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Ko RE, Ryu JA, Cho YH, Sung K, Jeon K, Suh GY, Park TK, Lee JM, Song YB, Hahn JY, Choi JH, Choi SH, Gwon HC, Carriere KC, Ahn J, Yang JH. The differential neurologic prognosis of low-flow time according to the initial rhythm in patients who undergo extracorporeal cardiopulmonary resuscitation. Resuscitation 2020; 148:121-127. [DOI: 10.1016/j.resuscitation.2020.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/25/2019] [Accepted: 01/10/2020] [Indexed: 01/12/2023]
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Manzoor N, Minhaj A, Akmal M. Congenital Adrenal Hyperplasia Presenting as Pulseless Ventricular Tachycardia in a Neonate. Cureus 2019; 11:e4749. [PMID: 31363431 PMCID: PMC6663285 DOI: 10.7759/cureus.4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive inherited disorders that arise due to defects in one of the enzymes of steroidogenesis pathway in the adrenal glands. Ninety-five percent of the cases occur due to deficiency in 21-hydroxylase (21-OH). Clinically, CAH due to 21-OH deficiency presents in two distinct forms, classic CAH and non-classic CAH. Females with classical forms present with genial ambiguity while the presentation in males is more subtle with severe electrolyte disturbances being the initial manifestation in many cases. Arrhythmias are a rare manifestation of CAH. We report the case of an 18-day-old male child who presented with pulseless ventricular tachycardia and was later diagnosed with congenital adrenal hyperplasia based on the laboratory findings of elevated 17-hydroxyprogesterone (17-OHP) levels. Our case reveals that fatal arrhythmias such as a pulseless ventricular tachycardia can be the primary manifestation of the adrenal insufficiency of CAH even in the absence of any physical findings and hence clinicians should always maintain a strong suspicion for CAH in any child presenting with unexplained arrhythmia. Furthermore, this case also highlights the need for CAH screening in neonates so that the appropriate hormone replacement can be initiated before the development of life-threatening adrenal crisis.
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Affiliation(s)
- Nida Manzoor
- Pediatrics, Civil Hospital Karachi, Karachi, PAK
| | - Areeba Minhaj
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Manahil Akmal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Parish DC, Goyal H, Dane FC. Mechanism of death: there's more to it than sudden cardiac arrest. J Thorac Dis 2018; 10:3081-3087. [PMID: 29997977 DOI: 10.21037/jtd.2018.04.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David C Parish
- Mercer University School of Medicine, Macon, GA 31201, USA
| | - Hemant Goyal
- Mercer University School of Medicine, Macon, GA 31201, USA
| | - Francis C Dane
- Jefferson College of Health Sciences, Roanoke, VA 24013, USA
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van Gijn MS, Frijns D, van de Glind EMM, C van Munster B, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing 2014; 43:456-63. [PMID: 24760957 DOI: 10.1093/ageing/afu035] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND physicians are frequently confronted with the question whether cardiopulmonary resuscitation (CPR) is a medically appropriate treatment for older people. For physicians, patients and relatives, it is important to know the chance of survival and the functional outcome after CPR in order to make an informed decision. METHODS a systematic search was performed in MEDLINE, Embase and Cochrane up to November 2012. Studies that were included described the chance of survival, the social status and functional outcome after in-hospital CPR in older people aged 70 years and above. RESULTS we identified 11,377 publications of which 29 were included in this review; 38.6% of the patients who were 70 years and older had a return of spontaneous circulation. More than half of the patients who initially survived resuscitation died in the hospital before hospital discharge. The pooled survival to discharge after in-hospital CPR was 18.7% for patients between 70 and 79 years old, 15.4% for patients between 80 and 89 years old and 11.6% for patients of 90 years and older. Data on social and functional outcome after surviving CPR were scarce and contradictory. CONCLUSIONS the chance of survival to hospital discharge for in-hospital CPR in older people is low to moderate (11.6-18.7%) and decreases with age. However, evidence about functional or social outcomes after surviving CPR is scarce. Prospective studies are needed to address this issue and to identify pre-arrest factors that can predict survival in the older people in order to define subgroups that could benefit from CPR.
