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Chu SE, Huang CY, Cheng CY, Chan CH, Chen HA, Chang CH, Tsai KC, Chiu KM, Ma MHM, Chiang WC, Sun JT. Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study. Crit Care Med 2024:00003246-990000000-00336. [PMID: 38780398 DOI: 10.1097/ccm.0000000000006336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at "the center of the chest," ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA. DESIGN Prospective observational cohort study. SETTING Single center. PATIENTS This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co2 (Etco2) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Etco2, post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups. CONCLUSIONS Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.
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Affiliation(s)
- Sheng-En Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chiao-Yin Cheng
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiang Chan
- Department of Geography, National Taiwan Normal University, Taipei, Taiwan
| | - Hsuan-An Chen
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chin-Ho Chang
- Statistical Consulting Unit, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuang-Chau Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Jenten Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
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Outcomes of Out-of-hospital Cardiac Arrests After a Decade of System-wide Initiatives Optimising Community Chain of Survival in Taipei City. Resuscitation 2021; 172:149-158. [PMID: 34971722 DOI: 10.1016/j.resuscitation.2021.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/02/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A strengthened chain of survival benefits patient outcomes after out-of-hospital cardiac arrest (OHCA).2 Over the past decade, the Taipei Fire Department (TFD) has continuously implemented system-wide initiatives on this issue.We hypothesised that for adult, non-trauma OHCA patients, the bundle of these system-wide initiatives are associated with better outcomes. METHODS We conducted a registry-based, retrospective study to examine the association between consecutive system-level initiatives and OHCA survival on a two-yearly basis using trend analysis and multivariable logistic regression. The primary outcome was survival to hospital discharge (STHD) and favourable neurological status. RESULTS We analysed 18,076 cases from 2008 to 2017. The numbers of two-yearly cases of OHCA with resuscitation attempts from 2008 to 2017 were 3,576, 3,456, 3,822, 3,811, and 3,411. There was a significant trend of improved STHD (Two-fold) and favourable neurological outcome (Six-fold) over the past decade. Similar trends were observed in the shockable and non-shockable groups. Considering the first 2 years as baseline, the odds of STHD and favourable neurological status in the end of the initiatives increased significantly after adjusting for universally recognised predictors for OHCA survival. CONCLUSION For non-trauma adult OHCA in Taipei, continuous, multifaceted system-wide initiatives on the community chain of survival were associated with improved odds of STHD and favourable neurologic outcomes.
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Mould‐Millman N, Dixon J, Lee M, Meese H, Mata LV, Burkholder T, Moreira F, Bester B, Thomas J, de Vries S, Wallis LA, Ginde AA. Measuring quality of pre-hospital traumatic shock care-development and validation of an instrument for resource-limited settings. Health Sci Rep 2021; 4:e422. [PMID: 34693030 PMCID: PMC8516037 DOI: 10.1002/hsr2.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Improving the quality of pre-hospital traumatic shock care, especially in low- and middle-income countries, is particularly relevant to reducing the large global burden of disease from injury. What clinical interventions represent high-quality care is an actively evolving field and often dependent on the specific injury pattern. A key component of improving the quality of care is having a consistent way to assess and measure the quality of shock care in the pre-hospital setting. The objective of this study was to develop and validate a chart abstraction instrument to measure the quality of trauma care in a resource-limited, pre-hospital emergency care setting. METHODS Traumatic shock was selected as the tracer condition. The pre-hospital quality of traumatic shock care (QTSC) instrument was developed and validated in three phases. A content development phase utilized a rapid literature review and expert consensus to yield the contents of the draft instrument. In the instrument validation phase, the QTSC instrument was created and underwent end user and content validation. A pilot-testing phase collected user feedback and performance characteristics to iteratively refine draft versions into a final instrument. Accuracy and inter- and intra-rater agreement were calculated. RESULTS The final QTSC instrument contains 10 domains of quality, each with specific criteria that determine how the domain is measured and the level of quality of care rendered. The instrument is over 90% accurate and has good inter- and intra-rater reliability when used by trained pre-hospital provider users in South Africa. Pre-hospital provider user feedback indicates the tool is easy to learn and quick to use. CONCLUSION We created and validated a novel chart abstraction instrument that can reliably and accurately measure the quality of pre-hospital traumatic shock care. We provide a systematic methodology for developing and validating a quality of care tool for resource-limited care settings.
