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Carrick RT, Park JG, McGinnes HL, Lundquist C, Brown KD, Janes WA, Wessler BS, Kent DM. Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances. J Am Heart Assoc 2020; 9:e017625. [PMID: 32787675 PMCID: PMC7660807 DOI: 10.1161/jaha.119.017625] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background More than 500 000 sudden cardiac arrests (SCAs) occur annually in the United States. Clinical predictive models (CPMs) may be helpful tools to differentiate between patients who are likely to survive or have good neurologic recovery and those who are not. However, which CPMs are most reliable for discriminating between outcomes in SCA is not known. Methods and Results We performed a systematic review of the literature using the Tufts PACE (Predictive Analytics and Comparative Effectiveness) CPM Registry through February 1, 2020, and identified 81 unique CPMs of SCA and 62 subsequent external validation studies. Initial cardiac rhythm, age, and duration of cardiopulmonary resuscitation were the 3 most commonly used predictive variables. Only 33 of the 81 novel SCA CPMs (41%) were validated at least once. Of 81 novel SCA CPMs, 56 (69%) and 61 of 62 validation studies (98%) reported discrimination, with median c‐statistics of 0.84 and 0.81, respectively. Calibration was reported in only 29 of 62 validation studies (41.9%). For those novel models that both reported discrimination and were validated (26 models), the median percentage change in discrimination was −1.6%. We identified 3 CPMs that had undergone at least 3 external validation studies: the out‐of‐hospital cardiac arrest score (9 validations; median c‐statistic, 0.79), the cardiac arrest hospital prognosis score (6 validations; median c‐statistic, 0.83), and the good outcome following attempted resuscitation score (6 validations; median c‐statistic, 0.76). Conclusions Although only a small number of SCA CPMs have been rigorously validated, the ones that have been demonstrate good discrimination.
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Affiliation(s)
- Richard T Carrick
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Jinny G Park
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Hannah L McGinnes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Christine Lundquist
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Kristen D Brown
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - W Adam Janes
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston MA
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Bautista TG, Fong AY, Dutschmann M. Spontaneous swallowing occurs during autoresuscitation in the in situ brainstem preparation of rat. Respir Physiol Neurobiol 2014; 202:35-43. [PMID: 25086277 DOI: 10.1016/j.resp.2014.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022]
Abstract
Previous studies report that upper airway reflexes are operational during autoresuscitation from respiratory arrest. We investigated swallowing/breathing interactions, measured by recording of vagal (VNA) and phrenic nerve activities (PNA), during autoresuscitation in the in situ perfused brainstem preparation of juvenile rats. During the initial surgery, respiratory arrest was induced by exsanguination and cooling. Reperfusion (i.e. re-oxygenation and re-warming) of the brainstem circuits was associated with frequent spontaneous swallowing before resumption of respiration (n=6, 'stage 1 autoresuscitation'). When recovered, the respiratory pattern was transiently apneustic-like ('stage 2 autoresuscitation'). Spontaneous swallowing often occurred at the end of the prolonged PNA (n=9/12). Successful autoresuscitation was characterised by re-establishment of the 3 phase respiratory motor pattern and no spontaneous swallowing. Pharmacological inhibition (isoguvacine, 10 mM, 50-75 nl; n=10) of the Kölliker-Fuse nucleus (KF) mimicked stage 2 autoresuscitation. However, the frequency of spontaneous swallowing after KF inhibition did not correlate with subsequent recovery of the eupneic respiratory motor pattern.
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Affiliation(s)
- Tara G Bautista
- Florey Institute of Neuroscience and Mental Health, Gate 11, Royal Parade, University of Melbourne, Victoria 3010 Australia.
