:330-334. [PMID: 34450396 DOI: 10.1016/j.ajem.2021.08.039] [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: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The association between the level of physical activity and quality of cardio-pulmonary resuscitation (CPR) performed by laypeople is unclear. The aim of this study was to evaluate the associations between physical activity level and laypeople performance during an eight-minute scenario of CPR. MATERIALS AND METHODS This study was a secondary analysis of the MANI-CPR Trial. The entire cohort of participants was grouped based on the level of physical activity assessed using the International Physical Activity Questionnaire (IPAQ) into a "low-moderate" level group and a "high" level group. Descriptive statistics were used for unadjusted analysis and multivariate logistic and linear regression models were also performed. RESULTS A total of 492 participants who reached the score of "Advanced CPR performer" at the 1-min final test monitored by Laerdal Resusci Anne QCPR were included in this analysis; 224 with a low-moderate level and 268 with a high level of physical activity. A statistically significant difference was found for the outcome of percentage of compressions with adequate depth (low-moderate group: 87.8% [41·4%-99·3%], high group: 97% [63·2%-100%]; P = 0·003). No associations remained significant after controlling for biometric characteristics of the participants, compression protocols and sex. CONCLUSION Adequate quality CPR may not need high baseline level of physical activity to be performed by a lay rescuer.
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Affiliation(s)
- Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
| | - Ottavia Eleonora Ferraro
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Paola Borrelli
- Department of Medical, Oral, and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Enrico Contri
- AAT 118 Pavia, AREU Lombardia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roman Burkart
- Swiss Resuscitation Council, Bern, Switzerland; Interassociation of Rescue Services, Bern, Switzerland
| | - Enrico Baldi
- Pavia nel Cuore, Pavia, Italy; Robbio nel Cuore, Robbio, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Field RA, Slowther AM. Treating patients with ReSPECT during a pandemic: Resuscitation decisions during COVID-19. Resuscitation 2021; 164:147-148. [PMID: 34089773 PMCID: PMC8170913 DOI: 10.1016/j.resuscitation.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Richard A Field
- University Hospital Coventry, Clifford Bridge Road, Coventry CV2 2DX, UK.
| | - Anne-Marie Slowther
- Warwick Medical School, Division of Health Sciences, Gibbet Hill Campus, Coventry CV4 7AL, UK
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