WorldWideScience

Sample records for out-of hospital cardiac

  1. Surviving out-of-hospital cardiac arrest.

    Evans, Nick

    2016-05-01

    Emergency care nurses have been urged to play their part in Scotland's push to revolutionise care for cardiac arrest patients - by teaching others how to save a life. This article discusses the Scottish out-of-hospital cardiac arrest strategy, with particular focus on the drive to increase bystander cardiopulmonary resuscitation (CPR) rates, and on how emergency nurses are being enlisted to help promote the training of members of the public. PMID:27165393

  2. [Out-of-hospital cardiac arrest].

    Virkkunen, Ilkka; Hoppu, Sanna; Kämäräinen, Antti

    2011-01-01

    Cardiac arrest as the first symptom of coronary artery disease is not uncommon. Some of previously healthy people with sudden cardiac arrest may be saved by effective resuscitation and post-resuscitative therapy. The majority of cardiac arrest patients experience the cardiac arrest outside of the hospital, in which case early recognition of lifelessness, commencement of basic life support and entry to professional care without delay are the prerequisites for recovery. After the heart has started beating again, the clinical picture of post-resuscitation syndrome must be recognized and appropriate treatment utilized. PMID:22204143

  3. Out-of-Hospital Cardiac Arrest in Denmark

    Wissenberg Jørgensen, Mads

    years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...... in patient survival following out-of hospital cardiac arrest; utilizing the Danish nationwide registries, we sought to answer these questions. Moreover, in order to further improve understanding and target future national strategies for cardiac arrest management, we examined whether there were sex...

  4. Variation in Out-of-Hospital Cardiac Arrest Management

    Jason M. Jones

    2016-01-01

    Full Text Available Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA. Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%], and one-quarter underwent three or more attempts (25/77 [25%]. One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]. Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

  5. Incidence of out-of-hospital cardiac arrest.

    Rea, Thomas D; Pearce, Rachel M; Raghunathan, Trivellore E; Lemaitre, Rozenn N; Sotoodehnia, Nona; Jouven, Xavier; Siscovick, David S

    2004-06-15

    Estimates of the incidence of out-of-hospital primary cardiac arrest (CA) have typically relied solely upon emergency medical service or death certificate records and have not investigated incidence in clinical subgroups. Overall and temporal patterns of CA incidence were investigated in clinically defined groups using systematic methods to ascertain CA. Estimates of incidence were derived from a population-based case-control study in a large health plan from 1986 to 1994. Subjects were enrollees aged 50 to 79 years who had had CA (n = 1,275). A stratified random sample of enrollees who had not had CA was used to estimate the population at risk with various clinical characteristics (n = 2,323). Poisson's regression was used to estimate incidence overall and for 3-year time periods (1986 to 1988, 1989 to 1991, and 1992 to 1994). The overall CA incidence was 1.89/1,000 subject-years and varied up to 30-fold across clinical subgroups. For example, incidence was 5.98/1,000 subject-years in subjects with any clinically recognized heart disease compared with 0.82/1,000 subject-years in subjects without heart disease. In subgroups with heart disease, incidence was 13.69/1,000 subject-years in subjects with prior myocardial infarction and 21.87/1,000 subject-years in subjects with heart failure. Risk decreased by 20% from the initial to the final time period, with a greater decrease observed in those with (25%) compared with those without (12%) clinical heart disease. Thus, CA incidence varied considerably across clinical groups. The results provide insights regarding absolute and population-attributable risk in clinically defined subgroups, information that may aid strategies aimed at reducing mortality from CA. PMID:15194012

  6. Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H; Lippert, Freddy K; Olesen, Jonas B; Andersson, Charlotte; Wissenberg, Mads; Poulsen, Henrik E; Nielsen, Søren L; Køber, Lars; Torp-Pedersen, Christian

    2012-01-01

    BACKGROUND: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. METHODS: OHCA patients...... were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. RESULTS......: We identified 16,924 OHCA patients, median age 70.0 years (Q1-Q3: 59-80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference 89) were...

  7. Temporal differences in out-of-hospital cardiac arrest incidence and survival

    Bagai, Akshay; McNally, Bryan F.; Al-Khatib, Sana M.;

    2013-01-01

    Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care....

  8. Survival after out-of-hospital cardiac arrest in relation to sex

    Wissenberg, Mads; Hansen, Carolina Malta; Folke, Fredrik;

    2014-01-01

    AIM: Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. METHODS: Patients≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation wa...

  9. Electronic registration of out-of-hospital cardiac arrests

    Nielsen, Niels Dalsgaard; Dahl, Michael; Gade, John;

    2007-01-01

    patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition of...... cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12...... considerably higher incidence rate for OHCA, than documented by the analogue nationwide registry. Further we discovered a high rate of first aid to OHCA-patients. Finally our data showed a high occurence of asystolia in patients who met the official criteria for OHCA....

  10. Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

    Beck, Ben; Bray, Janet; Smith, Karen; Walker, Tony; Grantham, Hugh; Hein, Cindy; Thorrowgood, Melanie; Smith, Anthony; Smith, Tony; Dicker, Bridget; Swain, Andy; Bailey, Mark; Bosley, Emma; Pemberton, Katherine; Cameron, Peter

    2016-01-01

    Introduction Out-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consort...

  11. Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest

    Blom, M T; van Hoeijen, D A; Bardai, A;

    2014-01-01

    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA......-reviewed journals and presented at relevant scientific symposia....

  12. Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest

    Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John;

    2015-01-01

    BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) ...

  13. Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest

    Frandsen, F; Nielsen, J R; Gram, L;

    1991-01-01

    form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more...

  14. Therapeutic Hypothermia and Out-of-Hospital Cardiac Arrest in a Child with Hypertrophic Obstructive Cardiomyopathy

    Nancy Spurkeland

    2015-01-01

    Full Text Available Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA.

  15. Anxiety and depression among out-of-hospital cardiac arrest survivors

    Lilja, G; Nilsson, G; Nielsen, N;

    2015-01-01

    AIM: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors. METHODS: OHCA-survivors randomized to targeted temperature of...... 33 °C or 36 °C within the Target Temperature Management trial (TTM-trial) attended a follow-up after 6 months that included the questionnaire Hospital Anxiety and Depression Scale (HADS). A control group with ST-elevation myocardial infarction (STEMI) completed the same follow-up. Correlations to...... normative data. Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. Clinical...

  16. Antipsychotics and Associated Risk of Out-of-Hospital Cardiac Arrest

    Weeke, Peter; Jensen, Aksel; Folke, Fredrik;

    2014-01-01

    Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug...... use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of event. Overall treatment with any antipsychotic was associated with OHCA (odds ratio [OR]= 1.53, 95...

  17. Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest

    Cabrini, L; Biondi-Zoccai, G; Landoni, G; Greco, M.; Vinciguerra, F; Greco, T; Ruggeri, L; Sayeg, J; Zangrillo, A

    2010-01-01

    Introduction Out-of-hospital cardiac arrest has a low survival rate to hospital discharge. Recent studies compared a simplified form of CPR, based on chest compression alone versus standard CPR including ventilation. We performed systematic review and meta-analysis of randomized controlled trials, focusing on survival at hospital discharge. Methods We extensively searched the published literature on out-of hospital CPR for non traumatic cardiac arrest in different databases. Results We identi...

  18. Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan

    Nagata, Takashi; Abe, Takeru; Noda, Eiichiro; Hasegawa, Manabu; Hashizume, Makoto; Hagihara, Akihito

    2014-01-01

    Objectives To better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA). Design A population-based, observational study. Setting The National Japan Utstein Registry. Participants 2900 children aged 5–17 years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or...

  19. Interposed Abdominal Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing Traditional CPR

    McClung, Christian D.; Alexander J. Anshus

    2015-01-01

    Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an alternative technique to traditional cardiopulmonary resuscitation (CPR) that can improve perfusion and lead to restoration of circulation in patients with chest wall deformity either acquired through vigorous CPR or co-morbidity such as chronic obstructive pulmonary disease. We report a case of out-of-hospital cardiac arrest where IAC-CPR allowed for restoration of spontaneous circulation and eventual ...

  20. The optimum timing of resuscitative thoracotomy for non-traumatic out-of-hospital cardiac arrest.

    Takino, M; Okada, Y

    1993-08-01

    Open-chest cardiopulmonary resuscitation (CPR) is a promising method for non-traumatic cardiac arrest. In this preliminary study, we investigated the optimum timing of thoracotomy which brings high rate of return of spontaneous circulation (ROSC) and keeps the incidence of unnecessary thoracotomy minimal. Ninety-five adult patients with non-traumatic out-of-hospital cardiac arrest were analyzed. Of those, 26 patients were treated by the open-chest CPR in a prospective consecutive fashion. In this group, the ROSC rate was investigated in connection with the interval from hospital arrival, or ambulance call, to thoracotomy. Another 69 patients were treated by standard CPR. In this uncontrolled group, the interval from arrival at hospital to ROSC was investigated to define the 'natural hospital course' by the conventional treatment. Patient characteristics in the open-chest CPR group and the standard CPR group were similar. In the open-chest CPR group, 15 patients obtained ROSC. There was a tendency that the ROSC rate was highest in the patients with thoracotomy within 5 min of hospital arrival and declined as the timing of thoracotomy was delayed. Similar tendency was noted when the timing of thoracotomy was counted from the ambulance call. In the standard CPR group, only two patients obtained ROSC during the initial 5 min of hospital course. These results suggest that thoracotomy within 5 min of hospital arrival brings the highest ROSC rate while keeps the incidence of unnecessary thoracotomy acceptable. PMID:8210734

  1. Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls

    Alfsen, David; Møller, Thea Palsgaard; Egerod, Ingrid; Lippert, Freddy K

    2015-01-01

    inductive thematic analysis of recordings of out-of-hospital cardiac arrest emergency calls from December 2012. Participants were the callers (bystanders) and the emergency medical dispatchers. Data were analysed using a hermeneutic approach. RESULTS: Based on the concept of data saturation, 13 recordings...... influences the dispatchers' recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers' recognition of OHCA during emergency calls in a qualitative analysis of calls. METHODS: An investigator triangulated...... of not recognised cardiac arrest and 8 recordings of recognised cardiac arrests were analysed. Three main themes, six subthemes and an embedded theme emerged from the analysis: caller's physical distance (caller near patient, caller not near patient), caller's emotional distance (keeping calm, losing...

  2. Return to Work in Out-of-Hospital Cardiac Arrest Survivors

    Kragholm, Kristian; Wissenberg, Mads; Mortensen, Rikke Normark;

    2015-01-01

    BACKGROUND: Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. METHODS AND RESULTS: In Denmark, out-of-hospital cardiac arrests have been systematically...... reported to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4354 patients employed before arrest among 12 332 working-age patients (18-65 years), of whom 796 survived to day 30. Among 796 survivors (median age, 53 years [quartile 1-3, 46-59 years]; 81.5% men), 610 (76.......6%) returned to work in a median time of 4 months [quartile 1-3, 1-19 months], with a median time of 3 years spent back at work. A total of 74.6% (N=455) remained employed without using sick leave during the first 6 months after returning to work. This latter proportion of survivors returning to work increased...

  3. Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.

    Masterson, Siobhán

    2011-05-01

    SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

  4. Interposed Abdominal Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing Traditional CPR

    Christian D. McClung

    2015-10-01

    Full Text Available Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR is an alternative technique to traditional cardiopulmonary resuscitation (CPR that can improve perfusion and lead to restoration of circulation in patients with chest wall deformity either acquired through vigorous CPR or co-morbidity such as chronic obstructive pulmonary disease. We report a case of out-of-hospital cardiac arrest where IAC-CPR allowed for restoration of spontaneous circulation and eventual full neurologic recovery when traditional CPR was failing to generate adequate pulses with chest compression alone.

  5. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F;

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were...... identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an OHCA; 2,913 (15.2%) were receiving antidepressant treatment at the time of OHCA, with citalopram...... being the most frequently used type of antidepressant (50.8%). Tricyclic antidepressants (TCAs; odds ratio (OR) = 1.69, confidence interval (CI): 1.14-2.50) and selective serotonin reuptake inhibitors (SSRIs; OR = 1.21, CI: 1.00-1.47) were both associated with comparable increases in risk of OHCA...

  6. Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography

    Yoshihiro Moriwaki

    2013-01-01

    Full Text Available Context: The spectrum of the etiology of out-of-hospital cardiopulmonary arrest (OHCPA has not been established. We have performed perimortem computed tomography (CT during cardiopulmonary resuscitation. Aims: To clarify the incidence of non-cardiac etiology (NCE, actual distribution of the causes of OHCPA via perimortem CT and its usefulness. Settings and Design: Population-based observational case series study. Materials and Methods: We reviewed the medical records of 1846 consecutive OHCPA cases and divided them into two groups: 370 showing an obvious cause of OHCPA with NCE (trauma, neck hanging, terminal stage of malignancy, and gastrointestinal bleeding and others. Results: Of a total OHCPA, perimortem CT was performed in 57.5% and 62.5% were finally diagnosed as NCE: Acute aortic dissection (AAD 8.07%, pulmonary thrombo-embolization (PTE 1.46%, hypoxia due to pneumonia 5.25%, asthma and acute worsening of chronic obstructive pulmonary disease 2.06%, cerebrovascular disorder (CVD 4.48%, airway obstruction 7.64%, and submersion 5.63%. The rates of patients who survived to hospital discharge were 6-14% in patients with NCE. Out of the 1476 cases excluding obvious NCE of OHCPA, 66.3% underwent perimortem CT, 14.6% of cases without obvious NCE and 22.1% of cases with perimortem CT were confirmed as having some NCE. Conclusions: Of the total OHCPA the incidences of NCE was 62.5%; the leading etiologies were AAD, airway obstruction, submersion, hypoxia and CVD. The rates of cases converted from cardiac etiology to NCE using perimortem CT were 14.6% of cases without an obvious NCE.

  7. Factors Associated With Successful Resuscitation After Out-of-Hospital Cardiac Arrest and Temporal Trends in Survival and Comorbidity

    Søholm, Helle; Hassager, Christian; Lippert, Freddy; Winther-Jensen, Matilde; Thomsen, Jakob Hartvig; Friberg, Hans; Bro-Jeppesen, John; Køber, Lars; Kjaergaard, Jesper

    2015-01-01

    % (P trend <.001), whereas the percentage of out-of-hospital cardiac arrest patients with successful resuscitation to hospital admission increased by 3% per year during the study period, from 37% in 2007 to 43% in 2011 (P trend <.001). CONCLUSION: Our observations confirm the importance of key features...

  8. Spatial Variation and Resuscitation Process Affecting Survival after Out-of-Hospital Cardiac Arrests (OHCA.

    Chien-Chou Chen

    Full Text Available Ambulance response times and resuscitation efforts are critical predictors of the survival rate after out-of-hospital cardiac arrests (OHCA. On the other hand, rural-urban differences in the OHCA survival rates are an important public health issue.We retrospectively reviewed the January 2011-December 2013 OHCA registry data of Kaohsiung City, Taiwan. With particular focus on geospatial variables, we aimed to unveil risk factors predicting the overall OHCA survival until hospital admission. Spatial analysis, network analysis, and the Kriging method by using geographic information systems were applied to analyze spatial variations and calculate the transport distance. Logistic regression was used to identify the risk factors for OHCA survival.Among the 4,957 patients, the overall OHCA survival to hospital admission was 16.5%. In the multivariate analysis, female sex (adjusted odds ratio:, AOR, 1.24 [1.06-1.45], events in public areas (AOR: 1.30 [1.05-1.61], exposure to automated external defibrillator (AED shock (AOR: 1.70 [1.30-2.23], use of laryngeal mask airway (LMA (AOR: 1.35 [1.16-1.58], non-trauma patients (AOR: 1.41 [1.04-1.90], ambulance bypassed the closest hospital (AOR: 1.28 [1.07-1.53], and OHCA within the high population density areas (AOR: 1.89 [1.55-2.32] were positively associated with improved OHCA survival. By contrast, a prolonged total emergency medical services (EMS time interval was negatively associated with OHCA survival (AOR: 0.98 [0.96-0.99].Resuscitative efforts, such as AED or LMA use, and a short total EMS time interval improved OHCA outcomes in emergency departments. The spatial heterogeneity of emergency medical resources between rural and urban areas might affect survival rate.

  9. Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.

    Hammer, Laure; Vitrat, François; Savary, Dominique; Debaty, Guillaume; Santre, Charles; Durand, Michel; Dessertaine, Geraldine; Timsit, Jean-François

    2009-06-01

    Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. A routine protocol of immediate postresuscitation cooling had been tested by an emergency team, which consisted of an infusion of large-volume, ice-cold intravenous saline. We decided to assess the efficacy and tolerance of this procedure. A total of 99 patients were studied; 22 were treated with prehospital TH, and 77 consecutive patients treated with prehospital standard resuscitation served as controls. For all patients, TH was maintained for 12 to 24 hours. The demographic, clinical, and biological characteristics of the patients were similar in the 2 groups. The rate of patients with a body temperature of less than 35 degrees C upon admission was 41% in the cooling group and 18% in the control group. Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units. PMID:19497463

  10. Prevalence of Out-of-Hospital Sudden Cardiac Death in Moscow in 2005–2009

    Leonid Makarov

    2015-01-01

    Full Text Available Background. The sudden out-of-hospital cardiac death (SOHCD in Russia is poorly investigated. The aim of study was to determine structure of SOHCD in Moscow. Methods. SOHCD were analyzed according to data for 2005–2009 from the 2nd Thanatology Department of Forensic Medicine of Moscow that serves 2502836 citizens in Moscow. Results. Prevalence of SOHCD was 49.1% of autopsies for all age groups and in 8.9% in the group aged 1–45 (22.3 cases per 100000 population/year. The frequency of SOHCD progressively increased with age. Most SOHCD victims (82% were males. The diagnosis of cardiomyopathy was prevalent (80–96% in the age 1–45 group; in 11–15 more 30% had normal heart; after 35 years of age, the role of ischaemic heart disease increased. In 67% of the people aged 19–25 SOHCD was associated with traces of alcohol (0.3–3.0 promile. Conclusion. The proportion of SOHCD in the Moscow population over all age groups has reached 123.2 per 100000 citizens annually. In the age group 1–45, the prevalence of SOHCD was 22.3 cases per 100000 citizens per year. The risk of SOHCD was greater in males. Possibly the role of alcohol in SOHCD in people older than 20 increased.

  11. Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation

    Folke, Fredrik; Gislason, Gunnar H; Lippert, Freddy; Nielsen, Søren L; Weeke, Peter; Hansen, Morten L; Fosbøl, Emil L; Andersen, Søren; Rasmussen, Søren; Schramm, Tina K; Køber, Lars; Torp-Pedersen, Christian

    2010-01-01

    The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external...... defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations....

