Trans-oral robotic surgery: a safe and effective tool in head and neck surgery in an Australian rural setting

BACKGROUND

Trans-oral robotic surgery (TORS) facilitates surgical resection of tumours as an alternative to open surgery and has demonstrated favourable oncological results. Given the novelty of TORS and the paucity of evidence on TORS-specific complications in a rural setting, we report our experience with TORS at an Australian rural head and neck centre.

METHODS

A retrospective review of all robotic cases performed at a regional head and neck centre in Queensland was undertaken from 2014 to 2019. Patient demographics, pre-operative surgical risk, complications and outcomes such as margins and cancer recurrence were recorded. Complications were graded based on the Clavien-Dindo grading system. Descriptive statistics were used to present patient characteristics and statistical analyses were performed using Stata.

RESULTS

Forty-two TORS surgeries were performed. Twenty-one had histology confirming malignancy. There were no adverse intraoperative effects. Overall, seven patients (16.7%) had at least one complication. Four were recorded as a Clavien-Dindo 3b (post-operative bleed, wound infection and drain dislodgment). Of two cases with residual positive margins, one declined further surgery, and another received chemoradiotherapy. One patient recurred with distant metastatic disease, and another had locoregional nodal recurrence. The distribution of complications was significant across the pre-operative risk categories for both American Society of Anaesthesiologists and surgical risk score (P = 0.02).

CONCLUSION

TORS in a rural head and neck centre is a safe and viable treatment option for patients so long as this is undertaken with appropriate training, mentorship and teamwork.

Unilateral Maxillary Sinus Plasmablastic Lymphoma in an Immunocompetent Patient. An Unusual Occurrence Report and Literature Review

Plasmablastic lymphoma (PBL) is a rare and aggressive form of mature B cell neoplasms almost exclusively identified in patients infected with the human immunodeficiency virus (HIV). The small number of HIV-negative PBL cases reported in the literature to date is composed of single case reports and small case series which characteristically are present involving the oral cavity mucosa or gingiva. We present a 72-year-old HIV-negative Australian patient without any cause of immunodeficiency, with an isolated left maxillary sinus PBL.

The epidemiology of multiple sclerosis in the Isle of Man: 2006-2011

BACKGROUND

We sought to determine the prevalence of MS on the Isle of Man in 2006 and 2011, and the incidence and mortality rates over this interval.

METHODS

Cases were identified by hospital medical record review, General Practitioners and the local MS Society. The significance of the change in prevalence over time and the significance of differences in frequencies by sex and place of birth were assessed by Poisson regression.

RESULTS

The 2006 prevalence was 153.64 per 100,000 persons and the 2011 prevalence was 179.89. The prevalence was higher among females and persons born in the Isle of Man at both time points. The 2006-2011 incidence rate was 6.86 per 100,000 person-years, much higher among females and persons born in the Isle of Man. The prevalence sex ratios in 2006 and 2011, 2.77 and 2.59, respectively, and the incidence sex ratio, 2.19, are similar to others found in the region. The mortality rate over the study period was 2.84 per 100,000 person-years, this solely among persons born overseas.

CONCLUSIONS

This is the first study of MS epidemiology in the Isle of Man, finding this area to be of high prevalence and to have one of the highest incidence rates in the UK region.

Antimicrobial Activity of some Honey Samples against Pathogenic Bacteria

The aim of the present research work to investigate antimicrobial activity of some honey samples six winter honeys six summer honeys collected from different regions of Western Ghats. The microbes used in this study are Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Antibacterial activity of the honeys was assayed using the Disc diffusion method. Noticeable variations in the antibacterial activity of the different honey samples were observed. Among the microbes Staphylococcus aureus is the most sensitive against all honey samples shows the maximum inhibitor zone compare to summer honeys.

