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Xu T, Wu C, Shen Q, Xu H, Huang H. The effect of sodium bicarbonate on OHCA patients: A systematic review and meta-analysis of RCT and propensity score studies. Am J Emerg Med 2023; 73:40-46. [PMID: 37611525 DOI: 10.1016/j.ajem.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Evidence on the efficacy of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) is controversial and generally of low quality. A systematic review and meta-analysis was performed to evaluate the effect of SB in OHCA patients based on randomized controlled trial (RCT) and propensity score matching (PSM) cohort studies. METHODS We searched the PubMed, Cochrane, and Embase databases for RCTs and PSM cohort studies from inception to July 15, 2023. We included studies involving adult (>16 years) no-trauma OHCA patients with clear comparisons between the Bicarbonate group and Control group. All studies reported our primary outcome of short-term survival rate included ROSC and survival to emergency department or hospital admission or secondary outcome of long-term survival rate included survival at hospital discharge and good neurologic survival at 1 month. Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI). To reduce bias, we performed a subgroup analysis of RCTs and PSM cohort studies. Also, we performed sensitivity analysis to resolve the heterogeneity. RESULTS Six studies (3 RCTs and 3 PSMs) comprising 21,402 patients were included. The primary outcome of this meta-analysis showed that short-term survival rate between the two groups was no difference (OR = 1.04; 95% CI, 0.98 to 1.12; P = 0.21; χ2 = 6.68; I2 = 25%). Secondary outcome demonstrated that long -term survival rate between the two groups was no difference (OR = 0.82; 95% CI, 0.50 to 1.34; P = 0.43; χ2 = 14.96; I2 = 80%). A sensitive analysis was performed by removing one study showed long-term survival rate of the Bicarbonate group was lower than that of the Control group. CONCLUSIONS In patients with OHCA, sodium bicarbonate administration was associated neither with short-term survival rate nor with long-term survival rate, it may even worsen the long-term survival.
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Affiliation(s)
- Tingzhen Xu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Chenxia Wu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Qinkang Shen
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China
| | - Hua Xu
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China.
| | - Haijun Huang
- Department of Emergency, The First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Traditional Chinese Medicine, Zhejiang 310018, Hangzhou, China.
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Dillon DG, Wang RC, Shetty P, Douchee J, Rodriguez RM, Montoy JCC. Efficacy of emergency department calcium administration in cardiac arrest: A 9-year retrospective evaluation. Resuscitation 2023; 191:109933. [PMID: 37562663 PMCID: PMC10529187 DOI: 10.1016/j.resuscitation.2023.109933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The efficacy of empiric calcium for patients with undifferentiated cardiac arrest has come under increased scrutiny, including a randomized controlled trial that was stopped early due to a trend towards harm with calcium administration. However, small sample sizes and non-significant findings have hindered precise effect estimates. In this analysis we evaluate the association of calcium administration with survival in a large retrospective cohort of patients with cardiac arrest treated in the emergency department (ED). METHODS We conducted a retrospective review of medical records from two academic hospitals (one quaternary care center, one county trauma center) in San Francisco between 2011 and 2019. Inclusion criteria were patients aged greater than or equal to 18 years old who received treatment for cardiac arrest during their ED course. Our primary exposure was the administration of calcium while in the ED and the main outcome was survival to hospital admission. The association between calcium and survival to admission was estimated using a multivariable log-binomial regression, and also with two propensity score models. RESULTS We examined 781 patients with cardiac arrest treated in San Francisco EDs between 2011 and 2019 and found that calcium administration was associated with decreased survival to hospital admission (RR 0.74; 95% CI 0.66-0.82). These findings remained significant after adjustment for patient age, sex, whether the cardiac arrest was witnessed, and including an interaction term for shockable cardiac rhythms (RR 0.60; 95% CI 0.50-0.72) and non-shockable cardiac rhythms (RR 0.87; 95% CI 0.76-0.99). Risk ratios for the association between calcium and survival to hospital admission were also similar between two propensity score-based models: nearest neighbor propensity matching model (RR 0.79; 95% CI 0.68-0.89) and inverse propensity weighted regression adjustment model (RR 0.75; 95% CI 0.67-0.84). CONCLUSIONS Calcium administration as part of ED-directed treatment for cardiac arrest was associated with lower survival to hospital admission. Given the lack of statistically significant outcomes from smaller, more methodologically robust evaluations on this topic, we believe these findings have an important role to serve in confirming previous results and allowing for more precise effect estimates. Our data adds to the growing body evidence against the empiric use of calcium in cardiac arrest.
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Affiliation(s)
- David G Dillon
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA.
