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Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Vaillancourt C, Rowan KM, Harrison DA, Nolan JP, Kyeremanteng K, McIsaac DI, Guyatt GH, Perry JJ. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis. BMJ 2019; 367:l6373. [PMID: 31801749 PMCID: PMC6891802 DOI: 10.1136/bmj.l6373] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database. STUDY SELECTION CRITERIA English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DATA EXTRACTION PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence. RESULTS The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival. CONCLUSION Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018104795.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Tran
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Hasanpour Dehkordi A, Sarokhani D, Ghafari M, Mikelani M, Mahmoodnia L. Effect of Palliative Care on Quality of Life and Survival after Cardiopulmonary Resuscitation: A Systematic Review. Int J Prev Med 2019; 10:147. [PMID: 31579159 PMCID: PMC6767805 DOI: 10.4103/ijpvm.ijpvm_191_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiac and respiratory arrest is reversible through immediate cardiopulmonary resuscitation (CPR). However, survival after CPR is very low for various reasons. This systematic review study was conducted to assess the effect of palliative care on quality of life and survival after CPR. Methods: In the present meta-analysis and systematic review study, two researchers independently searched Google Scholar and MagIran, MedLib, IranMedex, SID, and PubMed for articles published during 1994–2016 and containing a number of relevant keywords and their Medical Subject Headings (MeSH) combinations. A total of 156 articles were initially extracted. Results: The success of initial resuscitation was reported to be much higher than the success of secondary resuscitation (survival until discharge). Moreover, the early detection of cardiac arrest, a high-quality CPR, immediate defibrillation, and effective postresuscitation care improved short- and long-term outcomes in these patients and significantly affected their quality of life after CPR. Most survivors of CPR can have a reasonable quality of life if they are given proper follow-up and persistent treatment. Conclusions: Concerns about the low quality of life after CPR are therefore not a worthy reason to end the efforts taken for the victims of cardiac arrest. More comprehensive education programs and facilities are required for the resuscitation of patients and the provision of post-CPR intensive care.
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Affiliation(s)
- Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Scinces, Shahrekord University of Medical sciences, Shahrekord, Iran
| | - Diana Sarokhani
- Psychosocial Injuries Research Center, Ilam University of Medical Science, Ilam, Iran
| | - Mahin Ghafari
- Department of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Mikelani
- Department of Radiology, Tehran University of Medical Science, Tehran, Iran
| | - Leila Mahmoodnia
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Analysis of “Code Blue” events in a single center: A cohort study with 419 incidents. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.519289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang J, Ma Q, Zhang H, Liu S, Zheng Y. Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation: A systemic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13257. [PMID: 30508912 PMCID: PMC6283197 DOI: 10.1097/md.0000000000013257] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection. METHODS Electronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome. The literature was screened according to inclusion and exclusion criteria, the baseline information and interested outcomes were extracted. Two reviewers assessed the methodologic quality of the included studies and the quality of evidence for summary estimates independently. Pooled mean difference (MD) or odds ratio (OR) and 95% confidence interval (CI) were calculated by Review Manager Software 5.3. At last the quality of evidence for summary estimates was appraised according to Grading of Recommendations Assessment, Development, and Evaluation rating system. RESULTS In 16 studies, 1162 patients were enrolled. Out-of-hospital cardiac arrest (CA) (OR 0.58, 95% CI 0.36-0.93, P = .02), in-hospital CA (OR 1.73, 95% CI 1.08-2.77, P = .02), witnessed CA (OR 5.2, 95% CI 1.18-22.88, P = .01), bystander cardiopulmonary resuscitation (CPR) (OR 7.35, 95% CI 2.32-23.25, P < .01), initial shockable rhythm (OR 2.29, 95% CI 1.53-3.42, P < .01), 1st recorded nonshockable rhythm (OR 0.44, 95% CI 0.29-0.66, P < .01), CPR duration (MD -13.84 minutes, 95% CI -21 to -6.69, P < .0001), arrest-to-extracorporeal membrane oxygenation (ECMO) (MD -17.88 minutes, 95% CI -23.59 to -12.17, P < .01), PH (MD 0.14, 95% CI 0.08-0.21, P < .01), lactate (MD -3.66 mmol/L, 95% CI -7.15 to -0.17, P = .04), and percutaneous coronary intervention (PCI) (OR 1.63, 95% CI 1.02-2.58, P = .04)were identified as the survival predictors of ECPR. Shockable rhythm (OR 2.33, 95% CI 1.20-4.52, P = .01) and CPR duration (MD -9.85 minutes, 95% CI -15.71 to -3.99, P = .001) were identified as the neurologic outcome predictors of ECPR. CONCLUSION Current evidence showed that in-hospital CA, witnessed CA, bystander CPR, initial shockable rhythm, shorter CPR duration and arrest-to-ECMO duration, higher baseline PH, lower baseline lactate and PCI were favourable survival predictors of adult ECPR, and shockable rhythm and shorter CPR duration were good neurological outcome predictors of adult ECPR.
