1
|
Skhirtladze-Dworschak K, Felli A, Aull-Watschinger S, Jung R, Mouhieddine M, Zuckermann A, Tschernko E, Dworschak M, Pataraia E. The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome. J Clin Med 2022; 11:jcm11195668. [PMID: 36233535 PMCID: PMC9572147 DOI: 10.3390/jcm11195668] [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: 08/27/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Neurological complications after heart surgery are associated with tremendous morbidity and mortality. Nonconvulsive status epilepticus (NCSE), which can only be verified by EEG, may cause secondary brain damage. Its frequency and its impact on outcomes after cardiac surgery is still unclear. We collected the neurological files and clinical data of all our patients after heart surgery who, in the course of their ICU stay, had been seen by a neurologist who ordered an EEG. Within 18 months, 1457 patients had cardiac surgery on cardiopulmonary bypass. EEG was requested for 89 patients. Seizures were detected in 39 patients and NCSE was detected in 11 patients. Open heart surgery was performed in all 11 NSCE patients, of whom eight showed concomitant brain insults. None had a history of epilepsy. Despite the inhibition of seizure activity with antiseizure medication, clinical improvement was only noted in seven NCSE patients, three of whom were in cerebral performance category 2 and four in category 3 at hospital discharge. The four patients without neurological benefit subsequently died in the ICU. The occurrence of NCSE after open cardiac surgery is significant and frequently associated with brain injury. It seems prudent to perform EEG studies early to interrupt seizure activity and mitigate secondary cerebral injury.
Collapse
Affiliation(s)
- Keso Skhirtladze-Dworschak
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Alessia Felli
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, A-1090 Vienna, Austria
| | | | - Rebekka Jung
- Department of Neurology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Mohamed Mouhieddine
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, A-1090 Vienna, Austria
| | - Edda Tschernko
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-41090; Fax: +43-1-40400-41100
| | - Ekaterina Pataraia
- Department of Neurology, Medical University of Vienna, A-1090 Vienna, Austria
| |
Collapse
|
2
|
Tsai MJ, Tsai CH, Pan RC, Hsu CF, Sung SF. Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database. Clin Epidemiol 2022; 14:721-730. [PMID: 35669234 PMCID: PMC9166954 DOI: 10.2147/clep.s366874] [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: 03/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Taiwan’s national health insurance (NHI) database is a valuable resource for large-scale epidemiological and long-term survival research for out-of-hospital cardiac arrest (OHCA). We developed and validated case definition algorithms for OHCA based on the International Classification of Diseases (ICD) diagnostic codes and billing codes for NHI reimbursement. Patients and Methods Claims data and medical records of all emergency department visits from 2010 to 2020 were retrieved from the hospital’s research-based database. Death-related diagnostic codes and keywords were used to identify potential OHCA cases, which were ascertained by chart reviews. We tested the performance of the developed OHCA algorithms and validated them on an external dataset. Results The algorithm defining OHCA as any cardiac arrest (CA)-related ICD code in the first three diagnosis fields performed the best with a sensitivity of 89.5% (95% confidence interval [CI], 88.2–90.7%), a positive predictive value (PPV) of 90.6% (95% CI, 89.4–91.8%), and a kappa value of 0.900 (95% CI, 0.891–0.909). The second-best algorithm consists of any CA-related ICD code in any diagnosis field with a billing code for triage acuity level 1, achieving a sensitivity of 85.6% (95% CI, 84.1–87.0%), a PPV of 93.6% (95% CI, 92.5–94.5), and a kappa value of 0.894 (95% CI, 0.884–0.903). Both algorithms performed well in external validation. In subgroup analyses, the former algorithm performed the best in adult patients, outpatient claims, and during the ICD-9 era. The latter algorithm performed the best in the inpatient claims and during the ICD-10 era. The best algorithm for identifying pediatric OHCAs was any CA-related ICD code in the first three diagnosis fields with a billing code for triage acuity level 1. Conclusion Our results may serve as a reference for future OHCA studies using the Taiwan NHI database.