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Affiliation(s)
- Myke S van Gijn
- Geriatric Medicine, Diakonessenhuis, Prof Lorentzlaan 76, Zeist, Utrecht 3707 HL, Netherlands
| | - Dionne Frijns
- Geriatric Medicine, Diakonessenhuis, Prof Lorentzlaan 76, Zeist, Utrecht 3707 HL, Netherlands
| | - Esther M M van de Glind
- Section of Geriatrics, Internal Medicine, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Barbara C van Munster
- Section of Geriatrics, Internal Medicine, Academic Medical Center, Amsterdam, Noord-Holland, Netherlands
| | - Marije E Hamaker
- Geriatric Medicine, Diakonessenhuis, Prof Lorentzlaan 76, Zeist, Utrecht 3707 HL, Netherlands
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Mehta C, Brady W. Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram. Am J Emerg Med 2012; 30:236-9. [DOI: 10.1016/j.ajem.2010.08.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/11/2010] [Indexed: 01/24/2023] Open
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Shih CL, Lu TC, Jerng JS, Lin CC, Liu YP, Chen WJ, Lin FY. A web-based Utstein style registry system of in-hospital cardiopulmonary resuscitation in Taiwan. Resuscitation 2007; 72:394-403. [PMID: 17161519 DOI: 10.1016/j.resuscitation.2006.07.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Revised: 07/19/2006] [Accepted: 07/20/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE STUDY The Web-Based Registry System on In-hospital Resuscitation (WRSIR) is the first prospective, web-based, multi-site, and Utstein-based reporting system in Taiwan. This study was conducted to evaluate the feasibility of the system in one of the participating hospitals and identify prognostic factors associated with survival. MATERIAL AND METHODS The WRSIR is an on-line registry system coded with the active server page (ASP) programming method. Information was gathered and entered on-line by trained staff using spreadsheets that could be automatically created according to the updated Utstein in-hospital template. Through the implementation of the system, in a tertiary teaching hospital we evaluated all adults with in-hospital cardiac arrest receiving cardiopulmonary resuscitation between 1 October 2004 and 30 September 2005. The main outcome measures were return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category score at the time of discharge. Logistic regression analysis was performed to determine independent predictors of survival. RESULTS A total of 330 cases experienced in-hospital resuscitation. ROSC occurred in 233 cases (71%) and 61 patients (18%) survived to hospital discharge. Thirty-five patients (58%) had a good neurological outcome with the cerebral performance category (CPC) score of 1 or 2 among survivors. The major predictor of ROSC was initial rhythm of VT/VF (adjusted OR 0.36, 95% CI 0.16-0.78). CONCLUSION This study examined the feasibility of a web-based registry system on in-hospital resuscitation using the Utstein style in an oriental country. It provides a comprehensive and standardised method for on-line registry of data collection, allowing individual hospitals to track each case for quality improvement. A further nationwide registry will enforce the possibility of data analysis and future perspective research of in-hospital resuscitation.
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Affiliation(s)
- Chung-Liang Shih
- Department of Emergency Medicine, National Taiwan University Hospital, Taiwan
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Jones-Crawford JL, Parish DC, Smith BE, Dane FC. Resuscitation in the hospital: circadian variation of cardiopulmonary arrest. Am J Med 2007; 120:158-64. [PMID: 17275457 DOI: 10.1016/j.amjmed.2006.06.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 05/26/2006] [Accepted: 06/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in cardiopulmonary arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge. METHODS A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented. RESULTS Significant circadian variation was found at 1 hour (P=.01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P=.03) and asystole (P=.01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P=.002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P=.003 and P <.0001). In multivariate analysis, only rhythm remained significant. CONCLUSIONS Circadian variation of cardiopulmonary arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.
