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Maddali MM, Al Habsi AS, Al Dhamri MJ, Jayapal SK, Al Kindi HN. Sudden Cardiac Death in Patients Under 49 Years Including Adolescents: A single-centre study from Oman. Sultan Qaboos Univ Med J 2023; 23:16-21. [PMID: 38161762 PMCID: PMC10754306 DOI: 10.18295/squmj.12.2023.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives This study aimed to identify the incidence of sudden cardiac death (SCD0 in adult patients under the age of 49 years, including adolescents with an out-of-hospital cardiac arrest that presented to the emergency department of a tertiary care hospital. Methods This retrospective cross-sectional study was conducted at the Royal Hospital, Muscat, Oman, between January 2015 and December 2019. All patients with out-of-hospital cardiac arrest were enrolled. The incidence of SCD was evaluated. Information about the patient's demographic data, the site of cardiac arrest, the mode of arrival, the duration of pre-arrest symptoms and if cardiopulmonary resuscitation was performed was gathered. Survival data at 3-year follow-up was obtained. Results A total of 117 out of 769 (15%) patients met the criteria for SCD. Male gender was predominant, with a median age of 33 years. In about 79.5% of the patients, cardiac arrest was witnessed. Only 43 patients (36.8%) received cardiopulmonary resuscitation at the arrest site; 21 patients (17.9%) had a shockable rhythm and 96 patients (82.1%) had a non-shockable rhythm. Spontaneous circulation was returned in 15 patients (12.8%). Nine patients (7.7%) were discharged from the hospital and 8 (6.8%) survived at least 36 months. Conclusion The study findings indicate the prevalence of SCD among patients who experienced a cardiac arrest outside the hospital. Unfortunately, only a small number of patients were able to survive in the long term. By implementing preemptive screening for individuals and their families, it may be possible to prevent SCD and improve outcomes for those affected.
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Affiliation(s)
| | - Ahmed S. Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mariya J. Al Dhamri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, The National Heart Center, The Royal Hospital, Muscat, Oman
- Division of Cardiothoracic Surgery, Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Rashid M, Kinnaird T, Ludman P, Keeble TR, Mamas M, Curzen N. Variation in practice for out-of-hospital cardiac arrest treated with percutaneous coronary intervention in England and Wales. Catheter Cardiovasc Interv 2022; 100:306-316. [PMID: 35766046 DOI: 10.1002/ccd.30316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 06/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We assessed the association between total center volume, operator volume, and out-of-hospital cardiac arrest (OHCA) percutaneous coronary intervention (PCI) volume. BACKGROUND Variations between OHCA PCI volume, hospital total PCI, and primary PCI volume are not well studied and are unlikely to be clinically justifiable. METHODS Patients undergoing PCI for the acute coronary syndrome (ACS) between January 1, 2014, and March 31, 2019, in England and Wales were grouped as OHCA PCI and non-OHCA PCI. Spearman's correlation was used to determine the degree of correlation between each hospital PCI volume and OHCA PCI volume. RESULTS Out of 250,088 PCI procedures undertaken for ACS, 12,016 (4.8%) were performed for OHCA, and 238,072 (95.2%) were non-OHCA PCI procedures. The OHCA PCI group were younger [mean age (SD) 63.2 (12.3) and 65.6 (12.5, p < 0.001)], less likely to be female (20.2% vs. 26.9%, p < 0.001) or Black, Asian, and Minority Ethnicity (11.5% vs. 14.8%, p < 0.001) compared to the non-OHCA PCI group. Although there was a degree of correlation between total PCI and OHCA PCI, there was wide variation for both ACS cohort (Spearman correlation R2 = 0.50) and total PCI volume (Spearman correlation R2 = 0.60). Furthermore, the correlation between primary PCI volume and OHCA PCI within centers was weak (R2 = 0.10). Similarly, wide variations between operator PCI volume and OHCA PCI volume were observed. CONCLUSION These national data demonstrate wide variation in the practice of OHCA PCI both between centers and individuals. These variations are not expected according to clinical factors and require further investigation.