  12. Predicting the outcomes for out-of-hospital cardiac arrest patients using multiple biomarkers and suspension microarray assays

    Huang, Chien-Hua; Tsai, Min-Shan; Chien, Kuo-Liong; Chang, Wei-Tien; Wang, Tzung-Dau; Chen, Shyr-Chyr; Ma, Matthew Huei-Ming; Hsu, Hsin-Yun; Chen, Wen-Jone

    2016-01-01

    Predicting the prognosis for cardiac arrest is still challenging. Combining biomarkers from diverse pathophysiological pathways may provide reliable indicators for the severity of injury and predictors of long-term outcomes. We investigated the feasibility of using a multimarker strategy with key independent biomarkers to improve the prediction of outcomes in cardiac arrest. Adult out-of-hospital cardiac arrest patients with sustained return of spontaneous circulation were prospectively enrolled in this study. Blood samples were taken at 2 and 24 hours after cardiac arrest. Suspension microarray assays were used to test 21 different biomarkers. A total of 99 patients were enrolled, 45 of whom survived to hospital discharge. We identified 11 biomarkers that, when combined with clinical variables and factors of APACHE II score and history of arrhythmia, were independent determinants for outcome of in-hospital mortality (concordance = 0.9249, standard error = 0.0779). Three biomarkers combined with APACHE II and age were independent determinants for favorable neurological outcome at hospital discharge (area under the receiver-operator characteristic curve, 0.938; 95% confidence interval, 0.854 ~ 1.0). In conclusion, a systemic multiple biomarker approach using suspension microarray assays can identify independent predictors and model the outcomes of cardiac arrest patients during the post-cardiac arrest period. PMID:27256246

  13. Survival to admission after out-of-hospital cardiac arrest in Seoul, South Korea

    Kim JH

    2014-09-01

    Full Text Available Jin-Hue Kim,1 Tai-Hwan Uhm2 1Department of Emergency Medical Technology, Sun Moon University, Asan-si, Chungnam, South Korea; 2Department of Emergency Medical Services, Eulji University, Seongnam-si, Gyeonggi-do, South Korea Purpose: Out-of-hospital cardiac arrest (OHCA data derived according to the Utstein Style guidelines was used to try to determine factors influencing survival to admission (STA and epidemiological rates of OHCA. Patients and methods: This was an observational study of all age groups based on data from prehospital care reports in Seoul, South Korea. The collected data were reported according to the Utstein Style template for OHCA and analyzed in order to compare STA with non-STA. Univariate analysis was conducted using a binomial logistic regression model to identify predictors associated with trauma patients. Results: Eighty-three (4.8% OHCA survivors were admitted to the emergency department with carotid pulse. The median time from arrest to emergency medical personnel defibrillation was statistically significantly shorter in STA cases (8.0 minutes than in non-STA cases (12.0 minutes; P<0.001. Factors independently associated with better prognosis in terms of trauma patients were female sex (odds ratio [OR]: 0.67; 95% confidence interval [95% CI]: 0.50–0.91; P=0.01, arrest at home (OR: 0.36; 95% CI: 0.27–0.49; P<0.001, and witnessed arrest (OR: 2.64; 95% CI: 1.94–3.39; P<0.001. Conclusion: Early basic life support, performed by either a layperson or emergency medical personnel, had a positive effect on STA. Male sex, arrest outside of the home, and witnessed arrest are significantly associated with trauma. Keywords: Utstein Style, prehospital, defibrillation, basic life support

  14. Population density, call-response interval, and survival of out-of-hospital cardiac arrest

    Ogawa Toshio

    2011-04-01

    Full Text Available Abstract Background Little is known about the effects of geographic variation on outcomes of out-of-hospital cardiac arrest (OHCA. The present study investigated the relationship between population density, time between emergency call and ambulance arrival, and survival of OHCA, using the All-Japan Utstein-style registry database, coupled with geographic information system (GIS data. Methods We examined data from 101,287 bystander-witnessed OHCA patients who received emergency medical services (EMS through 4,729 ambulatory centers in Japan between 2005 and 2007. Latitudes and longitudes of each center were determined with address-match geocoding, and linked with the Population Census data using GIS. The endpoints were 1-month survival and neurologically favorable 1-month survival defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2. Results Overall 1-month survival was 7.8%. Neurologically favorable 1-month survival was 3.6%. In very low-density (2 and very high-density (≥10,000/km2 areas, the mean call-response intervals were 9.3 and 6.2 minutes, 1-month survival rates were 5.4% and 9.1%, and neurologically favorable 1-month survival rates were 2.7% and 4.3%, respectively. After adjustment for age, sex, cause of arrest, first aid by bystander and the proportion of neighborhood elderly people ≥65 yrs, patients in very high-density areas had a significantly higher survival rate (odds ratio (OR, 1.64; 95% confidence interval (CI, 1.44 - 1.87; p Conclusion Living in a low-density area was associated with an independent risk of delay in ambulance response, and a low survival rate in cases of OHCA. Distribution of EMS centers according to population size may lead to inequality in health outcomes between urban and rural areas.

  15. Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

    Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik;

    2013-01-01

    IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine...... temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which...

  16. Choice of hospital after out-of-hospital cardiac arrest - a decision with far-reaching consequences: a study in a large German city

    Wnent, Jan; Seewald, Stephan; Heringlake, Matthias; Lemke, Hans; Brauer, Kirk; Lefering, Rolf; Fischer, Matthias; Jantzen, Tanja; Bein, Berthold; Messelken, Martin; Gräsner, Jan-Thorsten

    2012-01-01

    Introduction Between 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have shown that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA. These data may only be partially transferable to the German medical system where responders are in-field emergency medical physicians. The present study determines the influence of the emergency physician's choice of admittin...

  17. Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: a case of Lazarus phenomenon.

    Kämäräinen, Antti; Virkkunen, Ilkka; Holopainen, Leevi; Erkkilä, Elja-Pekka; Yli-Hankala, Arvi; Tenhunen, Jyrki

    2007-12-01

    This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium. PMID:17629389

  18. Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest

    Hansen, Marco Bo; Lippert, Freddy Knudsen; Rasmussen, Lars Simon;

    2014-01-01

    BACKGROUND: Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable...... rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. METHODS: In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought to the...... emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. RESULTS: A total of 121 AEDs were...

  19. Out-of-hospital cardiac arrests in an urban/rural area during 1991 and 1996 : have emergency medical service changes improved outcome?

    Absalom, AR; Bradley, P; Soar, J

    1999-01-01

    Survival after out-of-hospital cardiac arrest is influenced by pre-hospital emergency medical care. This study compares outcome of cardiac arrest victims presenting to an emergency department serving a mixed urban/rural area (Norfolk, UK) in 1991 with 1996. Between these years the regional emergency

  20. Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

    Edouard Matevossian

    2009-04-01

    angiography. After a 16-day period of hospital convalescence, with preventive implantation of an implantable cardioverter defibrillator and several weeks of rehabilitation, the patient was able to return home with no evidence of health impairment.Keywords: resuscitation, cardiac arrest, cardiac massage, LUCAS

  1. The use of pre-hospital mild hypothermia after resuscitation from out-of-hospital cardiac arrest.

    Kim, Francis; Olsufka, Michele; Nichol, Graham; Copass, Michael K; Cobb, Leonard A

    2009-03-01

    Hypothermia has emerged as a potent neuroprotective modality following resuscitation from cardiac arrest. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling begun immediately following the return of spontaneous circulation may be more beneficial. Cooling in the field following resuscitation, however, presents new challenges, in that the cooling method has to be portable, safe, and effective. Rapid infusion of intravenous fluid at 4 degrees C, the use of a cooling helmet, and cooling plates have all been proposed as methods for field cooling, and are all in various stages of clinical and animal testing. Whether field cooling will improve survival and neurologic outcome remains an important unanswered clinical question. PMID:19072587

  2. Post resuscitation care of out-of-hospital cardiac arrest patients in the Nordic countries: a questionnaire study

    Saarinen, Sini; Castrén, Maaret; Virkkunen, Ilkka; Kämäräinen, Antti

    2015-01-01

    Background Aim of this study was to compare post resuscitation care of out-of-hospital cardiac arrest (OHCA) patients in Nordic (Denmark, Finland, Iceland, Norway, Sweden) intensive care units (ICUs). Methods An online questionnaire was sent to Nordic ICUs in 2012 and was complemented by an additional one in 2014. Results The first questionnaire was sent to 188 and the second one to 184 ICUs. Response rates were 51 % and 46 %. In 2012, 37 % of the ICUs treated all patients resuscitated from O...

  3. Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest

    Winther-Jensen, Matilde; Pellis, Tommaso; Kuiper, Michael;

    2015-01-01

    AIM: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. METHODS AND RESULTS: 950 patients included in the target temperature management (TTM) trial were randomly...... age groups, p = 0.001, the same was true for ST segment elevation on ECG at admission, p < 0.01. Increasing age was associated with a higher mortality rate (HR = 1.04 per year, 95% CI = 1.03-1.06, p < 0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR = 3.5, CI: 2...

  4. Advanced life support therapy and on out-of-hospital cardiac arrest patients: Applying signal processing and pattern recognition methods

    Trygve Eftestøl

    2005-10-01

    Full Text Available In the US alone, several hundred thousands die of sudden cardiac arrests each year. Basic life support defined as chest compressions and ventilations and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest, and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same, but studies show need for more individualiza- tion of treatment. This review will focus on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency, and optimize the sequence and quality of the various components of cardiopulmonary resuscitation.

  5. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian;

    2015-01-01

    in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. METHODS: During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation......BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care...... care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). RESULTS: 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30...

  6. Temporal trends in survival after out-of-hospital cardiac arrest in patients with and without underlying chronic obstructive pulmonary disease

    Møller, Sidsel G.; Rajan, Shahzleen; Folke, Fredrik;

    2016-01-01

    AIM: Survival after out-of-hospital cardiac arrest (OHCA) has tripled during the past decade in Denmark as a likely result of improvements in cardiac arrest management. This study analyzed whether these improvements were applicable for patients with chronic obstructive pulmonary disease (COPD). M...

  7. Out-of hospital cardiac arrest in Okayama city (Japan: outcome report according to the "Utsutein Style".

    Hayashi,Hoei

    2005-04-01

    Full Text Available

    The purpose of this study was to evaluate the outcomes for out-of-hospital cardiac arrest (OHCA and cardiopulmonary resuscitation (CPR in the city of Okayama, Japan, during a 1-year period after the reorganization of defibrillation by Emergency Life-Saving Technicians (ELSTs with standing orders of CPR. The data were collected prospectively according to an Utstein style between June 1, 2003 and May 31, 2004; OHCA was confirmed in 363 patients. Cardiac arrest of presumed cardiac etiology (179 was witnessed by a bystander in 62 (34.6% cases. Of this group, ventricular fibrillation (VF was documented in 20 cases (32.3%, and 1 patient (5% was discharged alive without severe neurological disability. This outcome is average in Japan, but it is quite low level compared with Western countries because there is less VF in Japan. The Utstein style revealed that we must try to detect VF before the rhythm changes and to provide defibrillation as soon as possible in order to improve outcomes. Further research will be required to accurately evaluate OHCA in Okayama city.

  8. Time-differentiated target temperature management after out-of-hospital cardiac arrest

    Kirkegaard, Hans; Rasmussen, Bodil S; de Haas, Inge;

    2016-01-01

    24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to...

  9. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  10. Assessment of the Efficacy of Pulsed Biphasic Defibrillation Shocks for Treatment of Out-of-hospital Cardiac Arrest

    Jean-Philippe Didon

    2008-10-01

    Full Text Available This study evaluates the efficacy of a Pulsed Biphasic Waveform (PBW for treatment of out-of-hospital cardiac arrest (OHCA patients in ventricular fibrillation (VF. Large database (2001-2006, collected with automated external defibrillators (AED, (FRED®, Schiller Medical SAS, France, is processed.In Study1 we compared the defibrillation efficacy of two energy stacks (90-130-180 J vs. (130-130-180 J in 248 OHCA VF patients. The analysis of the first shock PBW efficacy proves that energies as low as 90 J are able to terminate VF in a large proportion of OHCA patients (77% at 5 s and 69% at 30 s. Although the results show a trend towards the benefit of higher energy PBW with 130 J (86% at 5 s, 73% at 30 s, the difference in shock efficacy does not reach statistical significance. Both PBW energy stacks (90-130-180 J and (130-130-180 J achieve equal success rates of defibrillation. Analysis of the post-shock rhythm after the first shock is also provided.For Study2 of 21 patients with PBW shocks (130-130-180 J, we assessed some attending OHCA circumstances: call-to-shock delay (median 16min, range 11-41 min, phone advices of CPR (67%. About 50% of the patients were admitted alive to hospital, and 19% were discharged from hospital. After the first shock, patients admitted to hospital are more often presenting organized rhythm (OR (27% to 55% than patients not admitted (0% to 10%, with significant difference at 15 s and 30 s. Post-shock VFs appear significantly rare until 15s for patients admitted to hospital (0% to 9% than for patients not admitted to hospital (40% to 50%. Return of OR (ROOR and efficacy to defibrillate VF at 5 s and 15 s with first shock are important markers to predict patient admission to hospital.

  11. High resolution ECG-aided early prognostic model for comatose survivors of out of hospital cardiac arrest.

    Rauber, Martin; Štajer, Dušan; Noč, Marko; Schlegel, Todd T; Starc, Vito

    2015-01-01

    Out of hospital cardiac arrest (OHCA) has a high mortality despite modern treatment. Reliable early prognosis in OHCA could significantly improve clinical decision making. We explored prognostic utility of advanced ECG parameters, obtained from high-resolution ECG, in combination with clinical and OHCA-related parameters during treatment with mild induced hypothermia (MIH) and after rewarming in unconscious survivors of OHCA. Ninety-two patients during MIH and 66 after rewarming were included. During MIH, a score based on initial rhythm, QRS-upslope and systolic pressure resulted in an area under curve (AUC) of 0.82 and accuracy of 80% for survival. After rewarming, a score based on admission rhythm, sum of 12 lead QRS voltages, and mean lateral ST segment level in leads I and V6 resulted in an AUC of 0.88 and accuracy of 85% for survival. ECG can assist with early prognostication in unconscious survivors of OHCA during MIH and after rewarming. PMID:25911585

  12. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig;

    2016-01-01

    -hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition of...... myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence...... intervention was successful in 68% versus 36% (P<0.001) of STE compared to no STE patients. No significant difference was found in 180-day mortality rates between STE and no STE patients (36% vs. 30%, Plogrank=0.37). CONCLUSION: The pre-hospital ROSC-ECG is a suboptimal diagnostic tool to predict STEMI and...

  13. Trends in Outcomes for Out-of-Hospital Cardiac Arrest by Age in Japan: An Observational Study.

    Fukuda, Tatsuma; Ohashi-Fukuda, Naoko; Matsubara, Takehiro; Doi, Kent; Kitsuta, Yoichi; Nakajima, Susumu; Yahagi, Naoki

    2015-12-01

    Population aging has rapidly advanced throughout the world and the elderly accounting for out-of-hospital cardiac arrest (OHCA) has increased yearly.We identified all adults who experienced an out-of-hospital cardiac arrest in the All-Japan Utstein Registry of the Fire and Disaster Management Agency, a prospective, population-based clinical registry, between 2005 and 2010. Using multivariable regression, we examined temporal trends in outcomes for OHCA patients by age, as well as the influence of advanced age on outcomes. The primary outcome was a favorable neurological outcome at 1 month after OHCA.Among 605,505 patients, 454,755 (75.1%) were the elderly (≥65 years), and 154,785 (25.6%) were the oldest old (≥85 years). Although neurological outcomes were worse as the age group was older (P < 0.0001 for trend), there was a significant trend toward improved neurological outcomes during the study period by any age group (P < 0.005 for trend). After adjustment for temporal trends in various confounding variables, neurological outcomes improved yearly in all age groups (18-64 years: adjusted OR per year 1.15 [95% CI 1.13-1.18]; 65-84 years: adjusted OR per year 1.12 [95% CI 1.10-1.15]; and ≥85 years: adjusted OR per year 1.08 [95% CI 1.04-1.13]). Similar trends were found in the secondary outcomes.Although neurological outcomes from OHCA ware worse as the age group was older, the rates of favorable neurological outcomes have substantially improved since 2005 even in the elderly, including the oldest old. Careful consideration may be necessary in limiting treatment on OHCA solely for the reason of advanced age. PMID:26656330

  14. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community

    Folke, Fredrik

    2010-01-01

    INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibril...

  15. Five-year Outcome after Coronary Artery Bypass Surgery in Survivors of Out-of-Hospital Cardiac Arrest

    Matti-Aleski eMosorin

    2015-01-01

    Full Text Available Objective: The aim of this study is to evaluate the role of coronary artery bypass grafting (CABG in patients with out-of-hospital cardiac arrest (OHCA.Methods: The immediate and 5-year outcome after CABG of a consecutive series of 48 patients who survived OHCA were compared with those of control patients having had a recent myocardial infarction without ventricular arrhythmias.Results: All OHCA patients were found to have suffered myocardial infarction-related cardiac arrest. The mean delay from OHCA to CABG was 10.3±13.0 days. Despite not statistically significant, the risk of 30-day postoperative mortality was higher among OHCA patients than control patients (6.3% vs. 0%, p=0.24, propensity score adjusted analysis: p=1.00. Cardioverter defibrillator was implanted in two patients who were alive 3.8 and 4.4 years after CABG, respectively. At 5-year the overall survival rate was 80.7% in OHCA patients and 84.5% in control patients (p=0.98, propensity score adjusted analysis: p=0.87, and survival freedom from fatal cardiac event was 86.1% in OHCA patients and 86.5% in control patients (p=0.61; propensity score adjusted analysis: p=0.90. Conclusions: Early and 5-year survival rates after CABG in OHCA patients are excellent even when cardioverter defibrillator is very selectively implanted. Such good early and intermediate results observed after CABG suggest a confident approach toward surgical revascularization also in this critically ill patient population.

  16. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

    Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian;

    2016-01-01

    of spontaneous circulation (ROSC). METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by...... emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes. FINDINGS: Median time from CPR initiation to ROSC was 12min (IQR: 7-18) while 20.4% achieved ROSC after >25min. Overall, 37.......5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21...

  17. Adverse events associated with poor neurological outcome during targeted temperature management and advanced critical care after out-of-hospital cardiac arrest

    Kim, Young-Min; Youn, Chun Song; Kim, Soo Hyun; Lee, Byung Kook; Cho, In Soo; Cho, Gyu Chong; Jeung, Kyung Woon; Oh, Sang Hoon; Choi, Seung Pill; Shin, Jong Hwan; Cha, Kyoung-Chul; Oh, Joo Suk; Yim, Hyeon Woo; Park, Kyu Nam; ,

    2015-01-01

    Introduction The aim of this study was to investigate the association of adverse events (AEs) during targeted temperature management (TTM) and other AEs and concomitant treatments during the advanced critical care period with poor neurological outcome at hospital discharge in adult out-of-hospital cardiac arrest (OHCA) patients. Methods This was a retrospective study using Korean Hypothermia Network registry data of adult OHCA patients treated with TTM in 24 teaching hospitals throughout Sout...

  18. Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls

    Storm, Christian; Steffen, Ingo; Schefold, Joerg C.; Krueger, Anne; Oppert, Michael; Jörres, Achim; Hasper, Dietrich

    2008-01-01

    Introduction Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implications. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients. In this analysis, we investigate whether therapeutic hypothermia influences the length of intensive care unit (ICU) stay and ventilator time in patients surviving out-of-hospital cardiac arrest. Methods A prospective observational study with historical controls was conducted at ...

  19. Decreased Monocyte HLA-DR Expression in Patients After Non-Shockable out-of-Hospital Cardiac Arrest.

    Venet, Fabienne; Cour, Martin; Demaret, Julie; Monneret, Guillaume; Argaud, Laurent

    2016-07-01

    Out-of-hospital cardiac arrest (OHCA) constitutes a major health care problem with the development in immediate survivors of a post-cardiac arrest syndrome including systemic inflammatory response as observed in sepsis. As a decreased monocyte HLA-DR expression (mHLA-DR) has been repeatedly described in septic patients in association with an increased risk of death and nosocomial infections, we tested whether this immune alteration could also be observed after OHCA. Fifty-five non-shockable OHCA patients sampled at Day 0 (D0: within 4 h after OHCA), D1 (the next day), and D3: (after 2 additional days) were included. CD4+ lymphocyte count and mHLA-DR were evaluated by flow cytometry. We observed a marked decrease in mHLA-DR as early as D0 in patients compared with normal values. This decrease persisted till D3 and was associated with a moderate decrease in the number of circulating CD4+ lymphocytes. No correlations were identified between mHLA-DR and usual prognostic markers after OHCA. However, overtime evolution in mHLA-DR values appeared different between survivors and non-survivors with a quasisystematic decrease between D1 and D3 in non-survivors versus an increased expression in survivors. In conclusion, this preliminary pilot study describes the occurrence of OHCA-induced immune alterations as illustrated by a decreased mHLA-DR and CD4+ lymphopenia. Furthermore, we show for the first time the differential overtime evolution in mHLA-DR between survivors and non-survivors without association with usual prognostic markers and multiple organ failure. These initial results should now be confirmed in a larger cohort of OHCA patients. PMID:26796574

  20. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

  1. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...

  2. Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival

    Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta;

    2015-01-01

    BACKGROUND: Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS: Using data from the n...

  3. Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino

    Mauri, Romano; Burkart, Roman; Benvenuti, Claudio; Caputo, Maria Luce; Moccetti, Tiziano; Del Bufalo, Alessandro; Gallino, Augusto; Casso, Carlo; Anselmi, Luciano; Cassina, Tiziano; Klersy, Catherine; Auricchio, Angelo

    2015-01-01

    Aim To determine the incidence of out-of-hospital cardiac arrest (OHCA) fulfilling Utstein criteria in the Canton Ticino, Switzerland, the survival rate of OHCA patients and their neurological outcome. Methods and results All OHCAs treated in Canton Ticino between 1 January 2005 and 31 December 2014 were followed until either death or hospital discharge. The survival and neurological outcome of those OHCA fulfilling Utstein criteria are reported. A total of 3367 OHCAs occurred in the Canton T...

  4. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C

    Lilja, Gisela; Nielsen, Niklas; Friberg, Hans;

    2015-01-01

    cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ (P>0.30) between the 2 temperature groups (33°C/36°C). Compared with control subjects with ST-segment-elevation myocardial infarction......BACKGROUND: Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim of this...... study was to evaluate whether a target temperature of 33°C compared with 36°C was favorable for cognitive function; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general. METHODS AND RESULTS: Study sites included 652 cardiac arrest survivors originally randomized...