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Affiliation(s)
- Jennifer L Jones-Crawford
- Department of Internal Medicine, Mercer University School of Medicine/Medical Center of Central Georgia, Macon, Ga, USA
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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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Einav S, Weissman C, Kark J, Lotan C, Matot I. Future shock: automatic external defibrillators. Curr Opin Anaesthesiol 2006; 18:175-80. [PMID: 16534335 DOI: 10.1097/01.aco.0000162837.79215.a7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW This review provides a practical overview of the performance capabilities of automatic external defibrillators (AEDs), and of advances in technology and dissemination programmes for these devices. RECENT FINDINGS Arrhythmia analysis by AEDs is extremely reliable in most settings (sensitivity 81-100%, specificity 99.9-97.6%). Accurate detection of arrhythmias has also been demonstrated in children, leading the US Food and Drug Administration to approve the use of several AEDs in children aged 8 years or younger. Factors that potentially may reduce the quality of arrhythmia detection are the presence of wide complex supraventricular tachycardia and location of an arrythmic event near to high-power lines. AED use by professional basic life support providers resulted in increased survival in the prehospital setting. However, provision of AEDs to nonmedical rescue services did not result in universal improvement in patient outcome. Public access defibrillation programmes have led to higher rates of survival from cardiac arrest. The role of AEDs in hospitals has yet to be elucidated, although in-hospital mortality from ventricular arrhythmias has been shown to decrease following AED deployment. SUMMARY Given the correct setting, AEDs can ensure that defibrillation is not limited by lack of medical knowledge or difficulties in decision making. However, event-related variables and operator-related factors, that are yet to be determined, can significantly affect the efficacy of automatic external defibrillation.
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Affiliation(s)
- Sharon Einav
- Department of Anaesthesiology and Critical Care Medicine, School of Public Health and Community Medicine, Hadassah Hebrew University Medical Centre, Ein-Kerem, Jerusalem, Israel
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Einav S, Shleifer A, Kark JD, Landesberg G, Matot I. Performance of department staff in the window between discovery of collapse to cardiac arrest team arrival. Resuscitation 2006; 69:213-20. [PMID: 16563596 DOI: 10.1016/j.resuscitation.2005.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 09/13/2005] [Accepted: 09/14/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Guideline-directed therapy during the first minutes of resuscitation may be life saving. This study assessed the performance of American Heart Association (AHA) guidelines by trained departmental staff in the period between discovery of collapse and emergency team arrival. METHODS Over a period of 24 months, departmental performance prior to the arrival of the emergency team (median 180 s) was assessed by debriefings conducted within 24h of each event in a 740-bed tertiary hospital with a dedicated certified resuscitation team. Outcome measures were failure to meet AHA treatment recommendations (primary) and return of spontaneous circulation (ROSC)/survival to hospital discharge (secondary). RESULTS Two hundred and forty four events were included (216 patients). Mean age was 69+/-17 years; 45% were women. The underlying causes of collapse were mainly cardiac (39%) or respiratory (32%). Residents conducted most of the resuscitations (69%) prior to the arrival of the emergency team. Basic diagnostic measures such as assessments of pulse and rhythm were not performed in 19 and 33% of events. Therapeutic measures such as positive pressure ventilation, chest compressions and defibrillation were not provided according to the guidelines in 17, 12 and 44% of the events. ROSC occurred in 62% of events; 54% of VF/VT, 30% of asystole, 22% of PEA and 76% of bradyarrhythmias/severe bradycardias. Survival to hospital discharge was 37% overall and 41% for patients found in VF/VT (n=33). CONCLUSIONS Trained departmental staff performed poorly in the moments between patient discovery and arrival of the emergency team. Since patient outcomes were comparable to those described in the literature, poor resuscitation performance may be commonplace in hospitals where ward personnel are expected to deliver advanced life support prior to arrival of the emergency team.
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Affiliation(s)
- Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Centre, P.O. Box 3235, Jerusalem 91031, Israel.
