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Vaillancourt C, Charette M, Lanos C, Godbout J, Buhariwalla H, Dale-Tam J, Nemnom MJ, Brehaut J, Wells G, Stiell I. Multi-phase implementation of automated external defibrillator use by nurses during in-hospital cardiac arrest and its impact on survival. Resuscitation 2024; 197:110148. [PMID: 38382874 DOI: 10.1016/j.resuscitation.2024.110148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE We sought to evaluate the impact of a medical directive allowing nurses to use defibrillators in automated external defibrillator-mode (AED) on in-hospital cardiac arrest (IHCA) outcomes. METHODS We completed a health record review of consecutive IHCA for which resuscitation was attempted using a pragmatic multi-phase before-after cohort design. We report Utstein outcomes before (Jan.2012-Aug.2013;Control) the implementation of the AED medical directive following usual practice (Sept.2013-Aug.2016;Phase 1), and following the addition of a theory-based educational video (Sept.2016-Dec.2017;Phase 2). RESULTS There were 753 IHCA with the following characteristics (Before n = 195; Phase 1n = 372; Phase 2n = 186): mean age 66, 60.0% male, 79.3% witnessed, 29.1% noncardiac-monitored medical ward, 23.9% cardiac cause, and initial ventricular fibrillation/tachycardia (VF/VT) 27.2%. Comparing the Before, Phase 1 and 2: an AED was used 0 time (0.0%), 21 times (5.7%), 15 times (8.1%); mean times to 1st analysis were 7 min, 3 min and 1 min (p < 0.0001); mean times to 1st shock were 12 min, 10 min and 8 min (p = 0.32); return of spontaneous circulation (ROSC) was 63.6%, 59.4% and 58.1% (p = 0.77); survival was 24.6%, 21.0% and 25.8% (p = 0.37). Among IHCA in VF/VT (n = 165), time to 1st analysis and 1st shock decreased by 5 min (p = 0.01) and 6 min (p = 0.23), and ROSC and survival increased by 3.0% (p = 0.80) and 15.6% (p = 0.31). There was no survival benefit overall (1.2%; p = 0.37) or within noncardiac-monitored areas (-7.2%; p = 0.24). CONCLUSIONS The implementation of a medical directive allowing for AED use by nurses successfully improved key outcomes for IHCA victims, particularly following the theory-based education video and among the VF/VT group.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada.
| | - Manya Charette
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chelsea Lanos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Justin Godbout
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Hannah Buhariwalla
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada
| | - George Wells
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada; University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ian Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada
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Bailly J, Derkenne C, Roquet F, Cruc M, Bergis A, Lelong A, Hoffmann C, Lamblin A. In-hospital cardiac arrest rhythm analysis by anesthesiologists: a diagnostic performance study. Can J Anaesth 2023; 70:130-138. [PMID: 36289150 DOI: 10.1007/s12630-022-02346-6] [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: 12/24/2021] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE In-hospital cardiac arrest is associated with high morbidity and mortality, with an overall survival rate at one year of approximately 13%. The first cardiac rhythm is often analyzed by anesthesiologist-intensivists. We aimed to determine the diagnostic performance of anesthesiologist-intensivists when distinguishing between shockable and nonshockable rhythms. METHODS We conducted a simulation-based, multicentre, prospective, observational study between May 2019 and March 2020. The responses of the participants were used to calculate individual sensitivity (defined as the proportion of decisions to shock for shockable rhythms) and individual specificity (defined as the proportion of decisions not to shock for nonshockable rhythms). The main outcome measure was the overall diagnostic performance, defined as the overall sensitivity and specificity. Secondary outcome measures were the sensitivity and specificity of participants' decisions for each type of cardiac arrest rhythm and their decision-making times. RESULTS Among the 267 physicians contacted, 179 (67%) completed the test. The median [interquartile range (IQR)] overall sensitivity was 88 [79-95]% and the median overall specificity was 86 [77-92]%. Among shockable rhythms, the median [IQR] sensitivity was 100 [100-100]% for ventricular tachycardia (VT), 100 [100-100]% for coarse ventricular fibrillation (VF), and 60 [20-100]% for fine VF. The median [IQR] specificities for nonshockable rhythms were 93 [86-100]% for asystole and 83 [72-86]% for pulseless electrical activity. The median decision times ranged from 2.0 to 3.5 sec. CONCLUSION Anesthesiologist-intensivists were quickly and effectively able to analyze rhythms in this simulation-based study. Participants' sensitivity in deciding to deliver shocks for VT and coarse VF was excellent, while specificity of their decisions for pulseless electrical activity was insufficient.
