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Rahim Khan U, Baig N, Bhojwani KM, Raheem A, Khan R, Ilyas A, Khursheed M, Ahraz Hussain M, Razzak JA, Eng Hock Ong M, Ahmed F, Hanif B, Saleem G, Jamali S, Kashan A, Saad A, Kerai S, Kanza S, Sajid S, Ullah Khan N. Epidemiology and outcomes of out of hospital cardiac arrest in Karachi, Pakistan - A longitudinal study. Resusc Plus 2024; 20:100773. [PMID: 39314253 PMCID: PMC11417593 DOI: 10.1016/j.resplu.2024.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality globally, with survival outcomes remaining poor particularly in many low- and middle-income countries. We aimed to establish a pilot OHCA registry in Karachi, Pakistan to provide insights into OHCA patient demographics, pre-hospital and in-hospital care, and outcomes. Methods A multicenter longitudinal study was conducted from August 2015-October 2019 across 11 Karachi hospitals, using a standardized Utstein-based survey form. Data was retrospectively obtained from medical records, patients, and next-of-kin interviews at hospitals with accessible medical records, while hospitals without medical records system used on-site data collectors. Demographics, arrest characteristics, prehospital events, and survival outcomes were collected. Survivors underwent follow-up at 1 month, 6 months, 1 year, and 5 years. Results In total, 1068 OHCA patients were included. Mean age was 55 years, 61.1 % (n = 653) male. Witnessed arrests accounted for 94.9 % of the cases (n = 1013), whereas 89.4 % of the cases (n = 955) were transported via non-EMS. Bystander CPR was performed in 10.3 % (n = 110) cases whereas pre-hospital defibrillation performed in 0.4 % (n = 4). In-hospital defibrillation was performed in 9.9 % (n = 106) cases despite < 5 % shockable rhythms. Overall survival to discharge was 0.75 % (n = 8). Of these 8 patients, 7 patients survived to 1-year and 2 to 5-years. Neurological outcomes correlated with long-term survival. Conclusion OHCA survival rates are extremely low, necessitating public awareness interventions like CPR training, developing robust pre-hospital systems, and improving in-hospital emergency care through standardized training programs. This pilot registry lays the foundation for implementing interventions to improve survival and emergency medical infrastructure.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Noor Baig
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Kamlesh M. Bhojwani
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Rubaba Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ayaz Ilyas
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Munawar Khursheed
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Mohammad Ahraz Hussain
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Junaid A. Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New-York, USA
- Center of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Duke-NUS Medical School, Singapore
| | - Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | | | - Ghazanfar Saleem
- Department of Emergency Medicine, The Indus Hospital Karachi, Pakistan
| | - Seemin Jamali
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | | | - Alvia Saad
- Memon Medical Institute, Karachi, Pakistan
| | - Salima Kerai
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Syeda Kanza
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Saadia Sajid
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
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Ho AFW, Lim MJR, Earnest A, Blewer A, Graves N, Yeo JW, Pek PP, Tiah L, Ong MEH. Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 32:100672. [PMID: 36785853 PMCID: PMC9918801 DOI: 10.1016/j.lanwpc.2022.100672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
Background Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort. Methods We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan-Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up. Results We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5-17.8), decreasing to 1.2 (95% CI:0.7-1.8) at three years, and 0.4 (95% CI:0.2-0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02-1.04, p < 0.001), shockable presenting rhythm (HR:0.75, 95% CI:0.52-0.93, p = 0.015) and CPC category (HR:4.62, 95% CI:3.17-6.75, p < 0.001) were independently associated with mortality. Annual DALYs due to OHCA varied from 304.1 in 2010 to 849.7 in 2015, then 547.1 in 2018. Mean DALYs decreased from 12.162 in 2010 to 3.599 in 2018. Conclusions OHCA survivors had an increased mortality rate for the first three years which subsequently normalised compared to that of the general population. Annual OHCA disease burden in DALY trended downwards from 2010 to 2018. Improved surveillance and OHCA treatment strategies may improve long-term survivorship and decrease its global burden. Funding National Medical Research Council, Singapore, under the Clinician Scientist Award (NMRC/CSA-SI/0014/2017) and the Singapore Translational Research Investigator Award (MOH-000982-01).
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Corresponding author. Department of Emergency Medicine, Singapore General Hospital, Outram Rd, 169608, Singapore.
| | - Mervyn Jun Rui Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Audrey Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore
| | - Ling Tiah
- Accident & Emergency Department, Changi General Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
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Odom E, Nakajima Y, Vellano K, Al-Araji R, Coleman King S, Zhang Z, Merritt R, McNally B. Trends in EMS-attended Out-of-Hospital Cardiac Arrest Survival, United States 2015-2019. Resuscitation 2022; 179:88-93. [DOI: 10.1016/j.resuscitation.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022]
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Han Chin Y, Yu Leon Yaow C, En Teoh S, Zhi Qi Foo M, Luo N, Graves N, Eng Hock Ong M, Fu Wah Ho A. Long-term outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2021; 171:15-29. [PMID: 34971720 DOI: 10.1016/j.resuscitation.2021.12.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/21/2022]
Abstract
AIMS Long term outcomes after out-of-hospital cardiac arrest (OHCA) are not well understood. This study aimed to evaluate the long-term (1-year and beyond) survival outcomes, including overall survival and survival with favorable neurological status and the quality-of-life (QOL) outcomes, among patients who survived the initial OHCA event (30 days or till hospital discharge). METHODS Embase, Medline and PubMed were searched for primary studies (randomized controlled trials, cohort and cross-sectional studies) which reported the long-term survival outcomes of OHCA patients. Data abstraction and quality assessment was conducted, and survival at predetermined timepoints were assessed via single-arm meta-analyses of proportions, using generalized linear mixed models. Comparative meta-analyses were conducted using the Mantel-Haenszel Risk Ratio (RR) estimates, using the DerSimonian and Laird model. RESULTS 67 studies were included, and among patients that survived to hospital discharge or 30-days, 77.3% (CI=71.2-82.4), 69.6% (CI=54.5-70.3), 62.7% (CI=54.5-70.3), 46.5% (CI=32.0-61.6), and 20.8% (CI=7.8-44.9) survived to 1-, 3-, 5-, 10- and 15-years respectively. Compared to Asia, the probability of 1-year survival was greater in Europe (RR=2.1, CI=1.8-2.3), North America (RR=2.0, CI=1.7-2.2) and Oceania (RR=1.9,CI=1.6-2.1). Males had a higher 1-year survival (RR:1.41, CI=1.25-1.59), and patients with initial shockable rhythm had improved 1-year (RR=3.07, CI=1.78-5.30) and 3-year survival (RR=1.45, CI=1.19-1.77). OHCA occurring in residential locations had worse 1-year survival (RR=0.42, CI=0.25-0.73). CONCLUSION Our study found that up to 20.8% of OHCA patients survived to 15-years, and survival was lower in Asia compared to the other regions. Further analysis on the differences in survival between the regions are needed to direct future long-term treatment of OHCA patients.
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Affiliation(s)
- Yip Han Chin
- School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Seth En Teoh
- School of Medicine, National University Singapore, Singapore, Singapore
| | - Mabel Zhi Qi Foo
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Nicholas Graves
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore.
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Urquhart C, Martin J, Ross M. Outcomes following out-of-hospital cardiac arrest in the aeromedical retrieval population of the remote Top End of the Northern Territory, Australia. Aust J Rural Health 2021; 30:87-94. [PMID: 34797613 DOI: 10.1111/ajr.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Out-of-hospital cardiac arrest is an event with an extremely poor prognosis. There is limited literature on the outcomes for regional Australia, with none specifically addressing remote populations. We aimed to assess out-of-hospital cardiac arrest outcomes in the aeromedical retrieval population of the Top End Medical Retrieval Service. DESIGN We retrospectively identified all cardiac arrests, deaths and patients who had cardiopulmonary resuscitation within the aeromedical retrieval database for a 5-year period from January 2012 to December 2016. SETTING Retrieval patients across the Top End of the Northern Territory, Australia. PARTICIPANTS All patients within the cohort with a non-traumatic out-of-hospital cardiac arrest. MAIN OUTCOME MEASURES Data were collected on outcomes as per Utstein definitions, along with patient demographics, retrieval timings and interventions. RESULTS Seventy-five patients suffering cardiac arrest were identified, with 58 having a non-traumatic arrest in an out-of-hospital setting. The median age of the cohort was 40 years, and 53% had an initial shockable rhythm. Return of spontaneous circulation was achieved in 55% and 43% survived to hospital. The survival to hospital discharge and 28 days were 31% and 29%, respectively. CONCLUSIONS Although the study has a small sample size and limitations on generalisability due to the restricted nature of the cohort selection, the results suggest a 28-day survival rate is potentially comparable to other regions of Australia and the rest of the world. Further research needs to be undertaken in out-of-hospital cardiac arrest in remote regions to establish a true population-based cohort and ascertain where improvements can be made.