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Affiliation(s)
- Junhong Wang
- Emergency Department, Peking University Third Hospital
| | - Qingbian Ma
- Emergency Department, Peking University Third Hospital
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Shaoyu Liu
- Emergency Department, Peking University Third Hospital
| | - Yaan Zheng
- Emergency Department, Peking University Third Hospital
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Liu Q, Peng J, Zhou Y, Zeng W, Xiao S, Cheng H, Zhong Z, Liao X, Xiao X, Luo L, Liu X. Clinical observation of ulinastatin combined with CRRT in the treatment of early cardiopulmonary resuscitation. Exp Ther Med 2017; 14:6064-6068. [PMID: 29285158 PMCID: PMC5740734 DOI: 10.3892/etm.2017.5325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/10/2017] [Indexed: 01/04/2023] Open
Abstract
The clinical efficacy of ulinastatin (UTI) combined with continuous renal replacement therapy (CRRT) in the treatment after early cardiopulmonary resuscitation (CPR) was evaluated. A total of 70 patients who were successfully treated with CPR in Ganzhou People's Hospital from October 2016 to March 2017 were selected as the subjects. The patients were randomly divided into control group (35 cases, conventional treatment) and UTI combined with CRRT group (35 cases, UTI + CRRT). The whole blood of patients was collected at 0, 3, 6 and 12 h after CPR. Reverse transcription-polymerase chain reaction assay was used to detect the changes of toll-like receptor 4 (TLR4) gene in mRNA levels between the two groups, i-STAT system 300 was used to analyze pH level, SO2, HCO3- and lactic acid (LAC) concentration; Abbott AXSYM system was used to detect the expression of cardiac troponin I (cTnI) in serum; the concentration of plasma malondialdehyde (MDA) was examined by a special kit; interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients was determined by enzyme-linked immunosorbent assay. The effect of UTI combined with CRRT in the early stage of CPR was analyzed. The levels of TLR4, cTnI, TNF-α, IL-6 and MDA in the plasma of patients in both groups were significantly increased (P<0.05), but the expression level in UTI + CRRT group was lower than that in control group (P<0.05). Compared with the control group, the HCO3- decreased significantly (P<0.05) in the UTI + CRRT group at 3 h, while the pH and SO2 did not change significantly. UTI + CRRT could significantly shorten the average recovery time of consciousness and the average recovery time of consciousness and spontaneous respiration in patients treated with CPR (P<0.05). Moreover, the score of APACHE II was significantly lower than that of control group (P<0.05). UTI combined with CRRT treatment can significantly improve the patient's condition after early CPR.
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Affiliation(s)
- Qinghong Liu
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Jinliang Peng
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Yuming Zhou
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Weilan Zeng
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Shihui Xiao
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Hui Cheng
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Zhenzhou Zhong
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Xiangming Liao
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Xiaoliu Xiao
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Liang Luo
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
| | - Xianghong Liu
- Department of Emergency, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, P.R. China
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Fennessy G, Hilton A, Radford S, Bellomo R, Jones D. The epidemiology of in-hospital cardiac arrests in Australia and New Zealand. Intern Med J 2017; 46:1172-1181. [PMID: 26865245 DOI: 10.1111/imj.13039] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of in-hospital cardiac arrests (IHCA) in Australia and New Zealand (ANZ) has not been systematically assessed. AIM To conduct a systematic review of the frequency, characteristics and outcomes of adult IHCA in ANZ. METHODS Medline search for studies published in 1964-2014 using MeSH terms 'arrest AND hospital AND Australia', 'arrest AND hospital AND New Zealand', 'inpatient AND arrest AND Australia' and 'inpatient AND arrest AND New Zealand'. RESULTS We screened 934 studies, analysed 50 and included 30. Frequency of IHCA ranged from 1.31 to 6.11 per 1000 admissions in 4 population studies and 0.58 to 4.59 per 1000 in 16 cohort studies. The frequency was 4.11 versus 1.32 per 1000 admissions in hospitals with rapid response system (RRS) compared with those without (odds ratio: 0.32; 95% confidence interval 0.28-0.37; P < 0.001). On aggregate, the initial cardiac rhythm was ventricular tachycardia/fibrillation in 31.4% (range 19.0-48.8%) in 10 studies reporting such data. On aggregate, IHCA were witnessed in 80.2% cases (three studies) and monitored patients in 53.4% cases (four studies). Details of life support were poorly documented. On aggregate, return of spontaneous circulation occurred in 46.0% of patients. Overall, 74.6% (range 59.4-77.5%) died in-hospital but survival was higher among monitored or younger patients, in those with a shockable rhythm, or during working hours. CONCLUSION IHCA are uncommon in ANZ and three quarters die in-hospital. However, their frequency varies markedly across institutions and may be affected by the presence of RRS. Where reported, the long-term outcomes survivors appear to have acceptable neurological outcomes.
