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Treml B, Eckhardt C, Oberleitner C, Ploner T, Rugg C, Radovanovic Spurnic A, Rajsic S. [Quality of life after in-hospital cardiac arrest : An 11-year experience from an university center]. DIE ANAESTHESIOLOGIE 2024; 73:454-461. [PMID: 38819460 PMCID: PMC11222208 DOI: 10.1007/s00101-024-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Cardiac arrest is a life-threatening condition requiring urgent medical care and is one of the leading causes of death worldwide. Given that in-hospital cardiac arrest (IHCA) is still poorly investigated, data on health-associated quality of life thereafter remains scarce. The available evidence is mostly transferred from out-of-hospital cardiac arrest studies, but the epidemiology and determinants of success might be different. The aim of the study was to investigate the change in the quality of life after in-hospital cardiac arrest and to identify potential risk factors for a poor outcome. MATERIAL AND METHODS This retrospective analysis of data and prospective evaluation of quality of life included all patients surviving an IHCA and being treated by the emergency medical team between 2010 and 2020. The primary endpoint of the study was the quality of life after IHCA at the reference date. Secondary endpoints covered determination of risk factors and predictors of poor outcome after in-hospital cardiopulmonary resuscitation. RESULTS In total 604 patients were resuscitated within the period of 11 years and 61 (10%) patients survived until the interview took place. Finally, 48 (79%) patients fulfilled the inclusion criteria and 31 (65%) were included in the study. There was no significant difference in the quality of life before and after cardiac arrest (EQ-5D-5L utility 0.79 vs. 0.78, p = 0.567) and in the EQ-5D-5L visual analogue scale (VAS) score. CONCLUSION The quality of life before and after IHCA in survivors was good and comparable. The quality of life was mostly affected by reduced mobility and anxiety/depression. Future studies with larger patient samples should focus on potentially modifiable factors that could prevent, warn, and limit the consequences of in-hospital cardiac arrest. Moreover, research on outcomes of IHCA should include available tools for the quality of life assessment.
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Affiliation(s)
- Benedikt Treml
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Christine Eckhardt
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Christoph Oberleitner
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Thomas Ploner
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich
| | - Christopher Rugg
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | | | - Sasa Rajsic
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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Hansen CJ, Rayo MF, Patterson ES, Yamokoski T, Abdel-Rasoul M, Allen TT, Socha JJ, Moffatt-Bruce SD. Perceptually Discriminating the Highest Priority Alarms Reduces Response Time: A Retrospective Pre-Post Study at Four Hospitals. HUMAN FACTORS 2023; 65:636-650. [PMID: 34320859 DOI: 10.1177/00187208211032870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Reduce nurse response time for emergency and high-priority alarms by increasing discriminability between emergency and all other alarms and suppressing redundant and likely false high-priority alarms in a secondary alarm notification system (SANS). BACKGROUND Emergency alarms are the most urgent, requiring immediate action to address a dangerous situation. They are clinician-triggered and have higher positive predictive value (PPV). High-priority alarms are automatically triggered and have lower PPV. METHOD We performed a retrospective pre-post study, analyzing data 15 months before and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, we incorporated digitized human speech to distinguish them from automatically triggered alarms, leaving their onset and escalation pathways unchanged. For automatically triggered alarms, we suppressed some by delaying initial onset and escalation by 20 s. We used linear mixed models to assess the change in response time, Fisher's exact test for the proportion of response times longer than 120 s, and control charts for process stability. RESULTS Response time for emergency alarms decreased at all hospitals (main, from 26.91 s to 22.32 s, p < .001; cardiac, from 127.10 s to 52.43 s, p < .001; cancer, from 18.03 s to 15.39 s, p < .001). Improvements were sustained. Automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals. CONCLUSION Auditory sound disambiguation was associated with a sustained reduced nurse response time for emergency alarms, but suppressing some high-priority automatically triggered alarms was not. APPLICATION Distinguishing and escalating urgent, actionable alarms with higher PPV improves response time.
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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Choi HJ, Noh H. Successful defibrillation using double sequence defibrillation: Case reports. Medicine (Baltimore) 2021; 100:e24992. [PMID: 33725873 PMCID: PMC7969327 DOI: 10.1097/md.0000000000024992] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Defibrillation is effective and the most common treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia in patients with cardiac arrest. PATIENT CONCERNS Recently we experienced 3 cases refractory ventricular fibrillation (RVF) which was successfully terminated with double sequence defibrillation (DSD) in our emergency department, so we'd like to report and discuss it. DIAGNOSIS Cardiac arrest. INTERVENTIONS A single defibrillation 200J was performed twice for patients with ventricular fibrillation in the initial rhythm of the emergency room. At the same time, intubation and intravenous access were achieved and epinephrine and amiodarone were administered. The 400J DSD was performed on RVF patients with sustained VFs, despite several trials of 150-200J defibrillation and adherence to advanced cardiac life support. OUTCOMES All three RVF patients recovered spontaneous circulation after DSD. CONCLUSION The three cases we have shown are small, but DSD improves the chance of spontaneous circulation. Therefore it is suggested that attempts of DSD to patients with RVF, especially in the prehospital stages as a way to improve the return of spontaneous circulation.
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Affiliation(s)
- Hyo Jeong Choi
- Department of Emergency Medical Technology, Sun Moon University. 70, Asan-si, Chungcheongnam-do
| | - Hyun Noh
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, KR
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Hessulf F, Herlitz J, Rawshani A, Aune S, Israelsson J, Södersved-Källestedt ML, Nordberg P, Lundgren P, Engdahl J. Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest. Resuscitation 2020; 155:13-21. [PMID: 32707144 DOI: 10.1016/j.resuscitation.2020.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most resuscitation guidelines have recommendations regarding maximum delay times from collapse to calling for the rescue team and initiation of treatment following cardiac arrest. The aim of the study was to investigate the association between adherence to guidelines for cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest (IHCA) and survival with a focus on delay to treatment. METHODS We used the Swedish Registry for CPR to study 3212 patients with a shockable rhythm and 9113 patients with non-shockable rhythm from January 1, 2008 to December 31, 2017. Adult patients older than or equal to 18 years with a witnessed IHCA where resuscitation was initiated were included. We assessed trends in adherence to guidelines and their associations with 30-day survival and neurological function. Adherence to guidelines was defined as follows: time from collapse to calling for the rescue team and CPR within 1 min for non-shockable rhythms. For shockable rhythms, adherence was defined as the time from collapse to calling for the rescue team and CPR within 1 min and defibrillation within 3 min. RESULTS In patients with a shockable rhythm, the 30-day survival for those treated according to guidelines was 66.1%, as compared to 46.5% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.84 (95% CI 1.52-2.22). Among patients with a non-shockable rhythm the 30-day survival for those treated according to guidelines was 22.8%, as compared to 16.0% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.43 (95% CI 1.24-1.65). Neurological function (cerebral performance category 1-2) among survivors was better among patients treated in accordance with guidelines for both shockable (95.7% vs 91.1%, <0.001) and non-shockable rhythms (91.0% vs 85.5%, p < 0.008). Adherence to the Swedish guidelines for CPR increased slightly 2008-2017. CONCLUSIONS Adherence to guidelines was associated with increased probability of survival and improved neurological function in patients with a shockable and non-shockable rhythm, respectively. Increased adherence to guidelines could increase cardiac arrest survival.
