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Sayde GE, Shapiro PA, Kronish I, Agarwal S. A shift towards targeted post-ICU treatment: Multidisciplinary care for cardiac arrest survivors. J Crit Care 2024; 82:154798. [PMID: 38537526 DOI: 10.1016/j.jcrc.2024.154798] [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: 12/18/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 06/01/2024]
Abstract
Intensive Care Unit (ICU) survivorship comprises a burgeoning area of critical care medicine, largely due to our improved understanding of and concern for patients' recovery trajectory, and efforts to mitigate the post-acute complications of critical illness. Expansion of care beyond hospitalization is necessary, yet evidence for post-ICU clinics remains limited and mixed, as both interventions and target populations studied to date are too heterogenous to meaningfully demonstrate efficacy. Here, we briefly present the existing evidence and limitations related to post-ICU clinics, identify cardiac arrest survivors as a unique ICU subpopulation warranting further investigation and treatment, and propose a clinical framework that addresses the multifaceted needs of this well-defined patient population.
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Affiliation(s)
- George E Sayde
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Peter A Shapiro
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, PH9-311, New York, NY 10032, USA.
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care and Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 8GS-300, New York, NY 10032, USA.
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2
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Ayyıldız A, Ayyıldız FA, Yıldırım ÖT, Yıldız G. Investigation of mortality rates and the factors affecting survival in out-of-hospital cardiac arrest patients. Aging Male 2023; 26:2255013. [PMID: 37724359 DOI: 10.1080/13685538.2023.2255013] [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: 06/02/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND It is known that even if spontaneous circulation returns after cardiopulmonary resuscitation(CPR) in geriatric out-of-hospital cardiac arrests(OHCA), the overall one-year survival rate of these patients is very low. In our study, we aimed to investigate the factors affecting survival in OHCA cases. METHODS OHCA patients over 18 years of age were examined in two different groups as 18-64 years old and over 65 years old. Demographic data, comorbidities, cardiac arrest rhythms and minutes, and the number of days they were hospitalized in the intensive care unit were recorded. RESULTS The mean age was 65.9 ± 15.8 years and 39.9% (n = 110) of the patients were female. The number of intensive care unit stays was significantly higher in the over-65 age group (p = 0.011). The mortality rate and one-year survival rate were significantly lower in the over-65 age group (p < 0.001). Median CPR time was 21 min (IQR:14-32) in the entire patient population. The duration of CPR was 22 min (IQR:14-35) in patients with in-hospital mortality, and 15 min (IQR:13-25) in patients discharged from the hospital. In this comparison, the difference is statistically significant (p = 0.008). CONCLUSION In our study, it was determined that especially over 65 years of age, coronary artery disease, and post-arrest CPR duration were determinant and predictive factors in in-hospital and long-term survival.
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Affiliation(s)
- Ayşe Ayyıldız
- Department of Intensive Care, Eskişehir City Hospital, Eskişehir, Turkey
| | | | | | - Göknur Yıldız
- Department of Emergency Medicine, Eskişehir City Hospital, Eskişehir, Turkey
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3
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Srinivasan V, Hall J, Wahlster S, Johnson NJ, Branch K. Associations between clinical characteristics of cardiac arrest and early CT head findings of hypoxic ischaemic brain injury following out-of-hospital cardiac arrest. Resuscitation 2023; 190:109858. [PMID: 37270091 DOI: 10.1016/j.resuscitation.2023.109858] [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: 03/01/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND/OBJECTIVE Post-cardiac arrest patients are vulnerable to hypoxic-ischaemic brain injury (HIBI), but HIBI may not be identified until computed tomography (CT) scan of the brain is obtained post-resuscitation and stabilization. We aimed to evaluate the association of clinical arrest characteristics with early CT findings of HIBI to identify those at the highest risk for HIBI. METHODS This is a retrospective analysis of out-of-hospital cardiac arrest (OHCA) patients who underwent whole-body imaging. Head CT reports were analyzed with an emphasis on findings suggestive of HIBI; HIBI was present if any of the following were noted on the neuroradiologist read: global cerebral oedema, sulcal effacement, blurred grey-white junction, and ventricular compression. The primary exposure was duration of cardiac arrest. Secondary exposures included age, cardiac vs noncardiac etiology, and witnessed vs unwitnessed arrest. The primary outcome was CT findings of HIBI. RESULTS A total of 180 patients (average age 54 years, 32% female, 71% White, 53% witnessed arrest, 32% cardiac etiology of arrest, mean CPR duration of 15 ± 10 minutes) were included in this analysis. CT findings of HIBI were seen in 47 (48.3%) patients. Multivariate logistic regression demonstrated a significant association between CPR duration and HIBI (adjusted OR = 1.1, 95% CI 1.01-1.11, p < 0.01). CONCLUSION Signs of HIBI are commonly seen on CT head within 6 hours of OHCA, occurring in approximately half of patients, and are associated with CPR duration. Determining risk factors for abnormal CT findings can help clinically identify patients at higher risk for HIBI and target interventions appropriately.
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Affiliation(s)
- Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington School of Medicine, United States.
| | - Jane Hall
- Department of Emergency Medicine, University of Washington School of Medicine, United States
| | - Sarah Wahlster
- Department of Neurology, University of Washington School of Medicine, United States; Department of Neurosurgery, University of Washington School of Medicine, United States; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, United States
| | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington School of Medicine, United States; Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, United States
| | - Kelley Branch
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, United States
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Baldor DJ, Smyrnios NA, Faris K, Guilarte-Walker Y, Celik U, Torres U. A Controlled Study in CPR-Survival in Propensity Score Matched Full-Code and Do-Not-Resuscitate ICU Patients. J Intensive Care Med 2022; 37:1363-1369. [PMID: 35815880 DOI: 10.1177/08850666221114052] [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: 11/15/2022]
Abstract
BACKGROUND Cardiopulmonary Resuscitation (CPR) causes significant injuries and increased cost among transiently resuscitated patients that do not survive their hospitalizations. Descriptive studies show zero and near-zero percent survival for CPR recipients with high Apache II scores. Despite these factors, no controlled studies exist in CPR to guide patient selection for CPR candidacy. Our objective was therefore to perform a controlled study in CPR to inform recommendations for CPR candidacy. We hypothesize that the protective effects of CPR decrease as illness severity increases, and that Full-Code status provides no survival benefit over Do-Not-Resuscitate (DNR) status for patients with the highest predicted mortality by Apache IV score. METHODS We performed propensity-score matched survival analyzes between Full-Code and DNR patients after stratifying by predicted mortality quartiles using Apache IV scores. Primary outcomes were mortality hazard ratios. Secondary outcomes were Median Survival Differences, ICU LOS, and tracheostomy rates. RESULTS Among 17,710 propensity-score matched ICU encounters, DNR status was associated with greater mortality in the first through third predicted mortality quartiles. There was no difference in survival outcomes in the fourth quartile (HR 0.99, p = .96). There was a stepwise decrease in the mortality hazard ratio for DNR patients as quartiles increased. CONCLUSION Full-Code status provides no survival benefit over DNR status in individuals with greater than 75% predicted mortality by Apache IV score. There is a stepwise decrease in survival benefit for Full-Code patients as predicted mortality increases. We propose that it is reasonable to consider a very high predicted mortality by Apache IV score a contraindication to CPR given the lack of survival benefit seen in these patients. Larger studies with similar methods should be performed to reinforce or refute these findings.
