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Lu TC, Wang CH, Chou FY, Sun JT, Chou EH, Huang EPC, Tsai CL, Ma MHM, Fang CC, Huang CH. Machine learning to predict in-hospital cardiac arrest from patients presenting to the emergency department. Intern Emerg Med 2023; 18:595-605. [PMID: 36335518 DOI: 10.1007/s11739-022-03143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022]
Abstract
In-hospital cardiac arrest (IHCA) in the emergency department (ED) is not uncommon but often fatal. Using the machine learning (ML) approach, we sought to predict ED-based IHCA (EDCA) in patients presenting to the ED based on triage data. We retrieved 733,398 ED records from a tertiary teaching hospital over a 7 year period (Jan. 1, 2009-Dec. 31, 2015). We included only adult patients (≥ 18 y) and excluded cases presenting as out-of-hospital cardiac arrest. Primary outcome (EDCA) was identified via a resuscitation code. Patient demographics, triage data, and structured chief complaints (CCs), were extracted. Stratified split was used to divide the dataset into the training and testing cohort at a 3-to-1 ratio. Three supervised ML models were trained and performances were evaluated and compared to the National Early Warning Score 2 (NEWS2) and logistic regression (LR) model by the area under the receiver operating characteristic curve (AUC). We included 316,465 adult ED records for analysis. Of them, 636 (0.2%) developed EDCA. Of the constructed ML models, Random Forest outperformed the others with the best AUC result (0.931, 95% CI 0.911-0.949), followed by Gradient Boosting (0.930, 95% CI 0.909-0.948) and Extra Trees classifier (0.915, 95% CI 0.892-0.936). Although the differences between each of ML models and LR (AUC: 0.905, 95% CI 0.882-0.926) were not significant, all constructed ML models performed significantly better than using the NEWS2 scoring system (AUC 0.678, 95% CI 0.635-0.722). Our ML models showed excellent discriminatory performance to identify EDCA based only on the triage information. This ML approach has the potential to reduce unexpected resuscitation events if successfully implemented in the ED information system.
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Affiliation(s)
- Tsung-Chien Lu
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fan-Ya Chou
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Eric H Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX, USA
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Yunlin Branch, Yunlin, Taiwan
| | - Cheng-Chung Fang
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, 7, Zhongshan S. Rd, Taipei City, 100, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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El-Seify M, Shata MO, Salaheldin S, Bawady S, Rezk AR. Evaluation of Serum Biomarkers and Electroencephalogram to Determine Survival Outcomes in Pediatric Post-Cardiac-Arrest Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020180. [PMID: 36832309 PMCID: PMC9955226 DOI: 10.3390/children10020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
Cardiac arrest causes primary and secondary brain injuries. We evaluated the association between neuron-specific enolase (NSE), serum S-100B (S100B), electroencephalogram (EEG) patterns, and post-cardiac arrest outcomes in pediatric patients. A prospective observational study was conducted in the pediatric intensive care unit and included 41 post-cardiac arrest patients who underwent EEG and serum sampling for NSE and S100B. The participants were aged 1 month to 18 years who experienced cardiac arrest and underwent CPR after a sustained return of spontaneous circulation for ≥48 h. Approximately 19.5% (n = 8) of patients survived until ICU discharge. Convulsions and sepsis were significantly associated with higher mortality (relative risk: 1.33 [95% CI = 1.09-1.6] and 1.99 [95% CI = 0.8-4.7], respectively). Serum NSE and S100B levels were not statistically associated with the outcome (p = 0.278 and 0.693, respectively). NSE levels were positively correlated with the duration of CPR. EEG patterns were significantly associated with the outcome (p = 0.01). Non-epileptogenic EEG activity was associated with the highest survival rate. Post-cardiac arrest syndrome is a serious condition with a high mortality rate. Management of sepsis and convulsions affects prognosis. We believe that NSE and S100B may have no benefit in survival evaluation. EEG can be considered for post-cardiac arrest patients.
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Affiliation(s)
- Magda El-Seify
- Department of Pediatrics, Chest Unit, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Mennatallah O. Shata
- Department of Pediatrics, Neurology Unit, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Sondos Salaheldin
- Department of Pediatrics, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Somia Bawady
- Department of Clinical Pathology, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Ahmed R. Rezk
- Department of Pediatrics, Intensive Care Unit, Ain Shams University Hospitals, Cairo 11566, Egypt
- Correspondence:
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Shi D, McLaren C, Evans C. Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review. Trauma Surg Acute Care Open 2021; 6:e000817. [PMID: 34796272 PMCID: PMC8573669 DOI: 10.1136/tsaco-2021-000817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background Despite appropriate care, most patients do not survive traumatic cardiac arrest, and many survivors suffer from permanent neurological disability. The prevalence of non-dismal neurological outcomes remains unclear. Objectives The aim of the current review is to summarize and assess the quality of reporting of the neurological outcomes in traumatic cardiac arrest survivors. Data sources A systematic review of Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and ProQuest databases was performed from inception of the database to July 2020. Study eligibility criteria Observational cohort studies that reported neurological outcomes of patients surviving traumatic cardiac arrest were included. Participants and interventions Patients who were resuscitated following traumatic cardiac arrest. Study appraisal and synthesis methods The quality of the included studies was assessed using ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) for observational studies. Results From 4295 retrieved studies, 40 were included (n=23 644 patients). The survival rate was 9.2% (n=2168 patients). Neurological status was primarily assessed at discharge. Overall, 45.8% of the survivors had good or moderate neurological recovery, 29.0% had severe neurological disability or suffered a vegetative state, and 25.2% had missing neurological outcomes. Seventeen studies qualitatively described neurological outcomes based on patient disposition and 23 studies used standardized outcome scales. 28 studies had a serious risk of bias and 12 had moderate risk of bias. Limitations The existing literature is characterized by inadequate outcome reporting and a high risk of bias, which limit our ability to prognosticate in this patient population. Conclusions or implications of key findings Good and moderate neurological recoveries are frequently reported in patients who survive traumatic cardiac arrest. Prospective studies focused on quality of survivorship in traumatic arrest are urgently needed. Level of evidence Systematic review, level IV. PROSPERO registration number CRD42020198482.
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Affiliation(s)
- Daniel Shi
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Christie McLaren
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Chris Evans
- Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Otto Q, Nolan JP, Chamberlain DA, Cummins RO, Soar J. Utstein Style for emergency care - the first 30 years. Resuscitation 2021; 163:16-25. [PMID: 33823223 DOI: 10.1016/j.resuscitation.2021.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Utstein Abbey near Stavanger in Norway, hosted a meeting in 1990 on guidelines for the uniform reporting of data from out-of-hospital cardiac arrest. In this paper we describe the last 30 years of the Utstein style. METHODS A systematic literature search identified publications from Utstein-style meetings or groups using the Utstein format. RESULTS 30 outputs were found, describing primarily resuscitation structure, process and outcome measures. They originated from all over the world and from multiple medical disciplines. Some were co-published in multiple journals. CONCLUSIONS The meeting at Utstein Abbey in 1990 has had a sustained and far-reaching impact, particularly in resuscitation science, implementation and outcomes. The Utstein format will continue to evolve following the key principles from the original meeting and with the ultimate aim of improving patient care and outcomes.
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Affiliation(s)
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | | | - Richard O Cummins
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Jasmeet Soar
- Consultant in Anaesthetics and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Gaspari R, Teran F, Kamilaris A, Gleeson T. Development and validation of a novel image quality rating scale for echocardiography during cardiac arrest. Resusc Plus 2021; 6:100097. [PMID: 34223362 PMCID: PMC8244517 DOI: 10.1016/j.resplu.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/05/2021] [Accepted: 02/12/2021] [Indexed: 11/02/2022] Open
Abstract
Objective Research into echocardiography (echo) during cardiac arrest has suffered from methodological flaws that limit aggregation of findings. We developed and validated a novel image rating scale for qualitative analysis of echo images obtained during resuscitation. Methods A novel 5-point ordinal rating scale was developed and validated using recorded echo images from 145 consecutive cardiac arrest patients. Recorded echo images were reviewed in a blinded fashion by investigators experienced in cardiac arrest echo, and image quality was rated using this scale. Cardiac activity was subsequently classified as no activity, disorganized activity and organized activity. The primary outcome was inter-rater agreement using the image quality rating scale. Secondary outcome was the qualitative evaluation of the type of cardiac activity. Results A total of 235 ultrasounds were analyzed by study investigators using the image quality rating scale. The overall image quality agreement between reviewers using the scale was good with a weighted kappa of 0.65. Agreement for image quality in subxyphoid images was greater than in parasternal images (0.65-0.52). Echo analysis of cardiac activity showed no activity (33%), disorganized activity (18%), and organized activity (49%). Agreement was great for presence or absence of "cardiac activity" and "organized cardiac activity" with a kappa of 0.84 and 0.78. Conclusions A novel image quality rating scale for echo during cardiac arrest demonstrates substantial agreement between reviewers. Agreement regarding the presence or absence, as well as the organization of cardiac activity was substantial.
