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Carmona-Puerta R, Choque-Laura JL, Chávez-González E, Peñaló-Batista J, Martínez-Sánchez MDC, Lorenzo-Martínez E. Associated factors with the occurrence of in-hospital cardiac arrest in patients admitted to internal medicine wards for non-cardiovascular causes. Med Clin (Barc) 2024; 162:574-580. [PMID: 38637218 DOI: 10.1016/j.medcli.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND OBJECTIVE In-hospital cardiac arrest (IHCA) has a low survival rate, so it is essential to recognize the cases with the highest probability of developing it. The aim of this study is to identify factors associated with the occurrence of IHCA. MATERIAL AND METHODS A single-center case-control study was conducted including 65 patients admitted to internal medicine wards for non-cardiovascular causes who experienced IHCA, matched with 210 admitted controls who did not present with IHCA. RESULTS The main reason for admission was pneumonia. The most prevalent comorbidity was arterial hypertension. Four characteristics were strongly and independently associated with IHCA presentation, these are electrical left ventricular hypertrophy (LVH) (OR: 13.8; 95% IC: 4.7-40.7), atrial fibrillation (OR: 9.4: 95% CI: 4.3-20.6), the use of drugs with known risk of torsades de pointes (OR: 2.7; 95% CI: 1.3-5.5) and the combination of the categories known risk plus conditional risk (OR: 17.1; 95% CI: 6.7-50.1). The first two detected in the electrocardiogram taken at the time of admission. CONCLUSION In admitted patients for non-cardiovascular causes, the use of drugs with a known risk of torsades de pointes, as well as the detection of electrical LVH and atrial fibrillation in the initial electrocardiogram, is independently associated with a higher probability of suffering a IHCA.
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Affiliation(s)
| | - José Luis Choque-Laura
- Servicio de Medicina Interna, Hospital Municipal Boliviano Holandés, Provincia Murillo, El Alto, Bolivia
| | - Elibet Chávez-González
- Servicio de Arritmología y Electrofisiología, Hospital Universitario Cardiocentro Ernesto Guevara, Santa Clara, Cuba
| | - Joel Peñaló-Batista
- Universidad Católica del Cibao (UCATECI), Centro de Medicina Familiar Especializada (CEMEFE), La Vega, República Dominicana
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Tanii R, Hayashi K, Naito T, Shui-Yee Wong Z, Yoshida T, Hayashi K, Fujitani S. Impact of dynamic parameter of trends in vital signs on the prediction of serious events in hospitalized patients -a retrospective observational study. Resusc Plus 2024; 18:100628. [PMID: 38617440 PMCID: PMC11015492 DOI: 10.1016/j.resplu.2024.100628] [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: 01/24/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Aim Although early detection of patients' deterioration may improve outcomes, most of the detection criteria use on-the-spot values of vital signs. We investigated whether adding trend values over time enhanced the ability to predict adverse events among hospitalized patients. Methods Patients who experienced adverse events, such as unexpected cardiac arrest or unplanned ICU admission were enrolled in this retrospective study. The association between the events and the combination of vital signs was evaluated at the time of the worst vital signs 0-8 hours before events (near the event) and at 24-48 hours before events (baseline). Multivariable logistic analysis was performed, and the area under the receiver operating characteristic curve (AUC) was used to assess the prediction power for adverse events among various combinations of vital sign parameters. Results Among 24,509 in-patients, 54 patients experienced adverse events(cases) and 3,116 control patients eligible for data analysis were included. At the timepoint near the event, systolic blood pressure (SBP) was lower, heart rate (HR) and respiratory rate (RR) were higher in the case group, and this tendency was also observed at baseline. The AUC for event occurrence with reference to SBP, HR, and RR was lower when evaluated at baseline than at the timepoint near the event (0.85 [95%CI: 0.79-0.92] vs. 0.93 [0.88-0.97]). When the trend in RR was added to the formula constructed of baseline values of SBP, HR, and RR, the AUC increased to 0.92 [0.87-0.97]. Conclusion Trends in RR may enhance the accuracy of predicting adverse events in hospitalized patients.