Collapse
Affiliation(s)
- Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Han Tsai
- Department of Emergency Medicine, Chiayi Branch, Taichung Veteran’s General Hospital, Chiayi City, Taiwan
- Department of Information Management, Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
| | - Ru-Chiou Pan
- Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Chi-Feng Hsu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
- Correspondence: Sheng-Feng Sung, Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan, Tel +886 5 276 5041 Ext 7283, Fax +886 5 278 4257, Email ;
| |
Collapse
|
3
|
Wongtanasarasin W, Ungrungseesopon N, Namsongwong N, Chotipongkul P, Visavakul O, Banping N, Kampeera W, Phinyo P. Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department. Turk J Emerg Med 2022; 22:67-74. [PMID: 35529024 PMCID: PMC9069921 DOI: 10.4103/2452-2473.342805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Calcium administration during cardiac arrest is limited in some circumstances, mainly due to lack of consistent evidence. This study aims to investigate whether calcium therapy administered during cardiac arrest at the Emergency Department is associated with good outcomes, including the probability of return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at discharge. METHODS We retrospectively reviewed 599 consecutive adult cardiac arrest events between 2016 and 2018. The primary outcome was the ROSC rate. Secondary outcomes included survival to hospital admission, survival to hospital discharge, and favorable neurologic outcome at hospital discharge. Multivariable logistic regression with inverse probability of treatment weighting was analyzed to examine the association between calcium administration and outcomes. RESULTS Of 599 events, calcium was administered in 72 (12%) cases. The use of calcium during cardiopulmonary resuscitation (CPR) after adjusting for confounding factors was not associated with any better outcomes, including ROSC (adjusted odds ratio (aOR) 0.53, 95% confidence interval [CI] 0.24-1.17), survival to hospital admission (aOR 1.07, 95% CI 0.47-2.41), survival to hospital discharge (aOR 1.93, 95% CI 0.43-8.56), and favorable neurological outcome (aOR 6.60, 95% CI 0.72-60.74). Besides, calcium use in traumatic cardiac arrest patients was associated with unfavorable outcomes, including ROSC (aOR 0.02, 95% CI 0.00-0.09) and survival to hospital admission (aOR 0.16, 95% CI 0.03-0.84). CONCLUSION The use of calcium during an adult cardiac arrest was not associated with better outcomes. Although associations drawn from this study did not indicate the causality, given calcium during CPR was linked to poorer outcomes in traumatic cardiac arrest patients, including ROSC and survival to hospital admission.
Collapse
Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Address for correspondence: Dr. Wachira Wongtanasarasin, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University 110 Intavarorot Street, Sriphum Chiang Mai 50200, Thailand. E-mail:
| | - Nat Ungrungseesopon
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nutthida Namsongwong
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsatorn Chotipongkul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Onwara Visavakul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napatsakorn Banping
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapot Kampeera
- Nursing Service Division, Outpatient and Emergency Service Section, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
4
|
Comparison between Prehospital Mechanical Cardiopulmonary Resuscitation (CPR) Devices and Manual CPR for Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. J Clin Med 2022; 11:jcm11051448. [PMID: 35268537 PMCID: PMC8911115 DOI: 10.3390/jcm11051448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.
Collapse
|
5
|
Cho Y, Oh J, Shin JH, Sik Kim B, Park JK, Ho Lee J, Hwan Kim J, Park M. Long-term prognosis and causes of death among survivors after out-of-hospital cardiac arrest: A population-based longitudinal study. Resuscitation 2022; 173:31-38. [DOI: 10.1016/j.resuscitation.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
|
6
|
Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111020. [PMID: 34769541 PMCID: PMC8582961 DOI: 10.3390/ijerph182111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.
Collapse
|
7
|
Mertens M, van Til J, Bouwers-Beens E, Boenink M. Chasing Certainty After Cardiac Arrest: Can a Technological Innovation Solve a Moral Dilemma? NEUROETHICS-NETH 2021. [DOI: 10.1007/s12152-021-09473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractWhen information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring (cEEG) is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes part of a socio-technical network in an Intensive Care Unit (ICU). Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on (a) the way patient outcomes are constructed, (b) the kind of decision support these outcomes provide, and (c) how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation.
Collapse
|
8
|
Fijačko N, Masterson Creber R, Gosak L, Štiglic G, Egan D, Chaka B, Debeljak N, Strnad M, Skok P. Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth 2021; 9:e25437. [PMID: 34283034 PMCID: PMC8335615 DOI: 10.2196/25437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/12/2020] [Accepted: 05/07/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable. OBJECTIVE This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children. METHODS We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps' BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy. RESULTS Of the 1207 potentially relevant apps, only 6 (0.49%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95% CI 3.0-3.4) and 47.1/100 points (95% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs. CONCLUSIONS Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills.
Collapse
Affiliation(s)
- Nino Fijačko
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Ruth Masterson Creber
- Healthcare Policy and Research, Division of Health Informatics, Weill Cornell Medicine, New York, NY, United States
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Gregor Štiglic
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Dominic Egan
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Brian Chaka
- School of Allied Health Professions and Midwifery, University of Bradford, Bradford, United Kingdom
| | - Nika Debeljak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Matej Strnad
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Pavel Skok
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| |
Collapse
|
9
|
Luo L, Zhang X, Xiang T, Dai H, Zhang J, Zhuo G, Sun Y, Deng X, Zhang W, Du M. Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department. J Int Med Res 2021; 49:3000605211025368. [PMID: 34182817 PMCID: PMC8246509 DOI: 10.1177/03000605211025368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED). Methods This was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes). Results The rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively). Conclusion Early mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.