Antimicrobial Activity of some Honey Samples against Pathogenic Bacteria

The aim of the present research work to investigate antimicrobial activity of some honey samples six winter honeys six summer honeys collected from different regions of Western Ghats. The microbes used in this study are Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Antibacterial activity of the honeys was assayed using the Disc diffusion method. Noticeable variations in the antibacterial activity of the different honey samples were observed. Among the microbes Staphylococcus aureus is the most sensitive against all honey samples shows the maximum inhibitor zone compare to summer honeys.

Antidiabetic activity of ethanolic extract of tubers of Dioscorea alata in alloxan induced diabetic rats

OBJECTIVE

To evaluate the antidiabetic activity of ethanolic extract of Dioscorea alata in glucose loaded and alloxan induced diabetic rats.

MATERIALS AND METHODS

The authenticated tubers of D. alata (DA) (JSSCPDP/2008/157) were collected from Dharmapuri, Tamil Nadu. The ethanol extract was tested for hypoglycemic activity in normal rats. In oral glucose tolerance test, glucose (3 g/kg, p.o.) was administered to non diabetic control, metformin (250 mg/kg, p.o.) and DA extract (100 and 200 mg/kg, p.o.) to treat treated rats. Diabetes mellitus was induced by alloxan monohydrate (120 mg/kg, i.p.) in physiological saline after overnight fasting for 18 hours. DA extract (100 and 200 mg/kg, p.o.) and standard drug metformin (250 mg/kg, p.o.) were administered to diabetic rats for 21 days. Fasting blood glucose level and changes in body weight were measured on days 0, 7, 14, and 21. At the end of 21(st) day, serum lipid profile, total protein, albumin, and creatinine were assessed.

RESULTS

In glucose loaded normal rats, the treatment with the extract of DA had shown a highly significant reduction (P < 0.001) in blood glucose levels at the doses of 100 and 200 mg/kg, respectively. The extract did not produce hypoglycemic activity at both the dose levels in normal, fasted rats. In alloxan induced diabetic rats, the body weight of the DA extract treated animals had shown a significant increase (P < 0.001) after 21 days treatment. The blood glucose level was reduced significantly by 47.48% and 52.09% after 21 days treatment at dose levels 100 and 200 mg/kg, respectively. Serum lipid levels, total protein, albumin, and creatinine were reversed toward near normal in treated rats as compared to diabetic control.

CONCLUSION

The results indicate that ethanol extract of DA tubers possesses significant antidiabetic activity.

Anticonvulsant activity of embelin isolated from Embelia ribes

Anticonvulsant activity of embelin (2.5, 5 and 10mg/kg, i.p.) was studied. It showed a significant inhibition of the seizures induced by electroshock and pentylenetetrazole in a dose dependent manner and the activity was comparable to phenytoin and diazepam. Significant decrease in locomotion revealing its CNS depressant activity was observed. The findings suggest that embelin possess anticonvulsant activity against both grand mal and petit mal epilepsy.

A comparison of Thiel and formalin embalmed cadavers for thyroid surgery training

BACKGROUND

The European Working Time Directive has increased the need for surgical skills training which does not involve patients. Recent changes in the anatomy legislation now make it possible to perform surgical procedures on human cadavers. Standard formalin embalming, however does not provide a very realistic model and alternative approaches, such as Thiel soft-fix embalmed cadavers, should be explored and evaluated.

METHODS

Two formalin and 3 Thiel embalmed cadavers were used at a senior trainee and consultant course in thyroid surgery. The 12 participants (8 trainees and 4 consultants) were asked to score 15 aspects, such as quality of different tissues, for each type of cadaver. Some of these aspects were specific to thyroid surgery, however many are equally applicable to other specialties.

RESULTS

All participants rated the Thiel embalmed cadavers better or equal for all aspects. Of the 180 pairs of scores 33 were excluded, 10 were equal for formalin and Thiel, while in the remaining 137 Thiel scored better. The preference was particularly pronounced in aspects that require flexibility of tissues such as flap raising.

CONCLUSIONS

Thiel embalmed cadavers provide a more realistic model for training of thyroid surgical skills; this is expected to be similar for many other types of surgery.