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Affiliation(s)
- Rimi Tanii
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, 1197-1 Yasushi-cho, Asahi-ku, Yokohama, Kanagawa, Japan
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Kuniyoshi Hayashi
- Faculty of Data Science, Kyoto Women’s University, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Zoie Shui-Yee Wong
- Graduate School of Public Health, St. Luke’s International University Omura Susumu & Mieko Memorial St.Luke’s Center for Clinical Academia, 5th floor, 3-6-2 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Koichi Hayashi
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, 1197-1 Yasushi-cho, Asahi-ku, Yokohama, Kanagawa, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
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Collie BL, Emami S, Lyons NB, Ramsey WA, O'Neil CF, Meizoso JP, Ginzburg E, Pizano LR, Schulman CI, Parker BM, Namias N, Proctor KG. Survival of In-Hospital Cardiopulmonary Arrest in Trauma Patients. J Surg Res 2024; 298:379-384. [PMID: 38669784 DOI: 10.1016/j.jss.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Relative to other hospitalized patients, trauma patients are younger with fewer comorbidities, but the incidence and outcomes of in-hospital cardiopulmonary arrest (IHCA) with cardiopulmonary resuscitation (CPR) in this population is unknown. Therefore, we aimed to investigate factors associated with survival in trauma patients after IHCA to test the hypothesis that compared to other hospitalized patients, trauma patients with IHCA have improved survival. METHODS Retrospective review of the Trauma Quality Improvement Program database 2017 to 2019 for patients who had IHCA with CPR. Primary outcome was survival to hospital discharge. Secondary outcomes were in-hospital complications, hospital length of stay, intensive care unit length of stay, and ventilator days. Data were compared with univariate and multivariate analyses at P < 0.05. RESULTS In 22,346,677 admitted trauma patients, 14,056 (0.6%) received CPR. Four thousand three hundred seventy-seven (31.1%) survived to discharge versus 26.4% in a national sample of all hospitalized patients (P < 0.001). In trauma patients, median age was 55 y, the majority were male (72.2%). Mortality was higher for females versus males (70.3% versus 68.3%, P = 0.026). Multivariate regression showed that older age 1.01 (95% confidence interval (CI) 1.01-1.02), Hispanic ethnicity 1.21 (95% CI 1.04-1.40), and penetrating trauma 1.51 (95% CI 1.32-1.72) were risk factors for mortality, while White race was a protective factor 0.36 (95% CI 0.14-0.89). CONCLUSIONS This is the first study to show that the incidence of IHCA with CPR is approximately six in 1000 trauma admissions and 31% survive to hospital discharge, which is higher than other hospitalized patients. Age, gender, racial, and ethnic disparities also influence survival.
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Affiliation(s)
- Brianna L Collie
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
| | - Shaheen Emami
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicole B Lyons
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Walter A Ramsey
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Christopher F O'Neil
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Jonathan P Meizoso
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Enrique Ginzburg
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Louis R Pizano
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Carl I Schulman
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Brandon M Parker
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Kenneth G Proctor
- Division of Trauma, Burns, and Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
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Luo H, Zhang Q, Meng X, Kan H, Chen R. Air Pollution and Cardiac Arrest: A More Significant Intermediate Role of COPD than Cardiac Events. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:7782-7790. [PMID: 38664224 DOI: 10.1021/acs.est.4c00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
No prior studies have linked long-term air pollution exposure to incident sudden cardiac arrest (SCA) or its possible development trajectories. We aimed to investigate the association between long-term exposure to air pollution and SCA, as well as possible intermediate diseases. Based on the UK Biobank cohort, Cox proportional hazard model was applied to explore associations between air pollutants and SCA. Chronic obstructive pulmonary disease (COPD) and major adverse cardiovascular events (MACE) were selected as intermediate conditions, and multistate model was fitted for trajectory analysis. During a median follow-up of 13.7 years, 2884 participants developed SCA among 458 237 individuals. The hazard ratios (HRs) for SCA were 1.04-1.12 per interquartile range increment in concentrations of fine particulate matter, inhalable particulate matter, nitrogen dioxide, and nitrogen oxides. Most prominently, air pollutants could induce SCA through promoting transitions from baseline health to COPD (HRs: 1.06-1.24) and then to SCA (HRs: 1.16-1.27). Less importantly, SCA could be developed through transitions from baseline health to MACE (HRs: 1.02-1.07) and further to SCA (HRs: 1.12-1.16). This study provides novel and compelling evidence that long-term exposure to air pollution could promote the development of SCA, with COPD serving as a more important intermediate condition than MACE.
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Affiliation(s)
- Huihuan Luo
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University School of Public Health, Shanghai 200032, China
| | - Qingli Zhang
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University School of Public Health, Shanghai 200032, China
| | - Xia Meng
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University School of Public Health, Shanghai 200032, China
| | - Haidong Kan
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University School of Public Health, Shanghai 200032, China
| | - Renjie Chen
- Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University School of Public Health, Shanghai 200032, China
- School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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Beekman R, Gilmore EJ. Cerebral edema following cardiac arrest: Are all shades of gray equal? Resuscitation 2024; 198:110213. [PMID: 38636600 DOI: 10.1016/j.resuscitation.2024.110213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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Vahedian-Azimi A, Hassan IF, Rahimi-Bashar F, Elmelliti H, Akbar A, Shehata AL, Ibrahim AS, Ait Hssain A. What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study. Int J Emerg Med 2024; 17:56. [PMID: 38632515 PMCID: PMC11022486 DOI: 10.1186/s12245-024-00608-2] [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: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR. METHODS This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests. RESULTS The mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021-3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289-4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907-5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092-3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161-0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration. CONCLUSION These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma research center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Anzila Akbar
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ahmed Labib Shehata
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Abdulsalam Saif Ibrahim
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar
| | - Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
- Department of Medicine, Weill Cornell Medical College, PO BOX 3050, Doha, Qatar.