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Affiliation(s)
- Colin Urquhart
- Cairns Hospital & LifeFlight Retrieval Medicine, Cairns, Qld, Australia.,CareFlight, Darwin, NT, Australia
| | | | - Mark Ross
- CareFlight & Royal Darwin Hospital, Darwin, NT, Australia
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Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest. Resuscitation 2021; 164:30-37. [PMID: 33965475 DOI: 10.1016/j.resuscitation.2021.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) causes brain injury. Functional status of survivors at hospital discharge is a core resuscitation measure, frequently using the Cerebral Performance Category (CPC) or modified Rankin Scale (mRS). Which scale better predicts long-term survival following OHCA is not known. METHODS We evaluated long-term survival after hospital discharge in a retrospective cohort of persons resuscitated from OHCA in King County, WA from 2007 to 2015. Patients were independently assessed at discharge using both scales, leveraging the regional quality improvement registry, which records the 5-level CPC, and concurrent research studies involving the Resuscitation Outcomes Consortium, which used the 7-level mRS, taken from information in the hospital record. The risk of mortality associated with CPC and mRS categories was estimated using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS Among 878 eligible patients discharged alive, there were 358 deaths during 9118.5 person-years of follow-up. Overall 1, 5 and 10-year survival was 84.4%, 68.5%, and 53.7% and varied according to CPC and mRS (p < 0.01 per Kaplan-Meier). Compared to CPC-1, hazard ratio (HR) increased incrementally for CPC-2 = 1.33 (1.03-1.73), CPC-3 = 1.90 (1.37-2.65), and CPC-4 = 8.25 (5.63-12.10). Compared to mRS = 0, HR for mRS-1 = 1.02 (0.66-1.58), mRS-2 = 1.52 (1.00-2.32), mRS-3 = 1.41 (0.92-2.14), mRS-4 = 2.00 (1.37-2.97), and mRS-5 = 4.90 (3.23-7.44). CONCLUSION In OHCA survivors, CPC and mRS scales both predicted long-term survival. However mRS 0-1 and 2-3 groups did not have distinct prognoses, suggesting that a consolidated mRS score may simplify capture of relevant prognostic information for survival predictions.
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Al-Dury N, Rawshani A, Karlsson T, Herlitz J, Ravn-Fischer A. The influence of age and gender on delay to treatment and its association with survival after out of hospital cardiac arrest. Am J Emerg Med 2020; 42:198-202. [PMID: 33234358 DOI: 10.1016/j.ajem.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nooraldeen Al-Dury
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; Dept. of Radiology, Østfold Hospital Trust, Grålum, Norway.
| | - Araz Rawshani
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics at the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Herlitz
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; University of Borås, Borås, Sweden
| | - Annica Ravn-Fischer
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden; Sahlgrenska University Hospital, Dept. of Cardiology, Gothenburg, Sweden
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Ohbe H, Ogura T, Matsui H, Yasunaga H. Extracorporeal cardiopulmonary resuscitation for acute aortic dissection during cardiac arrest: A nationwide retrospective observational study. Resuscitation 2020; 156:237-243. [PMID: 32800864 DOI: 10.1016/j.resuscitation.2020.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
AIM Acute aortic dissection (AAD) has been considered a contraindication for extracorporeal cardiopulmonary resuscitation (ECPR). However, studies are lacking regarding the epidemiology and effectiveness of ECPR for AAD. We aimed to examine whether ECPR for AAD during refractory cardiac arrest is effective. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified all emergently hospitalized adults who received ECPR on the day of admission and all AAD patients who received cardiopulmonary resuscitation on the day of admission. ECPR was defined as receiving both cardiopulmonary resuscitation and percutaneous extracorporeal membrane oxygenation. Outcomes were in-hospital mortality and neurological outcomes. We calculated the incremental cost-effectiveness ratio of ECPR for AAD. RESULTS We identified 398 AAD patients with ECPR, 9840 non-AAD patients with ECPR, and 9709 AAD patients with cardiopulmonary resuscitation but not ECPR. The incidence of AAD among the patients with ECPR on the day of admission was 3.9%. In-hospital mortality was 98% in AAD patients with ECPR, 79% in non-AAD patients with ECPR, and 98% in AAD patients with cardiopulmonary resuscitation but not ECPR. Seven AAD patients survived to discharge after ECPR; of these, six patients had good neurological outcomes at discharge. The incremental cost-effectiveness ratio of ECPR for AAD was estimated at 161,504 US dollars per quality-adjusted life year gained. CONCLUSION ECPR successfully improved outcomes and/or facilitated surgery for a small number of AAD patients with refractory cardiac arrest; however, the cost burden of ECPR for AAD patients may be unacceptably high.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation SAISEIKAI, Utsunomiya Hospital, Tochigi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Yen KC, Chan YH, Wu CT, Hsieh MJ, Wang CL, Wen MS, Chu PH. Resuscitation outcomes of a wireless ECG telemonitoring system for cardiovascular ward patients experiencing in-hospital cardiac arrest. J Formos Med Assoc 2020; 120:551-558. [PMID: 32653389 DOI: 10.1016/j.jfma.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE In-hospital cardiac arrest is a serious issue for hospitalized patients. The documented initial rhythm and detected medical events have been reported to influence the survival of cardiopulmonary resuscitation. This study aimed to identify the effect of continuous real-time electrocardiogram (ECG) monitoring on the prognosis of resuscitated patients in a general cardiac ward. METHODS We conducted this retrospective study using medical records of hospitalized patients in a cardiovascular ward who experienced an in-hospital cardiac arrest and received cardiopulmonary resuscitation from February 2015 to December 2018. The patients who were considered to be at high risk of cardiac events such as ventricular arrhythmia would receive continuous ECG monitoring. A wireless ECG telemonitoring system was introduced to replace traditional bedside ECG monitors. The outcome measures were the initial success of resuscitation, 24-h survival after resuscitation, and survival to discharge. RESULTS We enrolled 115 patients with a cardiac arrest during hospitalization, of whom 73 (63%) patients received wireless ECG telemonitoring. Patients receiving continuous ECG monitoring were associated with higher opportunities of initial success of resuscitation and 24-h survival after resuscitation (67.1% vs. 40.5%, p = 0.005; and 49.3% vs. 26.2%, p = 0.015, respectively) when comparing to the non-monitoring group; but no significant difference in survival to discharge (21.9% vs. 16.7%, p = 0.498) was observed. With adjustment of the covariates, the monitoring group was associated with a higher likelihood to reach the initial success of resuscitation (odds ratios [ORs], 3.21; 95% confidence interval [CI], 1.03-9.98). However, the effect of monitoring on 24-h survival and survival to discharge was close to null after adjusting for covariates. CONCLUSION A wireless ECG telemonitoring system were beneficial to the initial success of resuscitation for patients at high risk of cardiovascular events suffering an in-hospital cardiac arrest; but had less impact on 24-h survival and survival to discharge.
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Affiliation(s)
- Kun-Chi Yen
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chia-Tung Wu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Jer Hsieh
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Li Wang
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ming-Shien Wen
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
| | - Po-Hsien Chu
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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Heo S, Yoon SY, Kim J, Kim HS, Kim K, Yoon H, Hwang SY, Cha WC, Kim T. Effectiveness of a Real-Time Ventilation Feedback Device for Guiding Adequate Minute Ventilation: A Manikin Simulation Study. ACTA ACUST UNITED AC 2020; 56:medicina56060278. [PMID: 32516894 PMCID: PMC7353869 DOI: 10.3390/medicina56060278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: It is often challenging even for skilled rescuers to provide adequate positive pressure ventilation consistently. This study aimed to investigate the effectiveness of a newly developed real-time ventilation feedback device (RTVFD) that estimates tidal volume (TV) and ventilation interval (VI) in real time. Materials and methods: We conducted a randomised, crossover, manikin simulation study. A total of 26 medical providers were randomly assigned to the RTVFD-assisted ventilation (RAV) first group (n = 13) and the non-assisted ventilation (NV) first group (n = 13). Participants provided ventilation using adult and paediatric bag valves (BVs) for 2 min each. After a washout period, the simulation was repeated by exchanging the participants’ groups. Results: The primary outcome was optimal TV in the RAV and NV groups using adult and paediatric BVs. A secondary outcome was optimal VI in the RAV and NV groups using adult and paediatric BVs. The proportions of optimal TV values were higher for the RAVs when using both adult and paediatric BVs (adult BV: 47.29% vs. 18.46%, p < 0.001; paediatric BV: 89.51% vs. 72.66%, p < 0.001) than for the NVs. The proportions of optimal VI were significantly higher in RAVs when using both adult and paediatric BVs than that in NVs (adult BV: 95.64% vs. 50.20%, p < 0.001; paediatric BV: 95.83% vs. 57.14%, p < 0.001). Additionally, we found that with paediatric BVs, the simulation had a higher OR for both optimal TV (13.26; 95% CI, 9.96–17.65; p < 0.001) and VI (1.32; 1.08–1.62, p = 0.007), regardless of RTVFD use. Conclusion: Real-time feedback using RTVFD significantly improves the TV and VI in both adult and paediatric BVs in a manikin simulation study.
