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Dainty KN. Qualitative research in cardiac arrest research: A narrative review. Resusc Plus 2024; 17:100568. [PMID: 38370314 PMCID: PMC10869930 DOI: 10.1016/j.resplu.2024.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Qualitative research is defined as "the study of the nature of phenomena", including "their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived". It is a methodology which is becoming extremely valuable in resuscitation science, especially in terms of improving our understanding of the true impact of sudden cardiac arrest on survivors, family members, lay responders and health care providers. This narrative review provides a high-level overview of qualitative methods as well as the current state of the qualitative evidence and key knowledge gaps in resuscitation science. It finishes with discussion of the bright future of qualitative research in our field.
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Affiliation(s)
- Katie N. Dainty
- Research Chair, Patient-Centred Outcomes, North York General Hospital, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Canada
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Shaker MS, Abrams EM, Oppenheimer J, Singer AG, Shaker M, Fleck D, Greenhawt M, Grove E. Estimation of Health and Economic Benefits of a Small Automatic External Defibrillator for Rapid Treatment of Sudden Cardiac Arrest (SMART): A Cost-Effectiveness Analysis. Front Cardiovasc Med 2022; 9:771679. [PMID: 35282380 PMCID: PMC8907482 DOI: 10.3389/fcvm.2022.771679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. Early CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited.MethodsMarkov models were used to evaluate the cost-effectiveness of a portable SMART (SMall AED for Rapid Treatment of SCA) approach to early SCA management over a life-time horizon in at-risk and not at-risk populations. Simulated patients (n = 600,000) who had not received an implantable cardioverter defibrillator (ICD) were randomized to a SMART device with CPR prompts or non-SMART approaches. Annual SCA risk was varied from 0.2 to 3.5%. Analysis was performed in a US economy from both societal (SP) and healthcare (HP) perspectives to evaluate the number of SCA fatalities prevented by SMART, and SMART cost-effectiveness at a threshold of $100,000/Quality Adjusted Life Year (QALY).ResultsA SMART approach was cost-effective when annual SCA risk exceeded 1.51% (SP) and 1.62% (HP). The incremental cost-effectiveness ratios (ICER) were $95,251/QALY (SP) and $100,797/QALY (HP) at a 1.60% SCA annual risk. At a 3.5% annual SCA risk, SMART was highly cost-effective from both SP and HP [ICER: $53,925/QALY (SP), $59,672/QALY (HP)]. In microsimulation, SMART prevented 1,762 fatalities across risk strata (1.59% fatality relative risk reduction across groups). From a population perspective, SMART could prevent at least 109,839 SCA deaths in persons 45 years and older in the United States.Conclusions and RelevanceA SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk. The availability of a smart-phone enabled pocket-sized AED with CPR prompts has the potential to greatly improve population health and economic outcomes.
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Affiliation(s)
- Marcus S. Shaker
- Dartmouth Geisel School of Medicine, Hanover, NH, United States
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- *Correspondence: Marcus S. Shaker
| | - Elissa M. Abrams
- Department of Pediatrics, University of Manitoba, Winnipeg, CA, United States
| | - John Oppenheimer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Alexander G. Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, CA, United States
| | | | - Daniel Fleck
- Altrix Medical, Centreville, VA, United States
- Department of Computer Science, George Mason University, Fairfax, VA, United States
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Evan Grove
- Dartmouth Geisel School of Medicine, Hanover, NH, United States
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Acosta-Gutiérrez EG, Alba-Amaya AM, Roncancio-Rodríguez S, Navarro-Vargas JR. Post-cardiac arrest syndrome in adult hospitalized patients. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.
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Vercammen S, Moens E. Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:52. [PMID: 33292296 PMCID: PMC7673090 DOI: 10.1186/s12962-020-00248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. Methods An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. Results Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1. Conclusions EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.
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Affiliation(s)
- Steven Vercammen
- EVapp vzw, AA Tower - 8th floor, Technologiepark 122 (zone C2a), 9052, Zwijnaarde, België.
| | - Esther Moens
- UGent, Sint-Pietersnieuwstraat 25, 9000, Gent, Belgium
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Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e654-e685. [DOI: 10.1161/cir.0000000000000747] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.
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Hasanpour Dehkordi A, Sarokhani D, Ghafari M, Mikelani M, Mahmoodnia L. Effect of Palliative Care on Quality of Life and Survival after Cardiopulmonary Resuscitation: A Systematic Review. Int J Prev Med 2019; 10:147. [PMID: 31579159 PMCID: PMC6767805 DOI: 10.4103/ijpvm.ijpvm_191_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiac and respiratory arrest is reversible through immediate cardiopulmonary resuscitation (CPR). However, survival after CPR is very low for various reasons. This systematic review study was conducted to assess the effect of palliative care on quality of life and survival after CPR. Methods: In the present meta-analysis and systematic review study, two researchers independently searched Google Scholar and MagIran, MedLib, IranMedex, SID, and PubMed for articles published during 1994–2016 and containing a number of relevant keywords and their Medical Subject Headings (MeSH) combinations. A total of 156 articles were initially extracted. Results: The success of initial resuscitation was reported to be much higher than the success of secondary resuscitation (survival until discharge). Moreover, the early detection of cardiac arrest, a high-quality CPR, immediate defibrillation, and effective postresuscitation care improved short- and long-term outcomes in these patients and significantly affected their quality of life after CPR. Most survivors of CPR can have a reasonable quality of life if they are given proper follow-up and persistent treatment. Conclusions: Concerns about the low quality of life after CPR are therefore not a worthy reason to end the efforts taken for the victims of cardiac arrest. More comprehensive education programs and facilities are required for the resuscitation of patients and the provision of post-CPR intensive care.