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Affiliation(s)
- G Fennessy
- Intensive Care Unit, Western Health, Melbourne, Victoria, Australia
| | - A Hilton
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - S Radford
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - R Bellomo
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
| | - D Jones
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia. .,Monash University, Austin Hospital, Melbourne, Victoria, Australia.
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Pearce A, Lockwood C, van den Heuvel C, Pearce J. The use of therapeutic magnesium for neuroprotection during global cerebral ischemia associated with cardiac arrest and cardiac surgery in adults: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:86-118. [PMID: 28085730 DOI: 10.11124/jbisrir-2016-003236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Global cerebral ischemia occurs due to reduced blood supply to the brain. This is commonly caused by a cessation of myocardial activity associated with cardiac arrest and cardiac surgery. Survival is not the only important outcome because neurological dysfunction impacts on quality of life, reducing independent living. Magnesium has been identified as a potential neuroprotective agent; however, its role in this context is not yet clear. OBJECTIVES The objective of this review was to present the best currently available evidence related to the neuroprotective effects of magnesium during a period of global cerebral ischemia in adults with cardiac arrest or cardiac surgery. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered adults aged over 18 years who were at risk of global cerebral ischemia associated with cardiac arrest or cardiac surgery. Studies of patients with existing neurological deficits or under the age of 18 years were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The intervention of interest was magnesium administered in doses of at least of 2 g compared to placebo to adult patients within 24 hours of cardiac arrest or cardiac surgery. TYPES OF STUDIES The current review considered experimental designs including randomized controlled trials, non-randomized controlled trials and quasi-experimental designs. OUTCOMES The outcome of interest were neurological recovery post-cardiac arrest or cardiac surgery, as measured by objective scales, such as but not limited to, cerebral performance category, brain stem reflexes, Glasgow Coma Score and independent living or dependent living status. To enable assessment of the available data, neuroprotection was examined by breaking down neurological outcomes into three domains - functional neurological outcomes, neurophysiological outcomes and neuropsychological outcomes. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies between January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI) three-step search strategy. Databases searched included PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Australian Clinical Trials Register, Australian and New Zealand Clinical Trials Register, Clinical Trials, European Clinical Trials Register and ISRCTN Registry. METHODOLOGICAL QUALITY The studies included in this review were of moderate-to-good-quality randomized controlled trials. Studies included measured neurological outcome using functional neurological assessment, neuropsychiatric assessment or neurophysiological assessment. DATA EXTRACTION Data were extracted using standardized templates provided by the JBI Meta-analysis of Statistics Assessment and Review Instrument software. DATA SYNTHESIS Quantitative data were, where possible, pooled in statistical meta-analysis using Review Manager 5.3 (The Nordic Cochrane Centre, Cochrane; Copenhagen, Denmark). Where statistical pooling was not possible, the findings were presented in narrative form, including tables and figures, to aid in data presentation, where appropriate. RESULTS Seven studies with a total of 1164 participants were included in this review. Neurological outcome was categorized into three domains: functional neurological, neurophysiological and neuropsychological outcomes. Meta-analysis of three studies assessing the neuroprotective properties of magnesium administration post cardiac arrest found improved functional neurological outcome (odds ratio 0.44; 95% confidence interval 0.24-0.81). CONCLUSION Magnesium may improve functional neurological outcome in patients who suffer global cerebral ischemia associated with cardiac surgery and cardiac arrest. Magnesium does not decrease neuropsychological decline.Further testing of neurological outcomes in the domains of functional outcomes, neurophysiological markers and neuropsychological tests are required to further understanding of the neuroprotective effects of magnesium. Suitable dosing regimens should be investigated prior to introduction into clinical practice. Further research is required to investigate the optimal magnesium dose.
