1
|
Ballas C, Lakkas L, Kardakari O, Papaioannou E, Siaravas KC, Naka KK, Michalis LK, Katsouras CS. In-Hospital versus Out-of-Hospital Pulmonary Embolism: Clinical Characteristics, Biochemical Markers and Echocardiographic Indices. J Cardiovasc Dev Dis 2024; 11:103. [PMID: 38667721 PMCID: PMC11050175 DOI: 10.3390/jcdd11040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND A significant proportion of pulmonary embolisms (PEs) occurs in patients during hospitalisation for another reason. However, limited data regarding differences between out-of-hospital PE (OHPE) and in-hospital PE (IHPE) is available. We aimed to compare these groups regarding their clinical characteristics, biochemical markers, and echocardiographic indices. METHODS This was a prospective, single-arm, single-centre study. Adult consecutive patients with non-COVID-related PE from September 2019 to March 2022 were included and followed up for 12 months. RESULTS The study included 180 (84 women) patients, with 89 (49.4%) suffering from IHPE. IHPE patients were older, they more often had cancer, were diagnosed earlier after the onset of symptoms, they had less frequent pain and higher values of high sensitivity troponin I and brain natriuretic peptide levels compared to OHPE patients. Echocardiographic right ventricular (RV) dysfunction was detected in similar proportions in the 2 groups. IHPE had increased in-hospital mortality (14.6% vs. 3.3%, p = 0.008) and similar post-discharge to 12-month mortality with OHPE patients. CONCLUSIONS In this prospective cohort study, IHPE differed from OHPE patients regarding age, comorbidities, symptoms, and levels of biomarkers associated with RV dysfunction. IHPE patients had higher in-hospital mortality compared to OHPE patients and a similar risk of death after discharge.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Christos S. Katsouras
- Second Department of Cardiology, University Hospital of Ioannina, 45500 Ioannina, Greece (L.L.); (O.K.); (E.P.); (K.C.S.); (K.K.N.); (L.K.M.)
| |
Collapse
|
2
|
McCullough K, Baker M, Bloxsome D, Crevacore C, Davies H, Doleman G, Gray M, McKay N, Palamara P, Richards G, Saunders R, Towell-Barnard A, Coventry LL. Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: A scoping review. J Clin Nurs 2024; 33:874-889. [PMID: 37953491 DOI: 10.1111/jocn.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
AIMS To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION Not required as the Scoping Review used publicly available information.
Collapse
Affiliation(s)
- Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Melanie Baker
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Hugh Davies
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Nilufeur McKay
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gina Richards
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| |
Collapse
|
3
|
Kurz MC. "Hard and Fast" Resuscitation Guidelines May Need a Bit of "Breathing" Room. Circulation 2023; 148:1857-1859. [PMID: 37952160 DOI: 10.1161/circulationaha.123.066071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Michael Christopher Kurz
- Section of Emergency Medicine, Department of Medicine, Pritzker School of Medicine, University of Chicago, IL
| |
Collapse
|
4
|
Paratz ED, van Heusden A, Ball J, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry. Intern Med J 2023; 53:1776-1782. [PMID: 36001398 DOI: 10.1111/imj.15918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Administrative coding of out-of-hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain. AIM To characterize the prevalence and type of non-informative diagnoses in a young cardiac arrest population. METHODS Hospital discharge diagnoses provided to a statewide OHCA registry were characterised as either 'informative' or 'noninformative.' Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared. RESULTS Of 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019). CONCLUSION Almost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at-risk family care, data sampling strategies, international statistics and research funding.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander van Heusden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jocasta Ball
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tina Thompson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dion Stub
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Assaf M, Costa D, Massag J, Weber C, Mikolajczyk R, Lückmann SL. Comparison between In-Hospital and Out-of-Hospital Acute Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study. J Clin Med 2023; 12:6305. [PMID: 37834949 PMCID: PMC10573894 DOI: 10.3390/jcm12196305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
AIMS Risk factors and outcomes of in-hospital ST elevation myocardial infraction (STEMI) are well explored. Recent findings show that non-ST elevation myocardial infarction (NSTEMI) accounts for the majority of in-hospital infarctions (IHMIs). Our aim was to identify differences between IHMI and out-of-hospital myocardial infraction (OHMI) in terms of risk factors, treatment and outcomes, including both STEMI and NSTEMI. METHODS We analyzed the Regional Myocardial Infarction Registry of Saxony-Anhalt dataset. Patient characteristics, treatments and outcomes were compared between IHMI and OHMI. The association between clinical outcomes and myocardial infarction type was assessed using generalized additive models. RESULTS Overall, 11.4% of the included myocardial infractions were IHMI, and the majority were NSTEMI. Patients with IHMI were older and had more comorbidities than those with OHMI. Compared to OHMI, in-hospital myocardial infarction was associated with higher odds of 30-day mortality (OR = 1.85, 95% CI 1.32-2.59) and complications (OR = 2.36, 95 % CI 1.84-3.01). CONCLUSIONS We provided insights on the full spectrum of IHMI, in both of its classifications. The proportion of IHMI was one ninth of all AMI cases treated in the hospital. Previously reported differences in the baseline characteristics and treatments, as well as worse clinical outcomes, in in-hospital STEMI compared to out-of-hospital STEMI persist even when including NSTEMI cases.
Collapse
Affiliation(s)
| | | | | | | | | | - Sara Lena Lückmann
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle, Germany; (M.A.)
| |
Collapse
|
6
|
Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Rauchberger I, Stub D, La Gerche A. Sudden Cardiac Death in People With Schizophrenia: Higher Risk, Poorer Resuscitation Profiles, and Differing Pathologies. JACC Clin Electrophysiol 2023; 9:1310-1318. [PMID: 37558287 DOI: 10.1016/j.jacep.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND People with schizophrenia account for approximately 1.0% of the population and seem to experience increased rates of sudden cardiac death (SCD). OBJECTIVES This study sought to determine characteristics of increased SCD in people with schizophrenia. METHODS The End Unexplained Cardiac Death (EndUCD) prospective state-wide registry compared people aged 15 to 50 years with and without schizophrenia who experienced SCD within a 2-year time period and were referred for forensic evaluation. RESULTS We identified 579 individuals, of whom 65 (11.2%) had schizophrenia. Patients with schizophrenia were more commonly smokers (46.2% vs 23.0%; P < 0.0001), consumed excess alcohol (32.3% vs 21.4%; P = 0.05), and used QTc-prolonging medications (69.2% vs 17.9%; P < 0.0001). They were less likely to arrest while exercising (0.0% vs 6.4%; P = 0.04). Unfavorable arrest-related factors included lower rates of witnessed arrest (6.2% vs 23.5%; P < 0.0001), more likely to be found in asystole (92.3% vs 73.3%; P < 0.0001), and being more likely to be found as part of a welfare check after a prolonged period of time (median 42 hours vs 12 hours; P = 0.003). There was more frequent evidence of decomposition, and they more commonly underwent autopsy (41.2% vs 26.4%; P = 0.04 and 93.8% vs 82.5%; P = 0.05), with a diagnosis of nonischemic cardiomyopathy being more common (29.2% vs 18.1%; P = 0.04). CONCLUSIONS People with schizophrenia account for 11% of young SCD patients referred for forensic investigations, exceeding population rates by 11-fold. They have a higher preexisting cardiac risk factor burden, unfavorable resuscitation profiles, and higher rates of nonischemic cardiomyopathy. Strategies targeting biopsychosocial support may deliver not only psychological benefits, but also help to decrease unwitnessed cardiac arrest.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | | | - Dominica Zentner
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Melbourne, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, Parkville, Victoria, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul James
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Connell
- The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia; Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Ilan Rauchberger
- Alfred Hospital, Prahran, Victoria, Australia; Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia; St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| |
Collapse
|
7
|
Abstract
The classic out-of-hospital approach to a patient with severe acute respiratory failure involves both orotracheal intubation and invasive mechanical ventilation. The use of non-invasive methods for respiratory support has been shown to be beneficial in managing both acute and chronic respiratory failure. However, its use had not been previously considered for air medical transport due to concerns related to airway safety during flight, limited oxygen availability, and limited experience in this setting. We describe the successful inter-hospital helicopter transport of a patient with end-stage lung disease to a transplantation unit while utilizing a high-flow oxygen cannula, which was performed without significant complications. Our successful case report raises the possibility that high-flow nasal cannulas may be safely employed in the management of respiratory failure in specific patient populations during air medical transport.