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Affiliation(s)
- Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Scinces, Shahrekord University of Medical sciences, Shahrekord, Iran
| | - Diana Sarokhani
- Psychosocial Injuries Research Center, Ilam University of Medical Science, Ilam, Iran
| | - Mahin Ghafari
- Department of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Mikelani
- Department of Radiology, Tehran University of Medical Science, Tehran, Iran
| | - Leila Mahmoodnia
- Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Padmanabhan D, Asirvatham SJ. Non-ischemic cardiomyopathy in the elderly: A shocking conundrum. Indian Pacing Electrophysiol J 2019; 19:1-3. [PMID: 30615931 PMCID: PMC6354215 DOI: 10.1016/j.ipej.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
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Kongpolprom N, Cholkraisuwat J. Long-term Survival and Functional Neurological Outcome in Conscious Hospital Survivors Undergoing Therapeutic Hypothermia. Indian J Crit Care Med 2019; 23:20-25. [PMID: 31065204 PMCID: PMC6481257 DOI: 10.5005/jp-journals-10071-23107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction Therapeutic hypothermia (TH) is the neuroprotective strategy for comatose survivors of cardiac arrest. It improves neurological outcomes at hospital discharge. However, data regarding long-term outcomes are limited. We aimed to study functional ability and survival of the patients after discharge. Patients and methods We reviewed data of post-arrest patients undergoing TH in our hospital from 2006 to 2014 and assessed the functional ability of conscious survivors after hospital discharge by using a disability rating scale (DRS). We compared the patients' DRS after discharge with their cerebral performance category (CPC) at hospital discharge. Additionally, we analyzed survival rates at 6 months, 1, 2, and 3 years. Results Of 51 patients undergoing TH, 27 survived, and 17 of these were conscious. Approximately 75%, 73%, 71%, and 56% of the hospital survivors were alive at 6 months, 1, 2 and 3 years, respectively. We evaluated the functional ability (DRS) in 15 awake patients. The majority of the patients with good performance (CPC1) at discharge returned to normal function or minimal disability (DRS 0-3). Interestingly, although the patients with worse CPC scores at discharge had a greater risk of functional disability and death, a patient with severe disability (CPC3) at discharge fully recovered and was able to return to work later on. Conclusion Long-term survival of conscious patients undergoing TH was quite high. The good CPC score at discharge potentially predicted the favorable forthcoming outcome. However, it was difficult to predict the unfavorable long-term outcome from the poor condition at discharge. How to cite this article Kongpolprom N, Cholkraisuwat J. Long-term Survival and Functional Neurological Outcome in Conscious Hospital Survivors Undergoing Therapeutic Hypothermia. Indian Journal of Critical Care Medicine, January 2019; 23(1):20-26.
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Affiliation(s)
- Napplika Kongpolprom
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Chulalongkorn University, Thai Red Cross, Thailand
| | - Jiraphat Cholkraisuwat
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Chulalongkorn University, Thai Red Cross, Thailand
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Physical Therapy for an Adult Male Presenting With Torsion Dystonia Postcardiac Arrest: Posture Is Key. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Watson N, Potter M, Karamasis G, Damian M, Pottinger R, Clesham G, Gamma R, Aggarwal R, Sayer J, Robinson N, Jagathesan R, Kabir A, Tang K, Kelly P, Maccaroni M, Kadayam R, Nalgirkar R, Namjoshi G, Urovi S, Pai A, Waghmare K, Caruso V, Hampton-Till J, Noc M, Davies JR, Keeble TR. Is It Feasible and Safe to Wake Cardiac Arrest Patients Receiving Mild Therapeutic Hypothermia After 12 Hours to Enable Early Neuro-Prognostication? The Therapeutic Hypothermia and Early Waking Trial Protocol. Ther Hypothermia Temp Manag 2018; 8:150-155. [DOI: 10.1089/ther.2017.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noel Watson
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
- Anglia Ruskin University, Chelmsford, United Kingdom
| | - Matt Potter
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Grigoris Karamasis
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
- Anglia Ruskin University, Chelmsford, United Kingdom
| | - Max Damian
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | - Gerald Clesham
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
- Anglia Ruskin University, Chelmsford, United Kingdom
| | - Reto Gamma
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Rajesh Aggarwal
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Nicholas Robinson
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Rohan Jagathesan
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Alamgir Kabir
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Kare Tang
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Paul Kelly
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Maria Maccaroni
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Ramabhadran Kadayam
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Raghu Nalgirkar
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Gyanesh Namjoshi
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Sali Urovi
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Anirudda Pai
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Kunal Waghmare
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | - Vincenzo Caruso
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | | | - Marko Noc
- University Medical Centre, Ljubljana, Slovenia
| | - John R. Davies
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
- Anglia Ruskin University, Chelmsford, United Kingdom
| | - Thomas R. Keeble
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
- Anglia Ruskin University, Chelmsford, United Kingdom
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Abstract
Cardiac arrest is a common cause of coma with frequent poor outcomes. Palliative medicine teams are often called upon to discuss the scope of treatment and future care in cases of anoxic brain injury. Understanding prognostic tools in this setting would help medical teams communicate more effectively with patients’ families and caregivers and may promote improved quality of life overall. This article reviews multiple tools that are useful in determining outcomes in the setting of postarrest anoxic brain injury.
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Haywood KL, Pearson N, Morrison LJ, Castrén M, Lilja G, Perkins GD. Assessing health-related quality of life (HRQoL) in survivors of out-of-hospital cardiac arrest: A systematic review of patient-reported outcome measures. Resuscitation 2018; 123:22-37. [DOI: 10.1016/j.resuscitation.2017.11.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/03/2017] [Accepted: 11/26/2017] [Indexed: 12/14/2022]
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Cariou G, Pelaccia T. Are they trained? Prevalence, motivations and barriers to CPR training among cohabitants of patients with a coronary disease. Intern Emerg Med 2017; 12:845-852. [PMID: 27350627 DOI: 10.1007/s11739-016-1493-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
Out-of-hospital cardiac arrest occurs most often at home and often in the presence of family members of the patient who witness the event. Cardiopulmonary resuscitation (CPR) training of the next of kin of at-risk patients is thus potentially beneficial. The aim of our study was to document the prevalence of appropriate training among cardiac patients' cohabitants, as well as the motivations or obstacles to seeking training. 153 cohabitants of 127 patients who were hospitalized 1 year prior for confirmed coronary disease in a cardiology department (Paris, France) were interviewed using a structured questionnaire between October 2013 and March 2014. 38 % of interrogated cohabitants had received CPR training, and in two-thirds of the cases, their training was undertaken prior to the onset of the patient's heart disease. The training received was often a single instruction session. Half took place more than 5 years prior to the interview. For two-thirds of interrogated families, the reasons they sought training were related to professional or military duties. Training undertaken solely due to cohabitation with a patient affected by coronary disease represented only 3.5 % of the trained respondents. A lack of information regarding existing training programs and a lack of concrete propositions were given as the main barriers to seeking training. The families of patients who are at-risk for cardiac arrests that were interrogated in our study are inadequately trained in CPR. The creation of dedicated training programs at cardiac rehabilitation services for patients' next of kin or the use of alternative methods such as self-instruction kits could potentially remedy this situation.
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Affiliation(s)
- Guillaume Cariou
- Mobile Palliative Care Team, Cochin University Hospital, Paris Hospitals Public Assistance, 27 rue du Faubourg-Saint-Jacques, 75014, Paris, France
| | - Thierry Pelaccia
- Centre for Training and Research in Health Sciences Education (CFR-PS), Faculty of Medicine, University of Strasbourg, 4 rue Kirschleger, 67085, Strasbourg, France.
- Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, PO Box 426, 67200, Strasbourg, France.
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Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study. Med Care 2017; 55:552-560. [PMID: 28333708 DOI: 10.1097/mlr.0000000000000719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks. OBJECTIVE To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. RESEARCH DESIGN We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature. CVD events and health states considered in the model included stroke, coronary heart disease, heart failure, chronic kidney disease, and end-stage renal disease. SUBJECTS White and black adults with hypertension in the United States, 45 years of age and above. MEASURES Yearly risk of CVD was determined using REGARDS data and published literature. Antihypertensive medication costs were determined using Medicare claims. Event and health state costs were estimated from published literature. All costs were adjusted to 2012 US dollars. Effectiveness was assessed using QALYs. RESULTS Antihypertensive medication treatment was cost-saving and increased QALYs compared with no-treatment for white men ($7387; 1.14 QALYs), white women ($7796; 0.89 QALYs), black men ($8400; 1.66 QALYs), and black women ($10,249; 1.79 QALYs). CONCLUSIONS Antihypertensive medication treatment is cost-saving and increases QALYs for all groups considered in the model, particularly among black adults.
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Predictors of long-term functional outcome and health-related quality of life after out-of-hospital cardiac arrest. Resuscitation 2017; 113:77-82. [DOI: 10.1016/j.resuscitation.2017.01.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/22/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
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Koopman C, Vaartjes I, van Dis I, Verschuren WMM, Engelfriet P, Heintjes EM, Blokstra A, Deeg DJH, Visser M, Bots ML, O’Flaherty M, Capewell S. Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007. PLoS One 2016; 11:e0166139. [PMID: 27906998 PMCID: PMC5132334 DOI: 10.1371/journal.pone.0166139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objective We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. Methods We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed. Results The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed. Conclusion CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
- * E-mail:
| | | | - W. M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Peter Engelfriet
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Anneke Blokstra
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dorly J. H. Deeg
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
- Department of Dietetics and Nutrition Sciences, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin O’Flaherty
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
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Evaluation on health-related quality of life in deaf children with cochlear implant in China. Int J Pediatr Otorhinolaryngol 2016; 88:136-41. [PMID: 27497401 DOI: 10.1016/j.ijporl.2016.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previous studies have shown that deaf children benefit considerably from cochlear implants. These improvements are found in areas such as speech perception, speech production, and audiology-verbal performance. Despite the increasing prevalence of cochlear implants in China, few studies have reported on health-related quality of life in children with cochlear implants. The main objective of this study was to explore health-related quality of life on children with cochlear implants in South-west China. STUDY DESIGN A retrospective observational study of 213 CI users in Southwest China between 2010 and 2013. METHODS Participants were 213 individuals with bilateral severe-to-profound hearing loss who wore unilateral cochlear implants. The Nijmegen Cochlear Implant Questionnaire and Health Utility Index Mark III were used pre-implantation and 1 year post-implantation. Additionally, 1-year postoperative scores for Mandarin speech perception were compared with preoperative scores. RESULTS Health-related quality of life improved post-operation with scores on the Nijmegen Cochlear Implant Questionnaire improving significantly in all subdomains, and the Health Utility Index 3 showing a significant improvement in the utility score and the subdomains of ''hearing," ''speech," and "emotion". Additionally, a significant improvement in speech recognition scores was found. No significant correlation was found between increased in quality of life and speech perception scores. CONCLUSION Health-related quality of life and speech recognition in prelingual deaf children significantly improved post-operation. The lack of correlation between quality of life and speech perception suggests that when evaluating performance post-implantation in prelingual deaf children and adolescents, measures of both speech perception and quality of life should be used.
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Lim C, Verfaellie M, Schnyer D, Lafleche G, Alexander MP. Recovery, long-term cognitive outcome and quality of life following out-of-hospital cardiac arrest. J Rehabil Med 2016; 46:691-7. [PMID: 24849762 DOI: 10.2340/16501977-1816] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Among survivors of out-of-hospital cardiac arrest (OHCA), the functional outcomes of those with rapid early or with very delayed recoveries are known. For patients between those extremes early recovery is variable, and the probability of longer-term recovery and the implications for quality of life have not been clearly defined. METHODS Twenty-five patients of a consecutive cohort of OHCA survivors with coma duration between 12 h and 7 days and a matched group with acute coronary syndrome underwent cognitive and disability assessments 3 and 12 months after OHCA. Correlations and regression analyses of demographic, clinical arrest variables, and cognitive tests with quality of life outcomes were performed. RESULTS The OHCA group had impairments in all cognitive domains. There was little cognitive improvement. The OHCA group reported significantly greater health impact and lower quality of life at twelve months than the controls. Longer duration of coma (4-7 versus ≤ 3 days) and greater cognitive impairment at three months, particularly memory impairment, were both associated with reduced late quality of life. CONCLUSIONS These survivors of OHCA had persistent long-term cognitive deficits. Quality of life at one year after OHCA was reduced compared to cardiac controls. Coma duration and memory impairment at three months were harbingers of long term reduced quality of life.
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Affiliation(s)
- Chun Lim
- , Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston Massachusetts, USA.
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Axelsson ÅB, Sunnerhagen KS, Herlitz J. Representativity and co-morbidity: Two factors of importance when reporting health status among survivors of cardiac arrest. Resuscitation 2016; 101:44-9. [PMID: 26868077 DOI: 10.1016/j.resuscitation.2016.01.027] [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: 07/01/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 12/21/2022]
Abstract
AIM Reports on differences between respondents and non-respondents of out-of-hospital cardiac arrest (OHCA) survivors are sparse. This study compares respondents with non-respondents in a follow-up study of a consecutive sample of OHCA survivors and describes the relation between respondents' self-reported morbidity and health. METHODS/DESIGN Questionnaires were administered within 12 months after the OHCA. The study population was adult patients who had survived an OHCA during 2008 to 2011, with a cerebral performance score of ≤2 at discharge. The patients were identified through the Swedish registry of OHCA. The Self-administered comorbidity questionnaire and EQ VAS (Euroqol questionnaire visual analogue scale) was used to measure morbidity and health status. RESULTS Of 298 survivors, 224 were eligible for the study and 127 responded. Mean time from cardiac arrest (CA) to follow up was 178 days. Comparing the 127 respondents with the 97 lost to follow-up and non-respondents, no significant differences were found in terms of age, sex, factors at resuscitation and in-hospital interventions. The EQ VAS median was 75 (25th,75th percentile 60,80)). Self-rated health differed between respondents reporting 0-2 conditions (n=68) and respondents reporting more than two (n=43), median EQ VAS 78 (68,90) and 65 (50,80)), respectively; p-value 0.0001. CONCLUSIONS Despite a limited response rate, representativeness in terms of patient characteristics among survivors of OHCA with an acceptable cerebral function is achievable. A considerable proportion of the survivors lived with the burden of multi-morbidity which worsened health.