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Affiliation(s)
- Anna Pearce
- 1Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 2School of Medical Sciences, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 3School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australia
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Family presence during management of acute deterioration: Clinician attitudes, beliefs and perceptions of current practices. ACTA ACUST UNITED AC 2016; 19:159-65. [DOI: 10.1016/j.aenj.2016.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/15/2022]
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9
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Conrad SA. Extracorporeal cardiopulmonary resuscitation. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2016. [DOI: 10.1016/j.ejccm.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miranzadeh S, Adib-Hajbaghery M, Hosseinpour N. A Prospective Study of Survival After In-Hospital Cardiopulmonary Resuscitation and its Related Factors. Trauma Mon 2016; 21:e31796. [PMID: 27218061 PMCID: PMC4869436 DOI: 10.5812/traumamon.31796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 09/30/2015] [Accepted: 11/17/2015] [Indexed: 12/01/2022] Open
Abstract
Background Despite several studies, there is no agreement on factors that affect survival after in-hospital cardiopulmonary resuscitation (CPR). Objectives This study aimed to evaluate the survival rate of in-hospital CPR and its related factors at Shahid Beheshti hospital in Kashan, Iran, in 2014. Patients and Methods A descriptive study was conducted on all cases of CPR performed in Kashan Shahid Beheshti hospital during a 6-month period in 2014. Through a consecutive sampling method, 250 cases of CPR were studied. A three-part researcher-made instrument was used. The outcome of CPR was documented as either survival to hospital discharge or unsuccessful (death of the patient). Chi-square test, t test, and logistic regression analysis were used to analyze the data. Results Of all CPR cases, 238 (95.2%) were unsuccessful and 12 (4.8%) survived to hospital discharge. Only 2.6% of patients who were resuscitated in medical units survived to hospital discharge, whereas this rate was 11.4% in the emergency department. Only 45 (18%) patients were defibrillated during resuscitation; in 11 patients, defibrillation was performed between 15 to 45 minutes after the initiation of CPR. The mean time from initiation of CPR to the first DC shock was 13.93 ± 8.88 minutes. Moreover, the mean duration of CPR was 35.11 ± 11.42 minutes. The survival rate was higher in the morning shift and lower during the time of shift change (9.4% vs. 0). The duration of CPR and speed of arrival of the CPR team were identified as factors that predicted the outcome of CPR. Conclusions The survival rate after in-hospital CPR was very low. The duration of CPR and the time of initiating CPR effects patients’ outcomes. These findings highlight the crucial role of an organized, skilled, well-established and timely CPR team.
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Affiliation(s)
- Sedigheh Miranzadeh
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021, Fax: +98-3155546633, E-mail:
| | - Nadimeh Hosseinpour
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Pearce A, Lockwood C, Van Den Heuvel C. The use of therapeutic magnesium for neuroprotection during global cerebral ischemia associated with cardiac arrest and cardiac bypass surgery in adults: a systematic review protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513040-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Gebremedhn EG, Gebregergs GB, Anderson BB. The knowledge level of final year undergraduate health science students and medical interns about cardiopulmonary resuscitation at a university teaching hospital of Northwest Ethiopia. World J Emerg Med 2014; 5:29-34. [PMID: 25215144 DOI: 10.5847/wjem.j.issn.1920-8642.2014.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is a life-saving technique which is used after cardiopulmonary arrest. Chance of survival after arrest will increase if it is coupled with sufficient knowledge. Final year undergraduate health science students and interns manage many trauma and critically ill patients in our hospital. Even though all students took CPR training in undergraduate course, we sometimes saw difficulties in the resuscitation of patients after cardiopulmonary arrest by undergraduate health professionals. This study was to assess the level of knowledge of undergraduate health science students and medical interns about cardiopulmonary resuscitation. METHODS Hospital based cross-sectional study was conducted from February 1 to March 30, 2013. All undergraduate health professionals were included. The mean score of knowledge was compared for sex, original residence and department of the participants by using Student's t test and ANOVA with Scheffe's test. P values <0.05 were considered statistically significant. RESULTS Four hundred sixty-one out of 506 students were included in this study with a response rate of 91.1%. The overall mean knowledge score of final year undergraduate health science students and interns was 11.1 (SD=0.2). The mean knowledge scores of nurses, interns, health officer, midwifery, anesthesia and psychiatry nursing students were 9.84 (SD=2.5), 13.34 (SD=2.8), 9.81 (SD=3.0), 8.77 (SD=2.6), 13.31 (SD=2.7) and 8.43 (SD=2.4) respectively. CONCLUSIONS The knowledge level of undergraduate health professionals about cardiopulmonary resuscitation was insufficient. Training about CPR for undergraduate health professionals should be emphasized.