- Medical Intensive Care Unit, ECMO team, Hamad General Hospital, Doha, Qatar.
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Strömsöe A, Herlitz J. Incidence and percentage of survival after cardiac arrest outside and inside hospital: A comparison between two regions in Sweden. Resusc Plus 2024; 17:100594. [PMID: 38469565 PMCID: PMC10926284 DOI: 10.1016/j.resplu.2024.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Aim To compare the incidence and percentage of survival after cardiac arrest outside and inside hospital where cardiopulmonary resuscitation (CPR) had been started between two regions in Sweden in a 10-year perspective. Methods A retrospective observational study including CPR treated patients both after out-of-hospital and in-hospital cardiac arrest (OHCA and IHCA) in Sweden, 2013-2022. Data was retrieved from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). Results The overall incidence of OHCA and IHCA events were 2,940 in Dalarna (having a lower population and population density) and 16,187 in Västra Götaland (having a higher population and population density). The overall incidence of survival when OHCA and IHCA were combined was 20 per 100,000 person years in Dalarna and 19 per 100,000 person years in Västra Götaland. The corresponding result for OHCA was 9 versus 7 and for IHCA 11 versus 12. The overall percentage of survival was 20% in Dalarna and 19% in Västra Götaland. The corresponding result for OHCA was 13% versus 10% and for IHCA 37% versus 36%. Conclusion Overall, there was no marked difference neither in incidence nor in percentage of survival after cardiac arrest between the two regions. However, regarding cardiac arrest that took place outside hospital both incidence and percentage of survival was higher in Dalarna than in Västra Götaland despite the fact that the former had lower population density.
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Affiliation(s)
- A. Strömsöe
- School of Health and Welfare, Dalarna University, S-79188 Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, S-79182 Falun, Sweden
- Department of Prehospital Care, Region of Dalarna, S-79129 Falun, Sweden
| | - J. Herlitz
- Department of Caring Science, University of Borås, S-50190 Borås, Sweden
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8
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Silverplats J, Äng B, Källestedt MLS, Strömsöe A. Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry - A comparison of reported and non-reported events. Resuscitation 2024; 195:110119. [PMID: 38244762 DOI: 10.1016/j.resuscitation.2024.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Approximately 2500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence. METHODS Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events. RESULTS A total of 3638 hospital medical records were reviewed and 1109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1000 hospital admissions and 12.4/1000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events. CONCLUSION IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures.
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Affiliation(s)
- Jennie Silverplats
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Department of Anaesthesiology and Intensive Care, Region Dalarna, SE-79285 Mora, Sweden.
| | - Björn Äng
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14186 Huddinge, Sweden; Center for Clinical Research Dalarna, Uppsala University, SE-79182 Falun, Sweden.
| | - Marie-Louise Södersved Källestedt
- Centre for Clinical Research Västmanland, Uppsala University, Affiliated with Mälardalen University, Sweden, SE-72189 Västerås, Sweden.
| | - Anneli Strömsöe
- Department of Health and Welfare, Dalarna University, SE-79188 Falun, Sweden; Center for Clinical Research Dalarna, Uppsala University, SE-79182 Falun, Sweden; Department of Prehospital Care, Region Dalarna, SE-79129 Falun, Sweden.
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9
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Smith D, Kenigsberg BB. Management of Patients After Cardiac Arrest. Crit Care Clin 2024; 40:57-72. [PMID: 37973357 DOI: 10.1016/j.ccc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Cardiac arrest remains a significant cause of morbidity and mortality, although contemporary care now enables potential survival with good neurologic outcome. The core acute management goals for survivors of cardiac arrest are to provide organ support, sustain adequate hemodynamics, and evaluate the underlying cause of the cardiac arrest. In this article, the authors review the current state of knowledge and clinical intensive care unit practice recommendations for patients after cardiac arrest, particularly focusing on important areas of uncertainty, such as targeted temperature management, neuroprognostication, coronary evaluation, and hemodynamic targets.