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Affiliation(s)
- Fredrik Hessulf
- Department of Anaesthesiology and Intensive Care Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden; Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; PreHospen - Centre of Prehospital Research; Academy of Caring Science, Welfare and Work Life, University of Borås, SE-501 90 Borås, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Solveig Aune
- Unit for EMS-coordination, Provider Governance and Coordination, Head Office, Region Västra Götaland, Sweden
| | - Johan Israelsson
- Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | | | - Per Nordberg
- Karolinska Institute, Institution for Clinical Research and Education, South Hospital, Stockholm, Sweden
| | - Peter Lundgren
- Department of Anaesthesiology and Intensive Care Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden; Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Engdahl
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
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Yen KC, Chan YH, Wu CT, Hsieh MJ, Wang CL, Wen MS, Chu PH. Resuscitation outcomes of a wireless ECG telemonitoring system for cardiovascular ward patients experiencing in-hospital cardiac arrest. J Formos Med Assoc 2020; 120:551-558. [PMID: 32653389 DOI: 10.1016/j.jfma.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE In-hospital cardiac arrest is a serious issue for hospitalized patients. The documented initial rhythm and detected medical events have been reported to influence the survival of cardiopulmonary resuscitation. This study aimed to identify the effect of continuous real-time electrocardiogram (ECG) monitoring on the prognosis of resuscitated patients in a general cardiac ward. METHODS We conducted this retrospective study using medical records of hospitalized patients in a cardiovascular ward who experienced an in-hospital cardiac arrest and received cardiopulmonary resuscitation from February 2015 to December 2018. The patients who were considered to be at high risk of cardiac events such as ventricular arrhythmia would receive continuous ECG monitoring. A wireless ECG telemonitoring system was introduced to replace traditional bedside ECG monitors. The outcome measures were the initial success of resuscitation, 24-h survival after resuscitation, and survival to discharge. RESULTS We enrolled 115 patients with a cardiac arrest during hospitalization, of whom 73 (63%) patients received wireless ECG telemonitoring. Patients receiving continuous ECG monitoring were associated with higher opportunities of initial success of resuscitation and 24-h survival after resuscitation (67.1% vs. 40.5%, p = 0.005; and 49.3% vs. 26.2%, p = 0.015, respectively) when comparing to the non-monitoring group; but no significant difference in survival to discharge (21.9% vs. 16.7%, p = 0.498) was observed. With adjustment of the covariates, the monitoring group was associated with a higher likelihood to reach the initial success of resuscitation (odds ratios [ORs], 3.21; 95% confidence interval [CI], 1.03-9.98). However, the effect of monitoring on 24-h survival and survival to discharge was close to null after adjusting for covariates. CONCLUSION A wireless ECG telemonitoring system were beneficial to the initial success of resuscitation for patients at high risk of cardiovascular events suffering an in-hospital cardiac arrest; but had less impact on 24-h survival and survival to discharge.
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Affiliation(s)
- Kun-Chi Yen
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chia-Tung Wu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Jer Hsieh
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Li Wang
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Shien Wen
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Po-Hsien Chu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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Leung KHB, Sun CLF, Yang M, Allan KS, Wong N, Chan TCY. Optimal in-hospital defibrillator placement. Resuscitation 2020; 151:91-98. [PMID: 32268160 DOI: 10.1016/j.resuscitation.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/27/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
AIMS To determine if mathematical optimization of in-hospital defibrillator placements can reduce in-hospital cardiac arrest-to-defibrillator distance compared to existing defibrillators in a single hospital. METHODS We identified treated IHCAs and defibrillator placements in St. Michael's Hospital in Toronto, Canada from Jan. 2013 to Jun. 2017 and mapped them to a 3-D computer model of the hospital. An optimization model identified an equal number of optimal defibrillator locations that minimized the average distance between IHCAs and the closest defibrillator using a 10-fold cross-validation approach. The optimized and existing defibrillator locations were compared in terms of average distance to the out-of-sample IHCAs. We repeated the analysis excluding intensive care units (ICUs), operating theatres (OTs), and the emergency department (ED). We also re-solved the model using fewer defibrillators to determine when the average distance matched the performance of existing defibrillators. RESULTS We identified 433 treated IHCAs and 53 defibrillators. Of these, 167 IHCAs and 31 defibrillators were outside of ICUs, OTs, and the ED. Optimal defibrillator placements reduced the average IHCA-to-defibrillator distance from 16.1 m to 2.7 m (relative decrease of 83.0%; P = 0.002) compared to existing defibrillator placements. For non-ICU/OT/ED IHCAs, the average distance was reduced from 24.4 m to 11.9 m (relative decrease of 51.3%; P = 0.002. 8-9 optimized defibrillator locations were sufficient to match the average IHCA-to-defibrillator distance of existing defibrillator placements. CONCLUSIONS Optimization-guided placement of in-hospital defibrillators can reduce the distance from an IHCA to the closest defibrillator. Equivalently, optimization can match existing defibrillator performance using far fewer defibrillators.
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Affiliation(s)
- K H Benjamin Leung
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Christopher L F Sun
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Perioperative Services, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew Yang
- Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada
| | - Katherine S Allan
- Department of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Natalie Wong
- Department of Critical Care, St. Michael's Hospital, Toronto, ON, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Kang JY, Kim YJ, Shin YJ, Huh JW, Hong SB, Kim WY. Association Between Time to Defibrillation and Neurologic Outcome in Patients With In-Hospital Cardiac Arrest. Am J Med Sci 2019; 358:143-148. [PMID: 31200920 DOI: 10.1016/j.amjms.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The influence of time to defibrillation in patients with shockable in-hospital cardiac arrest (IHCA) has not been fully assessed. This study investigated the association between time to defibrillation and neurologic outcome in shockable IHCA survivors. MATERIALS AND METHODS A 7-year retrospective cohort study was conducted using a prospectively collected registry of adult IHCA patients. Patients whose first documented rhythm was pulseless ventricular tachycardia or ventricular fibrillation and who received defibrillation within 5 minutes were included. RESULTS Among 1,683 IHCA patients, 261 patients were included. At 28 days, a good neurologic outcome (Cerebral Performance Category score 1 or 2) according to time to defibrillation was seen in 49.0%, 21.1%, 13.4% and 16.5% of patients treated at <2 minutes (n = 128), 2-3 minutes (n = 55), 3-4 minutes (n = 35) and 4-5 minutes (n = 43) after IHCA, respectively. After adjusting for clinical characteristics, a graded inverse association was found after 3 minutes. CONCLUSIONS A graded inverse association between time to defibrillation and neurologic outcome was observed beyond 3 minutes following cardiac arrest. A target time to defibrillation of <3 minutes may be a practical target goal in resource-limited hospitals.