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Affiliation(s)
- Nee‐Kofi Mould‐Millman
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Julia Dixon
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Michael Lee
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Halea Meese
- Department of Family and Community MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Lina V. Mata
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern California, Keck School of MedicineCaliforniaLos AngelesUSA
| | - Fabio Moreira
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Beatrix Bester
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)University of Colorado DenverAuroraColoradoUSA
| | - Shaheem de Vries
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Lee A. Wallis
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
- Division of Emergency Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Adit A. Ginde
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
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Mitchell RD, O'Reilly GM, Phillips GA, Sale T, Roy N. Developing a research question: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S109-S114. [PMID: 33304792 PMCID: PMC7718466 DOI: 10.1016/j.afjem.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
As demand for emergency care (EC) systems in low- and middle-income countries (LMICs) grows, there is an urgent need to expand the evidence base for clinical and systems interventions in resource limited EC settings. Clinicians are well placed to identify, define and address unanswered research questions using both quantitative and qualitative approaches. This paper summarises established research priorities for global EC and provides a step-wise approach to developing a research question. Research priorities for global EC broadly fall into two categories: systems-based research and research with a clinical care focus. Systems research is integral to understanding the essential components of safe and effective EC delivery, while clinical research aims to answer questions related to particular disease states, presentations or population groups. Developing a specific research question requires an enquiring, questioning and critical approach to EC delivery. In quantitative research, use of the PECO formula (Population, Exposure, Comparator, Outcome) can help frame a research question. Qualitative research, which aims to understand, explore and examine, often requires application of a theoretical framework. Writing a brief purpose statement can be a helpful tool to clarify the objectives of a qualitative study. This paper includes lists of tips, pitfalls and resources to assist EC clinical researchers in developing research questions. Application of these tools and frameworks will assist EC clinicians in resource limited settings to perform impactful research and improve outcomes for patients with acute illness and injury.
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Affiliation(s)
- Rob D. Mitchell
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author. @robdmitchell
| | - Gerard M. O'Reilly
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Georgina A. Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital, Melbourne, Australia
| | - Trina Sale
- National Referral Hospital, Honiara, Solomon Islands
| | - Nobhojit Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Dept of Surgery, BARC Hospital (Govt. of India), Mumbai, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Jentzer JC, Herrmann J, Prasad A, Barsness GW, Bell MR. Utility and Challenges of an Early Invasive Strategy in Patients Resuscitated From Out-of-Hospital Cardiac Arrest. JACC Cardiovasc Interv 2020; 12:697-708. [PMID: 31000007 DOI: 10.1016/j.jcin.2019.01.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/16/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is frequently triggered by acute myocardial ischemia. Coronary angiography is an important component of post-resuscitation care for patients with OHCA without an evident noncardiac cause, to identify underlying coronary artery disease and allow revascularization. Most patients undergoing coronary angiography after OHCA have obstructive coronary artery disease, and nearly one-half of patients have acute coronary occlusion. Early coronary angiography and percutaneous coronary intervention after OHCA have been associated with improved survival in observational studies, but these studies demonstrate selection bias, and randomized trials are lacking. Selection of patients for coronary angiography after OHCA can be challenging, particularly in comatose patients whose outcomes are driven primarily by anoxic brain injury. As for other patients with acute coronary syndromes, patients with ST-segment elevation after OHCA have a high probability of acute coronary occlusion warranting emergent coronary angiography. Patients with cardiogenic shock after OHCA are a high-risk population also requiring emergent coronary angiography. Among patients in stable condition after OHCA without ST-segment elevation, other clinical predictors can be used to identify those needing early coronary angiography to identify obstructive coronary artery disease. Despite the challenges with early neurological prognostication in comatose patients with OHCA, those with multiple objective markers of poor prognosis appear less likely to benefit from revascularization, and early coronary angiography may be reasonably deferred in appropriately selected patients meeting these criteria. The authors propose an algorithm to guide patient selection for coronary angiography after OHCA that combines clinical predictors of acute coronary occlusion and early clinical predictors of severe brain injury.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