Collapse
Affiliation(s)
- Li Luo
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - XiaoDong Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Tao Xiang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Hang Dai
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - JiMei Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - GuangYing Zhuo
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - YuFang Sun
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - XiaoJun Deng
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Wei Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Ming Du
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| |
Collapse
|
10
|
The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073636. [PMID: 33807385 PMCID: PMC8036320 DOI: 10.3390/ijerph18073636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/02/2023]
Abstract
High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.
Collapse
|
11
|
Wongtanasarasin W, Srisurapanont K. Efficacy of bicarbonate therapy for adults with cardiac arrest: A systematic review and meta-analysis of randomized-controlled trials. Turk J Emerg Med 2021; 21:24-29. [PMID: 33575512 PMCID: PMC7864130 DOI: 10.4103/2452-2473.301917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Because the benefits of bicarbonate therapy remain unclear, it is not routinely recommended for the cardiopulmonary resuscitation (CPR) given to individuals with cardiac arrest (CA). This study aims to evaluate the clinical benefits of bicarbonate therapy in adults with CA. METHODS Without any language restriction, we searched PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL from the inception until April 30, 2020. We performed hand-search to identify the relevant trials included in previous meta-analyses. Included studies were randomized controlled trials (RCTs) comparing bicarbonate and placebo treatment in adults with CA. Two authors independently assessed the trial risk of bias. The primary outcome was the survival to hospital admission. The secondary outcomes included the return of spontaneous circulation, the survival to hospital discharge, and the neurological outcome at discharge. We calculated the odds ratios of those outcomes using the Mantel-Haenszel model and assessed the heterogeneity using the I2statistic. RESULTS Our searches found 649 unduplicated studies. Of these, three RCTs involving 1344 patients were included in the meta-analysis. The trial risk of bias ranged between fair and poor, mainly due to no blindness of outcome assessment and the selective reports of outcomes. Bicarbonate therapy showed no significant improvement in the survival to hospital admission (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.73-1.25). Subgroup analysis in those receiving prolonged CPR showed a similar result (OR 0.88; 95% CI 0.10-8.01). No study reported the predefined secondary outcomes. CONCLUSION For both acute and prolonged CPR, bicarbonate therapy might not show benefit to improve the rate of survival to hospital admission in adults with cardiac arrest.
Collapse
Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Karan Srisurapanont
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
12
|
Wang Y, Wang M, Ni Y, Liang B, Liang Z. Can Systemic Thrombolysis Improve Prognosis of Cardiac Arrest Patients During Cardiopulmonary Resuscitation? A Systematic Review and Meta-Analysis. J Emerg Med 2019; 57:478-487. [PMID: 31594741 DOI: 10.1016/j.jemermed.2019.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/15/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cardiac arrests are caused in most cases by thromboembolic diseases, such as acute myocardial infarction (AMI) and pulmonary embolism (PE). OBJECTIVE We aimed to ascertain the associations of thrombolytic therapy with potential benefits among cardiac arrest patients during cardiopulmonary resuscitation (CPR). METHODS We searched PubMed, Embase, and Cochrane databases for studies that evaluated systemic thrombolysis in cardiac arrest patients. The primary outcome was survival to hospital discharge, and secondary outcomes included return of spontaneous circulation (ROSC), 24-h survival rate, hospital admission rate, and bleeding complications. RESULTS Nine studies with a total of 4384 cardiac arrest patients were pooled in the meta-analysis, including 1084 patients receiving systemic thrombolysis and 3300 patients receiving traditional treatments. Compared with conventional therapies, the use of systemic thrombolysis did not significantly improve survival to hospital discharge (13.5% vs. 10.8%; risk ratio [RR] 1.13; 95% confidence interval [CI] 0.92-1.39; p = 0.24, I2 = 35%), ROSC (50.9% vs. 44.3%; RR 1.29; 95% CI 1.00-1.66; p = 0.05, I2 = 73%), and 24-h survival (28.1% vs. 25.6%; RR 1.25; 95% CI 0.88-1.77; p = 0.22, I2 = 63%). We observed higher hospital admission rates for patients receiving systemic thrombolysis (43.4% vs. 30.6%; RR 1.53; 95% CI 1.04-2.24; p = 0.03, I2 = 87%). In addition, higher risk of bleeding was observed in the thrombolysis group (8.8% vs. 5.0%; RR 1.65; 95% CI 1.16-2.35; p = 0.005, I2 = 7%). CONCLUSIONS Systemic thrombolysis during CPR did not improve hospital discharge rate, ROSC, and 24-h survival for cardiac arrest patients. Patients receiving thrombolytic therapy have a higher risk of bleeding. More high-quality studies are needed to confirm our results.