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Affiliation(s)
- Åsa B Axelsson
- Institute of Health and Care Sciences, University of Gothenburg, PO Box 457, SE 405 30 Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden; Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
| | - Johan Herlitz
- Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; The Prehospital Research Center Western Sweden, Prehospen University College of Borås, SE-501 90 Borås, Sweden.
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20
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Israelsson J, Lilja G, Bremer A, Stevenson-Ågren J, Årestedt K. Post cardiac arrest care and follow-up in Sweden - a national web-survey. BMC Nurs 2016; 15:1. [PMID: 26752975 PMCID: PMC4706707 DOI: 10.1186/s12912-016-0123-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden. Methods An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis. Results Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up. Conclusions Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0123-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johan Israelsson
- Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, SE-39185 Kalmar, Sweden ; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, SE-58185 Linköping, Sweden ; Kalmar Maritime Academy, Linnaeus University, SE-39182 Kalmar, Sweden
| | - Gisela Lilja
- Department of Clinical Science, Division of Neurology, Lund University, Lund, Sweden ; Department of Neurology and Rehabilitation Medicine, Skane University Hospital, SE-22185 Lund, Sweden
| | - Anders Bremer
- Faculty of Caring Science, Work Life and Social Welfare and the Centre for Prehospital Research, University of Borås, SE-50190 Borås, Sweden ; Division of Emergency Medical Services, Kalmar County Hospital, SE-39185 Kalmar, Sweden
| | - Jean Stevenson-Ågren
- Information School, University of Sheffield, Regent Court, 211 Portobello Street, Sheffield, S1 4DP England ; eHealth Institute, Linnaeus University, SE-39182 Kalmar, Sweden
| | - Kristofer Årestedt
- Center for Collaborative Palliative Care, Linnaeus University, SE-39182 Kalmar, Sweden ; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, SE-58185 Linköping, Sweden
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21
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Functional Outcomes: One Year after a Cardiac Arrest. BIOMED RESEARCH INTERNATIONAL 2015; 2015:283608. [PMID: 26421282 PMCID: PMC4573239 DOI: 10.1155/2015/283608] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022]
Abstract
Objective. The study aim was to characterize the time-course of recovery in impairments, activity limitations, participation restrictions, disability, and quality of life during the first year after cardiac arrest. Secondarily, the study described the associations between the instruments used to measure each of these domains. Methods. Measures of global disability (Cerebral Performance Category, CPC, Modified Rankin Scale, mRS), quality of life, activity limitations, participation restrictions, and affective and cognitive impairments were administered to 29 participants 1, 6, and 12 months after cardiac arrest. Results. Global measures of disability indicated recovery between one month and one year after cardiac arrest (mean CPC: 2.1 versus 1.69, P < 0.05; mean mRS: 2.55 versus 1.83, P < 0.05). While global measures of disability were moderately associated with participation, they were poorly associated with other measures. The cohort endorsed depressive symptomatology throughout the year but did not have detectable cognitive impairment. Conclusions. Recovery from cardiac arrest is multifaceted and recovery continues for months depending upon the measures being used. Measures of global disability, reintegration into the community, and quality of life yield different information. Future clinical trials should include a combination of measures to yield the most complete representation of recovery after cardiac arrest.
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Libungan B, Lindqvist J, Strömsöe A, Nordberg P, Hollenberg J, Albertsson P, Karlsson T, Herlitz J. Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study. Resuscitation 2015; 94:28-32. [DOI: 10.1016/j.resuscitation.2015.05.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/17/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
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Gajarski RJ, Smitko K, Despres R, Meden J, Hutton DW. Cost-effectiveness analysis of alternative cooling strategies following cardiac arrest. SPRINGERPLUS 2015; 4:427. [PMID: 26306289 PMCID: PMC4540719 DOI: 10.1186/s40064-015-1199-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Using survival and neurologic outcome as endpoints , this study explored the incremental cost effectiveness of three mutually exclusive cooling strategies employed after resuscitated out-of-hospital cardiac arrests. DESIGN Economic analysis based on retrospective data collection and Markov modeling. SETTING Modeling based on patients housed in a tertiary ICU setting. PATIENTS Patients >18 years following resuscitation from out-of-hospital cardiac arrest. INTERVENTIONS Therapeutic cooling vs. conventional care. MEASUREMENTS AND MAIN RESULTS Using societal-based analytic decision modeling with a lifetime study horizon, incremental cost effectiveness ratios (ICERs) for blanket, peritoneal lavage, and V-V ECMO cooling strategies were compared with conventional care. Comprehensive cost data were obtained from available literature, national and local databases; health utility data were abstracted from previous publications and converted to quality-adjusted life years (QALYs)/person and stratified by neurologic outcome state. Future costs were discounted using a standard 3% discount rate. Cooling blankets produced better overall health outcomes at a lower cost than conventional care and V-V ECMO. Peritoneal lavage added an additional 0.67 QALYs at an ICER of $58,329/QALY. Monte-Carlo simulations incorporating uncertainty in all parameters showed that peritoneal lavage was 70% likely to be the preferred, cost-effective therapy if one were willing to pay (WTP) $100,000/QALY. CONCLUSIONS This analysis suggests that blankets are the most cost effective cooling strategy for post-ROSC therapeutic hypothermia, with peritoneal lavage as an acceptable alternative at higher WTP thresholds. Though uncertainty about the optimal therapy could be reduced with additional research, these results can inform policy-makers and healthcare providers about cost effectiveness of alternative cooling modalities designed to improve neurologic outcome for this expanding patient population. This may be particularly relevant as societal-based cost effectiveness analyses become more widely incorporated into studies evaluating treatment for frequently encountered diseases.
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Affiliation(s)
- Robert J Gajarski
- />University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 E. Medical Center Dr. Floor 11, Rm 715Z, Ann Arbor, MI 48109 USA
- />Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Kurtis Smitko
- />Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Renee Despres
- />Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Jeff Meden
- />Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - David W Hutton
- />Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
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Nichol G, Guffey D, Stiell IG, Leroux B, Cheskes S, Idris A, Kudenchuk PJ, Macphee RS, Wittwer L, Rittenberger JC, Rea TD, Sheehan K, Rac VE, Raina K, Gorman K, Aufderheide T. Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy. Resuscitation 2015; 93:74-81. [PMID: 26025570 DOI: 10.1016/j.resuscitation.2015.05.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022]
Abstract
IMPORTANCE Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. DESIGN Prospective cohort sub-study of a randomized trial. SETTING The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. PARTICIPANTS Consenting survivors to discharge. MAIN OUTCOME MEASURES Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). RESULTS Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. CONCLUSIONS AND RELEVANCE The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.