The objective of this study is to describe the epidemiology and causes of traumatic cardiac arrest (TCA) in Kuwait aiming to provide a preliminary background to update the current guidelines and improve patients' management.This is a retrospective analysis of TCA cases retrieved from emergency medical services archived data between 1 January and 31 December 2017. The TCA cases were sub-grouped based on mechanism of injury then compared in terms of patient demographics, vital signs, patterns of injuries, resuscitation practices, and outcomes.Outcomes; On scene mortality rate and pre-hospital return of spontaneous circulation.Among the 204 TCA patients, 140 patients met the inclusion criteria. This whole group was then divided in to 4 subgroups: road traffic accident (RTA) 76% (n=106), fall from height (FFH) 13% (n = 18), slip/fall 4% (n = 6), and assaults 7% (n = 10). There was significant difference between the four mechanisms in: mean age (P = < .001), type of injury (P = .005), head injury (P = .005), chest injury (P = .003), GCS score < 9 (P = .004) and initial hypertension (P = < .001). Initial hypertension and GCS score < 9 were only documented in head injuries of RTA and slip/fall groups. Significant difference was also seen in cardiopulmonary resuscitation (P = .006), airway management (P = .035) and on scene mortality rate (P = .003). All patients who had isolated head injury in FFH were pronounced dead on scene, 60%.Not all TCA incidents are the same, there are different pattern of injuries in each TCA mechanism. Head injuries are predominantly seen in RTA, FFH, slip /falls and chest injuries are seen in assaults. This can influence emergency medical services personals resuscitation plan. Further research is required to address the resuscitation of TCA of different mechanisms.
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Affiliation(s)
- Dalal Alhasan
- Department of Applied Medical Sciences, Public Authority of Applied Education and Training, Health Sciences College
| | - Ameen Yaseen
- Audit Department, Emergency Medicals Services, State of Kuwait
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Pigoga JL, Joiner AP, Chowa P, Luong J, Mhlanga M, Reynolds TA, Wallis LA. Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool. BMC Emerg Med 2020; 20:33. [PMID: 32375637 PMCID: PMC7201969 DOI: 10.1186/s12873-020-00327-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. METHODS We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. RESULTS All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). CONCLUSIONS The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.
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Affiliation(s)
- J L Pigoga
- Division of Emergency Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa.
| | - A P Joiner
- Division of Emergency Medicine, Duke University, Durham, North Carolina, USA
| | - P Chowa
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - J Luong
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - M Mhlanga
- Emergency Preparedness and Response, Eswatini Ministry of Health, Mbabane, Eswatini
| | - T A Reynolds
- Department for Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - L A Wallis
- Division of Emergency Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa
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Molyneux EM. Cardiopulmonary resuscitation in poorly resourced settings: better to pre-empt than to wait until it is too late. Paediatr Int Child Health 2020; 40:1-6. [PMID: 31116094 DOI: 10.1080/20469047.2019.1616150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E M Molyneux
- College of Medicine, University of Malawi, Blantyre, Malawi,
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Nadarajan G, Tiah L, Ho A, Azazh A, Castren M, Chong S, El Sayed M, Hara T, Leong B, Lippert F, Ma M, Ng Y, Ohn H, Overton J, Pek P, Perret S, Wallis L, Wong K, Ong M. Global resuscitation alliance utstein recommendations for developing emergency care systems to improve cardiac arrest survival. Resuscitation 2018; 132:85-89. [DOI: 10.1016/j.resuscitation.2018.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/26/2022]
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Bak MAR, Blom MT, Tan HL, Willems DL. Ethical aspects of sudden cardiac arrest research using observational data: a narrative review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:212. [PMID: 30208954 PMCID: PMC6136218 DOI: 10.1186/s13054-018-2153-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/07/2018] [Indexed: 01/13/2023]
Abstract
Sudden cardiac arrest (SCA) accounts for half of all cardiac deaths in Europe. In recent years, large-scale SCA registries have been set up to enable observational studies into risk factors and the effect of treatment approaches. The increasing scale and variety of data sources, coupled with the implementation of a new European data protection legal framework, causes researchers to struggle with how to handle these ‘big data’. Data protection in the SCA setting is especially complex since patients become at least temporarily incapacitated, and are thus unable to provide prospective informed consent, and because the majority of patients do not survive. A narrative review employing a systematic literature search was conducted to thematically analyse ethical aspects of non-interventional emergency medicine and critical care research. Although the identified issues may apply to a wider patient population, we describe them within the context of SCA research. Potential harms were found to include: privacy breaches, genetic discrimination and issues associated with the disclosure of individual findings, study design and application of research results. Measures proposed to mitigate harms were: alternative informed consent models including deferred or waived consent and data governance approaches promoting data security, responsible sharing and public engagement. The themes identified in this study may serve as a basis for a much-needed ethical framework regarding research with data from patients with acute and critical illness such as SCA.