Collapse
Affiliation(s)
- Francisco Das Neves Coelho
- Helicopter Emergency Medical Services, Instituto Nacional de Emergencia Medica, Lisboa, PRT
- Intensive Care, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, PRT
| | - Rui Alves
- Helicopter Emergency Medical Services, Instituto Nacional de Emergencia Medica, Lisboa, PRT
| | - Carlos Raposo
- Helicopter Emergency Medical Services, Instituto Nacional de Emergencia Medica, Lisboa, PRT
| |
Collapse
|
8
|
Aristidou M, Karanikola M, Kusi-Appiah E, Koutroubas A, Pant U, Vouzavali F, Lambrinou E, Papathanassoglou E. The living experience of surviving out-of-hospital cardiac arrest and spiritual meaning making. Nurs Open 2023. [PMID: 37085952 DOI: 10.1002/nop2.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
AIM To understand the meaning of surviving out of hospital cardiac arrest and its aftereffects among Greek-speaking survivors. DESIGN Hermeneutical phenomenological method based on Martin Heidegger's philosophy. METHODS Eight Greek-speaking out of hospital cardiac arrest survivors were recruited using purposive sampling method. Data collection and analysis using the seven stages of hermeneutic analysis described by Diekelman. Data were collected through semi-structured personal interviews with open-ended questions. RESULTS Analysis revealed five themes: 'The unexpected attack', 'Experiencing a different world: Transformation of Body, Time, Emotion and Sensation', 'Restoration of the re-embodied self', 'Life transformation' and 'Personal transformation'. The themes are commensurate with transcultural components of Near-Death Experiences. Surviving out of hospital cardiac arrest was perceived as a 'divine gift' and a chance to continue 'living in a more conscious and meaningful way'. Despite participants' physical and psychosocial challenges, the narratives highlighted a newly acquired deep appreciation for the joy of life, living and others. Construction of meaning and a heightened spirituality seem central in reconstructing life after out of hospital cardiac arrest survivors. PATIENT OR PUBLIC CONTRIBUTION Out of hospital cardiac arrest survivors reflected and described in-depth on their lived experiences of out of hospital cardiac arrest through a 60- to 90-min interview. In addition, the participants provided their feedback on the interpretation of the findings, confirmed the study findings, and ensured that the analysis reflected aspects of their individual experiences and were true to them.
Collapse
Affiliation(s)
- Maria Aristidou
- Department of Nursing, European University Cyprus, Nicosia, Cyprus
| | - Maria Karanikola
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Elizabeth Kusi-Appiah
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada
| | - Anna Koutroubas
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada
| | - Foteini Vouzavali
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Elizabeth Papathanassoglou
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada
- Neurosciences Rehabilitation & Vision Strategic Clinical Network™, Edmonton, Alberta, Canada
| |
Collapse
|
9
|
Zhou J, Wang FD, Li LQ, Chen EQ. Management of in- and out-of-hospital screening for hepatitis C. Front Public Health 2023; 10:984810. [PMID: 36761331 PMCID: PMC9905736 DOI: 10.3389/fpubh.2022.984810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Because of insidious progression and no significant clinical symptoms at early stage, chronic hepatitis C (CHC) is often diagnosed after the occurrence of cirrhosis and hepatocellular carcinoma. Highly effective and low drug resistance of direct-acting antiviral agents (DAAs) have enabled cure of CHC, encouraging the World Health Organization to propose a global viral hepatitis elimination program. To Date, vaccine for CHC is still under research. Therefore, reducing the source of infection is an important means of eliminating CHC other than cutting off the transmission route, which requires screening, diagnosing and treating as many patients in the population as possible. Hospital-based screening strategy have been found to be cost-effective in the management of CHC screening, as reported both nationally and internationally. Currently, China has issued In-hospital process for viral hepatitis C screening and management in China (Draft) in April, 2021, which provides a standardized implementation process and direction for in-hospital hepatitis C screening and treatment, but still requires medical institution to develop its own management process, taking into account its current situation and learning from domestic and international experience. In addition, screening for CHC outside the hospital among special populations, such as blood donors, pregnant women, homosexuals, intravenous drug users, prisoners, and residents in rural areas with scarce medical care resources, also requires attention and development of targeted and rational screening strategies. In this paper, we analyze and recommend the management of hepatitis C screening from both in-hospital and out-of-hospital perspectives, with the aim of contributing to the formulation of hepatitis C screening strategies.
Collapse
|
10
|
Ashburn NP, Beaver BP, Snavely AC, Nazir N, Winslow JT, Nelson RD, Mahler SA, Stopyra JP. One and Done Epinephrine in Out-of-Hospital Cardiac Arrest? Outcomes in a Multiagency United States Study. PREHOSP EMERG CARE 2022; 27:751-757. [PMID: 36041188 PMCID: PMC10088522 DOI: 10.1080/10903127.2022.2120135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Cardiac arrest guidelines recommend epinephrine every 3-5 minutes during cardiac arrest resuscitation. However, it is unclear if multiple epinephrine doses are associated with improved outcomes. The objective of this study was to determine if a single-dose epinephrine protocol was associated with improved survival compared to traditional multidose protocols. METHODS We conducted a pre-post study across five North Carolina EMS agencies from 11/1/2016 to 10/29/2019. Patients ≥18 years old with attempted resuscitation for non-traumatic prehospital cardiac arrest were included. Data were collected 1 year before and after implementation of the single-dose epinephrine protocol. Prior to implementation, all agencies used a multidose epinephrine protocol. The Cardiac Arrest Registry to Enhance Survival (CARES) was used to obtain patient outcomes. Study outcomes were survival to hospital discharge (primary) and return of spontaneous circulation (ROSC). Analysis was by intention to treat. Outcomes were compared pre- vs. post-implementation using generalized estimating equations to account for clustering within EMS agencies. Adjusted analyses included age, sex, race, shockable vs. non-shockable rhythm, witnessed arrest, automatic external defibrillator availability, EMS response interval, and bystander cardiopulmonary resuscitation. RESULTS During the study period there were 1,690 encounters (899 pre- and 791 post-implementation). The population was 74.7% white, 61.1% male, and had a median age of 65 (IQR 53-76) years. Survival to hospital discharge was similar pre- vs. post-implementation [13.6% (122/899) vs. 15.4% (122/791); OR 1.19, 95%CI 0.89-1.59]. However, ROSC was more common post-implementation [42.3% (380/899) vs. 32.5% (257/791); OR 0.66, 95%CI 0.54-0.81]. After adjusting for covariates, the single-dose protocol was associated with similar survival to discharge rates (aOR 0.88, 95%CI 0.77-1.29), but with decreased ROSC rates (aOR 0.58, 95%CI 0.47-0.72). CONCLUSION A prehospital single-dose epinephrine protocol was associated with similar survival to hospital discharge, but decreased ROSC rates compared to the traditional multidose epinephrine protocol.
Collapse
Affiliation(s)
- Nicklaus P. Ashburn
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bryan P. Beaver
- Department of Emergency Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Anna C. Snavely
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Niaman Nazir
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - James T. Winslow
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R. Darrell Nelson
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Simon A. Mahler
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jason P. Stopyra
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
11
|
Suppan L, Fehlmann CA, Stuby L, Suppan M. The Importance of Acknowledging an Intermediate Category of Airway Management Devices in the Prehospital Setting. Healthcare (Basel) 2022; 10:healthcare10050961. [PMID: 35628096 PMCID: PMC9141081 DOI: 10.3390/healthcare10050961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Prehospital airway devices are often classified as either basic or advanced, with this latter category including both supraglottic airway (SGA) devices and instruments designed to perform endotracheal intubation (ETI). Therefore, many authors analyze the impact of SGA and ETI devices jointly. There are however fundamental differences between these instruments. Indeed, adequate airway protection can only be achieved through ETI, and SGA devices all have relatively low leak pressures which might compromise both oxygenation and ventilation when lung compliance is decreased. In addition, there is increasing evidence that SGA devices reduce carotid blood flow in case of cardiac arrest. Nevertheless, SGA devices might be particularly useful in the prehospital setting where many providers are not experienced enough to safely perform ETI. Compared to basic airway management (bag-valve-mask) devices, SGA devices enable better oxygenation, decrease the odds of aspiration, and allow for more reliable capnometric measurement by virtue of their enhanced airtightness. For all these reasons, we strongly believe that SGA devices should be categorized as "intermediate airway management devices" and be systematically analyzed separately from devices designed to perform ETI.