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Affiliation(s)
| | | | - Yu Jung Shin
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Patel NJ, Atti V, Kumar V, Panakos A, Anantha Narayanan M, Bhardwaj B, Arora S, Deshmukh AJ, Patel N, Basir MB, Cohen MG, Kini AS, Sharma SK, Dangas G, O'Neill WW, Alfonso CE. Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation. Catheter Cardiovasc Interv 2019; 94:578-587. [DOI: 10.1002/ccd.28138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/30/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Nileshkumar J. Patel
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Varunsiri Atti
- Department of MedicineMichigan State University‐Sparrow Hospital East Lansing Michigan
| | - Varun Kumar
- Division of Cardiovascular DiseasesMt Sinai St Luke's Roosevelt New York New York
| | - Andrew Panakos
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
| | | | - Bhaskar Bhardwaj
- Division of Cardiovascular DiseasesUniversity of Missouri Columbia Missouri
| | - Shilpkumar Arora
- Department of MedicineGuthrie Robert Packer Hospital Sayre Pennsylvania
| | | | - Nish Patel
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Mir B. Basir
- Division of Cardiovascular DiseasesHenry Ford Health System Detroit Michigan
| | - Mauricio G. Cohen
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
| | - Annapoorna S. Kini
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Samin K. Sharma
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - George Dangas
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - William W. O'Neill
- Division of Cardiovascular DiseasesHenry Ford Health System Detroit Michigan
| | - Carlos E. Alfonso
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
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Reeson M, Kyeremanteng K, D'Egidio G. Defibrillator Design and Usability May Be Impeding Timely Defibrillation. Jt Comm J Qual Patient Saf 2018; 44:536-544. [PMID: 30166037 DOI: 10.1016/j.jcjq.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely defibrillation is the only rhythm-specific therapy proven to increase survival to hospital discharge following cardiac arrest secondary to ventricular tachyarrhythmia. Delayed defibrillation occurs in more than 30% of this population. A study was conducted to test the hypothesis that unintuitive defibrillator design and lack of usability are barriers to timely defibrillation, as measured by time to defibrillation and the proportion of defibrillations delivered within 2 minutes. METHODS A mixed-methods (qualitative and quantitative) prospective usability study was performed to evaluate the use of a defibrillator in a simulated hospital environment. Participants were asked to perform two simulated tasks typical of in-hospital cardiac arrest care: defibrillation and synchronized cardioversion. RESULTS The average time to defibrillation was 4 minutes 21 seconds. Only 9.1% of participants (2/22) performed a defibrillation within 2 minutes. Participants had difficulty with several aspects of defibrillator use, including attaching the hands-free defibrillator electrode pads and selecting an appropriate display. Participants rated defibrillator design 4.2 ± 1.8 (mean, standard deviation) on a perceived usability scale (1 = "poorly designed"; 9 = "perfectly designed"). CONCLUSION Most participants were unable to perform a simulated defibrillation within 2 minutes. This delay in defibrillation was likely at least partially the result of poor defibrillator design and lack of usability. Expert observation and participant feedback were largely congruent in terms of which aspects of defibrillator design do not suit the end user. Modification of future defibrillator design, along with improved education and training, may result in more timely defibrillation.
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Patel KK, Spertus JA, Khariton Y, Tang Y, Curtis LH, Chan PS. Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation 2017; 137:2041-2051. [PMID: 29279412 DOI: 10.1161/circulationaha.117.030488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients with in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown. METHODS We linked data from a national IHCA registry with Medicare files and identified 36 961 patients ≥65 years of age with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA caused by pulseless ventricular tachycardia or ventricular fibrillation were stratified by prompt (≤2 minutes) versus delayed (>2 minutes) defibrillation, whereas patients with IHCA caused by asystole or pulseless electric activity were stratified by prompt (≤5 minutes) versus delayed (>5 minutes) epinephrine treatment. The association between prompt treatment and long-term survival for each rhythm type was assessed with multivariable hierarchical modified Poisson regression models. RESULTS Of 8119 patients with an IHCA caused by ventricular tachycardia or ventricular fibrillation, the rate of 1-year survival was higher in those treated with prompt defibrillation than with delayed defibrillation (25.7% [1466 of 5714] versus 15.5% [373 of 2405]; adjusted relative risk [RR], 1.49; 95% confidence interval [CI] 1.32-1.69; P<0.0001). This survival advantage persisted at 3 years (19.1% versus 11.0%; adjusted RR, 1.45; 95% CI, 1.23-1.69; P<0.0001) and at 5 years (14.7% versus 7.9%; adjusted RR, 1.50; 95% CI, 1.22-1.83; P<0.0001). Of 28 842 patients with an IHCA caused by asystole/pulseless electric activity, the rate of 1-year survival with prompt epinephrine treatment was higher than with delayed treatment (5.4% [1341 of 24 885] versus 4.3% [168 of 3957]; adjusted RR, 1.20; 95% CI, 1.02-1.41; P=0.02), but this survival benefit was no longer present at 3 years (3.5% versus 2.9%; adjusted RR, 1.17; 95% CI, 0.95-1.45; P=0.15) and at 5 years (2.3% versus 1.9%; adjusted RR, 1.18; 95% CI, 0.88-1.58; P=0.27). CONCLUSIONS Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years. By quantifying the greater survival associated with timely defibrillation and epinephrine administration, these findings provide important insights into the durability of survival benefits for 2 process-of-care measures in current resuscitation guidelines.
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Affiliation(s)
- Krishna K Patel
- Mid America Heart Institute, Saint Luke's Hospital of Kansas City, MO (K.K.P., J.A.S., Y.K., Y.T., P.S.C.). .,University of Missouri-Kansas City (K.K.P., J.A.S., Y.K., P.S.C.)
| | - John A Spertus
- Mid America Heart Institute, Saint Luke's Hospital of Kansas City, MO (K.K.P., J.A.S., Y.K., Y.T., P.S.C.).,University of Missouri-Kansas City (K.K.P., J.A.S., Y.K., P.S.C.)
| | - Yevgeniy Khariton
- Mid America Heart Institute, Saint Luke's Hospital of Kansas City, MO (K.K.P., J.A.S., Y.K., Y.T., P.S.C.).,University of Missouri-Kansas City (K.K.P., J.A.S., Y.K., P.S.C.)
| | - Yuanyuan Tang
- Mid America Heart Institute, Saint Luke's Hospital of Kansas City, MO (K.K.P., J.A.S., Y.K., Y.T., P.S.C.)
| | | | - Paul S Chan
- Mid America Heart Institute, Saint Luke's Hospital of Kansas City, MO (K.K.P., J.A.S., Y.K., Y.T., P.S.C.).,University of Missouri-Kansas City (K.K.P., J.A.S., Y.K., P.S.C.)
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Aiello S, Perez M, Cogan C, Baetiong A, Miller SA, Radhakrishnan J, Kaufman CL, Gazmuri RJ. Real-Time Ventricular Fibrillation Amplitude-Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine. J Am Heart Assoc 2017; 6:JAHA.117.006749. [PMID: 29102980 PMCID: PMC5721767 DOI: 10.1161/jaha.117.006749] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The ventricular fibrillation amplitude spectral area (AMSA) predicts whether an electrical shock could terminate ventricular fibrillation and prompt return of spontaneous circulation. We hypothesized that AMSA can guide more precise timing for effective shock delivery during cardiopulmonary resuscitation. Methods and Results Three shock delivery protocols were compared in 12 pigs each after electrically induced ventricular fibrillation, with the duration of untreated ventricular fibrillation evenly stratified into 6, 9, and 12 minutes: AMSA‐Driven (AD), guided by an AMSA algorithm; Guidelines‐Driven (GD), according to cardiopulmonary resuscitation guidelines; and Guidelines‐Driven/AMSA‐Enabled (GDAE), as per GD but allowing earlier shocks upon exceeding an AMSA threshold. Shocks delivered using the AD, GD, and GDAE protocols were 21, 40, and 62, with GDAE delivering only 2 AMSA‐enabled shocks. The corresponding 240‐minute survival was 8/12, 6/12, and 2/12 (log‐rank test, P=0.035) with AD exceeding GDAE (P=0.026). The time to first shock (seconds) was (median [Q1–Q3]) 272 (161–356), 124 (124–125), and 125 (124–125) (P<0.001) with AD exceeding GD and GDAE (P<0.05); the average coronary perfusion pressure before first shock (mm Hg) was 16 (9–30), 10 (6–12), and 3 (−1 to 9) (P=0.002) with AD exceeding GDAE (P<0.05); and AMSA preceding the first shock (mV·Hz, mean±SD) was 13.3±2.2, 9.0±1.6, and 8.6±2.0 (P<0.001) with AD exceeding GD and GDAE (P<0.001). The AD protocol delivered fewer unsuccessful shocks (ie, less shock burden) yielding less postresuscitation myocardial dysfunction and higher 240‐minute survival. Conclusions The AD protocol improved the time precision for shock delivery, resulting in less shock burden and less postresuscitation myocardial dysfunction, potentially improving survival compared with time‐fixed, guidelines‐driven, shock delivery protocols.