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Affiliation(s)
- Endale G Gebremedhn
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremedhn B Gebregergs
- Department of Public Health, Bahir Dar College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bernard B Anderson
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sui B, Li Y, Ma L. Postconditioning improvement effects of ulinastatin on brain injury following cardiopulmonary resuscitation. Exp Ther Med 2014; 8:1301-1307. [PMID: 25187844 PMCID: PMC4151659 DOI: 10.3892/etm.2014.1876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to determine the effects of ulinastatin (UTI) on brain injury in rats subjected to cardiopulmonary resuscitation (CPR) following asphyxial cardiac arrest (CA) and identify the underlying mechanisms. In total, 100 healthy male Wistar rats were randomly divided into control and treatment groups (n=50). After 4 min of asphyxial CA, all the rats were immediately subjected to CPR. The treatment group animals were administered 15 mg/kg UTI at the onset of resuscitation. The mortality rate in the two groups was recorded at 24 h post-resuscitation. In addition, neurological function was evaluated at 24, 48 and 72 h post-resuscitation using a neurological deficit scale (NDS). Furthermore, the effects of UTI on the Toll-like receptor 4 (TLR4) signaling pathway in brain tissues were determined by assessing TLR4 mRNA expression, nuclear factor (NF)-κB activity and tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels at 1, 3, 6, 12, 24, 48 and 72 h post-resuscitation. After 24 h, the mortality rate significantly decreased in the treatment group when compared with the control animals (10 vs. 30%; P<0.05). Additionally, an overt improvement was observed in the NDS score following UTI treatment when compared with the control (P<0.01). Finally, statistically significant decreases in the levels of TLR4 mRNA expression, NF-κB activity and TNF-α and IL-6 were observed in the treatment group at each time point (P<0.01). Therefore, UTI treatment at the onset of CPR significantly inhibits the TLR4 signaling pathway, thereby alleviating the inflammatory responses following resuscitation and improving neurological function.
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Affiliation(s)
- Bo Sui
- Department of Anesthesiology, The Second Artillery General Hospital, Beijing 100088, P.R. China
| | - Yongwang Li
- Department of Anesthesiology, The Second Artillery General Hospital, Beijing 100088, P.R. China
| | - Li Ma
- Department of Gynecology and Obstetrics, The Second Artillery General Hospital, Beijing 100088, P.R. China
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Hart PL, Spiva L, Baio P, Huff B, Whitfield D, Law T, Wells T, Mendoza IG. Medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in acute patient deterioration events. J Clin Nurs 2014; 23:2769-78. [DOI: 10.1111/jocn.12523] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - LeeAnna Spiva
- WellStar Development Center; Center for Nursing Excellence; Atlanta GA USA
| | - Pamela Baio
- WellStar Kennestone Hospital; Marietta GA USA
| | | | | | - Tammy Law
- WellStar Douglas Hospital; Douglasville GA USA
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Hart PL, Spiva L, Mareno N. Psychometric Properties of the Clinical Decision-Making Self-Confidence Scale. J Nurs Meas 2014; 22:312-22. [DOI: 10.1891/1061-3749.22.2.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Nurses’ self-confidence in handling acute patient deterioration events may influence decision-making capabilities and implementation of lifesaving interventions during such events. The study purpose is to provide further psychometric testing of the Clinical Decision-Making Self-Confidence Scale (CDMSCS). Methods: The psychometric properties and factor structure of the CDMSCS was examined. Results: A two-factor solution was discovered for the CDMSCS. Construct validity was further supported by statistically significant differences between registered nurses and nursing students’ self-confidence level in handling deterioration events. Cronbach’s alpha coefficients were acceptable for the subscales and instrument. Conclusion: The CDMSCS is a valid and reliable instrument. Future studies should focus on establishing test–retest reliability and to determine factor loadings of subscale items to retain or delete cross-loading items.