WITHDRAWN: Evaluation of antidiabetic effect of embelin from Embelia ribes in alloxan induced diabetes in rats

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.bionut.2010.08.002. The duplicate article has therefore been withdrawn.

Behavioral and physiological correlates of temporal pitch perception in electric and acoustic hearing

In the "4-6" condition of experiment 1, normal-hearing (NH) listeners compared the pitch of a bandpass-filtered pulse train, whose inter-pulse intervals (IPIs) alternated between 4 and 6 ms, to that of isochronous pulse trains. Consistent with previous results obtained at a lower signal level, the pitch of the 4-6 stimulus corresponded to that of an isochronous pulse train having a period of 5.7 ms-longer than the mean IPI of 5 ms. In other conditions the IPI alternated between 3.5-5.5 and 4.5-6.5 ms. Experiment 2 was similar but presented electric pulse trains to one channel of a cochlear implant. In both cases, as overall IPI increased, the pitch of the alternating-interval stimulus approached that of an isochronous train having a period equal to the mean IPI. Experiment 3 measured compound action potentials (CAPs) to alternating-interval stimuli in guinea pigs and in NH listeners. The CAPs to pulses occurring after 4-ms intervals were smaller than responses to pulses occurring after 6-ms intervals, resulting in a modulated pattern that was independent of overall level. The results are compared to the predictions of a simple model incorporating auditory-nerve (AN) refractoriness, and where pitch is estimated from first-order intervals in the AN response.

Human auditory nerve compound action potentials and long latency responses

CONCLUSION

The compound action potential (CAP) is followed by a long latency response (LLR), attributable to the post-auricular musculature. The LLR to one pulse may overlap with the CAP to a subsequent one, contributing to the clinically observed reduction in CAP at high pulse rates.

OBJECTIVES

To measure refractory and other influences on CAPs in humans and guinea pigs.

MATERIALS AND METHODS

CAPs were obtained from humans using trans-tympanic and extra-tympanic electrocochleography and from anaesthetized guinea pigs. Stimuli were single pulses presented at a slow rate, pairs of pulses, and 100 ms pulse trains where the inter-pulse interval alternated between 4 and 6 ms.

RESULTS

For single pulses, the CAP shape was similar across species. For pairs of pulses, the CAP to the second pulse was smaller than that to the first, and decreased with increasing inter-pulse interval in a way that was similar across species. For pulse trains, CAPs were observed in response to each pulse in the train for the guinea pigs, but not for humans. For both filtered and unfiltered single pulses, there was a large LLR in humans, but not in guinea pigs, with peaks at latencies of 10-12 and 20-25 ms. Posture affected the LLR in a way consistent with the post-auricular response.

Bone anchored hearing aids: a second fixture reduces auditory deprivation in Cambridge

Bone anchored hearing aids are well established for canal atresia, otosclerosis and chronic suppurative otitis media. Refinements in technique to maximise gain while keeping the complications to a minimum are desirable. This study was taken up in order to explore the potential advantage of a second or spare fixture placed at the time of primary surgery. A group of patients who underwent BAHA insertion at The Emmeline Centre for Cochlear Implants and Bone Anchored Hearing Aids, Addenbrookes hospital, Cambridge, UK with the placement of a spare fixture between 1999 and 2002 were compared to those patients with one fixture BAHA undertaken from 1991. Main outcome measures were complications encountered and duration of disability, (i.e. loss of hearing while waiting for new fixture placement). Both groups had similar incidence of complications, but the group with two fixtures suffered a shorter period of disability when a fixture failed. In our experience the use of second or spare fixture reduces the duration of disability. It engenders no additional complications with minimal extra cost.