Collapse
Affiliation(s)
- Yiwei Wang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
| | - Maoyun Wang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
| | - Yuenan Ni
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
| | - Binmiao Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Sichuan, China
| |
Collapse
|
13
|
Bremer A, Dahné T, Stureson L, Årestedt K, Thylén I. Lived experiences of surviving in‐hospital cardiac arrest. Scand J Caring Sci 2018; 33:156-164. [DOI: 10.1111/scs.12616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anders Bremer
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- Division of Emergency Medical Services Kalmar County Council Kalmar Sweden
| | - Tova Dahné
- Department of Surgical Sciences Anaesthesiology and Intensive Care Akademiska Hospital Uppsala University Uppsala Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Lovisa Stureson
- Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- The Research Section Kalmar County Council Kalmar Sweden
| | - Ingela Thylén
- Departments of Cardiology and Medical and Health Sciences Linköping University Linköping Sweden
| |
Collapse
|
14
|
Assessing the efficacy of the new protocol for chest compressions before definitive cardiac arrest in emergency medical service-witnessed adult out-of-hospital cardiac arrests. Resuscitation 2018; 130:92-98. [DOI: 10.1016/j.resuscitation.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
|
15
|
Ebner F, Harmon MBA, Aneman A, Cronberg T, Friberg H, Hassager C, Juffermans N, Kjærgaard J, Kuiper M, Mattsson N, Pelosi P, Ullén S, Undén J, Wise MP, Nielsen N. Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy. Crit Care 2018; 22:196. [PMID: 30119692 PMCID: PMC6098627 DOI: 10.1186/s13054-018-2119-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6 months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3–5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0–7.30 kPa) and neurological outcome, its interaction with target temperature (33 °C and 36 °C), and the association between PaCO2 and peak serum-Tau were evaluated. Results Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P = 0.13–0.96). Mild hypercapnia was not associated with neurological outcome (P = 0.78) and there was no statistically significant interaction with target temperature (Pinteraction = 0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72 h after return of spontaneous circulation (ROSC). Conclusions Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome. Electronic supplementary material The online version of this article (10.1186/s13054-018-2119-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Florian Ebner
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
| | - Matt B A Harmon
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, 1871, Australia
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Hans Friberg
- Department of Anaesthesia and Intensive Care, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicole Juffermans
- Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kuiper
- Intensive Care Unit, Leeuwarden Medical Centrum, Borniastraat 38, NL8934 AD, Leeuwarden, The Netherlands
| | - Niklas Mattsson
- Department of Clinical Sciences, Neurology, Skåne University Hospital, Getingevägen 5, 221 85, Lund, Sweden
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, Anesthesia and Intensive Care, San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Susann Ullén
- Clinical Studies Sweden, Skåne University Hospital, Remissgatan 4, 221 85, Lund, Sweden
| | - Johan Undén
- Department of Anaesthesia and Intensive Care, Hallands Hospital, Halmstad, Sweden
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, CF144XW, UK
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
| |
Collapse
|
16
|
Tan NS, Dorian P. Out-of-Hospital Cardiac Arrest in the Presence of Ischemic Heart Disease: What Is the Long-term Arrhythmic Risk After Revascularization? Can J Cardiol 2018; 34:1079-1082. [PMID: 29958725 DOI: 10.1016/j.cjca.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022] Open
Abstract
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) frequently have underlying coronary artery disease (CAD), but the relationship between the arrest and myocardial ischemia or infarction due to CAD can be difficult to discern in clinical practice. Patients often present with clinical profiles that guideline recommendations for appropriate implantable cardioverter-defibrillator use do not address. In cases of incomplete revascularization or mild but sustained impairment of ventricular function, it is not clear if the cause of the cardiac arrest is completely "reversible." We describe distinct phenotypes of patients with OHCA and concomitant CAD and highlight current knowledge gaps in their management and outcomes.