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Fang X, Tang W, Sun S, Wang J, Huang L, Weil MH. The characteristics of postcountershock pulseless electrical activity may indicate the outcome of CPR. Resuscitation 2006; 69:303-9. [PMID: 16459008 DOI: 10.1016/j.resuscitation.2005.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 07/17/2005] [Accepted: 07/17/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES When ventricular fibrillation is cardioverted to pulseless electrical activity (PEA), PEA has been regarded as a non-resuscitatable rhythm. Yet, recent reports and our earlier observations suggested otherwise. We therefore investigated outcomes after postcountershock PEA, and aimed to develop a scoring system for outcome classification at the onset of initial postcountershock PEA. METHODS Data from 215 domestic pigs were retrospectively reviewed. VF was induced and untreated for 7 min. Defibrillation was attempted with up to three 150 J biphasic shocks. Failing to restore spontaneous circulation (ROSC), 1 min of CPR preceded subsequent sequences of shocks until animals were resuscitated or for a total of 15 min. Fifty-nine instances of PEA followed defibrillation, including 29 animals that attained ROSC. RESULTS ROSC animals required a shorter interval between the first shock and the initial postcountershock PEA, fewer shocks prior to onset of initial postcountershock PEA, demonstrated a greater VF wavelet amplitude prior to onset of initial PEA, smaller QRS intervals, and higher heart rates. Using Fisher's linear discriminant analysis, 79.3% of the ROSC and 63.3% of non-ROSC cases were predicted correctly. A total of 71.2% of all cases were classified correctly. CONCLUSIONS Animals in which postcountershock PEA was converted to ROSC required shorter intervals from first shock to initial postcountershock PEA, fewer shocks prior to onset of initial postcountershock PEA, had greater VF wavelet amplitude prior to initial postcountershock PEA, small QRS intervals, and higher heart rates. Fisher's discriminant analysis is helpful in predicting the likelihood of ROSC for an individual animal presenting with postcountershock PEA.
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Affiliation(s)
- Xiangshao Fang
- Weil Institute of Critical Care Medicine, 35100 Bob Hope Drive, Rancho Mirage, CA, USA
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López-Herce J, García C, Domínguez P, Carrillo A, Rodríguez-Núñez A, Calvo C, Delgado MA. Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 2005; 63:311-20. [PMID: 15582767 DOI: 10.1016/j.resuscitation.2004.06.008] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 05/31/2004] [Accepted: 06/11/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. DESIGN An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children. PATIENTS AND METHODS Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P <0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59-23.32). CONCLUSIONS In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.
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López-Herce J, García C, Rodríguez-Núñez A, Domínguez P, Carrillo A, Calvo C, Delgado MA. Long-term outcome of paediatric cardiorespiratory arrest in Spain. Resuscitation 2005; 64:79-85. [PMID: 15629559 DOI: 10.1016/j.resuscitation.2004.07.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Revised: 06/23/2004] [Accepted: 07/12/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the final outcome of cardiorespiratory arrest (CRA) in children and the neurological and functional state of survivors at 1 year. METHODS An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital CRA in children was carried out; 283 children between 7 days and 17 years of age were included. CRA and resuscitation data were registered according to Utstein style. The outcome variables were: sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). The status of survivors was evaluated by means of the paediatric cerebral performance category (PCPC) scale and the paediatric overall performance category (POPC) scale at Paediatric Intensive Care Unit discharge, at hospital discharge, and at 1 year follow-up. RESULTS In 283 children, 311 CRA episodes, 73 respiratory arrests (23.5%) and 238 cardiac arrests (76.5%) were analysed. Seventeen children suffered more than one CRA episode (range: 2-6). The initial survival was 60.2% and 1-year survival was 33.2%. The final survival was significantly higher in respiratory arrest than in cardiac arrest patients (70.0% versus 21.1%) (P < 0.0001). After 1 year follow-up, 87.3% of patients had scores 1 or 2 on the PCPC scale and 84.0% had scores 1 or 2 in the POPC scale; these results indicate that 1 year after CRA, the majority of survivors had normal neurological and functional status or showed only mild disability. CONCLUSIONS Prognosis of CRA in children continues to be poor in terms of survival but quite good in terms of neurological and functional status among survivors. Additional strategies and efforts are needed to improve the short-term prognosis of paediatric CRA. However, the long-term outcome of survivors is reassuring.