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Affiliation(s)
- Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sun Young Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Jongchul Kim
- Department of Biomedical Engineering, Samsung Medical Center, Seoul 06351, Korea;
| | - Hye Seung Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul 06351, Korea; (H.S.K.); (K.K.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.H.); (S.Y.Y.); (H.Y.); (S.Y.H.); (W.C.C.)
- Correspondence: ; Tel.: +82-2-3410-2053; Fax: +82-2-3410-0049
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Choi B, Kim T, Yoon SY, Yoo JS, Won HJ, Kim K, Kang EJ, Yoon H, Hwang SY, Shin TG, Sim MS, Cha WC. Effect of Watch-Type Haptic Metronome on the Quality of Cardiopulmonary Resuscitation: A Simulation Study. Healthc Inform Res 2019; 25:274-282. [PMID: 31777670 PMCID: PMC6859264 DOI: 10.4258/hir.2019.25.4.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/15/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to test the applicability of haptic feedback using a smartwatch to the delivery of cardiac compression (CC) by professional healthcare providers. Methods A prospective, randomized, controlled, case-crossover, standardized simulation study of 20 medical professionals was conducted. The participants were randomly assigned into haptic-first and non-haptic-first groups. The primary outcome was an adequate rate of 100–120/min of CC. The secondary outcome was a comparison of CC rate and adequate duration between the good and bad performance groups. Results The mean interval between CCs and the number of haptic and non-haptic feedback-assisted CCs with an adequate duration were insignificant. In the subgroup analysis, both the good and bad performance groups showed a significant difference in the mean CC interval between the haptic and non-haptic feedback-assisted CC groups—good: haptic feedback-assisted (0.57–0.06) vs. non-haptic feedback-assisted (0.54–0.03), p < 0.001; bad: haptic feedback-assisted (0.57–0.07) vs. non-haptic feedback-assisted (0.58–0.18), p = 0.005—and the adequate chest compression number showed significant differences— good: haptic feedback-assisted (1,597/75.1%) vs. non-haptic feedback-assisted (1,951/92.2%), p < 0.001; bad: haptic feedbackassisted (1,341/63.5%) vs. non-haptic feedback-assisted (523/25.4%), p < 0.001. Conclusions A smartwatch cardiopulmonary resuscitation feedback system could not improve rescuers' CC rate. According to our subgroup analysis, participants might be aided by the device to increase the percentage of adequate compressions after one minute.
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Affiliation(s)
- Boram Choi
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Sang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Ho-Jeong Won
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
| | - Eun Jin Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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12
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Bhardwaj A, Miano T, Geller B, Milewski RC, Williams M, Bermudez C, Vallabhajosyula P, Patel P, Mackay E, Vernick W, Lane-Fall M, Raiten J, McDonald M, Haddle J, Gutsche J. Venovenous Extracorporeal Membrane Oxygenation for Patients With Return of Spontaneous Circulation After Cardiac Arrest Owing to Acute Respiratory Distress Syndrome. J Cardiothorac Vasc Anesth 2019; 33:2216-2220. [PMID: 31182376 DOI: 10.1053/j.jvca.2019.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the survival to hospital discharge of patients who were treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) for respiratory failure after cardiac arrest. DESIGN Retrospective chart review. SETTING University-affiliated tertiary care hospitals. PARTICIPANTS The study comprised 21 patients. INTERVENTIONS Implementation of VV ECMO in patients with return of spontaneous circulation after cardiac arrest owing to respiratory insufficiency. MEASUREMENTS AND MAIN RESULTS The most common etiology of arrest was pneumonia-associated acute respiratory distress syndrome (8/21 [38%]). Overall, 12/21(57%) patients survived to hospital discharge. Two of 12 (17%) patients required hemodialysis upon discharge. CONCLUSION VV ECMO may be an appropriate alternative to venoarterial ECMO in select patients with return of spontaneous circulation after cardiac arrest owing to profound respiratory failure.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Todd Miano
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bram Geller
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Rita C Milewski
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Matthew Williams
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Christian Bermudez
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Prashant Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Prakash Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Emily Mackay
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Jesse Raiten
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Michael McDonald
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - John Haddle
- University of Pennsylvania Health System, Philadelphia, PA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA.
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13
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Bradley SM, Liu W, McNally B, Vellano K, Henry TD, Mooney MR, Burke MN, Brilakis ES, Grunwald GK, Adhaduk M, Donnino M, Girotra S. Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2018; 1:e184511. [PMID: 30646357 PMCID: PMC6324404 DOI: 10.1001/jamanetworkopen.2018.4511] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite evidence that therapeutic hypothermia improves patient outcomes for out-of-hospital cardiac arrest, use of this therapy remains low. OBJECTIVE To determine whether the use of therapeutic hypothermia and patient outcomes have changed after publication of the Targeted Temperature Management trial on December 5, 2013, which supported more lenient temperature management for out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort was conducted between January 1, 2013, and December 31, 2016, of 45 935 US patients in the Cardiac Arrest Registry to Enhance Survival who experienced out-of-hospital cardiac arrest and survived to hospital admission. EXPOSURES Calendar time by quarter year. MAIN OUTCOMES AND MEASURES Use of therapeutic hypothermia and patient survival to hospital discharge. RESULTS Among 45 935 patients (17 515 women and 28 420 men; mean [SD] age, 59.3 [18.3] years) who experienced out-of-hospital cardiac arrest and survived to admission at 649 US hospitals, overall use of therapeutic hypothermia during the study period was 46.4%. In unadjusted analyses, the use of therapeutic hypothermia dropped from 52.5% in the last quarter of 2013 to 46.0% in the first quarter of 2014 after the December 2013 publication of the Targeted Temperature Management trial. Use of therapeutic hypothermia remained at or below 46.5% through 2016. In segmented hierarchical logistic regression analysis, the risk-adjusted odds of use of therapeutic hypothermia was 18% lower in the first quarter of 2014 compared with the last quarter of 2013 (odds ratio, 0.82; 95% CI, 0.71-0.94; P = .006). Similar point-estimate changes over time were observed in analyses stratified by presenting rhythm of ventricular tachycardia or ventricular fibrillation (odds ratio, 0.89; 95% CI, 0.71-1.13, P = .35) and pulseless electrical activity or asystole (odds ratio, 0.75; 95% CI, 0.63-0.89; P = .001). Overall risk-adjusted patient survival was 36.9% in 2013, 37.5% in 2014, 34.8% in 2015, and 34.3% in 2016 (P < .001 for trend). In mediation analysis, temporal trends in use of hypothermia did not consistently explain trends in patient survival. CONCLUSIONS AND RELEVANCE In a US registry of patients who experienced out-of-hospital cardiac arrest, the use of guideline-recommended therapeutic hypothermia decreased after publication of the Targeted Temperature Management trial, which supported more lenient temperature thresholds. Concurrent with this change, survival among patients admitted to the hospital decreased, but was not mediated by use of hypothermia.
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Affiliation(s)
- Steven M. Bradley
- Minneapolis Heart Institute, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Wenhui Liu
- Veterans Affairs Eastern Colorado Health Care System, Denver
- University of Colorado School of Public Health, Aurora
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia
| | - Kimberly Vellano
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia
| | | | - Michael R. Mooney
- Minneapolis Heart Institute, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - M. Nicholas Burke
- Minneapolis Heart Institute, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute, Minneapolis, Minnesota
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Mehul Adhaduk
- University of Iowa Carver College of Medicine, Iowa City
| | | | - Saket Girotra
- University of Iowa Carver College of Medicine, Iowa City
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14
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Ye J, Zhu Z, Liang Q, Yan X, Xi X, Zhang Z. Efficacy and safety of Shenfu injection for patients with return of spontaneous circulation after sudden cardiac arrest: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12500. [PMID: 30235758 PMCID: PMC6160179 DOI: 10.1097/md.0000000000012500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sudden cardiac arrest (SCA) is one of the most common critical illnesses encountered in clinical practice. Shenfu injection (SFI) has received extensive attention as an alternative therapy that can effectively maintain the autonomic circulation function after cardiopulmonary resuscitation. However, the mechanism of SFI is not yet fully understood. In addition, there has been no systematic review or meta-analysis of SFI in the treatment of patients with return of spontaneous circulation after SCA. Herein, we describe the protocol of a proposed study based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that aims to systematically evaluate the efficacy and safety of SFI in patients with return of spontaneous circulation after SCA. METHODS Two researchers will search 9 electronic databases (PubMed, Medline, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese VIP Information, Wanfang, and Chinese Biomedical Database) to identify all studies that meet the inclusion criteria and were published before July 2018. After information extraction and methodological quality evaluation, we will use Stata 13.0 software (STATA Corporation, College Station, TX, USA) to synthesize the data. The primary outcomes will be the survival rate and Glasgow Coma Scale. RESULTS The data synthesis results will objectively illustrate the efficacy and safety of SFI in patients with return of spontaneous circulation after SCA. CONCLUSION The findings will provide a reference for the use of SFI in the treatment of patients with return of spontaneous circulation after SCA. REGISTRATION PROSPERO (registration number: CRD42018104230).