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Affiliation(s)
- Graham Nichol
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States; University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States.
| | - Danielle Guffey
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Brian Leroux
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Sheldon Cheskes
- Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital and Sunnybrook Center for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahamed Idris
- Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Peter J Kudenchuk
- King County EMS, Seattle and King County Public Health, and Department of Medicine, University of Washington, Seattle, WA, United States
| | | | - Lynn Wittwer
- Clark County Emergency Medical Services, Vancouver, WA, United States
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Thomas D Rea
- King County EMS, Seattle and King County Public Health, and Department of Medicine, University of Washington, Seattle, WA, United States
| | - Kellie Sheehan
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Val E Rac
- Toronto Health Economics and Technology Assessment Collaborative, Institute of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Keitki Raina
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kyle Gorman
- Clackamas Fire District #1, Clackamas, OR, United States
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Petrie J, Easton S, Naik V, Lockie C, Brett SJ, Stümpfle R. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system. BMJ Open 2015; 5:e005797. [PMID: 25838503 PMCID: PMC4390724 DOI: 10.1136/bmjopen-2014-005797] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY). SETTING We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention). PARTICIPANTS Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system. RESULTS Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1-2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50,000, cost per CPC 1-2 survivor was £65,000. Cost and length of stay of CPC 1-2 patients was considerably lower than CPC 3-4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1-2 survivor per QALY was £16,000. CONCLUSIONS The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.
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Affiliation(s)
- J Petrie
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - S Easton
- Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - V Naik
- Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - C Lockie
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - S J Brett
- Centre for Perioperative Medicine and Critical Care Research, London, UK
| | - R Stümpfle
- Centre for Perioperative Medicine and Critical Care Research, London, UK
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Moran PS, Teljeur C, Masterson S, O'Neill M, Harrington P, Ryan M. Cost-effectiveness of a national public access defibrillation programme. Resuscitation 2015; 91:48-55. [PMID: 25828922 DOI: 10.1016/j.resuscitation.2015.03.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
AIM Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement. METHODS We used a cost-utility analysis to estimate the costs and consequences of public access defibrillation (PAD) programmes from a societal perspective, based on AED deployment by building type. Comparator programmes ranged from those that only included building types with the highest incidence of OHCA, to the comprehensive programme outline in the proposed legislation. Data on OHCA incidence and outcomes were obtained from the Irish Out-of-Hospital-Cardiac-Arrest Register (OHCAR). Costs were obtained from the Irish health service, device suppliers and training providers. RESULTS The incremental cost effectiveness ratio (ICER) for the most comprehensive PAD scheme was €928,450/QALY. The ICER for the most scaled-back programme involving AED placement in transport stations, medical practices, entertainment venues, schools (excluding primary) and fitness facilities was €95,640/QALY. A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective. CONCLUSION National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.
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Affiliation(s)
- Patrick S Moran
- Department of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland; Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
| | - Conor Teljeur
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Siobhán Masterson
- Discipline of General Practice, National University of Ireland Galway, Ireland; Department of Public Health Medicine, Health Service Executive, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland
| | - Michelle O'Neill
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Patricia Harrington
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
| | - Máirín Ryan
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland
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MRI default mode network connectivity is associated with functional outcome after cardiopulmonary arrest. Neurocrit Care 2015; 20:348-57. [PMID: 24464830 DOI: 10.1007/s12028-014-9953-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND We hypothesized that the degree of preserved functional connectivity within the DMN during the first week after cardiopulmonary arrest (CPA) would be associated with functional outcome at hospital discharge. METHODS Initially comatose CPA survivors with indeterminate prognosis at 72 h were enrolled. Seventeen CPA subjects between 4 and 7 days after CPA and 17 matched controls were studied with task-free fMRI. Independent component analysis was performed to delineate the DMN. Connectivity strength in the DMN was compared between CPA subjects and controls, as well as between CPA subjects with good outcome (discharge Cerebral Performance Category or CPC 1-2) and those with bad outcome (CPC 3-5). The relationship between connectivity strength in the posterior cingulate cortex (PCC) and precuneus (PC) within the DMN with discharge CPC was evaluated using linear regression. RESULTS Compared to controls, CPA subjects had significantly lower connectivity strength in subregions of the DMN, the PCC and PC (p < 0.0001). Furthermore, connectivity strength in the PCC and PC was greater in CPA subjects with good outcome (n = 8) than those with bad outcome (n = 9) (p < 0.003). Among CPA subjects, the connectivity strength in the PCC and PC showed strong linear correlations with the discharge CPC (p < 0.005). CONCLUSIONS Among initially comatose CPA survivors with indeterminate prognosis, task-free fMRI demonstrated graded disruption of DMN connectivity, especially in those with bad outcomes. If confirmed, connectivity strength in the PC/PCC may provide a clinically useful prognostic marker for functional recovery after CPA.
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Barra S, Providência R, Paiva L, Heck P, Agarwal S. Implantable cardioverter-defibrillators in the elderly: rationale and specific age-related considerations. Europace 2014; 17:174-86. [PMID: 25480942 DOI: 10.1093/europace/euu296] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the increasingly high rate of implantation of cardioverter-defibrillators (ICD) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We comprehensively reviewed the state-of-the-art data regarding the applicability, safety, clinical- and cost-effectiveness of the ICD in elderly patients, and analysed which patients in this age stratum are more likely to get a survival benefit from this therapy. Although peri-procedural risk may be slightly higher in the elderly, this procedure is still relatively safe in this age group. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is comparable in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantage of the device on arrhythmic death may be largely attenuated by a higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in highly selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD intervention among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live >5-7 years after implantation. Biological age rather than chronological age per se should be the decisive factor in making a decision on ICD selection for survival benefit.