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Affiliation(s)
- Daniel J Baldor
- Department of General Surgery, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Nicholas A Smyrnios
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Khaldoun Faris
- Division of Anesthesiology Critical Care Medicine, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Yurima Guilarte-Walker
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Ugur Celik
- Center for Clinical and Translational Science, Research Informatics Core, The University of Massachusetts Chan School of Medicine, Worcester, MA, USA
| | - Ulises Torres
- George Washington University School of Medicine, Washington, DC, USA
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Incidence, characteristics and predictors of mortality following cardiac arrest in ICUs of a German university hospital: A retrospective cohort study. Eur J Anaesthesiol 2022; 39:452-462. [PMID: 35200202 DOI: 10.1097/eja.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac arrest in intensive care is a rarely studied type of in-hospital cardiac arrest. OBJECTIVE This study examines the incidence, characteristics, risk factors for mortality as well as long-term prognosis following cardiac arrest in intensive care. DESIGN Retrospective cohort study. SETTING Five noncardiac surgical ICUs (41 surgical and 37 medical beds) at a German university hospital between 2016 and 2019. PATIENTS Adults experiencing cardiac arrest defined as the need for chest compressions and/or defibrillation occurring for the first time on the ICU. MAIN OUTCOME MEASURES Primary endpoint: occurrence of cardiac-arrest in the ICU. Secondary endpoints: diagnostic and therapeutic measures; risk factors and marginal probabilities of no-return of spontaneous circulation; rates of return of spontaneous circulation, hospital discharge, 1-year-survival and 1-year-neurological outcome. RESULTS A total of 114 cardiac arrests were observed out of 14 264 ICU admissions; incidence 0.8%; 95% confidence interval (CI) 0.7 to 1.0; 45.6% received at least one additional diagnostic test, such as blood gas analysis (36%), echocardiography (19.3%) or chest x-ray (9.9%) with a resulting change in therapy in 52%, (more frequently in those with a return of spontaneous circulation vs none, P = 0.023). Risk factors for no-return of spontaneous circulation were cardiac comorbidities (OR 5.4; 95% CI, 1.4 to 20.7) and continuous renal replacement therapy (OR 5.9; 95% CI, 1.7 to 20.8). Bicarbonate levels greater than 21 mmol l-1 were associated with a higher mortality risk in combination either with cardiac comorbidities (bicarbonate <21 mmol l-1: 13%; 21 to 26 mmol l-1: 45%; >26 mmol l-1: 42%) or with a SOFA at least 2 (bicarbonate <21 mmol l-1: 8%; 21 to 26 mmol l-1: 40%; >26 mmol l-1: 37%). In-hospital mortality was 78.1% (n=89); 1-year-survival-rate was 10.5% (95% CI, 5.5 to 17.7) and survival with a good neurological outcome was 6.1% (95% CI, 2.5 to 12.2). CONCLUSION Cardiac arrest in ICU is a rare complication with a high mortality and low rate of good neurological outcome. The development of a structured approach to resuscitation should include all available resources of an ICU and adequately consider the complete diagnostic and therapeutic spectra as our results indicate that these are still underused. The development of prediction models of death should take into account cardiac and hepatic comorbidities, continuous renal replacement therapy, SOFA at least 2 before cardiac arrest and bicarbonate level. Further research should concentrate on identifying early predictors and on the prevention of cardiac arrest in ICU.
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Unexpected cardiac arrests occurring inside the ICU: outcomes of a French prospective multicenter study. Intensive Care Med 2020; 46:1005-1015. [DOI: 10.1007/s00134-020-05992-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
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Fayyazi Bordbar MR, Tavakkoli K, Nahidi M, Fayyazi Bordbar A. Investigating the Attitude of Healthcare Providers, Patients, and Their Families toward "Do Not Resuscitate" Orders in an Iranian Oncology Hospital. Indian J Palliat Care 2019; 25:440-444. [PMID: 31413462 PMCID: PMC6659519 DOI: 10.4103/ijpc.ijpc_29_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim The decision-making process for do-not-resuscitate (DNR) order has always been challenging. Cultural and religious issues have limited the issuance and execution of DNR orders in Iran. The purpose of this study was to assess the attitude of the nurses, physicians, patients, and their families toward the DNR order. Subjects and Methods In this cross-sectional study, 343 participants (201 patients, 95 family members, and 47 healthcare providers) from Omid Oncology Hospital, Mashhad, Iran, were surveyed during 2017-2018. All the participants were asked to fill in a checklist of demographic information and a validated questionnaire about their attitude toward DNR orders after giving consent. The data were analyzed using SPSS software and values of P < 0.05 were considered statistically significant. Results Overall, 201 patients and 95 of their family members, as well as 47 healthcare providers (doctors and nurses), were surveyed. The mean age of participants was 48.75 ± 15.62 years. The attitude of the participants regarding the DNR order was significantly different in 10 of the 11 items (P ≤ 0.005). Among the three groups of participants, healthcare providers showed the most positive attitude regarding the DNR order. The attitude of participants regarding the DNR orders was significantly associated with age, occupation status, residential place, educational status, and income level (P < 0.05). Conclusions Various factors, such as economic status, level of education, place of residence, and gender, can be effective on decision-making regarding the DNR orders. Unified and sustained education regarding moral and cultural issues can be helpful in the reconciliation of the attitudes between caregivers and patients.