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Affiliation(s)
- Jiarong Ye
- Guangdong Provincial Hospital of Chinese Medicine
- Guangzhou University of Chinese Medicine, The 2nd Clinical College
| | - Zehao Zhu
- Guangzhou University of Chinese Medicine, The 2nd Clinical College
| | - Qianrong Liang
- Guangdong University of Foreign Studies, Guangzhou, China
| | - Xia Yan
- Guangdong Provincial Hospital of Chinese Medicine
- Guangzhou University of Chinese Medicine, The 2nd Clinical College
| | - Xiaotu Xi
- Guangdong Provincial Hospital of Chinese Medicine
- Guangzhou University of Chinese Medicine, The 2nd Clinical College
| | - Zhongde Zhang
- Guangdong Provincial Hospital of Chinese Medicine
- Guangzhou University of Chinese Medicine, The 2nd Clinical College
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15
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Prognostic Factors of Cardiopulmonary Arrest Patients by a Physician-Staffed Helicopter. Air Med J 2018; 37:312-316. [PMID: 30322634 DOI: 10.1016/j.amj.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify the prognostic factors of cardiopulmonary arrest (CPA) patients transported by a physician-staffed helicopter who received cardiopulmonary resuscitation (CPR) using AutoPulse (ZOLL Circulation, Sunnyvale, CA). METHODS A total of 110 CPA patients who had CPR performed on them in the helicopter using AutoPulse were enrolled in this retrospective study. We used logistic regression analysis to examine the prognostic factors of CPA patients who were transported by a physician-staffed helicopter. RESULTS Of these patients, return of spontaneous circulation (ROSC) during transportation was observed in 19 (17.29%); 1 (.9%) survived through hospital discharge without neurologic disability. In multivariate analyses, bystander CPR (P = .023) and the time from the first call to the arrival of a helicopter medical crew (P = .041) were selected as independent factors associated with ROSC. CONCLUSION In our study, factors such as early contact from the first call to the arrival of a helicopter medical crew and the presence of bystander CPR appeared to play an important role in attaining ROSC of CPA patients who were transported by a physician-staffed helicopter using AutoPulse.
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16
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Extramiana F, Stordeur B, Furioli V, Gandjbakhch E, Lellouche N, Algalarrondo V, Varlet E, Messali A, Marijon E, Leenhardt A. Spectrum and Outcome of Patients Who Have Undergone Implantation of an Implantable Cardioverter Defibrillator After Aborted-Sudden Cardiac Arrest. Am J Cardiol 2018; 121:149-155. [PMID: 29153773 DOI: 10.1016/j.amjcard.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 11/15/2022]
Abstract
Most of implantable cardioverter defibrillator (ICD) secondary prevention studies have been published 2 decades ago. We aimed to describe a contemporary cohort of patients who have undergone implantation of an ICD after an aborted-sudden cardiac arrest (SCA). We retrospectively evaluated consecutive patients referred to our centers between 2005 and 2013. Predictors of overall mortality or heart transplant were analyzed using Cox proportional hazards models. A total of 250 patients (76.4% male, 48.7 ± 16.7 years) were included (mean follow-up = 49.6 ± 35 months). The presence of a structural heart disease (SHD) was considered as the primary cause of the aborted-SCA in 160 patients (64%). In 90 patients (36%), no SHD was observed, with patients much younger (40.9 ± 16.2 years vs 53.0 ± 15.5 years in the SHD group, p < 0.0001). The 5-year estimated rates of death or heart transplant were 14.3% and 5.2% in the group with and without SHD, respectively (hazard ratio = 4.65, 95% confidence interval 1.40 to 15.6, p = 0.014). The 5-year estimated rates of appropriate ICD therapy in the ventricular fibrillation zone were 16.7% and 25.1% in patients without and with SHD (p = 0.24), respectively. Only left ventricular ejection fraction remained independently associated with mortality or heart transplant (hazard ratio = 0.94, 95% confidence interval 0.90 to 0.97, p = 0.0004). Overall, 69 patients (27.6%) experienced at least 1 ICD-related complication. In conclusion, compared with secondary prevention pivotal studies, the current patients who have undergone implantation of an ICD after aborted-SCA are younger, with a high proportion of structurally normal hearts. Compared with patients without SHD, who depicted a relatively favorable outcome, patients with SHD present a fourfold higher risk of death during follow-up. Reduced left ventricular ejection fraction remains the major influencing factor.
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Affiliation(s)
- Fabrice Extramiana
- Université Paris Diderot, Sorbonne Paris Cité, Paris F-75018, France; AP-HP, Service de Cardiologie, Hôpital Bichat, Paris F-75018, France; CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris F-75018, France.
| | - Benjamin Stordeur
- AP-HP, Service de Cardiologie, Hôpital Bichat, Paris F-75018, France
| | - Vincent Furioli
- AP-HP, Hôpital européen Georges Pompidou, Paris F-75015, France
| | - Estelle Gandjbakhch
- AP-HP, Service de Cardiologie, Hôpital Pitié Salpêtrière, Paris F-75013, France
| | - Nicolas Lellouche
- AP-HP, Service de Cardiologie, Hôpital Henri Mondor, Créteil F-94000, France
| | | | - Emilie Varlet
- Université Paris Diderot, Sorbonne Paris Cité, Paris F-75018, France; AP-HP, Service de Cardiologie, Hôpital Bichat, Paris F-75018, France; CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris F-75018, France
| | - Anne Messali
- AP-HP, Service de Cardiologie, Hôpital Bichat, Paris F-75018, France; CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris F-75018, France
| | - Eloi Marijon
- AP-HP, Hôpital européen Georges Pompidou, Paris F-75015, France; Université Paris Descartes, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Antoine Leenhardt
- Université Paris Diderot, Sorbonne Paris Cité, Paris F-75018, France; AP-HP, Service de Cardiologie, Hôpital Bichat, Paris F-75018, France; CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris F-75018, France
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17
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Guterman EL, Kim AS, Josephson SA. Neurologic consultation and use of therapeutic hypothermia for cardiac arrest. Resuscitation 2017; 118:43-48. [DOI: 10.1016/j.resuscitation.2017.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/23/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022]
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18
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Burstein B, Jayaraman D, Husa R. Early left ventricular ejection fraction as a predictor of survival after cardiac arrest. ACTA ACUST UNITED AC 2017; 18:35-39. [DOI: 10.1080/17482941.2017.1293831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Barry Burstein
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Dev Jayaraman
- Department of Critical Care, McGill University Health Center and Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Regina Husa
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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19
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Andrew E, Nehme Z, Wolfe R, Bernard S, Smith K. Long-term survival following out-of-hospital cardiac arrest. Heart 2017; 103:1104-1110. [DOI: 10.1136/heartjnl-2016-310485] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 11/03/2022] Open
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20
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Nevrekar V, Panda PK, Wig N, Pandey RM, Agarwal P, Biswas A. An Interventional Quality Improvement Study to Assess the Compliance to Cardiopulmonary Resuscitation Documentation in an Indian Teaching Hospital. Indian J Crit Care Med 2017; 21:758-764. [PMID: 29279637 PMCID: PMC5699004 DOI: 10.4103/ijccm.ijccm_249_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) should be performed as per the international guidelines; however, compliance to these guidelines is difficult to assess. This study was conducted to determine the compliance to American Heart Association (2010) guideline on CPR documentation by among resident physicians before and after resident training (two arms). Methods This pre-postinterventional quality improvement study was conducted in a referral center, North India. Data of hospitalized in-hospital CPR patients were collected in the form of quality indicators (checklists) as defined by the guideline and compared between two arms of before-after resident training. Residents were given appropriate training in CPR technique as per the guideline. The compliance of CPR documentation was assessed pre- and post-intervention. Results The baseline arm compliance of various components of CPR documentation was low. The postintervention arm compliances of all components significantly increased (baseline, 2.5% to postintervention, 15.11%, P = 0.03). Individual components assessed were documentation of assessment of responsiveness (65% to 77.9%, P = 0.19), assessment of breathing (37.5% to 58.1%, P = 0.03), assessment of carotid pulse (62.5% to 79%, P = 0.05), rate of chest compressions (20% to 39.5%, P = 0.04), airway management (62.5% to 82.5%, P = 0.02), and compressions to breaths ratio (12.5% to 31.4%, P = 0.02). Documentation of chest compression rate compared to nondocumentation (12 of 42 vs. 11 of 84, P = 0.04) was independently associated with a higher rate of return of spontaneous circulation. The study however did not show any survival benefits. Conclusions This study establishes that the compliance to CPR documentation is poor as assessed by CPR documentation content and quality, which improves after physician training, but not up to the mark level (100%) that may be due to busy Indian hospital settings and human behavioral factors. Due to ethical constraints of live CPR assessment, this document checklist approach may be considered as an internal quality assessment method for CPR compliance. Furthermore, correct instruction in CPR technique along with proper documentation of the procedure is required, followed up with periodic re-education during the residency period and beyond.