Collapse
Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
- Correspondence:
| | - Christophe Alain Fehlmann
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, 1201 Geneva, Switzerland;
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland;
| |
Collapse
|
12
|
Scholte NTB, van Wees C, Rietdijk WJR, van der Graaf M, Jewbali LSD, van der Jagt M, van den Berg RCM, Lenzen MJ, den Uil CA. Clinical Outcomes with Targeted Temperature Management (TTM) in Comatose Out-of-Hospital Cardiac Arrest Patients-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11071786. [PMID: 35407394 PMCID: PMC8999846 DOI: 10.3390/jcm11071786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 01/23/2023] Open
Abstract
Purpose: we evaluated the effects of the shift of a targeted temperature management (TTM) strategy from 33 °C to 36 °C in comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the Intensive Care Unit (ICU). Methods: we performed a retrospective study of all comatose (GCS < 8) OHCA patients treated with TTM from 2010 to 2018 (n = 798) from a single-center academic hospital. We analyzed 90-day mortality, and neurological outcome (CPC score) at ICU discharge and ICU length of stay, as primary and secondary outcomes, respectively. Results: we included 798 OHCA patients (583 in the TTM33 group and 215 in the TTM36 group). We found no association between the TTM strategy (TTM33 and TTM36) and 90-day mortality (hazard ratio (HR)] 0.877, 95% CI 0.677−1.135, with TTM36 as reference). Also, no association was found between TTM strategy and favorable neurological outcome at ICU discharge (odds ratio (OR) 1.330, 95% CI 0.941−1.879). Patients in the TTM33 group had on average a longer ICU LOS (beta 1.180, 95% CI 0.222−2.138). Conclusion: no differences in clinical outcomes—both 90-day mortality and favorable neurological outcome at ICU discharge—were found between targeted temperature at 33 °C and 36 °C. These results may help to corroborate previous trial findings and assist in implementation of TTM.
Collapse
Affiliation(s)
- Niels T. B. Scholte
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Correspondence:
| | - Christiaan van Wees
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Wim J. R. Rietdijk
- Department of Hospital Pharmacy, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Lucia S. D. Jewbali
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | | | - Mattie J. Lenzen
- Department of Cardiology, Erasmus MC—University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (M.v.d.G.); (L.S.D.J.); (M.J.L.)
| | - Corstiaan A. den Uil
- Department of Intensive Care, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands;
| |
Collapse
|
13
|
Jarvis JL, Lyng JW, Miller BL, Perlmutter MC, Abraham H, Sahni R. Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:42-53. [PMID: 35001829 DOI: 10.1080/10903127.2021.1990447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. NAEMSP recommends:DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight. DAAM should not be used in settings without adequate resources.EMS physicians should develop clinical guidelines informed by evidence and oversee the training and credentialing for safe and effective DAAM.DAAM programs should include best practices of airway management including patient selection, assessmenct and positioning, preoxygenation strategies including apneic oxygenation, monitoring and management of physiologic abnormalities, selection of medications, post-intubation analgesia and sedation, equipment selection, airway confirmation and monitoring, and rescue airway techniques.Post-DAAM airway placement must be confirmed and continually monitored with waveform capnography.EMS clinicians must have the necessary equipment and training to manage patients with failed DAAM, including bag mask ventilation, supraglottic airway devices and surgical airway approaches.Continuous quality improvement for DAAM must include assessment of individual and aggregate performance metrics. Where available for review, continuous physiologic recordings (vital signs, pulse oximetry, and capnography), audio and video recordings, and assessment of patient outcomes should be part of DAAM continuous quality improvement.
Collapse
|
14
|
Dai S, Liu X, Chen X, Bie J, Du C, Miao J, Jiang M. Current Status of Out-of-Hospital Management of Cancer Patients and Awareness of Internet Medical Treatment: A Questionnaire Survey. Front Public Health 2022; 9:756271. [PMID: 34970526 PMCID: PMC8712547 DOI: 10.3389/fpubh.2021.756271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: To explore the current situation of the out-of-hospital management of patients with cancer and evaluate the feasibility of Internet medical intervention outside the hospital in China. Methods: The questionnaire was designed based on the investigators' clinical experience, literature data, and the Anderson Symptom Scale, and adopted a cross sectional survey method. Results: Totally 1,171 qualified questionnaires were analyzed. The results showed that 92.7% of patients with cancer experienced varying degrees of out-of-hospital symptoms after treatment, and a third of them needed clinical intervention. Abnormal blood test results outside the hospital were basically consistent with the events that occurred during the hospitalization. One third of patients with cancer could not identify abnormal results. The primary approaches to solve these abnormalities were to seek guidance from the physician in charge or from nearby hospitals, but only 6.75% patients sought help online. More than half of the life or work of patients with cancer are still greatly affected under the current management model. 92% of respondents required medical help outside the hospital, and 65% ones were willing to pay for the out-of-hospital management. Conclusions: Out-of-hospital management model needs to be improved. Most users are willing to accept Internet cancer management with fees. The survey has a positive effect on guiding future Internet cancer management practices in China to a certain extent.
Collapse
Affiliation(s)
- Shuang Dai
- Department of Lung Cancer Center, West China Hospital Sichuan University, Chengdu, China
| | - Xiaoqin Liu
- Department of Oncology, First People's Hospital of Jintang County, Chengdu, China
| | - Xi Chen
- Department of Cancer Center, Yibin Second People's Hospital, Yibin, China
| | - Jun Bie
- Department of Oncology, Nanchong Central Hospital, Nanchong, China
| | - Chi Du
- Department of Oncology, Hospital of Zhi Zhong Zhi Zhou & Cancer Hospital of Neijiang, Neijiang, China
| | - Jidong Miao
- Department of Oncology, Zigong Fourth People's Hospital, Zi Gong, China
| | - Ming Jiang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
15
|
Soto-Cámara R, García-Santa-Basilia N, Onrubia-Baticón H, Cárdaba-García RM, Jiménez-Alegre JJ, Reques-Marugán AM, Molina-Oliva M, Fernández-Domínguez JJ, Matellán-Hernández MP, Morales-Sanchez A, Navalpotro-Pascual S. Psychological Impact of the COVID-19 Pandemic on Out-of-Hospital Health Professionals: A Living Systematic Review. J Clin Med 2021; 10:jcm10235578. [PMID: 34884280 PMCID: PMC8658089 DOI: 10.3390/jcm10235578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/23/2022] Open
Abstract
Health professionals (HPs), especially those working in the front line, have been one of the groups most affected by the COVID-19 pandemic. The objective of this study is to identify the best available scientific evidence on the impact of the COVID-19 pandemic on the mental health of out-of-hospital HPs in terms of stress, anxiety, depression, and self-efficacy. A living systematic review of the literature was designed, consulting the electronic online versions of the CINHAL, Cochrane Library, Cuiden, IBECS, JBI, LILACS, Medline PyscoDoc, PsycoINFO, Scopus, and Web of Science databases in November 2021. Original research was selected, published in either English, Spanish, French, Italian, or Portuguese. In total, 2082 publications were identified, of which 16 were included in this review. The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection. Stopping unpleasant emotions and thoughts was the coping strategy most frequently used by these HPs.