Collapse
Affiliation(s)
- Nigel S Tan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
17
|
Du L, Ge B, Ma Q, Yang J, Chen F, Mi Y, Zhu H, Wang C, Li Y, Zhang H, Yang R, Guan J, Zhang Y, Jin G, Zhu H, Xiong Y, Wang G, Zhu Z, Zhang H, Zhang Y, Zhu J, Li J, Lan C, Xiong H. Changes in cardiac arrest patients' temperature management after the publication of 2015 AHA guidelines for resuscitation in China. Sci Rep 2017; 7:16087. [PMID: 29167495 PMCID: PMC5700174 DOI: 10.1038/s41598-017-16044-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023] Open
Abstract
A survey was performed to assess the current management of targeted temperature management (TTM) in patients following cardiac arrest (CA) and whether healthcare providers will change target temperature after publication of 2015 American Heart Association guidelines for resuscitation in China. 52 hospitals were selected from whole of China between August to November 2016. All healthcare providers in EMs and/or ICUs of selected hospitals participated in the study. 1952 respondents fulfilled the survey (86.8%). TTM in CA patients was declared by 14.5% of physicians and 6.7% of the nurses. Only 4 of 64 departments, 7.8% of physicians and 5.7% of the nurses had implemented TH for CA patients. Since the publication of 2015 AHA guidelines, 33.6% of respondents declared no modification of target temperature, whereas 51.5% declared a target temperature's change in future practice. Respondents were more likely to choose 35∼36 °C-TTM (54.7%) after guidelines publication, as compared to that before guidelines publication they preferred 32∼34 °C-TTM (54.0%). TTM for CA patients was still in the early stage in China. Publication of 2015 resuscitation guidelines did have impact on choice of target temperature among healthcare providers. They preferred 35∼36 °C-TTM after guidelines publication.
Collapse
Affiliation(s)
- Lanfang Du
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Baolan Ge
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Qingbian Ma
- Department of Emergency Medicine, The Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Jianzhong Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan South Rd., Wulumiqi, Xinjiang, 830054, China
| | - Fengying Chen
- Department of Emergency Medicine, The Affiliated Hospital of Innor Mongolia Medical University, No. 1, Tongdao North Rd., Huhehaote, Innor Mongolia, 010050, China
| | - Yuhong Mi
- Department of Emergency Medicine, Beijing Anzhen Hospital, 2 Anzhen Rd., Chaoyang District, Beijing, 100029, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, No. 1, Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Cong Wang
- Department of Emergency Medicine, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Xicheng District, Beijing, 100035, China
| | - Yan Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Shanxi Medical University, No. 382, Wuyi Rd., Taiyuan, Shanxi, 030001, China
| | - Hongbo Zhang
- Department of Emergency Medicine, China Japan friendship hospital, No. 2, Yinghua East Rd., Chaoyang District, Beijing, 100029, China
| | - Rongjia Yang
- Department of Emergency Medicine, Gansu Provincial Hospital, No. 204, Donggang West Rd., Lanzhou, Gansu, 730000, China
| | - Jian Guan
- Department of Emergency Medicine, The First Hospital of Tsinghua University, No. 6, Jiuxianqiao Yijiefang, Chaoyang District, Beijing, 100016, China
| | - Yixiong Zhang
- Department of Emergency Medicine, Hunan Provincial People's Hospital, No. 61, Jiefang West Rd., Changsha, Hunan, 410005, China
| | - Guiyun Jin
- Department of Emergency Medicine, The Affiliated Hospital of Hainan Medical University, No. 31, Longhua Rd., Haikou, Hainan, 570102, China
| | - Haiyan Zhu
- Department of Emergency Medicine, The General Hospital of People's Liberation Army, No. 28, Fuxing Rd., Beijing, 100853, China
| | - Yan Xiong
- Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Second Rd., Guangzhou, Guangdong, 510080, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, No. 95, Yongan Rd., Xicheng District, 100050, China
| | - Zhengzhong Zhu
- Department of Emergency Medicine, Beijing University Shougang Hospital, No. 9, Jinyuanzhuang Rd., Shijingshan District, Beijing, 100144, China
| | - Haiyan Zhang
- Department of Emergency Medicine, The Hospital of Shunyi District Beijing, No. 3, Guangming South Street, Shunyi District, Beijing, 101300, China
| | - Yun Zhang
- Department of Emergency Medicine, Beijing Tongren Hospital, No. 1, Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jihong Zhu
- Department of Emergency Medicine, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Jie Li
- Department of Emergency Medicine, Beijing Fuxing Hospital, No. 20, Fuxingmenwai Street, Xicheng District, Beijing, 100038, China
| | - Chao Lan
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Rd., Zhengzhou, Henan, 450052, China
| | - Hui Xiong
- Department of Emergency Medicine, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, China
| |
Collapse
|
18
|
Hayashida K, Tagami T, Fukuda T, Suzuki M, Yonemoto N, Kondo Y, Ogasawara T, Sakurai A, Tahara Y, Nagao K, Yaguchi A, Morimura N. Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out-of-Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS-KANTO [Survey of Survivors after Out-of-Hospital Cardiac Arrest in Kanto Area] 2012 Study). J Am Heart Assoc 2017; 6:JAHA.117.007420. [PMID: 29089341 PMCID: PMC5721797 DOI: 10.1161/jaha.117.007420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Mechanical cardiopulmonary resuscitation (mCPR) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the mCPR in the emergency department and clinical outcomes. Methods and Results In a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the mCPR with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual CPR group and 918 patients (14.0%) in the mCPR group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that mCPR was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78; P=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94; P=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80; P=0.001). Conclusions After accounting for potential confounders, the mCPR in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which mCPR may benefit these patients.