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Affiliation(s)
| | - Keyvan Tavakkoli
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Fayyazi Bordbar
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
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8
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9
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Detection of shockable ventricular arrhythmia using optimal orthogonal wavelet filters. Neural Comput Appl 2019. [DOI: 10.1007/s00521-019-04061-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2018; 132:90-100. [DOI: 10.1016/j.resuscitation.2018.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 02/03/2023]
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Limpawattana P, Aungsakul W, Suraditnan C, Panitchote A, Patjanasoontorn B, Phunmanee A, Pittayawattanachai N. Long-term outcomes and predictors of survival after cardiopulmonary resuscitation for in-hospital cardiac arrest in a tertiary care hospital in Thailand. Ther Clin Risk Manag 2018; 14:583-589. [PMID: 29593417 PMCID: PMC5865579 DOI: 10.2147/tcrm.s157483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There are limited data available regarding long-term survival and its predictors in cases of in-hospital cardiac arrest (IHCA) in which patients receive cardiopulmonary resuscitation. Purpose The objectives of this study were to determine the 1-year survival rates and predictors of survival after IHCA. Patients and methods Data were retrospectively collected on all adult patients who were administered cardiopulmonary resuscitation from January 1, 2013 to December 31, 2014 in Srinagarind Hospital (Thailand). Clinical outcomes of interest and survival at discharge and 1 year after hospitalization were reviewed. Descriptive statistics and survival analysis were used to analyze the outcomes. Results Of the 202 patients that were included, 48 (23.76%) were still alive at hospital discharge and 17 (about 8%) were still alive at 1 year post cardiac arrests. The 1-year survival rate for the cardiac arrest survivors post hospital discharge was 72.9%. Prearrest serum HCO3<20 meq/L, asystole, urine <800 cc/d, postarrest coma, and absence of pupillary reflex were predictors of death. Conclusion Only 7.9% of patients with IHCA were alive 1 year following cardiac arrest. Prearrest serum HCO3<20 meq/L, asystole, urine <800 cc/d, postarrest coma, and absence of pupillary reflex were the independent factors that predicted long-term mortality.
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Affiliation(s)
- Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wannaporn Aungsakul
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chomchanok Suraditnan
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anupol Panitchote
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Boonsong Patjanasoontorn
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anakapong Phunmanee
- Division of Critical Care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Abstract
The objective of this retrospective cohort study was to assess mortality and morbidity after cardiac arrest in hospital inpatients aged 80 years or older, in an Australian tertiary hospital. We studied patients aged 80 years or older who suffered an in-hospital cardiac arrest from 1 January 2000 to 31 December 2016. The main outcome measures were one-year survival and narrative morbidity. Two hundred and eighty-five patients were identified. Absolute one-year survival after cardiac arrest was, at best, 12.6%. Narrative descriptions of morbidity demonstrate high healthcare utilisation, dependency or residential care, and significant impairments of physical and social function. In conclusion, one-year survival after cardiac arrest in the very elderly is poor. In those who survive, significant morbidity is present.
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13
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Agarwal S, Presciutti A, Roth W, Matthews E, Rodriguez A, Roh DJ, Park S, Claassen J, Lazar RM. Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors. Crit Care Med 2018; 46:e141-e150. [PMID: 29135522 PMCID: PMC5771814 DOI: 10.1097/ccm.0000000000002846] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest. DESIGN Observational, retrospective review of a prospectively collected cohort. SETTING Medical or surgical ICUs in a single tertiary care center. PATIENTS Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3-4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1-15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2-13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03-0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06-0.9; p = 0.04). CONCLUSIONS Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest.
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Affiliation(s)
- Sachin Agarwal
- All authors: Department of Neurology, Columbia University Medical Center, New York, NY
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14
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Rodgers JL, Samal E, Mohapatra S, Panguluri SK. Hyperoxia-induced cardiotoxicity and ventricular remodeling in type-II diabetes mice. Heart Vessels 2017; 33:561-572. [PMID: 29209776 DOI: 10.1007/s00380-017-1100-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Abstract
Hyperoxia, or supplemental oxygen, is regularly used in the clinical setting for critically ill patients in ICU. However, several recent studies have demonstrated the negative impact of this treatment in patients in critical care, including increased rates of lung and cardiac injury, as well as increased mortality. The purpose of this study was to determine the predisposition for arrhythmias and electrical remodeling in a type 2 diabetic mouse model (db/db), as a result of hyperoxia treatment. For this, db/db and their heterozygous controls were treated with hyperoxia (> 90% oxygen) or normoxia (normal air) for 72-h. Immediately following hyperoxia or normoxia treatments, mice underwent surface ECG. Excised left ventricles were used to assess ion channel expression, including for Kv1.4, Kv1.5, Kv4.2, and KChIP2. Serum cardiac markers were also measured, including cardiac troponin I and lactate dehydrogenase. Our results showed that db/db mice have increased sensitivity to arrhythmia. Normoxia-treated db/db mice displayed features of arrhythmia, including QTc and JT prolongation, as well as QRS prolongation. A significant increase in QRS prolongation was also observed in hyperoxia-treated db/db mice, when compared to hyperoxia-treated heterozygous control mice. Db/db mice were also shown to exhibit ion channel dysregulation, as demonstrated by down-regulation in Kv1.5, Kv4.2, and KChIP2 under hyperoxia conditions. From these results, we conclude that: (1) diabetic mice showed distinct pathophysiology, when compared to heterozygous controls, both in normoxia and hyperoxia conditions. (2) Diabetic mice were more susceptible to arrhythmia at normal air conditions; this effect was exacerbated at hyperoxia conditions. (3) Unlike in heterozygous controls, diabetic mice did not demonstrate cardiac hypertrophy as a result of hyperoxia. (4) Ion channel remodeling was also observed in db/db mice under hyperoxia condition similar to its heterozygous controls.
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Affiliation(s)
- Jennifer Leigh Rodgers
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., MDC-30, Tampa, FL, 33612, USA
| | - Eva Samal
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Subhra Mohapatra
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Siva Kumar Panguluri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., MDC-30, Tampa, FL, 33612, USA.
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Bandrauk N, Downar J, Paunovic B. Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper. Can J Anaesth 2017; 65:105-122. [PMID: 29150778 DOI: 10.1007/s12630-017-1002-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - James Downar
- Divisions of Critical Care Medicine and Palliative Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bojan Paunovic
- Section of Critical Care Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
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Silva RMFLD, Silva BAGDLE, Silva FJME, Amaral CFS. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style. Rev Bras Ter Intensiva 2017; 28:427-435. [PMID: 28099640 PMCID: PMC5225918 DOI: 10.5935/0103-507x.20160076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to analyze the clinical profile of patients
with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients
with cardiac arrest treated in intensive care units over a period of 1
year. Results The study included 89 patients who underwent cardiopulmonary resuscitation
maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The
episodes occurred during the daytime in 64.6% of cases.
Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most
patients who exhibited a spontaneous return of circulation experienced
recurrent cardiac arrest, especially within the first 24 hours (61.4%). The
mean time elapsed between hospital admission and the occurrence of cardiac
arrest was 10.3 days, the mean time between cardiac arrest and
cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac
arrest and defibrillation was 7.1 min, and the mean duration of
cardiopulmonary resuscitation was 16.3 min. Associations between gender and
the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5
min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the
return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001)
and heart disease and age (60.6 years versus 53.6, p < 0.001) were
identified. The immediate survival rates after cardiac arrest, until
hospital discharge and 6 months after discharge were 71%, 9% and 6%,
respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval
between cardiac arrest and cardiopulmonary resuscitation was short, but
defibrillation was delayed. Women received cardiopulmonary resuscitation for
longer periods than men. The in-hospital survival rate was low.
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18
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Long-Term Outcomes in Critically Ill Septic Patients Who Survived Cardiopulmonary Resuscitation. Crit Care Med 2017; 44:1067-74. [PMID: 26807681 DOI: 10.1097/ccm.0000000000001608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale. DESIGN Retrospective and observational cohort study. SETTING Data were extracted from Taiwan's National Health Insurance Research Database. PATIENTS A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled. Post-discharge survival outcomes of ICU sepsis survivors who received cardiopulmonary resuscitation were compared with those of patients who did not experience cardiopulmonary arrest using propensity score matching with a 1:1 ratio. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Only 7% (n = 3,207) of sepsis patients who received cardiopulmonary resuscitation survived to discharge. The overall 1-, 2-, and 5-year postdischarge survival rates following cardiopulmonary resuscitation were 28%, 23%, and 14%, respectively. Compared with sepsis survivors without cardiopulmonary arrest, sepsis survivors who received cardiopulmonary resuscitation had a greater risk of all-cause mortality after discharge (hazard ratio, 1.38; 95% CI, 1.34-1.46). This difference in mortality risk diminished after 2 years (hazard ratio, 1.11; 95% CI, 0.96-1.28). Multivariable analysis showed that independent risk factors for long-term mortality following cardiopulmonary resuscitation were male sex, older age, receipt of care in a nonmedical center, higher Charlson Comorbidity Index score, chronic kidney disease, cancer, respiratory infection, vasoactive agent use, and receipt of renal replacement therapy during ICU stay. CONCLUSION The long-term outcome was worse in ICU survivors of sepsis who received in-hospital cardiopulmonary resuscitation than in those who did not, but this increased risk of mortality diminished at 2 years after discharge.
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Karagoz I, Aktas G, Yoldas H, Yildiz I, Ogun MN, Bilgi M, Demirhan A. Association Between Hemogram Parameters and Survival of Critically Ill Patients. J Intensive Care Med 2017; 34:511-513. [PMID: 28385106 DOI: 10.1177/0885066617703348] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution. METHODS We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups-dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients. RESULTS Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients ( P = .001). CONCLUSION We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.
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Affiliation(s)
- Ibrahim Karagoz
- 1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Gulali Aktas
- 2 Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Hamit Yoldas
- 1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Isa Yildiz
- 1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Muhammet Nur Ogun
- 3 Department of Neurology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Murat Bilgi
- 1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Abdullah Demirhan
- 1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Perman SM, Stanton E, Soar J, Berg RA, Donnino MW, Mikkelsen ME, Edelson DP, Churpek MM, Yang L, Merchant RM. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes. J Am Heart Assoc 2016; 5:JAHA.116.003638. [PMID: 27688235 PMCID: PMC5121474 DOI: 10.1161/jaha.116.003638] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. Methods and Results This is a retrospective study of adult IHCA events in the Get with the Guidelines—Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital‐level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed‐days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed‐days in both locations. Conclusions Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.
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Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO
| | - Emily Stanton
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Robert A Berg
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dana P Edelson
- Department of Internal Medicine, University of Chicago, Chicago, IL
| | | | - Lin Yang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Raina M Merchant
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes. J Stroke Cerebrovasc Dis 2016; 25:1644-1652. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/31/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022] Open
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Vancini-Campanharo CR, Vancini RL, Lira CABD, Andrade MDS, Góis AFTD, Atallah ÁN. Cohort study on the factors associated with survival post-cardiac arrest. SAO PAULO MED J 2015; 133:495-501. [PMID: 26760123 PMCID: PMC10496558 DOI: 10.1590/1516-3180.2015.00472607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/26/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Cardiac arrest is a common occurrence, and even with efficient emergency treatment, it is associated with a poor prognosis. Identification of predictors of survival after cardiopulmonary resuscitation may provide important information for the healthcare team and family. The aim of this study was to identify factors associated with the survival of patients treated for cardiac arrest, after a one-year follow-up period. DESIGN AND SETTING Prospective cohort study conducted in the emergency department of a Brazilian university hospital. METHODS The inclusion criterion was that the patients presented cardiac arrest that was treated in the emergency department (n = 285). Data were collected using the In-hospital Utstein Style template. Cox regression was used to determine which variables were associated with the survival rate (with 95% significance level). RESULTS After one year, the survival rate was low. Among the patients treated, 39.6% experienced a return of spontaneous circulation; 18.6% survived for 24 hours and of these, 5.6% were discharged and 4.5% were alive after one year of follow-up. Patients with pulseless electrical activity were half as likely to survive as patients with ventricular fibrillation. For patients with asystole, the survival rate was 3.5 times lower than that of patients with pulseless electrical activity. CONCLUSIONS The initial cardiac rhythm was the best predictor of patient survival. Compared with ventricular fibrillation, pulseless electrical activity was associated with shorter survival times. In turn, compared with pulseless electrical activity, asystole was associated with an even lower survival rate.