  5. Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

    Akihito Hagihara

    Full Text Available The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables. In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates; 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates; cerebral performance category (1 or 2: OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates; and overall performance category (1 or 2: OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates. A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with

  6. Systemic Inflammatory Response and Potential Prognostic Implications After Out-of-Hospital Cardiac Arrest: A Substudy of the Target Temperature Management Trial

    Bro-Jeppesen, John; Kjaergaard, Jesper; Wanscher, Michael;

    2015-01-01

    -1β, interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-9, interleukin-10, interleukin-12, interleukin-13, tumor necrosis factor-α, interferon-γ, C-reactive protein, and procalcitonin were measured. Mortality at 30 days was evaluated by Cox analysis, and the predictive capability...... of inflammatory markers was evaluated by area under the curve. Level of all inflammatory markers changed significantly within 72 hours after out-of-hospital cardiac arrest (all p values<0.001), but only procalcitonin levels showed overall differences between nonsurvivors and survivors (p=0.0002). At...... baseline, interleukin-6 was independently associated with mortality, whereas both interleukin-6 levels (hazard ratio=1.23 [1.01-1.49]; p=0.04) and procalcitonin levels (hazard ratio=1.20 [1.03-1.39]; p=0.02) 24 hours after out-of-hospital cardiac arrest were associated with 30-day mortality with no...

  7. Target Temperature Management after out-of-hospital cardiac arrest--a randomized, parallel-group, assessor-blinded clinical trial--rationale and design

    Nielsen, Niklas; Wetterslev, Jørn; al-Subaie, Nawaf;

    2012-01-01

    Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32°C to 34°C for 12 to 24 hours after resuscitation...... from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia in the...... control groups. The optimal target temperature management strategy is not known....

  8. Early-Onset Pneumonia in Non-Traumatic Out-of-Hospital Cardiac Arrest Patients with Special Focus on Prehospital Airway Management.

    Christ, Martin; von Auenmueller, Katharina Isabel; Amirie, Scharbanu; Sasko, Benjamin Michel; Brand, Michael; Trappe, Hans-Joachim

    2016-01-01

    BACKGROUND More than half of all non-traumatic out-of-hospital cardiac arrest (OHCA) patients die in the hospital. Early-onset pneumonia (EOP) has been described as one of the most common complications after successful cardiopulmonary resuscitation. However, the expanded use of alternative airway devices (AAD) might influence the incidence of EOP following OHCA. MATERIAL AND METHODS We analyzed data from all OHCA patients admitted to our hospital between 1 January 2008 and 31 December 2014. EOP was defined as proof of the presence of a pathogenic microorganism in samples of respiratory secretions within the first 5 days after hospital admission. RESULTS There were 252 patients admitted: 155 men (61.5%) and 97 women (38.5%), with a mean age of 69.1±13.8 years. Of these, 164 patients (77.6%) were admitted with an endotracheal tube (ET) and 62 (27.4%) with an AAD. We found that 36 out of a total of 80 respiratory secretion samples (45.0%) contained pathogenic microorganisms, with Staphylococcus aureus as the most common bacteria. Neither bacterial detection (p=0.765) nor survival rates (p=0.538) differed between patients admitted with ET and those with AAD. CONCLUSIONS Irrespective of increasing use of AAD, the incidence of EOP remains high. PMID:27295123

  9. Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm

    Frydland, Martin; Kjaergaard, Jesper; Erlinge, David;

    2015-01-01

    PURPOSE: Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia...... in comatose patient resuscitated from NSR. METHODS: Hundred and seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral...... prognosis. We found no effect of targeted temperature management at 33°C compared to 36°C in these patients....

  10. Sex and Age Aspects in Patients Suffering From Out-Of-Hospital Cardiac Arrest: A Retrospective Analysis of 760 Consecutive Patients.

    Piegeler, Tobias; Thoeni, Nils; Kaserer, Alexander; Brueesch, Martin; Sulser, Simon; Mueller, Stefan M; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt

    2016-05-01

    Cardiopulmonary resuscitation (CPR) is indicated in patients suffering from out-of-hospital cardiac arrest. Several studies suggest a sex- and age-based bias in the treatment of these patients. This particular bias may have a significant impact on the patient's outcome. However, the reasons for these findings are still unclear and discussed controversially. Therefore, the aim of this study was to retrospectively analyze treatment and out-of-hospital survival rates for potential sex- and age-based differences in patients requiring out-of-hospital CPR provided by an emergency physician in the city of Zurich, Switzerland.A total of 3961 consecutive patients (2003-2009) were included in this retrospective analysis to determine the frequency of out-of-hospital CPR and prehospital survival rate, and to identify potential sex- and age-based differences regarding survival and treatment of the patients.Seven hundred fifty-seven patients required CPR during the study period. Seventeen patients had to be excluded because of incomplete or inconclusive documentation, resulting in 743 patients (511 males, 229 females) undergoing further statistical analysis. Female patients were significantly older, compared with male patients (68 ± 18 [mean ± SD] vs 64 ± 18 years, P = .012). Men were resuscitated slightly more often than women (86.4% vs 82.1%). Overall out-of-hospital mortality rate was found to be 81.2% (492/632 patients) with no differences between sexes (82.1% for males vs 79% for females, odds ratio 1.039, 95% confidence interval 0.961-1.123). No sex differences were detected in out-of-hospital treatment, as assessed by the different medications administered, initial prehospital Glasgow Coma Scale, and prehospital suspected leading diagnosis.The data of our study demonstrate that there was no sex-based bias in treating patients requiring CPR in the prehospital setting in our physician-led emergency ambulance service. PMID:27149475

  11. No fate but what we make: a case of full recovery after out-of-hospital cardiac arrest

    Andrade Maria J

    2009-12-01

    Full Text Available Abstract An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on revaluation, the victim had pulse and spontaneous breathing. Thirty minutes later, the patient had been transferred to an emergency department. As he complained of chest pain, the ECG showed a ST segment depression in leads V4 to V6 and laboratorial tests showed cardiac troponine I slightly elevated. A coronary angiography was performed urgently: significant left main plus three vessel coronary artery disease was disclosed. Eighteen hours after the cardiac arrest, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the middle left anterior descendent artery. Post-operative course was uneventful and the patient was discharged seven days after the procedure. Twenty four months later, he remains asymptomatic. In this case, the immediate call for the Advanced Life Support team, prompt basic life support and the successful defibrillation, altogether, contributed for the full recovery. Furthermore, the swiftness in the detection and treatment of the acute reversible cause (myocardial ischemia in this case was crucial for long-term prognosis.

  12. Outcome in transferred and nontransferred patients after primary percutaneous coronary intervention for ischaemic out-of-hospital cardiac arrest

    Peels, Hans O.; Jessurun, Gillian A. J.; van der Horst, Iwan C. C.; Arnold, Alfons E. R.; Piers, Lieuwe H.; Zijlstra, Felix

    2008-01-01

    Objective: To evaluate the impact of transfer from a referral hospital to a center with primary percutaneous coronary intervention (PCI) facilities of ST-segment elevation myocardial infarction (STEMI) patients after successful cardiopulmonary resuscitation (CPR). Methods: We studied all STEMI patie

  13. Serum Potassium Changes During Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest-Should It Be Treated?

    Soeholm, Helle; Kirkegaard, Hans

    2012-01-01

    value of 4.0 mmol/L (quartiles 3.6-4.5 mmol/L) to a nadir of 3.6 mmol/L (3.5-3.9 mmol/L) 6 hours after target temperature (p=0.005), and 76% reached values of <3.5 mmol/L. During rewarming, serum potassium increased, with 15% reaching values of >5.5 mmol/L. Potassium supplementation was initiated at 3...... disadvantages of potassium supplementation are discussed. Methods: Fifty-four consecutive patients suffering from OHCA and treated with TH (32-34°C) for 24 hours at one University Hospital were included and followed for 48 hours. Results: Serum potassium levels decreased during cooling from a median admission...

  14. The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan--a nationwide population-based study.

    Cheng-Yi Wang

    Full Text Available This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA, as well as factors associated with OHCA outcomes in Taiwan.Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression.There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 180-day mortality rates had a long-term decreasing trend over the period (p<0.01. For both incidence and mortality rates, a significant second-order autoregressive effect emerged. Among OHCA patients with MV, 1-day, 30-day and 180-day mortality rates were 31.3%, 75.8%, and 86.0%, respectively. In this cohort, older age, the female gender, and a Charlson comorbidity index score ≥ 2 were associated with higher 180-day mortality; patients delivered to regional hospitals and those residing in non-metropolitan areas had higher death risk.Overall, both the 30-day and the 180-day mortality rates after OHCA had a long-term decreasing trend, while the 1-day mortality had no long-term decline. Among OHCA patients requiring MV, those delivered to regional hospitals and those residing in non-metropolitan areas tended to have higher mortality, suggesting a need for effort to further standardize and improve in-hospital care across hospitals and to advance pre-hospital care in non

  15. Targeted Temperature Management at 33°C Versus 36°C and Impact on Systemic Vascular Resistance and Myocardial Function After Out-of-Hospital Cardiac Arrest

    Bro-Jeppesen, John; Hassager, Christian; Wanscher, Michael;

    2014-01-01

    BACKGROUND: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest as part of the postcardiac arrest syndrome, and hypothermia may pose additional impact on hemodynamics. The aim was to investigate systemic vascular resistance index (SVRI), cardiac index, and myocardial perform...... because of lower heart rate with unaffected left ventricular systolic function compared with 36°C. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01020916....

  16. Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study

    Steen Petter

    2009-02-01

    Full Text Available Abstract Background One of the factors that limits survival from out-of-hospital cardiac arrest is the interruption of chest compressions. During ventricular fibrillation and tachycardia the electrocardiogram reflects the probability of return of spontaneous circulation associated with defibrillation. We have used this in the current study to quantify in detail the effects of interrupting chest compressions. Methods From an electrocardiogram database we identified all intervals without chest compressions that followed an interval with compressions, and where the patients had ventricular fibrillation or tachycardia. By calculating the mean-slope (a predictor of the return of spontaneous circulation of the electrocardiogram for each 2-second window, and using a linear mixed-effects statistical model, we quantified the decline of mean-slope with time. Further, a mapping from mean-slope to probability of return of spontaneous circulation was obtained from a second dataset and using this we were able to estimate the expected development of the probability of return of spontaneous circulation for cases at different levels. Results From 911 intervals without chest compressions, 5138 analysis windows were identified. The results show that cases with the probability of return of spontaneous circulation values 0.35, 0.1 and 0.05, 3 seconds into an interval in the mean will have probability of return of spontaneous circulation values 0.26 (0.24–0.29, 0.077 (0.070–0.085 and 0.040(0.036–0.045, respectively, 27 seconds into the interval (95% confidence intervals in parenthesis. Conclusion During pre-shock pauses in chest compressions mean probability of return of spontaneous circulation decreases in a steady manner for cases at all initial levels. Regardless of initial level there is a relative decrease in the probability of return of spontaneous circulation of about 23% from 3 to 27 seconds into such a pause.

  17. Combining Amplitude Spectrum Area with Previous Shock Information Using Neural Networks Improves Prediction Performance of Defibrillation Outcome for Subsequent Shocks in Out-Of-Hospital Cardiac Arrest Patients.

    Mi He

    Full Text Available Quantitative ventricular fibrillation (VF waveform analysis is a potentially powerful tool to optimize defibrillation. However, whether combining VF features with additional attributes that related to the previous shock could enhance the prediction performance for subsequent shocks is still uncertain.A total of 528 defibrillation shocks from 199 patients experienced out-of-hospital cardiac arrest were analyzed in this study. VF waveform was quantified using amplitude spectrum area (AMSA from defibrillator's ECG recordings prior to each shock. Combinations of AMSA with previous shock index (PSI or/and change of AMSA (ΔAMSA between successive shocks were exercised through a training dataset including 255shocks from 99patientswith neural networks. Performance of the combination methods were compared with AMSA based single feature prediction by area under receiver operating characteristic curve(AUC, sensitivity, positive predictive value (PPV, negative predictive value (NPV and prediction accuracy (PA through a validation dataset that was consisted of 273 shocks from 100patients.A total of61 (61.0% patients required subsequent shocks (N = 173 in the validation dataset. Combining AMSA with PSI and ΔAMSA obtained highest AUC (0.904 vs. 0.819, p<0.001 among different combination approaches for subsequent shocks. Sensitivity (76.5% vs. 35.3%, p<0.001, NPV (90.2% vs. 76.9%, p = 0.007 and PA (86.1% vs. 74.0%, p = 0.005were greatly improved compared with AMSA based single feature prediction with a threshold of 90% specificity.In this retrospective study, combining AMSA with previous shock information using neural networks greatly improves prediction performance of defibrillation outcome for subsequent shocks.

  18. Out-of-hospital cardiopulmonary arrest due to penetrating cardiac injury treated by percutaneous cardiopulmonary support in the emergency room: report of a case.

    Kurimoto, Yoshihiko; Kano, Hitoshi; Yama, Naoya; Nara, Satoshi; Hase, Mamoru; Asai, Yasufumi

    2007-01-01

    Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients. PMID:17342366

  19. Out-of-Hospital therapeutic hypothermia. A Systematic Review

    María Nélida Conejo Pérez

    2012-07-01

    Full Text Available Recent studies have demonstrated therapeutic mild hypothermia improves neurological outcome of patients after suffering an out-of-hospital cardiac arrest.Other studies in animals suggest that the sooner hypothermia is started after return of spontaneous circulation, the lower neurological symptoms are suffered by patients.The aim of this work is to know the efficiency of the therapeutic moderated hipotermia after the cardiopulmonar resuscitation realized extra hospitable.Methods: We made a literature search in Medline (Pubmed, Cinahl, Cuiden, Cochrane Library and the Joanna Briggs Institute, combining mesh and free terms; and searched in the journals Circulation, Resuscitation and Emergency Medicine Journal manually last year. We selected systematic reviews and randomized and nonrandomized clinical trials which had contrasted in-hospital and out-of-hospital TMH with over 18 years patients.Results: Only 5 articles met the inclusion criteria of the 35 selected: four randomized clinical trials and one nonrandomized. They were then subjected to a critical methodological evaluation (CASPe and statistic evaluation (IDIPaz.Conclusions: Pre hospital TMH is an effective and safe technique in comatose patients after being resuscitated from cardiac arrest, improving the neurological status at hospital discharge.

  20. Airmed-cardio: a GSM and Internet services-based system for out-of-hospital follow-up of cardiac patients.

    Salvador, Carlos H; Pascual Carrasco, Mario; Gonzalez de Mingo, Miguel A; Muñoz Carrero, Adolfo; Márquez Montes, Joaquin; Sosa Martín, Luis; Cavero, Miguel A; Fernández Lozano, Ignacio; Monteagudo, José Luis

    2005-03-01

    A platform built around three information entities (patient, health-care_agent, and central_station) was designed to enable patients with chronic heart disease (in stable condition; emergency situations were excluded deliberately) to complete specifically defined protocols for out-of-hospital follow-up and monitoring. The patients belonged to one of four specific risk groups: arterial hypertension, malignant arrhythmias, heart failure, and postinfarction rehabilitation. They were provided with portable recording equipment and a cellular phone that supported data transmission [electrocardiogram (ECG)] and wireless application protocol (WAP) (remaining parameters and ad hoc questionnaires). The central station was an automatized platform, with no human operator. The information received was organized chronologically in patient folders. The health-care_agents had continuous and secure access to the patient folders, through tools based on the world wide web and WAP, and to short messages sent by their patients. A pilot project was conducted with 89 patients (mean length of participation: 50.1 days). A total of 2168 ECGs (mean duration transmission = 2 min/30 s; network errors failures < 0.1%) were The functionality of the platform was also evaluated, analyzing the subjective component of usability, showing the evolution of patient acceptance over time. PMID:15787010

  1. Aetiologies of pulseless electrical activity in out-of-hospital cardiac arrests:A retrospective study and analysis of specific causes

    Beun, L

    2014-01-01

    Background: Pulseless electrical activity (PEA) cardiac arrest is defined as a cardiac arrest (CA) presenting with a residual organized electrical activity on the electrocardiogram. In the last decades, the incidence of PEA has regularly increased, compared to other types of CA like ventricular fibrillation or pulseless ventricular tachycardia. PEA is frequently induced by reversible conditions. The "4 (or 5) H" & "4 (or 5) T" are proposed as a mnemonic to asses for Hypoxia, Hypovolemia, ...

  2. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial

    Wik, L.; Olsen, J.A.; Persse, D.; Sterz, F.; Lozano Jr, M.; Brouwer, M.A.; Westfall, M.; Souders, C.M.; Malzer, R.; Grunsven, P.M. van; Travis, D.T.; Whitehead, A.; Herken, U.R.; Lerner, E.B.

    2014-01-01

    OBJECTIVE: To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge. METHODS: Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group s

  3. Combining multiple ECG features does not improve prediction of defibrillation outcome compared to single features in a large population of out-of-hospital cardiac arrests

    He, Mi; Gong, Yushun; Li, Yongqin; Mauri, Tommaso; Fumagalli, Francesca; Bozzola, Marcella; Cesana, Giancarlo; Latini, Roberto; Pesenti, Antonio; Ristagno, Giuseppe

    2015-01-01

    Introduction Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of the metabolic milieu of the myocardium during resuscitation and is a potentially useful tool to optimize the defibrillation strategy. However, whether combining multiple ECG features can improve the capability of defibrillation outcome prediction in comparison to single feature analysis is still uncertain. Methods A total of 3828 defibrillations from 1617 patients who experienced out-of...

  4. Sympathoadrenal activation and endothelial damage are inter correlated and predict increased mortality in patients resuscitated after out-of-hospital cardiac arrest. a post Hoc sub-study of patients from the TTM-trial.

    Pär I Johansson

    Full Text Available Sympathoadrenal activation and endothelial damage are hallmarks of acute critical illness. This study investigated their association and predictive value in patients resuscitated from out-of-hospital cardiac arrest (OHCA.Post-hoc analysis of patients included at a single site in The Targeted Temperature Management at 33 degrees versus 36 degrees after Cardiac Arrest (TTM trial. The main study reported similar outcomes with targeting 33 versus 36 degrees. TTM main study ClinicalTrials.gov: NCT01020916. One hundred sixty three patients resuscitated from OHCA were included at a single site ICU. Blood was sampled a median 135 min (Inter Quartile Range (IQR 103-169 after OHCA. Plasma catecholamines (adrenaline, noradrenaline and serum endothelial biomarkers (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin were measured at admission (immediately after randomization. We had access to data on demography, medical history, characteristics of the OHCA, patients and 180-day outcome.Adrenaline and noradrenaline correlated positively with syndecan-1 and thrombomodulin i.e., biomarkers reflecting endothelial damage (both p<0.05. Overall 180-day mortality was 35%. By Cox analyses, plasma adrenaline, serum sE-selectin, reflecting endothelial cell activation, and thrombomodulin levels predicted mortality. However, thrombomodulin was the only biomarker independently associated with mortality after adjusting for gender, age, rhythm (shockable vs. non-shockable, OHCA to return of spontaneous circulation (ROSC time, shock at admission and ST elevation myocardial infarction (30-day Hazards Ratio 1.71 (IQR 1.05-2.77, p=0.031 and 180-day Hazards Ratio 1.65 (IQR 1.03-2.65, p=0.037 for 2-fold higher thrombomodulin levels.Circulating catecholamines and endothelial damage were intercorrelated and predicted increased mortality. Interventions aiming at protecting and/or restoring the endothelium may be beneficial in OHCA patients.