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Affiliation(s)
- Sérgio Barra
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK
| | - Rui Providência
- Cardiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Luís Paiva
- Cardiology Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Patrick Heck
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK
| | - Sharad Agarwal
- Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK
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Geri G, Mongardon N, Daviaud F, Empana JP, Dumas F, Cariou A. Neurological consequences of cardiac arrest: where do we stand? ACTA ACUST UNITED AC 2013; 33:98-101. [PMID: 24361281 DOI: 10.1016/j.annfar.2013.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With increasing public education in basic life support and with the widespread use of automated defibrillators, post-cardiac arrest comatose patients represent a growing part of ICU admissions. However the prognosis remains very poor and only a very low proportion of these resuscitated patients will recover and will leave the hospital without major neurological impairments. Neurological dysfunction predominantly includes disorders of consciousness, and may also include other manifestations such as seizures, myoclonus status epilepticus and other forms of movement disorders including post-anoxic myoclonus. In the most severe cases, coma may be irreversible or evolve towards a minimally conscious state, a vegetative state or even brain death. These severe conditions represent by far the leading cause of mortality and disability in such patients. Currently, early use of mild therapeutic hypothermia is the only treatment that demonstrated its ability to decrease neurological consequences and to improve the prognosis. Prognostication outcome is still mainly based on a rigorous clinical evaluation coupled with neuro-physiological investigations, but brain functional imaging could become a valuable tool in the near future. Clinical research focusing on survivors should be strongly encouraged in order to assess the mid- and long-terms outcome of survivors and to evaluate the impact of new treatments or strategies.
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Affiliation(s)
- G Geri
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - N Mongardon
- Department of Anesthesiology and Surgical Intensive Care, Henri-Mondor Hospital, Assistance publique des Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Faculté de médecine, université Paris Est, 8, avenue du Général-Sarrail, 94000 Créteil, France
| | - F Daviaud
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France
| | - J-P Empana
- Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - F Dumas
- Emergency Department, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - A Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France.
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Sund B, Svensson L, Rosenqvist M, Hollenberg J. Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:811-8. [PMID: 21739334 DOI: 10.1007/s10198-011-0338-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 06/28/2011] [Indexed: 05/07/2023]
Abstract
AIMS Out-of-hospital cardiac arrest is fatal without treatment, and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden. METHODS AND RESULTS A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (<euro> 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be <euro> 13,000, and the cost per saved life was <euro> 60,000. CONCLUSIONS The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis, the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.
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Affiliation(s)
- Björn Sund
- Swedish Business School, Örebro University, 702 82, Örebro, Sweden.
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Petrie DA, De Maio V, Stiell IG, Dreyer J, Martin M, O'brien JA. Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system. CAN J EMERG MED 2012; 3:186-92. [PMID: 17610782 DOI: 10.1017/s1481803500005522] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. METHODS This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. RESULTS From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call response interval (CRI) </= 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were "CRI in minutes" (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77-0.98) and "bystander-witnessed" (OR = 2.6; 95% CI, 1.5-4.4). CONCLUSIONS In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.
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Affiliation(s)
- D A Petrie
- Ontario Prehospital Advanced Life Support (OPALS) Study Group
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Becker LB, Aufderheide TP, Geocadin RG, Callaway CW, Lazar RM, Donnino MW, Nadkarni VM, Abella BS, Adrie C, Berg RA, Merchant RM, O'Connor RE, Meltzer DO, Holm MB, Longstreth WT, Halperin HR. Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association. Circulation 2011; 124:2158-77. [PMID: 21969010 PMCID: PMC3719404 DOI: 10.1161/cir.0b013e3182340239] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The guidelines presented in this consensus statement are intended to serve researchers, clinicians, reviewers, and regulators in the selection of the most appropriate primary outcome for a clinical trial of cardiac arrest therapies. The American Heart Association guidelines for the treatment of cardiac arrest depend on high-quality clinical trials, which depend on the selection of a meaningful primary outcome. Because this selection process has been the subject of much controversy, a consensus conference was convened with national and international experts, the National Institutes of Health, and the US Food and Drug Administration. METHODS The Research Working Group of the American Heart Association Emergency Cardiovascular Care Committee nominated subject leaders, conference attendees, and writing group members on the basis of their expertise in clinical trials and a diverse perspective of cardiovascular and neurological outcomes (see the online-only Data Supplement). Approval was obtained from the Emergency Cardiovascular Care Committee and the American Heart Association Manuscript Oversight Committee. Preconference position papers were circulated for review; the conference was held; and postconference consensus documents were circulated for review and comments were invited from experts, conference attendees, and writing group members. Discussions focused on (1) when after cardiac arrest the measurement time point should occur; (2) what cardiovascular, neurological, and other physiology should be assessed; and (3) the costs associated with various end points. The final document underwent extensive revision and peer review by the Emergency Cardiovascular Care Committee, the American Heart Association Science Advisory and Coordinating Committee, and oversight committees. RESULTS There was consensus that no single primary outcome is appropriate for all studies of cardiac arrest. The best outcome measure is the pairing of a time point and physiological condition that will best answer the question under study. Conference participants were asked to assign an outcome to each of 4 hypothetical cases; however, there was not complete agreement on an ideal outcome measure even after extensive discussion and debate. There was general consensus that it is appropriate for earlier studies to enroll fewer patients and to use earlier time points such as return of spontaneous circulation, simple "alive versus dead," hospital mortality, or a hemodynamic parameter. For larger studies, a longer time point after arrest should be considered because neurological assessments fluctuate for at least 90 days after arrest. For large trials designed to have a major impact on public health policy, longer-term end points such as 90 days coupled with neurocognitive and quality-of-life assessments should be considered, as should the additional costs of this approach. For studies that will require regulatory oversight, early discussions with regulatory agencies are strongly advised. For neurological assessment of post-cardiac arrest patients, researchers may wish to use the Cerebral Performance Categories or modified Rankin Scale for global outcomes. CONCLUSIONS Although there is no single recommended outcome measure for trials of cardiac arrest care, the simple Cerebral Performance Categories or modified Rankin Scale after 90 days provides a reasonable outcome parameter for many trials. The lack of an easy-to-administer neurological functional outcome measure that is well validated in post-cardiac arrest patients is a major limitation to the field and should be a high priority for future development.
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Mongardon N, Dumas F, Ricome S, Grimaldi D, Hissem T, Pène F, Cariou A. Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 2011; 1:45. [PMID: 22053891 PMCID: PMC3223497 DOI: 10.1186/2110-5820-1-45] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 11/03/2011] [Indexed: 11/15/2022] Open
Abstract
The prognosis for postcardiac arrest patients remains very bleak, not only because of anoxic-ischemic neurological damage, but also because of the "postcardiac arrest syndrome," a phenomenon often severe enough to cause death before any neurological evaluation. This syndrome includes all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion triggered by cardiac arrest and return of spontaneous circulation. The main component of the postcardiac arrest syndrome is an early but severe cardiocirculatory dysfunction that may lead to multiple organ failure and death. Cardiovascular support relies on conventional medical and mechanical treatment of circulatory failure. Hemodynamic stabilization is a major objective to limit secondary brain insult. When the cause of cardiac arrest is related to myocardial infarction, percutaneous coronary revascularization is associated with improved prognosis; early angiographic exploration should then be discussed when there is no obvious extracardiac cause. Therapeutic hypothermia is now the cornerstone of postanoxic cerebral protection. Its widespread use is clearly recommended, with a favorable risk-benefit ratio in selected population. Neuroprotection also is based on the prevention of secondary cerebral damages, pending the results of ongoing therapeutic evaluations regarding the potential efficiency of new therapeutic drugs.
