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Vaillancourt C, Charette M, Lanos C, Godbout J, Buhariwalla H, Dale-Tam J, Nemnom MJ, Brehaut J, Wells G, Stiell I. Multi-phase implementation of automated external defibrillator use by nurses during in-hospital cardiac arrest and its impact on survival. Resuscitation 2024; 197:110148. [PMID: 38382874 DOI: 10.1016/j.resuscitation.2024.110148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE We sought to evaluate the impact of a medical directive allowing nurses to use defibrillators in automated external defibrillator-mode (AED) on in-hospital cardiac arrest (IHCA) outcomes. METHODS We completed a health record review of consecutive IHCA for which resuscitation was attempted using a pragmatic multi-phase before-after cohort design. We report Utstein outcomes before (Jan.2012-Aug.2013;Control) the implementation of the AED medical directive following usual practice (Sept.2013-Aug.2016;Phase 1), and following the addition of a theory-based educational video (Sept.2016-Dec.2017;Phase 2). RESULTS There were 753 IHCA with the following characteristics (Before n = 195; Phase 1n = 372; Phase 2n = 186): mean age 66, 60.0% male, 79.3% witnessed, 29.1% noncardiac-monitored medical ward, 23.9% cardiac cause, and initial ventricular fibrillation/tachycardia (VF/VT) 27.2%. Comparing the Before, Phase 1 and 2: an AED was used 0 time (0.0%), 21 times (5.7%), 15 times (8.1%); mean times to 1st analysis were 7 min, 3 min and 1 min (p < 0.0001); mean times to 1st shock were 12 min, 10 min and 8 min (p = 0.32); return of spontaneous circulation (ROSC) was 63.6%, 59.4% and 58.1% (p = 0.77); survival was 24.6%, 21.0% and 25.8% (p = 0.37). Among IHCA in VF/VT (n = 165), time to 1st analysis and 1st shock decreased by 5 min (p = 0.01) and 6 min (p = 0.23), and ROSC and survival increased by 3.0% (p = 0.80) and 15.6% (p = 0.31). There was no survival benefit overall (1.2%; p = 0.37) or within noncardiac-monitored areas (-7.2%; p = 0.24). CONCLUSIONS The implementation of a medical directive allowing for AED use by nurses successfully improved key outcomes for IHCA victims, particularly following the theory-based education video and among the VF/VT group.
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Affiliation(s)
- Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada.
| | - Manya Charette
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chelsea Lanos
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Justin Godbout
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Hannah Buhariwalla
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada
| | - George Wells
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada; University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ian Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada
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Gupte D, Assaf M, Miller MR, McKenzie K, Loosley J, Tijssen JA. Evaluation of hospital management of paediatric out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100433. [PMID: 37555196 PMCID: PMC10405089 DOI: 10.1016/j.resplu.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality. METHODS POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System. RESULTS 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group. DISCUSSION Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
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Affiliation(s)
- Dhruv Gupte
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Maysaa Assaf
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
| | - Michael R. Miller
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Jay Loosley
- Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
| | - Janice A. Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada
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Bodempudi S, Wus L, Kloo J, Zeniecki P, Coromilas J, West FM, Lev Y. Improving Time to Defibrillation Following Ventricular Tachycardia (VTach) and Ventricular Fibrillation (VFib) Cardiac Arrest: A Multicenter Retrospective and Prospective Quality Improvement Study. Am J Med Qual 2023; 38:73-80. [PMID: 36519966 DOI: 10.1097/jmq.0000000000000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The goal of this study was to identify how often 2 independent centers defibrillated patients within the American Heart Association recommended 2-minute time interval following ventricular fibrillation/ventricular tachycardia arrest. A retrospective chart review revealed significant delays in defibrillation. Simulation sessions and modules were implemented to train nursing staff in a single nursing unit at a Philadelphia teaching hospital. Recruited nurses completed a code blue simulation session to establish a baseline time to defibrillation. They were then given 2 weeks to complete an online educational module. Upon completion, they participated in a second set of simulation sessions to assess improvement. First round simulations resulted in 33% with delayed defibrillation and 27% no defibrillation. Following the module, 77% of the second round of simulations ended in timely defibrillation, a statistically significant improvement ( P < 0.00001). Next steps involve prospective collection of the code blue data to analyze improvement in real code blue events.