Collapse
Affiliation(s)
- Kei Hayashida
- Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan .,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.,Department of Emergency Medicine, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Masaru Suzuki
- Department of Emergency and Medicine, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health Kyoto University, Kyoto, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.,Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tomoko Ogasawara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Hospital, Tokyo, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | |
Collapse
|
19
|
Goury A, Poirson F, Chaput U, Voicu S, Garçon P, Beeken T, Malissin I, Kerdjana L, Chelly J, Vodovar D, Oueslati H, Ekherian JM, Marteau P, Vicaut E, Megarbane B, Deye N. Targeted temperature management using the "Esophageal Cooling Device" after cardiac arrest (the COOL study): A feasibility and safety study. Resuscitation 2017; 121:54-61. [PMID: 28951293 DOI: 10.1016/j.resuscitation.2017.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) between 32 and 36°C is recommended after out-of-hospital cardiac arrest (OHCA). We aimed to assess the feasibility and safety of the "Esophageal Cooling Device" (ECD) in performing TTM. PATIENTS AND METHODS This single-centre, prospective, interventional study included 17 comatose OHCA patients. Main exclusion criteria were: delay between OHCA and return of spontaneous circulation (ROSC)>60min, delay between sustained ROSC and inclusion >360min, known oesophageal disease. A TTM between 32 and 34°C was performed using the ECD (Advanced Cooling Therapy, USA) connected to a heat exchanger console (Meditherm III®, Gaymar, France), without cold fluids' use. Primary endpoint was feasibility of inducing, maintaining TTM, and rewarming using the ECD alone. Secondary endpoints were adverse events, focusing on potential digestive damages. Results were expressed as median (interquartiles 25-75). RESULTS Cooling rate to reach the Target Temperature (33°C-TT) was 0.26°C/h [0.19-0.36]. All patients reached the 32-34°C range with a time spent within the range of 26h [21-28] (3 patients did not reach 33°C). Temperature deviation outside the TT during TTM-maintenance was 0.10°C [0.03-0.20]. Time with deviation >1°C was 0h. Rewarming rate was 0.20°C/h [0.18-0.22]. Among the 16 gastrointestinal endoscopy procedures performed, 10 (62.5%) were normal. Minor oeso-gastric injuries (37.5% and 19%, respectively) were similar to usual orogastric tube injuries. One patient experienced severe oesophagitis mimicking peptic lesions, not cooling-related. No patient among the 9 alive at 3-month follow-up had gastrointestinal complains. CONCLUSION ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.
Collapse
Affiliation(s)
- Antoine Goury
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Florent Poirson
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Ulriikka Chaput
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Sebastian Voicu
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Pierre Garçon
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Thomas Beeken
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Isabelle Malissin
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Lamia Kerdjana
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jonathan Chelly
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; Clinical Research Unit-Groupe Hospitalier Sud Île de France, 77000 Melun, France
| | - Dominique Vodovar
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Haikel Oueslati
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Jean Michel Ekherian
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France
| | - Philippe Marteau
- Hépato-gastro-entérologie, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, Paris Cedex 10, France
| | - Bruno Megarbane
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM UMRS-1144, Paris, France
| | - Nicolas Deye
- Réanimation Médicale & Toxicologique, Hôpital Lariboisière, AP-HP, Paris Cedex 10, France; INSERM U942, Hôpital Lariboisière, Paris, France.
| |
Collapse
|
20
|
López Messa JB. [Is the Spanish population aware and capable of acting in response to cardiac arrest?]. Med Intensiva 2017; 40:73-4. [PMID: 26941047 DOI: 10.1016/j.medin.2016.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Affiliation(s)
- J B López Messa
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Palencia, Palencia, España.