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Effectiveness of a structured curriculum focused on recognition and response to acute patient deterioration in an undergraduate BSN program. Nurse Educ Pract 2014; 14:30-6. [DOI: 10.1016/j.nepr.2013.06.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 04/22/2013] [Accepted: 06/26/2013] [Indexed: 11/18/2022]
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Chan JC, Wong TW, Graham CA. Factors associated with survival after in-hospital cardiac arrest in Hong Kong. Am J Emerg Med 2013; 31:883-5. [PMID: 23478113 DOI: 10.1016/j.ajem.2013.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 10/27/2022] Open
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Duran N, Riera J, Nuvials X, Ruiz-Rodriguez JC, Serra J, Rello J. The sounds of cardiac arrest: innovating to obtain an accurate record during in-hospital cardiac arrest. Resuscitation 2012; 83:1219-22. [PMID: 22796406 DOI: 10.1016/j.resuscitation.2012.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 06/14/2012] [Accepted: 06/29/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND To obtain an accurate audit during in-hospital cardiac arrest, following recommendations of the Utstein style and measuring time intervals between the different interventions, is difficult. OBJECTIVE To assess whether the use of an audio recording system during in-hospital cardiac arrest resuscitation allows the register of more items during cardiopulmonary resuscitation. MATERIAL AND METHODS Prospective observational study between January 2008 and December 2009. The population that were included, were hospitalized patients and non-hospitalized patients assisted by a cardiac arrest team, except for critical areas. An audio recording system with a timer was turned on when cardiac arrest team was alerted. Recordings were reviewed to fill in the items recommended by the Utstein style. Time intervals were calculated. Mean number of completed items per patient were compared between recorded and non-recorded cardiac arrest. RESULTS 119 CA team alerts took place. 64 (53.7%) cases were real CA and 37 (57.8%) of them were properly recorded. A mean number of items per patient in recorded cardiac arrest cases were 18.18 (±3.2) vs. 15.96 (±4.1) in non-recorded cardiac arrest cases (p<0.05). In the recorded cases, mean times were: alert - arrival: 1.23 (±0.95)min; arrival - cardiopulmonary resuscitation initiation: 0.63 (±0.38)min; arrival - first defibrillation: 2.06 (±1.33)min; arrival - intubation: 8.42 (±4.64)min; arrival - first adrenaline: 3.30 (±1.98)min. CONCLUSIONS The audio recording system permits the register of a larger number of items per patient during in-hospital cardiac arrest and allows measurement of time intervals between the different interventions during cardiopulmonary resuscitation.
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Affiliation(s)
- N Duran
- Critical Care Department, Vall d'Hebron University Hospital, Research Group in Shock, Multiorgan Dysfunction and Resuscitation, Vall d' Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain.
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Chakravarthy M, Mitra S, Nonis L. Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital. Indian Heart J 2012; 64:7-11. [PMID: 22572417 DOI: 10.1016/s0019-4832(12)60003-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. AIMS OF THE AUDIT: To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. METHODS This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from 'code blue'. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. RESULTS Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. CONCLUSION A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval.
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Qureshi SA, Ahern T, O’Shea R, Hatch L, Henderson SO. A Standardized Code Blue Team Eliminates Variable Survival from In-hospital Cardiac Arrest. J Emerg Med 2012; 42:74-8. [DOI: 10.1016/j.jemermed.2010.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/21/2010] [Accepted: 10/31/2010] [Indexed: 11/29/2022]
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Buckley T, Gordon C. The effectiveness of high fidelity simulation on medical-surgical registered nurses' ability to recognise and respond to clinical emergencies. NURSE EDUCATION TODAY 2011; 31:716-721. [PMID: 20573428 DOI: 10.1016/j.nedt.2010.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/07/2010] [Accepted: 04/23/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND There is a paucity of evidence regarding the efficacy in preparing medical-surgical nurses to respond to patients with acutely deteriorating conditions. STUDY AIM The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator. METHODS This study was a follow-up survey of medical-surgical graduate nurses following immersive high fidelity simulation training. Thirty eight registered nurses practising in medical-surgical areas completed the simulation as part of university graduate study. A follow-up survey of the graduate medical-surgical registered nurses conducted three months following completion of a high fidelity simulation-based learning experience. Outcomes consisted of the number of times skills were used in practise and the usefulness of simulation in preparing for actual emergency events. RESULTS Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practising the team leader role and debriefing as the most useful aspects of simulation. CONCLUSIONS The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses.
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Affiliation(s)
- Thomas Buckley
- Faculty of Nursing and Midwifery (MO2), The University of Sydney, Sydney NSW 2006, Australia.