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Affiliation(s)
| | - Rodrigo Luiz Vancini
- Sports and Physical Education Center, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Claudio Andre Barbosa de Lira
- Human Physiology and Exercise Sector, School of Physical Education, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | | | | | - Álvaro Nagib Atallah
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Ocen D, Kalungi S, Ejoku J, Luggya T, Wabule A, Tumukunde J, Kwizera A. Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study. BMC Emerg Med 2015; 15:23. [PMID: 26376745 PMCID: PMC4574081 DOI: 10.1186/s12873-015-0047-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/09/2015] [Indexed: 01/12/2023] Open
Abstract
Background Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country. Methods Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05. Results There was a cardiac arrest in 2.3 % (190) of 8,131 hospital admissions; 34.5 % occurred in the intensive care unit, 4.4 % in emergency operating theaters, and 3.0 % in emergency wards. A majority (63.2 %) was unwitnessed, and only 35 patients (18.4 %) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4 %) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6 % of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity. Conclusion Our hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.
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Affiliation(s)
- Davidson Ocen
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Sam Kalungi
- Department of Pathology, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Joseph Ejoku
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Tonny Luggya
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Agnes Wabule
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Janat Tumukunde
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
| | - Arthur Kwizera
- Department of Anaesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, Kampala, Uganda.
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Gempeler R. FE. Reanimación cardiopulmonar. Más allá de la técnica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2014.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Gempeler R. FE. Cardiopulmonary resuscitation beyond the technique. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cardiopulmonary resuscitation beyond the technique☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543020-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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McIntyre RL, Hopper K, Epstein SE. Assessment of cardiopulmonary resuscitation in 121 dogs and 30 cats at a university teaching hospital (2009-2012). J Vet Emerg Crit Care (San Antonio) 2014; 24:693-704. [DOI: 10.1111/vec.12250] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Robin L. McIntyre
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Kate Hopper
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
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Hsu CH, Li J, Cinousis MJ, Sheak KR, Gaieski DF, Abella BS, Leary M. Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management*. Crit Care Med 2014; 42:2575-81. [PMID: 25072759 PMCID: PMC4236246 DOI: 10.1097/ccm.0000000000000547] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. DESIGN Retrospective chart review. SETTING Two academic medical centers from May 2005 to December 2012. PATIENTS The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management initiation, total duration of resuscitation, withdrawal of care, and location of arrest. CONCLUSION Patients with different Cerebral Performance Category scores at discharge have significantly different survival trajectories. Favorable Cerebral Performance Category at hospital discharge predicts better long-term outcomes of survivors of cardiac arrest who received targeted temperature management than those with less favorable Cerebral Performance Category scores.
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Affiliation(s)
- Cindy H Hsu
- Department of Emergency Medicine and Center for Resuscitation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Withdrawing versus not offering cardiopulmonary resuscitation: Is there a difference? Can Respir J 2014; 22:20-2. [PMID: 25393377 DOI: 10.1155/2015/508602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Conflict between substitute decision makers (SDMs) and health care providers in the intensive care unit is commonly related to goals of treatment at the end of life. Based on recent court decisions, even medical consensus that ongoing treatment is not clinically indicated cannot justify withdrawal of mechanical ventilation without consent from the SDM. Cardiopulmonary resuscitation (CPR), similar to mechanical ventilation, is a life-sustaining therapy that can result in disagreement between SDMs and clinicians. In contrast to mechanical ventilation, in cases for which CPR is judged by the medical team to not be clinically indicated, there is no explicit or case law in Canada that dictates that withholding/not offering of CPR requires the consent of SDMs. In such cases, physicians can ethically and legally not offer CPR, even against SDM or patient wishes. To ensure that nonclinically indicated CPR is not inappropriately performed, hospitals should consider developing ‘scope of treatment’ forms that make it clear that even if CPR is desired, the individual components of resuscitation to be offered, if any, will be dictated by the medical team’s clinical assessment.
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Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013. Intensive Care Med 2014; 40:1853-61. [PMID: 25387815 DOI: 10.1007/s00134-014-3509-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To estimate temporal trends in incidence and hospital mortality after cardiac arrest in Finnish intensive care units. METHODS Using a large nationwide intensive care unit (ICU) database we identified patients suffering from cardiac arrest following ICU admission (ICU-CA) during the study period (2003-2013). ICU-CA was defined as need for cardiopulmonary resuscitation and/or defibrillation (non-arrest cardioversions were excluded) according to the Therapeutic Intervention Scoring System-76. Patients admitted with an admission diagnosis of cardiac arrest were excluded. We determined crude incidence and risk-adjusted hospital mortality (based on a customized severity of illness model) for all ICU-CA patients, and for predefined admission diagnosis subgroups. Temporal trends for the observed period were calculated for crude incidence and risk-adjusted hospital mortality. RESULTS Crude incidence for all ICU-CA patients was 29/1,000 ICU admissions, with the highest incidence 118/1,000 in the non-operative cardiovascular subgroup. Overall hospital mortality for ICU-CA patients was 55.5% [95% confidence interval (CI) 54-57%]. Hospital mortality was 53.1% (95% CI 50.4-55.8%) for non-operative cardiovascular ICU-CA patients, 32.9% (95% CI 26.9-38.9%) for post cardiac surgery ICU-CA patients, and 56.3% (95% CI 51.2-61.3%) for neurological/neurosurgical ICU-CA patients. There was a significant reduction in the overall ICU-CA incidence and in the risk-adjusted hospital mortality of ICU-CA and non-cardiac arrest cases (non-CA) over the observed study period (p < 0.001). CONCLUSION Our data suggest that the incidence of ICU-CA has decreased in Finnish ICUs between 2003 and 2013. Similar reduction in hospital mortality over time was observed for both ICU-CA and non-CA populations.
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Rozen TH, Mullane S, Kaufman M, Hsiao YFF, Warrillow S, Bellomo R, Jones DA. Antecedents to cardiac arrests in a teaching hospital intensive care unit. Resuscitation 2014; 85:411-7. [PMID: 24326274 DOI: 10.1016/j.resuscitation.2013.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/07/2013] [Accepted: 11/16/2013] [Indexed: 11/26/2022]
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Al-Alwan A, Ehlenbach WJ, Menon PR, Young MP, Stapleton RD. Cardiopulmonary resuscitation among mechanically ventilated patients. Intensive Care Med 2014; 40:556-63. [PMID: 24570267 DOI: 10.1007/s00134-014-3247-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the outcomes, including long-term survival, after cardiopulmonary resuscitation (CPR) in mechanically ventilated patients. METHODS We analyzed Medicare data from 1994 to 2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated [defined by ICD-9 procedure code for intubation (96.04) or mechanical ventilation (96.7x) one or more days prior to procedure code for CPR (99.60 or 99.63)]. RESULTS We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4 % [95 % confidence interval (CI) 18.3-18.5 %]. Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1 % (95 % CI 9.8-10.4 %), compared to 19.2 % (95 % CI 19.1-19.3 %) in non-ventilated patients (p < 0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52 % lower odds of survival (OR 0.48, 95 % CI 0.46-0.49, p < 0.001). Median long-term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95 % CI 5.3-6.8 months), compared to 19.0 months (95 % CI 18.6-19.5 months) among the non-ventilated survivors (p < 0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1 % were alive at 1 year. CONCLUSIONS Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.