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Affiliation(s)
- Romolo Gaspari
- Professor of Emergency Medicine, UMASS Memorial Medical Center, 55 Lake Ave North, Worcester, MA 01655, United States
| | - Felipe Teran
- Clinical Instructor of Emergency Medicine, Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Medical School, United States
| | - Andrew Kamilaris
- Resident in Emergency Medicine, Department of Emergency Medicine, UMASS Memorial Medical Center, United States
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Brooks Carthon M, Brom H, McHugh M, Sloane DM, Berg R, Merchant R, Girotra S, Aiken LH. Better Nurse Staffing Is Associated With Survival for Black Patients and Diminishes Racial Disparities in Survival After In-Hospital Cardiac Arrests. Med Care 2021; 59:169-176. [PMID: 33201082 PMCID: PMC7855314 DOI: 10.1097/mlr.0000000000001464] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial disparities in survival among patients who had an in-hospital cardiac arrest (IHCA) have been linked to hospital-level factors. OBJECTIVES To determine whether nurse staffing is associated with survival disparities after IHCA. RESEARCH DESIGN Cross-sectional data from (1) the American Heart Association's Get With the Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey; and (3) The American Hospital Association annual survey. Risk-adjusted logistic regression models, which took account of the hospital and patient characteristics, were used to determine the association of nurse staffing and survival to discharge for black and white patients. SUBJECTS A total of 14,132 adult patients aged 18 and older between 2004 and 2010 in 75 hospitals in 4 states. RESULTS In models that accounted for hospital and patient characteristics, the odds of survival to discharge was lower for black patients than white patients [odds ratio (OR)=0.70; 95% confidence interval (CI), 0.61-0.82]. A significant interaction was found between race and medical-surgical nurse staffing for survival to discharge, such that each additional patient per nurse lowered the odds of survival for black patients (OR=0.92; 95% CI, 0.87-0.97) more than white patients (OR=0.97; 95% CI, 0.93-1.00). CONCLUSIONS Our findings suggest that disparities in IHCA survival between black and white patients may be linked to the level of medical-surgical nurse staffing in the hospitals in which they receive care and that the benefit of being admitted to hospitals with better staffing may be especially pronounced for black patients.
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Affiliation(s)
- Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Heather Brom
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Matthew McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Robert Berg
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care, Children’s Hospital of Philadelphia
| | - Raina Merchant
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Saket Girotra
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Iowa Carver College of Medicine Comprehensive Access Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, IA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
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Høybye M, Stankovic N, Holmberg M, Christensen HC, Granfeldt A, Andersen LW. In-Hospital vs. Out-of-Hospital Cardiac Arrest: Patient Characteristics and Survival. Resuscitation 2020; 158:157-165. [PMID: 33221361 DOI: 10.1016/j.resuscitation.2020.11.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiac arrests are often categorized into two separate groups depending on the location of the arrest: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, few studies have compared the two groups directly. The aim of this study was to compare patient characteristics, cardiac arrest characteristics, and outcomes for IHCA and OHCA patients. METHODS Data on IHCA and OHCA in Denmark were obtained from two nationwide, prospective registries. All adult (≥18 years old) patients with index IHCA or OHCA from January 1, 2017 to December 31, 2018 were included. Supplementary information on outcomes, hospitalizations, and chronic diseases came from additional national registries. The primary outcome was 30-day survival and secondary outcomes were return of spontaneous circulation (ROSC) and 1-year survival. RESULTS The study included 3501 patients with IHCA and 8846 patients with OHCA. The two groups were similar in demographics, most comorbidities, and initial cardiac arrest rhythm. In the unadjusted analysis, IHCA was associated with increased survival to 30 days compared to OHCA (risk ratio [RR] = 1.41; 95% CI, 1.30; 1.54) and 1 year (RR = 1.46; 95% CI, 1.33; 1.61). Adjusting for age, sex, and comorbidities did not change the RR substantially. When cardiac arrest characteristics were added to the model, the RR decreased from 1.51 (95% CI, 1.39; 1.65) to 1.06 (95% CI, 0.93; 1.20) for survival to 30 days and from 1.66 (95% CI, 1.50; 1.84) to 1.09 (95% CI, 0.94; 1.26) for survival to 1 year. In all subgroup analyses based on cardiac arrest characteristics (e.g. witnessed status), the association between location and outcome was substantially mitigated compared to the primary analyses. CONCLUSIONS In this large, national study, we found that IHCA and OHCA patients were remarkably similar in demographics and most comorbidities. IHCA patients had better outcomes compared to OHCA patients, although these differences disappeared when comparing patients with similar cardiac arrest characteristics.
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Affiliation(s)
- Maria Høybye
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
| | - Nikola Stankovic
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
| | - Mathias Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark.
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Capital Region of Denmark, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark.
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark.
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Denmark.
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Harrison JM, Aiken LH, Sloane DM, Brooks Carthon JM, Merchant RM, Berg RA, McHugh MD. In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest. Health Aff (Millwood) 2020; 38:1087-1094. [PMID: 31260358 DOI: 10.1377/hlthaff.2018.05064] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association's Get With the Guidelines-Resuscitation registry (for 2013-18), RN4CAST-US hospital nurse surveys (2015-16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing.
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Affiliation(s)
- Jordan M Harrison
- Jordan M. Harrison ( ) is a research fellow in the Center for Health Outcomes and Policy Research, a National Clinical Scholar in the Perelman School of Medicine, and an associate fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia
| | - Linda H Aiken
- Linda H. Aiken is the Claire M. Fagin Leadership Professor of Nursing, a professor of sociology, director of the Center for Health Outcomes and Policy Research, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
| | - Douglas M Sloane
- Douglas M. Sloane is an adjunct professor at the Center for Health Outcomes and Policy Research, University of Pennsylvania
| | - J Margo Brooks Carthon
- J. Margo Brooks Carthon is an associate professor in the Center for Health Outcomes and Policy Research and a senior fellow in the Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Raina M Merchant
- Raina M. Merchant is an associate professor of emergency medicine in the Perelman School of Medicine, director of the Penn Medicine Center for Digital Health, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
| | - Robert A Berg
- Robert A. Berg is a professor of anesthesiology and critical care at the Children's Hospital of Philadelphia
| | - Matthew D McHugh
- Matthew D. McHugh is a professor of nursing, the Independence Chair for Nursing Education, associate director of the Center for Health Outcomes and Policy Research, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
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- The American Heart Association's Get With the Guidelines-Resuscitation Investigators are acknowledged at the end of the article
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Wiberg S, Holmberg MJ, Donnino MW, Kjaergaard J, Hassager C, Witten L, Berg KM, Moskowitz A, Andersen LW. Age-dependent trends in survival after adult in-hospital cardiac arrest. Resuscitation 2020; 151:189-196. [PMID: 32246986 DOI: 10.1016/j.resuscitation.2020.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. METHODS This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between 2000 and 2016. The primary outcome was survival to hospital discharge. Patients were stratified into five age groups: <50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. RESULTS A total of 234,767 IHCA patients were included. The absolute increase in survival per calendar year was 0.8% (95% CI 0.7-1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95% CI 0.4-0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95% CI 0.4-0.6%, p < 0.001) for patients older than 80 years. We observed a significant interaction between calendar year and age group (p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. CONCLUSIONS For patients with IHCA, rates of survival to discharge have improved significantly from 2000 to 2016 across all age groups.
