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Shimoda-Sakano TM, Paiva EF, Schvartsman C, Reis AG. Factors associated with survival and neurologic outcome after in-hospital cardiac arrest in children: A cohort study. Resusc Plus 2023; 13:100354. [PMID: 36686327 PMCID: PMC9852640 DOI: 10.1016/j.resplu.2022.100354] [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: 11/20/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Aim In-hospital paediatric cardiopulmonary resuscitation (CPR) survival has been improving in high-income countries. This study aimed to analyse factors associated with survival and neurological outcome after paediatric CPR in a middle-income country. Methods This observational study of in-hospital cardiac arrest using Utstein-style registry included patients <18 years old submitted to CPR between 2015 and 2020, at a high-complexity hospital. Outcomes were survival and neurological status assessed using Paediatric Cerebral Performance Categories score at prearrest, discharge, and after 180 days. Results Of 323 patients who underwent CPR, 108 (33.4%) survived to discharge and 93 (28.8%) after 180 days. In multivariable analysis, lower survival at discharge was associated with liver disease (OR 0.060, CI 0.007-0.510, p = 0.010); vasoactive drug infusion before cardiac arrest (OR 0.145, CI 0.065-0.325, p < 0.001); shock as the immediate cause (OR 0.183, CI 0.069-0.486, p = 0.001); resuscitation > 30 min (OR 0.070, CI 0.014-0.344, p = 0.001); and bicarbonate administration during CPR (OR 0.318, CI 0.130-0.780, p = 0.01). The same factors remained associated with lower survival after 180 days. Neurological outcome was analysed in the 93 survivors after 180 days following CPR. Prearrest neurological dysfunction was observed in 31.4%, and neurological prognosis was favourable in 79.7% at discharge and similar after 180 days. Conclusion In-hospital paediatric cardiac arrest patients with complex chronic conditions had lower survival associated with liver disease, shock as cause of cardiac arrest, vasoactive drug infusion before cardiac arrest, bicarbonate administration during CPR, and prolonged resuscitation. Most survivors had favourable neurological outcome.
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Affiliation(s)
| | | | | | - Amelia G. Reis
- University of Sao Paulo Children Institute, São Paulo, SP, Brazil
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2
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Kobewka D, Young T, Adewole T, Fergusson D, Fernando S, Ramsay T, Kimura M, Wegier P. Quality of life and functional outcomes after in-hospital cardiopulmonary resuscitation. A systematic review. Resuscitation 2022; 178:45-54. [PMID: 35840012 DOI: 10.1016/j.resuscitation.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022]
Abstract
AIM Our aim was to determine the association of cardiopulmonary resuscitation (CPR) for in hospital cardiac arrest (IHCA) with quality of life after discharge. METHODS We performed a systematic review using available databases for studies that measured any quality-of-life or functional outcome both before and after CPR for IHCA. All screening and data abstraction was performed in duplicate. RESULTS We screened 10,927 records and included 24 papers representing 20 unique studies. Fifteen studies measured Cerebral Performance Category. Survival ranged from 11.8% to 39.5%. The risk of impaired cerebral function after discharged ranged from -16.1% (lower risk) to 44.7% increased risk of poor cerebral function after surviving to discharge. Four studies measured discharge to an institutional environment finding that the risk was increased by 18.2-72.2% among survivors. One study measured EQ-5D and found no difference pre and post CPR. One study measured performance of activities of daily living finding that survivors needed assistance with more activities after discharge. CONCLUSION Our review is limited by the lack of adjustment for confounders, including the baseline level of each outcome, in all included studies. Therefore, although risk for most outcomes was increased after discharge vs pre-admission we cannot be certain if this is a causal relationship.
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Affiliation(s)
- Daniel Kobewka
- Investigator, Bruyere Research Institute, Ottawa, ON, Canada; Clinician Investigator, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | | | | | - Dean Fergusson
- Senior Scientist, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shannon Fernando
- Clinician Investigator, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Tim Ramsay
- Senior Scientist, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Pete Wegier
- Researcher, Humber River Hospital, Toronto, ON, Canada
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3
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Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest. Sci Rep 2022; 12:5685. [PMID: 35383220 PMCID: PMC8983650 DOI: 10.1038/s41598-022-09510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged ≥ 18 years suffering IHCA (2008–2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) ≥ 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40–49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60–0.74) for HF alone, and 0.49 (0.43–0.57) for HF with AMI. OR for 30-day survival in 2017–2019 compared with 2008–2010 were 1.55 (1.24–1.93) for AMI alone, 1.37 (1.00–1.87) for HF with AMI and 1.30 (1.07–1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.