How we do it: the viability of free mucosal grafts on exposed bone in lacrimal surgery - a prospective study

To ascertain viability of free mucosal of grafts on bare bone and degree of contracture in vivo. Prospective study to ascertain graft survival where a small piece of mucosa, with a single centrally placed prolene suture for future identification, removed during endoscopic dacrocystorhinostomy (DCR) was replaced to cover exposed bone at the end of the procedure. The presence of the graft and the degree of contracture was assessed endoscopically in outpatients at the second and fourth weeks. All patients who fulfilled the inclusion criteria who underwent DCR in the study period April-October 2002. All the grafts survived intact at 4 weeks after the operation. Grafts underwent up to 20% contracture over this period. Free mucosal grafts survive well when applied to denuded bone in DCR operation.

Superior semicircular canal dehiscence with a large tegmental defect

We report on the presentation and clinical manifestations of superior semicircular canal dehiscence in association with a large defect of the tegmen tympani in a 41-year-old woman with no previous history of trauma. Based on this case we recommend that clinicians consider the possibility of superior semicircular canal dehiscence in patients presenting with symptoms associated with tegmen defects.

Audit of specialist registrar training in tympanomastoid surgery for chronic otitis media

BACKGROUND

A prospective audit of specialist registrars' (SRs') training in tympanomastoid surgery for chronic otitis media within the Anglia Regional Training Scheme is described. This audit recorded the surgical activity of the trainees and their contribution to operative procedures, and assessed the results of the procedures. This type of systematic approach to the audit of surgical training is important in light of the current shortened training programmes and increased accountability of trainers.

OBJECTIVES

The study aimed to establish the levels of exposure to, supervision of and outcome of ear operations for chronic otitis media performed by ENT trainees in the East Anglia region.

METHOD

A prospective, region-wide, minimum otology dataset-based proforma audit was undertaken, with compulsory SR participation. Proformas were completed at the time of operation (form one) and at a minimum interval of nine months post-operatively (form two). Data on form one included hospital, supervising consultant, name and training year of SR, contribution of SR (based on England Royal College of Surgeons guidelines interpreted by the SR), pre-operative audiology average (air conduction/bone conduction over 0.5, 1, 2 and 4 kHz), the pathology and the state of the ear at the time of surgery, and a breakdown of the procedure(s) undertaken. Form two recorded data relevant to form one as well as information regarding patient satisfaction and the operative result obtained, graded as 'gold' (no disease, dry ear and hearing average < 25 dB), 'silver' (two of these three) and 'bronze' (one of these three). All completed forms were analysed using Microsoft Access software.

RESULTS

Completed copies of 409 form ones and 156 form twos were analysed. With advancing years, SRs' contributions to procedures increased without significant effect on the graded outcome, which appeared to be independent of SR year of training. Different regional hospitals were compared. Data collected also provided an otology training portfolio for SRs, forming part of their registrar in-training assessment (RITA).

CONCLUSION

The East Anglia SR audit of SRs' training in tympanomastoid surgery for chronic otitis media was a powerful training tool. It demonstrated the safe progression of SR training in supervised ear surgery, with SRs' results being comparable to those for consultant-performed procedures.

Cutaneous metastases from a hypopharyngeal malignancy

We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.

Referral patterns in vestibular schwannomas --10 years on

Diagnostic imaging techniques, symptom awareness and education of local sources of referral in vestibular schwannomas, including general practitioners, have all improved in the last 10 years. The referral patterns in vestibular schwannomas in Cambridgeshire in the period 1981-1993 has been reported.(1) A direct comparison was made with regard to referral patterns seen in the last 10 years paying particular emphasis to source of referral, diagnosis at referral and symptoms/size at presentation. The incidence of vestibular schwannomas in the region is compared and discussed. Patients' managed by the 'watch and wait' policy were particularly scrutinized, as they were not discussed previously. Retrospective analysis of computerized database was used. We have demonstrated an increase in the proportion of referrals with known vestibular schwannoma to 90% of all referrals. No significant change in length of history prior to referral, source of referral or principal presenting symptom were found. An overall decrease in tumour size was found but an increase in the percentage with larger tumours (>4.5 cm). We attribute the significant findings to an increase in availability of magnetic resonance (MR) scanners in the country during the past 10 years. It appears that some tumours would still present with no symptoms until late and therefore will elude identification until large in spite of a low threshold for MR scanning.