| | - Angelina Y Fong
- Department of Physiology, University of Melbourne, Victoria 3010, Australia
| | - Mathias Dutschmann
- Florey Institute of Neuroscience and Mental Health, Gate 11, Royal Parade, University of Melbourne, Victoria 3010 Australia
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3
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Abstract
AIMS The aims of this study were to double check old (Resuscitation Predictor Scoring [RPS], Advanced Cardiac Life Support, and Early Prediction Score [EPS]) and form new (Serbian Quality of Life immediately [SR-QOLi], Serbian Quality of Life short-term [SR-QOLs], and Serbian Quality of Life long-term [SR-QOLl]) scores for survival prediction in out-of-hospital cardiopulmonary resuscitation (OHCPR) in Serbia. METHODS A prospective, 2-year, multicentric study was designed. By the means of the Utstein style, OHCPR performed and its outcome were followed. In every patient, immediate (i) (Return of Spontaneus Circulation [ROSC] >20 min), short-term (s) (to hospital discharge), and long-term [1] (1 year upon) survival after the OHCPR, under the application of RPS, ASCLS, and EPS models, was evaluated. We assessed the association between survival rate and individual predictors of OHCPR using RPS, ASCLS, and EPS: cardiopulmonary resuscitation (CPR) started (>4 or <4 minutes after out-of-hospital cardiac arrest), swallowing activity (present or not), the primary arrest mode (cardiac or respiratory), and initial pupillar photoreaction (present or absent). By the successive-logistic and linear-regression analysis method, the additional model of the type SR-QOL (SR-QOLi, SR-QOLs, and SR-QOLl) was created. RESULTS We found that bystander CPR, witnessed arrest, shockable rhythms, CPR within 4 minutes, pupillar photoreaction, and primary cardiac arrest mode were associated with improved survival. Cumulative survival upon OHCPR was 12.7% for immediate, 11.3% before patient's discharge, and 10% after 12 months. Applied on our sample, standard scores displayed satisfactory (RPS) and good (Advanced Cardiac Life Support and EPS) degree of survival prediction in OHCPR. In receiver operator characteristic (ROC) analysis, SR-QOLi (ROC = 0.833) and SR-QOLs (ROC = 0.882) were defined as a good models and SR-QOLl (ROC = 0.913) was defined as an excellent model for prediction of outpatient CPR outcomes. CONCLUSION In the course of the research, SR-QOL models were created for prediction of the immediate (SR-QOLi), short-term (SR-QOLs), and long-term (SR-QOLl) survival after the OHCPR, better predictions in our environment.
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Fichet J, Dumas F, Charbonneau H, Giovanetti O, Cariou A. [What is the outcome of cardiac arrest survivors?]. Presse Med 2010; 39:694-700. [PMID: 20399598 DOI: 10.1016/j.lpm.2010.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022] Open
Abstract
In spite of recent advances, cardiac arrest remains a serious illness for which survival rate stays very low. If prehospital death remains the major problem, in-hospital death is also important. Two thirds of deaths in intensive care are the result of initial brain damage. After discharge, risk of recurrence for victims of sudden death is important and requires specific care and sometimes the implant of a cardiac defibrillator. In survivors, medium and long-term survival is satisfactory and close to that of patients with similar age and comorbidities that have not suffered cardiac arrest. The << minor >> cerebral sequels remain unknown and their impact on quality of life needs further attention.
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5
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Abstract
OBJECTIVE To describe high level of awareness in a patient undergoing cardiopulmonary resuscitation for an asystolic cardiac arrest and review the literature regarding this phenomenon. METHODS This is a case report of a patient admitted to the Intensive Care Unit who suffered an asystolic cardiac arrest. We reviewed MEDLINE using the terms "awareness," "consciousness," "cerebral perfusion," "sedation," "analgesia," "termination," "cessation," and "cardiopulmonary resuscitation." RESULTS A 57-year-old man with renal failure suffered asystolic cardiac arrest. He was awake and alert during cardiopulmonary resuscitation (CPR). Cardiac arrest was confirmed by echocardiogram and invasive arterial monitoring. He briskly localized and consistently followed simple commands while chest compressions were in progress before becoming unresponsive and dying after a 3-h resuscitative effort. No sedation/analgesia was used. There are few reports in the literature describing similar events. CONCLUSION It is possible to retain a high level of awareness following cardiac arrest, particularly with effective CPR. Recognition of this situation when it occurs allows appropriate decisions to be made regarding the use of sedation and the length of resuscitative efforts.