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Farrell TW, Widera E, Rosenberg L, Rubin CD, Naik AD, Braun U, Torke A, Li I, Vitale C, Shega J. AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults. J Am Geriatr Soc 2016; 65:14-15. [PMID: 27874181 DOI: 10.1111/jgs.14586] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision-making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf. The process of arriving at a treatment decision for an unbefriended older adult should be conducted according to standards of procedural fairness and include capacity assessment, a search for potentially unidentified surrogate decision makers (including non-traditional surrogates) and a team-based effort to ascertain the unbefriended older adult's preferences by synthesizing all available evidence. A concerted national effort is needed to help reduce the significant state-to-state variability in legal approaches to unbefriended patients. Proactive efforts are also needed to identify older adults, including "adult orphans," at risk for becoming unbefriended and to develop alternative approaches to medical decision making for unbefriended older adults. This document updates the 1996 AGS position statement on unbefriended older adults.
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Affiliation(s)
- Timothy W Farrell
- University of Utah School of Medicine, Salt Lake City, UT.,VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, UT
| | - Eric Widera
- University of California San Francisco, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Craig D Rubin
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Aanand D Naik
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | - Ursula Braun
- Baylor College of Medicine, Houston, TX.,Michael E. DeBakey VA Medical Center, Houston, TX
| | | | - Ina Li
- Christiana Care Health System, Wilmington, DE
| | - Caroline Vitale
- University of Michigan, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Joseph Shega
- VITAS Hospice Care Healthcare, Gotha, FL.,University of Central Florida, Gotha, FL
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A. Mayer P, Daly BJ. CPR and hospice: Incompatible goals, irreconcilable differences. PROGRESS IN PALLIATIVE CARE 2015. [DOI: 10.1179/1743291x14y.0000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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López-Herce J, del Castillo J, Matamoros M, Canadas S, Rodriguez-Calvo A, Cecchetti C, Rodríguez-Núnez A, Carrillo Á. Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study. Crit Care 2014; 18:607. [PMID: 25672247 PMCID: PMC4245792 DOI: 10.1186/s13054-014-0607-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children. METHODS A prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality. RESULTS Return of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80. CONCLUSIONS Secondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.
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Affiliation(s)
- Jesús López-Herce
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
| | - Jimena del Castillo
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
| | | | - Sonia Canadas
- />Hospital Valle de Hebrón, Passeig Vall d’Hebron, 119-129 08035 Barcelona, Spain
| | | | - Corrado Cecchetti
- />Ospedale Bambinu Gesu, Via della Torre di Palidoro, 00050 Fiumicino Roma, Italy
| | - Antonio Rodríguez-Núnez
- />Hospital Clínico Universitario de Santiago de Compostela, Travesía de Choupana, s/n, 15706 A Coruña, Spain
| | - Ángel Carrillo
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
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Stecker EC, Teodorescu C, Reinier K, Uy-Evanado A, Mariani R, Chugh H, Gunson K, Jui J, Chugh SS. Ischemic heart disease diagnosed before sudden cardiac arrest is independently associated with improved survival. J Am Heart Assoc 2014; 3:e001160. [PMID: 25288613 PMCID: PMC4323832 DOI: 10.1161/jaha.114.001160] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Sudden cardiac arrest (SCA) is a significant public health problem, and rates of survival after resuscitation remain well below 10%. While several resuscitation‐related factors are consistently associated with survival from SCA, the impact of specific comorbid conditions has not been assessed. Methods and Results The Oregon Sudden Unexpected Study is an ongoing, multisource, community‐based study in Portland, Oregon. Patients with SCA who underwent attempted resuscitation between 2002 and 2012 were included in this analysis if there were both arrest and prearrest medical records available. Information from the emergency medical services system, medical examiner, public health division, hospitals, and clinics was used to adjudicate SCA, evaluate comorbidities, and identify medical treatments. Univariate and multivariate analyses were performed to investigate the influence of prearrest comorbidities on survival to hospital discharge. Among 1466 included patients, established resuscitation‐related predictors (Utstein factors) were associated with survival, consistent with prior reports. When a panel of prearrest comorbidities was evaluated along with Utstein factors, recognized coronary artery disease was significantly associated and predicted higher odds of survival (unadjusted odds ratio 1.5, P<0.001; adjusted odds ratio 1.5, P=0.02). In multivariable logistic models, prearrest coronary artery disease modified the survival effects of bystander cardiopulmonary resuscitation, but did not modify other Utstein factors. Conclusions An established diagnosis of coronary artery disease was associated with 50% higher odds of survival from resuscitated SCA after adjustment for all arrest‐related predictors. These findings raise novel potential mechanistic insights into survival after SCA, while highlighting the importance of early recognition and treatment of coronary artery disease.