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Affiliation(s)
- Sebastian Wiberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Mathias J Holmberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lise Witten
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Katherine M Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lars W Andersen
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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10
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Rudd AG, Bladin C, Carli P, De Silva DA, Field TS, Jauch EC, Kudenchuk P, Kurz MW, Lærdal T, Ong M, Panagos P, Ranta A, Rutan C, Sayre MR, Schonau L, Shin SD, Waters D, Lippert F. Utstein recommendation for emergency stroke care. Int J Stroke 2020; 15:555-564. [PMID: 32223543 PMCID: PMC7672780 DOI: 10.1177/1747493020915135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent advances in treatment for stroke give new possibilities for optimizing
outcomes. To deliver these prehospital care needs to become more
efficient. Aim To develop a framework to support improved delivery of prehospital care. The
recommendations are aimed at clinicians involved in prehospital and
emergency health systems who will often not be stroke specialists but need
clear guidance as to how to develop and deliver safe and effective care for
acute stroke patients. Methods Building on the successful implementation program from the Global
Resuscitation Alliance and the Resuscitation Academy, the Utstein
methodology was used to define a generic chain of survival for Emergency
Stroke Care by assembling international expertise in Stroke and Emergency
Medical Services (EMS). Ten programs were identified for Acute Stroke Care
to improve survival and outcomes, with recommendations for implementation of
best practice. Conclusions Efficient prehospital systems for acute stroke will be improved through
public awareness, optimized prehospital triage and timely diagnostics, and
quick and equitable access to acute treatments. Documentation, use of
metrics and transparency will help to build a culture of excellence and
accountability.
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Affiliation(s)
- A G Rudd
- NHS England and King's College, London, England
| | - C Bladin
- Eastern Health Monash University, Melbourne, Australia
| | - P Carli
- Emergency Medical Services, Paris, France
| | - D A De Silva
- National Neuroscience Institute, Singapore General Hospital, Singapore
| | - T S Field
- University of British Columbia, Vancouver, Canada
| | - E C Jauch
- Mission Health System, Asheville, USA
| | - P Kudenchuk
- University of Washington School of Medicine, Seattle, WA, USA
| | - M W Kurz
- Stavanger University Hospital, Stavanger, Norway
| | - T Lærdal
- The Laerdal Foundation, Stavanger, Norway
| | - Meh Ong
- Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - P Panagos
- Washington University School of Medicine, St. Louis, MO, USA
| | - A Ranta
- University of Otago, Dunedin, New Zealand
| | - C Rutan
- American Heart Association, Dallas, TX, USA
| | | | - L Schonau
- Danish Resuscitation Council, Copenhagen, Denmark
| | - S D Shin
- Seoul National University College of Medicine, Seoul, South Korea
| | - D Waters
- Ambulance New Zealand, Wellington, New Zealand
| | - F Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
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11
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Hoehne SN, Hopper K, Epstein SE. Prospective Evaluation of Cardiopulmonary Resuscitation Performed in Dogs and Cats According to the RECOVER Guidelines. Part 2: Patient Outcomes and CPR Practice Since Guideline Implementation. Front Vet Sci 2019; 6:439. [PMID: 31921901 PMCID: PMC6914737 DOI: 10.3389/fvets.2019.00439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) outcomes have not been prospectively described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines. This study aimed to prospectively describe CPR outcomes and document arrest variables in dogs and cats at a U.S. veterinary teaching hospital since implementation of the RECOVER guidelines using the 2016 veterinary Utstein-style CPR reporting guidelines. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) underwent CPR following implementation of the RECOVER guidelines and were prospectively included. Supervising clinicians completed a data form for CPR events immediately following completion of CPR from December 2013 to June 2018. Seventy-five (44%) dogs and 26 (55%) cats attained return of spontaneous circulation (ROSC), 45 dogs (26%) and 16 cats (34%) had ROSC ≥ 20 min, 13 dogs (8%) and 10 cats (21%) were alive 24 h after CPR, and 12 dogs (7%) and 9 cats (19%) survived to hospital discharge. The most common cause of death in animals with ROSC ≥ 20 min was euthanasia. Patient outcomes were not significantly different since publication of the RECOVER guidelines except for a higher feline survival to hospital discharge rate. Dogs (p = 0.02) but not cats with initial shockable rhythms had increased rates of ROSC while the development of a shockable rhythm during CPR efforts was not associated with ROSC (p = 0.30). In closed chest CPR an end-tidal carbon dioxide (EtCO2) value of >16.5 mmHg was associated with a 75% sensitivity and 64% specificity for achieving ROSC. Since publication of the RECOVER guidelines, CPR practice did not clinically significantly change at our institution and no improvement of already high ROSC rates was noted. The percentage of cats surviving to hospital discharge was higher than previously reported and the reason for this improvement is not evident with these results. Euthanasia remains a major confounding factor in assessing intermediate and long-term CPR outcomes in dogs and cats.
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Affiliation(s)
- Sabrina N Hoehne
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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12
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Hoehne SN, Epstein SE, Hopper K. Prospective Evaluation of Cardiopulmonary Resuscitation Performed in Dogs and Cats According to the RECOVER Guidelines. Part 1: Prognostic Factors According to Utstein-Style Reporting. Front Vet Sci 2019; 6:384. [PMID: 31788482 PMCID: PMC6854014 DOI: 10.3389/fvets.2019.00384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes “any return of spontaneous circulation (ROSC),” “sustained ROSC,” and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12–6.61), p = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52–15.58), p = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27–0.98), p = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57–7.55), p = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66–0.96), p = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16–20.63), p < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12–12.07), p = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46–0.91), p = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91–56.17), p = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined.
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Affiliation(s)
- Sabrina N Hoehne
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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13
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Huan L, Qin F, Wu Y. Effects of epinephrine for out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17502. [PMID: 31702610 PMCID: PMC6855610 DOI: 10.1097/md.0000000000017502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.
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Affiliation(s)
- Lu Huan
- Department of Hepatobiliary Surgery, Chongqing Fifth People's Hospital
| | - Fei Qin
- Department of Assisted Reproduction, The First Affiliated Hospital of Chongqing Medical University
| | - Yin Wu
- Department of Cardiovascular Medicine, Chongqing Construction Hospital, Chongqing, Chongqing, China
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14
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Descamps AMK, Vandijck DM, Buylaert WA, Mostin MA, Paepe PD. Characteristics and costs in adults with acute poisoning admitted to the emergency department of a university hospital in Belgium. PLoS One 2019; 14:e0223479. [PMID: 31584988 PMCID: PMC6777762 DOI: 10.1371/journal.pone.0223479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 09/23/2019] [Indexed: 11/21/2022] Open
Abstract
Objective The aims of this study were to assess the characteristics of all acute poisoning admissions among adult emergency department (ED) patients, to identify factors associated with admission and to calculate direct medical cost. Methods Data of 2017 (1st January to 31st December) were collected and analyzed retrospectively using patients’ medical records and hospital invoices. Factors associated with type of hospitalization were identified using appropriate statistics. Results A total of 1,214 hospital admissions were included, accounting for 3.6% of all ED admissions. Men (62.2%) and the age group 21–40 years (43.0%) accounted for the largest proportion. Substances most commonly involved were ethanol (52.9%), benzodiazepines (9.7%), cocaine (4.9%), cannabis (4.6%), antidepressants (4.6%) and psychostimulants (4.6%). A total of 4,561 treatment acts were recorded, most commonly monitoring of vital signs (63.6%) and medication and/or intravenous drip administration (62.9%). Patients were discharged home after having received care in the emergency department (ED-amb) in 54.5% of admissions, were admitted to the emergency-department-24-hours-observation unit (ED-24h) or were hospitalized (Hosp) in 24.6% and 20.9% of admissions, respectively. Factors found to be associated with hospitalization type were age, hour of admission, victim location, degree of severity, use of antidotes, involvement of antidepressants, antipsychotics, psychostimulants, benzodiazepines and ethanol. Total cost was €1,512,346 with an average of €1,287 per admission. Conclusion Poisonings entail a considerable percentage of patients admitted to an ED and financial burden. In particular, ethanol poisonings account for the largest proportion of all ED admissions. Comparison of our figures with other data is hampered by the heterogeneity in inclusion criteria. Availability of a uniform template would facilitate comparison and allow better monitoring policies for prevention and cost reduction.
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Affiliation(s)
- Anne-Marie K. Descamps
- Antigifcentrum/Centre Antipoisons, Brussels, Belgium
- Department of Public Health of Ghent University, Ghent, Belgium
- Department of Medicine and Health Sciences of Hasselt University, Diepenbeek, Belgium
- * E-mail: anne-marie.descamps@poisoncentre,
| | - Dominique M. Vandijck
- Department of Public Health of Ghent University, Ghent, Belgium
- Department of Medicine and Health Sciences of Hasselt University, Diepenbeek, Belgium
| | - Walter A. Buylaert
- Department of Emergency Medicine of Ghent University Hospital, Ghent, Belgium
| | | | - Peter De Paepe
- Department of Emergency Medicine of Ghent University Hospital, Ghent, Belgium
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Li H, Wu TT, Liu PC, Liu XS, Mu Y, Guo YS, Chen Y, Xiao LP, Huang JF. Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China. Am J Emerg Med 2018; 37:1301-1306. [PMID: 30401593 DOI: 10.1016/j.ajem.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS This retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest. METHODS ACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes. RESULTS The total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16-30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16-30 min), Killip ≤ II, and CCI ≤ 2. CONCLUSION Younger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.