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Affiliation(s)
- Sairamya Bodempudi
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Lisa Wus
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Juergen Kloo
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Patrick Zeniecki
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - James Coromilas
- Robert Wood Johnson Medical School, Division of Cardiovascular Diseases and Hypertension, Rutgers University, Newark, NJ
| | - Frances Mae West
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Yair Lev
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
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Feasibility of accelerated code team activation with code button triggered smartphone notification. Resuscitation 2023; 187:109752. [PMID: 36842677 DOI: 10.1016/j.resuscitation.2023.109752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Studies support rapid interventions to improve outcomes in patients with in-hospital cardiac arrest. We sought to decrease the time to code team activation and improve dissemination of patient-specific data to facilitate targeted treatments. METHODS We mapped code blue buttons behind each bed to patients through the electronic medical record. Pushing the button sent patient-specific data (admitting diagnosis, presence of difficult airway, and recent laboratory values) through a secure messaging system to the responding teams' smartphones. The code button also activated a hospital-wide alert through the operator. We piloted the system on seven medicine inpatient units from November 2019 through May 2022. We compared the time from code blue button press to smartphone message receipt vs traditional operator-sent overhead page. RESULTS The code button was the primary mode of code team activation for 12/35 (34.3%) cardiac arrest events. The code team received smartphone notifications a median of 78 s (IQR = 47-127 s) before overhead page. The median time to adrenaline administration for codes activated with the code button was not significantly different (240 s (IQR 142-300 s for code button) vs 148 s (IQR = 34-367 s) for overhead page, p = 0.89). Survival to discharge was 3/12 (25.0%) for codes activated with the code button vs 4/23 (17.4%) when activated by calling the operator (p = 0.67). CONCLUSION Implementation of a smartphone-based code button notification system reduced time to code team activation by 78 s. Larger cohorts are necessary to assess effects on patient outcomes.
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Toft LE, Bottinor W, Cobourn A, Blount C, Tripathi A, Mehta I, Koch J. A simulation-enhanced, spaced learning, interprofessional “code blue” curriculum improves ACLS algorithm adherence and trainee resuscitation skill confidence. J Interprof Care 2022; 37:623-628. [DOI: 10.1080/13561820.2022.2140130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lorrel E.B. Toft
- University of Nevada Reno School of Medicine, Cardiology, 89557, Reno, NV USA
| | - Wendy Bottinor
- Division of Cardiology, Virginia Commonwealth University Medical College of Virginia, Richmond, VA USA
| | - Andrew Cobourn
- University of Nevada Reno School of Medicine, Cardiology, 89557, Reno, NV USA
| | - Courtland Blount
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Avnish Tripathi
- Division of Cardiology, University of Kentucky College of Medicine, Bowling Green, KY USA
| | - Ishan Mehta
- Division of Pulmonology, Emory University School of Medicine, Atlanta, GA USA
| | - Jennifer Koch
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY USA
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 674] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Roessler LL, Holmberg MJ, Pawar RD, Lassen AT, Moskowitz A, Grossestreuer A, Moskowitz A, Edelson D, Ornato J, Peberdy MA, Churpek M, Kurz M, Starks MA, Chan P, Girotra S, Perman S, Goldberger Z. Resuscitation Quality in the ICU. Chest 2022; 162:569-577. [DOI: 10.1016/j.chest.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 11/25/2022] Open
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Survival outcomes and resuscitation process measures in maternal in-hospital cardiac arrest. Am J Obstet Gynecol 2022; 226:401.e1-401.e10. [PMID: 34688594 PMCID: PMC8917084 DOI: 10.1016/j.ajog.2021.