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Affiliation(s)
- Damien Smith
- Department of Medicine, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Benjamin B Kenigsberg
- Department of Critical Care, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA; Division of Cardiology, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.
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10
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Lee JH, Lee DH, Lee BK, Ryu SJ. The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest. World J Emerg Med 2024; 15:223-228. [PMID: 38855379 PMCID: PMC11153364 DOI: 10.5847/wjem.j.1920-8642.2024.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/12/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Ji Ho Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Seok Jin Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
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Poveda-Henao C, Valenzuela-Faccini N, Pérez-Garzón M, Mantilla-Viviescas K, Chavarro-Alfonso O, Robayo-Amortegui H. Neurological outcomes and quality of life in post-cardiac arrest patients with return of spontaneous circulation supported by ECMO: A retrospective case series. Medicine (Baltimore) 2023; 102:e35842. [PMID: 38115364 PMCID: PMC10727675 DOI: 10.1097/md.0000000000035842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 12/21/2023] Open
Abstract
Post-cardiac arrest brain injury constitutes a significant contributor to morbidity and mortality, leading to cognitive impairment and subsequent disability. Individuals within this patient cohort grapple with uncertainty regarding the potential advantages of extracorporeal life support (ECMO) cannulation. This study elucidates the neurological outcomes and quality of life of post-cardiac arrest patients who attained spontaneous circulation and underwent ECMO cannulation. This is a retrospective case study within a local context, the research involved 32 patients who received ECMO support following an intrahospital cardiac arrest with return of spontaneous circulation (ROSC). An additional 32 patients experienced cardiac arrest with ROSC before undergoing cannulation. The average age was 41 years, with the primary causes of cardiac arrest identified as acute coronary syndrome (46.8%), pulmonary thromboembolism (21.88%), and hypoxemia (18.7%). The most prevalent arrest rhythm was asystole (37.5%), followed by ventricular fibrillation (34.4%). The mean SOFA score was 7 points (IQR 6.5-9), APACHE II score was 12 (IQR 9-16), RESP score was -1 (IQR -1 to -4) in cases of respiratory ECMO, and SAVE score was -3 (IQR -5 to 2) in cases of cardiac ECMO. Overall survival was 71%, and at 6 months, the Barthel score was 75 points, modified Rankin score was 2, cerebral performance categories score was 1, and the SF-12 had an average score of 30. Notably, there were no significant associations between the time, cause, or rhythm of cardiac arrest and neurological outcomes. Importantly, cardiac arrest is not a contraindication for ECMO cannulation. A meticulous assessment of candidates who have achieved spontaneous circulation after cardiac arrest, considering the absence of early signs of poor neurological prognosis, is crucial in patient selection. Larger prospective studies are warranted to validate and extend these findings.
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Affiliation(s)
| | | | - Michel Pérez-Garzón
- Critical Medicine and Intensive Care, Fundación Clínica Shaio, Bogotá, Colombia
| | | | - Omar Chavarro-Alfonso
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
| | - Henry Robayo-Amortegui
- Critical Medicine and Intensive Care resident, Universidad de La Sabana, Chía, Colombia
- Grupo de Investigacion Clinica UPTC
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Thevathasan T, Paul J, Gaul AL, Degbeon S, Füreder L, Dischl D, Knie W, Girke G, Wurster T, Landmesser U, Skurk C. Mortality and healthcare resource utilisation after cardiac arrest in the United States - A 10-year nationwide analysis prior to the COVID-19 pandemic. Resuscitation 2023; 193:109946. [PMID: 37634860 DOI: 10.1016/j.resuscitation.2023.109946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
AIM Understanding the public health burden of cardiac arrest (CA) is important to inform healthcare policies, particularly during healthcare crises such as the COVID-19 pandemic. This study aimed to analyse outcomes of in-hospital mortality and healthcare resource utilisation in adult patients with CA in the United States over the last decade prior to the COVID-19 pandemic. METHODS The United States (US) National Inpatient Sample was utilised to identify hospitalised adult patients with CA between 2010 and 2019. Logistic and Poisson regression models were used to analyse outcomes by adjusting for 47 confounders. RESULTS 248,754 adult patients with CA (without "Do Not Resuscitate"-orders) were included in this study, out of which 57.5% were male. In-hospital mortality was high with 51.2% but improved significantly from 58.3% in 2010 to 46.4% in 2019 (P < 0.001). Particularly, elderly patients, non-white patients and patients requiring complex therapy had a higher mortality rate. Although the average hospital LOS decreased by 11%, hospital expenses have increased by 13% between 2010 and 2019 (each P < 0.001), presumably due to more frequent use of mechanical circulatory support (MCS, e.g. ECMO from 2.6% to 8.7% or Impella® micro-axial flow pump from 1.8% to 14.2%). Strong disparities existed among patient age groups and ethnicities across the US. Of note, the number of young adults with CA and opioid-induced CA has almost doubled within the study period. CONCLUSION Over the last ten years prior to the COVID-19 pandemic, CA-related survival has incrementally improved with shorter hospitalisations and increased medical expenses, while strong disparities existed among different age groups and ethnicities. National standards for CA surveillance should be considered to identify trends and differences in CA treatment to allow for standardised medical care.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Julia Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anna L Gaul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lisa Füreder
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Dominic Dischl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wulf Knie
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Girke
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Wurster
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany.