  5. Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after out-of-hospital cardiac arrest%介入与溶栓疗法救治院外心脏骤停的比较

    李颖庆; 柳娜; 胡春林; 魏红艳; 李慧; 李欣; 廖晓星

    2013-01-01

    目的 汇集有关ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)所致院外心脏骤停(out-of-hospital cardiac arrest,OHCA)的文献,分别对冠脉介入(percutaneous coronary intervention,PCI)与静脉溶栓在自主循环恢复(return of spontaneous circulation,ROSC)后患者中的疗效进行比较;通过揭示两种疗法对此阶段患者存活出院及神经功能恢复方面的作用,明确ROSC阶段治疗的重要性,以期指导对由STEMI所致OHCA患者的救治.方法 本研究通过查询PUBMED和MEDLINE数据库,对1995年1月至2011年10月间的有关STEMI所致OHCA的研究文献进行了回顾性分析,以获得ROSC的OHCA患者为研究对象,相关患者的存活出院率和神经功能良好率作为此项研究的评判标准.共有18篇文献纳入此项研究,由于Meta分析必须是同期对照性研究,笔者将同一队列研究中获得ROSC后接受PCI的患者作为治疗组、拒绝PCI的患者作为对照组;与之相应,接受静脉溶栓的患者作为治疗组、拒绝静脉溶栓的患者作为对照组;然后,利用Review Manager 5.1软件对各自相应的治疗组与对照组间进行Meta分析.此外,也对PCI与静脉溶栓两种疗法对此类患者的出院率及神经功能良好率间的差异,采用Pearson x2进行比较.结果 在由STEMI所致OHCA的患者中,Meta分析显示了对ROSC后患者的存活出院率方面PCI[OR(odds ratio,优势比),1.65; 95%CI(confidence interval,可信区间),1.05-2.59,P<0.01]与静脉溶栓(OR,2.03; 95%CI,1.24 ~3.34,P<0.01)明显优于各自的对照组;总体比较中,静脉溶栓与PCI在此类患者的存活出院率(63.00%vs.65.19%,P=0.548)及神经功能恢复率(88.62% vs.91.25%,P=0.351)方面具有相似的结果.结论 对STEMI所致的OHCA患者,在ROSC后进行PCI或静脉溶栓能够提高存活出院率;静脉溶栓在救治此类患者中具有与PCI同等的效益.%Objective To evaluate the effect of percutaneous

  6. Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation

    Theodore Kapadohos

    2015-10-01

    Full Text Available Sudden cardiac arrest is one of the leading causes of death in Europe. Bystanders’ early Cardio-Pulmonary Resuscitation (CPR may double or triple survival rates of out-of-hospital cardiac arrest victims. Aim: To investigate nurses’ attitude, in starting or not CPR and also the most frequent reasons that deter them from engaging in. Materials and Methods: The study had a sample of 177 nurses and assistant nurses that were working in nine hospitals of Athens. Nurses filled out the same, predetermined questionnaire, voluntarily and anonymously. The collected answers were analyzed with the help of the statistical program SPSS v.16, using x2 and Kendall’s Tau-B methods. Results: From 177 participants, 78% (137 were women and 22% (40 men with mean age 31 years (±7. According to their education, 16% (28 were Assistant Nurses, 79% (140 Registered Nurses (ATEI, AEI and 5% (9 Nurses had an MSc diploma. Nurses that had been recently trained in certified BLS courses felt more confident and were more willing to start CPR in a known victim (p=0.004 and in an unknown victim (p=0.02 comparing to nurses that had been trained a long time ago or never. Most frequent reasons nurses reported that deter them from starting CPR are the fear of a possible lawsuit (43%, the fear of harming instead of helping (30% and the fear of infectious transmission from victim to rescuer (15%. The fear of harming correlates considerably with lower ages (the younger the nurse the more is afraid, p=0.04 and also correlates substantially with the training in a certified CPR course (the more a nurse is trained, the less is afraid, p<0.001. Accordingly, the fear of infection diminishes as long as the CPR training is repeated (p=0.03. Conclusions: According to the results, there is a necessity of continuous education and re-education of nurses, in certified Basic Life Support programs. With frequent and specialized training, nurses will show more willingness to engage in an out-of-hospital

  7. Successful out-of-hospital defibrillation for ventricular fibrillation complicating solvent abuse.

    Nee, P A; Llewellyn, T; Pritty, P E

    1990-01-01

    The Authors describe the case history of a child who suffered a cardiac arrest with ventricular fibrillation after deliberate inhalation of 1,1,1-Trichloroethane in typewriter correction fluid thinners. Successful out-of-hospital defibrillation was carried out and the patient made a full recovery. The literature relating to this particular form of volatile substance abuse is reviewed.

  8. Depression Detection in Hospitalized Cardiac Patients

    Geddes, Martine S.

    2010-01-01

    Depression has been shown to increase an individual's risk for heart disease. Despite this finding, physicians are not identifying depression in their hospitalized cardiac patients. This study looked at hospitalized cardiac patients and determined whether their physicians were identifying depression in those that scored > 5 on the PHQ-9 depression inventory. Methods included assessing patient depression during their stay at an intensive care unit using the PHQ-9. Those patients scoring > ...

  9. Hospital Variation in Survival After In‐hospital Cardiac Arrest

    Merchant, Raina M.; Berg, Robert A.; Yang, Lin; Becker, Lance B.; Groeneveld, Peter W.; Chan, Paul S.; ,

    2014-01-01

    Background In‐hospital cardiac arrest (IHCA) is common and often fatal. However, the extent to which hospitals vary in survival outcomes and the degree to which this variation is explained by patient and hospital factors is unknown. Methods and Results Within Get with the Guidelines‐Resuscitation, we identified 135 896 index IHCA events at 468 hospitals. Using hierarchical models, we adjusted for demographics comorbidities and arrest characteristics (eg, initial rhythm, etiology, arrest locat...

  10. Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

    Stammet, Pascal; Collignon, Olivier; Hassager, Christian; Wise, Matthew P; Hovdenes, Jan; Åneman, Anders; Horn, Janneke; Devaux, Yvan; Erlinge, David; Kjaergaard, Jesper; Gasche, Yvan; Wanscher, Michael; Cronberg, Tobias; Friberg, Hans; Wetterslev, Jørn; Pellis, Tommaso; Kuiper, Michael; Gilson, Georges; Nielsen, Niklas

    2015-01-01

    BACKGROUND: Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperatu...

  11. Hospital Variation in Survival After In‐hospital Cardiac Arrest

    Merchant, Raina M.; Berg, Robert A.; Yang, Lin; Becker, Lance B.; Groeneveld, Peter W.; Chan, Paul S.

    2014-01-01

    Background In‐hospital cardiac arrest (IHCA) is common and often fatal. However, the extent to which hospitals vary in survival outcomes and the degree to which this variation is explained by patient and hospital factors is unknown. Methods and Results Within Get with the Guidelines‐Resuscitation, we identified 135 896 index IHCA events at 468 hospitals. Using hierarchical models, we adjusted for demographics comorbidities and arrest characteristics (eg, initial rhythm, etiology, arrest location) to generate risk‐adjusted rates of in‐hospital survival. To quantify the extent of hospital‐level variation in risk‐adjusted rates, we calculated the median odds ratio (OR). Among study hospitals, there was significant variation in unadjusted survival rates. The median unadjusted rate for the bottom decile was 8.3% (range: 0% to 10.7%) and for the top decile was 31.4% (28.6% to 51.7%). After adjusting for 36 predictors of in‐hospital survival, there remained substantial variation in rates of in‐hospital survival across sites: bottom decile (median rate, 12.4% [0% to 15.6%]) versus top decile (median rate, 22.7% [21.0% to 36.2%]). The median OR for risk‐adjusted survival was 1.42 (95% CI: 1.37 to 1.46), which suggests a substantial 42% difference in the odds of survival for patients with similar case‐mix at similar hospitals. Further, significant variation persisted within hospital subgroups (eg, bed size, academic). Conclusion Significant variability in IHCA survival exists across hospitals, and this variation persists despite adjustment for measured patient factors and within hospital subgroups. These findings suggest that other hospital factors may account for the observed site‐level variations in IHCA survival. PMID:24487717

  12. Neurologic Function and Health-Related Quality of Life in Patients Following Targeted Temperature Management at 33°C vs 36°C After Out-of-Hospital Cardiac Arrest

    Cronberg, Tobias; Lilja, Gisela; Horn, Janneke;

    2015-01-01

    from analysis for a total sample size of 939. INTERVENTIONS: Targeted temperature management at 33°C vs 36°C. MAIN OUTCOMES AND MEASURES: Cognitive function was measured by the Mini-Mental State Examination (MMSE) and assessed by observers through the Informant Questionnaire on Cognitive Decline in the...... Elderly (IQCODE). Patients reported their activities in daily life and mental recovery through Two Simple Questions and their quality of life through the Medical Outcomes Study 36-Item Short Form Health Survey, version 2. RESULTS: In the modified intent-to-treat population, including nonsurvivors, the...... summary score was 46.8 (13.8) and 47.5 (13.8) (P = .45), comparable to the population norm. CONCLUSIONS AND RELEVANCE: Quality of life was good and similar in patients with cardiac arrest receiving targeted temperature management at 33°C or 36°C. Cognitive function was similar in both intervention groups...

  13. Experience with bretylium tosylate by a hospital cardiac arrest team.

    Holder, D A; Sniderman, A D; Fraser, G; Fallen, E L

    1977-03-01

    The effect of bretylium tosylate (BT) was determined in 27 consecutive cases of resistant ventricular fibrillation (VF) encountered by a hospital cardiac arrest team. The VF was sustained and completely resistant to multiple injections of lidocaine, sequential DC shocks at 400 watt-sec and one or a combination of intravenous propranolol, diphenylhydantoin or procainamide. Following 30 min of sustained cardiac massage, BT (5 mg/kg i.v.) was administered. In 20 patients, VF was terminated within 9-12 min after DC shock. Eight of these patients failed to recover while 12 (44%) of all patients resuscitated survived to be discharged from hospital. Eleven out of 20 (55%) of all patients who had a cardiac arrest outside the CCU were survivors; only one out of seven in the CCU were successfully resuscitated. While receiving maintanance BT post-resuscitation (5 mg/kg i.m. q 8-12 hrs x 48 hrs), half the patients developed hypotension and three required vasopressors and/or fluid replacement. The data indicate that BT is a useful agent in patients with sustained VF refractory to repeated lidocaine injections, some other antiarrhythmic agents, and multiple DC shocks. PMID:837490

  14. Demographics, Bystander CPR, and AED Use in Out-of-Hospital Pediatric Arrests

    Johnson, M. Austin; Grahan, Brian J. H.; Haukoos, Jason S.; McNally, Bryan; Campbell, Robert; Sasson, Comilla; Slattery, David E.

    2016-01-01

    Background In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations. Methods We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were older than 1 year of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009 from an arrest presumed to be cardiac in nature. Hierarchical multivariable logistic regression analysis was used to estimate the associations between age, demographic factors, and AED use. Results 129 patients were 1–8 years of age (younger children), 88 patients were 9–17 years of age (older children), and 19,338 patients were ≥18 years of age (adults). When compared to adults, younger children were less likely to be found in a shockable rhythm (young children 11.6%, adults 23.7%) and were less likely to have an AED used (young children 16.3%, adults 28.3%). Older children had a similar prevalence of shockable rhythms as adults (31.8%) and AED use (20.5%). A multivariable analysis demonstrated that, when compared to adults, younger children had decreased odds of having an AED used (OR 0.42, 95% CI 0.26–0.69), but there was no difference in AED use among older children and adults. Conclusions Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation. PMID:24681302

  15. Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation

    Josip Ivić

    2009-02-01

    Full Text Available Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT providedcardiopulmonary resuscitation (CPR during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU. Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80, mostly male (60%. Most frequent victims were neurological patients(42%, surgical patients (21% and neurosurgical patients (10%. The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%.Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.

  16. Comparative studies of defibrillation effect of biphasic and unilateral wave defibrillator for out-of-hospital cardiac arrest%不同波形自动除颤仪在院外心肺复苏中的疗效比较

    刘成杰; 关紫云; 李晚泉; 何明丰

    2012-01-01

    Objective To test different automated external defibrillators ( AED) waveforms in order to improve the CPR for the patients with out - of - hospital cardiac arrest. Methods In a randomized controlled trial, patients with out - of - hospital cardiac arrest requiring defibrillation were treated with 1 of 2 AED protocols. The experimental group was treated with biphasic defibrillator, the control group was treated with a unilateral waveform defibrillator. The rate of terminating arrhythmia, the rates of restoration of spontaneous circulation, survival rates to hospital were compared between low -energy biphasic defibrillation group and high - energy unilateral defibrillation. Results 830 patients were included in the final analysis. Experimental patients(n =417) had small energy 150 ~ 200 J while the controls(n =413) had 300 ~ 360 J. Different proportions survived to hospital admission (43.4% versus 27. 1% ,P <0.05) , survived to hospital discharge( 13. 4% versus 9. 8% ,P < 0. 05) , achieved return of spontaneous circulation before physician arrival ( 49. 4% versus 30. 9% , P < 0. 05 ) , and survived to 1 year( P = 0. 45 ) . Conclusion Biphasic wave defibrillator has better hemodynamic effect, which suggests that biphasic wave method results in more successful rate of resuscitation and survival to hospital admission.%目的 探讨抢救院外心脏骤停患者的最佳自动除颤仪(AED)治疗方案,旨在提高心脏按压时间和心肺复苏的效果.方法 通过前瞻性随机对照研究,对院外因室颤或者心脏停跳需要除颤的患者使用两种不同的除颤方法,试验组(n=417)采用双相波除颤仪,能量150~200 J;对照组(n=413)采用单相波除颤仪,能量300~360 J.主要观察低能量双相与高能量单相除颤两组患者心律失常成功终止率、自主循环恢复率、复苏后存活到院率.结果 共对符合研究要求的830例患者进行了分析研究.试验组患者的安全存活到院率、电击后自主循

  17. What accounting leaves out of hospital financial management.

    Boles, K E; Glenn, J K

    1986-01-01

    As PPS and other fixed-price initiatives replace cost-based reimbursement in the hospital industry, the burden of assuming the risk for business success or failure shifts from the payor to the hospital. As a consequence, theories of risk to the business firm which have found application in other industries now deserve attention by hospital management. Incorporating such risk concepts into hospital strategies and actions requires a view of financial management that goes beyond the generally accepted accounting principles of managing and assigning costs for maximum revenue and profitability. This article examines the financial theory of risk in business firms, illustrates the various components of risk as they apply to a hospital business, and discusses how the hospital management strategies of cost-reduction, marketing, diversification, and multiorganizational affiliation can alter the risk characteristics of a hospital business. PMID:10275567

  18. Out-of-hospital cardiac arrests in children and adolescents

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik;

    2015-01-01

    .3%, respectively. High parental education was associated with improved survival after OHCA (OR 3.48, CI 1.27-9.41). Significant crude difference in survival (OR 3.18, CI 1.22-8.34) between high household incomes vs. low household incomes was found. CONCLUSION: OHCA incidences and survival rates varied...... population. METHODS: All OHCA patients in Denmark, ≤21 years of age, were identified from 2001 to 2010. The population was divided into infants (<1 year); pre-school children (1-5 years); school children (6-15 years); and high school adolescents/young adults (16-21 years). Multivariate logistic regression......-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9...

  19. A decade of diabetes: keeping children out of hospital.

    Swift, P G; Hearnshaw, J R; Botha, J L; Wright, G; Raymond, N. T.; Jamieson, K F

    1993-01-01

    OBJECTIVES--To document the number of children aged less than 15 years who developed diabetes and were managed within one large health district, and to evaluate the outcome of those children managed without hospital admission at diagnosis. DESIGN--A retrospective study over 1979-88, when a paediatrician and a physician with special interests in childhood diabetes initiated joint clinics. Data collected from the district diabetes register and files of consultants and health visitors specialisi...

  20. Risky locations for out-of-hospital cardiopulmonary arrest in a typical urban city

    Yoshihiro Moriwaki

    2014-01-01

    Full Text Available Background: The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA occur. Materials and Methods: Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA. Results: Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus, 8.3% on the street, 73.4% in a private location (victim′s home, the homes of the victims′ relatives or friends or cheap bedrooms, where poor homeless people live, and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7% took place in the lavatory and 166 (10.7% in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002, and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001. Conclusions: An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.

  1. Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response

    Andrea Aguilera-Campos

    2012-02-01

    Full Text Available OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE iniciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo.OBJETIVE: Out-of-hospital cardiac arrest (OCHA is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the

  2. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

    Leela K Lella

    Full Text Available The significance of right ventricular ejection fraction (RVEF, independent of left ventricular ejection fraction (LVEF, following isolated coronary artery bypass grafting (CABG and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR, independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25% and 61 patients had normal RVEF (mean 50% (p<0.001. Fifty-four patients had reduced LVEF (mean 30% and 55 patients had normal LVEF (mean 59% (p<0.001. Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05. Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03. Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.

  3. Pulseless electrical activity and successful out-of-hospital resuscitation – long-term survival and quality of life: an observational cohort study

    Saarinen Sini

    2012-10-01

    Full Text Available Abstract Background The aim of the study was to evaluate the long-term outcome of patients successfully resuscitated from pre-hospital cardiac arrest with initial pulseless electrical activity (PEA, because the long-term outcome of these patients is unknown. Survival, neurological status one year after cardiac arrest and self-perceived quality of life after five years were assessed. Methods This retrospective study included adult patients resuscitated from PEA between August 2001 and March 2003 in three urban areas in southern Finland. A validated questionnaire was sent to patients while neurological status according to the Cerebral Performance Category (CPC -classification was assessed based on medical database notes recorded during follow-up evaluations. Results Out of 99 included patients in whom resuscitation was attempted, 41 (41% were successfully resuscitated and admitted to hospital. Ten (10% patients were discharged from hospital. Seven were alive after one year and six after five years following cardiac arrest. Five of the seven patients alive one year after resuscitation presented with the same functional level as prior to cardiac arrest. Conclusions Patients with initial PEA have been considered to have poor prognosis, but in our material, half of those who survived to hospital discharge were still alive after 5 years. Their self-assessed quality of life seems to be good with only mild to moderate impairments in activities of daily life.

  4. People with Intellectual Disabilities in Out-of-Area Specialist Hospitals: What Do Families Think?

    Bonell, Simon; Ali, Afia; Hall, Ian; Chinn, Deborah; Patkas, Ioannis

    2011-01-01

    Background: Little has been published regarding the views of family members of people with intellectual disabilities who are being cared for in out-of-area psychiatric hospitals. This study explores this area with specific reference to whether culturally appropriate services were being provided. Materials and Methods: Sixteen family members were…

  5. Safety of Intranasal Fentanyl in the Out-of-Hospital Setting

    Karlsen, Anders P H; Pedersen, Danny M B; Trautner, Sven;

    2014-01-01

    : In this prospective observational study, we administered intranasal fentanyl in the out-of-hospital setting to adults and children older than 8 years with severe pain resulting from orthopedic conditions, abdominal pain, or acute coronary syndrome refractory to nitroglycerin spray. Patients received...

  6. The Effect of Meteorological Variables on Hospitalization with Cardiac Causes

    Sinan Albayrak

    2014-09-01

    Full Text Available Aim: The atmosphere which we are in continuous interaction has many meteorological parameters like temperature, humidity and wind that have impact on health. The aim of this study was to investigate the effect of meteorological factors on hospitalization with cardiovascular causes. Method: One thousand and three hundred seventy six patients who had been hospitalized in the Duzce University Faculty of Medicine Cardiology Department and Duzce Ataturk State Hospital Cardiology Service during 01 January 2009 and 31 December 2010 were included in the study. Meteorological data such as the daily temperature, humidity and wind speed of Duzce were received from the General Directorate of Meteorology of Turkey. The meteorological variables were compared with the hospitalized patient data. Results: The most number of patients were hospitalized in May and least in September. There was no difference in the number of hospitalization according to seasons or months. There was a significant correlation in hospitalization with ST wave elevation myocardial infarction and mean humidity, with congestive heart failure and mean temperature and mean wind speed, acute coronary syndrome and mean temperature. There was also a significant correlation between unstable angina pectoris or acute coronary syndrome and daily difference of humidity and temperature. Difference in maximum humidity, mean temperature, difference of temperature in consecutive days ad minimum humidity were independent correlates of the cardiovascular hospitalization number. Conclusion: Meteorological variables have significant impact on frequency of hospitalization due to cardiac causes. Keywords:

  7. Electrocardiogram characteristics prior to in-hospital cardiac arrest

    Attin, Mina; Feld, Gregory; Lemus, Hector; Najarian, Kayvan; Shandilya, Sharad; Wang, Lu; Sabouriazad, Pouya; Lin, Chii-Dean

    2014-01-01

    Survival after in-hospital cardiac arrest (I-HCA) remains < 30 %. There is very limited literature exploring the electrocardiogram changes prior to I-HCA. The purpose of the study was to determine demographics and electrocardiographic predictors prior to I-HCA. A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from I-HCA with initial rhythms of pulseless electrical activity (PEA) and asystole. Demographics including medical history, eje...

  8. Moving out of the Laboratory: Deploying Pervasive Technologies in a Hospital

    Hansen, Thomas Riisgaard; Bardram, Jakob; Søgaard, Mads

    2006-01-01

    The authors deployed a distributed system containing a location-tracking system, a context-awareness system, wall-sized displays, and mobile phones in a Danish hospital's operating ward. This article presents the lessons they learned from deploying these pervasive computing technologies and a...... checklist of questions for researchers to consider relating to hardware, software, and organizational issues when moving pervasive systems out of the laboratory. This article is part of a special issue on Real-World Deployments....