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Affiliation(s)
- Hong Li
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China.
| | - Ting Ting Wu
- Department of Nursing, Fujian Health College, Fujian, China
| | - Pei Chang Liu
- Department of Anesthesiology, Fujian Union Hospital Clinical Medical College, Fujian, China
| | - Xue Song Liu
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yan Mu
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China
| | - Yang Song Guo
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yuan Chen
- Department of Nursing, Xiamen Cardiovascular Disease Hospital, Xiamen University Medical School, Xiamen, China
| | - Li Ping Xiao
- Department of Nursing, First Hospital of Longyan, Fujian Medical University, Longyan, China
| | - Jiang Feng Huang
- School of Public Health, Fujian Medical University, Fujian, China
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16
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Bakhsh AA, Bakhsh AR, Karamelahi ZA, Bakhsh AA, Alzahrani AM, Alsharif LM, Sharton YM, Alotaibi AK, Basharahil KO. Communicating resuscitation. The importance of documentation in cardiac arrest. Saudi Med J 2018. [PMID: 29543304 PMCID: PMC5893915 DOI: 10.15537/smj.2018.3.21885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To primarily assess documentation during in-hospital cardiopulmonary arrest resuscitation and to secondarily observe cardiopulmonary resuscitation event and outcome variables. METHODS A retrospective review of 360 code blue forms and medical records at King Fahad General Hospital, King Abdulaziz General Hospital (Almahjar), and Althghar Hospital in Jeddah was performed between 2015 to 2016. RESULTS Survival to discharge rates and neurological outcomes were not documented at all. Other undocumented variables include gender 9 (2.5%), nationality 12 (3.3%), code blue announcement time 130 (36%), initial rhythm 10 (2.8%), time to airway placement 154 (57.2%), time to cardiology arrival 181 (50.27%), and time to anesthesia arrival 145 (40.27%). CONCLUSION We strongly recommend the use of standardized cardiopulmonary arrest sheets among all hospitals and follow up of neurological outcomes and survival to discharge as outcome variables.
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Affiliation(s)
- Amal A Bakhsh
- Department of Emergency Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
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17
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Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative. Pediatr Crit Care Med 2018. [PMID: 29533355 DOI: 10.1097/pcc.0000000000001520] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. DESIGN Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. SETTING Twelve pediatric hospitals across United States, Canada, and Europe. PATIENTS In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112). CONCLUSIONS Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.
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18
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Fiala A, Lederer W, Neumayr A, Egger T, Neururer S, Toferer E, Baubin M, Paal P. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scand J Trauma Resusc Emerg Med 2017; 25:104. [PMID: 29073915 PMCID: PMC5658918 DOI: 10.1186/s13049-017-0446-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Laryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA. Methods An open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared. Results Of 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups. Conclusions EMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation. Trial registration ClinicalTrials.gov (NCT01718795). Electronic supplementary material The online version of this article (10.1186/s13049-017-0446-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Fiala
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Lederer
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Agnes Neumayr
- Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Tamara Egger
- Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ernst Toferer
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael Baubin
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Teaching Hospital of the Paracelsus Private Medical University Salzburg, Salzburg, Austria.,Barts Heart Centre, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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19
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Perkins GD, Neumar R, Monsieurs KG, Lim SH, Castren M, Nolan JP, Nadkarni V, Montgomery B, Steen P, Cummins R, Chamberlain D, Aickin R, de Caen A, Wang TL, Stanton D, Escalante R, Callaway CW, Soar J, Olasveengen T, Maconochie I, Wyckoff M, Greif R, Singletary EM, O'Connor R, Iwami T, Morrison L, Morley P, Lang E, Bossaert L. The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future. Resuscitation 2017; 121:104-116. [PMID: 28993179 DOI: 10.1016/j.resuscitation.2017.09.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK.
| | - Robert Neumar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Koenraad G Monsieurs
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Swee Han Lim
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Maaret Castren
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Vinay Nadkarni
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Bill Montgomery
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Petter Steen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Cummins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Douglas Chamberlain
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Aickin
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Allan de Caen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Tzong-Luen Wang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - David Stanton
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Raffo Escalante
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Clifton W Callaway
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jasmeet Soar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Theresa Olasveengen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Ian Maconochie
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Myra Wyckoff
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert Greif
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eunice M Singletary
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert O'Connor
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Taku Iwami
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Laurie Morrison
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Morley
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eddy Lang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Leo Bossaert
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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Ellouze O, Vuillet M, Perrot J, Grosjean S, Missaoui A, Aho S, Malapert G, Bouhemad B, Bouchot O, Girard C. Comparable Outcome of Out-of-Hospital Cardiac Arrest and In-Hospital Cardiac Arrest Treated With Extracorporeal Life Support. Artif Organs 2017; 42:15-21. [PMID: 28877346 DOI: 10.1111/aor.12992] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 12/28/2022]
Abstract
Extracorporeal life support (ECLS) has shown benefits in the management of refractory in-hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS.
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Affiliation(s)
- Omar Ellouze
- Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France
| | | | - Justine Perrot
- Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France
| | | | - Anis Missaoui
- Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France
| | - Serge Aho
- Service d'Epidémiologie et d'Hygiène Hospitalières, CHU de Dijon, Dijon, France
| | - Ghislain Malapert
- Service de Chirurgie Cardiaque, Vasculaire et Thoracique, CHU de Dijon, Dijon, France
| | - Belaid Bouhemad
- Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France
| | - Oliver Bouchot
- Service de Chirurgie Cardiaque, Vasculaire et Thoracique, CHU de Dijon, Dijon, France
| | - Claude Girard
- Service d'Anesthésie Réanimation, CHU de Dijon, Dijon, France
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Sacre L, Ali S, Villa A, Jouffroy R, Raphalen JH, Garnier R, Baud F. Toxicodynetics in nordiazepam and oxazepam overdoses. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:163-171. [DOI: 10.1016/j.pharma.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/20/2017] [Indexed: 12/14/2022]
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Burstein B, Jayaraman D, Husa R. Early left ventricular ejection fraction as a predictor of survival after cardiac arrest. ACTA ACUST UNITED AC 2017; 18:35-39. [DOI: 10.1080/17482941.2017.1293831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Barry Burstein
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Dev Jayaraman
- Department of Critical Care, McGill University Health Center and Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Regina Husa
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Davies SE, Rhys M, Voss S, Greenwood R, Thomas M, Benger JR. Psychological wellbeing in survivors of cardiac arrest, and its relationship to neurocognitive function. Resuscitation 2017; 111:22-25. [DOI: 10.1016/j.resuscitation.2016.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/30/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
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Dane FC, Parish DC. Ethical Issues in Registry Research: In-Hospital Resuscitation as a Case Study. J Empir Res Hum Res Ethics 2016; 1:69-76. [DOI: 10.1525/jer.2006.1.4.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research based on registry studies involves significant ethical issues. Using detailed information about one registry concerning in-hospital resuscitation, we present issues concerning informed consent, access to identifiable medical information, and benefit for participants. In addition, multiple methodological difficulties have indirect implications for the ethical conduct of registry research, including consensus about variable definitions, validity and reliability for clinical decisions, sample sizes, and sources of data. Both direct and indirect ethical issues are examined from the viewpoint of accepted regulations and codes regarding ethical conduct of research; specific examples of more or less ethical solutions to the problems are presented from published research.
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Deng Y, He L, Yang J, Wang J. Serum D-dimer as an indicator of immediate mortality in patients with in-hospital cardiac arrest. Thromb Res 2016; 143:161-5. [DOI: 10.1016/j.thromres.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 01/08/2023]
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Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients. Med Care 2016; 54:74-80. [PMID: 26783858 DOI: 10.1097/mlr.0000000000000456] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. OBJECTIVES To determine the association between nurse staffing, nurse work environments, and IHCA survival. RESEARCH DESIGN Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. SUBJECTS A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). RESULTS Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio=0.95; 95% confidence interval, 0.91-0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio=0.84; 95% confidence interval, 0.71-0.99) than patients cared for in hospitals with better work environments. CONCLUSIONS Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.