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13
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Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
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14
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Thorén A, Jonsson M, Spångfors M, Joelsson-Alm E, Jakobsson J, Rawshani A, Kahan T, Engdahl J, Jadenius A, Boberg von Platen E, Herlitz J, Djärv T. Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study. Resuscitation 2023; 193:109978. [PMID: 37742939 DOI: 10.1016/j.resuscitation.2023.109978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs. METHODS A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs. RESULTS In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001). CONCLUSION IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.
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Affiliation(s)
- Anna Thorén
- Department of Medicine Solna, Center for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden.
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-221 84 Lund, Sweden; Department of Anaesthesia and Intensive Care, Kristianstad Hospital, SE-291 89 Kristianstad, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Jan Jakobsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Wallenberg Laboratory, University of Gothenburg, SE-413 45 Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital/Mölndal, SE-413 45 Gothenburg, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Johan Engdahl
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Arvid Jadenius
- Department of Molecular and Clinical Medicine, Institute of Medicine, Wallenberg Laboratory, University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Erik Boberg von Platen
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Johan Herlitz
- The Center for Pre-Hospital Research in Western Sweden, University of Borås, SE-501 90 Borås, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Center for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Acute and Reparative Medicine, Karolinska University Hospital, SE-171 64, Stockholm, Sweden
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15
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Hasegawa D, Sharma A, Dugar S, Lee YI, Sato R. Mortality of in-hospital cardiac arrest among patients with and without preceding sepsis: A national inpatient sample analysis. J Crit Care 2023; 78:154404. [PMID: 37647817 DOI: 10.1016/j.jcrc.2023.154404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/05/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The impact of preceding sepsis on in-hospital cardiac arrest (IHCA)-related mortality has not been established. This study aimed to determine the association between IHCA-related mortality and sepsis. METHODS This retrospective study used the National Inpatient Sample data from 01/2017 to 12/2019. The study included adults (≥18 years) who suffered from IHCA. The study classified cardiac arrest rhythms as ventricular tachycardia/ventricular fibrillation or pulseless electronic activity/asystole. We compared the IHCA-related in-hospital mortality between sepsis and non-sepsis groups in all patients and subgroups divided by cardiac arrest rhythm and age. Multivariable logistic regression analysis was performed to assess the independent association between sepsis and in-hospital mortality. RESULTS A total of 357,850 hospitalizations who suffered from IHCA were identified, with sepsis present in 17.6% of patients. IHCA-related in-hospital mortality was 84.8% in sepsis and 68.4% in non-sepsis-related hospitalizations (p < 0.001). IHCA-related in-hospital mortality was higher in sepsis than in non-sepsis groups, regardless of age or cardiac arrest rhythms. In multivariable logistic regression analysis, sepsis was significantly associated with higher mortality with an odds ratio of 2.27 (95% confidence interval: 2.07-2.50, p < 0.001). CONCLUSION Sepsis was associated with higher in-hospital cardiac arrest mortality compared to non-sepsis cases, regardless of age and cardiac rhythm.
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Affiliation(s)
- Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, NY, USA
| | - Aniket Sharma
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, NY, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, OH, USA; Cleveland Clinic Lerner College of Medicine, OH, USA
| | - Young Im Lee
- Department of Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, NY, USA
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, HI, USA.
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16
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Lee H, Yang HL, Ryu HG, Jung CW, Cho YJ, Yoon SB, Yoon HK, Lee HC. Real-time machine learning model to predict in-hospital cardiac arrest using heart rate variability in ICU. NPJ Digit Med 2023; 6:215. [PMID: 37993540 PMCID: PMC10665411 DOI: 10.1038/s41746-023-00960-2] [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: 06/20/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023] Open
Abstract
Predicting in-hospital cardiac arrest in patients admitted to an intensive care unit (ICU) allows prompt interventions to improve patient outcomes. We developed and validated a machine learning-based real-time model for in-hospital cardiac arrest predictions using electrocardiogram (ECG)-based heart rate variability (HRV) measures. The HRV measures, including time/frequency domains and nonlinear measures, were calculated from 5 min epochs of ECG signals from ICU patients. A light gradient boosting machine (LGBM) algorithm was used to develop the proposed model for predicting in-hospital cardiac arrest within 0.5-24 h. The LGBM model using 33 HRV measures achieved an area under the receiver operating characteristic curve of 0.881 (95% CI: 0.875-0.887) and an area under the precision-recall curve of 0.104 (95% CI: 0.093-0.116). The most important feature was the baseline width of the triangular interpolation of the RR interval histogram. As our model uses only ECG data, it can be easily applied in clinical practice.