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maternal in-hospital cardiac arrest is a rare event with the potential for resuscitation treatment delays because of the difficulty accessing hospital obstetrical units and limited simulation training or resuscitation experience of obstetrical staff. However, it is unclear whether survival rates and processes of care differ between women with a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac arrest. OBJECTIVE We aimed determine whether to there are delays in process measures and differences in survival outcomes between pregnant and nonpregnant women who have in-hospital cardiac arrest. STUDY DESIGN Using data from 2000 to 2019 in the Get With The Guidelines-Resuscitation registry, we compared resuscitation outcomes between women aged 18 to 50 years with a maternal or nonmaternal in-hospital cardiac arrest. Using a nonparsimonious propensity score, we matched patients with a maternal in-hospital cardiac arrest to as many as 10 women with a nonmaternal in-hospital cardiac arrest. We constructed conditional logistic regression models to compare survival outcomes (survival to discharge, favorable neurologic survival [discharge cerebral performance score of 1], and return of spontaneous circulation) and processes of care (delayed defibrillation [>2 minutes] and administration of epinephrine [>5 minutes]) between women with a maternal in-hospital cardiac arrest vs those with a nonmaternal in-hospital cardiac arrest. RESULTS Overall, 421 women with a maternal in-hospital cardiac arrest were matched by propensity score to 2316 women with a nonmaternal in-hospital cardiac arrest. The mean age among propensity score-matched women with a maternal in-hospital cardiac arrest was 31.4 (standard deviation, 6.5) years, where 33.7% were of Black race and 86.9% had an initial nonshockable cardiac arrest rhythm. Unadjusted survival rates were higher in women with a maternal in-hospital cardiac arrest than in women with a nonmaternal in-hospital cardiac arrest: survival to discharge of 45.1% vs 26.5%, survival with cerebral performance category 1 status of 36.1% vs 17.7%, and return of spontaneous circulation of 75.8% vs 70.6%. After adjustment, there was no difference in the likelihood of survival to discharge (odds ratio, 1.19; 95% confidence interval, 0.82-1.73) or return of spontaneous circulation (odds ratio, 0.94; 95% confidence interval, 0.65-1.35) between women with a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac arrest. However, women with a maternal in-hospital cardiac arrest were more likely to have favorable neurologic survival (odds ratio, 1.57; 95% confidence interval, 1.06-2.33). Compared with women with a nonmaternal in-hospital cardiac arrest, women with a maternal in-hospital cardiac arrest had similar rates of delayed defibrillation (42.5% vs 34.4%; odds ratio, 1.14 [95% confidence interval, 0.41-3.18]; P=.31) and delayed administration of epinephrine (13.8% vs 10.6%; odds ratio, 0.96 [95% confidence interval, 0.50-1.86]; P=.09). CONCLUSION Although concerns have been raised about resuscitation outcomes in women with a maternal in-hospital cardiac arrest, the rates of survival and resuscitation processes of care were not worse in women with a maternal in-hospital cardiac arrest.
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Haneef R, Tijhuis M, Thiébaut R, Májek O, Pristaš I, Tolenan H, Gallay A. Methodological guidelines to estimate population-based health indicators using linked data and/or machine learning techniques. Arch Public Health 2022; 80:9. [PMID: 34983651 PMCID: PMC8725299 DOI: 10.1186/s13690-021-00770-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The capacity to use data linkage and artificial intelligence to estimate and predict health indicators varies across European countries. However, the estimation of health indicators from linked administrative data is challenging due to several reasons such as variability in data sources and data collection methods resulting in reduced interoperability at various levels and timeliness, availability of a large number of variables, lack of skills and capacity to link and analyze big data. The main objective of this study is to develop the methodological guidelines calculating population-based health indicators to guide European countries using linked data and/or machine learning (ML) techniques with new methods. METHOD We have performed the following step-wise approach systematically to develop the methodological guidelines: i. Scientific literature review, ii. Identification of inspiring examples from European countries, and iii. Developing the checklist of guidelines contents. RESULTS We have developed the methodological guidelines, which provide a systematic approach for studies using linked data and/or ML-techniques to produce population-based health indicators. These guidelines include a detailed checklist of the following items: rationale and objective of the study (i.e., research question), study design, linked data sources, study population/sample size, study outcomes, data preparation, data analysis (i.e., statistical techniques, sensitivity analysis and potential issues during data analysis) and study limitations. CONCLUSIONS This is the first study to develop the methodological guidelines for studies focused on population health using linked data and/or machine learning techniques. These guidelines would support researchers to adopt and develop a systematic approach for high-quality research methods. There is a need for high-quality research methodologies using more linked data and ML-techniques to develop a structured cross-disciplinary approach for improving the population health information and thereby the population health.