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Pranav Shetty
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Jeremiah Douchee
- Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
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Messias Hirano Padrao E, Bustos B, Mahesh A, de Almeida Castro M, Randhawa R, John Dipollina C, Cardoso R, Grover P, Adler Maccagnan Pinheiro Besen B. Calcium use during cardiac arrest: A systematic review. Resusc Plus 2022; 12:100315. [PMID: 36238582 PMCID: PMC9550532 DOI: 10.1016/j.resplu.2022.100315] [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: 06/24/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Calcium use during cardiac arrest has conflicting results in terms of efficacy. Therefore, we performed a systematic review evaluating the role of calcium administration in cardiac arrest. Methods We searched PubMed, Cochrane, and EMBASE for studies comparing calcium administration versus no calcium administration during cardiac arrest. The study was prospectively registered in PROSPERO (CRD42022316641) adhering to PRISMA guideline recommendations. The primary outcome was return of spontaneous circulation (ROSC) or survival at one hour. The secondary outcomes included survival to discharge or at 30 days, and favorable neurologic outcomes at 30 and 90 days. We planned to perform a random-effects meta-analysis of low risk of bias studies. We evaluated risk of bias with RoB-2 and ROBINS-I. Results We identified 1,921 articles and included ten studies with 2509 patients. We were not able to perform a meta-analysis with low-risk of bias studies as only one study was found to be at low-risk of bias. However, for the primary outcome, the three RCTs included showed no benefit with calcium administration during cardiac arrest for ROSC. For the secondary outcomes, based on the most recent study and lower risk of bias, there was a neutral effect for survival to discharge or at 30 days and neurologic outcomes at 30 days. However, there was unfavorable neurologic outcomes at 90 days. Conclusion Based on our results, calcium administration in cardiac arrests shows no benefit and can cause harm. Further studies on this matter are likely not advisable.
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Affiliation(s)
- Eduardo Messias Hirano Padrao
- Department of Medicine, University of Connecticut, Farmington, CT, USA,Corresponding author at: 100 Trumbull Street, apt 310, Hartford, CT 06103, USA.
| | - Brian Bustos
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Ashwin Mahesh
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | | | - Ravneet Randhawa
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | | | - Rhanderson Cardoso
- Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Prashant Grover
- Pulmonary and Critical Care Department, Saint Francis Hospital, Hartford, CT, USA
| | - Bruno Adler Maccagnan Pinheiro Besen
- Department of Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil,Intensive Care Unit, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Wongtanasarasin W, Srisurapanont K. Efficacy of bicarbonate therapy for adults with cardiac arrest: A systematic review and meta-analysis of randomized-controlled trials. Turk J Emerg Med 2021; 21:24-29. [PMID: 33575512 PMCID: PMC7864130 DOI: 10.4103/2452-2473.301917] [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: 07/01/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Because the benefits of bicarbonate therapy remain unclear, it is not routinely recommended for the cardiopulmonary resuscitation (CPR) given to individuals with cardiac arrest (CA). This study aims to evaluate the clinical benefits of bicarbonate therapy in adults with CA. METHODS Without any language restriction, we searched PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL from the inception until April 30, 2020. We performed hand-search to identify the relevant trials included in previous meta-analyses. Included studies were randomized controlled trials (RCTs) comparing bicarbonate and placebo treatment in adults with CA. Two authors independently assessed the trial risk of bias. The primary outcome was the survival to hospital admission. The secondary outcomes included the return of spontaneous circulation, the survival to hospital discharge, and the neurological outcome at discharge. We calculated the odds ratios of those outcomes using the Mantel-Haenszel model and assessed the heterogeneity using the I2statistic. RESULTS Our searches found 649 unduplicated studies. Of these, three RCTs involving 1344 patients were included in the meta-analysis. The trial risk of bias ranged between fair and poor, mainly due to no blindness of outcome assessment and the selective reports of outcomes. Bicarbonate therapy showed no significant improvement in the survival to hospital admission (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.73-1.25). Subgroup analysis in those receiving prolonged CPR showed a similar result (OR 0.88; 95% CI 0.10-8.01). No study reported the predefined secondary outcomes. CONCLUSION For both acute and prolonged CPR, bicarbonate therapy might not show benefit to improve the rate of survival to hospital admission in adults with cardiac arrest.