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Affiliation(s)
- Marieke A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Anderson CR, Taira BR. The train the trainer model for the propagation of resuscitation knowledge in limited resource settings: A systematic review. Resuscitation 2018; 127:1-7. [PMID: 29545135 DOI: 10.1016/j.resuscitation.2018.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Train the Trainer (TTT) model is increasingly used in limited resource settings as a mechanism to disseminate resuscitation knowledge and skills among providers. Anecdotally, however, many resuscitation programs that use this model fail to achieve sustainability. OBJECTIVE We aim to systematically review the literature to describe the evidence for the TTT method of knowledge dissemination for resuscitation courses in limited resource settings. METHODS We conducted a systematic review of the literature in accordance with PRISMA guidelines of the PubMed, Cochrane Library, MEDLARS online (MEDLINE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Eleven manuscripts met inclusion criteria, the majority (7/11) focused on neonatal resuscitation. We found strong evidence for the TTT model for imparting knowledge and skills on providers, however, little evidence exists for the impact of these programs on patient outcomes or long term sustainability. Facilitators associated with successful programming include the use of language and resource appropriate materials, support from the Ministry of Health of the country, and economic support for supplies and salaries. CONCLUSION While the TTT model of programming for the dissemination of resuscitation education is promising, further research is necessary especially relating to sustainability and impact on patient outcomes. Familiarity with the local environment, language, culture, resources and economic realities prior to the initiation of programming is key to success.
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Affiliation(s)
- Chance R Anderson
- University of California, Davis School of Medicine, Davis, CA, United States
| | - Breena R Taira
- Olive View-UCLA Medical Center, Department of Emergency Medicine, Sylmar, CA, United States.
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Veronese JP, Wallis L, Allgaier R, Botha R. Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance. Afr J Emerg Med 2018; 8:6-11. [PMID: 30456138 PMCID: PMC6223582 DOI: 10.1016/j.afjem.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/10/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Survival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting. METHODS A descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills. RESULTS Overall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training. CONCLUSION Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.