  9. Hospital discharge diagnoses of ventricular arrhythmias and cardiac arrest were useful for epidemiologic research

    De Bruin, M L; van Hemel, N M; Leufkens, H G M;

    2005-01-01

    OBJECTIVE: We investigated the validity of hospital discharge diagnosis regarding ventricular arrhythmias and cardiac arrest. METHODS: We identified patients whose record in the PHARMO record linkage system database showed a code for ventricular or unspecified cardiac arrhythmias according to codes...

  10. Ambient air pollution, temperature and out-of-hospital coronary deaths in Shanghai, China

    Few studies have evaluated the effects of ambient air pollution and temperature in triggering out-of-hospital coronary deaths (OHCDs) in China. We evaluated the associations of air pollution and temperature with daily OHCDs in Shanghai, China from 2006 to 2011. We applied an over-dispersed generalized additive model and a distributed lag nonlinear model to analyze the effects of air pollution and temperature, respectively. A 10 μg/m3 increase in the present-day PM10, PM2.5, SO2, NO2 and CO were associated with increases in OHCD mortality of 0.49%, 0.68%, 0.88%, 1.60% and 0.08%, respectively. A 1 °C decrease below the minimum-mortality temperature corresponded to a 3.81% increase in OHCD mortality on lags days 0–21, and a 1 °C increase above minimum-mortality temperature corresponded to a 4.61% increase over lag days 0–3. No effects were found for in-hospital coronary deaths. This analysis suggests that air pollution, low temperature and high temperature may increase the risk of OHCDs. - Highlights: • Few studies have evaluated the effects of air pollution and temperature on OHCDs in China. • The present-day concentrations of air pollution were associated with OHCDs. • The effect of high temperatures on OHCDs was more immediate than low temperatures. • No significant effects were found for in-hospital coronary deaths. - Ambient air pollution and temperature may trigger out-of-hospital coronary deaths but not in-hospital coronary deaths

  11. Reasons for diagnostic delay in patient with out-of-hospital acute ischemic stroke

    Tongge Wang; Qi Ma

    2006-01-01

    BACKGROUND:Time window is a common problem in various therapies of acute ischemic stroke,and diagnostic duration plays an important role in prognosis.OBJECTIVE:To analyze the main reasons for out-of-hospital diagnostic delay of patients with acute ischemic stroke.DESIGN:Survey and analysis.SETTING:Department of Neurology,the First Affiliated Hospital of Jinan University.PARTICIPANTS: A total of 116 patients with acute ischemic stroke were selected from the Department of Neurology,the First Affiliated Hospital of Jinan University from December 2002 to December 2005,including 79 males and 37 females aged fnom 35 to 90 years with the mean age of(65+10)years.All patients met the diagnostic criteda of "mainly diagnostic points of various cerebrovascular diseases"established by the 4th National Cerebrovascular Diseases Meeting in 1995.Patients having acute ischemic stroke in hospital were excluded.Moreover,32 nurses received questionnaires of partial items.All patients and nurses provided informed consent.METHODS:①Information,such as social Position,educational level and incomes,was added up based on questionnaires.②Out-of-hospital diagnostic delay was surveyed based on the recorded time of patients treated in emergency department and out-patient clinic or during hospitalization. ③Ability of patients and nurses to identify symptoms of stroke dudng an early period was evaluated:meanwhile,understanding concept of stroke and using emergent system of social medicine by patients were surveyed,Especially.whether Patients understood the emergent number"120" or not and how they used it practically were investigated further.④Attitude and behavior of patients to stroke were surveyed.⑤Whether patients were able to identify the symptoms of stroke or not was investigated;furthermore,identification of stroke by patients and nurses was dealt with semi-quantitative analysis.The scores ranged from-10 to 10.The higher the scores were,the better the identification was

  12. Staged discharge out of hospital of the Novacor left ventricular assist system (LVAS) recipients.

    Viganó, M; Scuri, S; Cobelli, F; Opasich, C; Pagani, F M; Minzioni, G; Martinelli, L; Tavazi, L; Viganó, M

    1997-04-01

    The mobility afforded by the wearable Novacor LVAS provides the possibility for the recipients to leave the hospital, with undoubted improvements in their quality of life. A staged program for discharging LVAS recipients from the hospital has been set up at the Policlinico San Matteo of Pavia together with the Rehabilitation Center of Montescano and Baxter Novacor Service support, in order to proceed smoothly towards patient's self sufficiency and to minimize any associated risk. The steps are: stay in the hospital ward, discharge to Rehabilitation Center and discharge to home. Several excursions with and without an LVAS team member are encouraged before final discharge to home. Simple criteria of eligibility must be fulfilled to move to the next step. Every move towards a reduced presence of specialized personnel includes an appropriate training of the patient and relatives and a technical checkout of the needed equipment. During the stay at the Rehabilitation Center primarily the physical training and psychological preparation are taken care of by means of tailored programs. When the patient is discharged to home, the check of patient condition is performed weekly at the Rehab Center, bloodwork and technical evaluation is assessed once every two weeks and technical inspections at home twice per year. Complications are reported as in hospital protocol. Control parameters of the LVAS are reported only in case of alarms or abnormal operation. Periodic review of patient training is performed during the check visits, mostly focused on how to address emergency situations. The hospital is responsible for providing one LVAS operator available on call (all hours). Up to date, 11 patients received an implant of LVAS, 9 of them with the wearable system. All of these 9 patients made excursions out of the hospital and 4 patients have successfully undergone the staged program, showing a satisfactory general condition and restoration to social life. PMID:9271181

  13. Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population

    Hendrikx, Tijn; Hörnsten, Rolf; Rosenqvist, Mårten; Sandström, Herbert

    2013-01-01

    BACKGROUND: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke. METHOD: Design: Cross-sectional study. Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden. Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors assoc...

  14. Safety of Monitoring Exercise for Early Hospital-based Cardiac Rehabilitation

    Kim, Chul; Moon, Chang Jin; Lim, Min Ho

    2012-01-01

    Objective To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR. Method All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescript...

  15. Out of pocket payments and social health insurance for private hospital care: Evidence from Greece.

    Grigorakis, Nikolaos; Floros, Christos; Tsangari, Haritini; Tsoukatos, Evangelos

    2016-08-01

    The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector. PMID:27421172

  16. End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study

    De Korte-Verhoef Maria C

    2012-08-01

    Full Text Available Abstract Background Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called. Methods A retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006 in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands. All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life. Results In all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1, cardiovascular problems (OR 8,3, digestive problems (OR 2,5 and endocrine, metabolic and nutritional (EMN problems (OR 2,5 had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2 and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4 had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%, EMN (19% and respiratory (17% problems. Conclusion Whilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.

  17. Achieving better in-hospital and after-hospital care of patients with acute cardiac disease.

    Scott, Ian A; Denaro, Charles P; Bennett, Cameron J; Hickey, Annabel C; Mudge, Alison M; Flores, Judy L; Sanders, Daniela C J; Thiele, Justine M; Wenck, Beres; Bennett, John W; Jones, Mark A

    2004-05-17

    In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes. PMID:15139843

  18. A hospital based study on causes peculiar of congestive car-diac failure (CCF)

    Hamzullah Khan; Hikmatullah Jan; Mohammad Hafizullah; Mahmoodul Hassan; Adnan Gul

    2008-01-01

    Objective:To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar.Methods:This retrospective observational study was conducted in department of Cardiology,Post-graduate Medical Institute,Lady Reading Hospital Peshawar,from March 2005 to September 2007.Relevant information regarding the risk factors of congestive cardiac failure were recorded on questionnaire prepared in accordance with the objectives of the study.Results:1 019 patients with established diagnosis of cardiac fail-ure (based on clinical findings and relevant investigations) were included.Out of total sampling 583 (57.12%)were males and 436(42.78%)were females.The age range of the patients was from 6 years to 82 years with mean age of 48.5 years and mode of age was 45 years.The distribution of causative factors of CCF was:ischemic heart disease (IHD)36.31%,hypertension 26.30%,dilated cardiomyopathy 10.10%,obstr-uctve and restrictive cardiomyopathies 5.39%,valvular heart diseases (VHD)9.32%,congenital heart dis-ease like ventricular septal defects (VSD)4.41%,atrial septal defects (ASD)0.58%,atrial fibrillation (AF)2.25%,constrictive pericardidtis 1.07%,Pericardial effusion 0.68%,chronic obstructive pulmonary disease and pulmonary hypertension 1.47%,thyrotoxicosis 0.68%,complete heart block 0.29% and paget disease in 0.09% cases.Conclusion:Ischemic heart disease,hypertension,cardiomypathies,valvular heart disease and congenital heart disease are major contributor to CCF in our patients.

  19. Associations of hospital characteristics with nosocomial pneumonia after cardiac surgery can impact on standardized infection rates.

    Sanagou, M; Leder, K; Cheng, A C; Pilcher, D; Reid, C M; Wolfe, R

    2016-04-01

    To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001-2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P < 0·001). Other hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare. PMID:26449769

  20. Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest

    Youichi Yanagawa

    2012-01-01

    Full Text Available Background: At low concentrations, carbon monoxide (CO can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO. Aim of study: To investigate the significance of the value of carboxyhemoglobin for out-of-hospital (OH cardiopulmonary arrest (CPA. Materials and Methods: This study involved a medical chart review of cases treated from January to December 2005. The inclusion criteria included a patient who was transported to this department due to an OH CPA. The exclusion criteria included a patient who did not undergo blood gas analysis on arrival and who experienced CPA due to acute carbon monoxide intoxication. The subjects were divided into two groups based on their final outcome of either survival or non-survival. Results: There was no significant difference associated with the sex, age, frequency of witness collapse, bystander cardiopulmonary arrest, electrocardiogram at scene, cause of CPA, value of PCO 2 , HCO3 - , and methemoglobin. The frequency of OH return of spontaneous circulation and the value of pH, PO 2 , base excess, and carboxyhemoglobin in the survival group were greater than those values in the non-survival group. There were no subjects whose carboxyhemoglobin level was 0% on arrival in the survival groups. Conclusion: There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.

  1. Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase

    Eliane Roseli Winkelmann

    2015-02-01

    Full Text Available Objective: To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods: This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results: In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1% and up to two years period (8.6% when compared to 30 days after hospital discharge (1.1%. Among the postoperative complications, the hemodynamic (63.4% and respiratory (42.6% were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion: This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery.

  2. The Dutch Hospital Standardised Mortality Ratio (HSMR) method and cardiac surgery: benchmarking in a national cohort using hospital administration data versus a clinical database

    Siregar, S.; Pouw, M E; Moons, K G M; Versteegh, M. I. M.; Bots, M. L.; van der Graaf, Y; Kalkman, C.J.; van Herwerden, L.A.; Groenwold, R. H. H.

    2013-01-01

    Objective To compare the accuracy of data from hospital administration databases and a national clinical cardiac surgery database and to compare the performance of the Dutch hospital standardised mortality ratio (HSMR) method and the logistic European System for Cardiac Operative Risk Evaluation, for the purpose of benchmarking of mortality across hospitals. Methods Information on all patients undergoing cardiac surgery between 1 January 2007 and 31 December 2010 in 10 centres was extracted f...

  3. No difference in mortality between men and women after out-of-hospital cardiac arrest

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Wanscher, Michael; Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Friberg, Hans; Gasche, Yvan; Horn, Janneke; Hovdenes, Jan; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wise, Matthew P; Åneman, Anders; Hassager, Christian

    2015-01-01

    the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors. RESULTS: Compared to men, women more often had OHCA at home...

  4. Long-term survival after out-of-hospital cardiac arrest

    Holler, Nana G; Mantoni, Teit; Nielsen, Søren L;

    2007-01-01

    from the Danish Causes of Death Registry and the Danish Civil Registration System. We conducted a search to find out whether patients were still alive on 31 January 2005. RESULTS: Resuscitation was indicated and attempted in 1095 cases and 95 patients (8.7%) survived to discharge. Of these 75% had an...... system was comparable to survival after myocardial infarction with 46% being alive after ten years....

  5. Debriefing bystanders of out-of-hospital cardiac arrest is valuable

    Møller, Thea Palsgaard; Hansen, Carolina Malta; Fjordholt, Martin;

    2014-01-01

    , positively influencing the ability to cope with the emotional reactions and the cognitive perception of own performance and motivates improvement of CPR skills. Importantly, it increases confidence to provide CPR in the future. Implementation of telephone debriefing to bystanders at Emergency Medical...

  6. Variability in case-mix adjusted in-hospital cardiac arrest rates

    Merchant, Raina M.; Yang, Lin; Becker, Lance B.; Berg, Robert A.; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G.; Mitra, Nandita; Bradley, Steven M.; Abella, Benjamin S.; Groeneveld, Peter W.

    2011-01-01

    Background It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Objectives Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Research design Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003-2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Subjects adult patients with IHCA Measures Case-mix adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent ICU beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability and a patient risk score. Results We evaluated 103,117 adult IHCAs at 433 US hospitals. The case mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7-1.3 events/1000 bed-days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals (rate ratio [RR] 1.1, 95% confidence interval [CI] 1.0-1.3, p=0.03) and hospitals with higher proportions of black patients (RR 1.2, 95% CI 1.0-1.3, p=0.01) and lower in larger hospitals (RR 0.54, 95% CI 0.45-0.66, p<.0001). Conclusion Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care. PMID:22249921

  7. Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.

    Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

    2014-11-01

    Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. PMID:25200319

  8. In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

    XUN Yi-wen; YANG Jin-gang; SONG Li; SUN Yi-hong; LU Chang-lin; YANG Yue-jin; HU Da-yi

    2010-01-01

    Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P<0.001; 55 minutes vs. 45 minutes, P=0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

  9. Trends in Out-of-Hospital Births in the United States, 1990-2012

    ... 0.46% to Hispanic women, 0.81% to American Indian women, and 0.54% to Asian or Pacific Islander women. In 2012, out-of- ... Hispanic (from 0.44% to 0.46%), and Asian or Pacific Islander [API (from 0.49% to ... American Indian women. Figure 2. Percentage of births occurring ...

  10. QTc-prolonging drugs and hospitalizations for cardiac arrhythmias

    De Bruin, Marie L; Hoes, Arno W; Leufkens, Hubert G M

    2003-01-01

    Cardiac arrhythmia as an adverse effect of noncardiac drugs has been an issue of growing importance during the past few years. In this population-based study, we evaluated the risk for serious cardiac arrhythmias during the use of several noncardiac QTc-prolonging drugs in day-to-day practice, and...... use of QTc-prolonging drugs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariate conditional logistic regression, adjusting for potential confounding factors. Data were obtained from the PHARMO record linkage system. We identified 501 cases, 39 of whom used QTc...

  11. Providing Rapid Out of Hospital Acute Cardiovascular Treatment 4 (PROACT‐4)

    Ezekowitz, Justin A.; Welsh, Robert C.; Weiss, Dale; Chan, Michael; Keeble, William; Khadour, Fadi; Sharma, Sanjay; Tymchak, Wayne; Sookram, Sunil; Brass, Neil; Knapp, Darren; Koshy, Thomas L.; Zheng, Yinggan; Armstrong, Paul W.

    2015-01-01

    Background Whether prehospital point‐of‐care (POC) troponin further accelerates the time to diagnosis in patients with chest pain (CP) is unknown. We conducted a randomized trial of POC‐Troponin testing in the ambulance. Methods and Results Patients with chest pain presenting by ambulance were randomized to usual care (UC) or POC‐Troponin; ST‐elevation myocardial infarction patients or those with noncardiovascular symptoms were excluded. Pre‐hospital high‐sensitivity troponin was analyzed on ...

  12. REGISTRO DE PARO CARDÍACO EN EL ADULTO Registries of outer hospital cardiac arrest in Bogotta-Colombia

    Ricardo Navarro Vargas

    2005-07-01

    Full Text Available En nuestro país no hay un registro estandarizado de los eventos cardíacos que requieren reanimación cerebro-cardio-pulmonar (RCCP siguiendo los lineamientos "Utstein". El propósito de este estudio fue determinar la calidad de los registros extrahospitalarios de paro cardíaco en el adulto, en Bogotá-Colombia. Entre enero y marzo de 2005 se realizó un análisis retrospectivo de los casos que correspondieron a paro cardíaco en el adulto atendidos por el "Centro Regulador de Urgencias del Distrito (CRU". El estudio reveló un registro deficiente de los eventos que requirieron RCCP realizados a nivel prehospitalario, e identificó al trauma como causa de paro cardíaco en 22% de los casos, una cifra particularmente elevada si se compara con los reportes mundiales, que oscilan entre 5% y 8%. Recomienda la estandarización del registro de paro cardíaco en el adulto, para lo cual se sugiere utilizar el formato de registro que sigue los lineamientos "Utstein".There is not a standardized registry form of cardiac events requiring cardiopulmonary resuscitation (CPR in our country such as the Utstein style. The purpose of this study was to determine the quality of the registries of out-ofhospital cardiac arrests in Bogotá-Colombia. A retrospective survey of registries of cardiac events assisted by a regulatory center "Centro Regulador de Urgencias del Distrito (CRU" was conducted, between January and March, 2005. The study reveals a poor registry of outof-hospital cardiac arrest in Bogotá-Colombia, and identifies trauma as the cause of cardiac arrest in 22% of cases, a particularly high figure compared with 5-8% registered worldwide. Recommend the standardization of the registry form of out-of-hospital cardiac arrest and suggest to use the "uniform reporting of data following cardiac arrest - the Utstein style". The registry forms are shown in appendix 1-2. Suggestions are welcome.

  13. RETROSPECTIVE ANALYSIS: TO ENHANCE PATIENT SAFETY BY MINIMIZING MEDICATION ERRORS IN TERTIARY CARE CARDIAC HOSPITAL

    Lal Sukhbir; Saini Vikas; Choudhary Balram; Saini Reetu

    2012-01-01

    To identify and measure the frequency of medication errors, to understand the causes for errors and best strategies to decrease medication errors rate in a cardiac hospital New Delhi. The Retrospective study of 137 case files, was undertaken to find out the medication errors in new drugs to be included in hospital formulary and to study policy compliances,for the period of a month, February 2010.We studied 137 patient files and Medication error related were reported most often at the stages ...

  14. Data integration in cardiac surgery health care institution: experience at G. Pasquinucci Heart Hospital

    Taddei, Alessandro; Dalmiani, Stefano; Vellani, Antonio; Piccini, Giacomo; Rocca, Emiliano; Carducci, T; Borghini, R; Marcheschi, Paolo; Macerata, Alberto

    2008-01-01

    During last ten years the Hospital Information System (HIS) was developed at Institut e of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical s ide into the OG. Monasterio Foundationo (FGM) by joint efforts of CNR, Tuscany Region and Universi ties. G. Pasquinucci Heart Hospital (GPH) in Massa, currently one of the two FGMoes sections, i s specialised in Cardiology and Cardiac Surgery (adult and pediatric)

  15. Data Integration in Cardiac Surgery Health Care Institution: Experience at G. Pasquinucci Heart Hospital

    Taddei, Alessandro; Dalmiani, Stefano; Vellani, Antonio; Rocca, E.; Piccini, Giacomo; Carducci, T; Gori, A.; Borghini, R; Marcheschi, Paolo; Mazzarisi, Alessandro; Salvatori, Cristina; Macerata, Alberto; Varanini, Maurizio

    2008-01-01

    During the last ten years the Hospital Information System (HIS) was developed at the Institute of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical side into the "Gabriele Monasterio Foundation" (FGM) by joint efforts of CNR, Tuscany Region and Universities. At G.Pasquinucci Heart Hospital (GPH), currently FGM's section in Massa, the HIS was adapted and extended to Cardiac Surgery and Pediatric Cardiology. Data archiving and middleware integration th...

  16. Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

    Sohil Pothiawala

    2012-01-01

    Full Text Available Spontaneous subarachnoid hemorrhage is the most common neurological disorder leading to pre-hospital cardiac arrest. ECG changes in SAH may mimic myocardial infarction or ischemia, and thus lead to delayed treatment of the primary problem. Early identification of SAH-induced cardiac arrest with the use of computed tomography scan of the brain obtained immediately after resuscitation will aid emergency physicians make further decisions. The overall prognosis of patients who are resuscitated is extremely poor. But, prompt neurosurgical referral and multidisciplinary intensive care management can improve the survival rate and the functional outcome. Thus, physicians should consider SAH as a differential diagnosis in patients presenting with pre-hospital cardiac arrest.