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Affiliation(s)
- Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France.
| | - Mariken Tijhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rodolphe Thiébaut
- Bordeaux University, Bordeaux School of Public Health, Bordeaux, France.,INSERM / INRIA SISTM team, Bordeaux Population health, Bordeaux, France.,Medical Information Department, Bordeaux University Hospital, Bordeaux, France
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Pristaš
- National Institute of public health, division of health informatics and biostatistics, Zagreb, Croatia
| | - Hanna Tolenan
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
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Evans E, Swanson MB, Mohr N, Boulos N, Vaughan-Sarrazin M, Chan PS, Girotra S. Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis. BMJ 2021; 375:e066534. [PMID: 34759038 PMCID: PMC8579224 DOI: 10.1136/bmj-2021-066534] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. DESIGN Propensity matched analysis. SETTING 2000-18 data from 497 hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation registry. PARTICIPANTS Adults aged 18 and older with an index in-hospital cardiac arrest due to an initial shockable rhythm treated with defibrillation. INTERVENTIONS Administration of epinephrine before first defibrillation. MAIN OUTCOME MEASURES Survival to discharge; favorable neurological survival, defined as survival to discharge with none, mild, or moderate neurological disability measured using cerebral performance category scores; and survival after acute resuscitation (that is, return of spontaneous circulation for >20 minutes). A time dependent, propensity matched analysis was performed to adjust for confounding due to indication and evaluate the independent association of epinephrine before defibrillation with study outcomes. RESULTS Among 34 820 patients with an initial shockable rhythm, 7054 (20.3%) were treated with epinephrine before defibrillation, contrary to current guidelines. In comparison with participants treated with defibrillation first, participants receiving epinephrine first were less likely to have a history of myocardial infarction or heart failure, but more likely to have renal failure, sepsis, respiratory insufficiency, and receive mechanical ventilation before in-hospital cardiac arrest (standardized differences >10% for all). Treatment with epinephrine before defibrillation was strongly associated with delayed defibrillation (median 4 minutes v 0 minutes). In propensity matched analysis (6569 matched pairs), epinephrine before defibrillation was associated with lower odds of survival to discharge (22.4% v 29.7%; adjusted odds ratio 0.69; 95% confidence interval 0.64 to 0.74; P<0.001), favorable neurological survival (15.8% v 21.6%; 0.68; 0.61 to 0.76; P<0.001) and survival after acute resuscitation (61.7% v 69.5%; 0.73; 0.67 to 0.79; P<0.001). The above findings were consistent in a range of sensitivity analyses, including matching according to defibrillation time. CONCLUSIONS Contrary to current guidelines that prioritize immediate defibrillation for in-hospital cardiac arrest due to a shockable rhythm, one in five patients are treated with epinephrine before defibrillation. Use of epinephrine before defibrillation was associated with worse survival outcomes.
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Affiliation(s)
- Erin Evans
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Morgan B Swanson
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicholas Mohr
- Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Nassar Boulos
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mary Vaughan-Sarrazin
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Centre for Access Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Centre, Iowa City, IA, USA
| | - Paul S Chan
- Saint Luke's Mid America Heart and Vascular Institute, University of Missouri-Kansas, Kansas City, MO, USA
| | - Saket Girotra
- Centre for Access Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Centre, Iowa City, IA, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Nakajima J, Sawada Y, Isshiki Y, Ichikawa Y, Fukushima K, Aramaki Y, Oshima K. Influence of the prehospital administered dosage of epinephrine on the plasma levels of catecholamines in patients with out-of-hospital cardiac arrest. Heliyon 2021; 7:e07708. [PMID: 34401588 PMCID: PMC8353485 DOI: 10.1016/j.heliyon.2021.e07708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/07/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022] Open
Abstract
Aim This study evaluated whether the prehospital administered dosage of epinephrine (Ep) influences the plasma levels of catecholamines in patients with out-of-hospital cardiac arrest (OHCA). Methods This was a prospective, observational clinical study. Patients with OHCA transferred to our hospital between July 2014 and July 2017 were analyzed. The plasma levels of catecholamines were measured using blood samples obtained immediately upon arrival at the hospital and before the administration of Ep. Patients were divided into three groups based on the prehospital administered dosage of Ep: no prehospital administration (group Z); 1 mg of Ep (group O); and 2 mg of Ep (group T). The levels of catecholamines, as well as the conditions of resuscitation prior to and after arrival at the hospital were compared between the three groups. Results We analyzed 145 patients with OHCA (96, 38, and 11 patients in groups Z, O, and T, respectively). Group T exhibited the highest plasma levels of Ep with a statistically significant difference, however, there were no significant differences in the plasma levels of norepinephrine (Nep), dopamine (DOA) and vasopressin (ADH) among the three groups. Conclusion The prehospital administered dosage of Ep influences the plasma levels of Ep; however, it does not contribute to the plasma levels of Nep, DOA and ADH in patients with OHCA.