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Affiliation(s)
- Jordan Bailly
- Anesthesiology and Critical Care Department, Edouard Herriot Hospital, Lyon, France.
| | | | - Florian Roquet
- Critical Care Department, Georges-Pompidou European Hospital, Paris, France.,INSERM 1153 Unit, St Louis Hospital, Paris, France
| | - Maximilien Cruc
- Anesthesiology and Critical Care Department, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Alexandre Bergis
- Anesthesiology and Critical Care Department, Charles-Nicolle University Hospital, Rouen, France
| | - Anne Lelong
- Anesthesiology and Critical Care Department, Gui de Chauliac Hospital, Montpellier, France
| | | | - Antoine Lamblin
- Anesthesiology and Critical Care Department, Edouard Herriot Hospital, Lyon, France.,Anesthesiology Department, Desgenettes Military Teaching Hospital, Lyon, France
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Stærk M, Lauridsen KG, Krogh K, Løfgren B. Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals. Resusc Plus 2022; 9:100211. [PMID: 35199074 PMCID: PMC8842076 DOI: 10.1016/j.resplu.2022.100211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Automated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. However, the effect of AEDs for in-hospital cardiac arrest (IHCA) remains uncertain. This study aims to describe the distribution and use of AEDs in Danish hospitals and investigate whether early rhythm analysis is associated with return of spontaneous circulation (ROSC). Methods All Danish public hospitals with a cardiac arrest team were included and sent a questionnaire on the in-hospital distribution of AEDs and manual defibrillators. Further, we collected data on IHCAs including rhythm analysis, device type, cardiac arrest team arrival, and ROSC from the national database on IHCA (DANARREST). Results Of 46 hospitals, 93% had AEDs and 93% had manual defibrillators. AEDs were often placed in wards or non-clinical areas, whereas manual defibrillators were often placed in areas with high-risk patients. We identified 3,204 IHCAs. AEDs were used in 13% of IHCAs. After adjustment for confounders, chance of ROSC was higher if the first rhythm analysis was performed before the arrival of the cardiac arrest team (RR: 1.28 (95% CI: 1.12–1.46)). The relative risk of ROSC was 1.09 (0.84–1.41) when analyzing with an AED before cardiac arrest team arrival and 1.19 (1.00–1.41) when using a manual defibrillator. However, there was no significant effect modification for AED vs manual defibrillator (p = 0.26). Conclusion AEDs are widely distributed in Danish hospitals but less commonly used for IHCAs compared to manual defibrillators. Rhythm analysis before arrival of the cardiac arrest team was associated with ROSC without significant effect modification of device type.
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Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Denmark
- Education and Research, Randers Regional Hospital, Denmark
| | - Kasper G. Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Emergency Department, Randers Regional Hospital, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, USA
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Denmark
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NE, Denmark.