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Affiliation(s)
- Hyeonhoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Lim Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Device Development Support, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Bin Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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17
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Nallamothu BK, Greif R, Anderson T, Atiq H, Couto TB, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Leong CKL, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mohamed MTM, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Athieno Odakha J, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Chan PS. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Circ Cardiovasc Qual Outcomes 2023; 16:e010491. [PMID: 37947100 PMCID: PMC10659256 DOI: 10.1161/circoutcomes.123.010491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland (R.G.)
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor (B.K.N., T.A.)
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan (H.A.)
| | | | | | - Allan R. De Caen
- Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Canada (A.R.D.C.)
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden (T.D.)
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA (A.D.)
| | - Matthew J. Douma
- Department of Critical Care Medicine, University of Alberta, Canada (M.J.D.)
| | - Dana P. Edelson
- Department of Medicine, University of Chicago Medicine, IL (D.P.E.)
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China (F.X.)
| | - Judith C. Finn
- School of Nursing, Curtin University, Perth, Australia (J.F.)
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica (G.F.)
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (S.G.)
| | | | - Carrie Kah-Lai Leong
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Peter T. Morley
- Department of Intensive Care, The University of Melbourne, Australia (P.T.M.)
| | - Laurie J. Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada (L.J.M.)
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY (A.M.)
| | | | | | | | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA (V.N.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (R.W.N.)
| | - Jerry P. Nolan
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | - Theresa M. Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway (T.M.O.)
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia (J.O.)
| | - Gavin D. Perkins
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | | | | | | | - Paul S. Chan
- Mid-America Heart Institute, Kansas City, MO (P.S.C.)
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Strototte LM, May TW, Laker S, Latka E, Thaemel D, Thies KC, Rehberg SW, Jansen G. Efficacy of in-bed chest compressions depending on provider position during in-hospital cardiac arrest: a controlled manikin study. Minerva Anestesiol 2023; 89:1003-1012. [PMID: 37671538 DOI: 10.23736/s0375-9393.23.17390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND In contrast to the pre-hospital environment, patients with in-hospital cardiac arrest are usually lying in a hospital bed. Interestingly, there are no current recommendations for optimal provider positioning. The present study evaluates in bed chest compression quality in different provider positions during in-hospital-cardiac-arrest. METHODS Paramedics conducted four resuscitation scenarios: manikin lying on the floor with provider position kneeling next to the manikin (control group), manikin lying in a hospital bed with the provider kneeling astride, kneeling beside or standing next to the manikin. A resuscitation board was not used according to the current guideline recommendations. Quality of resuscitation, compression depth, compression rate and percentage of compressions with complete chest rebound were recorded. Afterwards, the paramedics were asked about subjective efficiency and fatigue. Data were analyzed using Generalized-Linear-Mixed-Models and, in addition, by non-parametric Friedman test. RESULTS A total of 60 participants were recruited. The total quality of chest compressions was significantly higher in floor-based control position compared to the standing (P<.001) and both kneeling positions (P<.05). Also, the compression depth was significantly more guideline compliant in the control (P<.001) and the kneeling position (P<.05) compared to the standing position. The compression frequency as well as the complete chest wall recoil did not differ significantly. The standing position was rated as more fatiguing than the other positions (p≤0.001), kneeling beside as subjectively more efficient than the standing position (P<0.001). CONCLUSIONS In case of an in-bed resuscitation, high quality chest compressions are possible. Kneeling astride or beside the patient should be preferred because these positions demonstrated a good chest compression quality and were more efficient and less exhausting.