Collapse
Affiliation(s)
- Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | - Noemí García-Santa-Basilia
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
- Correspondence: (N.G.-S.-B.); (R.M.C.-G.)
| | - Henar Onrubia-Baticón
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | - Rosa M. Cárdaba-García
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
- Nursing Department, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
- Correspondence: (N.G.-S.-B.); (R.M.C.-G.)
| | - José Julio Jiménez-Alegre
- Emergency Medical Service of Madrid—SUMMA 112, 28045 Madrid, Spain; (J.J.J.-A.); (J.J.F.-D.); (S.N.-P.)
| | - Ana María Reques-Marugán
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | - María Molina-Oliva
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | | | - María Paz Matellán-Hernández
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | - Almudena Morales-Sanchez
- Emergency Medical Service of Castilla y León—Sacyl, 47007 Valladolid, Spain; (H.O.-B.); (A.M.R.-M.); (M.M.-O.); (M.P.M.-H.); (A.M.-S.)
| | - Susana Navalpotro-Pascual
- Emergency Medical Service of Madrid—SUMMA 112, 28045 Madrid, Spain; (J.J.J.-A.); (J.J.F.-D.); (S.N.-P.)
| |
Collapse
|
16
|
Floer M, Ziegler M, Lenkewitz B, Auer A, Meister T. Out-of-hospital sepsis recognition by paramedics improves the course of disease and mortality: A single center retrospective study. ADV CLIN EXP MED 2021; 30:1115-1125. [PMID: 34418337 DOI: 10.17219/acem/140357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early recognition of sepsis and a prompt initiation of goal-directed therapy is important for sepsis survival. Little is known about the impact of early recognition of sepsis in the out-of-hospital setting when paramedics are the 1st medical professionals arriving on the scene. OBJECTIVES To characterize the impact of sepsis recognition by paramedics in the 1st out-of-hospital contact and to establish a predictive model by combining preclinical patient characteristics. MATERIAL AND METHODS In this retrospective single-center cohort study, we included a total of 263 patients diagnosed with sepsis after admission to the emergency department and correlated them to the emergency medical protocols of the paramedics who have seen the patient out-of-hospital. RESULTS Only 25 patients were correctly diagnosed by paramedics out-of-hospital. If sepsis was diagnosed, the median time to antibiotic administration was significantly lower (136.50 min compared to 206.98 min, p = 0.0069) and mortality was reduced from 22.8% to 8% (p = 0.0292). We have identified predictors for prognosis and calculated a predictive model with a modified quick Sepsis-related Organ Failure Assessment (qSOFA) score, which fits the needs for out-of-hospital usage and results in a better discrimination of vitally threatened patients (receiver operating characteristic (ROC) area under curve (AUC) of 0.641 compared to 0.719), as compared to the standard qSOFA. CONCLUSIONS Sepsis recognition by paramedics at the 1st out-of-hospital contact significantly reduces sepsis mortality. The qSOFA and modified qSOFA are suitable tools for sepsis recognition, and have an impact on mortality and disease management when used.
Collapse
Affiliation(s)
- Martin Floer
- The First Department of Medicine, Klinikum Ibbenbüren, Germany
| | - Mario Ziegler
- Helios Albert-Schweitzer-Hospital, Northeim, Germany
- Emergency Medical Service, Northeim, Germany
| | | | - Agneta Auer
- The First Department of Medicine, Klinikum Ibbenbüren, Germany
| | - Tobias Meister
- The First Department of Medicine, Klinikum Ibbenbüren, Germany
| |
Collapse
|
17
|
Granozzi B, Guardigni V, Badia L, Rosselli Del Turco E, Zuppiroli A, Tazza B, Malosso P, Pieralli S, Viale P, Verucchi G. Out-of-Hospital Treatment of Hepatitis C Increases Retention in Care among People Who Inject Drugs and Homeless Persons: An Observational Study. J Clin Med 2021; 10:jcm10214955. [PMID: 34768474 PMCID: PMC8584608 DOI: 10.3390/jcm10214955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background. People who inject drugs (PWID) and homeless people represent now a large reservoir of Hepatitis C virus (HCV) infection. However, Hepatis C elimination programs can barely reach these subgroups of patients. We aimed to evaluate and compare the retention in care among these difficult-to-treat patients when managed for HCV in hospital or in an out-of-hospital setting. Methods. In our retrospective study, we categorized the included patients (PWID and homeless persons) into two groups according to whether anti-HCV treatment was offered and provided in a hospital or an out-of-hospital setting. We run logistic regressions to evaluate factors associated with retention in care (defined as the completion of direct antiviral agents (DAAs) therapy). Results. We included 56 patients in our study: 27 were in the out-of-hospital group. Overall, 33 patients completed DAAs therapy. A higher rate of retention in care was observed in the out-of-hospital group rather than in-hospital group (p = 0.001). At the univariate analysis, retention in care was associated with the out-of-hospital management (p = 0.002) and with a shorter time between the first visit and the scheduled start of DAAs (p = 0.003). Conclusions. The choice of treatment models that can better adapt to difficult-to-treat populations, such as an out-of-hospital approach, will be important for achieving the eradication of HCV infection.
Collapse
Affiliation(s)
- Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Viola Guardigni
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
- Correspondence: ; Tel.: +39-333-4502053
| | - Lorenzo Badia
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Elena Rosselli Del Turco
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Alberto Zuppiroli
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Pietro Malosso
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | | | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| | - Gabriella Verucchi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, 40139 Bologna, Italy; (B.G.); (L.B.); (E.R.D.T.); (A.Z.); (B.T.); (P.M.); (P.V.); (G.V.)
| |
Collapse
|
18
|
Deaver KS, Cone DC, Rhone AM, Kupas DF. The Clinical Role and Activity of Advanced Clinicians in the Out-of-Hospital Environment. PREHOSP EMERG CARE 2021; 26:682-688. [PMID: 34477480 DOI: 10.1080/10903127.2021.1976330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Recent evolution of the EMS system has resulted in an increased role for specially trained advanced clinicians (physicians, physician assistants, and registered nurses) in out-of-hospital field response. Despite this expansion into the out-of-hospital environment there is a lack of data regarding the actual clinical roles and activity of these clinicians in the United States. We seek to describe the clinical roles of advanced clinicians in the field through description of skills used during both 9-1-1 field responses and interfacility transports in the state of Pennsylvania. Methods: Our data were taken from existing Pennsylvania Department of Health EMS records for all 9-1-1 and interfacility requests for service from January 2018 through June 2020. Descriptive statistics were applied to skills used, medications administered, clinician activity data, and patient demographics for each clinician type in four response categories: 9-1-1 air, 9-1-1 ground, interfacility air, and interfacility ground. Results: There were few statistically significant differences in skill or medication usage between clinician types. There were no statistically significant differences in level of skills (basic life support, ALS, or specialty skills) performed between clinician levels. Patient demographics for each clinician type were similar. Conclusions: Our findings indicate advanced clinicians provide care at the ALS and specialty care levels in similar patient populations with little difference in the roles between clinician types in the out-of-hospital environment. Our data demonstrate successful integration of advanced clinicians into the out-of-hospital environment in Pennsylvania and provide a framework for future planning and expansion of these roles and responsibilities.
Collapse
Affiliation(s)
- Kyle S Deaver
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - David C Cone
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - Aaron M Rhone
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - Douglas F Kupas
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| |
Collapse
|
19
|
van Wees C, Rietdijk W, Mandigers L, van der Graaf M, Scholte NTB, Adriaansens KO, van den Berg RCM, den Uil CA. Do Women Have a Higher Mortality Risk Than Men following ICU Admission after Out-of-Hospital Cardiac Arrest? A Retrospective Cohort Analysis. J Clin Med 2021; 10:jcm10184286. [PMID: 34575397 PMCID: PMC8470772 DOI: 10.3390/jcm10184286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: previous studies showed that women have a higher mortality risk than men after out-of-hospital cardiac arrest (OHCA). This sex difference may disappear after adjustment for cardiac arrest characteristics. Most studies also included patients who were not admitted to the intensive care unit (ICU). We analyzed whether sex impacts the mortality of ICU-admitted OHCA patients. Methods: a retrospective cohort analysis of 1240 OHCA patients admitted to the ICU (310 women, 25%, AgeMedian 64.0 (IQR 53.8–73.0)) at an academic hospital in the Netherlands between 1 January 2007 and 31 December 2018. The primary outcome was 90-day mortality; the secondary outcome was a favorable cerebral performance category (CPC) score at ICU discharge and ICU length of stay (ICU LOS). Results: we found no association between sex and 90-day mortality (hazard ratio (HR) 0.867; 95% confidence interval (95% CI) 0.678–1.108) after adjusting for relevant cardiac arrest characteristics. Similarly, we found no difference for favorable CPC score (OR 1.117; 95% CI 0.777–1.608) or ICU LOS between sexes (Beta 0.428; 95% CI −0.442 to 1.298). Conclusions: after adjusting for cardiac arrest characteristics, we found no difference between women and men with respect to 90-day mortality, ICU LOS, and CPC score.