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Abstract
BACKGROUND In cardiac ischaemia, the accumulation of adenosine may lead to or exacerbate bradyasystole and diminish the effectiveness of catecholamines administered during resuscitation. Aminophylline is a competitive adenosine antagonist. Case studies suggest that aminophylline may be effective for atropine-resistant bradyasystolic arrest. OBJECTIVES To determine the effects of aminophylline in the treatment of patients in bradyasystolic cardiac arrest, primarily survival to hospital discharge. We also considered survival to admission, return of spontaneous circulation, neurological outcomes and adverse events. SEARCH METHODS For this updated review, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform in November 2014. We checked the reference lists of retrieved articles, reviewed conference proceedings, contacted experts and searched further using Google. SELECTION CRITERIA All randomised controlled trials comparing intravenous aminophylline with administered placebo in adults with non-traumatic, normothermic bradyasystolic cardiac arrest who were treated with standard advanced cardiac life support (ACLS). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the studies and extracted the included data. We contacted study authors when needed. Pooled risk ratio (RR) was estimated for each study outcome. Subgroup analysis was predefined according to the timing of aminophylline administration. MAIN RESULTS We included five trials in this analysis, all of which were performed in the prehospital setting. The risk of bias was low in four of these studies (n = 1186). The trials accumulated 1254 participants. Aminophylline was found to have no effect on survival to hospital discharge (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.12 to 2.74) or on secondary survival outcome (survival to hospital admission: RR 0.92, 95% CI 0.61 to 1.39; return of spontaneous circulation: RR 1.15, 95% CI 0.89 to 1.49). Survival was rare (6/1254), making data about neurological outcomes and adverse events quite limited. The planned subgroup analysis for early administration of aminophylline included 37 participants. No one in the subgroup survived to hospital discharge. AUTHORS' CONCLUSIONS The prehospital administration of aminophylline in bradyasystolic arrest is not associated with improved return of circulation, survival to admission or survival to hospital discharge. The benefits of aminophylline administered early in resuscitative efforts are not known.
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Affiliation(s)
- Katrina F Hurley
- Department of Emergency Medicine, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, NS, Canada, B3K 6R8
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Abstract
OBJECTIVE To determine the accuracy of paper cardiopulmonary resuscitation records. DESIGN Case series. SETTING Twenty-six-bed video-monitored pediatric cardiac ICU. PATIENTS All patients who had a resuscitation event with available video and electronically stored vital sign and waveform data from May 2012 to February 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 41 cardiopulmonary resuscitation events during the study period. Fifteen had complete and valid data from the paper cardiopulmonary resuscitation forms, the retrieved monitor data, and the continuous bedside video monitoring. These 15 events occurred in 12 individual patients, and there was 100% agreement of data in the documentation of interventions in place (ventilation, arterial catheter, pulse oximetry, and vascular access) and in the presence of a witness at the onset of the arrest. All events were witnessed. Of the 15 events, video and monitor review revealed that 14 used waveform and numeric capnometry to confirm endotracheal tube/tracheostomy placement, but this section was only completed on the paper cardiopulmonary resuscitation record in three of the 14 cases. All records showed no discrepancies in the time of return of spontaneous circulation. The video and monitor review revealed delay in initiating cardiopulmonary resuscitation (mode, 2 min; two cases ≥ 7 min) and shockable rhythms (ventricular arrhythmia) in two cases. A sign of pulseless state was discovered in seven cases classified on the paper record as "always with a pulse." Those include sudden loss of consciousness, flat arterial line tracing, and abrupt drop in the partial pressure of exhaled carbon dioxide tracing (< 10 mm Hg). CONCLUSIONS Eyewitness accounts of cardiopulmonary resuscitation are often inaccurate and incomplete. Review of information from video and electronically stored vital sign and waveform data provides more accurate information than review of paper-based cardiopulmonary resuscitation records and may provide the insight necessary to improving cardiopulmonary resuscitation.
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Lavecchia M, Abenhaim HA. Cardiopulmonary resuscitation of pregnant women in the emergency department. Resuscitation 2015; 91:104-7. [PMID: 25625776 DOI: 10.1016/j.resuscitation.2015.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 01/26/2023]
Abstract
AIM Little is known about outcomes of cardiopulmonary resuscitation (CPR) in pregnancy. The purpose of this study was to determine the prognostic value of pregnancy in women receiving CPR in the emergency department (ED). METHODS We conducted a population-based, matched cohort study using the Nationwide Emergency Department Sample (NEDS) from 2006 to 2010. A cohort of pregnant women receiving CPR in the ED was compared to an age-matched cohort of non-pregnant women at a 1:10 ratio. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables of interest and survival. RESULTS Among 8162 women requiring CPR in the ED, we identified 157 pregnant women. Pregnancy was associated with better overall survival of 36.9% compared to 25.9% in non-pregnant women, OR 1.89 (1.32-2.70), p < 0.01. Traumatic injury was identified as a significant predictor of outcome in pregnancy. In non-trauma patients, pregnant women had significantly better odds of surviving CPR than non-pregnant women, OR 2.10 (1.41-3.13), p < 0.01. In cases of trauma, no significant difference was observed between groups. CONCLUSION Although further studies are needed, CPR in pregnancy is associated with a better prognosis compared to non-pregnant women, with trauma status being a key factor predicting outcome in the pregnant patient.
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Affiliation(s)
- Melissa Lavecchia
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
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Greenfield MLV, O'Brien DD, Kofflin SK, Mhyre JM. A Cross-Sectional Survey Study of Nurses' Self-Assessed Competencies in Obstetric and Surgical Postanesthesia Care Units. J Perianesth Nurs 2014; 29:385-96. [DOI: 10.1016/j.jopan.2013.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 10/24/2022]
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Iannacone S, Leary M, Esposito EC, Ruparel K, Savitt A, Mott A, Richard JA, Gur RC, Abella BS. Feasibility of cognitive functional assessment in cardiac arrest survivors using an abbreviated laptop-based neurocognitive battery. Ther Hypothermia Temp Manag 2014; 4:131-6. [PMID: 25010524 DOI: 10.1089/ther.2014.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cardiac arrest survivors exhibit varying degrees of neurological recovery even in the setting of targeted temperature management (TTM) use, ranging from severe impairments to making a seemingly full return to neurologic baseline function. We sought to explore the feasibility of utilizing a laptop-based neurocognitive battery to identify more subtle cognitive deficits in this population. In a convenience sample of cardiac arrest survivors discharged with a cerebral performance category (CPC) of 1, we evaluated the use of a computerized neurocognitive battery (CNB) in this group compared to a healthy control normative population. The CNB was designed to test 11 specific neurocognitive domains, including such areas as working memory and spatial processing. Testing was scored for both accuracy and speed. In a feasibility convenience sample of 29 cardiac arrest survivors, the mean age was 52.9±16.7 years; 12 patients received postarrest TTM and 17 did not receive TTM. Patients tolerated the battery well and performed at normative levels for both accuracy and speed on most of the 11 domains, but showed reduced accuracy of working memory and speed of spatial memory with large magnitudes (>1 SD), even among those receiving TTM. Across all domains, including those using speed and accuracy, 7 of the 29 subjects (24%) achieved statistically significant scores lower from the normative population in two or more domains. In this population of CPC 1 cardiac arrest survivors, a sensitive neurocognitive battery was feasible and suggests that specific cognitive deficits can be detected compared to a normative population, despite CPC 1 designation. Such testing might allow improved measurement of outcomes following TTM interventions in future trials.