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Affiliation(s)
- Nicolas Mongardon
- Medical Intensive Care Unit, Cochin Hospital, Groupe Hospitalier Universtitaire Cochin Broca Hôtel-Dieu, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.
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Beskind DL, Keim SM, Spaite DW, Garrison HG, Lerner EB, Howse D, Maio RF. Risk adjustment measures and outcome measures for prehospital trauma research: recommendations from the emergency medical services outcomes project (EMSOP). Acad Emerg Med 2011; 18:988-1000. [PMID: 21906205 DOI: 10.1111/j.1553-2712.2011.01148.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research. METHODS A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association ("Physical Rehabilitation Outcome Measures"). RESULTS Among the 4,885 articles reviewed, 96 RAMs and/or OMs were identified from the existing literature (January 1958 to February 2010). Only one measure, the Glasgow Coma Scale (GCS), currently meets Level 1 quality of evidence status and a Category 1 (strong) recommendation for use in EMS trauma research. Twelve RAMs or OMs received Category 2 status (promising, but not sufficient current evidence to strongly recommend), including the motor component of GCS, simplified motor score (SMS), the simplified verbal score (SVS), the revised trauma score (RTS), the prehospital index (PHI), EMS provider judgment, the revised trauma index (RTI), the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the field trauma triage (FTT), the pediatric triage rule, and the out-of-hospital decision rule for pediatrics. CONCLUSIONS Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures.
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Affiliation(s)
- Daniel L Beskind
- Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, USA.
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Abstract
Red blood cells (RBCs) are transfused to treat anemia and to maintain oxygen delivery to vital organs during critical illness. Laboratory and observational studies have raised the possibility that prolonged RBC storage may adversely affect clinical outcomes. Compared with RBCs stored less than 1 week, there are no clinical data demonstrating that RBCs stored longer remain as effective at carrying or releasing oxygen, and observational studies have risen to possibility that prolonged RBC storage might result in harm to vulnerable patients requiring blood transfusions. The "Age of Blood Evaluation" (ABLE) study (ISRCTN44878718) is a double-blind, multicenter, parallel randomized controlled clinical trial. It will test the hypothesis that the transfusion of prestorage leukoreduced RBCs stored for 7 days or less (fresh arm) as compared with standard-issue RBCs stored, on average, 15 to 20 days (control arm) will lead to lower 90-day all-cause mortality and reduced morbidity in critically ill adults. We include adults in intensive care units (ICUs) who (1) have had a request for a first RBC unit transfusion during the first 7 days of ICU admission and (2) have an anticipated requirement for ongoing invasive and noninvasive mechanical ventilation exceeding 48 hours. Enrolled patients are randomized at the time of transfusion to receive either standard-issue RBC units or RBCs stored 7 days or less issued by the local hospital transfusion service. The primary outcome is 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, organ failure, and serious nosocomial infections. With 2510 patients, we will be able to detect a 5% absolute risk reduction (from 25% to 20%). The ABLE study is currently enrolling patients in 23 university-affiliated and community-hospital ICUs across Canada; sites in France and United Kingdom are expected to start recruitment in 2011. Regardless of the results, ABLE study will have significant implications on the duration of RBC storage. A negative trial will reassure clinicians and blood bankers regarding the effectiveness and safety of standard-issue RBCs. A positive trial will have significant implications with respect to inventory management of RBCs given to critically ill adults with a high risk of mortality and will also prompt research to better understand the RBC storage lesion in the hopes of minimizing its clinical consequences through the development of better storage methods.
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Mooty RC, Oliveira K, Dunn E, Mangram A. Cardiopulmonary Resuscitation in the Field: A Battle Worth Fighting For? Am Surg 2011. [DOI: 10.1177/000313481107700431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Kristin Oliveira
- Department of General Surgery Methodist Health Systems Dallas, Texas
| | - Ernest Dunn
- Department of General Surgery Methodist Health Systems Dallas, Texas
| | - Alicia Mangram
- Department of General Surgery Methodist Health Systems Dallas, Texas
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Björck L, Capewell S, Bennett K, Lappas G, Rosengren A. Increasing evidence-based treatments to reduce coronary heart disease mortality in Sweden: quantifying the potential gains. J Intern Med 2011; 269:452-67. [PMID: 21205025 DOI: 10.1111/j.1365-2796.2010.02339.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Between 1986 and 2002, coronary heart disease (CHD) mortality in Sweden fell by more than 50%. Approximately one-third (4800 fewer deaths) of this decline in age-adjusted CHD mortality could be attributed to treatments in patients with CHD and primary prevention medications. High treatment levels were achieved in some cases, but in others, only 50-80% of eligible patients received appropriate therapy. We therefore examined to what extent increasing the use of specific treatments in eligible patients might have reduced CHD mortality rates in Sweden. DESIGN AND METHODS We used the previously validated IMPACT CHD model to combine data on CHD patient numbers, medical and surgical uptake levels and treatment effectiveness. We estimated the number of deaths prevented or postponed for 2002 (baseline scenario) and for an alternative scenario (if at least 60% of eligible patients were treated). RESULTS If treatments were increased to consistently cover at least 60% of eligible patients, approximately 8900 deaths could have been postponed or prevented, representing a potential gain of approximately 4100 fewer deaths than actually occurred in 2002. Approximately 45% of the 4100 gain would have come from primary prevention with statins, 23% from acute coronary syndrome treatments, 15% from secondary prevention therapies and 15% from treatments for heart failure. CONCLUSION Increasing the proportion of eligible patients with CHD who receive evidence-based treatment could have resulted in approximately 4100 fewer deaths in 2002, almost doubling the actual mortality reduction. These findings further emphasize the importance of aggressively identifying and treating patients with CHD and high-risk individuals.