Collapse
Affiliation(s)
- Christiaan van Wees
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Wim Rietdijk
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
- Department of Hospital Pharmacy, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | - Loes Mandigers
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Niels T. B. Scholte
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | - Karst O. Adriaansens
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
| | | | - Corstiaan A. den Uil
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.v.W.); (L.M.); (C.A.d.U.)
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.v.d.G.); (N.T.B.S.); (K.O.A.)
- Department of Intensive Care, Maasstad Ziekenhuis, 3079 DZ Rotterdam, The Netherlands
| |
Collapse
|
20
|
Semeraro F, Corona G, Scquizzato T, Gamberini L, Valentini A, Tartaglione M, Scapigliati A, Ristagno G, Martella C, Descovich C, Picoco C, Gordini G. New Early Warning Score: EMS Off-Label Use in Out-of-Hospital Patients. J Clin Med 2021; 10:jcm10122617. [PMID: 34198651 PMCID: PMC8232239 DOI: 10.3390/jcm10122617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization.
Collapse
Affiliation(s)
- Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy; (L.G.); (M.T.); (C.P.); (G.G.)
- Correspondence: ; Tel.: +39-0516478868
| | - Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, 3-40139 Bologna, Italy;
| | - Tommaso Scquizzato
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy; (L.G.); (M.T.); (C.P.); (G.G.)
| | - Anna Valentini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, 40126 Bologna, Italy; (A.V.); (C.M.)
| | - Marco Tartaglione
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy; (L.G.); (M.T.); (C.P.); (G.G.)
| | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, 00168 Milan, Italy;
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ GrandaOspedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carmela Martella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, 40126 Bologna, Italy; (A.V.); (C.M.)
| | - Carlo Descovich
- Clinical Governance and Quality Unit, Bologna Local Healthcare Authority Staff, 40133 Bologna, Italy;
| | - Cosimo Picoco
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy; (L.G.); (M.T.); (C.P.); (G.G.)
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy; (L.G.); (M.T.); (C.P.); (G.G.)
| |
Collapse
|
21
|
Schultz BV, Hall S, Parker L, Rashford S, Bosley E. Epidemiology of Oxytocin Administration in Out-of-Hospital Births Attended by Paramedics. PREHOSP EMERG CARE 2020; 25:412-417. [PMID: 32584626 DOI: 10.1080/10903127.2020.1786613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births. METHODS A retrospective analysis was undertaken of all OOH births between the 1st January 2018 and 31st December 2018 attended by the Queensland Ambulance Service. The demographic and epidemiological characteristics of patients that were administered oxytocin and the occurrence of adverse side effects were described. RESULTS In total, 350 OOH births were included in this study with the majority involving multigravidas women (94.3%) and all but two involving singleton pregnancies. Oxytocin was administered following 222 births (63.4%), while 67 patients (19.1%) declined administration preferring a physiological third stage of labor, and in 61 cases (17.4%) oxytocin was withheld by the attending paramedic. There were no documented adverse events or side effects following administration. Oxytocin administration occurred on average 14 minutes (interquartile range 9-25) following the time of birth. The median time from oxytocin administration to placenta delivery was 10 minutes (interquartile range 5-22). CONCLUSION Oxytocin is well accepted and safe treatment adjunct for the management of the third stage of labor in OOH births and should be considered for routine practice by other emergency medical services.
Collapse
Affiliation(s)
- Brendan V Schultz
- Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020
| | - Shonel Hall
- Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020
| | - Lachlan Parker
- Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020
| | - Stephen Rashford
- Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020
| | - Emma Bosley
- Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020
| |
Collapse
|
22
|
GUTVIRTZ G, WAINSTOCK T, LANDAU D, SHEINER E. Unplanned Out-of-Hospital Birth-Short and Long-Term Consequences for the Offspring. J Clin Med 2020; 9:jcm9020339. [PMID: 31991747 PMCID: PMC7073687 DOI: 10.3390/jcm9020339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/08/2023] Open
Abstract
The unpredictable nature of childbirth infrequently results in unplanned out-of-hospital birth, in a pre-hospital setting. We evaluated the perinatal and long-term outcome of children accidentally born out-of-hospital. This was a population-based analysis of singleton deliveries occurring at a single tertiary hospital. The maternal characteristics and pregnancy outcome of unplanned out-of-hospital births were compared with in-hospital attended deliveries. Long-term cumulative incidence of hospitalizations (up to 18 years) involving respiratory, neurological, endocrine or infectious morbidity were evaluated using Kaplan-Meier survival curves and Cox regression models were used to control for confounders. In total, 243,682 deliveries were included, and 1.5% (n = 3580) were unplanned out-of-hospital births. Most occurred in multiparous women, and about a quarter of these women had inadequate prenatal care. Perinatal mortality rate was significantly higher for out-of-hospital births as compared with in-hospital births (OR = 2.9; 95% CI 2.2-3.8, p < 0.001). Kaplan-Meier survival curves demonstrated a significantly lower cumulative incidence of hospitalizations of children born out-of-hospital and the Cox models showed that hospitalization rates involving any of the above morbidities were significantly lower in children born out-of-hospital. While perinatal mortality was higher in unplanned out-of-hospital births, offspring born out-of-hospital showed a lower incidence of hospitalizations involving a variety of morbidities, possibly owing to under-utilization of healthcare services in this population.
Collapse
Affiliation(s)
- Gil GUTVIRTZ
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
- Correspondence:
| | - Tamar WAINSTOCK
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel;
| | - Daniella LANDAU
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
| | - Eyal SHEINER
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
| |
Collapse
|
23
|
Antonaglia V, Pegani C, Caggegi GD, Patsoura A, Xu V, Zambon M, Sanson G. Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest. J Clin Med 2019; 8:jcm8070926. [PMID: 31252641 PMCID: PMC6678170 DOI: 10.3390/jcm8070926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
In out-of-hospital cardiac arrest (OHCA), the occurrence of temporary periods of return to spontaneous circulation (t-ROSC) has been found to be predictive of survival to hospital discharge. The relationship between the duration of t-ROSCs and OHCA outcome has not been explored yet. The aim of this prospective observational study was to analyze the duration of t-ROSCs during OHCA and its impact on outcome. Defibrillator-recorded OHCA events were analyzed via dedicated software. The number of t-ROSC episodes and their overall durations were recorded. The study endpoint was the good neurologic outcome at hospital discharge. Among 285 patients included in the study, 45 (15.8%) had one or more t-ROSCs. The likelihood of t-ROSC occurrence was higher in patients with a shockable rhythm (p = 0.009). The cumulative length of t-ROSC episodes was significantly higher for patients who achieved sustained ROSC (p < 0.001). The adjusted cumulative t-ROSC length was an independent predictor for good neurological outcome at hospital discharge (OR 1.588, 95% CI 1.017 to 2.481; p = 0.042). According to our findings and data from previous studies, t-ROSC episodes during OHCA should be considered as a favorable prognostic factor, encouraging continuing resuscitative efforts.
Collapse
Affiliation(s)
- Vittorio Antonaglia
- Regional Emergency Medical Service System, Azienda Regionale Coordinamento della Salute, 33057 Udine, Italy
| | - Carlo Pegani
- Regional Emergency Medical Service System, Azienda Regionale Coordinamento della Salute, 33057 Udine, Italy
| | - Giuseppe Davide Caggegi
- Emergency Medical Service System, Azienda Sanitaria Universitaria Integrata, 734128 Trieste, Italy
| | - Athina Patsoura
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, School of Medicine, University of Verona, 837129 Verona, Italy
| | - Veronica Xu
- Azienda USL Toscana Sud Est, 54-52100 Arezzo, Italy
| | - Marco Zambon
- Emergency Medical Service System, Azienda Sanitaria Universitaria Integrata, 734128 Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 9-34100 Piazzale Europa, Italy.
| |
Collapse
|
24
|
Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekingil A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2019; 60:488-496. [PMID: 30968623 DOI: 10.24953/turkjped.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekin-Keser A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2018; 60: 488-496. The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1- 15) min, while it was 15 (5-40) min for the remaining patients (p < 0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p < 0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.