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Affiliation(s)
- Stephen Iannacone
- 1 Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania , Philadelphia, Pennsylvania
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Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, Altman DG, Hirst A, Hoey J, Palepu A, Schulz KF, Moher D. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ 2014; 348:g3804. [PMID: 24965222 PMCID: PMC4070413 DOI: 10.1136/bmj.g3804] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the completeness of reporting of health research is related to journals' endorsement of reporting guidelines. DESIGN Systematic review. DATA SOURCES Reporting guidelines from a published systematic review and the EQUATOR Network (October 2011). Studies assessing the completeness of reporting by using an included reporting guideline (termed "evaluations") (1990 to October 2011; addendum searches in January 2012) from searches of either Medline, Embase, and the Cochrane Methodology Register or Scopus, depending on reporting guideline name. STUDY SELECTION English language reporting guidelines that provided explicit guidance for reporting, described the guidance development process, and indicated use of a consensus development process were included. The CONSORT statement was excluded, as evaluations of adherence to CONSORT had previously been reviewed. English or French language evaluations of included reporting guidelines were eligible if they assessed the completeness of reporting of studies as a primary intent and those included studies enabled the comparisons of interest (that is, after versus before journal endorsement and/or endorsing versus non-endorsing journals). DATA EXTRACTION Potentially eligible evaluations of included guidelines were screened initially by title and abstract and then as full text reports. If eligibility was unclear, authors of evaluations were contacted; journals' websites were consulted for endorsement information where needed. The completeness of reporting of reporting guidelines was analyzed in relation to endorsement by item and, where consistent with the authors' analysis, a mean summed score. RESULTS 101 reporting guidelines were included. Of 15,249 records retrieved from the search for evaluations, 26 evaluations that assessed completeness of reporting in relation to endorsement for nine reporting guidelines were identified. Of those, 13 evaluations assessing seven reporting guidelines (BMJ economic checklist, CONSORT for harms, PRISMA, QUOROM, STARD, STRICTA, and STROBE) could be analyzed. Reporting guideline items were assessed by few evaluations. CONCLUSIONS The completeness of reporting of only nine of 101 health research reporting guidelines (excluding CONSORT) has been evaluated in relation to journals' endorsement. Items from seven reporting guidelines were quantitatively analyzed, by few evaluations each. Insufficient evidence exists to determine the relation between journals' endorsement of reporting guidelines and the completeness of reporting of published health research reports. Journal editors and researchers should consider collaborative prospectively designed, controlled studies to provide more robust evidence. SYSTEMATIC REVIEW REGISTRATION Not registered; no known register currently accepts protocols for methodology systematic reviews.
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Affiliation(s)
- Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
| | - Erica Weinstein
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
| | - Fatemeh Yazdi
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Justin Thielman
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, UK
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - John Hoey
- Population and Public Health Initiative, Queen's University, Kingston, ON, Canada, K7L 3N6
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y9 Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Kenneth F Schulz
- International Clinical Sciences Support Center, FHI 360, Durham, NC 27713, USA
| | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
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Donnino MW, Salciccioli JD, Howell MD, Cocchi MN, Giberson B, Berg K, Gautam S, Callaway C. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ 2014; 348:g3028. [PMID: 24846323 PMCID: PMC4027796 DOI: 10.1136/bmj.g3028] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if earlier administration of epinephrine (adrenaline) in patients with non-shockable cardiac arrest rhythms is associated with increased return of spontaneous circulation, survival, and neurologically intact survival. DESIGN Post hoc analysis of prospectively collected data in a large multicenter registry of in-hospital cardiac arrests (Get With The Guidelines-Resuscitation). SETTING We utilized the Get With The Guidelines-Resuscitation database (formerly National Registry of Cardiopulmonary Resuscitation, NRCPR). The database is sponsored by the American Heart Association (AHA) and contains prospective data from 570 American hospitals collected from 1 January 2000 to 19 November 2009. PARTICIPANTS 119,978 adults from 570 hospitals who had a cardiac arrest in hospital with asystole (55%) or pulseless electrical activity (45%) as the initial rhythm. Of these, 83,490 arrests were excluded because they took place in the emergency department, intensive care unit, or surgical or other specialty unit, 10,775 patients were excluded because of missing or incomplete data, 524 patients were excluded because they had a repeat cardiac arrest, and 85 patients were excluded as they received vasopressin before the first dose of epinephrine. The main study population therefore comprised 25,095 patients. The mean age was 72, and 57% were men. MAIN OUTCOME MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included sustained return of spontaneous circulation, 24 hour survival, and survival with favorable neurologic status at hospital discharge. RESULTS 25,095 adults had in-hospital cardiac arrest with non-shockable rhythms. Median time to administration of the first dose of epinephrine was 3 minutes (interquartile range 1-5 minutes). There was a stepwise decrease in survival with increasing interval of time to epinephrine (analyzed by three minute intervals): adjusted odds ratio 1.0 for 1-3 minutes (reference group); 0.91 (95% confidence interval 0.82 to 1.00; P=0.055) for 4-6 minutes; 0.74 (0.63 to 0.88; P<0.001) for 7-9 minutes; and 0.63 (0.52 to 0.76; P<0.001) for >9 minutes. A similar stepwise effect was observed across all outcome variables. CONCLUSIONS In patients with non-shockable cardiac arrest in hospital, earlier administration of epinephrine is associated with a higher probability of return of spontaneous circulation, survival in hospital, and neurologically intact survival.
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Affiliation(s)
- Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, W/CC 2, MA, 02215, USA Department of Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Justin D Salciccioli
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, W/CC 2, MA, 02215, USA
| | - Michael D Howell
- Center for Quality, University of Chicago Medicine, 850 E 58th Street, Chicago, IL, 60637, USA
| | - Michael N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, W/CC 2, MA, 02215, USA Department of Anesthesia Critical Care, Division of Neurological/Trauma/Surgical Critical Care, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Brandon Giberson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, W/CC 2, MA, 02215, USA
| | - Katherine Berg
- Department of Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Shiva Gautam
- Department of Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh, 3600 Forbes Avenue, Iroquois Building, Suite 400A, Pittsburgh, PA, 15261, USA
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Mardegan K, Heland M, Whitelock T, Millar R, Jones D. Developing a medical emergency team running sheet to improve clinical handoff and documentation. Jt Comm J Qual Patient Saf 2014; 39:570-5. [PMID: 24416948 DOI: 10.1016/s1553-7250(13)39073-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND During medical emergency team (MET) and cardiac arrest calls, a scribe usually records events on a running sheet. There is more agreement on what data should be recorded in cardiac arrest calls than for MET calls. In addition, handoff (handover) from ward staff to the arriving MET may be variable. METHODS In a quality improvement project, a novel MET running sheet was developed to document events and therapies administered during MET calls. Key characteristics of the form were improved form layout, increased space for event documentation, and prompts to assist handoff to the arriving MET using the Identity Situation, Background, Assessment, Request (ISBAR) format. Ward nurses commonly involved in MET activation were surveyed to assess their perceptions of the new MET running sheet. Files of 100 consecutive MET calls were reviewed to assess compliance. RESULTS Of 109 nurses invited to complete the survey, 103 did so (94.5% response rate). Overall, 87 (84.5%) of the 103 respondents agreed or strongly agreed that the new MET running sheet was better than the previous form for documenting MET management, and 58 (57.4%) of 101 respondents agreed or strongly agreed that it assisted handoff. The form was completed in 91 of a sample of 100 consecutive MET calls. Areas of less complete documentation included aspects of the ISBAR handover to the arriving MET and notification of the next of kin and usual clinicians at the completion of the call. CONCLUSION The MET running sheet, tailored to the clinical events that occur during episodes of MET review, may assist handoff from ward nurses to the arriving MET and event documentation.
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Affiliation(s)
| | - Melodie Heland
- Division of Surgery Clinical Services Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tifany Whitelock
- Division of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Robert Millar
- Department of Emergency Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- Austin Hospital, Heidelberg, Victoria, Australia
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Chen LM, Nallamothu BK, Krumholz HM, Spertus JA, Tang F, Chan PS. Association between a hospital's quality performance for in-hospital cardiac arrest and common medical conditions. Circ Cardiovasc Qual Outcomes 2013; 6:700-7. [PMID: 24221831 DOI: 10.1161/circoutcomes.113.000377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown whether this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions. METHODS AND RESULTS Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia from Hospital Compare for the same period. The relationship between a hospital's performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26 270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an interquartile range of 19.7% to 24.2%. There were no significant correlations between a hospital's outcomes for its cardiac arrest patients and its patients admitted for acute myocardial infarction (correlation, -0.12; P=0.16), heart failure (correlation, -0.05; P=0.57), or pneumonia (correlation, -0.15; P=0.10). CONCLUSIONS Hospitals that performed better on publicly reported outcomes for 3 common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality.