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Affiliation(s)
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - Rachel Allgaier
- Division of Emergency Medicine, Stellenbosch University, South Africa
| | - Ryan Botha
- Faculty of Science, University of Fort Hare, South Africa
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Polderman K, Malinoski D, Timerman S, Keeble T. Current Advances in the Use of Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2018; 8:9-13. [PMID: 29356614 DOI: 10.1089/ther.2017.29040.khp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kees Polderman
- 1 Department of Critical Care, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Darren Malinoski
- 2 Department of Surgery, Oregon Health & Science University , Portland, Oregon
| | - Sergio Timerman
- 3 Medicine and Health Sciences, Laureate International Universities , Sao Paulo, Brazil
| | - Thomas Keeble
- 4 Essex Cardiothoracic Centre, Anglia Ruskin University , Cambridge, United Kingdom
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Low CT, Lai PC, Yeung PSS, Siu AYC, Leung KTY, Wong PPY. Temperature and age–gender effects on out-of-hospital cardiac arrest cases. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907917751301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Temperature is a key factor influencing the occurrence of out-of-hospital cardiac arrest, yet there is no equivalent study in Hong Kong. This study reports results involving a large-scale territory-wide investigation on the impacts of ambient temperature and age–gender differences on out-of-hospital cardiac arrest outcome in Hong Kong. Methods: This study included 25,467 out-of-hospital cardiac arrest cases treated by the Hong Kong Fire Services Department between December 2011 and November 2016 inclusive. Simple correlation and regression analyses were used to examine the relationships between out-of-hospital cardiac arrest cases and temperature, age and gender. Calendar charts were used to visualise temporal patterns of pre-hospital emergency medical services related to out-of-hospital cardiac arrest cases. Results: A strong negative curvilinear relationship was found between out-of-hospital cardiac arrest and daily temperature (r2 > 0.9) with prominent effects on elderly people aged ≥85 years. For each unit decrease in mean temperature in °C, there was a maximum of 5.6% increase in out-of-hospital cardiac arrest cases among all age groups and 7.3% increase in the ≥85 years elderly age group. Men were slightly more at risk of out-of-hospital cardiac arrest compared with women. The demand for out-of-hospital cardiac arrest–related emergency medical services was highest between 06:00 and 11:00 in the wintertime. Conclusion: This study provides the first local evidence linking weather and demographic effects with out-of-hospital cardiac arrest in Hong Kong. It offers empirical evidence to policymakers in support of strengthening existing emergency medical services to deal with the expected increase in out-of-hospital cardiac arrest in the wintertime and in regions with a large number of elderly population.
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Affiliation(s)
- Chien Tat Low
- Department of Geography, The University of Hong Kong, Hong Kong
| | - Poh Chin Lai
- Department of Geography, The University of Hong Kong, Hong Kong
| | | | | | | | - Paulina Pui Yun Wong
- Department of Geography, The University of Hong Kong, Hong Kong
- Science Unit, Lingnan University, Hong Kong
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Kim SC, Ro YS, Shin SD, Wi DH, Jeong J, Park JO, Sun KM, Bae K. Assessment of Competence in Emergency Medicine among Healthcare Professionals in Cameroon. J Korean Med Sci 2017; 32:1931-1937. [PMID: 29115073 PMCID: PMC5680490 DOI: 10.3346/jkms.2017.32.12.1931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/10/2017] [Indexed: 11/20/2022] Open
Abstract
Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, -0.02; 95% confidence interval, -0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.
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Affiliation(s)
- Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Han Wi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | | | - Ju Ok Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyong Min Sun
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwangsoo Bae
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Andong Hospital, Andong, Korea
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Zha Y, Ariyo M, Olaniran O, Ariyo P, Lyon C, Kalu Q, Latif A, Edmond B, Sampson JB. Cardiopulmonary Resuscitation Capacity in Referral Hospitals in Nigeria: Understanding the Global Health Disparity in Resuscitation Medicine. J Natl Med Assoc 2017; 110:407-413. [PMID: 30126569 DOI: 10.1016/j.jnma.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Little is known about the state of resuscitation services in low- and middle-income countries (LMICs), including Nigeria, Africa's most populous country. We sought to assess the cardiopulmonary resuscitation (CPR) care in referral hospitals across Nigeria to better inform capacity-building initiatives. METHODS We designed a survey to evaluate infrastructure, equipment, personnel, training, and clinical management, as no standardized instrument for assessing resuscitation in LMICs was available. We included referral teaching hospitals with a functioning intensive care unit (ICU) and a department of anaesthesiology. We pilot-tested our tool at four hospitals in Nigeria and recruited participants electronically via the Nigerian Society of Anaesthetists directory. RESULTS Our survey included 17 hospitals (82% public, 12% private, 6% public-private partnership), although some questions include only a subset of these. We found that 20% (3 out of 15) of hospitals had a cardiac arrest response team system, 21% (3/14) documented CPR events, and 21% (3/14) reviewed such events for education and quality improvement. Most basic supplies were sufficient in the ICU (100% [15/15] availability of defibrillators, 94% [16/17] of adrenaline) but were less available in other departments. While 67% [10/15] of hospitals had a resuscitation training program, only 27% [4/15] had at least half their physicians trained in basic life support. CONCLUSION In this first large-scale assessment of resuscitation care in Nigeria, we found progress in training centre development and supply availability, but a paucity of cardiac arrest response team systems. Our data indicate a need for improved capacity development, especially in documentation and continuous quality improvement, both of which are low-cost solutions.