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Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Karan Srisurapanont
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chung CW, Lui CT, Tsui KL. Role of Sodium Bicarbonate in Resuscitation of out-of-Hospital Cardiac Arrest. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To report the use of sodium bicarbonate (SB) in out-of-hospital cardiac arrest (OHCA) and to explore the role of sodium bicarbonate in resuscitation of OHCA in terms of restoration of spontaneous circulation (ROSC) and survival, and existence of dose-dependent relationship, especially in those with prolonged arrest. Design Retrospective cohort study. Setting Emergency department of two regional hospitals in a cluster of Hong Kong. Methods Adult patients aged at least 18 years old who presented to the study centres with non-traumatic OHCA in the period between March 2013 and December 2013 were included. Cases in which resuscitations were considered medically futile or not actually performed were excluded. Those with do-not-resuscitate (DNR) order or advance directives, those who were death before arrival with postmortem changes, and those who developed ROSC before or within 15 minutes of arrival were excluded from the study. Patients with known poisoning from tricyclic antidepressant or other sodium channel blockers were excluded from analysis if any. The primary outcome of this study was ROSC. Other outcome variables included survival to hospital admission (STA) and survival to hospital discharge (STD). Results A total of 489 patients were included during the study period for analysis. We found that patients who received sodium bicarbonate injection (SB group) during CPR had a higher percentage of ROSC than those who did not (no-SB group) (60.8% vs 22.5%; p<0.001). The survival-to-admission rate was higher in the SB group (56.8%) compared with the contrary (21.4%). The difference of survival-to-discharge between the two groups did not reach statistical significance (4.1% in SB group and 2.9% in the no-SB group; p=0.484). The rate of ROSC was found to be dose dependent, being higher in higher dose of SB administration. The ROSC rate increased from no-SB (22.4%) to 57.1% if given 50 ml SB, and further to 64.1% if given ≥100 ml SB. Conclusions Our study shows that the use of sodium bicarbonate in the CPR of OHCA is beneficial in ROSC. The effect is dose dependent, with better results in higher dose (>100 ml) of sodium bicarbonate; however, we fail to demonstrate its benefit for prolonged CPR cases (>30 minutes). (Hong Kong j.emerg. med. 2015;22:281-290)
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Velissaris D, Karamouzos V, Pierrakos C, Koniari I, Apostolopoulou C, Karanikolas M. Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review. J Clin Med Res 2016; 8:277-83. [PMID: 26985247 PMCID: PMC4780490 DOI: 10.14740/jocmr2456w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 01/17/2023] Open
Abstract
The aim of the review was to summarize the literature over the last 25 years regarding bicarbonate administration in out-of-hospital cardiac arrest. A PubMed search was conducted using the terms "bicarbonates" and "cardiac arrest", limited to human studies and reviews published in English (or at least with a meaningful abstract in English) in the last 25 years. Clinical and experimental data raised questions regarding the safety and effectiveness of sodium bicarbonate (SB) administration during cardiac arrest. Earlier advanced cardiac life support (ACLS) guidelines recommended routine bicarbonate administration as part of the ACLS algorithm, but recent guidelines no longer recommend its use. The debate in the literature is ongoing, but at the present time, SB administration is only recommended for cardiac arrest related to hypokalemia or overdose of tricyclic antidepressants. Several studies challenge the assumption that bicarbonate administration is beneficial for treatment of acidosis in cardiac arrest. At the present time, there is a trend against using bicarbonates in cardiac arrest, and this trend is supported by guidelines published by professional societies and organizations.
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Affiliation(s)
| | | | | | - Ioanna Koniari
- Cardiology Department, University Hospital of Patras, Greece
| | | | - Menelaos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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Bar-Joseph G, Abramson NS, Kelsey SF, Mashiach T, Craig MT, Safar P. Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand 2005; 49:6-15. [PMID: 15675975 DOI: 10.1111/j.1399-6576.2005.00572.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high-dose to standard-dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional. METHODS The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: 'low SB user' sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and 'high SB user' sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min. RESULTS Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse (r = - 0.579 P = 0.018) from initiation of ACLS (r = - 0.685 P = 0.003) and from first epinephrine (r = - 0.611 P = 0.012) to SB administration. Mean ROSC rate in the 'high SB user' sites was 33.5% (CI = 30.0-37.0) compared to 25.7% (CI = 23.1-28.4) in the 'low SB user' sites. In the 'high SB user' sites, hospital discharge rate was 5.3% (CI = 3.6-7.0) compared to 3% (CI = 2.0-4.0) in the 'low SB user' sites, and 5.3% (CI = 3.6-7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2-3.0) in the 'low SB user' sites. Collapse to ACLS interval was 8.5 min (CI = 8.1-9.0) in the 'high SB user' sites compared to 10.2 min (CI = 9.8-10.6) in the 'low SB user' sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5-7.5) compared to 9.7 min (CI = 9.3-10.2). Multivariate regression analysis found that belonging to 'high SB user' sites independently increased the chances for ROSC (OR 1.36, CI 1.08-1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23-3.86). CONCLUSIONS Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long-term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.