Collapse
Affiliation(s)
- Funda Kurt
- Division of Pediatric Emergency Medicine, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine
| | - Ramiz Coskun Gündüz
- Department of Pediatrics, Ankara Children's Hematology Oncology Training and Research Hospital
| | - Selman Kesici
- Division of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Halise Akça
- Division of Pediatric Emergency Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Şanlıay Şahin
- Department of Pediatrics, Ankara Children's Hematology Oncology Training and Research Hospital
| | - Gökhan Kalkan
- Division of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Derbent
- Division of Pediatric Emergency Medicine, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Nilden Tuygun
- Division of Pediatric Emergency Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Çağlar Ödek
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine
| | - Ayşe Gültekingil
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara Turkey
| | - Sinan Oğuz
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emine Polat
- Department of Pediatrics, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara Turkey
| | - Okşan Derinöz
- Division of Pediatric Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Tekşam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara Turkey
| | - Benan Bayrakcı
- Division of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emine Suskan
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
25
|
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a major public health problem, leading to a substantial number of deaths in the UK. In response to this, the Yorkshire Ambulance Service NHS Trust (YAS) has introduced red arrest teams (RATs). RAT members attend a three-day training course, focusing on the technical and non-technical skills that are required to effectively team lead an OHCA and provide high quality post-resuscitation care. This evaluation aims to determine the impact of the RATs on survival to 30 days and return of spontaneous circulation (ROSC) at hospital. METHODS All adult (≥ 18 years) OHCAs entered onto the YAS computer aided dispatch (CAD) system between 1 October 2015 and 30 September 2017 were included if the patient was resuscitated and the cause of the arrest was considered to be medical in origin. Multi-variable logistic regression models were created to enable adjustment for common predictors of survival and ROSC. RESULTS During the 2-year data collection period, YAS attended 15,151 cardiac arrests. After removing ineligible cases, 5868 cardiac arrests remained. RATs attended 2000/5868 (34.1%) incidents, with each RAT attending a median of 13 cardiac arrests (IQR 7-23, min. 1, max. 78).The adjusted odds ratios suggest that a RAT on scene is associated with a slight increase in the odds of survival to 30 days (OR 1.01, 95% CI 0.74-1.38) and odds of ROSC on arrival at hospital (OR 1.13, 95% CI 0.99-1.29), compared to the odds of not having a RAT present, although neither result is statistically significant. CONCLUSION The presence of a RAT paramedic was associated with a small increase in survival to 30 days and ROSC on arrival at hospital, although neither were statistically significant. Larger prospective studies are required to determine the effect of roles such as RAT on outcomes from OHCA.
Collapse
Affiliation(s)
| | | | - Daniel Lawton
- University of Huddersfield; Yorkshire Ambulance Service NHS Trust
| |
Collapse
|
26
|
Özkurtul O, Struck MF, Fakler J, Bernhard M, Seinen S, Wrigge H, Josten C. Physician-based on-scene airway management in severely injured patients and in-hospital consequences: is the misplaced intubation an underestimated danger in trauma management? Trauma Surg Acute Care Open 2019; 4:e000271. [PMID: 30899797 PMCID: PMC6407536 DOI: 10.1136/tsaco-2018-000271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Endotracheal intubation (ETI) is the gold standard for the out-of-hospital emergency airway management in severely injured patients. Due to time-critical circumstances, poor patient presentation and hostile environments, it may be prone for mechanical complications and failure. Methods In a retrospective study (January 2011 to December 2013), all patients who underwent out-of-hospital ETI before admittance to a level 1 trauma center were analyzed consecutively. Patients with supraglottic airways, being under cardiopulmonary resuscitation and interfacility transports were excluded. The main study endpoint was the incidence of unrecognized tube malposition; secondary endpoints were Glasgow Outcome Scale (GOS) and in-hospital mortality adjusted to on-scene Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Scale head (AIS head), and on-scene time. Results Out of 1176 patients, 151 underwent out-of-hospital ETI. At hospital admission, tube malpositions were recognized in nine patients (5.9%). Accidental and unrecognized esophageal intubation was detected in five patients (3.3%) and bronchial intubation in four patients (2.7%). Although ISS (p=0.053), AIS head (p=0.469), on-scene GCS (p=0.151), on-scene time (p=0.530), GOS (p=0.748) and in-hospital mortality (p=0.431) were similar compared with correctly positioned ETI tubes, three esophageal intubation patients died due to hypoxemic complications. Discussion In our study sample, out-of-hospital emergency ETI in severely injured patients was associated with a considerable tube misplacement rate. For safety, increased compliance to consequently use available technologies (eg, capnography, video laryngoscopy) for emergency ETI should be warranted. Level of evidence Level of Evidence IIA.
Collapse
Affiliation(s)
- Orkun Özkurtul
- Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Johannes Fakler
- Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Moorenstr, Germany
| | - Silja Seinen
- Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hermann Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
27
|
Weston BW, Jasti J, Mena M, Unteriner J, Tillotson K, Yin Z, Colella MR, Aufderheide TP. Self-Assessment Feedback Form Improves Quality of Out-of-Hospital CPR. PREHOSP EMERG CARE 2018; 23:66-73. [PMID: 30118617 DOI: 10.1080/10903127.2018.1477887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: Various continuous quality improvement (CQI) approaches have been used to improve quality of cardiopulmonary resuscitation (CPR) delivered at the scene of out-of-hospital cardiac arrest. We evaluated a post-event, self-assessment, CQI feedback form to determine its impact on delivery of CPR quality metrics. Methods: This before/after retrospective review evaluated data from a CQI program in a midsized urban emergency medical services (EMS) system using CPR quality metrics captured by Zoll Medical Inc. X-series defibrillator ECG files in adult patients (≥18 years old) with non-traumatic out-of-hospital cardiac arrest. Two 9-month periods, one before and one after implementation of the feedback form on December 31, 2013 were evaluated. Metrics included the mean and percentage of goal achievement for chest compression depth (goal: >5 centimeters [cm]; >90%/episode), rate (goal: 100-120 compressions/minute [min]), chest compression fraction (goal: ≥75%), and preshock pause (goal: <10 seconds [sec]). The feedback form was distributed to all EMS providers involved in the resuscitation within 72 hours for self-review. Results: A total of 439 encounters before and 621 encounters after were evaluated including basic life support (BLS) and advanced life support (ALS) providers. The Before Group consisted of 408 patients with an average age of 61 ± 17 years, 61.8% male. The After Group consisted of 556 patients with an average age of 61 ± 17 years, 58.3% male. Overall, combining BLS and ALS encounters, the mean CPR metric values before and after were: chest compression depth (5.0 cm vs. 5.5 cm; p < 0.001), rate (109.6/min vs 114.8/min; p < 0.001), fraction (79.2% vs. 86.4%; p < 0.001), and preshock pause (18.8 sec vs. 11.8 sec; p < 0.001), respectively. Overall, the percent goal achievement before and after were: chest compression depth (48.5% vs. 66.6%; p < 0.001), rate (71.8% vs. 71.7%, p = 0.78), fraction (68.1% vs. 91.0%; p < 0.001), and preshock pause (24.1% vs. 59.5%; p < 0.001), respectively. The BLS encounters and ALS encounters had similar statistically significant improvements seen in all metrics. Conclusion: This post-event, self-assessment CQI feedback form was associated with significant improvement in delivery of out-of-hospital CPR depth, fraction and preshock pause time.
Collapse
|
28
|
Abstract
Introduction Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped. Problem There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries. METHODS A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care. RESULTS There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing the prehospital care system. CONCLUSION The implementation and development of an EMS system is varied among LMICs. Many LMICs lack an organized EMS system with most ambulances used purely for transport and not as an emergency care vehicle. Financial issues are the most common problems faced by LMICs with support from developed countries a necessity. Suryanto , Plummer V , Boyle M . EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64-70.