  17. Pulseless electrical activity and successful out-of-hospital resuscitation – long-term survival and quality of life: an observational cohort study

    Saarinen Sini; Kämäräinen Antti; Silfvast Tom; Yli-Hankala Arvi; Virkkunen Ilkka

    2012-01-01

    Abstract Background The aim of the study was to evaluate the long-term outcome of patients successfully resuscitated from pre-hospital cardiac arrest with initial pulseless electrical activity (PEA), because the long-term outcome of these patients is unknown. Survival, neurological status one year after cardiac arrest and self-perceived quality of life after five years were assessed. Methods This retrospective study included adult patients resuscitated from PEA between August 2001 and March 2...

  18. Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

    Anadi Gupt

    Full Text Available Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY, should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013.We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains.Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%. The median overall OOPE was $39 (Rs 2567 in the non-beneficiaries group as compared to $11 (Rs 713 in the beneficiaries group (p<0.01. Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500 in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01. Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3] with OOPE above median independently and also after adjusting for various covariates.RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

  19. Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013

    Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P.; Murthy, B. N.

    2016-01-01

    Introduction Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. Methods We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Results Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $ 11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $ 23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3–4.3)] with OOPE above median independently and also after adjusting for various covariates. Conclusion RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility. PMID:26895419

  20. Incidence of treated cardiac arrest in hospitalized patients in the United States

    Merchant, Raina M.; Yang, Lin; Becker, Lance B.; Berg, Robert A.; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G.; Mitra, Nandita; Bradley, Steven M.; Abella, Benjamin S.; Groeneveld, Peter W.

    2011-01-01

    Objective The incidence and incidence over time of cardiac arrest in hospitalized patients (IHCA) is unknown. We sought to estimate the event rate and temporal trends of adult inhospital cardiac arrest (IHCA) treated with a resuscitation response. Design Three approaches were used to estimate the IHCA event rate. First approach: Calculate the IHCA event rate at hospitals (n=433) in the Get With The Guidelines-Resuscitation (GWTG-R) registry, years 2003–2007 and multiply this by US annual bed-days. Second approach: Use the GWTG-R, IHCA event rate to develop a regression model (including hospital demographic, geographic, organizational factors) and use the model coefficients to calculate predicted event rates for acute care hospitals (n=5,445) responding to the American Hospital Association survey. Third approach: Classify acute care hospitals into groups based on academic, urban, bed size-and determine the average event rate for GWTG-R hospitals in each group and then use weighted averages to calculate the national IHCA rate. Annual event rates were calculated to estimate temporal trends. Setting GWTG-R registry Patients Adult IHCA with a resuscitation response Measurements and main results The mean adult treated IHCA event rate at GWTG-R hospitals was 0.92/1000 bed-days (IQR 0.58 to 1.2/1000). In hospitals (n=150) contributing data for all years of the study period, the event rate increased from 2003–2007. With 2.09 million annual US bed-days, we estimated 192,000 IHCA throughout the US annually. Based on the regression model, extrapolating GWTG-R hospitals to hospitals participating in the American Hospital Association survey projected 211,000 annual IHCA. Using weighted averages projected 209,000 annual US IHCA. Conclusions There are approximately 200,000 treated cardiac arrests among US hospitalized patients annually and this rate may be increasing. This is important for understanding the burden of IHCA and developing strategies to improve care for

  1. Drug–drug Interactions in Hospitalized Cardiac Patients

    Mateti, UV; Rajakannan, T; Nekkanti, H; V. Rajesh; Mallaysamy, SR; Ramachandran, P.

    2011-01-01

    Drug–drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April–July 2009). During the study period, a total...

  2. In-Hospital Cardiac Arrest: An Update on Pulseless Electrical Activity and Asystole.

    Attin, Mina; Tucker, Rebecca G; Carey, Mary G

    2016-09-01

    Nonshockable rhythms, including pulseless electrical activity (PEA) and asystole, precede more than 70% of in-hospital cardiac arrests (I-HCA). Compared with shockable rhythms (ventricular fibrillation and ventricular tachycardia), nonshockable rhythms have higher mortality and morbidity. Therefore, investigating the underlying mechanisms of these arrhythmias to improve the quality of care and outcome for patients who suffer cardiac arrest is a priority. As the first responders to I-HCA, nurses must have the proper knowledge and training to provide timely and efficient cardiopulmonary resuscitation therapy. This article provides an overview of nonshockable cardiac arrhythmias preceding I-HCA as a means of addressing the gap between science and clinical practice. PMID:27484665

  3. Prevalence of hospital malnutrition among cardiac patients: results from six nutrition screening tools

    Pathirana, Anidu K; Lokunarangoda, Niroshan; Ranathunga, Ishara; Santharaj, Wijeyasingam Samuel; Ekanayake, Ruwan; Jayawardena, Ranil

    2014-01-01

    Malnutrition is highly prevalent among hospitalized patients, ranging from 30% to 50% depending on the patient population and the criteria used for diagnosis. Identifying early those who are malnourished and at risk of malnutrition and intervening at an early stage will improve patients overall prognosis and will reduce the costs to the state. Even though cardiac patients are at risk of malnutrition, data on the prevalence of malnutrition among cardiology inpatients is limited. The aim of the...

  4. Sudden Cardiac Death in Young Adults With Previous Hospital-Based Psychiatric Inpatient and Outpatient Treatment

    Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers;

    2015-01-01

    hospital contact and was identified using The Danish Psychiatric Central Research Register. All diagnoses in Danish registries are coded according to ICD-8 or ICD-10. All hospital records were retrieved manually. Results: Among 5,178 deaths, 395 were due to SCD and autopsies were performed on 262 (66%). In...... 77 SCD cases, a previous psychiatric hospital contact was identified. The SCD incidence rate in psychiatric patients was 14.8 (95% CI, 11.7–18.5) per 100,000 person-years versus 3.8 (95% CI, 3.4–4.3) per 100,000 person-years in individuals without psychiatric hospital contact (incidence rate ratio...... often unexplained (65% vs 40%, P = .02), and cardiac symptoms were reported prior to death in 46% of psychiatric patients. Conclusions: Patients with prior psychiatric hospital contact have a 4-fold increased risk of SCD. Since almost 50% had possible cardiac symptoms prior to death, cardiovascular risk...

  5. The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity

    Peng, Teng J; Andersen, Lars W.; Saindon, Brian Z.; Giberson, Tyler A; Kim, Won Young; Berg, Katherine; Novack, Victor; Donnino, Michael W; ,

    2015-01-01

    Introduction Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. Methods We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administrat...

  6. Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

    Christ M

    2014-06-01

    Full Text Available Martin Christ, Wolfgang Dierschke, Katharina Isabel von Auenmueller, Marc van Bracht, Martin Grett, Hans-Joachim Trappe Department of Cardiology and Angiology, Marienhospital Herne, Ruhr – University Bochum, Herne, Germany Objectives: Little is known about the factors that influence survival following in-hospital resuscitation, but previous investigations have suggested that in-hospital resuscitations outside of regular working hours are associated with worse survival rates. Material and methods: In-hospital cardiac arrest teams at our hospital were instructed to complete a questionnaire following every emergency call between July 2011 and June 2013. Data on all resuscitation attempts were collected and analyzed. Results: A total of 65 in-hospital resuscitations were recorded in 42 males (64.6% and 23 females (35.4% (mean age 72.0±14.3 years. A total of 54 (83.1% cardiac arrests were witnessed; seven (10.8% showed a shockable rhythm at the time of the first ECG. Resuscitation attempts lasted 29.3±41.3 minutes, and 4.1±3.1 mg epinephrine was given. Return of spontaneous circulation could be achieved in 38 patients (58.5%; 29 (44.6% survived the first day, 23 (35.4% the seventh day, and 15 patients (23.1% were discharged alive. Significantly more in-hospital resuscitations were obtained for those performed during non-regular working hours (P<0.001, with higher neuron-specific enolase levels at 72 hours after resuscitation during nonregular working hours (P=0.04. Patients who were discharged alive were significantly younger (P=0.01, presented more often with an initial shockable rhythm (P=0.04, and had a shorter duration of resuscitation (P<0.001 with the need of a lower dose of epinephrine (P<0.001. Discussion: Survival rates following in-hospital resuscitation were poor at any time, but appear to depend less on time-dependent effects of the quality of resuscitation and more on time-dependent effects of recognition of cardiac arrests

  7. Frequency of cardiac defects among children at echocardiography centre in a teaching hospital

    Objective: To assess frequency of cardiac defects among children from birth to 12 years of age on each Methodology: A cross sectional study was conducted at echocardiography centre in coronary care unit at Bahawal Victoria Hby Paediatric Transthoracic echo probe; 2-D colour Doppler, Acuson CV-70 and Niemo-30 echocardiography machines. Mothers of children with cardiac defects were interviewed at the echocardiography centre. Variables included were A- Muscular plus Vascular defects; B- Valvular defects; C-Pericardial effusion; D- Dextrocardia and E- Congestive cardiac failure. History of children for sore throat followed by joint pains; history of mothers for drug intake (antihypertensive, antipyretic, anti-emetic, hypoglycaemic) as well as chronic diseases (diabetes mellitus, hypertension, anaemia) during pregnancy were surveyed. Parity of mothers, their cousin marriages, and family socio-economic status was also inquired. The results were tabulated, analyzed and finally subjected to suitable test of significant (SR of proportion) to find out statistical significant if any. Results: It was found that out of 150 patients, 76 (50.66%) were suffering from Cardiac muscular and Vascular defects, 61 (40.66%) Valvular defects, 7 (4.66%) Pericardial effusion, 2 (1.33%) Dextrocardia and 4 (2.66%) from Congestive Cardiac Failure. According to age, 54 (36%) were from birth to 3 years of age and 51 (34%) from 10 to 12 years. There was history of Rheumatic fever among 45 (30%) children. There were 106 (70.6%) children from lower socio-economic class and 79 (52.6%) parents had history of cousin marriages. Conclusion: Frequency of cardiac defects was more in children of male sex, lower socio-economic group, from birth to three years age and children from primipara mothers in our specified locality. Rheumatic fever, cousin's marriage, and prescribed drugs intake during pregnancy (for metabolic and hormonal disorders) were other contributors to cardiac defects. (author)

  8. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

    Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

    2008-09-01

    This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits. PMID:18486978

  9. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

    Murtaza, Ghulam; Khan, Muhammad Yasir Ghani; Azhar, Saira; Khan, Shujaat Ali; Khan, Tahir M

    2016-03-01

    Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs. PMID:27013915

  10. Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients

    Emons, Wilco H M; Sijtsma, Klaas; Pedersen, Susanne S.

    2012-01-01

    The hospital anxiety and depression scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined...... items each were found to be structurally sound and reliable. These scales covered the two key attributes of anxiety and (anhedonic) depression. The findings suggest that the HADS may be reduced to a 10-item questionnaire comprising two 5-item scales measuring anxiety and depressive symptoms....

  11. Major depression and first-time hospitalization with ischemic heart disease, cardiac procedures and mortality in the general population

    Gasse, Christiane; Laursen, Thomas M; Baune, Bernhard T

    2014-01-01

    death were significantly increased by up to 15% and 68%, respectively, in persons with hospital admissions due to depression, and were most increased in 15-59 year old women (IRR: 1.64; MRR: 2.57) and men with depression (IRR: 1.39; MRR: 2.21), and during the first 180 days after being diagnosed with...... depression (women: IRR: 1.38; MRR: 2.35; men: IRR: 1.42; MRR: 2.67). One-year mortality after new ischemic heart disease was elevated by 34% in women and men. By contrast, overall rates of invasive cardiac procedures following cardiac hospitalizations were significantly decreased by 34% in persons with......Objective: We investigated the association between unipolar depression and incident hospital admissions due to ischemic heart disease, invasive cardiac procedures and mortality independent of other medical illnesses.Methods: A population-based cohort of 4.6 million persons aged 15 years or older...

  12. Assessment of potential drug–drug interactions and its associated factors in the hospitalized cardiac patients

    Ghulam Murtaza

    2016-03-01

    Full Text Available Drug–drug interactions (DDIs may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug–drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug–drug interactions (pDDIs in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug–drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55% or major severity (45%; established (24.2%, theoretical (18.8% or probable (57% type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001, hospital stay of 7 days or longer (p < 0.001 and taking 7 or more drugs (p < 0.001. We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

  13. Relationship between quantitative cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    Parker, Matthew W.; Sood, Nitesh [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Ahlberg, Alan W. [Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States); Heller, Gary V. [The Intersocietal Accreditation Commission, Ellicott City, MD (United States); Lundbye, Justin B. [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); The Hospital of Central Connecticut, Division of Cardiology, New Britain, CT (United States)

    2014-09-15

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between {sup 123}I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using {sup 123}I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  14. Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by 123I-meta-iodobenzylguanidine (123I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between 123I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using 123I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  15. Postoperative cardiac arrest due to cardiac surgery complications

    To examine the role of anesthetists in the management of cardiac arrest occurring in association with cardiac anesthesia. In this retrospective study we studied the potential performances for each of the relevant incidents among 712 patients undergoing cardiac operations at Golestan and Naft Hospitals Ahwaz between November 2006 and July 2008. Out of total 712 patients undergoing cardiac surgery, cardiac arrest occurred in 28 cases (3.9%) due to different postoperative complications. This included massive bleeding (50% of cardiac arrest cases, 1.9% of patients); pulseless supra ventricular tachycardia (28.5% of cardiac arrest cases, 1.1% of patients); Heart Failure (7% of cardiac arrest cases, 0.2% of patients); Aorta Arc Rapture (3.5% of cardiac arrest cases, 0.1% of patients); Tamponade due to pericardial effusion (3.5% of cardiac arrest cases, 0.1% of total patients); Right Atrium Rupture (3.5% of cardiac arrest cases, 0.1% of patients) were detected after cardiac surgery. Out of 28 cases 7 deaths occurred (25% of cardiac arrest cases, 0.1% of patients). The most prevalent reason for cardiac arrest during post operative phase was massive bleeding (50%) followed by pulseless supra ventricular tachycardia (28.5%). Six patients had some morbidity and the remaining 15 patients recovered. There are often multiple contributing factors to a cardiac arrest under cardiac anesthesia, as much a complete systematic assessment of the patient, equipment, and drugs should be completed. We also found that the diagnosis and management of cardiac arrest in association with cardiac anesthesia differs considerably from that encountered elsewhere. (author)

  16. RETROSPECTIVE ANALYSIS: TO ENHANCE PATIENT SAFETY BY MINIMIZING MEDICATION ERRORS IN TERTIARY CARE CARDIAC HOSPITAL

    Lal Sukhbir

    2012-09-01

    Full Text Available To identify and measure the frequency of medication errors, to understand the causes for errors and best strategies to decrease medication errors rate in a cardiac hospital New Delhi. The Retrospective study of 137 case files, was undertaken to find out the medication errors in new drugs to be included in hospital formulary and to study policy compliances,for the period of a month, February 2010.We studied 137 patient files and Medication error related were reported most often at the stages of prescription- 32 cases(23.35%, 12 administration errors(8.75%, 9 documentation errors(6.56%, 7 transcription errors (5.1%. This study has demonstrated a whole range of different types of errors in different phases of medication use and documentation process. We have seen that handwritten prescriptions are associated with large number of errors. A combined effort is required by the physician’s, managerial staff, nursing staff and educational interventions to improve patient safety in hospital.KEY WORDS:

  17. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

    Ostenfeld, Sarah; Lindholm, Matias Greve; Kjaergaard, Jesper; Bro-Jeppesen, John; Møller, Jacob Eifer; Wanscher, Michael; Hassager, Christian

    to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9mmol/l (SD 6) vs. 6mmol/l (SD 4) p<0.0001). Co......-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR)=1.02 [CI 1.00-1.03], p=0.01) and lactate at admission (HR=1.06 [CI 1.03-1.09], p<0.001), but not OHCA (HR=1.1 [CI 0.8-1.4], p=NS) was associated with mortality. In multivariate analysis, only age (HR=1.02 [CI 1...

  18. Challenges in out-of-hospital cardiac arrest - A study combining closed-circuit television (CCTV) and medical emergency calls

    Linderoth, Gitte; Hallas, Peter; Lippert, Freddy;

    2015-01-01

    to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene. A team approach, with the dispatcher responsible for the role as team leader......, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example...... of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA....

  19. Ultrasonography for Proper Endotracheal Tube Placement Confirmation in Out-of-hospital Cardiac Arrest Patients: Two-center Experience

    Jen-Tang Sun

    2014-06-01

    Conclusion: Real-time tracheal ultrasonography is an accurate method for identifying endotracheal tube position during cardiopulmonary resuscitation without the need for interruption of chest compression.

  20. Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in Cardiac Patients: Comparison of Mokken Scale Analysis and Factor Analysis

    Emons, Wilco H. M.; Sijtsma, Klaas; Pedersen, Susanne S.

    2012-01-01

    The Hospital Anxiety and Depression Scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined (a) the dimensionality of the HADS using Mokken…

  1. Survival of male patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study

    Deborah Caruso, MD

    2014-11-01

    Full Text Available Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate, both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.

  2. Predictors of Elevated Cardiac Enzyme Levels in Hospitalized Patients with Atrial Fibrillation and No Known Coronary Artery Disease

    Vinales, Karyne L.; Najib, Mohammad Q.; Marella, Punnaiah C.; Katayama, Minako

    2016-01-01

    We retrospectively studied the predictive capabilities of elevated cardiac enzyme levels in terms of the prognosis of patients who were hospitalized with atrial fibrillation and who had no known coronary artery disease. Among 321 patients with atrial fibrillation, 60 without known coronary artery disease had their cardiac enzyme concentrations measured during hospitalization and underwent stress testing or cardiac catheterization within 12 months before or after hospitalization. We then compared the clinical and electrocardiographic characteristics of the 20 patients who had elevated cardiac enzyme levels and the 40 patients who had normal levels. Age, sex, and comorbidities did not differ between the groups. In the patients with elevated cardiac enzyme levels, the mean concentrations of troponin T and creatine kinase-MB isoenzymes were 0.08 ± 0.08 ng/mL and 6.49 ± 4.94 ng/mL, respectively. In univariate analyses, only peak heart rate during atrial tachyarrhythmia was predictive of elevated enzyme levels (P <0.0001). Mean heart rate was higher in the elevated-level patients (146 ± 22 vs 117 ± 29 beats/min; P=0.0007). Upon multivariate analysis, heart rate was the only independent predictor of elevated levels. Coronary artery disease was found in only 2 patients who had elevated levels and in one patient who had normal levels (P=0.26). Increased myocardial demand is probably why the presenting heart rate was predictive of elevated cardiac enzyme levels. Most patients with elevated enzyme levels did not have coronary artery disease, and none died of cardiac causes during the 6-month follow-up period. To validate our findings, larger studies are warranted. PMID:27047283

  3. Hospital-Based Multidisciplinary Teams Can Prevent Unnecessary Child Abuse Reports and Out-of-Home Placements

    Wallace, Gregory H.; Makoroff, Kathi L.; Malott, Heidi A.; Shapiro, Robert A.

    2007-01-01

    Objective: To determine how often and for what reasons a hospital-based multidisciplinary child abuse team concluded that a report of alleged or suspected child abuse was unnecessary in young children with fractures. Methods: A retrospective review was completed of all children less than 12 months of age who, because of fractures, were referred to…

  4. Organisational strategies and midwives' readiness to provide care for out of hospital births: An analysis from the Birthplace organisational case studies

    McCourt, C; Rayment, J.; Rance, S.; Sandall, J.

    2012-01-01

    Objective: the objective of the Birthplace in England Case Studies was to explore the organisational and professional issues that may impact on the quality and safety of labour and birth care in different birth settings: Home, Freestanding Midwifery Unit, Alongside Midwifery Unit or Obstetric Unit. This analysis examines the factors affecting the readiness of community midwives to provide women with choice of out of hospital birth, using the findings from the Birthplace in England Case Studie...

  5. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan.

    Miyata, Kei; Ochi, Satoko; Enatsu, Rei; Wanibuchi, Masahiko; Mikuni, Nobuhiro; Inoue, Hiroyuki; Uemura, Shuji; Tanno, Katsuhiko; Narimatsu, Eichi; Maekawa, Kunihiko; Usui, Keiko; Mizobuchi, Masahiro

    2016-05-15

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9-52 years; interquartile range (IQR), 24-45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5-30; IQR, 3-21), and the median disease duration was 25 years (4-38; IQR, 6-32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  6. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

    MIYATA, Kei; OCHI, Satoko; ENATSU, Rei; WANIBUCHI, Masahiko; MIKUNI, Nobuhiro; INOUE, Hiroyuki; UEMURA, Shuji; TANNO, Katsuhiko; NARIMATSU, Eichi; MAEKAWA, Kunihiko; USUI, Keiko; MIZOBUCHI, Masahiro

    2016-01-01

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9–52 years; interquartile range (IQR), 24–45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5–30; IQR, 3–21), and the median disease duration was 25 years (4–38; IQR, 6–32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  7. Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: A prospective multicenter multinational observational study

    López Herce, Jesús; del Castillo, Jimena; Matamoros, Marta; (et al.); Rey Galán, Corsino

    2014-01-01

    Introduction Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children. Methods A prospective multicenter, multinational, observational study in 48 hospitals from 12 co...