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Affiliation(s)
- Viraj Nevrekar
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prasan Kumar Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Agarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
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21
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Choi AJ, Thomas SS, Singh JP. Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator Therapy in Advanced Heart Failure. Heart Fail Clin 2016; 12:423-36. [PMID: 27371518 DOI: 10.1016/j.hfc.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patients with advanced heart failure are at high risk for progression of their disease and sudden cardiac death. The role of device therapy in this patient population continues to evolve and is directed toward improving cardiac pump function and/or reducing sudden arrhythmic death.
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Affiliation(s)
- Anthony J Choi
- Electrophysiology Laboratory, Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Sunu S Thomas
- Heart Failure & Transplant Services, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jagmeet P Singh
- Electrophysiology Laboratory, Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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22
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Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics. Emerg Med Int 2016; 2016:6983750. [PMID: 27379186 PMCID: PMC4917693 DOI: 10.1155/2016/6983750] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (p = 0.05), with a stronger disparity between low- and high-income neighborhoods (p = 0.01 and p = 0.03, resp.). Survival with bystander CPR was statistically greater in white- versus black-predominant neighborhoods (p = 0.04). Increased survival, overall and with bystander CPR, was seen with high- versus low-education neighborhoods (p = 0.03). Neighborhoods with more high school age persons displayed the lowest survival. We discovered a significant disparity in OHCA survival within neighborhoods of low-income, black-predominance, and low-education. Reduced survival was seen in neighborhoods with larger populations of high school students. This group is a potential target for training, and instruction can conceivably change survival outcomes in these neighborhoods, closing the gap, thus improving survival for all.
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Kajino K, Kitamura T, Kiyohara K, Iwami T, Daya M, Ong MEH, Shimazu T, Sadamitsu D. Temporal Trends in Outcomes after Out-of-Hospital Cardiac Arrests Witnessed by Emergency Medical Services in Japan: A Population-Based Study. PREHOSP EMERG CARE 2016; 20:477-84. [PMID: 26852940 DOI: 10.3109/10903127.2015.1115931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Survival after out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical service (EMS) personnel has been insufficiently understood. The aim of this study was to evaluate temporal trends in survival after EMS-witnessed OHCAs in Japan. METHODS A nationwide, population-based, observational cohort study of consecutive adult OHCA patients with emergency responder resuscitation attempts from January 2005 to December 2012 in Japan. We assessed the trends in annual incidence, characteristics, and outcomes of OHCA patients witnessed by EMS personnel. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome defined as cerebral performance category scale 1or 2. RESULTS During the study period, a total of 66,760 EMS-witnessed OHCAs were documented. The annual incidence rates per 100,000 persons of EMS-witnessed OHCA patients increased from 4.6 (n = 7219) in 2005 to 4.9 (n = 9256) in 2012 (p for trend = 0.035). The proportion of one-month survival with neurologically favorable outcome improved from 5.9% in 2005 to 8.6% in 2012 (p for trend < 0.001), and the proportion increased from 22.1% in 2005 to 30.2% in 2012 in cases with shockable rhythm (p for trend < 0.001). In a multivariate analysis, adults, male gender, shockable rhythm, presumed cardiac origin, and year were associated with a better neurological outcome. CONCLUSIONS In this population, the proportion of one-month survival with neurologically favorable outcome among OHCA patients witnessed by EMS personnel significantly improved during the study period.
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Zima E. Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview. ACTA ACUST UNITED AC 2015; 1:167-170. [PMID: 29967826 DOI: 10.1515/jccm-2015-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/28/2015] [Indexed: 01/15/2023]
Abstract
A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD), however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC) is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.
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Affiliation(s)
- Endre Zima
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
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25
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Hulleman M, Zijlstra JA, Beesems SG, Blom MT, van Hoeijen DA, Waalewijn RA, Tan HL, Tijssen JG, Koster RW. Causes for the declining proportion of ventricular fibrillation in out-of-hospital cardiac arrest. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sutter J, Panczyk M, Spaite DW, Ferrer JME, Roosa J, Dameff C, Langlais B, Murphy RA, Bobrow BJ. Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers. West J Emerg Med 2015; 16:736-42. [PMID: 26587099 PMCID: PMC4644043 DOI: 10.5811/westjem.2015.6.26058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/05/2015] [Accepted: 06/28/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC) Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR) pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs) focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA. Methods We conducted this survey in 2010, identifying 5,686 PSAPs; 3,555 had valid e-mail addresses and were contacted. Each received a preliminary e-mail announcing the survey, an e-mail with a link to the survey, and up to three follow-up e-mails for non-responders. The survey contained 23 primary questions with sub-questions depending on the response selected. Results Of the 5,686 identified PSAPs in the United States, 3,555 (63%) received the survey, with 1,924/3,555 (54%) responding. Nearly all were public agencies (n=1,888, 98%). Eight hundred seventy-eight (46%) responding agencies reported that they provide no instructions for medical emergencies, and 273 (14%) reported that they are unable to transfer callers to another facility to provide T-CPR. Of the 1,924 respondents, 975 (51%) reported that they provide pre-arrival instructions for OHCA: 67 (3%) provide compression-only CPR instructions, 699 (36%) reported traditional CPR instructions (chest compressions with rescue breathing), 166 (9%) reported some other instructions incorporating ventilations and compressions, and 92 (5%) did not specify the type of instructions provided. A validation follow up showed no substantial difference in the provision of instructions for OHCA by non-responders to the survey. Conclusion This is the first large-scale, nationwide assessment of the practices of PSAPs in the United States regarding T-CPR for OHCA. These data showing that nearly half of the nation’s PSAPs do not provide T-CPR for OHCA, and very few PSAPs provide compression-only instructions, suggest that there is significant potential to improve the implementation of this critical link in the chain of survival for OHCA.
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Affiliation(s)
- John Sutter
- Arizona Department of Health Services, Bureau of EMS and Trauma System, Phoenix, Arizona ; University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Micah Panczyk
- Arizona Department of Health Services, Bureau of EMS and Trauma System, Phoenix, Arizona
| | - Daniel W Spaite
- University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, Phoenix, Arizona
| | | | - Jason Roosa
- Lutheran Medical Center, Wheat Ridge, Colorado
| | - Christian Dameff
- Arizona Department of Health Services, Bureau of EMS and Trauma System, Phoenix, Arizona
| | - Blake Langlais
- Arizona Department of Health Services, Bureau of EMS and Trauma System, Phoenix, Arizona
| | - Ryan A Murphy
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Bentley J Bobrow
- Arizona Department of Health Services, Bureau of EMS and Trauma System, Phoenix, Arizona ; University of Arizona, Department of Emergency Medicine, Arizona Emergency Medicine Research Center, Phoenix, Arizona
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Libungan B, Lindqvist J, Strömsöe A, Nordberg P, Hollenberg J, Albertsson P, Karlsson T, Herlitz J. Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study. Resuscitation 2015; 94:28-32. [DOI: 10.1016/j.resuscitation.2015.05.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/17/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
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Characterization of in-hospital cardiac arrest in adult patients at a tertiary hospital in Kenya. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Odden MC, Pletcher MJ, Coxson PG, Thekkethala D, Guzman D, Heller D, Goldman L, Bibbins-Domingo K. Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States. Ann Intern Med 2015; 162:533-41. [PMID: 25894023 PMCID: PMC4476404 DOI: 10.7326/m14-1430] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence to guide primary prevention in adults aged 75 years or older is limited. OBJECTIVE To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. DESIGN Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. DATA SOURCES Trial, cohort, and nationally representative data sources. TARGET POPULATION U.S. adults aged 75 to 94 years. TIME HORIZON 10 years. PERSPECTIVE Health care system. INTERVENTION Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. OUTCOME MEASURES Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. RESULTS OF BASE-CASE ANALYSIS All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. RESULTS OF SENSITIVITY ANALYSIS An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. LIMITATION Limited trial evidence targeting primary prevention in adults aged 75 years or older. CONCLUSION At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. PRIMARY FUNDING SOURCE American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
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Affiliation(s)
- Michelle C. Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Pamela G. Coxson
- Department of Medicine, University of California, San Francisco, CA
| | - Divya Thekkethala
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR
| | - David Guzman
- Department of Medicine, University of California, San Francisco, CA
| | - David Heller
- Department of Medicine, University of California, San Francisco, CA
| | - Lee Goldman
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
- Department of Medicine, University of California, San Francisco, CA
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Riggs KR, Becker LB, Sugarman J. Ethics in the use of extracorporeal cardiopulmonary resuscitation in adults. Resuscitation 2015; 91:73-5. [PMID: 25866287 DOI: 10.1016/j.resuscitation.2015.03.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 12/21/2022]
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) promises to be an important advance in the treatment of cardiac arrest. However, ECPR involves ethical challenges that should be addressed as it diffuses into practice. Benefits and risks are uncertain, so the evidence base needs to be further developed, at least through outcomes registries and potentially with randomized trials. To inform decision making, patients' preferences regarding ECPR should be obtained, both from the general population and from inpatients at risk for cardiac arrest. Fair and transparent appropriate use criteria should be developed and could be informed by economic analyses.