| |
Collapse
|
21
|
Deye N, Vincent F, Michel P, Ehrmann S, da Silva D, Piagnerelli M, Kimmoun A, Hamzaoui O, Lacherade JC, de Jonghe B, Brouard F, Audoin C, Monnet X, Laterre PF. Changes in cardiac arrest patients' temperature management after the 2013 "TTM" trial: results from an international survey. Ann Intensive Care 2016; 6:4. [PMID: 26753837 PMCID: PMC4709360 DOI: 10.1186/s13613-015-0104-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Therapeutic hypothermia (TH between 32 and 34 °C) was recommended until recently in unconscious successfully resuscitated cardiac arrest (CA) patients, especially after initial shockable rhythm. A randomized controlled trial published in 2013 observed similar outcome between a 36 °C-targeted temperature management (TTM) and a 33 °C-TTM. The main aim of our study was to assess the impact of this publication on physicians regarding their TTM practical changes. METHODS A declarative survey was performed using the webmail database of the French Intensive Care Society including 3229 physicians (from May 2014 to January 2015). RESULTS Five hundred and eighteen respondents from 264 ICUs in 11 countries fulfilled the survey (16 %). A specific attention was generally paid by 94 % of respondents to TTM (hyperthermia avoidance, normothermia, or TH implementation) in CA patients, whereas 6 % did not. TH between 32 and 34 °C was declared as generally maintained during 12-24 h by 78 % of respondents or during 24-48 h by 19 %. Since the TTM trial publication, 56 % of respondents declared no modification of their TTM practice, whereas 37 % declared a practical target temperature change. The new temperature targets were 35-36 °C for 23 % of respondents, and 36 °C for 14 %. The duration of overall TTM (including TH and/or normothermia) was declared as applied between 12 and 24 h in 40 %, and between 24 and 48 h in 36 %. In univariate analysis, the physicians' TTM modification seemed related to hospital category (university versus non-university hospitals, P = 0.045), to TTM-specific attention paid in CA patients (P = 0.008), to TH durations (<12 versus 24-48 h, P = 0.01), and to new targets temperature (32-34 versus 35-36 °C, P < 0.0001). CONCLUSIONS The TTM trial publication has induced a modification of current practices in one-third of respondents, whereas the 32-34 °C target temperature remained unchanged for 56 %. Educational actions are needed to promote knowledge translations of trial results into clinical practice. New international guidelines may contribute to this effort.
Collapse
Affiliation(s)
- Nicolas Deye
- />Réanimation Médicale et Toxicologique, Unité Inserm U942, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75010 Paris, France
| | - François Vincent
- />Réanimation Polyvalente, Groupe Hospitalier Inter-Communal Le Raincy-Montfermeil, Montfermeil, France
| | - Philippe Michel
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
| | - Stephan Ehrmann
- />Réanimation Polyvalente, Centre Hospitalier Régional Universitaire, Tours, France
| | - Daniel da Silva
- />Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Michael Piagnerelli
- />Department of Intensive Care Experimental Medicine Laboratory, Centre Hospitalier Universitaire, Charleroi, Belgium
| | - Antoine Kimmoun
- />Réanimation Médicale, Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - Olfa Hamzaoui
- />Réanimation Polyvalente, Hôpital Antoine Béclère, APHP, Clamart, France
| | - Jean-Claude Lacherade
- />Réanimation Polyvalente, Centre Hospitalier Départemental Les Oudairies, La Roche-Sur-Yon, France
| | - Bernard de Jonghe
- />Réanimation Médicale, Centre Hospitalier Inter-Communal, Poissy, France
| | - Florence Brouard
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
| | | | - Xavier Monnet
- />Réanimation Médicale, Centre Hospitalier Universitaire Paris-Sud, APHP, Kremlin-Bicêtre, France
| | - Pierre-François Laterre
- />Medical-surgical intensive care unit, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - For the SRLF Trial Group
- />Réanimation Médicale et Toxicologique, Unité Inserm U942, Centre Hospitalier Universitaire Lariboisière, Assistance Publique des Hôpitaux de Paris, 2, rue Ambroise Paré, 75010 Paris, France
- />Réanimation Polyvalente, Groupe Hospitalier Inter-Communal Le Raincy-Montfermeil, Montfermeil, France
- />Réanimation Polyvalente, Centre Hospitalier Régional René Dubost, Pontoise, France
- />Réanimation Polyvalente, Centre Hospitalier Régional Universitaire, Tours, France
- />Réanimation, Centre Hospitalier Delafontaine, Saint-Denis, France
- />Department of Intensive Care Experimental Medicine Laboratory, Centre Hospitalier Universitaire, Charleroi, Belgium
- />Réanimation Médicale, Centre Hospitalier Universitaire de Nancy Brabois, Vandoeuvre-les-Nancy, France
- />Réanimation Polyvalente, Hôpital Antoine Béclère, APHP, Clamart, France
- />Réanimation Polyvalente, Centre Hospitalier Départemental Les Oudairies, La Roche-Sur-Yon, France
- />Réanimation Médicale, Centre Hospitalier Inter-Communal, Poissy, France
- />Clinique des Cèdres-Cornebarrieu, Blagnac, France
- />Réanimation Médicale, Centre Hospitalier Universitaire Paris-Sud, APHP, Kremlin-Bicêtre, France
- />Medical-surgical intensive care unit, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
22
|