Collapse
|
29
|
Hubert H, Escutnaire J, Michelet P, Babykina E, El Khoury C, Tazarourte K, Vilhelm C, El Hiki L, Guinhouya B, Gueugniaud PY. Can we identify termination of resuscitation criteria in cardiac arrest due to drowning: results from the French national out-of-hospital cardiac arrest registry. J Eval Clin Pract 2016; 22:924-931. [PMID: 27292052 DOI: 10.1111/jep.12562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aim of this study was to describe the cohort of persons having experiences fatal and non-fatal drowning events, registered in the French cardiac arrest registry and to identify termination of resuscitation criteria. METHODS We performed a prospective multicenter study based on data from French cardiac arrest registry database. All patients with cardiac arrest after drowning (CAD) recorded between July 2011 and November 2014 were included. The population description was carried out by medians [interquartile ranges (IQR)] or frequencies. The characteristics were compared in terms of the primary endpoint (alive vs dead at hospital admission) using chi-square or Fisher's exact and the Mann-Whitney U test. The predictive model was carried out using the multivariate logistic regression. RESULTS The analysis included 234 CAD. The majority of patients were adults (83.6%) and males (64.5%). Most of the submersions occurred out of home (75.6%). We recorded 66.7% of incidents in fresh water. About a third of CAD was witnessed of which 33.8% had an immediate basic life support. Most of CAD patients received an advanced cardiac life support (87.2%). The median Mobile Medical Team response time was 22 [15-30] minutes. At hospital, 40.6% of patients were alive. Twenty one patients (9.0%) were discharged alive. Among them, 17 had a good neurological outcome. Faster interventions generally resulted in higher survival chances (Mobile Medical Team response time OR: 0.960[0.925; 0.996]; P = 0.0.031; no flow duration OR: 0.535[0.313; 0.913]; P = 0.022) if associated with ventilation (OR: 6.742[2.043; 22.250]; P = 0.002). Age (OR: 0.971[0.955; 0.988]; P = 0.001) and location outside (OR: 0.203[0.064; 0.625]; P = 0.007) are the other criteria of our model. CONCLUSIONS The model is helpful to highlight explanative variables concerning CAD patients' outcome. The next step is the validation of these five factors by a larger study. Prevention and public training to lifesaving behaviours must be considered as priorities in French public health programmes.
Collapse
Affiliation(s)
- Hervé Hubert
- Public Health Department EA 2694, ILIS-University of Lille, Loos, France
| | | | | | - Evgéniya Babykina
- Public Health Department EA 2694, ILIS-University of Lille, Loos, France
| | - Carlos El Khoury
- RESCUE (Réseau Cardiologie Médecine d'Urgence) Network, Hussel Hospital, Vienne, France
| | - Karim Tazarourte
- SAMU 69 and the department of Emergency Medicine, Lyon University Hospital, University of Claude Bernard-Lyon 1, Lyon, France
| | - Christian Vilhelm
- Public Health Department EA 2694, ILIS-University of Lille, Loos, France
| | | | - Benjamin Guinhouya
- Public Health Department EA 2694, ILIS-University of Lille, Loos, France
| | - Pierre-Yves Gueugniaud
- SAMU 69 and the department of Emergency Medicine, Lyon University Hospital, University of Claude Bernard-Lyon 1, Lyon, France
| | -
- Research Group on the French National Out-of-hospital Cardiac Arrest Registry, RéAC, Lille, France
| |
Collapse
|
30
|
Williams TA, Martin R, Celenza A, Bremner A, Fatovich D, Krause J, Arena S, Finn J. Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: A cohort study. Emerg Med Australas 2016; 28:171-8. [PMID: 26929190 DOI: 10.1111/1742-6723.12560] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We examined the association of serum lactate levels and early lactate clearance with survival to hospital discharge for patients suffering an out-of-hospital cardiac arrest (OHCA). METHODS A retrospective cohort analysis was performed of patients with OHCA transported by ambulance to two adult tertiary hospitals in Perth, Western Australia. Exclusion criteria were traumatic cardiac arrest, return of spontaneous circulation prior to the arrival of the ambulance, age less than 18 years and no serum lactate levels recorded. Serum lactate levels recorded for up to 48 h post-arrest were obtained from the hospital clinical information system, and lactate clearance over 48 h was calculated. Descriptive and logistic regression analyses were conducted. RESULTS There were 518 patients with lactate values, of whom 126 (24.3%) survived to hospital discharge. Survivors and non-survivors had different mean initial lactate levels (mean ± SD 6.9 ± 4.7 and 12.2 ± 5.5 mmol/L, respectively; P < 0.001). Lactate clearance was higher in survivors. Lactate levels for non-survivors did not decrease below 2 mmol/L until at least 30 h after the ambulance call. CONCLUSION In OHCA patients who had serum lactate levels measured, both lower initial serum lactate and early lactate clearance in the first 48 h following OHCA were associated with increased likelihood of survival. However, the use of lactate in isolation as a predictor of survival or neurological outcome is not recommended. Prospective studies that minimise selection bias are required to determine the clinical utility of serum lactate levels in OHCA patients.
Collapse
Affiliation(s)
- Teresa A Williams
- Prehospital Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,St John Ambulance, Belmont, Western Australia, Australia
| | - Ry Martin
- Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Antonio Celenza
- Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Alexandra Bremner
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Fatovich
- Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Joel Krause
- Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Steven Arena
- Discipline of Emergency Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,St John Ambulance, Belmont, Western Australia, Australia
| |
Collapse
|
31
|
Hugenschmitt D, Souquet ML, Lefort H, Bagur J, Gueugniaud PY. [Emergency nurse faced with death in pre-hospital situations]. Rev Infirm 2015; 64:41-43. [PMID: 26145698 DOI: 10.1016/j.revinf.2015.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The occurrence of a death in the out-of-hospital environment is often brutal and the reactions of the deceased's family and friends, unprepared for this event, can be unpredictable. After the technical procedures have been carried out and within a limited period of intervention, the caregivers, and in particular the nurse of the mobile emergency and intensive care service, must provide the family and friends with support enabling them to begin the grieving process. To help the caregivers in this mission, a pedagogical tool remains to be developed.
Collapse
Affiliation(s)
- Delphine Hugenschmitt
- Samu/Smur de Lyon, Hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
| | - Marie-Laure Souquet
- Samu/Smur de Lyon, Hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - Hugues Lefort
- Service médical d'urgence, Brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - Jacques Bagur
- Institut médico-Légal de Lyon, 12, avenue Rockfeller, 69000 Lyon, France
| | - Pierre-Yves Gueugniaud
- Samu/Smur de Lyon, Hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| |
Collapse
|
32
|
Sanson G, Verduno J, Zambon M, Trevi R, Caggegi GD, Di Bartolomeo S, Antonaglia V. Emergency medical service treated out-of-hospital cardiac arrest: Identification of weak links in the chain-of-survival through an epidemiological study. Eur J Cardiovasc Nurs 2015; 15:328-36. [PMID: 25676670 DOI: 10.1177/1474515115573365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-depth analysis of emergency medical services (EMSs) performances in out-of-hospital cardiac arrest (OHCA) promotes quality improvement. AIMS The purpose of this study was to identify the improvable factors of the EMS response to OHCA through the description and analysis of OHCA incidence, characteristics, management and outcome. METHODS This was a retrospective cohort study on all OHCA patients treated by the EMSs of the district of Trieste, Italy (236,556 inhabitants) in 2011. RESULTS A total of 678 OHCAs occurred and 142 (20.1%) underwent cardiopulmonary resuscitation (CPR), with a respective incidence of 287/100,000/year and 60/100,000/year. The incidence of shockable rhythms in the CPR group was 13/100,000. OHCAs occurred mainly during daytime, though the proportion of patients receiving CPR was significantly higher by night-time (p=0.01). Thirty-four CPR patients (23.9%) restored spontaneous circulation on scene; 12 (8.5%) survived to hospital discharge (11 with good neurological recovery). Survival was not correlated with age, while was significantly higher for patients with shockable rhythms (32.3%; p<0.001). Mean response time was 8 min. Direct intervention of physician-staffed units did not improve the outcome when compared with two-tiered activation. Patients immediately identified as OHCA by dispatch nurses and those undergoing therapeutic hypothermia showed a non-significant trend towards improved survival (p=0.09 and 0.07, respectively). CONCLUSIONS OHCA identification by dispatch nurses and reduction of response time were the factors most susceptible to improvement.