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Affiliation(s)
- Shailesh Bihari
- Critical Care Unit, Apollo Hospitals, No. 21, Greams Lane, Chennai, 600 006, Tamilnadu, India
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Affiliation(s)
- J. P. Nolan
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - C. D. Deakin
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - J. Soar
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - B. W. Böttiger
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - G. Smith
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - M. Baubin
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
| | - B. Dirks
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Prittwitzstraße 43, 89075 Ulm
| | - V. Wenzel
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
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Lien WC, Chang WT, Huang SP, Chiu HM, Lai TI, Weng TI, Fang CC, Wang HP, Chen WJ. Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients. Resuscitation 2004; 60:303-7. [PMID: 15050763 DOI: 10.1016/j.resuscitation.2003.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Revised: 10/30/2003] [Accepted: 12/02/2003] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). METHODS From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). RESULTS HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P = 0.039), their cardiac arrest was witnessed less frequently (P = 0.01), they received more prolonged resuscitation (P = 0.008), and needed more accumulated doses of adrenaline (epinephrine) (P = 0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P < 0.001), less survival to hospital admission (P < 0.001), less 24 h survival (P < 0.001) and less survival to discharge (P = 0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. CONCLUSION HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital Taipei No. 7, Chung-Shan South Road, Taipei 100, Taiwan
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Monsieurs KG, De Cauwer H, Wuyts FL, Bossaert LL. A rule for early outcome classification of out-of-hospital cardiac arrest patients presenting with ventricular fibrillation. Resuscitation 1998; 36:37-44. [PMID: 9547842 DOI: 10.1016/s0300-9572(97)00079-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the study was to develop a scoring system for outcome classification at the start of prehospital first tier resuscitation for patients with cardiac arrest from ventricular fibrillation (VF). We studied a consecutive sample of 100 out-of-hospital cardiac arrest patients, presenting with VF of presumed cardiac etiology on arrival of the first tier (in a two-tiered urban Emergency Medical Services system). The number of patients discharged was 29 ('survivors') and 71 died ('non-survivors'). The electrocardiography (ECG) tracings recorded during resuscitation using a semi-automatic defibrillator were retrospectively analysed. For each patient, VF amplitude in mV (VF_a) and the number of base-line crossings per second (VF_blc) were calculated. Fisher's linear discriminant analysis was applied to discriminate between survivors and non-survivors using the variables VF_a, VF_blc and age. Patients were classed as potential survivors or non-survivors using a survival index = 0.6*(VF_a) + 0.4*(VF_blc)-4.0. If for a given patient the survival index is < 0, he is classified in the non-survivor group, if the survival index is > 0, he is classified in the survivor group. Using this index 79% of the survivors and 70% of the non-survivors could be classified correctly. Adding age to the formula increased the correct classification of survivors to 86 and 73% for the non-survivors. The survival index provides a research tool for the discrimination between potential survivors and non-survivors, which opens the possibility for the development of alternative treatment protocols in cardiac arrest.
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Affiliation(s)
- K G Monsieurs
- Department of Intensive Care, University Hospital Antwerp-UIA, Belgium
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9
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Abstract
We reviewed the hospital records of 127 consecutive patients who were resuscitated from cardiac arrest in a retrospective cohort analysis. A cardiac arrest score utilizing time to return of spontaneous circulation, systolic blood pressure at the time of presentation, and initial neurologic exam were calculated. This score was analyzed with 39 other clinical variables for significance with regard to mortality or neurologic survival using multivariate analysis. Combining these variables into a cardiac arrest score (levels 0, 1, 2, 3, from least to most favorable) allowed prediction of neurologic outcomes and mortality from a single variable in an independent fashion (p < 0.0001). Logistic regression models found scores of 0, 1, 2, and 3 predicted in-hospital mortality rates of 90%, 71%, 42%, 18%, and neurologic recovery in 3%, 17%, 57%, and 89%, respectively. The cardiac arrest score was able to predict in-hospital mortality and neurologic outcomes in those who survived to emergency department arrival. This scoring scheme may aide in selection of patients for early aggressive measures, including triage coronary angiography and angioplasty.