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Affiliation(s)
- Yuanting Zha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; University of California Irvine School of Medicine, Irvine, CA, USA
| | - Mojisola Ariyo
- Babcock University, Ben Carson Sr. School of Medicine, Ilishan-Remo, Ogun, Nigeria; Emory University School of Medicine, Atlanta, GA, USA
| | - Olabiyi Olaniran
- Babcock University, Ben Carson Sr. School of Medicine, Ilishan-Remo, Ogun, Nigeria
| | - Promise Ariyo
- Johns Hopkins University, Department of Anesthesiology & Critical Care, Baltimore, MD, USA
| | - Camila Lyon
- Vanderbilt University, Department of Anesthesiology, Nashville, TN, USA
| | - Queeneth Kalu
- University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Asad Latif
- Johns Hopkins University, Department of Anesthesiology & Critical Care, Baltimore, MD, USA
| | - Byron Edmond
- Walter Reed National Medical Center, Bethesda, MD, USA
| | - John B Sampson
- Johns Hopkins University, Department of Anesthesiology & Critical Care, Baltimore, MD, USA.
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Becker TK, Tafoya CA, Osei-Ampofo M, Tafoya MJ, Kessler RA, Theyyunni N, Yakubu HA, Opuni D, Clauw DJ, Cranford JA, Oppong CK, Oteng RA. Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resource-limited setting: the AFRICA trial. Trop Med Int Health 2017; 22:1599-1608. [PMID: 29072885 DOI: 10.1111/tmi.12992] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting. METHODS Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the CPUS training. The physician's initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added CPUS examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patient's care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24-h mortality and use of IV fluids, diuretics, vasopressors and bronchodilators. RESULTS Of 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the CPUS examination (71.9% vs. 57.1%, Δ 14.8% [CI 0.5%, 28.4%]). This effect was particularly pronounced for patients with a 'cardiac' diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% vs. 40.0%, Δ 54.7% [CI 8.9%, 86.4%]). Secondary outcomes were not different between groups. CONCLUSIONS In an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24-h mortality and a number of patient care interventions.
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Affiliation(s)
- Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Chelsea A Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, CA, USA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Matthew J Tafoya
- Department of Emergency Medicine, Highland Hospital, Oakland, CA, USA
| | - Ross A Kessler
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nikhil Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hussein A Yakubu
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel Opuni
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Daniel J Clauw
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - James A Cranford
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Chris K Oppong
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rockefeller A Oteng
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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Myers JG, Hunold KM, Ekernas K, Wangara A, Maingi A, Mutiso V, Dunlop S, Martin IBK. Patient characteristics of the Accident and Emergency Department of Kenyatta National Hospital, Nairobi, Kenya: a cross-sectional, prospective analysis. BMJ Open 2017; 7:e014974. [PMID: 29025826 PMCID: PMC5652550 DOI: 10.1136/bmjopen-2016-014974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Resource-limited settings are increasingly experiencing a 'triple burden' of disease, composed of trauma, non-communicable diseases (NCDs) and known communicable disease patterns. However, the epidemiology of acute and emergency care is not well characterised and this limits efforts to further develop emergency care capacity. OBJECTIVE To define the burden of disease by describing the patient population presenting to the Accident and Emergency Department (A&E) at Kenyatta National Hospital (KNH) in Kenya. METHODS We completed a prospective descriptive assessment of patients in KNH's A&E obtained via systematic sampling over 3 months. Research assistants collected data directly from patients and their charts. Chief complaint and diagnosis codes were grouped for analysis. Patient demographic characteristics were described using the mean and SD for age and n and percentages for categorical variables. International Classification of Disease 10 codes were categorised by 2013 Global Burden of Disease Study methods. RESULTS Data were collected prospectively on 402 patients with an average age of 36 years (SD 19), and of whom, 50% were female. Patients were most likely to arrive by taxi or bus (39%), walking (28%) or ambulance (17%). Thirty-five per cent of patients were diagnosed with NCDs, 24% with injuries and 16% with communicable diseases, maternal and neonatal conditions. Overall, head injury was the single most common final diagnosis and occurred in 32 (8%) patients. The most common patient-reported mechanism for head injury was road traffic accident (39%). CONCLUSION This study estimates the characteristics of the A&E population at a tertiary centre in Kenya and highlights the triple burden of disease. Our findings emphasise the need for further development of emergency care resources and training to better address patient needs in resource-limited settings, such as KNH.