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Affiliation(s)
- Kevin R Riggs
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States.
| | - Lance B Becker
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Jeremy Sugarman
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States
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Abstract
BACKGROUND Despite intensive efforts over many years, the United States has made limited progress in improving rates of survival from out-of-hospital cardiac arrest. Recently, national organizations, such as the American Heart Association, have focused on promoting bystander cardiopulmonary resuscitation, use of automated external defibrillators, and other performance improvement efforts. METHODS AND RESULTS Using the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective clinical registry, we identified 70 027 U.S. patients who experienced an out-of-hospital cardiac arrest between October 2005 and December 2012. Using multilevel Poisson regression, we examined temporal trends in risk-adjusted survival. After adjusting for patient and cardiac arrest characteristics, risk-adjusted rates of out-of-hospital cardiac arrest survival increased from 5.7% in the reference period of 2005 to 2006 to 7.2% in 2008 (adjusted risk ratio, 1.27; 95% confidence interval, 1.12-1.43; P<0.001). Survival improved more modestly to 8.3% in 2012 (adjusted risk ratio, 1.47; 95% confidence interval, 1.26-1.70; P<0.001). This improvement in survival occurred in both shockable and nonshockable arrest rhythms (P for interaction=0.22) and was also accompanied by better neurological outcomes among survivors (P for trend=0.01). Improved survival was attributable to both higher rates of prehospital survival, where risk-adjusted rates increased from 14.3% in 2005 to 2006 to 20.8% in 2012 (P for trend<0.001), and in-hospital survival (P for trend=0.015). Rates of bystander cardiopulmonary resuscitation and automated external defibrillator use modestly increased during the study period and partly accounted for prehospital survival trends. CONCLUSIONS Data drawn from a large subset of U.S communities suggest that rates of survival from out-of-hospital cardiac arrest have improved among sites participating in a performance improvement registry.
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Affiliation(s)
- Paul S Chan
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., F.T.); the Department of Emergency Medicine, Emory University, and Rollins School of Public Health, Atlanta, GA (B.M.); and the Uniformed Services University of the Health Sciences, Bethesda, MD (A.K.).
| | - Bryan McNally
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., F.T.); the Department of Emergency Medicine, Emory University, and Rollins School of Public Health, Atlanta, GA (B.M.); and the Uniformed Services University of the Health Sciences, Bethesda, MD (A.K.)
| | - Fengming Tang
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., F.T.); the Department of Emergency Medicine, Emory University, and Rollins School of Public Health, Atlanta, GA (B.M.); and the Uniformed Services University of the Health Sciences, Bethesda, MD (A.K.)
| | - Arthur Kellermann
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., F.T.); the Department of Emergency Medicine, Emory University, and Rollins School of Public Health, Atlanta, GA (B.M.); and the Uniformed Services University of the Health Sciences, Bethesda, MD (A.K.)
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Nassel AF, Root ED, Haukoos JS, McVaney K, Colwell C, Robinson J, Eigel B, Magid DJ, Sasson C. Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado. Resuscitation 2014; 85:1667-73. [PMID: 25263511 DOI: 10.1016/j.resuscitation.2014.08.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/14/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prior research has shown that high-risk census tracts for out-of-hospital cardiac arrest (OHCA) can be identified. High-risk neighborhoods are defined as having a high incidence of OHCA and a low prevalence of bystander cardiopulmonary resuscitation (CPR). However, there is no consensus regarding the process for identifying high-risk neighborhoods. OBJECTIVE We propose a novel summary approach to identify high-risk neighborhoods through three separate spatial analysis methods: Empirical Bayes (EB), Local Moran's I (LISA), and Getis Ord Gi* (Gi*) in Denver, Colorado. METHODS We conducted a secondary analysis of prospectively collected Emergency Medical Services data of OHCA from January 1, 2009 to December 31, 2011 from the City and County of Denver, Colorado. OHCA incidents were restricted to those of cardiac etiology in adults ≥18 years. The OHCA incident locations were geocoded using Centrus. EB smoothed incidence rates were calculated for OHCA using Geoda and LISA and Gi* calculated using ArcGIS 10. RESULTS A total of 1102 arrests in 142 census tracts occurred during the study period, with 887 arrests included in the final sample. Maps of clusters of high OHCA incidence were overlaid with maps identifying census tracts in the below the Denver County mean for bystander CPR prevalence. Five census tracts identified were designated as Tier 1 high-risk tracts, while an additional 7 census tracts where designated as Tier 2 high-risk tracts. CONCLUSION This is the first study to use these three spatial cluster analysis methods for the detection of high-risk census tracts. These census tracts are possible sites for targeted community-based interventions to improve both cardiovascular health education and CPR training.
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Affiliation(s)
| | | | - Jason S Haukoos
- Department of Emergency Medicine, University of Colorado, Aurora, CO, United States; Denver Health and Hospital Authority, Denver, CO, United States; Colorado School of Public Health, Aurora, CO, United States
| | - Kevin McVaney
- Department of Emergency Medicine, University of Colorado, Aurora, CO, United States; Denver Health and Hospital Authority, Denver, CO, United States
| | - Christopher Colwell
- Department of Emergency Medicine, University of Colorado, Aurora, CO, United States; Denver Health and Hospital Authority, Denver, CO, United States
| | - James Robinson
- Denver Health and Hospital Authority, Denver, CO, United States
| | - Brian Eigel
- American Heart Association, Dallas, TX, United States
| | | | - Comilla Sasson
- Department of Emergency Medicine, University of Colorado, Aurora, CO, United States; Colorado School of Public Health, Aurora, CO, United States; American Heart Association, Dallas, TX, United States.
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Blom MT, van Hoeijen DA, Bardai A, Berdowski J, Souverein PC, De Bruin ML, Koster RW, de Boer A, Tan HL. Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest: rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry. Open Heart 2014; 1:e000112. [PMID: 25332818 PMCID: PMC4189338 DOI: 10.1136/openhrt-2014-000112] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/06/2014] [Accepted: 07/15/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA. Methods and analysis We set up a large-scale prospective community-based registry (AmsteRdam Resuscitation Studies, ARREST) in which we prospectively include all resuscitation attempts from OHCA in a large study region in the Netherlands in collaboration with Emergency Medical Services. Of all OHCA victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case–control, cohort, case only and case-cross over designs. Ethics and dissemination We describe the rationale, outline and potential results of the ARREST registry. The design allows for a stable and reliable collection of multiple determinants of OHCA, while assuring that the patient, lay-caregiver or medical professional is not hindered in any way. Such comprehensive data collection is required to unravel the complex basis of OHCA. Results will be published in peer-reviewed journals and presented at relevant scientific symposia.
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Affiliation(s)
- M T Blom
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - D A van Hoeijen
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - A Bardai
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands ; Interuniversity Cardiology Institute Netherlands , Utrecht , The Netherlands
| | - J Berdowski
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - P C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology , Utrecht Institute for Pharmaceutical Sciences , Utrecht , The Netherlands
| | - M L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology , Utrecht Institute for Pharmaceutical Sciences , Utrecht , The Netherlands
| | - R W Koster
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - A de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology , Utrecht Institute for Pharmaceutical Sciences , Utrecht , The Netherlands
| | - H L Tan
- Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Strömsöe A, Svensson L, Axelsson ÅB, Claesson A, Göransson KE, Nordberg P, Herlitz J. Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival. Eur Heart J 2014; 36:863-71. [PMID: 25205528 DOI: 10.1093/eurheartj/ehu240] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/19/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation. METHODS AND RESULTS All cases of OHCA (n = 59,926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100,000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P < 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008-2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008-2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm. CONCLUSION From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.