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Leech C, Perkins GD. Shockingly simple? Should you use manual or automated defibrillation in out of hospital cardiac arrest? Emerg Med J 2022; 39:344-345. [PMID: 35172978 DOI: 10.1136/emermed-2021-211999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Caroline Leech
- Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest. Anesthesiology 2020; 130:414-422. [PMID: 30707123 DOI: 10.1097/aln.0000000000002563] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Rapid response to witnessed, pulseless cardiac arrest is associated with increased survival. WHAT THIS ARTICLE TELLS US THAT IS NEW Assessment of witnessed, pulseless cardiac arrests occurring at 538 hospitals during a 9-yr period indicates that CPR did not occur immediately at 0 min in 5.7% of patients despite guidelines for instantaneous initiation. Delay in initiation of CPR was associated with significantly decreased survival.Time to initiation of CPR and subsequent time to initiation of administration of defibrillation shock (for shockable arrhythmias) and epinephrine were both associated with reduced patient survival. BACKGROUND Because the extent to which delays in initiating cardiopulmonary resuscitation (CPR) versus the time from CPR to defibrillation or epinephrine treatment affects survival remains unknown, it was hypothesized that all three independently decrease survival in in-hospital cardiac arrest. METHODS Witnessed, index cases of cardiac arrest from the Get With The Guidelines-Resuscitation Database occurring between 2000 and 2008 in 538 hospitals were included in this analysis. Multivariable risk-adjusted logistic regression examined the association of time to initiation of CPR and time from CPR to either epinephrine treatment or defibrillation with survival to discharge. RESULTS In the overall cohort of 57,312 patients, there were 9,802 survivors (17.1%). Times to initiation of CPR greater than 2 min were associated with a survival of 14.7% (91 of 618) as compared with 17.1% (9,711 of 56,694) if CPR was begun in 2 min or less (adjusted odds ratio [95% CI], 0.68 [0.54 to 0.87]; P < 0.002). Times from CPR to either defibrillation or epinephrine treatment of 2 min or less were associated with a survival of 18.0% (7,654 of 42,475), as compared with 15.0% (1,680 of 11,227) for 3 to 5 min (reference, 0 to 2 min; adjusted odds ratios [95% CI], 0.83 [0.78 to 0.88]; P < 0.001), 12.8% (382 of 2,983) for 6 to 8 min (0.67 [0.60 to 0.76], P < 0.001), and 13.7% (86 of 627) for 9 to 11 min (0.54 [0.42 to 0.69], P < 0.001). CONCLUSIONS Delays in the initiation of CPR and from CPR to defibrillation or epinephrine treatment were each associated with lower survival.
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Vincelette C, Quiroz-Martinez H, Fortin O, Lavoie S. Timely Recognition of Ventricular Fibrillation and Initiation of Cardiopulmonary Resuscitation by Intensive Care Unit Nurses: A High-Fidelity Simulation Observational Study. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2018.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Nehme Z, Andrew E, Nair R, Bernard S, Smith K. Manual Versus Semiautomatic Rhythm Analysis and Defibrillation for Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003577. [PMID: 28698191 DOI: 10.1161/circoutcomes.116.003577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although manual and semiautomatic external defibrillation (SAED) are commonly used in the management of out-of-hospital cardiac arrest, the optimal strategy is not known. We hypothesized that SAED would reduce the time to first shock and lead to higher rates of cardioversion and survival compared with a manual strategy. METHODS AND RESULTS Between July 2005 and June 2015, we included adult out-of-hospital cardiac arrest of presumed cardiac pathogenesis. On October 2012, a treatment protocol using SAED was introduced after years of manual defibrillation. The effect of the SAED implementation on the time to first shock, successful cardioversion, and patient outcomes was assessed using interrupted time series regression adjusting for arrest factors and temporal trend. Of the 14 776 cases, 10 224 (69.2%) and 4552 (30.8%) occurred during the manual and SAED protocols, respectively. Although the proportion of patients shocked within 2 minutes of arrival increased during the SAED protocol for initial shockable rhythms (from 58.9% to 69.2%; P<0.001), there was no difference in unadjusted rate of successful cardioversion after first shock (from 12.3% to 13.8%; P=0.13). After adjustment, the odds of delivering the first shock within 2 minutes of arrival increased under the SAED protocol (adjusted odds ratio [AOR], 1.72; 95% confidence interval [CI], 1.32-2.26; P<0.001). Despite this, the SAED protocol was associated with a reduction in survival to hospital discharge (AOR, 0.71; 95% CI, 0.55-0.92; P=0.009), event survival (AOR, 0.74; 95% CI, 0.62-0.88; P=0.001), and prehospital return of spontaneous circulation (AOR, 0.81; 95% CI, 0.68-0.96; P=0.01) when compared with the manual protocol. There was also no improvement in the rate of successful cardioversion after first shock (AOR, 0.73; 95% CI, 0.51-1.06; P=0.10). CONCLUSIONS Although SAED improved the time to first shock, this did not translate into higher rates of successful cardioversion or survival after out-of-hospital cardiac arrest. Advanced life support providers should be trained to use a manual defibrillation protocol.