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Affiliation(s)
- Justin Guy Myers
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Karen Ekernas
- Department of Emergency Medicine, Saint Joseph Hospital, Denver, Colorado, USA
| | - Ali Wangara
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Alice Maingi
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Vincent Mutiso
- Department of Orthopedics, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Stephen Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ian B K Martin
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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López-Herce J, Matamoros MM, Moya L, Almonte E, Coronel D, Urbano J, Carrillo Á, del Castillo J, Mencía S, Moral R, Ordoñez F, Sánchez C, Lagos L, Johnson M, Mendoza O, Rodriguez S. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience. BMC MEDICAL EDUCATION 2017; 17:161. [PMID: 28899383 PMCID: PMC5596484 DOI: 10.1186/s12909-017-1005-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. METHODS A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. RESULTS Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. CONCLUSIONS Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.
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Affiliation(s)
- Jesús López-Herce
- Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Paediatrics Department, Faculty of Medicine, Complutense University, Madrid, Dr Castelo 47, 28009 Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Mother-Child and Developmental Health Network (Red SAMID), Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) referencia Instituto de Salud Carlos III RD12/0026/0001, Madrid, Spain
| | | | - Luis Moya
- Hospital General San Juan de Dios, Ciudad de Guatemala, Guatemala
| | - Enma Almonte
- Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Diana Coronel
- Centro Nacional para la Salud de la Infancia y la Adolescencia, México, Distrito Federal Mexico
| | - Javier Urbano
- Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Paediatrics Department, Faculty of Medicine, Complutense University, Madrid, Dr Castelo 47, 28009 Madrid, Spain
- Mother-Child and Developmental Health Network (Red SAMID), Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) referencia Instituto de Salud Carlos III RD12/0026/0001, Madrid, Spain
| | - Ángel Carrillo
- Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Paediatrics Department, Faculty of Medicine, Complutense University, Madrid, Dr Castelo 47, 28009 Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Mother-Child and Developmental Health Network (Red SAMID), Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) referencia Instituto de Salud Carlos III RD12/0026/0001, Madrid, Spain
| | | | | | - Santiago Mencía
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ramón Moral
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Bossaert L, Perkins G, Askitopoulou H, Raffay V, Greif R, Haywood K, Mentzelopoulos S, Nolan J, Van de Voorde P, Xanthos T. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hansoti B, Aluisio AR, Barry MA, Davey K, Lentz BA, Modi P, Newberry JA, Patel MH, Smith TA, Vinograd AM, Levine AC. Global Health and Emergency Care: Defining Clinical Research Priorities. Acad Emerg Med 2017; 24:742-753. [PMID: 28103632 DOI: 10.1111/acem.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/03/2017] [Accepted: 01/07/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. METHODS A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. RESULTS Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. CONCLUSIONS Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide.