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Affiliation(s)
- G Bar-Joseph
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
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Bar-Joesph G. Improved chance of resuscitation after 10 min cardiac arrest in dogs treated with sodium bicarbonate. Resuscitation 2002; 55:348-9. [PMID: 12458074 DOI: 10.1016/s0300-9572(02)00288-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bar-Joseph G, Abramson NS, Jansen-McWilliams L, Kelsey SF, Mashiach T, Craig MT, Safar P. Clinical use of sodium bicarbonate during cardiopulmonary resuscitation--is it used sensibly? Resuscitation 2002; 54:47-55. [PMID: 12104108 DOI: 10.1016/s0300-9572(02)00045-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study retrospectively analyzed the pattern of sodium bicarbonate (SB) use during cardiopulmonary resuscitation (CPR) in the Brain Resuscitation Clinical Trial III (BRCT III). BRCT III was a prospective clinical trial, which compared high-dose to standard-dose epinephrine during CPR. SB use was left optional in the study protocol. Records of 2915 patients were reviewed. Percentage, timing and dosage of SB administration were correlated with demographic and cardiac arrest variables and with times from collapse to Basic Life Support, to Advanced Cardiac Life Support (ACLS) and to the major interventions performed during CPR. SB was administered in 54.5% of the resuscitations. The rate of SB use decreased with increasing patient age-primarily reflecting shorter CPR attempts. Mean time intervals from arrest, from start of ACLS and from first epinephrine to administration of the first SB were 29+/-16, 19+/-13, and 10.8+/-11.1 min, respectively. No correlation was found between the rate of SB use and the pre-ACLS hypoxia times. On the other hand, a direct linear correlation was found between the rate of SB use and the duration of ACLS. We conclude that when SB was used, the time from initiation of ACLS to administration of its first dose was long and severe metabolic acidosis probably already existed at this point. Therefore, if SB is used, earlier administration may be considered. Contrary to physiological rationale, clinical decisions regarding SB use did not seem to take into consideration the duration of pre-ACLS hypoxia times. We suggest that guidelines for SB use during CPR should emphasize the importance of pre-ACLS hypoxia time in contributing to metabolic acidosis and should be more specific in defining the duration of "protracted CPR or long resuscitative efforts", the most frequent indication for SB administration.
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Affiliation(s)
- Gad Bar-Joseph
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Premachandran S, Redmond AD, Liddle R, Jones JM. Cardiopulmonary arrest in general wards: a retrospective study of referral patterns to an intensive care facility and their influence on outcome. J Accid Emerg Med 1997; 14:26-9. [PMID: 9023619 PMCID: PMC1342839 DOI: 10.1136/emj.14.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyse the effect on outcome of referral to specialist facilities after cardiopulmonary arrest in a general ward. METHODS A retrospective analysis of resuscitation records of 743 patients in whom cardiopulmonary resuscitation was performed in a general ward between 1988 and 1992. After successful initial cardiopulmonary resuscitation, patients were identified as transferred to coronary care unit (CCU) or intensive care unit (ITU), or as staying in a general ward. MAIN OUTCOME MEASURE Survival to discharge home. RESULTS There were 322 initial survivors, of whom 148 (20% of the overall total) survived to be discharged from hospital; 63% of those transferred to CCU and 48% of those transferred to ITU survived to discharge, compared with 28% of those who stayed on the ward (P < 0.001). Of those aged less than 65 years, 75% survived to discharge after transfer to CCU and 54% after transfer to ITU, compared with 44% of those who stayed on the ward (P = 0.023); the respective figures for those over 65 years were: CCU 25%, ITU 34%, ward 25% (P = 0.014). Only half of those aged more than 65 years were transferred to a specialist facility, compared with 90% of those aged less than 65. CONCLUSIONS Transfer to a specialist care facility after resuscitation from cardiopulmonary arrest has an influence on outcome. Age as an independent factor is not an appropriate criterion to use in deciding on transfer. The decision to arrange transfer must always be taken by the most experienced person available, and in line with peer reviewed guidelines.
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Affiliation(s)
- S Premachandran
- Accident and Emergency Department, St George's Hospital NHS Trust, London
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Voelckel W, Kroesen G. Unexpected return of cardiac action after termination of cardiopulmonary resuscitation. Resuscitation 1996; 32:27-9. [PMID: 8809916 DOI: 10.1016/0300-9572(96)00954-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Application of sodium bicarbonate is still an option when resuscitation efforts remain unsuccessful. Despite this, there are no recommendations on how long resuscitation should be performed after administration of this drug. Here we describe a case in which prehospital resuscitation efforts were terminated about 35 min after cardiac arrest. Seven minutes after all efforts had been discontinued, spontaneous sinus rhythm appeared from a zero-line ECG, giving normal hemodynamic values. The underlying reason might be unexpected and unrecognized hyperkalemia, which was diminished by administration of sodium bicarbonate, even under the conditions of cardiocirculatory arrest.
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Affiliation(s)
- W Voelckel
- Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens-University of Innsbruck, Austria
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Ballew KA, Philbrick JT. Causes of variation in reported in-hospital CPR survival: a critical review. Resuscitation 1995. [DOI: 10.1016/0300-9572(95)00894-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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