Collapse
Affiliation(s)
| | | | - Marco Zambon
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Roberto Trevi
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Giuseppe D Caggegi
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Stefano Di Bartolomeo
- Department of Anesthesia, University Hospital, Udine, Italy Department of Clinical Governance, Agenzia Sanitaria e Sociale Regionale Emilia Romagna, Italy
| | - Vittorio Antonaglia
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| |
Collapse
|
33
|
Cabañas JG, Myers JB, Williams JG, De Maio VJ, Bachman MW. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. PREHOSP EMERG CARE 2014; 19:126-130. [PMID: 25243771 DOI: 10.3109/10903127.2014.942476] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with VF. Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation. Methods. A retrospective case series was performed in an urban/suburban emergency medical services (EMS) system with advanced life support care and a population of 900,000. Included were all adult OOHCAs having RVF during resuscitation efforts by EMS providers. RVF was defined as persistent VF following at least 5 unsuccessful single shocks, epinephrine administration, and a dose of antiarrhythmic medication. Once the patient was in RVF, EMS personnel applied a second set of pads and utilized a second defibrillator for single defibrillation with the new monitor/pad placement. If VF continued, EMS personnel then utilized the original and second monitor/defibrillator charged to maximum energy, and shocks were delivered from both machines simultaneously. Data were collected from electronic dispatch and patient care reports for descriptive analysis. Results. From 01/07/2008 to 12/31/2010, a total of 10 patients were treated with DSED. The median age was 76.5 (IQR: 65-82), with median resuscitation time of 51minutes (IQR: 45-62). The median number of single shocks was 6.5 (IQR: 6-11), with a median of 2 (IQR: 1-3) DSED shocks delivered. VF broke after DSED in 7 cases (70%). Only 3 patients (30%) had ROSC in the field, and none survived to discharge. Conclusion. This case series demonstrates that DSED may be a feasible technique as part of an aggressive treatment plan for RVF in the out-of-hospital setting. In this series, RVF was terminated 70% of the time, but no patient survived to discharge. Further research is needed to better understand the characteristics of and treatment strategies for RVF.
Collapse
|
34
|
Faucher A, Savary D, Jund J, Dorez D, Debaty G, Gaillard A, Atchabahian A, Tazarourte K. Out-of-hospital traumatic cardiac arrest: an underrecognized source of organ donors. Transpl Int 2013; 27:42-8. [PMID: 24118355 DOI: 10.1111/tri.12196] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/10/2013] [Accepted: 09/15/2013] [Indexed: 11/28/2022]
Abstract
Whereas the gap between organ supply and demand remains a worldwide concern, resuscitation of out-of-hospital traumatic cardiac arrest (TCA) remains controversial. The aim of this study is to evaluate, in a prehospital medical care system, the number of organs transplanted from victims of out-of-hospital TCA. This is a descriptive study. Victims of TCA are collected in the out-of-hospital cardiac arrest registry of the French North Alpine Emergency Network from 2004 to 2008. In addition to the rates of admission and survival, brain-dead patients and the organ transplanted are described. Among the 540 resuscitated patients with suspected TCA, 79 were admitted to a hospital, 15 were discharged alive from the hospital, and 22 developed brain death. Nine of these became eventually organ donors, with 31 organs transplanted, all functional after 1 year. Out-of-hospital TCA should be resuscitated just as medical CA. With a steady prevalence in our network, 19% of admitted TCA survived to discharge, and 11% became organ donors. It is essential to raise awareness among rescue teams that out-of-hospital TCA are an organ source to consider seriously.
Collapse
Affiliation(s)
- Anna Faucher
- Department of Emergency Medicine, Annecy General Hospital, Annecy, France
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Prehospital pediatric cardiac arrest is a rare event compared with adult cardiac arrest. Despite the recent advancements in postresuscitation care improving the outcome of adult patients, similar evidence is lacking in pediatric victims of cardiac arrest. In this brief article, the current data on pediatric cardiac arrest occurring in the prehospital setting are reviewed. The annual incidence of pediatric out-of-hospital cardiac arrest is approximately 8–10 cases per 100,000 persons. The outcome is generally poor, as only 2–9.6% of patients survive to hospital discharge. The neurologic outcome of survivors is good in 24–31% of patients. Current evidence is insufficient to strongly support or refute the use of mild therapeutic hypothermia during the postresuscitation phase in pediatric patients. The application of a goal-directed treatment protocol for pediatric cardiac arrest and postresuscitation syndrome needs to be evaluated.
Collapse
Affiliation(s)
- Antti Kämäräinen
- Helsinki Area Helicopter Emergency Medical Service Medi-Heli 01, Vantaa, Finland, Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
36
|
Rosenthal FS, Carney JP, Olinger ML. Out-of-hospital cardiac arrest and airborne fine particulate matter: a case-crossover analysis of emergency medical services data in Indianapolis, Indiana. Environ Health Perspect 2008; 116:631-6. [PMID: 18470283 PMCID: PMC2367645 DOI: 10.1289/ehp.10757] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 02/20/2008] [Indexed: 05/12/2023]
Abstract
BACKGROUND Previous studies have found particulate matter (PM) < 2.5 microm in aerodynamic diameter (PM2.5) associated with heart disease mortality. Although rapid effects of PM2.5 exposure on the cardiovascular system have been proposed, few studies have investigated the effect of short-term exposures on out-of-hospital cardiac arrest (OHCA). OBJECTIVES We aimed to determine whether short-term PM2.5 exposures increased the risk of OHCA and whether risk depended on subject characteristics or presenting heart rhythm. METHODS A case-crossover analysis determined hazard ratios (HRs) for OHCAs logged by emergency medical systems (EMS) versus hourly and daily PM2.5 exposures at the time of the OHCA and for daily and hourly periods before it. RESULTS For all OHCAs (n = 1,374), exposures on the day of the arrest or 1-3 days before arrest had no significant effect on the incidence of OHCA. For cardiac arrests witnessed by bystanders (n = 511), OHCA risk significantly increased with PM2.5 exposure during the hour of the arrest (HR for a 10-microg/m3 increase in PM2.5 exposure = 1.12; 95% confidence interval, 1.01-1.25). For the subsets of subjects who were white, 60-75 years of age, or presented with asystole, OHCA risk significantly increased with PM2.5 during the hour of the arrest (HRs for a 10-microg/m3 increase in PM2.5 = 1.18, 1.25, or 1.22, respectively; p < 0.05). HR generally decreased as the time lag between PM2.5 exposure and OHCA increased. CONCLUSION The results suggest an acute effect of short-term PM2.5 exposure in precipitating OHCAs, and a need to investigate further the role of subject factors in the effects of PM on the risk of OHCA.
Collapse
Affiliation(s)
- Frank S Rosenthal
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, USA.
| | | | | |
Collapse
|
37
|
van Eck FM, Noyez L, Verheugt FWA, Brouwer RMHJ. Identification of patients at risk for early out-of-hospital mortality after redocoronary artery surgery. Neth Heart J 2003; 11:394-400. [PMID: 25696148 PMCID: PMC2499976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE Analyse risk factors and construct a predictive model for identification of patients at risk of early out-of-hospital mortality after coronary reoperations (RECABG). METHODS 505 patients, discharged from hospital after a RECABG (1987-1998), were studied by univariate and multivariate analysis. A stepwise selective procedure (p<0.05) was used to identify a subset of variables with prognostic value for early out-of-hospital mortality. This subset was used to calculate a prognostic score 'S' and a predicted probability 'p' for early out-of-hospital mortality, p=1/1+ e-s. Sensitivity analysis was used for evaluation. RESULTS The best predictive variables for early out-of-hospital mortality were diabetes (p=0.002), lung disease (p=0.05), emergency operation (p=0.0001) and a perioperative myocardial infarction (p=0.0001). Emergency operation (p=0.001) and antegrade/retrograde cardioplegia (p<0.0000) were independent predictors of a perioperative myocardial infarction. The prognostic accuracy (ROC area) was 86%. Patients were classified into low risk (5%), intermediate risk (15%), high risk (30%) and very high risk (≥40%). A predicted probability of ≥0.40 was used as cut-off point. The specificity of this test was 99%, sensitivity 33%, predictive value of a positive test 79%, and 95% for a negative test. CONCLUSION The results show that patients discharged from hospital after RECABG can be stratified according to their early out-of-hospital risk. A perioperative myocardial infarction is the major independent risk factor and can be affected by use of retrograde cardioplegia.
Collapse
|