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Affiliation(s)
- Salvatore Aiello
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Michelle Perez
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Chad Cogan
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Alvin Baetiong
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Steven A Miller
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jeejabai Radhakrishnan
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | | | - Raúl J Gazmuri
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Critical Care Medicine Captain James A. Lovell Federal Health Care Center, North Chicago, IL
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13
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Hirlekar G, Karlsson T, Aune S, Ravn-Fischer A, Albertsson P, Herlitz J, Libungan B. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation 2017; 118:101-106. [PMID: 28736324 DOI: 10.1016/j.resuscitation.2017.07.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND There have been few studies of the outcome in elderly patients who have suffered in-hospital cardiac arrest (IHCA) and the association between cardiac arrest characteristics and survival. AIM The aim of this large observational study was to investigate the survival and neurological outcome in the elderly after IHCA, and to identify which factors were associated with survival. METHODS We investigated elderly IHCA patients (≥70years of age) who were registered in the Swedish Cardiopulmonary Resuscitation Registry 2007-2015. For descriptive purposes, the patients were grouped according to age (70-79, 80-89, and ≥90years). Predictors of 30-day survival were identified using multivariable analysis. RESULTS Altogether, 11,396 patients were included in the study. Thirty-day survival was 28% for patients aged 70-79 years, 20% for patients aged 80-89 years, and 14% for patients aged ≥90years. Factors associated with higher survival were: patients with an initially shockable rhythm, IHCA at an ECG-monitored location, IHCA was witnessed, IHCA during daytime (8 a.m.-8 p.m.), and an etiology of arrhythmia. A lower survival was associated with a history of heart failure, respiratory insufficiency, renal dysfunction and with an etiology of acute pulmonary oedema. Patients over 90 years of age with VF/VT as initial rhythm had a 41% survival rate. We found a trend indicating a less aggressive care with increasing age during cardiac arrest (fewer intubations, and less use of adrenalin and anti-arrhythmic drugs) but there was no association between age and delay in starting cardiopulmonary resuscitation (CPR). In survivors, there was no significant association between age and a favourable neurological outcome (CPC score: 1-2) (92%, 93%, and 88% in the three age groups, respectively). CONCLUSIONS Increasing age among the elderly is associated with a lower 30-day survival after IHCA. Less aggressive treatment and a worse risk profile might contribute to these findings. Relatively high survival rates among certain subgroups suggest that discussions about advanced directives should be individualized. Most survivors have good neurological outcome, even patients over 90 years of age.
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Affiliation(s)
- G Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - T Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - S Aune
- CPR Training Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Herlitz
- Sahlgrenska University Hospital and Center for Pre-Hospital Research, Western Sweden University of Borås, Borås, Sweden
| | - B Libungan
- University Hospital of Iceland, Reykjavik, Iceland
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Castan C, Münch A, Mahling M, Haffner L, Griewatz J, Hermann-Werner A, Riessen R, Reutershan J, Celebi N. Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study. PLoS One 2017; 12:e0178794. [PMID: 28594858 PMCID: PMC5464587 DOI: 10.1371/journal.pone.0178794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/18/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation. Methods Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario. Results The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107–270 s), more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49) was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17%) of the overall time needed for defibrillation (maximum 67%). Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused. Conclusions Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of defibrillation delay and can be used to generate new hypotheses on how to provide a timely defibrillation.
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Affiliation(s)
- Christoph Castan
- Medical School, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Alexander Münch
- Department of Anesthesiology and Intensive Care Medicine, University of Tuebingen, Tuebingen, Germany
| | - Moritz Mahling
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Leopold Haffner
- Medical School, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Jan Griewatz
- Competence Centre for University Teaching in Medicine, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Anne Hermann-Werner
- DocLab, Faculty of Medicine, University of Tuebingen, Tuebingen, Germany
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tuebingen, Tuebingen, Germany
| | - Jörg Reutershan
- Department of Anesthesiology and Intensive Care Medicine, Bayreuth Hospital, Preuschwitzer Straße 101, Bayreuth, Germany
| | - Nora Celebi
- PHV-Dialysezentrum Waiblingen, Beinsteiner Straße 8/3, Waiblingen, Germany
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Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients. Med Care 2016; 54:74-80. [PMID: 26783858 DOI: 10.1097/mlr.0000000000000456] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. OBJECTIVES To determine the association between nurse staffing, nurse work environments, and IHCA survival. RESEARCH DESIGN Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. SUBJECTS A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). RESULTS Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio=0.95; 95% confidence interval, 0.91-0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio=0.84; 95% confidence interval, 0.71-0.99) than patients cared for in hospitals with better work environments. CONCLUSIONS Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.
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Bergum D, Haugen BO, Nordseth T, Mjølstad OC, Skogvoll E. Recognizing the causes of in-hospital cardiac arrest--A survival benefit. Resuscitation 2015; 97:91-6. [PMID: 26449872 DOI: 10.1016/j.resuscitation.2015.09.395] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/21/2015] [Accepted: 09/26/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The in-hospital emergency team (ET) may or may not recognize the causes of in-hospital cardiac arrest (IHCA) during the provision of cardiopulmonary resuscitation (CPR). In a previous 4.5-year prospective study, this rate of recognition was found to be 66%. The aim of this study was to investigate whether survival improved if the cause of arrest was recognized by the ET. METHODS The difference in survival if the causes were recognized versus not recognized was estimated after propensity score matching patients from these two groups. RESULTS Overall survival to hospital discharge was 25%. After propensity score matching, the benefit of recognizing the cause regarding 1-hour survival of the episode was 29% (p<0.01), and 19% regarding hospital discharge, respectively. Variables commonly known to affect the outcome after cardiac arrest were found to be balanced between the two groups. The largest difference was found in patients with non-cardiac causes and non-shockable presenting rhythms. Patient records and pre-arrest clinical symptoms were the information sources most frequently utilized by the ET to establish the causes of arrest. CONCLUSIONS Patients suffering an IHCA showed a substantial survival benefit if the causes of arrest were recognized by the ET. Patient records and pre-arrest clinical symptoms were the sources of information most frequently utilized in these instances.