  8. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital

    Kanwalpreet Sodhi

    2011-01-01

    Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the post-BLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the pre-BLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.

  9. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery.

    Costanza Emanueli

    Full Text Available Exosome nanoparticles carry a composite cargo, including microRNAs (miRs. Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG surgery, we investigated if: 1 exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2 circulating exosomes and exosomal cardiac miRs correlate with cardiac troponin (cTn, the current "gold standard" surrogate biomarker of myocardial damage.The concentration of exosome-sized nanoparticles was determined in serial plasma samples. Cardiac-expressed (miR-1, miR-24, miR-133a/b, miR-208a/b, miR-210, non-cardiovascular (miR-122 and quality control miRs were measured in whole plasma and in plasma exosomes. Linear regression analyses were employed to establish the extent to which the circulating individual miRs, exosomes and exosomal cardiac miR correlated with cTn-I. Cardiac-expressed miRs and the nanoparticle number increased in the plasma on completion of surgery for up to 48 hours. The exosomal concentration of cardiac miRs also increased after CABG. Cardiac miRs in the whole plasma did not correlate significantly with cTn-I. By contrast cTn-I was positively correlated with the plasma exosome level and the exosomal cardiac miRs.The plasma concentrations of exosomes and their cargo of cardiac miRs increased in patients undergoing CABG and were positively correlated with hs-cTnI. These data provide evidence that CABG induces the trafficking of exosomes from the heart to the peripheral circulation. Future studies are necessary to investigate the potential of circulating exosomes as clinical biomarkers in cardiac patients.

  10. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs:An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery

    Emanueli, Costanza; Shearn, Andrew I. U.; Laftah, Abas; Fiorentino, Francesca; Reeves, Barnaby C.; Beltrami, Cristina; Mumford, Andrew; Clayton, Aled; Gurney, Mark; Shantikumar, Saran; Angelini, Gianni D.

    2016-01-01

    INTRODUCTION: Exosome nanoparticles carry a composite cargo, including microRNAs (miRs). Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG) surgery, we investigated if: 1) exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2) circulating exosomes and exosomal cardiac mi...

  11. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery

    Emanueli, Costanza; Shearn, Andrew I. U.; Laftah, Abas; Fiorentino, Francesca; Reeves, Barnaby C.; Beltrami, Cristina; Mumford, Andrew; Clayton, Aled; Gurney, Mark; Shantikumar, Saran; Angelini, Gianni D.

    2016-01-01

    Introduction Exosome nanoparticles carry a composite cargo, including microRNAs (miRs). Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG) surgery, we investigated if: 1) exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2) circulating exosomes and exosomal cardiac miR...

  12. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

    Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John;

    2015-01-01

    adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography...

  13. Cardiac Complication Rate In Emergent Vascular Procedures Tehran Sina Hospital (2000-2001

    Ahmadi H

    2003-06-01

    Full Text Available Complications of Coronary artery disease remain the most common cause of morbidity and mortality after vascular surgical procedures. Goldman risk factor analysis has been suggested as peri-operative noninvasive screening method to detect significant coronary artery disease in emergent vascular procedures."nMethods and Materials: In this study, the accuracy of the Goldman scale was assessed with regard to the development of cardiac complications such as asymptomatic ischemic change in ECG, arrhythmia, myocardial infarction and cardiac death. We studied 100 patients that were required emergent vascular procedures from 2000-2001. Data about perioperative complications were extracted and analyzed using SPSS computer program."nResults: Our study indicated there is not statistical correlation between cardiac death, infarction, arrythmia, ECG change, age, sex and cardiac class."nConclusion: We concluded that Goldman scale could not be regarded as a screening method to predict peri-operative cardiac complications in emergent vascular procedures.

  14. Frequency and causes of discharges against medical advice from hospital cardiac care units of East Azerbaijan, Iran

    Saber Azami-Aghdash

    2016-05-01

    Full Text Available Introduction: Discharges against medical advice (DAMA is a common problem of hospitals that could lead increasing the complications and readmission. For this, the aim of this study is to investigate the frequency and effective factors of DAMA in patients with cardiovascular disease in hospital cardiac care units (CCU of East Azerbaijan, Iran. Methods: This cross-sectional study was performed, in 2013, in Tabriz University of Medical Sciences, Iran. Required information was extracted using valid and reliable forms of medical records of 2000 patients admitted to 20 CCU in 17 hospitals of East Azerbaijan, by two trained interviewers. Data analysis was performed using descriptive statistics (frequency, mean, percentage, etc., chi-square test, and linear regression model using the SPSS software. The tests were considered a statistically significant level of 0.05%. Results: The results showed that 272 patients (13.6% were DAMA from the hospital. The frequency of DAMA was in men more than women. The most frequency of discharge has occurred in the range of 40-80 years old. Results of linear regression showed that there was a significant correlation between DAMA and type of insurance, history of myocardial infarction (MI, comorbid disease, cause of hospitalization, location of hospital, and staying < 48 hours (P < 0.050. Conclusion: In this study, the rate of DAMA was relatively high compared with similar studies and it is considered as a concern problem that should study the reasons and its effective factors and plan effective interventions to reduce them.

  15. Out of hospital needlestick injuries.

    Wyatt, J. P.; Robertson, C E; Scobie, W G

    1994-01-01

    Retrospective analysis showed that 67 children had presented in Edinburgh with needlestick injuries on 70 occasions over five years. Worryingly, 10 children sustained injuries pretending to be intravenous drug abusers. Despite risks of hepatitis B and HIV infection, protection and follow up were inadequate. Publicity about discarded needles and a treatment plan for use in accident and emergency departments are recommended.

  16. Can linked emergency department data help assess the out-of-hospital burden of acute lower respiratory infections? A population-based cohort study

    Moore Hannah C

    2012-08-01

    Full Text Available Abstract Background There is a lack of data on the out-of-hospital burden of acute lower respiratory infections (ALRI in developed countries. Administrative datasets from emergency departments (ED may assist in addressing this. Methods We undertook a retrospective population-based study of ED presentations for respiratory-related reasons linked to birth data from 245,249 singleton live births in Western Australia. ED presentation rates Results ED data from metropolitan WA, representing 178,810 births were available for analysis. From 35,136 presentations, 18,582 (52.9% had an International Classification of Diseases (ICD code for ALRI and 434 had a symptom code directly relating to an ALRI ICD code. A further 9600 presentations had a non-specific diagnosis. From the combined 19,016 ALRI presentations, the highest rates were in non-Aboriginal children aged 6–11 months (81.1/1000 child-years and Aboriginal children aged 1–5 months (314.8/1000. Croup and bronchiolitis accounted for the majority of ALRI ED presentations. Of Aboriginal births, 14.2% presented at least once to ED before age 5 years compared to 6.5% of non-Aboriginal births. Male sex and maternal age Conclusions ED data can give an insight into the out-of-hospital burden of ALRI. Presentation rates to ED for ALRI were high, but are minimum estimates due to current limitations of the ED datasets. Recommendations for improvement of these data are provided. Despite these limitations, ALRI, in particular bronchiolitis and croup are important causes of presentation to paediatric EDs.

  17. Cardiac tumors in a tertiary care cancer hospital: clinical features, echocardiographic findings, treatment and outcomes

    Joseph Swafford

    2012-02-01

    Full Text Available Cardiac tumors are a rare entity, comprised of tumors with diverse histology and natural history. We report the clinical characteristics, echocardiograhic findings, therapy and outcome of 59 patients with primary and metastatic cardiac tumors. Our institutional echocardiogram data base from 1993 through 2005 was reviewed to identify patients diagnosed with intra-cardiac tumor. A total of 59 patients with cardiac tumors were identified and included in the study. The patient’s characteristics, presenting symptoms, diagnostic tests, location, histology of the tumor, treatment and one year survival rate of this population was collected from the medical records. Of the 59 cardiac tumor cases, 16 (27% were primary cardiac tumors and 43 (73% were secondary cardiac tumors. The most common primary tumor was sarcoma affecting 13 (81% of the 16 cases. Of these, 5 patients were angiosarcoma, 5 unclassified sarcoma, one myxoid sarcoma and 2 maignant fibrous histiocytoma. The mean age at presentation was 41.1 years, and the most common location was right atrium affecting 6 cases (37.5%. The most common symptom of dyspnea was present in 10 (62.5% cases. Eleven (25.6% of the 43 secondary cardiac tumors were metastasis from renal cell carcinoma. The mean age at presentation was 55.4 years. Right atrium was the most frequent location affecting 18 (42% of the 43 patients. The most common presenting symptom was dyspnea in 15 (35% cases. For both primary and secondary tumors, dyspnea was the most common symptom and right atrium was most frequently involved. Sarcoma was the most common primary cardiac tumor while metastasis from renal cell carcinoma was the most common secondary tumor.

  18. Cardiac arrest in children

    Tress Erika

    2010-01-01

    Full Text Available Major advances in the field of pediatric cardiac arrest (CA were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term "post-cardiac arrest syndrome" has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners.

  19. Cardiac arrest in children.

    Tress, Erika E; Kochanek, Patrick M; Saladino, Richard A; Manole, Mioara D

    2010-07-01

    Major advances in the field of pediatric cardiac arrest (CA) were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term "post-cardiac arrest syndrome" has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners. PMID:20930971

  20. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery

    Emanueli, Costanza; Fiorentino, Francesca; Reeves, Barnaby C.; Beltrami, Cristina; Mumford, Andrew; Clayton, Aled; Gurney, Mark; Shantikumar, Saran; Angelini, Gianni D.

    2016-01-01

    Introduction Exosome nanoparticles carry a composite cargo, including microRNAs (miRs). Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG) surgery, we investigated if: 1) exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2) circulating exosomes and exosomal cardiac miRs correlate with cardiac troponin (cTn), the current “gold standard” surrogate biomarker of myocardial damage. Methods and Results The concentration of exosome-sized nanoparticles was determined in serial plasma samples. Cardiac-expressed (miR-1, miR-24, miR-133a/b, miR-208a/b, miR-210), non-cardiovascular (miR-122) and quality control miRs were measured in whole plasma and in plasma exosomes. Linear regression analyses were employed to establish the extent to which the circulating individual miRs, exosomes and exosomal cardiac miR correlated with cTn-I. Cardiac-expressed miRs and the nanoparticle number increased in the plasma on completion of surgery for up to 48 hours. The exosomal concentration of cardiac miRs also increased after CABG. Cardiac miRs in the whole plasma did not correlate significantly with cTn-I. By contrast cTn-I was positively correlated with the plasma exosome level and the exosomal cardiac miRs. Conclusions The plasma concentrations of exosomes and their cargo of cardiac miRs increased in patients undergoing CABG and were positively correlated with hs-cTnI. These data provide evidence that CABG induces the trafficking of exosomes from the heart to the peripheral circulation. Future studies are necessary to investigate the potential of circulating exosomes as clinical biomarkers in cardiac patients. PMID:27128471

  1. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Rasmussen, Søren; Frederiksen, Marianne; Abadini, Sadollah; Appel, Jon; Rasmussen, Hanne; Gluud, Christian; Iversen, Lars; Sigurd, Bjarne; Madsen, Mette; Fischer-Hansen, Jørgen; Group, DANREHAB

    2008-01-01

    BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic ...... Depression Scale did not differ significantly. CONCLUSION: At 12 months, the CCR and UC groups did not differ regarding the primary composite outcome. Comprehensive cardiac rehabilitation significantly reduced length of hospital stay and improved cardiac risk factors.......BACKGROUND: Current guidelines broadly recommend comprehensive cardiac rehabilitation (CCR), although evidence for this is still limited. We investigated the 12-month effect of hospital-based CCR versus usual care (UC) for a broadly defined group of cardiac patients within the modern therapeutic......, risk profile, and quality of life. The trial included 770 participants (20-94 years) with congestive heart failure (12%), ischemic heart disease (58%), or high risk of ischemic heart disease (30%). Comprehensive cardiac rehabilitation is composed of 6 weeks of intensive intervention and systematic...

  2. Incidence of sexual dysfunction in men after cardiac surgery in Afshar hospital, Yazd

    Seyed Khalil Foruzan-Nia; Mohammad Hassan Abdollahi; Seyed Hossein Hekmatimoghaddam; Seyedeh Mahdiyeh Namayandeh; Mohammad Hadi Mortazavi

    2011-01-01

    Background: Successful rehabilitation of cardiac surgery patients should include consideration of their sexual activity, but there is paucity of data regarding this matter. Objective: This study determined the incidence and type of sexual dysfunction in our patients. Materials and Methods: Two hundred-seventy nine men with age under 70 years old who had coronary artery bypass graft (CABG), valvular, or other types of cardiac surgery from Dec. 2006 until Dec. 2007 were enrolled in this descrip...

  3. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

    Noyez, L.; Biemans, I.; Verkroost, M.; van Swieten, H.

    2013-01-01

    Objective This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. Methods Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The end...

  4. Hospital-level associations with 30-day patient mortality after cardiac surgery: a tutorial on the application and interpretation of marginal and multilevel logistic regression

    Sanagou Masoumeh

    2012-03-01

    Full Text Available Abstract Background Marginal and multilevel logistic regression methods can estimate associations between hospital-level factors and patient-level 30-day mortality outcomes after cardiac surgery. However, it is not widely understood how the interpretation of hospital-level effects differs between these methods. Methods The Australasian Society of Cardiac and Thoracic Surgeons (ASCTS registry provided data on 32,354 patients undergoing cardiac surgery in 18 hospitals from 2001 to 2009. The logistic regression methods related 30-day mortality after surgery to hospital characteristics with concurrent adjustment for patient characteristics. Results Hospital-level mortality rates varied from 1.0% to 4.1% of patients. Ordinary, marginal and multilevel regression methods differed with regard to point estimates and conclusions on statistical significance for hospital-level risk factors; ordinary logistic regression giving inappropriately narrow confidence intervals. The median odds ratio, MOR, from the multilevel model was 1.2 whereas ORs for most patient-level characteristics were of greater magnitude suggesting that unexplained between-hospital variation was not as relevant as patient-level characteristics for understanding mortality rates. For hospital-level characteristics in the multilevel model, 80% interval ORs, IOR-80%, supplemented the usual ORs from the logistic regression. The IOR-80% was (0.8 to 1.8 for academic affiliation and (0.6 to 1.3 for the median annual number of cardiac surgery procedures. The width of these intervals reflected the unexplained variation between hospitals in mortality rates; the inclusion of one in each interval suggested an inability to add meaningfully to explaining variation in mortality rates. Conclusions Marginal and multilevel models take different approaches to account for correlation between patients within hospitals and they lead to different interpretations for hospital-level odds ratios.

  5. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

    Chan, Elisa K. [Department of Oncology, Saint John Regional Hospital, Saint John (Canada); Woods, Ryan; McBride, Mary L. [Cancer Control Research Department, BC Cancer Agency, Vancouver (Canada); Virani, Sean [Division of Cardiology, University of British Columbia, Vancouver (Canada); Nichol, Alan [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada); Speers, Caroline [Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver (Canada); Wai, Elaine S. [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada); Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca [Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada)

    2014-03-15

    Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast

  6. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

    Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast

  7. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias;

    2013-01-01

    unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The......Background Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is...... (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. Conclusions In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as...

  8. Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

    Christ M; Dierschke W; von Auenmueller KI; van Bracht M; Grett M; Trappe HJ

    2014-01-01

    Martin Christ, Wolfgang Dierschke, Katharina Isabel von Auenmueller, Marc van Bracht, Martin Grett, Hans-Joachim Trappe Department of Cardiology and Angiology, Marienhospital Herne, Ruhr – University Bochum, Herne, Germany Objectives: Little is known about the factors that influence survival following in-hospital resuscitation, but previous investigations have suggested that in-hospital resuscitations outside of regular working hours are associated with worse survival rates. Materi...

  9. Impact of Dispatcher‐Assisted Bystander Cardiopulmonary Resuscitation on Neurological Outcomes in Children With Out‐of‐Hospital Cardiac Arrests: A Prospective, Nationwide, Population‐Based Cohort Study

    Goto, Yoshikazu; Maeda, Tetsuo; GOTO, YUMIKO

    2014-01-01

    Background The impact of dispatcher‐assisted bystander cardiopulmonary resuscitation (CPR) on neurological outcomes in children is unclear. We investigated whether dispatcher‐assisted bystander CPR shows favorable neurological outcomes (Cerebral Performance Category scale 1 or 2) in children with out‐of‐hospital cardiac arrest (OHCA). Methods and Results Children (n=5009, age

  10. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

    J. Berdowski; M.J. Kuiper; M.G.W. Dijkgraaf; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac ca

  11. Pregnancy with cardiac disease: a retrospective five year study in a teaching hospital

    Manohar Rangaswamy; Pradeep Musale Ramachandra

    2016-01-01

    Background: Prevalence of heart disease in pregnancy is found to vary between 0.3%-3.5%. Heart disease is one of the 3 major indirect causes of maternal mortality in India. Methods: This is a retrospective study conducted in department of OBG, Mandya Institute of Medical Science, India. Mandya for a period of five years from January 2011 to December 2015.All cases of cardiac disease during pregnancy admitted during this period will be included in the study. All case records will be obtai...

  12. Cardiac surgery in patients on hemodialysis: Eight years experience of the Tunisian military hospital

    Gharsallah Hedi

    2010-01-01

    Full Text Available End-stage renal disease (ESRD is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality.

  13. Factors affecting the development of adverse drug reactions to β-blockers in hospitalized cardiac patient population

    Mugoša, Snežana; Djordjević, Nataša; Djukanović, Nina; Protić, Dragana; Bukumirić, Zoran; Radosavljević, Ivan; Bošković, Aneta; Todorović, Zoran

    2016-01-01

    The aim of the present study was to undertake a study on the prevalence of cytochrome P450 2D6 (CYP2D6) poor metabolizer alleles (*3, *4, *5, and *6) on a Montenegrin population and its impact on developing adverse drug reactions (ADRs) of β-blockers in a hospitalized cardiac patient population. A prospective study was conducted in the Cardiology Center of the Clinical Center of Montenegro and included 138 patients who had received any β-blocker in their therapy. ADRs were collected using a specially designed questionnaire, based on the symptom list and any signs that could point to eventual ADRs. Data from patients’ medical charts, laboratory tests, and other available parameters were observed and combined with the data from the questionnaire. ADRs to β-blockers were observed in 15 (10.9%) patients. There was a statistically significant difference in the frequency of ADRs in relation to genetically determined enzymatic activity (Phospitalization, CYP2D6 poor metabolizer phenotype, and the concomitant use of other CYP2D6-metabolizing drugs. Therefore, in hospitalized patients with polypharmacy CYP2D6 genotyping might be useful in detecting those at risk of ADRs.

  14. What Is Cardiac Rehabilitation?

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  15. Cardiac arrest - cardiopulmonary resuscitation

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  16. The early minutes of in-hospital cardiac arrest: Shock or CPR? A population based prospective study

    Skogvoll Eirik

    2008-09-01

    Full Text Available Abstract Objectives In the early minutes of cardiac arrest, timing of defibrillation and cardiopulmonary resuscitation during the basic life support phase (BLS CPR is debated. Aims of this study were to provide in-hospital incidence and outcome data, and to investigate the relation between outcome and time from collapse to defibrillation, time to BLS CPR, and CPR quality. Methods Resuscitation attempts during a 3-year period at St. Olav's University Hospital (960 beds were prospectively registered. The times between collapse and initiation of BLS CPR, and defibrillation were determined. CPR quality was assessed by the resuscitation team. The relation between these variables and outcome (short term survival and discharge was explored using non-parametric correlation and logistic regression. Results CPR was started in a total of 223 arrests, an incidence of 77 episodes per 1000 beds per year. Return of spontaneous circulation occurred in 40%, and 29 patients (13% survived to discharge. Median time from collapse to BLS CPR was 1 minute; CPR was judged to be of good quality in half of the episodes. CPR during the first 3 minutes in ventricular fibrillation (VF/VT was negatively associated with survival, but later proved beneficial. For patients with non-shockable rhythms, we found no association between outcome and time to BLS or CPR quality. Conclusion Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality.