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Affiliation(s)
- Jesús López-Herce
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Parish DC, Dinesh Chandra KM, Dane FC. Success changes the problem: why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it. Resuscitation 2003; 58:31-5. [PMID: 12867307 DOI: 10.1016/s0300-9572(03)00104-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Programs for research and practice in resuscitation have focused on identification and reversal of ventricular fibrillation (VF). While substantial progress has been achieved, evidence is accumulating that clinical death is less likely to be caused by fibrillation now than in the 1960s and 1970s. Pulseless electrical activity (PEA) has emerged as the most common rhythm found in arrests in the hospital and is rapidly rising in pre-hospital reports. PURPOSE To identify the magnitude of changes occurring, search for potential explanations from population and clinical epidemiology and present the data available regarding etiology and treatment of PEA. DATA SOURCES Synthesis of material from population epidemiology, clinical epidemiology, animal and human research on VF and PEA. CONCLUSIONS VF is a manifestation of severe, undiagnosed coronary artery disease (CAD). Rates of death from CAD increased from rare in 1930 to become the most common cause of death in the US. CAD death rates peaked in the early 1960s and had declined over 50% by the late 1990s. Primary and secondary prevention, early diagnosis and aggressive, successful treatment have contributed to this decline. PEA is a brief phase in clinical death that occurs after losses in consciousness, ventilatory drive and circulation but before decay to asystole; survival rates are poor. PEA is a common stage in clinical death from any of a variety of tissue hypoxic/anoxic insults. Research on PEA is needed; 50 years of attention to CAD and VF have resulted in improved survival and changed the disease spectrum. Similar attention to animal and clinical research on PEA may have the potential to improve survival.
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Affiliation(s)
- David C Parish
- Department of Internal Medicine, The Medical Center of Central Georgia, 707 Pine Street, Macon, GA, USA.
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Huang CH, Chen WJ, Ma MHM, Chang WT, Lai CL, Lee YT. Factors influencing the outcomes after in-hospital resuscitation in Taiwan. Resuscitation 2002; 53:265-70. [PMID: 12062841 DOI: 10.1016/s0300-9572(02)00024-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. MATERIALS AND METHODS We studied the in-hospital resuscitation events in a tertiary medical center in Taipei city, Taiwan. All events and variables were recorded using the Utstein style for in-hospital resuscitation. We measured the influence of patients and event variables on the outcomes of return of spontaneous circulation (ROSC) and survival to discharge. RESULTS The rate of establishing a ROSC was 67% and the rate of survival to discharge was 17% in the studied population. The 1-year survival rate was 3.9%. Only 17% of the patients resuscitated had coronary artery disease. VT/VF was the initial rhythm in only 13.6% patients. Nearly half (49%) of the resuscitation attempts took place in emergency department (ED). Patients who were already intubated or had received mechanical ventilation before resuscitation had reduced chances of achieving ROSC. (P<0.05). Favorable prognostic factors of survival to discharge were shorter time intervals from patient collapse to arrival of the resuscitation team (69 vs. 154 s, P<0.05) and to confirmation of arrest (93 vs. 217 s, P<0.05). CONCLUSION Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.
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Affiliation(s)
- Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan
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Herlitz J, Bång A, Alsén B, Aune S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation 2002; 53:127-33. [PMID: 12009216 DOI: 10.1016/s0300-9572(02)00014-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.
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Affiliation(s)
- Johan Herlitz
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, SE, Sweden.
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Affiliation(s)
- A P Clark
- University of Texas at Austin School of Nursing, 78701, USA.
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Leonard R. Patch4 the flowing dam. Acad Emerg Med 2001; 8:299. [PMID: 11229959 DOI: 10.1111/j.1553-2712.2001.tb01313.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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