1
|
Bauer J, Moormann D, Strametz R, Groneberg DA. Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study. BMJ Open 2021; 11:e043791. [PMID: 33483448 PMCID: PMC7825255 DOI: 10.1136/bmjopen-2020-043791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA. PARTICIPANTS 3296 emergency medical stations in Germany. SETTING Rural areas in Germany. PRIMARY AND SECONDARY OUTCOME MEASURES Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS. RESULTS Current EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158). CONCLUSION These results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.
Collapse
Affiliation(s)
- Jan Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Dieter Moormann
- Institute for Flight System Dynamics, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany
| | - Reinhard Strametz
- Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Hessen, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| |
Collapse
|
2
|
von Vopelius-Feldt J, Powell J, Benger JR. Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model. BMJ Open 2019; 9:e028574. [PMID: 31345972 PMCID: PMC6661553 DOI: 10.1136/bmjopen-2018-028574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective? SETTING A single National Health Service ambulance service and a charity-funded prehospital critical care service in England. PARTICIPANTS The patient population is adult, non-traumatic OHCA. METHODS We combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses. RESULTS Costs of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%-5%. CONCLUSION This is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive. Knowledge of the MEID for prehospital critical care can guide future research in this field. TRIAL REGISTRATION NUMBER ISRCTN18375201.
Collapse
Affiliation(s)
- Johannes von Vopelius-Feldt
- Faculty of Health and Applied Sciences, The University of the West of England, Bristol, UK
- Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jane Powell
- Centre for Public Health and Wellbeing, University of the West of England, Bristol, Bristol, UK
| | - Jonathan Richard Benger
- Faculty of Health and Applied Sciences, The University of the West of England, Bristol, UK
- Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
3
|
Bharmal MI, Venturini JM, Chua RFM, Sharp WW, Beiser DG, Tabit CE, Hirai T, Rosenberg JR, Friant J, Blair JEA, Paul JD, Nathan S, Shah AP. Cost-utility of extracorporeal cardiopulmonary resuscitation in patients with cardiac arrest. Resuscitation 2019; 136:126-130. [PMID: 30716427 DOI: 10.1016/j.resuscitation.2019.01.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a resource-intensive tool that provides haemodynamic and respiratory support in patients who have suffered cardiac arrest. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. METHODS We performed a retrospective review of patients who received ECPR following cardiac arrest between 2012 and 2018. All medical care-associated charges with ECPR and subsequent hospital admission were recorded. The quality-of-life of survivors was assessed with the Health Utilities Index Mark II. The cost-utility of ECPR was calculated with cost and quality-of-life data. RESULTS ECPR was used in 32 patients (15/32 in-hospital, 47%) with a median age of 55.0 years (IQR 46.3-63.3 years), 59% male and 66% African American. The median duration of ECPR support was 2.1 days (IQR 0.9-3.8 days). Survival to hospital discharge was 16%. The median score of the Health Utilities Index Mark II at discharge for the survivors was 0.44 (IQR 0.32-0.52). The median operating cost for patients undergoing ECMO was $125,683 per patient (IQR $49,751-$206,341 per patient). The calculated cost-utility for ECPR was $56,156/QALY gained. CONCLUSIONS The calculated cost-utility is within the threshold considered cost-effective in the United States (<$150,000/QALY gained). These results are comparable to the cost-effectiveness of heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics, affect the cost-utility benefit.
Collapse
Affiliation(s)
- Murtaza I Bharmal
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States.