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Affiliation(s)
- Ali Al-Alwan
- Seacoast Pulmonary Medicine, Wentworth-Douglass Hospital, 789 Central Avenue, Dover, NH, 03820, USA
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Efendijev I, Nurmi J, Castrén M, Skrifvars MB. Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature. Resuscitation 2014; 85:472-9. [PMID: 24412160 DOI: 10.1016/j.resuscitation.2013.12.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Significant amount of data on the incidence and outcome of out-of-hospital and in-hospital cardiac arrest have been published. Cardiac arrest occurring in the intensive care unit has received less attention. AIMS To evaluate and summarize current knowledge of intensive care unit cardiac arrest including quality of data, and results focusing on incidence and patient outcome. SOURCES AND METHODS We conducted a literature search of the PubMed, CINAHL and Cochrane databases with the following search terms (medical subheadings): heart arrest AND intensive care unit OR critical care OR critical care nursing OR monitored bed OR monitored ward OR monitored patient. We included articles published from the 1st of January 1990 till 31st of December 2012. After exclusion of all duplicates and irrelevant articles we evaluated quality of studies using a predefined quality assessment score and summarized outcome data. RESULTS The initial search yielded 794 articles of which 780 were excluded. Three papers were added after a manual search of the eligible studies' references. One paper was identified manually from the literature published after our initial search was completed, thus the final sample consisted of 18 papers. Of the studies included thirteen were retrospective, two based on prospective registries and three were focused prospective studies. All except two studies were from a single institution. Six studies reported the incidence of intensive care unit cardiac arrest, which varied from 5.6 to 78.1 cardiac arrests per 1000 intensive care unit admissions. The most frequently reported initial cardiac arrest rhythms were non-shockable. Patient outcome was variable with survival to hospital discharge being in the range of 0-79% and long-term survival ranging from 1 to 69%. Nine studies reported neurological status of survivors, which was mostly favorable, either no neurological sequelae or cerebral performance score mostly of 1-2. Studies focusing on post cardiac surgery patients reported the best long-term survival rates of 45-69%. CONCLUSIONS At present data on intensive care unit cardiac arrest is quite limited and originates mostly from retrospective single center studies. The quality of data overall seems to be poor and thus focused prospective multi-center studies are needed.
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Affiliation(s)
- Ilmar Efendijev
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland.
| | - Jouni Nurmi
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland
| | - Maaret Castrén
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, University of Turku, Finland
| | - Markus B Skrifvars
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland
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LEE HK, LEE H, NO JM, JEON YT, HWANG JW, LIM YJ, PARK HP. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand 2013; 57:784-92. [PMID: 23550795 DOI: 10.1111/aas.12117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-arrest variables associated with long-term survival after cardiopulmonary resuscitation (CPR) in intensive care unit (ICU) patients remain unclear. This study was designed to identify pre- and intra-arrest factors associated with survival 3 months after CPR in ICU patients and to identify post-arrest factors associated with long-term survival in those who survived 24 h after CPR. METHODS A total of 131 ICU patients undergoing CPR from January 2009 to June 2010 were included. Data were retrospectively analysed and categorized based on the Utstein template. RESULTS The overall survival rate 3 months after CPR was 20.6%. Logistic regression analysis revealed that acute physiology and chronic health evaluation (APACHE) II score (odds ratio, 95% confidence interval, 0.87 [0.83-0.93]; P < 0.001), ventricular tachycardia/ventricular fibrillation (VT/VF, 5.55 [1.55-19.83]; P = 0.032), and normoxia during CPR (4.45 [1.34-14.71]; P = 0.045) were significant independent pre- and intra-arrest predictors of 3-month survival after CPR in ICU patients. Fifty-seven patients survived 24 h after CPR, and their 3-month survival rate was 47.4%. Early enteral nutrition (9.94 [1.96-50.43]; P = 0.030) and normoxia after return of spontaneous circulation (10.75 [2.03-55.56]; P = 0.030) were predictive of 3-month survival in patients who survived 24 h after CPR. CONCLUSIONS Normoxia during CPR and VT/VF were predictors of long-term survival after CPR in ICU patients. In patients surviving 24 h after CPR, initiation of enteral nutrition within 48 h and maintenance of normoxia were associated with a positive outcome.
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Affiliation(s)
- H.-K. LEE
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - H. LEE
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - J.-M. NO
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - Y.-T. JEON
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam; Korea
| | - J.-W. HWANG
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam; Korea
| | - Y.-J. LIM
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
| | - H.-P. PARK
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul; Korea
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Amer MS, Abdel Rahman TT, Aly WW, Ahmad NG. Retracted: Cardiopulmonary resuscitation: Outcome and its predictors among hospitalized elderly patients in Egypt. Geriatr Gerontol Int 2013; 14:309-14. [DOI: 10.1111/ggi.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Walaa Wessam Aly
- Geriatrics Department; Ain Shams University Hospitals; Cairo Egypt
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Khasawneh FA, Kamel MT, Abu-Zaid MI. Predictors of cardiopulmonary arrest outcome in a comprehensive cancer center intensive care unit. Scand J Trauma Resusc Emerg Med 2013; 21:18. [PMID: 23510300 PMCID: PMC3606609 DOI: 10.1186/1757-7241-21-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some comprehensive cancer centers in industrialized countries have reported improved outcomes in their cardiopulmonary arrest (CPA) patients. Little is known about the outcomes and predictors of CPA in cancer centers in other parts of the world. The objective of this study was to examine the predictors of CPA outcome in a comprehensive cancer center closed medical-surgical intensive care unit (ICU) located in Amman, Jordan. METHODS In this retrospective single-center cohort study, we identified 104 patients who had a CPA during their stay in the ICU between 1/1/2008 and 6/30/2009. Demographic data and CPA-related variables and outcome were extracted from medical records. Comparisons between different variables and CPA outcome were conducted using logistic regression. RESULTS The mean age of the group was 49.7 ± 15.3 years. The mean APACHE II score was 23.7 ± 8.0. Thirty six patients (34.6%) were resuscitated successfully but 8 of them (7.7% of the cohort) left the ICU alive and only 6 out of the 8 (5.8% of the cohort) left the hospital alive. The following variables predict resuscitation failure: acute kidney injury (OR 1.7, CI: 1.1-2.6), being on mechanical ventilation (OR 3.8, CI: 1.3-11), refractory shock (OR 4.7, CI: 1.8-12) and CPR duration (OR 1.1, CI: 1.1-1.2). CONCLUSION Survival among cancer patients who develop CPA in the ICU continues to be poor. Once cancer patients suffered a CPA in the ICU multiple factors predicted resuscitation failure but CPR duration was the only factor that predicted resuscitation failure and ICU as well as hospital mortality.