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Affiliation(s)
- R J Thompson
- Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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10
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Martens P, Haymerle A, Sterz F, Vanhaute O, Calle P. Limitation of life support after resuscitation from cardiac arrest: practice in Belgium and Austria. Resuscitation 1997; 35:123-8. [PMID: 9316195 DOI: 10.1016/s0300-9572(97)00037-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P Martens
- Critical Care Department, AZ St.-Jan, Brugge, Belgium
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12
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital "Utstein style". American Heart Association. Ann Emerg Med 1997; 29:650-79. [PMID: 9140252 DOI: 10.1016/s0196-0644(97)70256-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R O Cummins
- Emergency Cardiac Care Committee, American Heart Association, Dallas, Tx 75231-4596, USA.
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. Circulation 1997; 95:2213-39. [PMID: 9133537 DOI: 10.1161/01.cir.95.8.2213] [Citation(s) in RCA: 253] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Resuscitation 1997; 34:151-83. [PMID: 9141159 DOI: 10.1016/s0300-9572(97)01112-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Zaritsky A, Nadkarni V, Hazinski MF, Foltin G, Quan L, Wright J, Fiser D, Zideman D, O'Malley P, Chameides L. Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. Ann Emerg Med 1995; 26:487-503. [PMID: 7574133 DOI: 10.1016/s0196-0644(95)70119-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This statement is the product of a task force meeting held June 8, 1994, in Washington DC in conjunction with the First International Conference on Pediatric Resuscitation and a follow-up task force writing group meeting held September 18, 1994, in Chicago. Draft versions of the statement were circulated for comment to all members of the task force, the American Heart Association Subcommittee on Pediatric Resuscitation, and several outside reviewers. This statement and the International Conference on Pediatric Resuscitation were cosponsored by the American Academy of Pediatrics and the American Heart Association. The development of this statement was authorized by the American Academy of Pediatrics; the American Heart Association National Subcommittees on Pediatric Resuscitation, Basic Life Support, and Advanced Cardiac Life Support, the Committee on Emergency Cardiac Care, the Science Advisory Committee; and the European Resuscitation Council. In addition to the writing group, members of the Pediatric Utstein Task Force are Paul Anderson, M Douglas Baker, Jane Ball, Desmond Bohn, Dena Brownstein, J Michael Dean, Niranjan Kissoon, Bruce Klein, Patrick Malone, Karin McCloskey, James McCrory, P Pearl O'Rourke, Mary Patterson, Charles Schleien, James Seidel, Joseph J Tepas III, and Becky Yano.
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Affiliation(s)
- A Zaritsky
- Office of Scientific Affairs, American Heart Association, Dallas, Texas 75231-4596, USA
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Zaritsky A, Nadkarni V, Hazinski MF, Foltin G, Quan L, Wright J, Fiser D, Zideman D, O'Malley P, Chameides L. Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. Resuscitation 1995; 30:95-115. [PMID: 8560109 DOI: 10.1016/0300-9572(95)00884-v] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, recommendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
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Affiliation(s)
- A Zaritsky
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596, USA
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Abstract
OBJECTIVE To identify a series of variables which predict death after in-hospital cardiopulmonary resuscitation (CPR). DESIGN Retrospective observational study. SETTING A nonteaching community hospital with 24-hr on-site critical care specialists. PATIENTS Consecutive adults undergoing CPR between August 1989 and July 1991. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Two hundred forty-two patients suffered a total of 289 cardiopulmonary arrests. Forty patients (16.5%) survived to discharge. Thirty-nine (16%) patients had more than one cardiopulmonary arrest. Survival of second CPR was 18%. Acute physiology and chronic health evaluation (APACHE) II scores within 24 h of admission and CPR (APACHE[a] and APACHE[b]) were measured. APACHE(a) and (b) scores more than 20 had a 96% predictive value positive and were associated with a five-fold decrease in survival. Besides APACHE, cardiopulmonary arrests on medical floors and after day 4 of hospitalization, duration of CPR more than 15 min, and asystole assumed significance at multivariate levels for predicting death. Ventilatory assistance and Glasgow coma score of less than 9 at 24 h after CPR predicted death for initial survivors at multivariate levels. Survival on telemetry units were similar to the ICU (17 vs 21%) but twice that of the medical floors. CONCLUSIONS The CPR outcome can be predicted early during hospital course, which may assist physicians to formulate a do-not-resuscitate order. Patients surviving a CPR should be considered candidates for another resuscitation if clinically warranted. Low-risk patients can safely be admitted to telemetry units instead of to more costly ICUs.