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Affiliation(s)
- Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (E.C.S.)
| | - Carmen Teodorescu
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
| | - Kyndaron Reinier
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
| | - Audrey Uy-Evanado
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
| | - Ronald Mariani
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
| | - Harpriya Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
| | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland, OR (K.G.)
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR (J.J.)
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.T., K.R., A.U.E., R.M., H.C., S.S.C.)
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Serrano M, Rodríguez J, Espejo A, del Olmo R, Llanos S, del Castillo J, López-Herce J. Relationship between previous severity of illness and outcome of in-hospital cardiac arrest. An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Serrano M, Rodríguez J, Espejo A, del Olmo R, Llanos S, Del Castillo J, López-Herce J. [Relationship between previous severity of illness and outcome of in-hospital cardiac arrest]. An Pediatr (Barc) 2014; 81:9-15. [PMID: 24286880 DOI: 10.1016/j.anpedi.2013.09.018] [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: 06/08/2013] [Revised: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. METHODS The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. RESULTS The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. CONCLUSION A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.
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Affiliation(s)
- M Serrano
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Rodríguez
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - A Espejo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - R del Olmo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - S Llanos
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España.
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Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS. Hospital variation in survival after in-hospital cardiac arrest. J Am Heart Assoc 2014; 3:e000400. [PMID: 24487717 PMCID: PMC3959682 DOI: 10.1161/jaha.113.000400] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is common and often fatal. However, the extent to which hospitals vary in survival outcomes and the degree to which this variation is explained by patient and hospital factors is unknown. METHODS AND RESULTS Within Get with the Guidelines-Resuscitation, we identified 135 896 index IHCA events at 468 hospitals. Using hierarchical models, we adjusted for demographics comorbidities and arrest characteristics (eg, initial rhythm, etiology, arrest location) to generate risk-adjusted rates of in-hospital survival. To quantify the extent of hospital-level variation in risk-adjusted rates, we calculated the median odds ratio (OR). Among study hospitals, there was significant variation in unadjusted survival rates. The median unadjusted rate for the bottom decile was 8.3% (range: 0% to 10.7%) and for the top decile was 31.4% (28.6% to 51.7%). After adjusting for 36 predictors of in-hospital survival, there remained substantial variation in rates of in-hospital survival across sites: bottom decile (median rate, 12.4% [0% to 15.6%]) versus top decile (median rate, 22.7% [21.0% to 36.2%]). The median OR for risk-adjusted survival was 1.42 (95% CI: 1.37 to 1.46), which suggests a substantial 42% difference in the odds of survival for patients with similar case-mix at similar hospitals. Further, significant variation persisted within hospital subgroups (eg, bed size, academic). CONCLUSION Significant variability in IHCA survival exists across hospitals, and this variation persists despite adjustment for measured patient factors and within hospital subgroups. These findings suggest that other hospital factors may account for the observed site-level variations in IHCA survival.
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Affiliation(s)
- Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
Dyspnea is the predominant symptom for patients with acute heart failure and initial treatment is largely directed towards the alleviation of this. Contrary to conventional belief, not all patients present with fluid overload and the approach to management is rapidly evolving from a solitary focus on diuresis to one that more accurately reflects the complex interplay of underlying cardiac dysfunction and acute precipitant. Effective treatment thus requires an understanding of divergent patient profiles and an appreciation of various therapeutic options for targeted patient stabilization. The key principle within this paradigm is directed management that aims to diminish the work of breathing through situation appropriate ventillatory support, volume reduction and hemodynamic improvement. With such an approach, clinicians can more efficiently address respiratory discomfort while reducing the likelihood of avoidable harm.
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Affiliation(s)
- Phillip D Levy
- Associate Professor of Emergency Medicine, Assistant Director of Clinical Research, Cardiovascular Research Institute, Associate Director of Clinical Research, Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine; UHC - 6G, Detroit, MI 48201, Office: +1 313 993 8558
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Saevareid TJ, Balandin S. Nurses’ perceptions of attempting cardiopulmonary resuscitation on oldest old patients. J Adv Nurs 2011; 67:1739-48. [DOI: 10.1111/j.1365-2648.2011.05622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Opie LH, Lecour S, Mardikar H, Deshpande GP. Cardiac survival strategies: an evolutionary hypothesis with rationale for metabolic therapy of acute heart failure. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/0035919x.2010.537886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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