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Affiliation(s)
- Faisal A Khasawneh
- Section of Critical Care Medicine, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
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Chan PS, Nallamothu BK, Krumholz HM, Spertus JA, Li Y, Hammill BG, Curtis LH. Long-term outcomes in elderly survivors of in-hospital cardiac arrest. N Engl J Med 2013; 368:1019-26. [PMID: 23484828 PMCID: PMC3652256 DOI: 10.1056/nejmoa1200657] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge. METHODS We linked data from a national registry of inpatient cardiac arrests with Medicare files and identified 6972 adults, 65 years of age or older, who were discharged from the hospital after surviving an in-hospital cardiac arrest between 2000 and 2008. Predictors of 1-year survival and of readmission to the hospital were examined. RESULTS One year after hospital discharge, 58.5% of the patients were alive, and 34.4% had not been readmitted to the hospital. The risk-adjusted rate of 1-year survival was lower among older patients than among younger patients (63.7%, 58.6%, and 49.7% among patients 65 to 74, 75 to 84, and ≥85 years of age, respectively; P<0.001), among men than among women (58.6% vs. 60.9%, P=0.03), and among black patients than among white patients (52.5% vs. 60.4%, P=0.001). The risk-adjusted rate of 1-year survival was 72.8% among patients with mild or no neurologic disability at discharge, as compared with 61.1% among patients with moderate neurologic disability, 42.2% among those with severe neurologic disability, and 10.2% among those in a coma or vegetative state (P<0.001 for all comparisons). Moreover, 1-year readmission rates were higher among patients who were black, those who were women, and those who had substantial neurologic disability (P<0.05 for all comparisons). These differences in survival and readmission rates persisted at 2 years. At 3 years, the rate of survival among survivors of in-hospital cardiac arrest was similar to that of patients who had been hospitalized with heart failure and were discharged alive (43.5% and 44.9%, respectively; risk ratio, 0.98; 95% confidence interval, 0.95 to 1.02; P=0.35). CONCLUSIONS Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge. (Funded by the American Heart Association and the National Heart, Lung, and Blood Institute.).
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Affiliation(s)
- Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.
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Cleverley K, Mousavi N, Stronger L, Ann-Bordun K, Hall L, Tam JW, Tischenko A, Jassal DS, Philipp RK. The impact of telemetry on survival of in-hospital cardiac arrests in non-critical care patients. Resuscitation 2013; 84:878-82. [PMID: 23428352 DOI: 10.1016/j.resuscitation.2013.01.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Since the introduction of telemetry over a half century ago, it has expanded to various units and wards within health care institutions outside of the traditional critical care setting. Little is known on whether routine telemetry use is beneficial in this patient population. The aim of this study was to determine the impact of telemetry monitoring on survival of in-hospital cardiac arrests in patients admitted to non-critical care units. METHODS A retrospective study of cardiac arrests in patients admitted to non-critical care units within the Winnipeg Regional Health Authority from 2002 to 2006 inclusive was performed. Baseline demographic, cardiac arrest, and outcome data were collected. RESULTS Of the total 668 patients, the mean age was 70±14 years with 404 (61%) males. Patients presenting with asystole or pulseless electrical activity (PEA) demonstrated an increased mortality as compared to those presenting with ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 268 of 668 patients (40%) survived their initial arrest, 66 (10%) survived to hospital discharge and 49 (7%) survived transfer to another facility. Patients on telemetry vs. no telemetry had higher survival rates immediately following cardiac arrest (66% vs. 34%, OR=3.67, p=0.02), as well as higher survival to hospital discharge (30% vs. 6%, OR=7.17, p=0.01). Finally, patients with cardiac arrest during the night and early morning benefited proportionally the greatest from telemetry use. CONCLUSION Regardless of whether cardiac arrest was witnessed or unwitnessed, telemetry use was an independent and strong predictor of survival to hospital discharge.
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Affiliation(s)
- Kelby Cleverley
- Institute of Cardiovascular Sciences, Cardiology Division, Department of Physiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Matos RI, Watson RS, Nadkarni VM, Huang HH, Berg RA, Meaney PA, Carroll CL, Berens RJ, Praestgaard A, Weissfeld L, Spinella PC. Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests. Circulation 2013; 127:442-51. [DOI: 10.1161/circulationaha.112.125625] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests.
Methods and Results—
We examined the effect of CPR duration for pediatric in-hospital cardiac arrests from the Get With The Guidelines–Resuscitation prospective, multicenter registry of in-hospital cardiac arrests. We included 3419 children from 328 US and Canadian Get With The Guidelines–Resuscitation sites with an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma. Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes. Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute. Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes. Among survivors, favorable neurological outcome occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes. Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8–3.4) and 2.7 (95% confidence interval, 2.0–3.9), respectively.
Conclusions—
CPR duration was independently associated with survival to hospital discharge and neurological outcome. Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.
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Affiliation(s)
- Renée I. Matos
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - R. Scott Watson
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Vinay M. Nadkarni
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Hsin-Hui Huang
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Robert A. Berg
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Peter A. Meaney
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Christopher L. Carroll
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Richard J. Berens
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Amy Praestgaard
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Lisa Weissfeld
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
| | - Philip C. Spinella
- From the CRISMA Center, Pittsburgh, PA (R.I.M., R.S.W, L.W.); Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (R.I.M., R.S.W.); Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX (R.I.M.); The Children’s Hospital of Philadelphia, Philadelphia, PA (V.M.N., R.A.B., P.A.M.); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (H.-H.H., L.W.); Connecticut Children’s Medical
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Brindley PG. Perioperative do-not-resuscitate orders: it is time to talk. BMC Anesthesiol 2013; 13:1. [PMID: 23312034 PMCID: PMC3546949 DOI: 10.1186/1471-2253-13-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 11/28/2012] [Indexed: 11/10/2022] Open
Abstract
A study by Burkle et al. in BMC Anesthesiology examined attitudes around perioperative do-not-resuscitate orders. Questionnaires were given to patients, as well as to anesthesiologists, internists and surgeons. The study has limitations and is open to interpretation. However, the findings are important. There appear to be attitudinal differences between patients and doctors, and between specialties. A small majority of patients are content to have a do-not-resuscitate order postponed during the perioperative period. A large majority expects open communication from doctors before proceeding. However, this article could also encourage a broader debate. This is about how to respect patient autonomy, while ensuring that resuscitation truly serves the patient's best interests. This commentary outlines how more communication is needed at the bedside and in wider society.