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Affiliation(s)
- Ziad Nehme
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.).
| | - Emily Andrew
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Resmi Nair
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Stephen Bernard
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Karen Smith
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
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Stewart JA. Automated external defibrillators in the hospital: A case of medical reversal. Am J Emerg Med 2017; 36:871-874. [PMID: 29162440 DOI: 10.1016/j.ajem.2017.11.035] [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: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
Abstract
Automated external defibrillators (AEDs) emerged in the 1980s as an important innovation in pre-hospital emergency cardiac care (ECC). In the years since, the American Heart Association (AHA) and the International Liaison Committee for Resuscitation (ILCOR) have promoted AED technology for use in hospitals as well, resulting in the widespread purchase and use of AED-capable defibrillators. In-hospital use of AEDs now appears to have decreased survival from cardiac arrests. This article will look at the use of AEDs in hospitals as a case of "medical reversal." Medical reversal occurs when an accepted, widely used treatment is found to be ineffective or even harmful. This article will discuss the issue of AEDs in the hospital using a conceptual framework provided by recent work on medical reversal. It will go on to consider the implications of the reversal for in-hospital resuscitation programs and emergency medicine more generally.
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Problems with time-interval data from In-hospital resuscitation records. Int J Cardiol 2016; 223:879-880. [PMID: 27584564 DOI: 10.1016/j.ijcard.2016.07.300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/31/2016] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Approximately 18 million patients are treated in German hospitals annually. On the basis of internationally published data the number of in-hospital cardiac arrests can be estimated as 54,000 per year. A structured treatment of in-hospital resuscitation according to the current scientific evidence is essential. AIM In-hospital resuscitation shows some special characteristics in comparison to resuscitation in emergency services, which are highlighted in this article. MATERIAL AND METHODS This article is based on the international guidelines for cardiopulmonary resuscitation (CPR) first published in 1992 by the European Resuscitation Council (ERC) and the American Heart Association (AHA) as well as the amendments (current version 2010). Some current studies are also presented, which could not be taken into consideration for the guidelines from 2010. RESULTS High quality chest compressions with as few interruptions as possible are of utmost importance. Patients with cardiac rhythms which can be defibrillated should be defibrillated within less than 2 min after the collapse. There is no evidence that equipping hospitals with automated external defibrillators is an advantage for survival after in-hospital cardiac arrest. Endotracheal intubation represents the gold standard of airway management during CPR. During in-hospital resuscitation experienced anesthesiologists are mostly involved; however, the use of supraglottic airway devices may help to minimize interruptions in chest compressions especially before the medical emergency team arrives at the scene. Feedback devices may improve the quality of manual chest compressions; however, most devices overestimate the compression depth if the patient is resuscitated when lying in bed. There is no evidence that mechanical chest compression devices improve the outcome after cardiac arrest. Mild therapeutic hypothermia is still recommended for neuroprotection after successful in-hospital resuscitation. CONCLUSION The prevention of cardiac arrest is of special importance. Uniform and low threshold criteria for alarming the medical emergency team have to be defined to be able to identify and treat critically ill patients in time before cardiac arrest occurs.