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Affiliation(s)
- Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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12
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Lemke DS, Young AL, Won SK, Rus MC, Villareal NN, Camp EA, Doughty C. Rapid-cycle deliberate practice improves time to defibrillation and reduces workload: A randomized controlled trial of simulation-based education. AEM EDUCATION AND TRAINING 2021; 5:e10702. [PMID: 34901686 PMCID: PMC8637872 DOI: 10.1002/aet2.10702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The optimal structure of simulation to train teams to perform pediatric advanced life support (PALS) requires further research. Most simulation is structured with an uninterrupted scenario with postsimulation debriefing (PSD). Rapid-cycle deliberate practice (RCDP) is structured with a series of simulations with microdebriefing quickly switching within action targeting specific performance goals. OBJECTIVE The objective was to compare team performance immediately after training, as well as learner workload, for teams trained using either PSD or RCDP. METHODS In 2018-2019, a total of 41 interprofessional teams of 210 residents and nurses were recruited from 250 eligible participants (84%) and randomized into either arm (RCDP or PSD) teaching the same objectives of resuscitation of a patient in PEA arrest, in the same time frame. The structure of the simulation varied. Demographic surveys were collected before training, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) was administered immediately after training to assess workload during training and performance was assessed immediately after training using a pulseless ventricular tachycardia arrest with the primary outcome being time to defibrillation. RESULTS Thirty-nine teams participated over a 16-month time span. Performance of teams randomized to RCDP showed significantly better time to defibrillation, 100 s (95% confidence interval [CI] = 90-111), compared to PSD groups, 163 s (95% CI = 120-201). The workload of the groups also showed a lower total NASA-TLX score for the RCDP groups. CONCLUSIONS For team-based time-sensitive training of PALS, RCDP outperformed PSD. This may be due to a reduction in the workload faced by teams during training.
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Affiliation(s)
- Daniel S. Lemke
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | - Ann L Young
- Division of Emergency MedicineBoston Children’s HospitalBostonMassachusettsUSA
| | - Sharon K. Won
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | - Marideth C. Rus
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
| | | | | | - Cara Doughty
- Division of Emergency MedicineDepartment of PediatricsBaylor College of MedicineTexas Children’s HospitalHoustonTexasUSA
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Kienzle MF, Morgan RW, Faerber JA, Graham K, Katcoff H, Landis WP, Topjian AA, Kilbaugh TJ, Nadkarni VM, Berg RA, Sutton RM. The Effect of Epinephrine Dosing Intervals on Outcomes from Pediatric In-Hospital Cardiac Arrest. Am J Respir Crit Care Med 2021; 204:977-985. [PMID: 34265230 DOI: 10.1164/rccm.202012-4437oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Animal studies of cardiac arrest suggest shorter epinephrine dosing intervals than currently recommended (every 3-5 minutes) may be beneficial in select circumstances. OBJECTIVES To evaluate the association between epinephrine dosing intervals and pediatric cardiac arrest outcomes. METHODS Single-center retrospective cohort study of children (<18 years of age) who received ≥1 minute of cardiopulmonary resuscitation and ≥2 doses of epinephrine for an index in-hospital cardiac arrest. Exposure was epinephrine dosing interval: ≤2 minutes (frequent epinephrine) vs. >2 minutes. Primary outcome was survival to hospital discharge with a favorable neurobehavioral outcome (Pediatric Cerebral Performance Category score 1-2 or unchanged). Logistic regression evaluated the association between dosing interval and outcomes; additional analyses explored duration of CPR as a mediator. In a subgroup, the effect of dosing interval on diastolic blood pressure was investigated. MEASUREMENTS AND MAIN RESULTS Between January 2011 and December 2018, 125 patients met inclusion/exclusion criteria; 33 (26%) received frequent epinephrine. Frequent epinephrine was associated with increased odds of survival with favorable neurobehavioral outcome (aOR 2.56; CI95 1.07, 6.14; p=0.036), with 66% of the association mediated by CPR duration. Delta diastolic blood pressure was greater after the second dose of epinephrine among patients who received frequent epinephrine (median [IQR] 6.3 [4.1, 16.9] vs. 0.13 [-2.3, 1.9] mmHg, p=0.034). CONCLUSIONS In patients who received at least two doses of epinephrine, dosing intervals ≤2 minutes were associated with improved neurobehavioral outcomes compared to dosing intervals >2 minutes. Mediation analysis suggests improved outcomes are largely due to frequent epinephrine shortening duration of CPR.