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Affiliation(s)
- Anneli Strömsöe
- School of Health and Social Sciences, University of Dalarna, Falun SE-791 88, Sweden Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Leif Svensson
- Stockholm Pre-hospital Centre, South Hospital, Stockholm SE-118 83, Sweden
| | - Åsa B Axelsson
- Institute of Health and Caring Science, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Andreas Claesson
- The Prehospital Research Centre Western Sweden, Prehospen University College of Borås, Borås SE-501 90, Sweden Kungälv Ambulance Service, Kungälv SE-442 40, Sweden
| | - Katarina E Göransson
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Medicine, Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Section of Cardiology, Södersjukhuset, Stockholm SE-118 83, Sweden
| | - Johan Herlitz
- Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden The Prehospital Research Centre Western Sweden, Prehospen University College of Borås, Borås SE-501 90, Sweden
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Dumas F, Cariou A. [Epidemiology, prognostic data of cardiac arrest in 2014]. Presse Med 2014; 43:768-74. [PMID: 24890640 DOI: 10.1016/j.lpm.2014.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022] Open
Abstract
Epidemiological data on the incidence, the survival and the prognostic factors of cardiac arrest (CA) are often heterogeneous. However, recent advances in methodology and research have improved the knowledge on that topic. The prognosis of victims CA depends on the initial patient's characteristics, the circumstances of the CA and the quality of the management. As a result, the subsequent outcome of these patients relies on the efficiency of the chain of survival: prompt alert, bystander cardiopulmonary resuscitation and early defibrillation, the advanced care life support provided by the emergency medical services and the integration of in-hospital care. Other parameters are also likely to influence the prognosis (such as the system of care or the environment) though their assessment remains incomplete. More important, factors potentially affecting the long-term outcome are currently very less investigated. Finally, despite the potential improvements in the management of these patients for some years now, the temporal trends of the overall survival appear fairly stable. The transition in the profile of patients could partly explain the absence of clear effect on survival.
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Affiliation(s)
- Florence Dumas
- AP-HP, hôpital Cochin, Inserm U970 (équipe 4), université Paris Descartes, service des urgences, centre d'expertise mort subite, 75014 Paris, France.
| | - Alain Cariou
- AP-HP, hôpital Cochin, Inserm U970 (équipe 4), université Paris Descartes, service de réanimation médicale, 75014 Paris, France
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Lindner T, Vossius C, Mathiesen W, Søreide E. Life years saved, standardised mortality rates and causes of death after hospital discharge in out-of-hospital cardiac arrest survivors. Resuscitation 2014; 85:671-5. [DOI: 10.1016/j.resuscitation.2014.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/20/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022]
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Rea T, Dumas F. Life after death. Resuscitation 2014; 85:585-6. [DOI: 10.1016/j.resuscitation.2014.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
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Eftestøl T, Sherman LD. Towards the automated analysis and database development of defibrillator data from cardiac arrest. BIOMED RESEARCH INTERNATIONAL 2014; 2014:276965. [PMID: 24524074 PMCID: PMC3913461 DOI: 10.1155/2014/276965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/22/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND During resuscitation of cardiac arrest victims a variety of information in electronic format is recorded as part of the documentation of the patient care contact and in order to be provided for case review for quality improvement. Such review requires considerable effort and resources. There is also the problem of interobserver effects. OBJECTIVE We show that it is possible to efficiently analyze resuscitation episodes automatically using a minimal set of the available information. METHODS AND RESULTS A minimal set of variables is defined which describe therapeutic events (compression sequences and defibrillations) and corresponding patient response events (annotated rhythm transitions). From this a state sequence representation of the resuscitation episode is constructed and an algorithm is developed for reasoning with this representation and extract review variables automatically. As a case study, the method is applied to the data abstraction process used in the King County EMS. The automatically generated variables are compared to the original ones with accuracies ≥ 90% for 18 variables and ≥ 85% for the remaining four variables. CONCLUSIONS It is possible to use the information present in the CPR process data recorded by the AED along with rhythm and chest compression annotations to automate the episode review.
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Affiliation(s)
- Trygve Eftestøl
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway
| | - Lawrence D. Sherman
- Department of Medicine, University of Washington, 999 3rd Avenue, Suite 700, Seattle, WA 98104, USA
- Department of Bioengineering, University of Washington, 999 3rd Avenue, Suite 700, Seattle, WA 98104, USA
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Kramer AH, Zygun DA, Doig CJ, Zuege DJ. Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region. CMAJ 2013; 185:E838-45. [PMID: 24167208 DOI: 10.1503/cmaj.130271] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hospital mortality has decreased over time for critically ill patients with various forms of brain injury. We hypothesized that the proportion of patients who progress to neurologic death may have also decreased. METHODS We performed a prospective cohort study involving consecutive adult patients with traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage or anoxic brain injury admitted to regional intensive care units in southern Alberta over a 10.5-year period. We used multivariable logistic regression to adjust for patient age and score on the Glasgow Coma Scale at admission, and to assess whether the proportion of patients who progress to neurologic death has changed over time. RESULTS The cohort consisted of 2788 patients. The proportion of patients who progressed to neurologic death was 8.1% at the start of the study period, and the adjusted odds of progressing to neurologic death decreased over the study period (odds ratio [OR] per yr 0.92, 95% confidence interval [CI] 0.87-0.98, p = 0.006). This change was most pronounced among patients with traumatic brain injury (OR per yr 0.87, 95% CI 0.78-0.96, p = 0.005); there was no change among patients with anoxic injury (OR per yr 0.96, 95% CI 0.85-1.09, p = 0.6). A review of the medical records suggests that missed cases of neurologic death were rare (≤ 0.5% of deaths). INTERPRETATION The proportion of patients with brain injury who progress to neurologic death has decreased over time, especially among those with head trauma. This finding may reflect positive developments in the prevention and care of brain injury. However, organ donation after neurologic death represents the major source of organs for transplantation. Thus, these findings may help explain the relatively stagnant rates of deceased organ donation in some regions of Canada, which in turn has important implications for the care of patients with end-stage organ failure.
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Michiels EA, Dumas F, Quan L, Selby L, Copass M, Rea T. Long-term outcomes following pediatric out-of-hospital cardiac arrest*. Pediatr Crit Care Med 2013; 14:755-60. [PMID: 23925145 DOI: 10.1097/pcc.0b013e31829763e2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pediatric out-of-hospital cardiac arrest is an uncommon event with measurable short-term survival to hospital discharge. For those who survive to hospital discharge, little is known regarding duration of survival. We sought to evaluate the arrest circumstances and long-term survival of pediatric patients who experienced an out-of-hospital cardiac arrest and survived to hospital discharge. DESIGN Retrospective cohort study SETTING King County, WA Emergency Medical Service Catchment and Quaternary Care Children's Hospital PATIENTS Persons less than 19 years old who had an out-of-hospital cardiac arrest and were discharged alive from the hospital between 1976 and 2007. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS During the study period, 1,683 persons less than 19 years old were treated for pediatric out-of-hospital cardiac arrest in the study community, with 91 patients surviving to hospital discharge. Of these 91 survivors, 20 (22%) subsequently died during 1449 person-years of follow-up. Survival following hospital discharge was 92% at 1 year, 86% at 5 years, and 77% at 20 years. Compared to those who subsequently died, long-term survivors were more likely at the time of discharge to be older (mean age, 8 vs 1 yr), had a witnessed arrest (83% vs 56%), presented with a shockable rhythm (40% vs 10%), and had a favorable Pediatric Cerebral Performance Category of 1 or 2 (67% vs 0%). CONCLUSIONS In this population-based cohort study evaluating the long-term outcome of pediatric survivors of out-of-hospital cardiac arrest, we observed that long-term survival was generally favorable. Age, arrest characteristics, and functional status at hospital discharge were associated with prognosis. These findings support efforts to improve pediatric resuscitation, stabilization, and convalescent care.