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Affiliation(s)
- Lena M Chen
- Division of General Medicine, Department of Internal Medicine, and Institute for Healthcare Policy and Innovation
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Abstract
BACKGROUND In cardiac ischaemia, the accumulation of adenosine may lead to or exacerbate bradyasystole and diminish the effectiveness of catecholamines administered during resuscitation. Aminophylline is a competitive adenosine antagonist. Case studies suggest that aminophylline may be effective for atropine-resistant bradyasystolic arrest. OBJECTIVES To determine the effects of aminophylline in the treatment of patients in bradyasystolic cardiac arrest, primarily survival to hospital discharge. We also considered survival to admission, return of spontaneous circulation, neurological outcomes and adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 4, 2009), MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. We checked the reference lists of retrieved articles, reviewed conference proceedings, contacted experts and searched further using Google. The search strategy was updated in March 2012. SELECTION CRITERIA All randomised controlled trials comparing intravenous aminophylline with administered placebo in adults with non-traumatic, normothermic bradyasystolic cardiac arrest who were treated with standard advanced cardiac life support (ACLS). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the studies and extracted the included data. We contacted study authors when needed. Pooled risk ratio (RR) was estimated for each study outcome. Subgroup analysis was predefined according to the timing of aminophylline administration. MAIN RESULTS Five trials are included in this analysis, all of which were performed in the prehospital setting. The risk of bias was low in four of these studies (n = 1186). The trials accumulated 1254 participants. Aminophylline was found to have no effect on survival to hospital discharge (RR 0.58, 95% confidence interval (CI) 0.12 to 2.74) or on secondary survival outcome (survival to hospital admission: RR 0.92, 95% CI 0.61 to 1.39; return of spontaneous circulation: RR 1.15, 95% CI 0.89 to 1.49). Survival was rare (6/1254), making data about neurological outcomes and adverse events quite limited. The planned subgroup analysis for early administration of aminophylline included 37 participants. No one in the subgroup survived to hospital discharge. AUTHORS' CONCLUSIONS The prehospital administration of aminophylline in bradyasystolic arrest is not associated with improved return of circulation, survival to admission or survival to hospital discharge. The benefits of aminophylline administered early in resuscitative efforts are not known.
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Affiliation(s)
- Katrina F Hurley
- Department of Emergency Medicine, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8
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Chen LM, Nallamothu BK, Spertus JA, Li Y, Chan PS. Association between a hospital's rate of cardiac arrest incidence and cardiac arrest survival. JAMA Intern Med 2013; 173:1186-95. [PMID: 23689900 PMCID: PMC4181325 DOI: 10.1001/jamainternmed.2013.1026] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE National efforts to measure hospital performance in treating cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. OBJECTIVE To describe the association between inpatient cardiac arrest incidence and survival rates. DESIGN Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000, and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital's cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics. MAIN OUTCOMES AND MEASURES The correlation between a hospital's incidence rate and case-survival rate for cardiac arrest. RESULTS Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (interquartile range, 2.95-5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (interquartile range, 14.5%-22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (r, -0.16; P = .003). This relationship persisted after adjusting for patient characteristics (r, -0.15; P = .004). After adjusting for potential mediators of this relationship (ie, hospital characteristics), the relationship between incidence and case survival was attenuated (r, -0.07; P = .18). The one modifiable hospital factor that most attenuated this relationship was a hospital's nurse-to-bed ratio (r, -0.12; P = .03). CONCLUSIONS AND RELEVANCE Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case mix. This relationship is partially mediated by measured hospital attributes. Performance measures focused on case-survival rates seem an appropriate first step in quality measurement for in-hospital cardiac arrest.
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Affiliation(s)
- Lena M Chen
- Division of General Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Cardiac arrest resuscitation “without walls”: A concept of the past? The present?? The future??? Resuscitation 2012; 83:1177-8. [DOI: 10.1016/j.resuscitation.2012.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/06/2012] [Indexed: 11/21/2022]
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Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest. Resuscitation 2011; 82:1036-40. [PMID: 21524837 PMCID: PMC3138855 DOI: 10.1016/j.resuscitation.2011.03.034] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/29/2011] [Accepted: 03/31/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition are commonly used to determine outcomes following cardiac arrest. This study tested the association between these outcome measures. METHODS Retrospective chart review of subjects who survived to hospital discharge between 1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS, and discharge disposition). Discharge disposition was classified in 6 categories: home with no services, home with home healthcare, acute rehabilitation facility, skilled nursing facility, long term acute care facility, and hospice. Intra-and inter-rater reliabilities were calculated for outcome measures. Rates of "good outcome" (defined as a CPC of 1-2, mRS of 0-3, or discharge disposition to home or acute rehabilitation facility) were also determined. Kendall's tau correlation coefficients explored relationships among measures. RESULTS A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%) were white males, in- and out-of hospital cardiac arrests were equally prevalent, and ventricular dysrhythmia was most common (N=109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%) received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS abstraction was 95.24% (kappa 0.89, p<0.001) and 95.24% (kappa 0.90, p<0.001) respectively. "Good outcomes" were found in 44 subjects (20%) using the CPC definition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects using discharge disposition definition. There was fair relationship between the CPC and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau 0.23) and between mRS and discharge disposition (tau 0.25). CONCLUSIONS Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable from chart review. These instruments provide widely differing estimates of "good outcome". Agreement between these measures ranges from poor to fair. A more nuanced outcome measure designed for the post-cardiac arrest population is needed.
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Affiliation(s)
- Jon C Rittenberger
- University of Pittsburgh, Department of Emergency Medicine, School of Medicine, PA 15261, United States.
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40
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Brady WJ, Gurka KK, Mehring B, Peberdy MA, O’Connor RE. In-hospital cardiac arrest: Impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation 2011; 82:845-52. [DOI: 10.1016/j.resuscitation.2011.02.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/30/2011] [Accepted: 02/14/2011] [Indexed: 11/25/2022]
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41
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Chang SH, Huang CH, Shih CL, Lee CC, Chang WT, Chen YT, Lee CH, Lin ZY, Tsai MS, Hsu CY, Ma MHM, Chen SC, Chen WJ. Who survives cardiac arrest in the intensive care units? J Crit Care 2009; 24:408-14. [DOI: 10.1016/j.jcrc.2008.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 09/24/2008] [Accepted: 10/19/2008] [Indexed: 11/15/2022]
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Raina KD, Callaway C, Rittenberger JC, Holm MB. Neurological and functional status following cardiac arrest: method and tool utility. Resuscitation 2008; 79:249-56. [PMID: 18692288 PMCID: PMC2600809 DOI: 10.1016/j.resuscitation.2008.06.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 05/21/2008] [Accepted: 06/04/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assessing the neurological and disability status of cardiac arrest (CA) survivors is important for evaluating the outcomes of resuscitation interventions. The Cerebral Performance Category (CPC)--the standard outcome measurement after CA--has been criticized for its poorly defined, subjective criteria, lack of information regarding its psychometric properties, and poor relationships with long-term measures of disability and quality of life (QOL). This study examined the relationships among the CPC and measures of global disability and QOL at discharge from the hospital and at 1 month after CA. METHODS Twenty-one CA survivors participated in the study. A medical chart review was conducted at the time of discharge to determine CPC and Modified Rankin Scale (mRS) scores, while 1-month in-person interview was conducted to collect mRS and Health Utilities Index Mark 3 (HUI3) scores. Data collected during the interview were used to determine follow-up CPC scores. RESULTS The strength of relationships among measures at discharge and 1 month ranged between fair to good. An examination of scatter plots revealed substantial variability and a wide distribution of chart review and 1-month mRS and HUI3 scores within each CPC category. CPC scores obtained through chart review were significantly better than the CPC 1-month scores, thus overestimating the participants' cognitive and disability status 1 month later. CONCLUSION When compared to disability and quality of life measures, it is apparent that the CPC has limited ability to discriminate between mild and moderate brain injury. The validity of using the chart review method for obtaining scores is questionable.
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Affiliation(s)
- Ketki D Raina
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Occupational Therapy, 5012 Forbes Tower, Pittsburgh, PA 15260, USA.
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Morrison LJ, Nichol G, Rea TD, Christenson J, Callaway CW, Stephens S, Pirrallo RG, Atkins DL, Davis DP, Idris AH, Newgard C. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Resuscitation 2008; 78:161-9. [PMID: 18479802 DOI: 10.1016/j.resuscitation.2008.02.020] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 02/14/2008] [Accepted: 02/20/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry-Cardiac Arrest. METHODS The ROC Epistry--Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry--Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. CONCLUSION We describe the rationale, development, design and future implications of the ROC Epistry--Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry--Cardiac Arrest and the ROC trials.
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Affiliation(s)
- Laurie J Morrison
- Prehospital and Transport Medicine Research Program, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, Suite C753, Toronto, Ontario, Canada M4N 3M5.