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Affiliation(s)
- Muhammad Rashid
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke on Trent, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, Edgbaston, Birmingham, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, MSE, Basildon, UK.,MTRC, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Mamas Mamas
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke on Trent, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cardiology, University Hospital NHS Trust, Southampton, UK
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Alves N, Mota M, Cunha M, Ribeiro JM. Impact of emergent coronary angiography after out-of-the-hospital cardiac arrest without ST-segment elevation - a systematic review and meta-analysis. Int J Cardiol 2022; 364:1-8. [PMID: 35660557 DOI: 10.1016/j.ijcard.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/15/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronary artery disease is a leading cause of out-of-the-hospital cardiac arrest (OHCA). However, there is no consensus on whether OHCA patients without ST-segment elevation (STE) benefit from emergent (ie < 2 h) coronary angiography (CAG). Our aim was to assess the impact of emergent CAG in no-STE OHCA patients. METHODS We performed a systematic review and meta-analysis by searching the MEDLINE, Cochrane, Scopus, CINAHL and JBI databases for randomized controlled trials (RCTs) comparing emergent CAG versus standard of care (ie CAG >2 h after OHCA or not performed) in no-STE OHCA patients of presumed cardiac aetiology. The primary outcome was short term survival. Secondary outcomes included survival with good neurological outcome, mid-term survival, left ventricle ejection fraction (LVEF), acute kidney injury (AKI) and renal replacement therapy (RRT), ventricular arrhythmias and major bleeding during hospital stay. RESULTS Seven RCTs met the inclusion and exclusion criteria and were included; one was included only in the analysis of mid-term survival and another in the LVEF analysis. Five studies (1278 patients, 643 with early CAG and 635 with no early CAG) were included in the analysis of the primary endpoint. The groups were balanced for all baseline characteristics but previous PCI, which was more frequent in the standard of care groups. There were no significant differences between groups for short-term survival (57 vs 61%; OR0.85, 95% CI0.68-1.07; I2 = 0%). There were also no differences for any of the secondary endpoints. CONCLUSION Routine emergent CAG did not improve survival in comatose survivors of OHCA with shockable rhythm and no-STE.
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Affiliation(s)
- Nuno Alves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; UICISA:E, ESEnfC, Coimbra / SIGMA - Phi Xi Chapter, ESEnfC, Coimbra, Portugal
- CIEC -, UM, Braga, Portugal
| | - Mauro Mota
- Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA:E)
- Unidade Local de Saúde da Guarda, Portugal
| | - Madelena Cunha
- Politécnico de Viseu, Escola Superior de Saúde, Viseu, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Joana Maria Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
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Nikolaou NI, Netherton S, Welsford M, Drennan IR, Nation K, Belley-Cote E, Torabi N, Morrison LJ. A systematic review and meta-analysis of the effect of routine early angiography in patients with return of spontaneous circulation after Out-of-Hospital Cardiac Arrest. Resuscitation 2021; 163:28-48. [PMID: 33838169 DOI: 10.1016/j.resuscitation.2021.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early coronary angiography (CAG) has been reported in individual studies and systematic reviews to significantly improve outcomes of patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). METHODS We undertook a systematic review and meta-analysis to evaluate the impact of early CAG on key clinical outcomes in comatose patients after ROSC following out-of-hospital CA of presumed cardiac origin. We searched the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials databases from 1990 until April 2020. Eligible studies compared patients undergoing early CAG to patients with late or no CAG. When randomized controlled trials (RCTs) existed for a specific outcome, we used their results to estimate the effect of the intervention. In the absence of randomized data, we used observational data. We excluded studies at high risk of bias according to the Robins-I tool from the meta-analysis. The GRADE system was used to assess certainty of evidence at an outcome level. RESULTS Of 3738 citations screened, 3 randomized trials and 41 observational studies were eligible for inclusion. Evidence certainty across all outcomes for the RCTs was assessed as low. Randomized data showed no benefit from early as opposed to late CAG across all critical outcomes of survival and survival with favourable neurologic outcome for undifferentiated patients and for patient subgroups without ST-segment-elevation on post ROSC ECG and shockable initial rhythm. CONCLUSION These results do not support routine early CAG in undifferentiated comatose patients and patients without STE on post ROSC ECG after OHCA. REVIEW REGISTRATION PROSPERO - CRD42020160152.