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Affiliation(s)
- Erica A Michiels
- 1University of Washington, School of Medicine, Seattle, WA. 2Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI. 3Department of Pediatrics, Seattle Children's Hospital, Seattle, WA. 4Paris Cardiovascular Research Center, Paris Descartes University, Paris, France
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Acute myocardial infarction — Historical notes. Int J Cardiol 2013; 167:1825-34. [DOI: 10.1016/j.ijcard.2012.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/05/2012] [Accepted: 12/25/2012] [Indexed: 01/30/2023]
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Cerebral Performance Category and Long-Term Prognosis Following Out-of-Hospital Cardiac Arrest*. Crit Care Med 2013; 41:1252-7. [DOI: 10.1097/ccm.0b013e31827ca975] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med 2012; 367:1912-20. [PMID: 23150959 PMCID: PMC3517894 DOI: 10.1056/nejmoa1109148] [Citation(s) in RCA: 645] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite advances in resuscitation care in recent years, it is not clear whether survival and neurologic function after in-hospital cardiac arrest have improved over time. METHODS We identified all adults who had an in-hospital cardiac arrest at 374 hospitals in the Get with the Guidelines-Resuscitation registry between 2000 and 2009. Using multivariable regression, we examined temporal trends in risk-adjusted rates of survival to discharge. Additional analyses explored whether trends were due to improved survival during acute resuscitation or postresuscitation care and whether they occurred at the expense of greater neurologic disability in survivors. RESULTS Among 84,625 hospitalized patients with cardiac arrest, 79.3% had an initial rhythm of asystole or pulseless electrical activity, and 20.7% had ventricular fibrillation or pulseless ventricular tachycardia. The proportion of cardiac arrests due to asystole or pulseless electrical activity increased over time (P<0.001 for trend). Risk-adjusted rates of survival to discharge increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval [CI], 1.03 to 1.06; P<0.001 for trend). Survival improvement was similar in the two rhythm groups and was due to improvement in both acute resuscitation survival and postresuscitation survival. Rates of clinically significant neurologic disability among survivors decreased over time, with a risk-adjusted rate of 32.9% in 2000 and 28.1% in 2009 (adjusted rate ratio per year, 0.98; 95% CI, 0.97 to 1.00; P=0.02 for trend). CONCLUSIONS Both survival and neurologic outcomes after in-hospital cardiac arrest have improved during the past decade at hospitals participating in a large national quality-improvement registry. (Funded by the American Heart Association.).
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Affiliation(s)
- Saket Girotra
- University of Iowa Hospitals and Clinics, Department of Internal Medicine, Division of Cardiovascular Diseases, 200 Hawkins Dr., Suite 4430 RCP, Iowa City, IA 52242, USA.
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Fischer H, Zapletal B, Neuhold S, Rützler K, Fleck T, Frantal S, Theiler L, Stumpf D, Havel C, Greif R. Single rescuer exertion using a mechanical resuscitation device: a randomized controlled simulation study. Acad Emerg Med 2012; 19:1242-7. [PMID: 23167854 DOI: 10.1111/acem.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/28/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this experimental study was to investigate rescuer exertion when using "Animax," a manually operated hand-powered mechanical resuscitation device (MRD) for cardiopulmonary resuscitation (CPR), compared to standard basic life support (BLS). METHODS This was a prospective, open, randomized, crossover simulation study. After being trained, 80 medical students with substantial knowledge in BLS performed one-rescuer CPR using either the MRD or the standard BLS for 12-minute intervals in random order. The main outcome parameter was the heart rate pressure product (RPP) as an index of cardiac work. Secondary outcome parameters were physical exhaustion quantified by the Borg scale (measurement of perceived exertion), Nine Hole Peg Test (NHPT; measurement of fine motor skills), and capillary lactate concentration during testing. RESULTS While no significant difference could be found for the RPP, a significantly increased mean heart rate during the final minute of standard BLS compared to the MRD was found (139 ± 22 beats/min vs. 135 ± 26 beats/min, p = 0.027). By contrast, subjective exertion using the MRD was rated significantly higher on the Borg scale (15.1 ± 2.4 vs. 14.6 ± 2.6, p = 0.027). Mean serum lactate concentration was significantly higher when the MRD was used compared to standard BLS (3.4 ± 1.5 mmol/L vs. 2.1 ± 1.3 mmol/L, p ≤ 0.001). CONCLUSIONS Use of the MRD leads to a RPP of the rescuers comparable to standard BLS. These findings suggest that there is no clinically relevant reduction of exertion if this MRD is used by a single rescuer. If this kind of MRD is used for CPR, frequent changeovers with a second rescuer should be considered as the guidelines suggest for standard CPR.
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Affiliation(s)
- Henrik Fischer
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Bernhard Zapletal
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Stephanie Neuhold
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | - Kurt Rützler
- Department of Anesthesia; General Intensive Care and Pain Control; Division of Cardiothoracic and Vascular Anesthesia and Intensive Care; Vienna Austria
| | | | - Sophie Frantal
- The Center for Medical Statistics; Informatics and Intelligent Systems; Vienna Austria
| | - Lorenz Theiler
- The Department of Anesthesiology; Perioperative Medicine and Pain Management; University of Miami; Miller School of Medicine Division of Neuroanesthesia Division of Translational Research; Miami FL
| | | | | | - Robert Greif
- The Department of Anesthesiology and Pain Therapy; University Hospital Bern and University; Bern Switzerland
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Hulleman M, Berdowski J, de Groot JR, van Dessel PFHM, Borleffs CJW, Blom MT, Bardai A, de Cock CC, Tan HL, Tijssen JGP, Koster RW. Implantable cardioverter-defibrillators have reduced the incidence of resuscitation for out-of-hospital cardiac arrest caused by lethal arrhythmias. Circulation 2012; 126:815-21. [PMID: 22869841 DOI: 10.1161/circulationaha.111.089425] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Over the last decades, a gradual decrease in ventricular fibrillation (VF) as initial recorded rhythm during resuscitation for out-of-hospital cardiac arrest (OHCA) has been noted. We sought to establish the contribution of implantable cardioverter-defibrillator (ICD) therapy to this decline. METHODS AND RESULTS Using a prospective database of all OHCA resuscitation in the province North Holland in the Netherlands (Amsterdam Resuscitation Studies [ARREST]), we collected data on all patients in whom resuscitation for OHCA was attempted in 2005-2008. VF OHCA incidence (per 100 000 inhabitants per year) was compared with VF OHCA incidence data during 1995-1997, collected in a similar way. We also collected ICD interrogations of all ICD patients from North Holland and identified all appropriate ICD shocks in 2005-2008; we calculated the number of prevented VF OHCA episodes, considering that only part of the appropriate shocks would result in avoided resuscitation. VF OHCA incidence decreased from 21.1/100 000 in 1995-1997 to 17.4/100 000 in 2005-2008 (P<0.001). Non-VF OHCA increased from 12.2/100 000 to 19.4/100 000 (P<0.001). VF as presenting rhythm declined from 63% to 47%. In 2005-2008, 1972 ICD patients received 977 shocks. Of these shocks, 339 were caused by a life-threatening arrhythmia. We estimate that these 339 shocks have prevented 81 (minimum, 39; maximum, 152) cases of VF OHCA, corresponding with 33% (minimum, 16%; maximum, 63%) of the observed decline in VF OHCA incidence. CONCLUSIONS The incidence of VF OHCA decreased over the last 10 years in North Holland. ICD therapy explained a decrease of 1.2/100 000 inhabitants per year, corresponding with 33% of the observed decline in VF OHCA.
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Affiliation(s)
- Michiel Hulleman
- Department of Cardiology, Room G4-229, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Sherren PB, Lewinsohn A, Jovaisa T, Wijayatilake DS. Comparison of the Mapleson C system and adult and paediatric self-inflating bags for delivering guideline-consistent ventilation during simulated adult cardiopulmonary resuscitation*. Anaesthesia 2011; 66:563-7. [DOI: 10.1111/j.1365-2044.2011.06695.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neumar RW, Barnhart JM, Berg RA, Chan PS, Geocadin RG, Luepker RV, Newby LK, Sayre MR, Nichol G. Implementation strategies for improving survival after out-of-hospital cardiac arrest in the United States: consensus recommendations from the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation 2011; 123:2898-910. [PMID: 21576656 DOI: 10.1161/cir.0b013e31821d79f3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Golia E, Piro M, Tubaro M. Out-of-hospital CPR: better outcome for our patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:149. [PMID: 21489324 PMCID: PMC3219366 DOI: 10.1186/cc10108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Out-of-hospital cardiac arrest is a leading cause of death in developed countries and early resuscitation attempts are crucial to improve survival rates and neurological outcome. Gräsner and colleagues performed an intriguing analysis on the combined approach of mild therapeutic hypothermia (MTH) and immediate percutaneous coronary intervention (PCI) for post-resuscitation care of 584 patients with out-of-hospital cardiac arrest from the German Resuscitation Registry. PCI was independently associated with good neurological outcome at hospital discharge after successful resuscitation, and MTH was associated as an independent factor with increased chance of 24-hour survival. Moreover, a binary logistic regression analysis did not show statistical significance for MTH, in addition to PCI, as an independent predictor for good neurological outcome. The present study supports the evidence that post-resuscitation care based on standardized protocols is beneficial after successful resuscitation. Further prospective and randomized studies are warranted to elucidate criteria for a better selection of candidates for those strategies and to evaluate the potential, in terms of neurological outcome at hospital discharge, of a prehospital cooling strategy in patients who cannot be referred to immediate PCI.
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Affiliation(s)
- Enrica Golia
- ICCU, Cardiovascular Department, San Filippo Neri Hospital, Via Martinotti 20, 00135 Rome, Italy.
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