To divide or manipulate the chorda tympani in stapedotomy

The objective of this study is to determine the nature, duration and severity of chorda tympani symptoms in post-stapedotomy patients when the nerve has been known to have either sustained surgical manipulation or division. The study design was retrospective and blind, based at a tertiary Otology Referral Center (Gloucestershire Royal Hospital). All successive patients undergoing stapedotomy operated upon by the senior author (JMR) between November 1991 and October 1998 were included. The main outcome measures were postoperative graded dysgeusia (questionnaire) and post operative electrogustometry score, comparing the chorda tympani cut group and the chorda tympani preserved group. Sixty stapedotomies were performed in the study period. After a minimum interval of 8 months, questionnaire data were obtained in 55/60 (92%), and electrogustometry studies were carried out in 48/60 (80%). Symptoms of dysgeusia were experienced in the chorda tympani nerve cut (CC) group in 95% and in the chorda preserved (CP) group in 52%. For those with symptoms, duration was 6.7 months (+/-4.9 SD) and 3.4 months (+/-3.7 SD) for the CC and CP groups, respectively. From the electrogustometry data, after 8 months, the risk of total loss of response is significantly higher in CC patients (94%) than in CP patients (25%) (P = 0.0001). Also at 8 months, 54% of CP patients had normal ipsilateral electrogustometry responses compared with 6% in the CC group. In conclusion, cutting the chorda tympani results in significantly greater symptoms than when subjected to manipulation only, and these symptoms are likely to be more long lasting. Therefore, it is our recommendation that where possible the chorda be preserved. The risk of severe chorda symptoms when the chorda is cut is small (<5%). Preoperative consent to include dysgeusia is advised.

Mastoid Obliteration with Hydroxyapatite Cement: The Ipswich Experience

OBJECTIVE

This article reports the outcomes of a series of patients who underwent obliteration of the mastoid cavity using hydroxyapatite cement. A comparison is made with a group of patients who underwent similar surgery in the same period using hydroxyapatite granules.

STUDY DESIGN

Nonrandomized observational analysis.

SETTING

Tertiary otology unit.

PATIENTS AND INTERVENTIONS

All patients requiring mastoid surgery and primary obliteration or revision mastoid surgery and obliteration.

MAIN OUTCOME MEASURES

Dry cavity with full epithelialization and good tolerance to swimming at 1 year postoperatively.

RESULTS

In four of eight patients who had obliteration using hydroxyapatite cement, there was infection of the obliteration site, requiring revision. All of the patients who had obliteration with hydroxyapatite granules had dry and well-epithelialized mastoid cavities at 1-year follow-up, with ears that tolerated swimming.

CONCLUSION

The use of hydroxyapatite cement is not recommended in mastoid obliteration surgery.

Interventions for acute auricular haematoma

BACKGROUND

Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity.

OBJECTIVES

To assess the effectiveness of treatment options in acute auricular haematoma.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003.

SELECTION CRITERIA

Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma.

DATA COLLECTION AND ANALYSIS

Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria.

MAIN RESULTS

Due to the lack of data from trials fulfilling selection criteria no results could be presented.

REVIEWERS' CONCLUSIONS

There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.

Could the presence of a Carhart notch predict the presence of glue at myringotomy?

The Carhart notch is a dip in the bone conduction at 2000 Hz without a corresponding dip in the air conduction. The main objective of this study was to establish how reliable is the presence of the Carhart notch in a preoperative audiogram in predicting the presence of glue at myringotomy. A prospective study has been carried out in 50 children presenting with glue ear to find out the association between the Carhart notch and the presence of glue at myringotomy. Children were seen before the operation and an audiogram and tympanogram were carried out. Myringotomy was carried out in 95 ears and the presence or absence of glue was recorded. The significance of the air-bone gap and the type of tympanogram in predicting a middle ear effusion were also examined. The audiograms of 37 ears showed a Carhart notch; of these, 36 ears were noted to have glue ear. The correlation between the presence of a Carhart notch in the preoperative audiogram and the presence of glue at myringotomy was found to be significant (P < 0.001) (chi-square test). Using the decision rule that the presence of a Carhart notch predicts the presence of glue, the following operating characteristics were determined: correct, 83 ears (87.4%); false positive, one ear (1.1%); false negative, 11 ears (11.6%). The presence of a Carhart notch was found to be a strong predictor of the presence of glue at myringotomy.