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Monsieurs K, on behalf of the ERC Guidelines 2015 Writing Group, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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13
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Wurmb T, Vollmer T, Sefrin P, Kraus M, Happel O, Wunder C, Steinisch A, Roewer N, Maier S. Monitoring of in-hospital cardiac arrest events with the focus on Automated External Defibrillators--a retrospective observational study. Scand J Trauma Resusc Emerg Med 2015; 23:87. [PMID: 26521230 PMCID: PMC4628300 DOI: 10.1186/s13049-015-0170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background Patients with cardiac arrest have lower survival rates, when resuscitation performance is low. In In-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such cases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg University Hospital (Germany) an AED-program was initiated in 2007. Aim of the presented study was to monitor the impact of Automated External Defibrillators on the management of in-hospital cardiac arrest events. Methods The data acquisition was part of a continuous quality improvement process of the Wuerzburg University Hospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no flow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED-activation to the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A questionnaire was completed by the first responders. Results From 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AED-application. Complete data were available in 46 cases. The TtC was 34 (32–52) seconds (median and IQR).The TtS was 30 (28–32) seconds (median and IQR) . The TtCS was 4 (3–6) seconds (median and IQR) . The CCD was 5.5 ± 1 cm while the CCR was 107 ± 11/min. The NFF was calculated as 41 %. ROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred under ongoing CPR to an Intensive Care Unit (ICU). Conclusion The TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be markedly reduced, when the user is trained to interrupt the AED’s “chain of advices” by placing the electrode-paddles immediately on the patient’s thorax. At this time the AED switches directly to the analysing mode. Intensive training and adaption of the training contents is needed to optimize the handling of the AED in order to maximize its advantages and to minimize its disadvantages.
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Affiliation(s)
- Thomas Wurmb
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
| | - Tina Vollmer
- Department of Anaesthesiology, Hospital of Ludwigsburg, Posilipoststrasse 4, 71640, Ludwigsburg, Germany.
| | - Peter Sefrin
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany
| | | | - Oliver Happel
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
| | - Christian Wunder
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
| | - Andreas Steinisch
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
| | - Norbert Roewer
- Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
| | - Sebastian Maier
- Department of Internal Medicine II, St. Elisabeth Hospital Straubing GmbH, St. Elisabeth-Strasse 23, 97315, Straubing, Germany
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 741] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 586] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Stewart JA. Time to change course: comment on the section regarding automated external defibrillator use in the 2013 American Heart Association consensus statement on in-hospital resuscitation. Am J Emerg Med 2014; 32:1431-2. [DOI: 10.1016/j.ajem.2014.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
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Abstract
Early defibrillation is an essential step in the "chain of survival" for patients with in-hospital cardiac arrest. To increase the rate of early defibrillation by nurse first responders in noncritical care areas, our institution employed a quality resuscitation consultant, implemented nursing education programs, and standardized equipment and practices. Automated external defibrillator application by nurse first responders prior to advanced cardiac life support team arrival has improved from 15% in 2011 to 76% in 2013 (P < .001).
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In-hospital cardiac arrest characteristics and outcome after defibrillator implementation and education: from 1 single hospital in Sweden. Am J Emerg Med 2012; 30:1712-8. [DOI: 10.1016/j.ajem.2012.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/21/2022] Open
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Affiliation(s)
- Allan R Mottram
- Division of Emergency Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, F2/204 Clinical Science Center, MC 3280, 600 Highland Ave, Madison, WI 53792, USA.
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The effect of the AED and AED programs on survival of individuals, groups and populations. Prehosp Disaster Med 2012; 27:419-24. [PMID: 22985768 DOI: 10.1017/s1049023x12001197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved. METHODS A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences. RESULTS AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program. CONCLUSION The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.