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Jones P, Miles J, Mitchell N. Survival from in-hospital cardiac arrest in Auckland City Hospital. Emerg Med Australas 2011; 23:569-79. [PMID: 21995471 DOI: 10.1111/j.1742-6723.2011.01450.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe in-hospital resuscitation outcomes and factors associated with survival at Auckland City Hospital, New Zealand. METHODS The Utstein template for in-hospital cardiac arrests was used. A retrospective audit of all cardiac arrests 2004-06 determined patient demographics, resuscitation time intervals, interventions, survival and neurological outcome at 12 months. Factors associated with survival to discharge were explored with logistic regression. RESULTS There were 3470 in-hospital deaths. Resuscitation was attempted in 415 patients (12%), with survival to discharge 27.2%. Survival was higher in first rhythm VT/VF (52.7% vs 13.1%, χ(2) = 75.3, P < 0.001), when the arrest was 'In-Hours' (41.4% vs 17%, χ(2) = 30.1, P < 0.001) and with younger age (mean [SD] for survivors 59.4 [7.1]vs 69.1 [14] for non-survivors). These associations were independent predictors of survival after multivariate logistic regression, with OR 6.2 (95% CI 3.6-10.5), 3.1 (95% CI 1.8-5.4) and 1.04 (95% CI 1.02-1.06), respectively (all P < 0.001). Other univariate predictors of survival; cardiac arrest team on site, monitored arrest and time to CPR were not significant after multivariate logistic regression. Time intervals to arrest interventions were short. Twelve month neurological outcome was good (CPC1 or 2) in 97.1% (95% CI 91.6-99.4) of survivors. CONCLUSIONS Survival from cardiac arrest in our hospital compared well to similar centres and good neurological outcome was higher than reported previously. Reduced survival during the 'After-Hours' period is cause for concern, and further research into the factors underlying this is required.
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Affiliation(s)
- Peter Jones
- Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
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Laurens N, Dwyer T. The impact of medical emergency teams on ICU admission rates, cardiopulmonary arrests and mortality in a regional hospital. Resuscitation 2011; 82:707-12. [PMID: 21411218 DOI: 10.1016/j.resuscitation.2010.11.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/15/2010] [Accepted: 11/09/2010] [Indexed: 11/16/2022]
Abstract
CONTEXT In-hospital cardiac arrests are commonly associated with poor outcomes and preceded by observable signs of clinical deterioration. Medical emergency teams (METs) have emerged to provide early specialist care intervention to critically ill patients. OBJECTIVE To determine the effect of MET implementation on hospital-wide mortality rates, cardiopulmonary arrests and admissions to the intensive care unit (ICU) in a regional Queensland hospital. METHOD A prospective cohort before and after interventional trial was conducted on adult and paediatric inpatients admitted in 2004-2008 at a 150 bed regional teaching hospital in Australia. MET was introduced in 2006 and attended clinically unstable patients. Response was activated by the bedside nurse or doctor according to predefined criteria. RESULTS There were a total of 296 MET activations. After MET implementation, mean hospital-wide mortality rates decreased from 9.9 to 7.5 per 1000 admissions (relative risk reduction, RRR: 24.2%; p = 0.003). Similarly, ICU admissions decreased from 22.4 to 17.6 per 1000 admissions (RRR: 21.4%; p < 0.0001). There was also a significant decline in hospital-wide cardiopulmonary arrests post intervention (77 versus 42, RRR: 45.5%; p = 0.0025) however this may be explained by the increase in the number of patients deemed not for resuscitation by the MET. Secondary analysis revealed evidence of MET underuse that may have affected the mortality findings. CONCLUSION Implementation of the MET in a regional hospital was associated with statistically significant reductions in hospital-wide mortality rates, ICU admissions and cardiopulmonary arrests.
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Affiliation(s)
- Natasha Laurens
- Mackay Base Hospital, PO Box 5580, Mackay MC, QLD 4741, Australia.
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Gordon CJ, Buckley T. The Effect of High-Fidelity Simulation Training on Medical-Surgical Graduate Nurses’ Perceived Ability to Respond to Patient Clinical Emergencies. J Contin Educ Nurs 2009; 40:491-8; quiz 499-500. [DOI: 10.3928/00220124-20091023-06] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jäntti H, Silfvast T, Turpeinen A, Kiviniemi V, Uusaro A. Quality of cardiopulmonary resuscitation on manikins: on the floor and in the bed. Acta Anaesthesiol Scand 2009; 53:1131-7. [PMID: 19388894 DOI: 10.1111/j.1399-6576.2009.01966.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In general, in-hospital resuscitation is performed in a bed and out-of-hospital resuscitation on the floor. The surface under the patient may affect the cardiopulmonary resuscitation (CPR) quality; therefore, we evaluated CPR quality (the percentage of chest compressions of correct depth) and rescuer's fatigue (the mean compression depth minute by minute) when CPR is performed on a manikin on the floor or in the bed. METHODS Forty-four simulated cardiac arrest scenarios of 10 min were treated by intensive care unit (ICU) nurses in pairs using a 30 : 2 chest compression-to-ventilation ratio. The rescuer who performed the compressions was changed every 2 min. CPR was randomly performed either on the floor or in the bed without a backboard; in both settings, participants kneeled beside the manikin. RESULTS A total number of 1060 chest compressions, 44% with correct depth, were performed on the floor; 1068 chest compressions were performed in the bed, and 58% of these were the correct depth. These differences were not significant between groups. The mean compression depth during the scenario was 44.9+/-6.2 mm (mean+/-SD) on the floor and 43.0+/-5.9 mm in the bed (P=0.3). The mean chest compression depth decreased over time on both surfaces (P<0.001), indicating rescuer fatigue, but this change was not different between the groups (P=0.305). CONCLUSIONS ICU nurses perform chest compression as effectively on the floor as in the bed. The mean chest compression depth decreases over time, but the surface had no significant effect.