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Affiliation(s)
- Daniel Bergum
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway.
| | - Bjørn Olav Haugen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St Olav University Hospital, Trondheim, Norway
| | - Trond Nordseth
- Department of Anaesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St Olav University Hospital, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway
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Rozen TH, Mullane S, Kaufman M, Hsiao YFF, Warrillow S, Bellomo R, Jones DA. Antecedents to cardiac arrests in a teaching hospital intensive care unit. Resuscitation 2014; 85:411-7. [DOI: 10.1016/j.resuscitation.2013.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/07/2013] [Accepted: 11/16/2013] [Indexed: 11/26/2022]
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In-hospital cardiac arrest: can we change something? Wien Klin Wochenschr 2013; 125:516-23. [PMID: 23928936 DOI: 10.1007/s00508-013-0409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Cardiac arrest is classified as 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization.The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period.We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4 %), surgical (25.24 %) and neurosurgical patients (15.2 %) with many associated severe diseases. In 85.6 % of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67 % of the cases. However, in 14.6 % of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p = 0.001), presence of cerebral ischemia (p = 0.026) or cardiomyopathy (p = 0.004) and duration of CPR (p = 0.041). Initial survival was very low (14.6 %), and full recovery was accomplished in only eight patients out of 309 (2.59 %).Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success.
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Kloppe C, Jeromin A, Kloppe A, Ernst M, Mügge A, Hanefeld C. First Responder for In-Hospital Resuscitation: 5-Year Experience with an Automated External Defibrillator-Based Program. J Emerg Med 2013; 44:1077-82. [DOI: 10.1016/j.jemermed.2012.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/16/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Rozanski EA, Rush JE, Buckley GJ, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S44-64. [DOI: 10.1111/j.1476-4431.2012.00755.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - John E. Rush
- Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA
| | - Gareth J. Buckley
- College of Veterinary Medicine, University of Florida; Gainesville; FL
| | - Daniel J. Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies, School of Veterinary Medicine and the Department of Emergency Medicine, School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Rousek JB, Hallbeck MS. The ergonomics of “Code Blue” medical emergencies: a literature review. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/19488300.2011.628556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Saghafinia M, Motamedi MHK, Piryaie M, Rafati H, Saghafi A, Jalali A, Madani SJ, Kolahdehi RB. Survival after in-hospital cardiopulmonary resuscitation in a major referral center. Saudi J Anaesth 2011; 4:68-71. [PMID: 20927265 PMCID: PMC2945517 DOI: 10.4103/1658-354x.65131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aim: This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation (CPR), by the code blue team at our center to compare with other centers. Materials and Methods: Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests. Results: Of the 290 patients included, 95 patients (30.4%) had successful CPR. However, only 35 patients (12%) were alive at discharge. The majority requiring CPR were above 60 years of age (61.7%). Males required CPR more than females. There were 125 women (43.1%) and 165 males (56.9%) aged 3 to 78 (average 59.6) years. Majority (179) of the cases (61.7%) were above 60 years of age. Regarding the various wards, 54 cases (17.3%) were in the internal medicine ward, 63 cases (20.1%) in the surgery ward, 1 case (0.3%) in the clinic, 11 cases (3.5%) in the paraclinic, 116 cases (37.1%) in the emergency (ER), 55 cases (17.5%) in the Intensive Care Unit (ICU) and Coronary Care Unit (CCU), and 13 cases (4.2%) were in other wards. Cardiac massage was done in 133 cases (42.5%), defibrillation only via electroshock 3 cases (1%), and both were used in177 cases (56.5%). The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases. Conclusion: In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge.
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Affiliation(s)
- Masoud Saghafinia
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Jones P, Miles J, Mitchell N. Survival from in-hospital cardiac arrest in Auckland City Hospital. Emerg Med Australas 2011; 23:569-79. [PMID: 21995471 DOI: 10.1111/j.1742-6723.2011.01450.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe in-hospital resuscitation outcomes and factors associated with survival at Auckland City Hospital, New Zealand. METHODS The Utstein template for in-hospital cardiac arrests was used. A retrospective audit of all cardiac arrests 2004-06 determined patient demographics, resuscitation time intervals, interventions, survival and neurological outcome at 12 months. Factors associated with survival to discharge were explored with logistic regression. RESULTS There were 3470 in-hospital deaths. Resuscitation was attempted in 415 patients (12%), with survival to discharge 27.2%. Survival was higher in first rhythm VT/VF (52.7% vs 13.1%, χ(2) = 75.3, P < 0.001), when the arrest was 'In-Hours' (41.4% vs 17%, χ(2) = 30.1, P < 0.001) and with younger age (mean [SD] for survivors 59.4 [7.1]vs 69.1 [14] for non-survivors). These associations were independent predictors of survival after multivariate logistic regression, with OR 6.2 (95% CI 3.6-10.5), 3.1 (95% CI 1.8-5.4) and 1.04 (95% CI 1.02-1.06), respectively (all P < 0.001). Other univariate predictors of survival; cardiac arrest team on site, monitored arrest and time to CPR were not significant after multivariate logistic regression. Time intervals to arrest interventions were short. Twelve month neurological outcome was good (CPC1 or 2) in 97.1% (95% CI 91.6-99.4) of survivors. CONCLUSIONS Survival from cardiac arrest in our hospital compared well to similar centres and good neurological outcome was higher than reported previously. Reduced survival during the 'After-Hours' period is cause for concern, and further research into the factors underlying this is required.
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Affiliation(s)
- Peter Jones
- Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
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ICU nurses' perceptions of potential constraints and anticipated support to practice defibrillation: a qualitative study. Intensive Crit Care Nurs 2011; 27:186-93. [PMID: 21641223 DOI: 10.1016/j.iccn.2011.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
AIM The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. METHOD This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. RESULTS Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. CONCLUSION Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed.
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Löf S, Sandström A, Engström Å. Patients treated with therapeutic hypothermia after cardiac arrest: relatives’ experiences. J Adv Nurs 2010; 66:1760-8. [DOI: 10.1111/j.1365-2648.2010.05352.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de-la-Chica R, Colmenero M, Chavero M, Muñoz V, Tuero G, Rodríguez M. Factores pronósticos de mortalidad en una cohorte de pacientes con parada cardiorrespiratoria hospitalaria. Med Intensiva 2010; 34:161-9. [DOI: 10.1016/j.medin.2009.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 10/27/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
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Mäkinen M, Niemi-Murola L, Kaila M, Castrén M. Nurses’ attitudes towards resuscitation and national resuscitation guidelines—Nurses hesitate to start CPR-D. Resuscitation 2009; 80:1399-404. [DOI: 10.1016/j.resuscitation.2009.08.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 08/14/2009] [Accepted: 08/27/2009] [Indexed: 12/01/2022]
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Spearpoint K, Gruber P, Brett S. Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: An observational study over 6 years. Resuscitation 2009; 80:638-43. [DOI: 10.1016/j.resuscitation.2009.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/01/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
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Abstract
External electrical cardioversion was first performed in the 1950s. Urgent or elective cardioversions have specific advantages, such as termination of atrial and ventricular tachycardia and recovery of sinus rhythm. Electrical cardioversion is life-saving when applied in urgent circumstances. The succcess rate is increased by accurate tachycardia diagnosis, careful patient selection, adequate electrode (paddles) application, determination of the optimal energy and anesthesia levels, prevention of embolic events and arrythmia recurrence and airway conservation while minimizing possible complications. Potential complications include ventricular fibrillation due to general anesthesia or lack of synchronization between the direct current (DC) shock and the QRS complex, thromboembolus due to insufficient anticoagulant therapy, non-sustained VT, atrial arrhythmia, heart block, bradycardia, transient left bundle branch block, myocardial necrosis, myocardial dysfunction, transient hypotension, pulmonary edema and skin burn. Electrical cardioversion performed in patients with a pacemaker or an incompatible cardioverter defibrillator may lead to dysfunction, namely acute or chronic changes in the pacing or sensitivity threshold. Although this procedure appears fairly simple, serious consequences might occur if inappropriately perfformed.