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Affiliation(s)
- L Björck
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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Elliott VJ, Rodgers DL, Brett SJ. Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival. Resuscitation 2011; 82:247-56. [DOI: 10.1016/j.resuscitation.2010.10.030] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/21/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
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Long-term survival and quality of life after cardiac resuscitation following coronary artery bypass grafting. Eur J Cardiothorac Surg 2010; 40:249-54. [PMID: 21168340 DOI: 10.1016/j.ejcts.2010.10.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/21/2010] [Accepted: 10/25/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Follow-up studies of patients surviving emergency resternotomy, open cardiac massage, and additional emergency cardiac surgery following coronary artery bypass grafting (CABG) remain sparse and studies focusing on health-related quality of life are lacking. Our aim was to elucidate the long-term course of patients experiencing this hazardous complication. METHODS Between 1988 and 1999, 76 patients suffered sudden hemodynamic collapse following isolated CABG. All patients underwent emergency resternotomy and open cardiac massage. An emergency cardiac reoperation was performed in the 62 (82%) primary survivors. Additional 76 patients were pair-matched to the study patients on the basis of their preoperative characteristics and served as controls. Of the study patients, 41 (54%), and of the controls, 76, (100%) were discharged. In December 2009, all patients were traced with respect to mortality data and the health-related quality of life of living patients was studied using the RAND-36 Item Health Survey questionnaire. RESULTS Altogether 19 (73%) of the 26 study patients, and 38 (84%) of the 45 controls were available. After exclusion of the early deaths, the life expectancy was similar between the groups: neither overall (p = 0.60) nor cardiac (p = 0.64) survival differed significantly after a mean follow-up time of 15.1 ± 3.5 years. In addition, cardiac re-interventions were equally frequently required in both the groups. The RAND-36 scores were congruent (p = ns) between the groups and the age- and sex-matched national reference population in the health-related quality-of-life dimensions describing physical, mental, and social domains. CONCLUSIONS Patients who have survived severe hemodynamic collapse, open cardiac massage, and emergency cardiac reoperation following CABG achieve similar long-term prognosis in terms of survival and cardiac interventions as the pair-matched control patients. In addition, 15 years postoperatively, they have a good health-related quality of life, similar to that of an age- and sex-matched national reference population.
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Mancini ME, Soar J, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S539-81. [PMID: 20956260 DOI: 10.1161/circulationaha.110.971143] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lippert F, Raffay V, Georgiou M, Steen P, Bossaert L. Ethik der Reanimation und Entscheidungen am Lebensende. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1376-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1: Executive Summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S250-75. [PMID: 20956249 DOI: 10.1161/circulationaha.110.970897] [Citation(s) in RCA: 282] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soar J, Mancini ME, Bhanji F, Billi JE, Dennett J, Finn J, Ma MHM, Perkins GD, Rodgers DL, Hazinski MF, Jacobs I, Morley PT. Part 12: Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010; 81 Suppl 1:e288-330. [PMID: 20956038 PMCID: PMC7184565 DOI: 10.1016/j.resuscitation.2010.08.030] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol,United Kingdom.
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Nolan JP, Hazinski MF, Billi JE, Boettiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O'Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2010; 81 Suppl 1:e1-25. [PMID: 20956042 PMCID: PMC7115798 DOI: 10.1016/j.resuscitation.2010.08.002] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lippert FK, Raffay V, Georgiou M, Steen PA, Bossaert L. European Resuscitation Council Guidelines for Resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation 2010; 81:1445-51. [DOI: 10.1016/j.resuscitation.2010.08.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OOHCA) is a common public health problem. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. We review evidence of the effectiveness of regional cardiac resuscitation systems and describe preliminary recommended elements of such systems. RECENT FINDINGS There is large and important regional variation in survival among patients treated with OOHCA by emergency medical services, or among patients transported to the hospital after return of spontaneous circulation (ROSC). Most regions lack a well coordinated approach to postcardiac arrest care. There is little evidence to show small increases in transport time or distance have an adverse impact on survival, so bypassing closer hospitals may be feasible. Hospitals that have facilities to provide a comprehensive package of postresuscitation care including percutaneous coronary intervention and therapeutic hypothermia appear to have better survival but further studies are needed. A well defined relationship between increased volume of patients or procedures of individual providers and hospitals and better outcomes has been observed for several clinical disorders and there are suggestions that this may also be true for patients with ROSC after cardiac arrest. SUMMARY Many more people could survive OOHCA if regional systems of cardiac resuscitation were established. The time has come to implement such systems whenever feasible.
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Abstract
In spite of recent advances, cardiac arrest remains a serious illness for which survival rate stays very low. If prehospital death remains the major problem, in-hospital death is also important. Two thirds of deaths in intensive care are the result of initial brain damage. After discharge, risk of recurrence for victims of sudden death is important and requires specific care and sometimes the implant of a cardiac defibrillator. In survivors, medium and long-term survival is satisfactory and close to that of patients with similar age and comorbidities that have not suffered cardiac arrest. The << minor >> cerebral sequels remain unknown and their impact on quality of life needs further attention.
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Hanefeld C. A first city-wide early defibrillation project in a German city: 5-year results of the Bochum against sudden cardiac arrest study. Scand J Trauma Resusc Emerg Med 2010; 18:31. [PMID: 20550655 PMCID: PMC2902410 DOI: 10.1186/1757-7241-18-31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/15/2010] [Indexed: 11/16/2022] Open
Abstract
Background Immediate defibrillation is the decisive determinant of prognosis in patients suffering from cardiac/circulatory arrest caused by ventricular fibrillation (VF). Therefore, various national and international associations recommend that first responders use defibrillators as soon as possible and also recommend public access to early defibrillation programmes. Here we report the results of the first city-wide early defibrillation project in a large German urban area. Methods There were 155 automated external defibrillators (AEDs) put into operation in the Bochum municipal area, and 6,294 people took part in cardiopulmonary resuscitation (CPR) and AED training. Free, accessible AEDs were installed in places with large volumes of people. Additionally, emergency forces were progressively equipped with AEDs. Results Twelve AED administrations prior to the arrival of an emergency physician were recorded and analysed over a period of 5 years (08/2004-08/2009). Rhythm analysis via AED demonstrated VF in seven cases, non-malignant dysrhythmias in four cases and asystole in one case. Two of the seven patients with VF were successfully defibrillated and survived cardiac/circulatory arrest without any neurological sequelae. Eight of the 12 AED applications were performed by laymen. The mean time between switching the unit on and applying the electrodes to the patient was 39 seconds (SD +/-20 sec). On average, another 20 seconds elapsed before the AED recommendation of "shock delivery" was displayed, and a total of 96 seconds elapsed before shock administration (± 56 sec). Conclusion Consistent with other reports, our findings show that the organisation of a city-wide initiative by a project office combining public access and first-responder defibrillation programmes can be safe, feasible and successful. Our experiences confirm that strategic planning of AED placement is a prerequisite for successful, cost-effective resuscitation.
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Affiliation(s)
- Christoph Hanefeld
- Emergency Medical System of the city of Bochum, Brandwacht 1, 44894 Bochum, Germany.
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