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Affiliation(s)
- Lisa M Strototte
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany -
| | - Theodor W May
- Coordination Office for Studies in Biomedicine and Preclinical and Clinical Research, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | - Stefan Laker
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Eugen Latka
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Daniel Thaemel
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Karl-Christian Thies
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Gerrit Jansen
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
- University Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Medical Center of Minden, Ruhr University of Bochum, Minden, Germany
- Medical School and University Medical Center East Westphalia-Lippe, University of Bielefeld, Bielefeld, Germany
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19
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Jagarlamudi NS, Soni K, Ahmed SS, Makkapati NSR, Janarthanam S, Vallejo-Zambrano CR, Patel KC, Xavier R, Ponnada PK, Zaheen I, Ehsan M. Unveiling Breakthroughs in Post-resuscitation Supportive Care for Out-of-Hospital Cardiac Arrest Survivors: A Narrative Review. Cureus 2023; 15:e44783. [PMID: 37809191 PMCID: PMC10558054 DOI: 10.7759/cureus.44783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Survivors of out-of-hospital cardiac arrest (OHCA) experience significant mortality rates and neurological impairment, potentially attributed to the hypoxic-ischemic injury sustained amid the cardiac arrest episode. Post-resuscitation care plays a crucial role in determining outcomes for survivors of OHCA. Supportive therapies have proven to be influential in shaping these outcomes. However, targeting higher blood pressure or oxygen levels during the post-resuscitative phase has not been shown to offer any mortality or neurological benefits. In terms of maintaining hemodynamic instability after resuscitation, it is recommended to use norepinephrine rather than epinephrine. While extracorporeal cardiopulmonary resuscitation has shown promising results, targeted temperature management has been found ineffective in improving outcomes despite its previous potential. This review also investigates various challenges and barriers associated with the practical implementation of these supportive therapies in clinical settings. The review also highlights areas ripe for future research and proposes potential directions to further enhance post-resuscitation supportive care for OHCA survivors.
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Affiliation(s)
| | - Kriti Soni
- Internal Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Center, Pune, IND
| | - Saima S Ahmed
- Internal Medicine, Dow International Medical College, Karachi, PAK
| | | | - Sujaritha Janarthanam
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research Center, Chennai, IND
| | | | | | - Roshni Xavier
- Internal Medicine, Rajagiri Hospital, Aluva, IND
- Internal Medicine, Carewell Hospital, Malappuram, IND
| | | | - Iqra Zaheen
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Muhammad Ehsan
- General Medicine, International Medical Graduates (IMG) Helping Hands, Lahore, PAK
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Schloss D, Steinberg A. The chain of survival for in-hospital cardiac arrest: improving systems of care. Resuscitation 2023; 187:109814. [PMID: 37121463 DOI: 10.1016/j.resuscitation.2023.109814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Daniel Schloss
- Department of Emergency Medicine and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. USA
| | - Alexis Steinberg
- Department of Emergency Medicine and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA. USA
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Mohamed Jiffry MZ, Hassan R, Davis A, Scharf S, Walgamage T, Ahmed-Khan MA, Dandwani M. Sickle Cell Anemia Associated With Increased In-Hospital Mortality in Post-Cardiac Arrest Patients. Cureus 2023; 15:e37987. [PMID: 37223169 PMCID: PMC10202522 DOI: 10.7759/cureus.37987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Sickle cell anemia (SCA) is a hemoglobinopathy that arises from a point mutation in the beta-globin gene, which causes the polymerization of deoxygenated hemoglobin that leads to a wide variety of clinical complications. Deaths in patients with SCA most commonly arise from renal, cardiovascular disease, infections, and stroke. In-hospital cardiac arrest has been found to be more common in older patients and those on ventilatory life support, among others. This study aims to provide more insight into how SCA affects the risk of in-hospital mortality in post-cardiac arrest patients. Methods The National Inpatient Survey database years 2016 to 2019 was utilized. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS) codes for cardiopulmonary resuscitation were used to identify in-hospital cardiac arrest (IHCA) patients. ICD-10 Clinical Modification (CM) codes were used to identify SCA and other medical comorbidities. Categorical data was compared using Person's chi-square test, and continuous variables were compared using the independent samples t-test. Multinomial logistic regression was used to study the effects of SCA on post-arrest in-hospital mortality controlling for age, Charlson comorbidity score, and demographic variables. Binomial logistic regression models for dichotomous variables were utilized in the subgroup and secondary outcomes analysis. Results In patients with IHCA, patients who had SCA were found to have a significantly increased risk of in-hospital mortality adjusted for baseline characteristics and Charlson comorbidity score (OR: 1.16, 95% CI: 1.02-1.32, p=0.0025). Patient characteristics most strongly associated with an increased risk of in-hospital mortality in this cohort were found to be Black race (OR: 1.92, 95% CI: 1.87-1.97, p<0.001) and self-payer status (OR: 2.14, 95% CI: 2.06-2.22, p<0.001). Subgroup analysis revealed only patients with sickle cell disease had a statistically significant increased risk of in-hospital mortality in this cohort (OR: 4.41, 95% CI: 3.5-5.55, p<0.001), and patients with sickle cell trait did not. Conclusion In patients with IHCA, SCA is associated with an increased risk of in-hospital mortality. This risk was confined to patients with sickle cell disease and not patients with sickle cell trait.