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Draper HM, Eppert JA. Association of Pharmacist Presence on Compliance with Advanced Cardiac Life Support Guidelines During In-Hospital Cardiac Arrest. Ann Pharmacother 2008; 42:469-74. [DOI: 10.1345/aph.1k475] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND: The pharmacist has many potential roles as part of the resuscitation team during cardiopulmonary arrest. Limited published research has evaluated the practice of advanced cardiac life support (ACLS) during in-hospital arrest. Recent reviews indicate that an audit of in-hospital resuscitation practices should be performed to guide future resuscitation training programs for hospital personnel. OBJECTIVE: To assess compliance with ACLS guidelines during in-hospital cardiopulmonary arrest in a community teaching hospital and evaluate the association of compliance with the presence of a pharmacist on the resuscitation team. METHODS: A retrospective analysis of the records of 74 consecutive in-hospital arrests occurring between January 1, 2003, and June 30, 2004, was conducted to evaluate compliance with American Heart Association ACLS guidelines. RESULTS: A total of 74 arrests were evaluated. Noncompliance was noted in 58.1% of all documented arrests; of the 650 treatment interventions identified, 10.6% were noncompliant with ACLS guidelines. The reasons cited for noncompliance included an incorrect medication dosage (20.3%), prolonged period of time between sequential interventions (26.1%), omission of an indicated treatment (17.4%), deviation from recommended treatment guidelines (26.1%), and incorrect energy for defibrillation (10.1%). A pharmacist was present at 36.5% of documented arrests. Compliance with ACLS treatment guidelines was more likely during resuscitations in which a pharmacist was present (59.3% vs 31.9%; p = 0.03). CONCLUSIONS: Noncompliance with resuscitation guidelines was common during in-hospital resuscitation. The presence of a pharmacist on the resuscitation team was associated with improved compliance with treatment guidelines. Despite institutional requirements for pharmacist participation during resuscitation efforts, participation rates remain low. Further evaluation of the role of the pharmacist on the resuscitation team and the impact of the pharmacist on resuscitation practices should be considered.
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Affiliation(s)
- Heather M Draper
- Heather M Draper PharmD, Clinical Specialist, Emergency Medicine, Department of Pharmacy, Blount Memorial Hospital, Maryville, TN; Assistant Professor, Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee, Knoxville, TN
| | - J Alex Eppert
- J Alex Eppert MD, Emergency Medicine Physician, Team Health MidSouth, Southeastern Emergency Physicians, Department of Emergency Medicine, Methodist Medical Center, Oak Ridge, TN
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Henderson SO, McClung CD, Sintuu C, Swadron SP. The presence of an Emergency Airway Response Team and its effects on in-hospital Code Blue. J Emerg Med 2008; 36:116-20. [PMID: 18375087 DOI: 10.1016/j.jemermed.2007.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 10/05/2007] [Accepted: 10/08/2007] [Indexed: 11/30/2022]
Abstract
The survival rate from in-hospital cardiac arrest due to pulseless electrical activity (PEA)/asystole in our institution was higher than expected (70%). It was the impression of the Emergency Department-led Code Blue Team (CBT) that many of these patients were actually suffering respiratory arrests before their cardiac events. To address this, the facility developed an early intervention team focused on early airway intervention-the Emergency Airway Response Team (EART). The objective of this study was to assess the effect of early intervention in patients during the "pre-Code Blue" period, specifically with regard to airway stabilization. Our hypothesis was that there would be fewer CBT calls (cardiac arrests) due to PEA and asystole and that the survival from these events would decrease. This was a retrospective review of all cardiac arrests responded to by the CBT and EART for a period of 2 years. Charts were reviewed for the initial presenting rhythm (as defined by the Utstein Format) and event survival for the 12-month period immediately before and immediately after the establishment of the EART (Time Periods 1 and 2, respectively). The total number of CBT calls decreased by 15%, return of spontaneous circulation from any rhythm decreased by 9%, and survival to discharge decreased by 8% (p = non-significant). The number of CBT calls specifically for asystole/PEA decreased by 8%. Deaths in hospital were significantly associated with Period 2 (odds ratio 1.84; 95% confidence interval 1.03-3.28) after adjusting for age, gender, and presenting rhythms. The total number of CBT calls decreased slightly with the creation of the Emergency Airway Response Team. Return of spontaneous circulation and survival to hospital discharge after cardiac arrest due to asystole/PEA were significantly decreased, suggesting early intervention may have benefit.
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Affiliation(s)
- Sean O Henderson
- Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, California, USA
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DENARO CP, BENNETT CJ, CLARNETTE RM, LEFROY RB. The Medical Emergency Team in acute hospital patients. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1445-5994.1999.tb01636.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ong MEH, Tan EH, Ng FSP, Panchalingham A, Lim SH, Manning PG, Ong VYK, Lim SHC, Yap S, Tham LP, Ng KS, Venkataraman A. Survival Outcomes With the Introduction of Intravenous Epinephrine in the Management of Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2007; 50:635-42. [PMID: 17509730 DOI: 10.1016/j.annemergmed.2007.03.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 03/14/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) system that previously did not use intravenous medications. METHODS This observational, prospective, before-after clinical study constitutes phase II of the Cardiac Arrest and Resuscitation Epidemiology project. Included were all patients who are older than 8 years, with nontraumatic out-of-hospital cardiac arrest conveyed by the national emergency ambulance service. The comparison between the 2 intervention groups for survival to discharge was made with logistic regression and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI). RESULTS From October 1, 2002, to October 14, 2004, 1,296 patients were enrolled into the study, with 615 in the pre-epinephrine and 681 in the epinephrine phase. Demographic and EMS characteristics were similar in both groups. Forty-four percent of patients received intravenous epinephrine in the epinephrine phase. There was no significant difference in survival to discharge (pre-epinephrine 1.0%; epinephrine 1.6%; OR 1.7 [95% CI 0.6 to 4.5]; adjusted for rhythm OR 2.0 [95% CI 0.7 to 5.5]); return of circulation (pre-epinephrine 17.9%; epinephrine 15.7%; OR 0.9 [95% CI 0.6 to 1.2]), or survival to admission (pre-epinephrine 7.5%; epinephrine 7.5%; OR 1.0 [95% CI 0.7 to 1.5]). There was a minimal increase in scene time in the epinephrine phase (10.3 minutes versus 10.7 minutes; 95% CI of difference 0.02 to 0.94 minutes). CONCLUSION We were unable to establish a significant survival benefit with the introduction of intravenous epinephrine to an EMS system. More research is needed to determine the effectiveness of drugs such as epinephrine in resuscitation.
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Affiliation(s)
- Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore City, Singapore.
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Hurley K, Magee K, Green R. Aminophylline for bradyasystolic cardiac arrest in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hou SK, Chern CH, How CK, Wang LM, Huang CI, Lee CH. Is ward experience in resuscitation effort related to the prognosis of unexpected cardiac arrest? J Chin Med Assoc 2007; 70:385-91. [PMID: 17908653 DOI: 10.1016/s1726-4901(08)70025-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the outcome of patients of unexpected cardiac arrest initially resuscitated by first responders with dissimilar experiences under the support of cardiac arrest team (CAT). METHODS All unexpected cardiac arrest patients receiving in-hospital resuscitation with the activation of CAT in a tertiary-care teaching hospital over a 12-month period were recorded according to the Utstein criteria. We prospectively recorded various factors at resuscitation and retrospectively evaluated the outcome. Outcome measures included return of spontaneous circulation (ROSC), survival longer than 24 hours, and survival to discharge. RESULTS Altogether, 76 emergency calls were registered, and among these, 44 calls (58%) were cardiac arrests, including 8 ventricular tachycardia/fibrillation, 15 pulseless electrical activity, and 21 asystole. The rate of ROSC was 61%, the rate of survival longer than 24 hours was 37%, and the rate of survival to discharge was 18%. The response time of our CAT was 271 seconds (4 minutes and 31 seconds) on average. The patients who collapsed in the wards experienced in resuscitation effort received higher rates of appropriate basic and advanced cardiac life support interventions before CAT arrival (79% vs. 44%; p = 0.019), had an increased chance of ROSC (75% vs. 38%; p = 0.014), survival longer than 24 hours (54% vs. 13%; p = 0.007), and survival to discharge (29% vs. 0%; p = 0.036). CONCLUSION Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.
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Affiliation(s)
- Sen-Kuang Hou
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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50
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Jones-Crawford JL, Parish DC, Smith BE, Dane FC. Resuscitation in the hospital: circadian variation of cardiopulmonary arrest. Am J Med 2007; 120:158-64. [PMID: 17275457 DOI: 10.1016/j.amjmed.2006.06.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 05/26/2006] [Accepted: 06/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in cardiopulmonary arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge. METHODS A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented. RESULTS Significant circadian variation was found at 1 hour (P=.01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P=.03) and asystole (P=.01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P=.002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P=.003 and P <.0001). In multivariate analysis, only rhythm remained significant. CONCLUSIONS Circadian variation of cardiopulmonary arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.
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Affiliation(s)
- Jennifer L Jones-Crawford
- Department of Internal Medicine, Mercer University School of Medicine/Medical Center of Central Georgia, Macon, Ga, USA
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