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Affiliation(s)
- Martha F Kienzle
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Ryan W Morgan
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Jennifer A Faerber
- The Children's Hospital of Philadelphia, 6567, CPCE, Philadelphia, Pennsylvania, United States
| | - Kathryn Graham
- The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care, Philadelphia, Pennsylvania, United States
| | - Hannah Katcoff
- The Children's Hospital of Philadelphia, 6567, Department of Biomedical and Health Informatics, Philadelphia, Pennsylvania, United States
| | - William P Landis
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Alexis A Topjian
- University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - Todd J Kilbaugh
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Vinay M Nadkarni
- The Children's Hospital of Philadelphia, 6567, Anesthesia and Critical Care, Philadelphia, Pennsylvania, United States
| | - Robert A Berg
- The Children's Hospital of Philadelphia, 6567, Anesthesiology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - Robert M Sutton
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States;
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Outcomes of In-hospital Cardiac Arrest: A Review of the Evidence. Crit Care Nurs Clin North Am 2021; 33:343-356. [PMID: 34340795 DOI: 10.1016/j.cnc.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac arrest is a significant cause of morbidity and mortality in the United States. Cardiac arrest can occur in the community or among hospitalized patients. There are many commonalities between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest; however, significant differences exist. Optimizing outcomes for patients with IHCA depends on high-quality care supported by the best available evidence. It is essential that critical care nurses are familiar with the evidence related to IHCA. This article focuses on a review of the evidence on IHCA, focusing on practical implications for critical care nursing practice.
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Gill HS, Lindgren E, Steele AD, Chakraborti G, Calhoun DA, Bharati P, Srikanth S, Nett ST, Braga MS. Errors of Commission in Cardiac Arrest Care in the Intensive Care Unit. J Intensive Care Med 2021; 36:749-757. [PMID: 34041967 DOI: 10.1177/08850666211018101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cardiopulmonary arrests (CPAs) are common in the intensive care unit (ICU). However, effects of protocol deviations on CPA outcomes in the ICU are relatively unknown. OBJECTIVES To establish the frequency of errors of commission (EOCs) during CPAs in the ICU and their relationship with CPA outcomes. METHODS Retrospective analysis of data entered into institutional registry with inclusion criteria of age >18 years and non-traumatic cardiac arrest in the ICU. EOCs consist of administration of drugs or procedures performed during a CPA that are not recommended by ACLS guidelines.Primary outcome: relationship of EOCs with likelihood of return of spontaneous circulation (ROSC). Secondary outcomes: relationship of specific EOCs to ROSC and relationship of EOCs and CPA length on ROSC. RESULTS Among 120 CPAs studied, there was a cumulative ROSC rate of 66%. Cumulatively, EOCs were associated with a decreased likelihood of ROSC (OR: 0.534, 95% CI: 0.387-0.644). Specifically, administration of sodium bicarbonate (OR: 0.233, 95% CI: 0.084-0.644) and calcium chloride (OR: 0.278, 95% CI: 0.098-0.790) were the EOCs that significantly reduced likelihood of attaining ROSC. Each 5-minute increment in CPA duration and/or increase in number of EOCs corresponded to fewer patients sustaining ROSC. CONCLUSIONS EOCs during CPAs in the ICU were common. Among all EOCs studied, sodium bicarbonate and calcium chloride seemed to have the greatest association with decreased likelihood of attaining ROSC. Number of EOCs and CPA duration both seemed to have an inversely proportional relationship with the likelihood of attaining and sustaining ROSC. EOCs represent potentially modifiable human factors during a CPA through resources such as life safety nurses.
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Affiliation(s)
- Harman Singh Gill
- Department of Emergency Medicine and Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Elsa Lindgren
- 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | - Pankaj Bharati
- Department of Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Sathvik Srikanth
- Department of Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Sholeen T Nett
- Department of Pediatrics, Critical Care Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Matthew S Braga
- Department of Pediatrics, Critical Care Medicine, 22916Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Oh J, Cha KC, Lee JH, Park S, Kim DH, Lee BK, Park JS, Jung WJ, Lee DK, Roh YI, Kim TY, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support. Clin Exp Emerg Med 2021; 8:S26-S40. [PMID: 34034448 PMCID: PMC8171171 DOI: 10.15441/ceem.21.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Seungmin Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Hyeok Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Keon Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Youn Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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李 伟, 谢 佳, 彭 莉, 魏 良, 王 双, 李 永. [Recent advances in external cardiac defibrillation techniques]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2020; 37:1095-1100. [PMID: 33369350 PMCID: PMC9929988 DOI: 10.7507/1001-5515.202003013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 06/12/2023]
Abstract
As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.