Tagami T, Matsui H, Kuno M, Moroe Y, Kaneko J, Unemoto K, Fushimi K, Yasunaga H. Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study. BMC Anesthesiol 2016; 16:89. [PMID: 27717334 PMCID: PMC5055699 DOI: 10.1186/s12871-016-0257-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypothesis that early treatment with antibiotics reduces mortality in patients with cardiac arrest receiving TTM. Methods We identified 2803 patients with cardiogenic out-of-hospital cardiac arrest (OHCA) that were treated with TTM and were admitted to 371 hospitals that contribute to the Japanese Diagnosis Procedure Combination inpatient database between July 2007 and March 2013. Of these, 1272 received antibiotics within the first 2 days (antibiotics) and 1531 did not (control). We generated 802 propensity score-matched pairs. Results There was no significant difference in 30-day mortality between the groups (control vs. antibiotics; 33.0 % vs. 29.9 %; difference, 3.1 %; 95 % confidence interval [CI], −1.4 to 7.7 %, p = 0.18). Analysis using the hospital antibiotics prescribing rate as an instrumental variable showed that antibiotic use was not significantly associated with a reduction in 30-day mortality (6.6 %, CI 95 %, −0.5 to 13.7 %, p = 0.28). A subgroup analysis of patients who required extracorporeal membrane oxygenation (ECMO) indicated a significant difference in 30-day mortality between the 2 groups (62.9 % vs. 43.5 %; difference 19.3 %, CI 95 %, 5.9 to 32.7 %, p = 0.005). In the instrumental variable model, the estimated reduction in 30-day mortality associated with antibiotics was 18.2 % (CI 95 %, 21.3 to 34.4 %, p = 0.03) in ECMO patients. Conclusions Although there was no significant association between the use of antibiotics and mortality after overall cardiogenic OHCA treated with TTM, antibiotics may be beneficial in patients who require ECMO.
Collapse
Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| | | | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 1138510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| |
Collapse
|
23
|
Sauneuf B, Bouffard C, Cornet E, Daubin C, Brunet J, Seguin A, Valette X, Chapuis N, du Cheyron D, Parienti JJ, Terzi N. Immature/total granulocyte ratio improves early prediction of neurological outcome after out-of-hospital cardiac arrest: the MyeloScore study. Ann Intensive Care 2016; 6:65. [PMID: 27422256 PMCID: PMC4947062 DOI: 10.1186/s13613-016-0170-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Elevation of the immature/total granulocyte (I/T-G) ratio has been reported after out-of-hospital cardiac arrest (OHCA). Our purpose here was to evaluate the prognostic significance of the I/T-G ratio and to investigate whether the I/T-G ratio improves neurological outcome prediction after OHCA. Methods This single-center prospective cohort study included consecutive immunocompetent patients admitted to our intensive care unit over a 3-year period (2012–2014) after successfully resuscitated OHCA. The I/T-G ratio was determined in blood samples collected at admission. Results We studied 204 patients (77 % male, median age, 58 [48–67] years), of whom 64 % had a suspected cardiac cause of OHCA, 62 % died in the unit, and 31.5 % survived with good cerebral function. Independent outcome predictors by multivariate analysis were age, first shockable rhythm, bystander-initiated resuscitation, and I/T-G ratio. Compared to the model computed without the I/T-G ratio, the model with the ratio performed significantly better [areas under the ROC curves (AUCs), 0.78 vs. 0.83, respectively; P = 0.04]. These items were used to develop the MyeloScore equation: ([0.47 × I/T-G ratio] + [0.023 × age in years]) − 1.26 if initial VF/VT − 1.1 if bystander-initiated CPR. The MyeloScore predicted neurological outcomes with similar accuracy to the previously reported OHCA score (0.83 and 0.85, respectively; P = 0.6). The ROC–AUC was 0.84, providing external validation of the MyeloScore. Conclusions The I/T-G ratio independently predicts neurological outcome after OHCA and, when added to other known risk factors, improves neurological outcome prediction. The clinical performance of the MyeloScore requires evaluation in a prospective study.
Collapse
Affiliation(s)
- Bertrand Sauneuf
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France.
| | - Claire Bouffard
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Edouard Cornet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4652 - MILPAT, Université de Caen Basse-Normandie, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Cedric Daubin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Jennifer Brunet
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Amélie Seguin
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Xavier Valette
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hôpital Cochin, AP-HP, Paris, France.,Institut Cochin, CNRS (UMR8104), INSERM, U1016, Université Paris Descartes, Paris, France
| | - Damien du Cheyron
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Faculté de Médecine, EA 4655 U2RM, Université de Caen Basse-Normandie, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France.,Inserm U 1075 COMETE, 14032, Caen, France.,Faculté de Médecine, Université de Caen Basse-Normandie, 14032, Caen, France.,HP2, Inserm U1042, Université Grenoble-Alpes, 38000, Grenoble, France.,Service de réanimation médicale, CHU Grenoble Alpes, 38000, Grenoble, France.,Faculté de Médecine, Université Grenoble-Alpes, 38000, Grenoble, France
| |
Collapse
|