| | - Joseph M Venturini
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Rhys F M Chua
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Willard W Sharp
- Section of Emergency Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5068, Chicago, IL, 60637, United States
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5068, Chicago, IL, 60637, United States
| | - Corey E Tabit
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Taishi Hirai
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States; Department of Cardiology, St Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, United States
| | - Jonathan R Rosenberg
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States; Department of Cardiology, NorthShore University Health System, 2650 Ridge Road, Evanston, IL, 60201, United States
| | - Janet Friant
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - John E A Blair
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Jonathan D Paul
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Sandeep Nathan
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Atman P Shah
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| |
Collapse
|
4
|
Perkins GD, Quinn T, Deakin CD, Nolan JP, Lall R, Slowther AM, Cooke M, Lamb SE, Petrou S, Achana F, Finn J, Jacobs IG, Carson A, Smyth M, Han K, Byers S, Rees N, Whitfield R, Moore F, Fothergill R, Stallard N, Long J, Hennings S, Horton J, Kaye C, Gates S. Pre-hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest (PARAMEDIC-2): Trial protocol. Resuscitation 2016; 108:75-81. [PMID: 27650864 PMCID: PMC5081174 DOI: 10.1016/j.resuscitation.2016.08.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/13/2016] [Accepted: 08/26/2016] [Indexed: 12/15/2022]
Abstract
Despite its use since the 1960s, the safety or effectiveness of adrenaline as a treatment for cardiac arrest has never been comprehensively evaluated in a clinical trial. Although most studies have found that adrenaline increases the chance of return of spontaneous circulation for short periods, many studies found harmful effects on the brain and raise concern that adrenaline may reduce overall survival and/or good neurological outcome. The PARAMEDIC-2 trial seeks to determine if adrenaline is safe and effective in out-of-hospital cardiac arrest. This is a pragmatic, individually randomised, double blind, controlled trial with a parallel economic evaluation. Participants will be eligible if they are in cardiac arrest in the out-of-hospital environment and advanced life support is initiated. Exclusions are cardiac arrest as a result of anaphylaxis or life threatening asthma, and patient known or appearing to be under 16 or pregnant. 8000 participants treated by 5 UK ambulance services will be randomised between December 2014 and August 2017 to adrenaline (intervention) or placebo (control) through opening pre-randomised drug packs. Clinical outcomes are survival to 30 days (primary outcome), hospital discharge, 3, 6 and 12 months, health related quality of life, and neurological and cognitive outcomes (secondary outcomes). Trial registration (ISRCTN73485024).
Collapse
Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK.
| | - Tom Quinn
- Faculty of Health, Social Care and Education, Kingston University London and St. George's, University of London, London SW17 0RE, UK
| | - Charles D Deakin
- Respiratory BRU, University Hospital Southampton SO16 6YD, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - Jerry P Nolan
- School of Clinical Sciences, University of Bristol, Bristol BS8 1TH, UK; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | | | - Matthew Cooke
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - Sarah E Lamb
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Felix Achana
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
| | - Ian G Jacobs
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; St John Ambulance Western Australia, Belmont, Australia
| | - Andrew Carson
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill DY5 1LX, UK
| | - Mike Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill DY5 1LX, UK
| | - Kyee Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK
| | - Sonia Byers
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales LL17 0RS, UK
| | - Richard Whitfield
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales LL17 0RS, UK
| | - Fionna Moore
- London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 0BW, UK
| | - Rachael Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 0BW, UK
| | - Nigel Stallard
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - John Long
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Jessica Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Charlotte Kaye
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Simon Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| |
Collapse
|
5
|
Wesley K, Wesley K. ALS VS. BLS. JEMS 2016; 41:28. [PMID: 26901958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
6
|
Petrie J, Easton S, Naik V, Lockie C, Brett SJ, Stümpfle R. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system. BMJ Open 2015; 5:e005797. [PMID: 25838503 PMCID: PMC4390724 DOI: 10.1136/bmjopen-2014-005797] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY). SETTING We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention). PARTICIPANTS Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system. RESULTS Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1-2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50,000, cost per CPC 1-2 survivor was £65,000. Cost and length of stay of CPC 1-2 patients was considerably lower than CPC 3-4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1-2 survivor per QALY was £16,000. CONCLUSIONS The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.