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Affiliation(s)
- Peter G Brindley
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Survival and functional outcomes after cardiopulmonary resuscitation in the intensive care unit. J Crit Care 2012; 27:421.e9-17. [DOI: 10.1016/j.jcrc.2011.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/27/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022]
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Kim MJ, Park YS, Kim SW, Yoon YS, Lee KR, Lim TH, Lim H, Park HY, Park JM, Chung SP. Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation 2012; 84:361-4. [PMID: 22819881 DOI: 10.1016/j.resuscitation.2012.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Traumatic chest injuries may occur following cardiopulmonary resuscitation (CPR). The aim of this study was to address the frequency of injuries, especially rib and sternal fractures, and also to identify factors that contribute to post-CPR trauma. METHODS This study was a prospective cross-sectional study conducted in the emergency departments (ED) of eight academic tertiary care centers. To evaluate injuries secondary to CPR, we performed chest computed tomography (CT) in patients who were successfully resuscitated from cardiac arrest. Contributing factors that might be related to injuries were also investigated. RESULTS We enrolled 71 patients between 1 January 2011 and 30 June 2011. Rib and sternal fractures were diagnosed in 22 and 3 patients, respectively. Females were more susceptible to rib fracture (p=0.036). When non-physicians participated as chest compressors in the ED, more ribs were fractured (p=0.048). The duration of CPR and number of compressors were not contributing factors to trauma secondary to CPR. There was a wide variation in the frequency of rib fractures from hospital to hospital (0-83.3%). In high-risk hospitals (in which more than 50% of patients had rib fractures), the average age of the patients was higher, and non-physicians took part in ED CPR more often than they did at low-risk hospitals. CONCLUSION The incidence of rib fracture following CPR was different in various hospitals. The presence of non-physician chest compressors in the ED was one of the contributing factors to rib fracture. Further studies on the influence of resuscitators and relation between quality of chest compression and CPR-induced injuries are warranted to reduce complications following CPR.
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Affiliation(s)
- Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Skrifvars M, Varghese B, Parr M. Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation 2012; 83:728-33. [DOI: 10.1016/j.resuscitation.2011.11.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/23/2011] [Accepted: 11/29/2011] [Indexed: 11/15/2022]
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Giuliani D, Minutoli L, Ottani A, Spaccapelo L, Bitto A, Galantucci M, Altavilla D, Squadrito F, Guarini S. Melanocortins as potential therapeutic agents in severe hypoxic conditions. Front Neuroendocrinol 2012; 33:179-93. [PMID: 22531139 DOI: 10.1016/j.yfrne.2012.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/26/2012] [Accepted: 04/09/2012] [Indexed: 01/14/2023]
Abstract
Melanocortin peptides with the adrenocorticotropin/melanocyte-stimulating hormone (ACTH/MSH) sequences and synthetic analogs have protective and life-saving effects in experimental conditions of circulatory shock, myocardial ischemia, ischemic stroke, traumatic brain injury, respiratory arrest, renal ischemia, intestinal ischemia and testicular ischemia, as well as in experimental heart transplantation. Moreover, melanocortins improve functional recovery and stimulate neurogenesis in experimental models of cerebral ischemia. These beneficial effects of ACTH/MSH-like peptides are mostly mediated by brain melanocortin MC(3)/MC(4) receptors, whose activation triggers protective pathways that counteract the main ischemia/reperfusion-related mechanisms of damage. Induction of signaling pathways and other molecular regulators of neural stem/progenitor cell proliferation, differentiation and integration seems to be the key mechanism of neurogenesis stimulation. Synthesis of stable and highly selective agonists at MC(3) and MC(4) receptors could provide the potential for development of a new class of drugs for a novel approach to management of severe ischemic diseases.
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Affiliation(s)
- Daniela Giuliani
- Department of Biomedical Sciences, Section of Pharmacology, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Charapov I, Eipe N. Cardiac arrest in the operating room requiring prolonged resuscitation. Can J Anaesth 2012; 59:578-85. [PMID: 22467067 DOI: 10.1007/s12630-012-9698-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Prolonged cardiopulmonary resuscitation (CPR) is often associated with limited success and poor long-term outcomes. The purpose of this report is to present the case of a patient who suffered an unanticipated cardiac arrest in the operating room and survived following a prolonged period of CPR. CLINICAL FEATURES A previously healthy 53-yr-old male with inflammatory bowel disease was diagnosed with a perforated bowel and underwent emergency exploratory laparotomy under general anesthesia. Approximately two hours after induction of anesthesia, the patient experienced cardiac arrest, and for 55 min, he underwent CPR and defibrillation according to the Advanced Cardiac Life Support (ACLS) protocols. As the decision to terminate CPR was being considered, a return of spontaneous circulation was detected 56 min after the onset of cardiac arrest. The patient survived with no major organ failure or adverse neurological outcome. No definitive cause of cardiac arrest was diagnosed in the postoperative period. At the follow-up 14 months after the event, the patient had returned to the pre-arrest level of functioning. The results of our literature search showed that no upper limit for the duration of CPR has been defined. Good outcomes after prolonged CPR depend on the patient's pre-arrest condition and the etiology of the cardiac arrest. CONCLUSION Perioperative cardiac arrests are rare events, and there is little evidence to suggest an upper limit for the duration of resuscitation. Unknown etiologies and the presence of good patient predictors may support the continuation of prolonged CPR with good outcomes.
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Affiliation(s)
- Ilia Charapov
- Department of Anesthesiology, The Ottawa Hospital (TOH), University of Ottawa, Carling Ave. Suite B310, Ottawa, ON, K1Y 4E9, Canada
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Affiliation(s)
- Benjamin S Abella
- Center for Resuscitation Science and the Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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