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Affiliation(s)
- 伟明 李
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
| | - 佳玲 谢
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
| | - 莉 彭
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
| | - 良 魏
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
| | - 双卫 王
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
| | - 永勤 李
- 陆军军医大学 生物医学工程与影像医学系(重庆 400038)Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China
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18
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Malik AO, Nallamothu BK, Trumpower B, Kennedy M, Krein SL, Chinnakondepalli KM, Hejjaji V, Chan PS. Association Between Hospital Debriefing Practices With Adherence to Resuscitation Process Measures and Outcomes for In-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2020; 13:e006695. [PMID: 33201736 DOI: 10.1161/circoutcomes.120.006695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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 Identifying actionable resuscitation practices that vary across hospitals could improve adherence to process measures or outcomes after in-hospital cardiac arrest (IHCA). We sought to examine whether hospital debriefing frequency after IHCA varies across hospitals and whether hospitals which routinely perform debriefing have higher rates of process-of-care compliance or survival. Methods We conducted a nationwide survey of hospital resuscitation practices in April of 2018, which were then linked to data from the Get With The Guidelines-Resuscitation national registry for IHCA. Hospitals were categorized according to their reported frequency of debriefing immediately after IHCA; rarely (0%-20% of all IHCA cases), occasionally (21%-80%), and frequently (81%-100%). Hospital-level rates of timely defibrillation (≤2 minutes), epinephrine administration (≤5 minutes), survival to discharge, return of spontaneous circulation, and neurologically intact survival were comparted for patients with IHCA from 2015 to 2017. Results Overall, there were 193 hospitals comprising 44 477 IHCA events. Mean patient age was 65±16, 41% were females, and 68% were of White race. Across hospitals, 84 (43.5%) rarely performed debriefings immediately after an IHCA, 82 (42.5%) performed debriefing sessions occasionally, and 27 (14.0%) performed debriefing frequently. There was no association between higher reported debriefing frequency and hospital rates of timely defibrillation and epinephrine administration. Mean hospital rates of risk-standardized survival to discharge were similar across debriefing frequency groups (rarely 25.6%; occasionally 26.0%; frequently 25.2%, P=0.72), as were hospital rates of risk-adjusted return of spontaneous circulation (rarely 72.2%; occasionally 73.0%; frequently 70.0%, P=0.06) and neurologically intact survival (rarely 21.9%, occasionally 22.2%, frequently 21.1%, P=0.75). Conclusions In a large contemporary nationwide quality improvement registry, hospitals varied widely in how often they conducted debriefings immediately after IHCA. However, hospital debriefing frequency was not associated with better adherence to timely delivery of epinephrine or defibrillation or higher rates of IHCA survival.
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Affiliation(s)
- Ali O Malik
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
| | | | - Brad Trumpower
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- University of Michigan, Ann Arbor (B.K.N., B.T., S.L.K.)
| | | | - Sarah L Krein
- University of Michigan, Ann Arbor (B.K.N., B.T., S.L.K.)
- VA Ann Arbor Healthcare System, MI (S.L.K.)
| | | | - Vittal Hejjaji
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
| | - Paul S Chan
- University of Missouri Kansas City (A.O.M., M.K., V.H., P.S.C.)
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., K.M.C., V.H., P.S.C.)