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Affiliation(s)
- H Jäntti
- Department of Anaesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
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Spearpoint K, Gruber P, Brett S. Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: An observational study over 6 years. Resuscitation 2009; 80:638-43. [DOI: 10.1016/j.resuscitation.2009.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/01/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
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Ezquerra García A, Suberviola Fernández I, Pavía Pesquera M. Evaluación de la efectividad de un sistema de alarma cardiaca intrahospitalaria. ENFERMERIA INTENSIVA 2009; 20:58-68. [DOI: 10.1016/s1130-2399(09)71147-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVES Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams. METHODS Mock Code Blue exercises using high-fidelity simulation were implemented in real workplace settings to orient CBTs to critical events. We measured arrival time of first responder, crash cart to code site, first six CBT responders, first chest compression, and first electrical shock. After each mock code, participants were debriefed to assess any barriers to effective response and decision making. RESULTS Twelve mock codes were conducted at different locations of the new facility. Sixty-nine percent of the participants reported that the training was beneficial. The median time of arrival of the first responders was 42 seconds and the first CBT member was 66 seconds. The median time to initiation of chest compressions was 80 seconds, crash cart arrival was 68 seconds, and first electrical shock was 341 seconds. An additional outcome of the study was the identification of facility and systems issues that had the potential to impact patient safety. CONCLUSIONS Clinical simulation can be effectively used to orient CBTs and identify critical safety issues in a newly constructed healthcare facility.
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Abstract
PURPOSE OF REVIEW To explore recent findings on the treatment and outcome of cardiac arrhythmias and how they affect ICU activities. RECENT FINDINGS The rate vs. rhythm control debate for the treatment of chronic atrial fibrillation continues. It is still unclear whether the postcardiac surgery inflammatory response contributes to the development of atrial fibrillation. In noncardiothoracic surgery/trauma patients hospitalized in an ICU, new-onset supraventricular arrhythmias are associated with markedly elevated mortality when compared with patients with a prior history of such arrhythmias and patients who do not develop arrhythmias. The onset of new supraventricular arrhythmias in such patients appears to be a manifestation of multiple system organ failure as it is closely associated with sepsis. Cardioversion of supraventricular arrhythmias with biphasic waveforms is being studied to determine whether it is more effective than cardioversion with monophasic waveforms. SUMMARY Supraventricular arrhythmias, especially atrial fibrillation, occur frequently in ICU patients. Intensivists not only treat atrial fibrillation itself but also its complications and the complications of the therapies used to prevent these complications. In ICU patients, ventricular arrhythmias have ominous implications because they usually portend either a major cardiac or a systemic dysfunction or both.
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Risk of cardiopulmonary arrest after acute respiratory compromise in hospitalized patients. Resuscitation 2008; 79:234-40. [DOI: 10.1016/j.resuscitation.2008.06.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/20/2008] [Accepted: 06/30/2008] [Indexed: 11/19/2022]
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Overcoming barriers to in-hospital cardiac arrest documentation. Resuscitation 2007; 76:369-75. [PMID: 18023958 DOI: 10.1016/j.resuscitation.2007.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/17/2007] [Accepted: 08/17/2007] [Indexed: 11/21/2022]
Abstract
AIMS (1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. METHOD A retrospective audit of cardiac arrest documentation for a 3-year period following the introduction of a standard documentation form. RESULTS There was an initial improvement in use of the template (29% (95%CI 22-37%) to 88% (95%CI 82-92%), p<0.001) after identification of barriers and implementation of tailored strategies. Use of the template declined (77%, 95%CI 69-84%, p=0.023) after the key facilitator left the hospital. Time interval documentation ranged from 66% (95%CI 54-77%) for tracheal intubation to 91% (95%CI 80-93%) for first dose of adrenaline (epinephrine). CONCLUSIONS Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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