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Affiliation(s)
- L Bialecki
- Department of Critical Care Medicine, Christian Hospital Northeast-Northwest, St. Louis, MO 63136, USA
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Zaritsky A, Nadkarni V, Hazinski MF, Foltin G, Quan L, Wright J, Fiser D, Zideman D, O'Malley P, Chameides L. Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. Writing Group. Circulation 1995; 92:2006-20. [PMID: 7671387 DOI: 10.1161/01.cir.92.7.2006] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of the King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
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Affiliation(s)
- A Zaritsky
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596, USA
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20
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Abstract
Many patients who receive cardiopulmonary resuscitation (CPR) for cardiac arrest do not survive to leave hospital. Factors associated with adverse outcomes include unwitnessed cardiac arrest in general wards, particularly at night, prolonged resuscitation, asystole, associated disorders (e.g. sepsis, malignancy, renal failure, and left ventricular dysfunction), absent pupillary responses, hypoxaemia, low PetCO2 during resuscitation, and severe acid base imbalance. Outside hospitals, cardiac arrests result in more favourable outcomes if they occur at work, and bystander CPR and early defibrillation are initiated. On admission to ICU, likely predictors of death or severe neurological disability include prolonged coma, impaired brainstem reflexes, and persistent convulsions. Experience with cerebrospinal fluid enzymes and electrophysiological measurements is limited. Multivariate scoring systems are not sufficiently reliable. The importance of hyperglycaemia, the required level of CPR training, and the appropriateness of responding to some cases, remain debatable.
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Affiliation(s)
- H Y So
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital
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Martens PR, Mullie A, Buylaert W, Calle P, van Hoeyweghen R. Early prediction of non-survival for patients suffering cardiac arrest--a word of caution. The Belgian Cerebral Resuscitation Study Group. Intensive Care Med 1992; 18:11-4. [PMID: 1578040 DOI: 10.1007/bf01706419] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A total of 6178 persons with out-of-hospital (70%) and in hospital (30%) cardiac arrests from the first of January 1982 until the end of 1989 were reviewed retrospectively with respect to 4 variables, contributing to a score for specific prediction of poor prognosis (cut-off point: greater than 3 points). These included age, initial ECG, type of respiratory arrest and bystander resuscitation. Presence of ventricular fibrillation, gasping and bystander resuscitation contributes nothing to the score, while presence of asystole or EMD (electromechanical dissociation), apnoea and absence of bystander resuscitation adds one point to it. Of patients scoring 4 or 5 points 44 were awake 14 days post CPR (Class 3). The positive predictive value of the score was 97% (95% CI 96-98%) for the out-of-hospital group and 92.2% (95% CI 88-95%) for the in-hospital group. The specificity was respectively 92.3% (95% CI 89-95%) and 94.2% (95% CI 91-96%). Although the score can weigh the likelihood of no success against that of success, we cannot recommend it for decision making as far as abandoning or continuing cardiopulmonary resuscitation efforts.
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Affiliation(s)
- P R Martens
- Department of Anaesthesia and Critical Care, A.Z. St. Jan Hospital, Brugge, Belgium
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Chamberlain D, Cummins RO, Abramson N, Allen M, Baskett P, Becker L, Bossaert L, Delooz H, Dick W, Eisenberg M, Evans T, Holmberg S, Kerber R, Mullie A, Ornato JP, Sandoe E, Skulberg A, Tunstall-pedoe H, Swanson R, Thies W. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the ‘Utstein style’. Resuscitation 1991; 22:1-26. [DOI: 10.1016/0300-9572(91)90061-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991; 84:960-75. [PMID: 1860248 DOI: 10.1161/01.cir.84.2.960] [Citation(s) in RCA: 1038] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R O Cummins
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231
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