Surgical management of massive cerebellar infarction

Massive cerebellar infarction accounts for less than 2% of strokes. Unlike massive hemispherical infarctions, in pure cerebellar infarctions, the prognosis is better. This case report discusses, a 61 year old lady who presented with atrial fibrillation and a massive cerebellar infarction. Timely surgical intervention reversed the deterioration in neurological status. The indications for surgical management, based on review of the literature, is presented.

Familial vocal fold paralysis

Familial clustering of congenital bilateral abductor vocal fold paralysis has been reported very rarely. So far, only a handful of cases have been reported, mostly with the autosomal dominant of X-linked recessive mode of inheritance. We describe the cases of a brother and sister, who presented with neonatal stridor due to bilateral abductor vocal fold paralysis. First-degree parental consanguinity suggests an autosomal recessive mode of inheritance. Karyotype analysis revealed a paracentric balanced inversion of chromosome 13 in both cases, that was also present in the unaffected mother. An updated review of the literature on this interesting but rare condition is also presented.

Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration

Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.

Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study

BACKGROUND

Successful treatment of acute myocardial infarction is dependent on early presentation of the patient to the hospital. The factors that contribute to delay in seeking treatment have not been systematically evaluated in the Indian milieu.

METHODS

Patients admitted with acute myocardial infarction to a 125-bed urban community hospital were evaluated prospectively. A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent predictors of delayed admission were identified by logistic regression.

RESULTS

Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% men]. The distribution of presentation times was skewed, with the mode, median and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hours, respectively. Seventy-nine patients (59.4%) consulted a general practitioner prior to hospital referral and 48 patients (36.1%) delayed admission to hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (OR 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe symptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08-0.82) minimized delay.

CONCLUSION

Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to the general practitioner were found to be an independent correlate of delay.

Survival after cardiopulmonary resuscitation in an urban Indian hospital

BACKGROUND

Survival after cardiopulmonary resuscitation depends upon the quality of pre-hospital support, availability of resuscitation equipment and the competence of the resuscitator. There are few data on the prognosis of patients undergoing such resuscitation in India.

METHODS

In a retrospective analysis of 215 resuscitations done in a 125-bed community hospital between January 1995 and November 1997, return of spontaneous circulation and survival to discharge were evaluated. Multivariate methods were used to identify the predictors of successful outcome.

RESULTS

Of all the patients, 14.4% were alive at discharge. Survival after a cardiorespiratory arrest in the hospital was 18.4%, which was significantly better than survival after pre-hospital events (5.9%; p = 0.027). Multivariate predictors of survival at discharge were resuscitation duration of less than 20 minutes [odds ratio (95% confidence limit): 32.6 (6.5-164.3)], presentation with ventricular tachycardia or fibrillation [odds ratio: 18.5 (4.4-77.9)], in-hospital cardiorespiratory arrest [odds ratio: 5.2 (1.2-21.6)] and female sex [odds ratio: 3.2 (1.1-9.6)]. Bystander resuscitation, though rarely provided, increased survival at discharge (p = 0.026).

CONCLUSIONS

With 5.5 resuscitation attempts needed for one live discharge after in-hospital cardiorespiratory arrest and 17 attempts to save a life after pre-hospital events, our outcomes are comparable to those reported from developed nations. A return of pulse after shorter durations of cardiopulmonary resuscitation, ventricular fibrillation or tachycardia as the abnormal presenting rhythm, in-hospital location of cardiorespiratory (CR) arrest and female sex were independent predictors of live discharge. Age and aetiology of CR arrest did not influence the outcome.