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Lang D, Ang E. Effectiveness of using automated external defibrillator by trained healthcare professionals on survival outcomes among adult patients after in-hospital cardiac arrest: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2012; 10:1-10. [PMID: 27820408 DOI: 10.11124/jbisrir-2012-338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Dora Lang
- 1. Singapore National University Hospital Centre for Evidence Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, 2. Singapore National University Hospital Centre for Evidenced Based Nursing: A Collaborating Centre of the Joanna Briggs Institute,
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Smith RJ, Hickey BB, Santamaria JD. Automated external defibrillators and in-hospital cardiac arrest: Patient survival and device performance at an Australian teaching hospital. Resuscitation 2011; 82:1537-42. [DOI: 10.1016/j.resuscitation.2011.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/21/2011] [Indexed: 10/18/2022]
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Dwyer TA, Dennett J. In-hospital use of automated external defibrillators does not improve survival. Aust Crit Care 2011; 24:210-2. [DOI: 10.1016/j.aucc.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/31/2011] [Indexed: 11/26/2022] Open
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Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2011; 81:1219-76. [PMID: 20956052 DOI: 10.1016/j.resuscitation.2010.08.021] [Citation(s) in RCA: 860] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
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Chan PS, Krumholz HM, Spertus JA, Jones PG, Cram P, Berg RA, Peberdy MA, Nadkarni V, Mancini ME, Nallamothu BK. Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA 2010; 304:2129-36. [PMID: 21078809 PMCID: PMC3587791 DOI: 10.1001/jama.2010.1576] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrests, but data on their effectiveness in hospitalized patients are limited. OBJECTIVE To evaluate the association between AED use and survival for in-hospital cardiac arrest. DESIGN, SETTING, AND PATIENTS Cohort study of 11,695 hospitalized patients with cardiac arrests between January 1, 2000, and August 26, 2008, at 204 US hospitals following the introduction of AEDs on general hospital wards. MAIN OUTCOME MEASURE Survival to hospital discharge by AED use, using multivariable hierarchical regression analyses to adjust for patient factors and hospital site. RESULTS Of 11,695 patients, 9616 (82.2%) had nonshockable rhythms (asystole and pulseless electrical activity) and 2079 (17.8%) had shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used in 4515 patients (38.6%). Overall, 2117 patients (18.1%) survived to hospital discharge. Within the entire study population, AED use was associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78-0.92; P < .001). Among cardiac arrests due to nonshockable rhythms, AED use was associated with lower survival (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65-0.83; P < .001). In contrast, for cardiac arrests due to shockable rhythms, AED use was not associated with survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88-1.13; P = .99). These patterns were consistently observed in both monitored and nonmonitored hospital units where AEDs were used, after matching patients to the individual units in each hospital where the cardiac arrest occurred, and with a propensity score analysis. CONCLUSION Among hospitalized patients with cardiac arrest, use of AEDs was not associated with improved survival.
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Affiliation(s)
- Paul S Chan
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Fifth Floor, Kansas City, MO 64111, USA.
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Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE. Part 6: Electrical Therapies. Circulation 2010; 122:S706-19. [DOI: 10.1161/circulationaha.110.970954] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1369-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2010; 81:1293-304. [DOI: 10.1016/j.resuscitation.2010.08.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Stewart JA. Focused nurse-defibrillation training: a simple and cost-effective strategy to improve survival from in-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2010; 18:42. [PMID: 20670421 PMCID: PMC2924258 DOI: 10.1186/1757-7241-18-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 07/29/2010] [Indexed: 12/21/2022] Open
Abstract
Time to first defibrillation is widely accepted to correlate closely with survival and recovery of neurological function after cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Focused training of a cadre of nurses to defibrillate on their own initiative may significantly decrease time to first defibrillation in cases of in-hospital cardiac arrest outside of critical care units. Such a program may be the best single strategy to improve in-hospital survival, simply and at reasonable cost.
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