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Tenney JW, Yip JHY, Lee RHY, Wong BCY, Hung KKC, Lam RPK, Wong DKW, Wong WT. Retrospective evaluation of resuscitation medication utilization in hospitalized adult patients with cardiac arrest. J Cardiol 2020; 76:9-13. [DOI: 10.1016/j.jjcc.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/18/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
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Affiliation(s)
- Joseph E Tonna
- Department of Surgery, University of Utah Health, Salt Lake City
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21
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Wang H, Tang L, Zhang L, Zhang ZL, Pei HH. Development a clinical prediction model of the neurological outcome for patients with coma and survived 24 hours after cardiopulmonary resuscitation. Clin Cardiol 2020; 43:1024-1031. [PMID: 32573817 PMCID: PMC7462189 DOI: 10.1002/clc.23403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Cardiac arrest is still a global public health problem at present. The neurological outcome is the core indicator of the prognosis of cardiac arrest. However, there is no effective means or tools to predict the neurological outcome of patients with coma and survived 24 hours after successful cardiopulmonary resuscitation (CPR). Hypothesis Therefore, we expect to construct a prediction model to predict the neurological outcome for patients with coma and survived 24 hours after successful CPR. Methods A retrospective cohort study was used to construct a prediction model of the neurological function for patients with coma and survived 24 hours after successful CPR. From January 2007 to December 2015, a total of 262 patients met the inclusion and exclusion criteria. Results The predictive model was developed using preselected variables by a systematic review of the literature. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) which with similar predictive value. The stepwise model, which including seven variables (age, noncardiac etiology, nonshockable rhythm, bystander CPR, total epinephrine dose, APTT, and SOFA score), was the simplest model, so we choose it as our final predictive model. The area under the ROC curve (AUC), specificity, and sensitivity of the stepwise model were respectively 0.82 (0.77, 0.87), 0.72and 0.82. The AUC, specificity, and sensitivity of the bootstrap stepwise (BS stepwise) model were respectively 0.82 (0.77, 0.87), 0.71, and 0.82. Conclusion This new and validated predictive model may provide individualized estimates of neurological function for patients with coma and survived 24 hours after successful CPR using readily obtained clinical risk factors. External validation studies are required further to demonstrate the model's accuracy in diverse patient populations.
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Affiliation(s)
- Hai Wang
- Emergency Department & EICU , The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Long Tang
- Department of Emergency, Shaanxi Provincial People's Hospital, Xi'an, Shaan Xi, China
| | - Li Zhang
- Emergency Department & EICU , The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Zheng-Liang Zhang
- Emergency Department & EICU , The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
| | - Hong-Hong Pei
- Emergency Department & EICU , The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaan Xi, China
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Hejjaji V, Malik AO, Peri-Okonny PA, Thomas M, Tang Y, Wooldridge D, Spertus JA, Chan PS. Mobile App to Improve House Officers' Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study. JMIR Mhealth Uhealth 2020; 8:e15762. [PMID: 32427115 PMCID: PMC7267993 DOI: 10.2196/15762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/21/2019] [Accepted: 02/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Ali O Malik
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Poghni A Peri-Okonny
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Merrill Thomas
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Yuanyuan Tang
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - David Wooldridge
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - John A Spertus
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Paul S Chan
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
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Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e881-e894. [PMID: 31722552 DOI: 10.1161/cir.0000000000000732] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.
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Vasopressors during adult cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 139:106-121. [DOI: 10.1016/j.resuscitation.2019.04.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
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Kang JY, Kim YJ, Shin YJ, Huh JW, Hong SB, Kim WY. Association Between Time to Defibrillation and Neurologic Outcome in Patients With In-Hospital Cardiac Arrest. Am J Med Sci 2019; 358:143-148. [PMID: 31200920 DOI: 10.1016/j.amjms.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The influence of time to defibrillation in patients with shockable in-hospital cardiac arrest (IHCA) has not been fully assessed. This study investigated the association between time to defibrillation and neurologic outcome in shockable IHCA survivors. MATERIALS AND METHODS A 7-year retrospective cohort study was conducted using a prospectively collected registry of adult IHCA patients. Patients whose first documented rhythm was pulseless ventricular tachycardia or ventricular fibrillation and who received defibrillation within 5 minutes were included. RESULTS Among 1,683 IHCA patients, 261 patients were included. At 28 days, a good neurologic outcome (Cerebral Performance Category score 1 or 2) according to time to defibrillation was seen in 49.0%, 21.1%, 13.4% and 16.5% of patients treated at <2 minutes (n = 128), 2-3 minutes (n = 55), 3-4 minutes (n = 35) and 4-5 minutes (n = 43) after IHCA, respectively. After adjusting for clinical characteristics, a graded inverse association was found after 3 minutes. CONCLUSIONS A graded inverse association between time to defibrillation and neurologic outcome was observed beyond 3 minutes following cardiac arrest. A target time to defibrillation of <3 minutes may be a practical target goal in resource-limited hospitals.
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Affiliation(s)
| | | | - Yu Jung Shin
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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