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Affiliation(s)
- Nikolaos I Nikolaou
- Department of Cardiology and Cardiac Intensive Care, Konstantopouleio General Hopsital, Athens, Greece.
| | | | | | - Ian R Drennan
- Sunnybrook Research Institute, Sunnybrook Health Science Centre, Canada
| | | | - Emilie Belley-Cote
- Division of Cardiology, Department of Medicine, McMaster University, Canada
| | | | - Laurie J Morrison
- Rescu, Emergency Department, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Alnajjar H, Hilal RM, Alharbi AJ, Alharthi OH, Batwie RA, AlShehri RM, Algethami MR. Evaluation of Awareness, Knowledge, and Attitudes Towards Basic Life Support Among Non-Medical Students at Two Academic Institutions in Jeddah, Saudi Arabia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:1015-1021. [PMID: 33380857 PMCID: PMC7767641 DOI: 10.2147/amep.s271130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cardiac arrests are a leading cause of mortality in Saudi Arabia. Prompt and quick intervention using early cardiopulmonary resuscitation (CPR) can be a life-saving strategy. Sufficient knowledge and awareness regarding CPR are important in initial care, particularly during an out-of-hospital cardiac arrest. We aim to assess the knowledge, awareness, and attitude toward CPR among the students of King Abdulaziz University and Jeddah University. MATERIALS AND METHODS A descriptive, cross-sectional study design with a sample of 1053 non-medical students, regardless of their academic year, was conducted from May to July 2019 at both universities. Data were analyzed through chi-square and analysis of variance where a P-value <0.05 was considered statistically significant. RESULTS Out of 1053 students, 28.7% received CPR training. Also, the majority of the subjects were female 71%. The science department provided the largest response. Results showed that chest pain was the most observed early sign of cardiac arrest among participants by a percentage of 84.6. Majority of the participants (90.9%) felt no hesitation in performing early CPR on a family member. Additionally, committing a mistake was the most feared factor that deterred students from performing CPR. CONCLUSION Knowledge and awareness of CPR among non-medical university students were poor, despite positive attitudes toward it. Integrating mandatory CPR courses in the orientation and in the first year of the undergraduate curriculum could increase awareness and improve the outcomes of out-of-hospital cardiac arrest (OHCA).
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Affiliation(s)
- Hani Alnajjar
- Department of Anesthesia, University of Jeddah, Jeddah, Saudi Arabia
| | | | | | | | | | | | - Mohammed R Algethami
- Preventive Medicine Resident, Joint Program, Ministry of Health, Jeddah, Saudi Arabia
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Moafa HN, van Kuijk SMJ, Franssen GHLM, Moukhyer ME, Haak HR. What is known about the quality of out-of-hospital emergency medical services in the Arabian Gulf States? A systematic review. PLoS One 2019; 14:e0226230. [PMID: 31856219 PMCID: PMC6922377 DOI: 10.1371/journal.pone.0226230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Emergency Medical Services (EMS) have been developed in the Arabian Gulf States (AGS) in the last three decades. The EMS needs continuous quality assessment of their performance to improve and provide the best out-of-hospital care. This study aims to assess the quality of EMS in the AGS according to the six quality domains of the Institute of Medicine. METHODS We searched four databases (i.e., PubMed, EMBASE, Web of Science, and CINAHL) for studies that reported on the quality of EMS in any of the AGS using clinical or non-clinical performance indicators. To quantify study quality and risk of bias, the adapted Newcastle Ottawa Scale was used. We focused on structural and functional indicators, clinical and non-clinical. RESULTS Twenty-five studies were eligible for inclusion. One study contained result of safety, fifteen time-centeredness, twenty effectiveness, five patient-centeredness, and thirteen studies reported on equity of EMS. None of the studies reported on efficiency of EMS. A significant proportion of studies showed high scores on the Newcastle-Ottawa scale. Limited studies on EMS quality were available, not covering all relevant quality domains and not covering the whole AGS region. The equity domain showed the best outcome performance finding, whereas finding of the patient-centeredness domain showed room for improvement in the foreseeable future. CONCLUSION This review highlights the need for more and better studies of sufficient quality about all domains of quality in EMS in all the AGS. EMS research in Kuwait and Bahrain is warranted, as currently studies of EMS quality are unavailable for these States. Moreover, efficiency researches exploring this discipline should be conducted specially no studies were found has been searching this domain. TRIAL REGISTRATION PROSPERO registration number: CRD42019123896.
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Affiliation(s)
- H. N. Moafa
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - S. M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - M. E. Moukhyer
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - H. R. Haak
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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