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Affiliation(s)
- Murat Sucu
- Department of Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
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31
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Cardiac arrest survival after implementation of automated external defibrillator technology in the in-hospital setting. Crit Care Med 2009; 37:1229-36. [DOI: 10.1097/ccm.0b013e3181960ff3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Cardiac arrests of hospital staff and visitors: Experience from the national registry of cardiopulmonary resuscitation. Resuscitation 2009; 80:65-8. [DOI: 10.1016/j.resuscitation.2008.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 09/10/2008] [Accepted: 09/18/2008] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The use of postarrest variables to predict survival after discharge following in-hospital cardiopulmonary resuscitation has not been definitive. This study evaluates whether the duration of cardiopulmonary resuscitation (CPR) and other variables affect discharge rates and survival rates after discharge. METHODS Prospective cohort survival data and arrest variables were collected, including initial observed rhythm, duration of CPR, time of arrest, and number of arrests. Arrests on unmonitored general medical units, monitored telemetry units, and critical care units were included. Outcome measures were: survival after CPR, 24 hours post-CPR, survival to discharge, and to six months postdischarge. RESULTS At both discharge and six months after discharge, ventricular fibrillation and ventricular tachycardia were associated with better survival rates than other initial rhythms (P < 0.001). There were significantly higher survival rates (P < 0.001) for those receiving CPR for < or =10 minutes as compared with those receiving CPR >10 minutes. Multiple versus single arrests and monitored versus unmonitored arrests approached significance. The time of day of the arrest was not a significant factor. CONCLUSIONS Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge and six months postdischarge. Low six-month survival rates may reflect the relatively high proportion of initial rhythms other than ventricular in the study group.
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Avansi PDA, Meneghin P. [Translation and adaptation of the In-Hospital Utstein style into the Portuguese language]. Rev Esc Enferm USP 2008; 42:504-11. [PMID: 18856118 DOI: 10.1590/s0080-62342008000300013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiopulmonary arrest (CPA) is a potentially lethal event in which the quality of the service depends on agility, knowledge and the skills of all of the involved team. The development of the guide identifying the significant points during the procedure of an in-hospital CPA appeared in 1997, with the creation of the In-Hospital Utstein. The purpose of this study was the translation and adaptation of the procedures into the Portuguese language. Outcomes of this process resulted in a pre-test instrument administered on 20 CPA patients. The outcome variables were not collected, because it involved accompanying these patients over a lengthy period of time. The most common CPA rhythm was pulseless electrical activity (65%); the defibrillation average time was 1.25 minutes. Some information was not recorded. In conclusion, the instrument is adaptable to the Brazilian reality, therefore improving care administered during the CPA event.
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Affiliation(s)
- Patrícia do Amaral Avansi
- Programa de Pós-Graduação em Saúde do Adulto da Escola de Enfermagem, Universidade de São Paulo (EEUSP). São Paulo, SP, Brasil.
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Overcoming barriers to in-hospital cardiac arrest documentation. Resuscitation 2007; 76:369-75. [PMID: 18023958 DOI: 10.1016/j.resuscitation.2007.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/17/2007] [Accepted: 08/17/2007] [Indexed: 11/21/2022]
Abstract
AIMS (1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. METHOD A retrospective audit of cardiac arrest documentation for a 3-year period following the introduction of a standard documentation form. RESULTS There was an initial improvement in use of the template (29% (95%CI 22-37%) to 88% (95%CI 82-92%), p<0.001) after identification of barriers and implementation of tailored strategies. Use of the template declined (77%, 95%CI 69-84%, p=0.023) after the key facilitator left the hospital. Time interval documentation ranged from 66% (95%CI 54-77%) for tracheal intubation to 91% (95%CI 80-93%) for first dose of adrenaline (epinephrine). CONCLUSIONS Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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Davis DP, Fisher R, Aguilar S, Metz M, Ochs G, McCallum-Brown L, Ramanujam P, Buono C, Vilke GM, Chan TC, Dunford JV. The feasibility of a regional cardiac arrest receiving system. Resuscitation 2007; 74:44-51. [PMID: 17346870 DOI: 10.1016/j.resuscitation.2006.11.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 11/06/2006] [Accepted: 11/06/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients suffering out-of-hospital cardiac arrest (OOHCA) are generally transported to the closest ED, presumably to expedite a hospital level of care and improve the chances of return for spontaneous circulation (ROSC) or provide post-resuscitative care for patients with prehospital ROSC. As hospital-based therapies for survivors of OOHCA are identified, such as hypothermia and emergency primary coronary interventions (PCI), certain hospitals may be designated as cardiac arrest receiving facilities. The safety of bypassing non-designated facilities with such a regional system is not known. OBJECTIVES To explore the potential ED contribution in OOHCA victims without prehospital ROSC and document the relationship between transport time and outcome in patients with prehospital ROSC. METHODS This was a prospective, observational study conducted in a large, urban EMS system over an 18-month period. Data were collected using the Utstein template for OOHCA. The incidence of prehospital ROSC was calculated for patients who were declared dead on scene, transported but died in the ED, died in the hospital, and survived to hospital discharge. The relationship between transport time and survival was also explored for patients with prehospital ROSC. RESULTS A total of 1141 cardiac arrest patients were enrolled over the 18-month period. A strong association between prehospital ROSC and final disposition was observed (chi-square test for trend p<0.001). Only two patients who survived to hospital discharge did not have prehospital ROSC. Mean transport times were not significantly different for patients with prehospital ROSC who were declared dead in the ED (8.3min), died following hospital admission (7.8min), and survived to hospital discharge (8.5min). Outcomes in patients with prehospital ROSC who had shorter (7min or less) versus longer transport times were similar, and receiver-operator curve analysis indicated no predictive ability of transport time with regard to survival to hospital admission (area under the curve=0.52). CONCLUSIONS In this primarily urban EMS system, the vast majority of survivors from OOHCA are resuscitated in the field. A relationship between transport time and survival to hospital admission or discharge was not observed. This supports the feasibility of developing a regional cardiac arrest system with designated receiving facilities.
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Affiliation(s)
- Daniel P Davis
- University of California San Diego, Department of Emergency Medicine, San Diego, CA 92103-8676, United States.
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Augenstein S, Wenzel V, Krismer AC, Lindner KH. In-hospital resuscitation. Curr Opin Anaesthesiol 2007; 14:423-30. [PMID: 17019125 DOI: 10.1097/00001503-200108000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A recent world expert conference on resuscitation and emergency cardiac care led to evidence-based international guidelines for cardiopulmonary resuscitation (CPR). Several changes to CPR interventions were recommended, and will have to be implemented into clinical practice. The poor prognosis of patients who suffer in-hospital cardiac arrest may be improved with developments in CPR interventions. In the present review the most important changes recommended by the new CPR guidelines and the latest promising CPR investigations are described, focusing on their impact on in-hospital resuscitation.