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Affiliation(s)
| | - Rehana Hassan
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Alexis Davis
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Shelbie Scharf
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | | | - Mohammad A Ahmed-Khan
- Department of Internal Medicine, University of Vermont, Burlington, USA
- Internal Medicine, Danbury Hospital, Danbury, USA
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22
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Obesity Is Indirectly Associated with Sudden Cardiac Arrest through Various Risk Factors. J Clin Med 2023; 12:jcm12052068. [PMID: 36902855 PMCID: PMC10004688 DOI: 10.3390/jcm12052068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Although obesity is a well-established risk factor of cardiovascular event, the linkage between obesity and sudden cardiac arrest (SCA) is not fully understood. Based on a nationwide health insurance database, this study investigated the impact of body weight status, measured by body-mass index (BMI) and waist circumference, on the SCA risk. A total of 4,234,341 participants who underwent medical check-ups in 2009 were included, and the influence of risk factors (age, sex, social habits, and metabolic disorders) was analyzed. For 33,345,378 person-years follow-up, SCA occurred in 16,352 cases. The BMI resulted in a J-shaped association with SCA risk, in which the obese group (BMI ≥ 30) had a 20.8% increased risk of SCA compared with the normal body weight group (18.5 ≤ BMI < 23.0) (p < 0.001). Waist circumference showed a linear association with the risk of SCA, with a 2.69-fold increased risk of SCA in the highest waist circumference group compared with the lowest waist circumference group (p < 0.001). However, after adjustment of risk factors, neither BMI nor waist circumference was associated with the SCA risk. In conclusion, obesity is not independently associated with SCA risk based on the consideration of various confounders. Rather than confining the findings to obesity itself, comprehensive consideration of metabolic disorders as well as demographics and social habits might provide better understanding and prevention of SCA.
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23
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Feasibility of accelerated code team activation with code button triggered smartphone notification. Resuscitation 2023; 187:109752. [PMID: 36842677 DOI: 10.1016/j.resuscitation.2023.109752] [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: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Studies support rapid interventions to improve outcomes in patients with in-hospital cardiac arrest. We sought to decrease the time to code team activation and improve dissemination of patient-specific data to facilitate targeted treatments. METHODS We mapped code blue buttons behind each bed to patients through the electronic medical record. Pushing the button sent patient-specific data (admitting diagnosis, presence of difficult airway, and recent laboratory values) through a secure messaging system to the responding teams' smartphones. The code button also activated a hospital-wide alert through the operator. We piloted the system on seven medicine inpatient units from November 2019 through May 2022. We compared the time from code blue button press to smartphone message receipt vs traditional operator-sent overhead page. RESULTS The code button was the primary mode of code team activation for 12/35 (34.3%) cardiac arrest events. The code team received smartphone notifications a median of 78 s (IQR = 47-127 s) before overhead page. The median time to adrenaline administration for codes activated with the code button was not significantly different (240 s (IQR 142-300 s for code button) vs 148 s (IQR = 34-367 s) for overhead page, p = 0.89). Survival to discharge was 3/12 (25.0%) for codes activated with the code button vs 4/23 (17.4%) when activated by calling the operator (p = 0.67). CONCLUSION Implementation of a smartphone-based code button notification system reduced time to code team activation by 78 s. Larger cohorts are necessary to assess effects on patient outcomes.
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Introducing novel insights into the postresuscitation clinical course and care of cardiac arrest. Resuscitation 2023; 183:109691. [PMID: 36646372 DOI: 10.1016/j.resuscitation.2023.109691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
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Penketh J, Nolan JP. Response to: In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest. Crit Care 2023; 27:22. [PMID: 36650564 PMCID: PMC9847072 DOI: 10.1186/s13054-023-04314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 01/18/2023] Open
Affiliation(s)
- James Penketh
- grid.416091.b0000 0004 0417 0728Intensive Care Unit, Royal United Hospital, Bath, UK
| | - Jerry P. Nolan
- grid.416091.b0000 0004 0417 0728Intensive Care Unit, Royal United Hospital, Bath, UK ,grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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de Roux Q, Chalkias A, Xanthos T, Mongardon N. In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest. Crit Care 2023; 27:17. [PMID: 36639660 PMCID: PMC9840306 DOI: 10.1186/s13054-022-04300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Quentin de Roux
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
| | - Athanasios Chalkias
- grid.410558.d0000 0001 0035 6670Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece ,grid.512286.aOutcomes Research Consortium, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Theodoros Xanthos
- grid.499377.70000 0004 7222 9074School of Health Sciences, University of West Attica, 12243 Athens, Greece
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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