Collapse
Affiliation(s)
- J Petrie
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - S Easton
- Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - V Naik
- Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - C Lockie
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - S J Brett
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - R Stümpfle
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| |
Collapse
|
7
|
Fake AL, Swain AH, Larsen PD. Survival from out-of-hospital cardiac arrest in Wellington in relation to socioeconomic status and arrest location. N Z Med J 2013; 126:28-37. [PMID: 23822959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS The study examined the influence of physical location on survival from out-of-hospital cardiac arrest (OHCA). Firstly, OHCAs occurring in residential settings were compared to those occurring in public locations. Secondly, the residential OHCAs were classified according to socioeconomic status and the relationship between socioeconomic status and outcome from OHCA was examined. METHODS For all OHCAs that occurred between 1 July 2007 and 30 June 2010, we compared OHCA characteristics and outcomes between public and residential locations, and for residential locations examined across deciles of socioeconomic status. RESULTS Of the 445 arrests that occurred during the study period, 413 met the inclusion criteria. Survival from OHCA in public locations was approximately twice that for residential OHCA (19.8% vs 10.7%, p=0.021). We found no association between survival from residential OHCA and socioeconomic status. Similarly, we found no association between socioeconomic status and witnessing of the event, bystander cardiopulmonary resuscitation, the initial presenting rhythm, and ambulance response time. CONCLUSION Residential OHCA in the Wellington region has a much poorer prognosis than OHCA in public locations. There is no evidence to suggest that any socioeconomic group in the Wellington region is disadvantaged when a community and ambulance response is required for an OHCA.
Collapse
Affiliation(s)
- Aimee L Fake
- University of Otago, Wellington, Department of Surgery, Anaesthesia and Emergency Medicine, PO Box 7343, Wellington 6242, New Zealand.
| | | | | |
Collapse
|
8
|
Sund B, Svensson L, Rosenqvist M, Hollenberg J. Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest. Eur J Health Econ 2012; 13:811-8. [PMID: 21739334 DOI: 10.1007/s10198-011-0338-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/28/2011] [Indexed: 05/07/2023]
Abstract
AIMS Out-of-hospital cardiac arrest is fatal without treatment, and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden. METHODS AND RESULTS A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (<euro> 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be <euro> 13,000, and the cost per saved life was <euro> 60,000. CONCLUSIONS The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis, the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.
Collapse
Affiliation(s)
- Björn Sund
- Swedish Business School, Örebro University, 702 82, Örebro, Sweden.
| | | | | | | |
Collapse
|
9
|
Constantine M. Current evidence in therapeutic hypothermia for postcardiac arrest care. Emerg Med Pract 2011; 13:1-22. [PMID: 22164400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The ring of the red notification phone breaks the relative calm of an otherwise typical Monday morning and heralds the arrival of a critically ill patient. The dispatcher announces that EMS is on the way with a 57-year-old man in cardiac arrest, with an ETA of 3 minutes. Shortly after preparations for their arrival are complete, EMS personnel enter with CPR in progress and the patient already intubated. As monitor/defibrillator attachment, ETT placement confirmation, additional IV access, and complete exposure of the patient occur, you hear more about the clinical scenario from EMS. Mr. I.C. is a 57-year-old male who was moving furniture when, as described by witnesses, he complained of difficulty catching his breath and a slight tightness in his chest. He began coughing violently, vomited once, gasped, and collapsed. Emergency medical services personnel state that they arrived approximately 20 minutes after the patient had collapsed, with CPR in progress. The patient was intubated in the field, and EMS reports that the initial rhythm was PEA. Upon the patient's arrival in the ED, the rhythm is noted to be ventricular fibrillation. Defibrillation is attempted twice over the next 4 minutes, with concomitant administration of medications. During the next rhythm check, QRS complexes are noted on the monitor and a pulse is palpated. The patient has had a return of spontaneous circulation, apparently 50 minutes from onset of the arrest. As you initiate postresuscitation care, you consider the patient's prognosis and wonder if he qualifies for therapeutic hypothermia; ie, will therapeutic hypothermia make a difference in his outcome?
Collapse
Affiliation(s)
- Matthew Constantine
- Department of Emergency Medicine, State University of New York, Downstate/Kings County Hospital, Brooklyn, NY, USA
| |
Collapse
|