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Affiliation(s)
- Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Adam R. Aluisio
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Meagan A. Barry
- Department of Medicine; Section of Emergency Medicine; Baylor College of Medicine; Houston TX
| | - Kevin Davey
- Department of Emergency Medicine; University of California San Francisco; San Francisco CA
| | - Brian A. Lentz
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Payal Modi
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester MA
| | | | - Melissa H. Patel
- Department of Emergency Medicine; Johns Hopkins University School of Medicine; Baltimore MD
| | - Tricia A. Smith
- Department of Emergency Medicine; University of Connecticut School of Medicine; San Francisco CA
| | - Alexandra M. Vinograd
- Department of Emergency Medicine; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA
| | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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Lin BC, Chen CW, Chen CC, Kuo CL, Fan IC, Ho CK, Liu IC, Chan TC. Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA). Int J Health Geogr 2016; 15:17. [PMID: 27225882 PMCID: PMC4881177 DOI: 10.1186/s12942-016-0046-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrence of out-of-hospital cardiac arrest (OHCA) is a critical life-threatening event which frequently warrants early defibrillation with an automated external defibrillator (AED). The optimization of allocating a limited number of AEDs in various types of communities is challenging. We aimed to propose a two-stage modeling framework including spatial accessibility evaluation and priority ranking to identify the highest gaps between demand and supply for allocating AEDs. METHODS In this study, a total of 6135 OHCA patients were defined as demand, and the existing 476 publicly available AEDs locations and 51 emergency medical service (EMS) stations were defined as supply. To identify the demand for AEDs, Bayesian spatial analysis with the integrated nested Laplace approximation (INLA) method is applied to estimate the composite spatial risks from multiple factors. The population density, proportion of elderly people, and land use classifications are identified as risk factors. Then, the multi-criterion two-step floating catchment area (MC2SFCA) method is used to measure spatial accessibility of AEDs between the spatial risks and the supply of AEDs. Priority ranking is utilized for prioritizing deployment of AEDs among communities because of limited resources. RESULTS Among 6135 OHCA patients, 56.85 % were older than 65 years old, and 79.04 % were in a residential area. The spatial distribution of OHCA incidents was found to be concentrated in the metropolitan area of Kaohsiung City, Taiwan. According to the posterior mean estimated by INLA, the spatial effects including population density and proportion of elderly people, and land use classifications are positively associated with the OHCA incidence. Utilizing the MC2SFCA for spatial accessibility, we found that supply of AEDs is less than demand in most areas, especially in rural areas. Under limited resources, we identify priority places for deploying AEDs based on transportation time to the nearest hospital and population size of the communities. CONCLUSION The proposed method will be beneficial for optimizing resource allocation while considering multiple local risks. The optimized deployment of AEDs can broaden EMS coverage and minimize the problems of the disparity in urban areas and the deficiency in rural areas.
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Affiliation(s)
- Bo-Cheng Lin
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
| | - Chao-Wen Chen
- />Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- />Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - Chien-Chou Chen
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
| | - Chiao-Ling Kuo
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
- />Department of Geomatics, National Cheng Kung University, Tainan, Taiwan
| | - I-chun Fan
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
- />Institute of History and Philology, Academia Sinica, Taipei, Taiwan
| | - Chi-Kung Ho
- />Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan
- />Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Chuan Liu
- />Fire Bureau, Kaohsiung City Government, Kaohsiung, Taiwan
| | - Ta-Chien Chan
- />Research Center for Humanity and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 115 Taiwan
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Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. J Formos Med Assoc 2015; 115:628-38. [PMID: 26596689 DOI: 10.1016/j.jfma.2015.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.
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Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study. Prehosp Disaster Med 2015; 30:553-9. [PMID: 26487267 DOI: 10.1017/s1049023x15005221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region. METHODS This cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility. RESULTS Three MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals' emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers. CONCLUSIONS Deficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.
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Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Georgiou M, Lippert FK, Steen PA. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:302-11. [DOI: 10.1016/j.resuscitation.2015.07.033] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mercer MP, Mahadevan SV, Pirrotta E, Ramana Rao GV, Sistla S, Nampelly B, Danthala R, Strehlow ANT, Strehlow MC. Epidemiology of Shortness of Breath in Prehospital Patients in Andhra Pradesh, India. J Emerg Med 2015; 49:448-54. [PMID: 26014761 DOI: 10.1016/j.jemermed.2015.02.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 02/10/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India. OBJECTIVE This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India. METHODS This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days. RESULTS Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05). CONCLUSIONS Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.
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Affiliation(s)
- Mary P Mercer
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Swaminatha V Mahadevan
- Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Elizabeth Pirrotta
- Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - G V Ramana Rao
- GVK-Emergency Management Research Institute, Hyderabad, India
| | - Sreeram Sistla
- GVK-Emergency Management Research Institute, Hyderabad, India
| | | | - Rajini Danthala
- GVK-Emergency Management Research Institute, Hyderabad, India
| | - Anne N T Strehlow
- Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew C Strehlow
- Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California
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