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Affiliation(s)
- S Augenstein
- Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria.
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Peters R, Boyde M. Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience. Am J Crit Care 2007. [DOI: 10.4037/ajcc2007.16.3.240] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training.
Objectives To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest.
Methods An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model.
Results Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge.
Conclusions The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.
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Affiliation(s)
- Robyn Peters
- Robyn Peters was a Clinical Nurse Consultant-Resuscitation with the Princess Alexandra Hospital when this study was conducted; she is now a Nurse Practitioner Candidate-Heart Failure, Princess Alexandra Hospital. Mary Boyde is a Nurse Educator at the Princess Alexandra Hospital and a Clinical Lecturer with the University of Queensland School of Nursing and Midwifery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Mary Boyde
- Robyn Peters was a Clinical Nurse Consultant-Resuscitation with the Princess Alexandra Hospital when this study was conducted; she is now a Nurse Practitioner Candidate-Heart Failure, Princess Alexandra Hospital. Mary Boyde is a Nurse Educator at the Princess Alexandra Hospital and a Clinical Lecturer with the University of Queensland School of Nursing and Midwifery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Skrifvars MB, Castrén M, Aune S, Thoren AB, Nurmi J, Herlitz J. Variability in survival after in-hospital cardiac arrest depending on the hospital level of care. Resuscitation 2007; 73:73-81. [PMID: 17250948 DOI: 10.1016/j.resuscitation.2006.08.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 08/17/2006] [Accepted: 08/23/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Survival after in-hospital cardiac arrest (IHCA) differs considerably between hospitals. This study tries to determine whether this difference is due to patient selection because of the hospital level of care or to effective resuscitation management. METHODS Prospectively collected data on management of in-hospital cardiac arrests from Sahlgrenska Hospital, a tertiary hospital in Gothenburg, Sweden (cohort one) and from five Finnish secondary hospitals (cohort two). A multiple logistic regression model was created for predicting survival to hospital discharge. RESULTS A total of 954 cases from Sahlgrenska Hospital and 624 patients from the hospitals in Finland were included. The delay to defibrillation was longer at Sahlgrenska than at the five Finnish secondary hospitals (p=0.045). Significant predictors of survival were: (1) age below median (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.5-2.8); (2) no diabetes (OR 1.9, CI 1.2-2.9); (3) arrests occurring during office hours (OR 1.5, CI 1.1-2.2); (4) witnessed cardiac arrest (OR 6.3, CI 2.6-15.3); (5) ventricular fibrillation or ventricular tachycardia as the initial rhythm (OR 4.9, CI 3.5-6.7); (6) location of the arrest (compared to arrests in general wards, GW): thoracic surgery and heart transplantation ward (OR 2.9, CI 1.5-5.9), interventional radiology (OR 4.8, CI 1.9-12.0) and other in-hospital locations (3.0, CI 1.6-5.7) and (7) hospital (compared to arrests at Sahlgrenska Hospital); arrests at Etelä-Karjala Central Hospital [CH] (OR 0.3, CI 0.1-0.7), Päijät-Hame CH (OR 0.3, CI 0.1-0.8) and Seinäjoki CH (OR 0.4, CI 0.3-0.7). CONCLUSION The comparison of survival following IHCA between different hospitals is difficult, there seems to be undefined factors greatly associated with outcome. A great variability in survival within different hospital areas probably because of differences in patient selection, patient surveillance and resuscitation management was also noted. A locally implemented strong in-hospital chain of survival is probably the only way to improve outcome following IHCA.
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Affiliation(s)
- M B Skrifvars
- Helsinki EMS, Helsinki University Hospital, P.O. Box 112, FIN-00099 Helsinki, Finland.
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Scapigliati A, Sanna T, Zamparelli R, Sandroni C, Colizzi C, Fenici P, Arlotta G, Nuzzo C, Bonarrigo C, Bellocci F, Schiavello R, Possati G. The immediate life support (ILS) course – The Italian experience. Resuscitation 2007; 72:451-7. [PMID: 17161900 DOI: 10.1016/j.resuscitation.2006.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 07/20/2006] [Accepted: 07/27/2006] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY The 1-day immediate life support course (ILS) was started in the United Kingdom and adopted by the ERC to train healthcare professionals who attend cardiac arrests only occasionally. Currently, there are no reports about the ILS course from outside the UK. In this paper we describe our initial Italian experience of teaching ILS to nurses. We have also measured the impact that ILS has on the resuscitation knowledge of nurses. METHODS The ILS course materials were translated by Italian ALS instructors who had observed the ILS course previously in the UK. From March to November 2005 nurses from a single hospital department attended the Italian ILS course. Candidate feedback was collected using an evaluation form. The change in knowledge of candidates was measured using a pre- and post-course test. Variables associated with candidate performance on course papers were investigated using multivariate linear regression analysis. RESULTS A total of 119 nurses attended nine ILS courses. All candidates completed the course successfully and gave high evaluation scores. ILS produced a significant increase from pre- to post-course score (10.15+/-2.75 to 13.19+/-2.53, p<0.001). The pre-course score was higher for nurses working in ICU compared with those coming from non-intensive wards, but this difference disappeared in the post-course evaluation (13.89+/-2.18 versus 12.79+/-2.65, p=ns). CONCLUSIONS We have reproduced the ILS course in Italy successfully. ILS teaching resulted in an improvement in resuscitation knowledge of the first group of nurses trained.
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Affiliation(s)
- Andrea Scapigliati
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy.
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Rodríguez-Núñez A, López-Herce J, García C, Domínguez P, Carrillo A, Bellón JM. Pediatric defibrillation after cardiac arrest: initial response and outcome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R113. [PMID: 16882339 PMCID: PMC1751019 DOI: 10.1186/cc5005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 07/23/2006] [Accepted: 08/01/2006] [Indexed: 11/10/2022]
Abstract
Introduction Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. Methods Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and one-year survival. Characteristics of patients and of resuscitation were evaluated. Results Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. Conclusion Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.
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Affiliation(s)
- Antonio Rodríguez-Núñez
- Pediatric Emergency and Critical Care Division, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Servicio Galego de Saúde (SERGAS) and University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina García
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Domínguez
- Pediatric Intensive Care Unit, Hospital Infantil Vall d'Hebrón, Barcelona, Spain
| | - Angel Carrillo
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose María Bellón
- Preventive Medicine Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Nurmi J, Skrifvars MB, Rosenberg PH, Castrén M. Increase in rapid defibrillation programmes after publication of guidelines. Int J Qual Health Care 2006; 18:446-51. [PMID: 17062820 DOI: 10.1093/intqhc/mzl056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE . To monitor the implementation of in-hospital resuscitation strategies including (i) rapid defibrillation programmes, (ii) the use of amiodarone for prolonged ventricular fibrillation, and (iii) uniform data collection on resuscitation, all recommended by international guidelines published in 2000 and by Finnish national resuscitation guidelines published in 2002. DESIGN In 2004, a questionnaire was sent to the chief anaesthesiologists. The results were compared with those of a previous study performed using similar methods in 2000. SETTING All public hospitals that provide anaesthetic services in Finland. MAIN OUTCOME MEASURES Number of hospitals allowing nurses to perform defibrillation without the presence of physician and number of hospitals using amiodarone as primary antiarrhythmic drug in resuscitation and performing uniform data collection. RESULTS The response rate was 95% (52/55). The proportion of the hospitals with rapid defibrillation programmes on general wards had increased from 15% in 2000 to 67% in 2004, and most (79%) hospitals had obtained automated external defibrillators. Amiodarone was used in 88% of the hospitals. Data collection of resuscitation attempts using definitions provided in the Utstein guidelines was performed only in 22% of the hospitals. CONCLUSIONS Rapid defibrillation programmes have markedly increased, and the use of amiodarone has been established in Finnish hospitals since the publication of the international and the national resuscitation guidelines.
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Affiliation(s)
- Jouni Nurmi
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
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Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2006; 33:237-45. [PMID: 17019558 DOI: 10.1007/s00134-006-0326-z] [Citation(s) in RCA: 420] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 07/20/2006] [Indexed: 12/31/2022]
Abstract
DESIGN Review. OBJECTIVE Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. RESULTS AND CONCLUSIONS The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
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Affiliation(s)
- Claudio Sandroni
- Intensive Care Unit, Catholic University School of Medicine, Rome, Italy.
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45
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Friedman FD, Dowler K, Link MS. A public access defibrillation programme in non-inpatient hospital areas. Resuscitation 2006; 69:407-11. [PMID: 16563600 DOI: 10.1016/j.resuscitation.2005.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 09/12/2005] [Accepted: 09/12/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Automatic external defibrillators (AED) have proven to be valuable and life saving for out of hospital cardiac arrests. Their use in hospital arrests is less well documented, but they offer the opportunity to improve survival in the hospital setting also. METHODS The implementation of a public access defibrillation (PAD) programme at a tertiary care hospital is described, with reference specifically to targeting areas where time from arrest to arrival of defibrillation would be greater than 3 min. RESULTS Nine AEDs were placed in areas of the hospital distant from inpatient or outpatient floors. The locations of the AEDs were chosen based on a 3 min walk from currently available defibrillators to all areas of the hospital, including parking garages and walkways from building to building. In this programme AED use in non-inpatient hospital locations resulted in the resuscitation of a patient in ventricular fibrillation. CONCLUSION PAD in non-inpatient hospital settings can be life saving and similar programmes should be considered for other hospitals.
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Affiliation(s)
- Franklin D Friedman
- Tufts University School of Medicine, Emergency Physician, Tufts-New England Medical Center, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA.
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Cavalcante TDMC, Lopes RS. O atendimento à parada cardiorrespiratória em unidade coronariana segundo o Protocolo Utstein. ACTA PAUL ENFERM 2006. [DOI: 10.1590/s0103-21002006000100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: registrar os esforços de ressuscitação cardiopulmonar (RCP) conforme o preconizado pelo protocolo de registro de Utstein e apresentar os resultados de acordo com o recomendado pelo mesmo. MÉTODOS: estudo de natureza exploratório-descritiva de 30 esforços ressuscitatórios realizados na Unidade Coronariana do HSP entre Agosto à Dezembro de 2003. RESULTADOS: Dos 30 pacientes estudados 56.66% eram do sexo masculino, com média de idade de 64.5 anos. A modalidade mais freqüente foi a Atividade Elétrica Sem Pulso. Do total de pacientes, treze (43.33%) retornaram a circulação espontânea, porém somente quatro destes mantiveram-se vivos até o término da pesquisa. CONCLUSÃO: Em 90% dos prontuários, os registros apresentavam-se incompletos demonstrando a necessidade de um registro único e sistematizado para RCP, no intuito de melhorar os registros para uma melhor organização do serviço e realização de pesquisas, além de prevenir dispustas éticas e legais.
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Perkins GD, Soar J. In hospital cardiac arrest: missing links in the chain of survival. Resuscitation 2006; 66:253-5. [PMID: 16098654 DOI: 10.1016/j.resuscitation.2005.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2005] [Accepted: 05/18/2005] [Indexed: 10/25/2022]
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Fredriksson M, Aune S, Thorén AB, Herlitz J. In-hospital cardiac arrest--an Utstein style report of seven years experience from the Sahlgrenska University Hospital. Resuscitation 2006; 68:351-8. [PMID: 16458407 DOI: 10.1016/j.resuscitation.2005.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 07/05/2005] [Accepted: 07/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In-hospital cardiac arrest is one of the most stressful situations in modern medicine. Since 1997, there has been a uniform way of reporting - the Utstein guidelines for in-hospital cardiac arrest reporting. MATERIAL AND METHODS We have studied all consecutive cardiac arrest in the Sahlgrenska University Hospital (SU) between 1994 and 2001 for who the rescue team was alerted in all 833 patients. The primary endpoint for this study was survival to discharge. RESULTS Thirty-seven percent survived to hospital discharge. Among patients who were discharged alive, 86% were alive 1 year later. The survivors have a good cerebral outcome (94% among those who were discharged alive had cerebral performance category (CPC) score 1 or 2). The organization at SU is efficient; 80% of the cardiac arrest had CPR within 1 min. Time from cardiac arrest to first defibrillation is a median of 2 min. Almost two-thirds of the patients were admitted for cardiac related diagnoses. CONCLUSION The current study is the largest single-centre study of in hospital cardiac arrest reported according to the Utstein guidelines. We report a high survival for in-hospital cardiac arrest. We have pointed out that a functional chain of survival, short intervals before the start of CPR and defibrillation are probably contributing factors for this.
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Affiliation(s)
- Martin Fredriksson
- Sahlgrenska University Hospital, Department of Cardiology, SE-413 45 Goteborg, Sweden.
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Timsit JF, Paquin S, Pease S, Macrez A, Aim JL, Texeira A, Lefevre G, Scheuble A, Kermarrec N. Évaluation de la mise en place d'une formation continue du personnel de l'hôpital Bichat à la prise en charge des arrêts cardiocirculatoires intrahospitaliers. ACTA ACUST UNITED AC 2006; 25:135-43. [PMID: 16269232 DOI: 10.1016/j.annfar.2005.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 09/19/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Management of in-hospital cardiac arrest is now considered as a hospital quality indicator. Such management actually requires training health care workers (HCWs) for basic life support (BLS). OBJECTIVE To assess the usefulness and efficacy of a short mandatory BLS training course amongst general ward HCWs in a 1,200 bed teaching hospital. STUDY DESIGN The in-hospital medical emergency team (MET) established a 45-min BLS training course comprising 10 goals for basic CPR and preparing for the arrival of the MET. Assessment was based on satisfaction questionnaires, cross-sectional evaluation of knowledge and skills of HCWs before and 1 year after the start of the training course. Efficacy of BLS performed on ward was assessed by the MET on scene. RESULTS One year after, 68 training sessions had been fulfilled and 522 HCWs had been trained (46.27% of total HCWs). HCWs were satisfied with the teaching course. Instant retention of objectives was over 90%. Cross-sectional surveys showed an improvement of BLS knowledge and skills. The knowledge of initial clinical assessment remained low. Knowledge and skills were significantly higher amongst HCWs who had been trained than amongst those who had not. Unfortunately, general ward BLS performance showed no improvement. CONCLUSION Short mandatory training courses are stimulating and well appreciated amongst HCWs. Although basic knowledge and skills improve dramatically, no improvement of on-scene BLS performance occurs.
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Affiliation(s)
- J-F Timsit
- Réanimation médicale, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
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