  17. Hospitals

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  18. Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure

    Objective: To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Subject: Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Results: Out of fifty patients admitted with cardiac failure 27 (54%) cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 (24%), 8 (16%) and 3 (6%) cases respectively. Conclusion: Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure. (author)

  19. Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis

    Zhai XB

    2016-02-01

    Full Text Available Xiao-bo Zhai,1 Zhi-chun Gu,2 Xiao-yan Liu2 1Department of Pharmacy, Shanghai East Hospital, Affiliated to Tongji University School of Medicine, 2Department of Pharmacy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China Background: Pharmacist-led medication review services have been assessed in the meta-analyses in hospital. Of the 135 relevant articles located, 21 studies met the inclusion criteria; however, there was no statistically significant difference found between pharmacists’ interventions and usual care for mortality (odds ratio 1.50, 95% confidence interval 0.65, 3.46, P=0.34. These analyses may not have found a statistically significant effect because they did not adequately control the wide variation in the delivery of care and patient selection parameters. Additionally, the investigators did not conduct research on the cases of death specifically and did not identify all possible drug-related problems (DRPs that could cause or contribute to mortality and then convince physicians to correct. So there will be a condition to use a more precise approach to evaluate the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients. Objective: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to the cardiology unit. Methods: A comparative study was conducted in a cardiology unit of a university-affiliated hospital. The clinical pharmacists did not perform any intervention associated with improper use of medications during Phase I (preintervention and consulted with the physicians to address the DRPs during Phase II (postintervention. The two phases were compared to evaluate the outcome, and propensity score (PS matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality during Phase I and Phase II

  20. Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

    Dr. Nagla Hamdi Kamal Khalil El- Meanawi

    2015-08-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

  1. Implementation of new echocardiographic modalities in routine practice in a general hospital – Pocket-size cardiac ultrasound and 3 dimensional echocardiography. Studies on feasibility and diagnostic accuracy

    2015-01-01

    This thesis is based upon the implementation of pocket-size cardiac ultrasound (PCU) among medical students and residents in internal medicine and 3 dimensional echocardiography (3DE) in routine care at a general hospital. The introduction of widely available and handy ultrasound devices has represented a challenge to the medical community as implementation in clinical practice can be made by non-specialists. In view of favorable results from the non-expert use of the larger laptop-sized d...

  2. Cardiac Procedures among American Indians and Alaska Natives compared to Non-Hispanic Whites Hospitalized with Ischemic Heart Disease in California

    Jolly, Stacey; Kao, Chi; Bindman, Andrew B.; Korenbrot, Carol

    2010-01-01

    Background American Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population. Objective To determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina. Design Cross-sectional study. Events A total of 796 ischemic heart...

  3. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    Layton, Aimee M.; James Whitworth; James Peacock; Bartels, Matthew N.; Jellen, Patricia A.; Thomashow, Byron M.

    2014-01-01

    The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five parti...

  4. Factors affecting the development of adverse drug reactions to β-blockers in hospitalized cardiac patient population

    Mugoša S

    2016-08-01

    Full Text Available Snežana Mugoša,1,2 Nataša Djordjević,3 Nina Djukanović,4 Dragana Protić,5 Zoran Bukumirić,6 Ivan Radosavljević,7 Aneta Bošković,8 Zoran Todorović5,9 1Department of Pharmacotherapy, Faculty of Pharmacy, University of Montenegro, 2Clinical Trial Department, Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 3Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, 4High Medical School “Milutin Milanković”, Belgrade, 5Department of Pharmacology, Clinical Pharmacology and Toxicology, 6Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, 7Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; 8Clinic for Heart Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro; 9Department of Clinical Immunology and Allergy, Medical Center “Bežanijska kosa”, Belgrade, Serbia Abstract: The aim of the present study was to undertake a study on the prevalence of cytochrome P450 2D6 (CYP2D6 poor metabolizer alleles (*3, *4, *5, and *6 on a Montenegrin population and its impact on developing adverse drug reactions (ADRs of β-blockers in a hospitalized cardiac patient population. A prospective study was conducted in the Cardiology Center of the Clinical Center of Montenegro and included 138 patients who had received any β-blocker in their therapy. ADRs were collected using a specially designed questionnaire, based on the symptom list and any signs that could point to eventual ADRs. Data from patients’ medical charts, laboratory tests, and other available parameters were observed and combined with the data from the questionnaire. ADRs to β-blockers were observed in 15 (10.9% patients. There was a statistically significant difference in the frequency of ADRs in relation to genetically determined enzymatic activity (P<0.001, with ADRs’ occurrence significantly

  5. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33 °C or 36 °C

    Bro-Jeppesen, John; Kjaergaard, Jesper; Wanscher, Michael;

    2014-01-01

    (CRP) and procalcitonin (PCT) at randomization and 24, 48 and 72 h after CA. Severity of PCAS was assessed by Sequential Organ Failure Assessment (SOFA) score. RESULTS: Plasma levels of both IL-6 and IL-10 determined at randomization correlated with severity of PCAS at day 2 (r=0.36 and r=0.27, p<0...

  6. Chest Compressions Cause Recurrence of Ventricular Fibrillation After the First Successful Conversion by Defibrillation in Out-of-Hospital Cardiac Arrest

    J. Berdowski; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Background-Unlike Resuscitation Guidelines (GL) 2000, GL2005 advise resuming cardiopulmonary resuscitation (CPR) immediately after defibrillation. We hypothesized that immediate CPR resumption promotes earlier recurrence of ventricular fibrillation (VF). Methods and Results-This study used data of a

  7. Design of the Circulation Improving Resuscitation Care (CIRC) Trial: a new state of the art design for out-of-hospital cardiac arrest research

    Lerner, E.B.; Persse, D.; Souders, C.M.; Sterz, F.; Malzer, R.; Lozano, M., Jr.; Westfall, M.; Brouwer, M.A.; Grunsven, P.M. van; Whitehead, A.; Olsen, J.A.; Herken, U.R.; Wik, L.

    2011-01-01

    PURPOSE: Mechanical chest compression devices, such as the AutoPulse((R)), have been developed to overcome problems associated with manual CPR (M-CPR). Animal and human studies have shown that AutoPulse CPR improves hemodynamic parameters over M-CPR. However, human studies conducted in the prehospit

  8. Hemodynamics and vasopressor support during targeted temperature management at 33°C Versus 36°C after out-of-hospital cardiac arrest

    Bro-Jeppesen, John; Annborn, Martin; Hassager, Christian; Wise, Matt P; Pelosi, Paolo; Nielsen, Niklas; Erlinge, David; Wanscher, Michael; Friberg, Hans; Kjaergaard, Jesper

    2015-01-01

    targeted temperature management at 33 °C or 36 °C. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, heart rate, and lactate were registered at prespecified time points. The population was stratified according to cardiovascular Sequential Organ Failure Assessment = 4 defining the...... high vasopressor group and cardiovascular Sequential Organ Failure Assessment less than or equal to 3 definingthe low vasopressor group. The targeted temperature management 33 (TTM33) group had a hemodynamic profile with lower heart rate (-7.0 min(-1) [95% confidence limit, -8.7, -5.1]; p(group) < 0...... decreased heart rate, elevated levels of lactate, and need for increased vasopressor support compared with targeted temperature management at 36 °C. Low mean arterial pressure and need for high doses of vasopressors were associated with increased mortality independent of allocated targeted temperature...

  9. Ventricular ectopic activity is reduced in comatose survivors of out of hospital cardiac arrest treated with target temperature management at 36 degrees C compared to 33 degrees C

    Thomsen, J. H.; Kjaergaard, J.; Graff, Claus;

    2015-01-01

    Introduction: The classification of myocardial infarction (MI) into five types was introduced in 2007 as a component of the Universal definition. However, data outlining clinical symptoms in different MI types are limited. Purpose: To describe the presenting symptoms in patients with type 1 MI vs...... debut symptoms at the time of MI. The diagnosis and classification of MI were according to the Universal definition. Thus, a rise/fall pattern of troponin values was required with at least one value above the 99th percentile of the upper reference limit. Also, clilinical evidence of myocardial ischemia...

  10. Sympathoadrenal Activation and Endothelial Damage Are Inter Correlated and Predict Increased Mortality in Patients Resuscitated after Out-Of-Hospital Cardiac Arrest

    I. Johansson, Pär; Bro-Jeppesen, John; Kjaergaard, Jesper;

    2015-01-01

    at a single site ICU. Blood was sampled a median 135 min (Inter Quartile Range (IQR) 103-169) after OHCA. Plasma catecholamines (adrenaline, noradrenaline) and serum endothelial biomarkers (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin) were measured at admission (immediately after...... randomization). We had access to data on demography, medical history, characteristics of the OHCA, patients and 180-day outcome. RESULTS: Adrenaline and noradrenaline correlated positively with syndecan-1 and thrombomodulin i.e., biomarkers reflecting endothelial damage (both p<0.05). Overall 180-day mortality...... was 35%. By Cox analyses, plasma adrenaline, serum sE-selectin, reflecting endothelial cell activation, and thrombomodulin levels predicted mortality. However, thrombomodulin was the only biomarker independently associated with mortality after adjusting for gender, age, rhythm (shockable vs. non...

  11. Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

    Langkjær, Sandra; Hassager, Christian; Kjaergaard, Jesper; Salam, Idrees; Thomsen, Jakob Hartvig; Lippert, Freddy K; Wanscher, Michael; Køber, Lars; Nielsen, Niklas; Søholm, Helle

    2015-01-01

    . The primary endpoint was 30-day mortality analysed by log-rank and multivariate Cox-regression analyses. RESULTS: A cCT scan was performed in 341(30%) of the clinical OHCA-cohort, and an early CT (<24h) was performed in 188 patients. The early CT was found 'normal' in 163(89%) and with reduced......(60%), 'cerebral bleeding' in 4(3%), 'new cerebral infarction' in 10(7%), and 'reduced discrimination between white and grey matter and/or oedema' in 45(30%) patients. 'Reduced discrimination and/or oedema' by late cCT was independently associated with higher 30-day mortality compared to patients with a normal...... late CT (HR(adjusted) = 2.6 (95%CI: 1.4-4.8, p = 0.002). CONCLUSION: Our observations suggest that a cCT may be useful as part of the neurological prognostication in patients with OHCA. 'Reduced discrimination between white and grey matter and/or oedema' on cCT was independently associated with a poor...

  12. Cardiac sarcoidosis

    Costello BT; Nadel J.; Taylor AJ

    2016-01-01

    Benedict T Costello,1,2 James Nadel,3 Andrew J Taylor,1,21Department of Cardiovascular Medicine, The Alfred Hospital, 2Baker IDI Heart and Diabetes Research Institute, Melbourne, VIC, 3School of Medicine, University of Notre Dame, Sydney, NSW, Australia Abstract: Cardiac sarcoidosis is a rare but life-threatening condition, requiring a high degree of clinical suspicion and low threshold for investigation to make the diagnosis. The cardiac manifestations include heart failure, conducting syst...

  13. Nourishing change. Partnership enlists dozens of hospitals to put healthier food on their menus and kick junk food out of the cafeteria.

    Lee, Jaimy

    2012-10-01

    More than 150 hospitals have signed on to the Partnership for a Healthier America's push to ditch the deep-fat fryer in their cafeterias and bulk up on fruit and veggies. "Our focus is to ensure that if people want to make a healthy choice, they can," says Larry Soler, left, president and CEO of the partnership, which is working to reduce childhood obesity. PMID:23163198

  14. The German Birth Order Register - order-specific data generated from perinatal statistics and statistics on out-of-hospital births 2001-2008

    Michaela Kreyenfeld; Scholz, Rembrandt D.; Frederik Peters; Ines Wlosnewski

    2010-01-01

    Until 2008, Germany’s vital statistics did not include information on the biological order of each birth. This resulted in a dearth of important demographic indicators, such as the mean age at first birth and the level of childlessness. Researchers have tried to fill this gap by generating order-specific birth rates from survey data, and by combining survey data with vital statistics. This paper takes a different approach by using hospital statistics on births to generate birth order-specific...

  15. Management of penetrating cardiac injuries in the Department of surgery, Mohamed Thahar Maamouri Hospital, Tunisia: report of 19 cases

    Ezzine, Sonia Baccari; Bouassida, Mahdi; Benali, Mechaal; Ghannouchi, Mosaab; Chebbi, Fethi; Sassi, Sélim; Mighri, Mohamed Mongi; Touinsi, Hassen; Sassi, Sadok

    2012-01-01

    The goal of this paper is to discuss how to ameliorate the management of penetrating cardiac injuries in general surgery department. An algorithm for the initial assessment of penetrating injuries in cardiac box, based on our own experience, is presented. This was a retrospective study of 19 patients undergoing thoracotomy for penetrating cardiac injuries, managed in the department of general surgery of Nabeul-Tunisia, between 1994 and 2010. The mean age of patients was 25 years old. Sex rati...

  16. A Systemic Capillary Leak Syndrome (Clarkson Syndrome in a Patient with Chronic Lymphocytic Leukemia: A Case Report in an Out-of-Hospital Setting

    Manon Durand Bechu

    2016-01-01

    Full Text Available Systemic Capillary Leak Syndrome (SCLS is a rare disease with poor prognosis, characterized by the occurrence of mucocutaneous and visceral edema with hypotension, hemoconcentration, and unexpected hypoalbuminemia. The disease can be idiopathic (Clarkson syndrome or secondary to other diseases and treatments. We describe this syndrome in a prehospitalized, 63-year-old patient with chronic lymphocytic leukemia and an idiopathic form of SCLS manifesting as hypovolemic shock. Initial care is hospitalization in intensive care. In addition to etiological treatment if fluid replacement is necessary, treatment must be closely monitored for secondary overload complications. Catecholamine rather than arrhythmogenic support may be associated.

  17. A Systemic Capillary Leak Syndrome (Clarkson Syndrome) in a Patient with Chronic Lymphocytic Leukemia: A Case Report in an Out-of-Hospital Setting

    Durand Bechu, Manon; Rouget, Antoine; Recher, Christian; Azoulay, Elie; Bounes, Vincent

    2016-01-01

    Systemic Capillary Leak Syndrome (SCLS) is a rare disease with poor prognosis, characterized by the occurrence of mucocutaneous and visceral edema with hypotension, hemoconcentration, and unexpected hypoalbuminemia. The disease can be idiopathic (Clarkson syndrome) or secondary to other diseases and treatments. We describe this syndrome in a prehospitalized, 63-year-old patient with chronic lymphocytic leukemia and an idiopathic form of SCLS manifesting as hypovolemic shock. Initial care is hospitalization in intensive care. In addition to etiological treatment if fluid replacement is necessary, treatment must be closely monitored for secondary overload complications. Catecholamine rather than arrhythmogenic support may be associated. PMID:27069700

  18. Knowledge, attitude and practices on needle-stick and sharps injuries in tertiary care cardiac hospital: A survey

    S Sharma

    2010-01-01

    Full Text Available Aims: One of the potential hazards for health care workers (HCWs is needle-stick and sharp injuries (NSSIs. The objective of the study was to assess the knowledge and attitude of health care workers about the NSSIs. Settings and Design: This was a cross-sectional survey conducted in the tertiary care cardiac center. The participants were health care workers including doctors, nurses, technicians, and housekeeping staff from the different areas of the hospital. Methods and Materials: This cross-sectional survey was conducted in the institute using a self-administered validated questionnaire. The participants consisted of a total of 190 HCWs namely doctors, nurses, technicians, and housekeeping staff. Statistical Analysis Used: Nil. Results: Results showed maximum participant were in the age group of 20-30 years. 94.7% were aware about standard precautions. 91.5% knew about the procedure for reporting of NSSIs. Only 50.2% HCWs gave correct answers regarding disease transmission through needle stick and sharp injury. The prevalence of NSSIs was highest among nurses (38.4%, and needle on the disposable syringe (76.9% was the most common source of NSSIs. Conclusions: The survey revealed few gaps in the knowledge amongst HCWs about NSSIs like risks associated with needle-stick injuries and use of preventive measures, disassembling of needles prior to disposal. These gaps can be addressed by extensive education. As nurses were the most affected victim for the NSSIs, more emphasis should be given towards them for reducing the NSSIs.

  19. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle;

    2014-01-01

    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopres...

  20. Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263

    Lane Deirdre

    2003-09-01

    Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the

  1. Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America

    Pablo Lister

    2009-08-01

    Full Text Available Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascular avançado. Um desfibrilador automático externo (DAE foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce.El presente reporte de caso, relata la atencion prehospitalaria de un paciente con factores de riesgo atendido en el area prehospitalaria al sufrir arresto cardiaco y presentar fibrilacion ventricular. El paciente fue atendido bajo estandares de Soporte Basico Vital y Soporte Cardiovascular Avanzado Vital, se aplico un Desfibrilador Automatizado Externo (DEA con resultado favorable y exito al recuperar al paciente de su condicion de compromiso de vida. Este es el primer reporte documentado con resultado favorable en el pais, en el area prehospitalaria y refuerza la conveniencia de adoptar politicas de Acceso Publico a la Desfibrilacion Temprana.This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.

  2. Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009 Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009

    Sergio Sesma-Vázquez

    2011-01-01

    Full Text Available OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Adecuado (ENSATA de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82%. Los hospitales de los Servicios Estatales de Salud (SESA mostraron una disponibilidad de 77% (variación de 30 a 96%. El surtimiento completo de recetas fue de 97% en las instituciones de seguridad social, cifra que contrasta con 56.2% de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94% La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1% gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas.OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA 2009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the

  3. Management of penetrating cardiac injuries in the Department of surgery, Mohamed Thahar Maamouri Hospital, Tunisia: report of 19 cases.

    Ezzine, Sonia Baccari; Bouassida, Mahdi; Benali, Mechaal; Ghannouchi, Mosaab; Chebbi, Fethi; Sassi, Sélim; Mighri, Mohamed Mongi; Touinsi, Hassen; Sassi, Sadok

    2012-01-01

    The goal of this paper is to discuss how to ameliorate the management of penetrating cardiac injuries in general surgery department. An algorithm for the initial assessment of penetrating injuries in cardiac box, based on our own experience, is presented. This was a retrospective study of 19 patients undergoing thoracotomy for penetrating cardiac injuries, managed in the department of general surgery of Nabeul-Tunisia, between 1994 and 2010. The mean age of patients was 25 years old. Sex ratio was 8,5. All patients had cardiac injury resulting from stab wounds inside of the pericardium. 42% of them were critically unstable, 21% had cardiac tamponnade. All these patients were quickly transferred to the operating room without any other investigations. 37% of patients were hemodynamically stable and underwent additional investigations. The management of penetrating cardiac injuries is possible in a general surgery department, but it requires a rapid prehospital transfer, a yet thorough physical examination along with efficient surgical management, all done in minimal time. PMID:22593790

  4. Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

    Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

    2016-03-01

    Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. PMID:24782478

  5. [Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology].

    Schenk, Peter; Eber, Ernst; Funk, Georg-Christian; Fritz, Wilfried; Hartl, Sylvia; Heininger, Peter; Kink, Eveline; Kühteubl, Gernot; Oberwaldner, Beatrice; Pachernigg, Ulrike; Pfleger, Andreas; Schandl, Petra; Schmidt, Ingrid; Stein, Markus

    2016-02-01

    The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail. PMID:26837865

  6. Weight-for-age standard score - distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery

    Antony George

    2015-01-01

    Full Text Available Objective: To study the distribution of weight for age standard score (Z score in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical unit at our institute were enrolled. Z score for weight for age was calculated. Patients were classified according to Z score and mortality across the classes was compared. Discrimination and calibration of the for Z score model was assessed. Improvement in predictability of mortality after addition of Z score to Aristotle Comprehensive Complexity (ACC score was analyzed. Results: The median Z score was -3.2 (Interquartile range -4.24 to -1.91] with weight (mean±SD of 8.4 ± 3.38 kg. Overall mortality was 11.5%. 71% and 52.59% of patients had Z score < -2 and < -3 respectively. Lower Z score classes were associated with progressively increasing mortality. Z score as continuous variable was associated with O.R. of 0.622 (95% CI- 0.527 to 0.733, P < 0.0001 for in-hospital mortality and remained significant predictor even after adjusting for age, gender, bypass duration and ACC score. Addition of Z score to ACC score improved its predictability for in-hosptial mortality (δC - 0.0661 [95% CI - 0.017 to 0.0595, P = 0.0169], IDI- 3.83% [95% CI - 0.017 to 0.0595, P = 0.00042]. Conclusion: Z scores were lower in our cohort and were associated with in-hospital mortality. Addition of Z score to ACC score significantly improves predictive ability for in-hospital mortality.

  7. Hospitals

    Mullins, Michael

    2013-01-01

    is to minimize the negative effects of stress inducing environments based on research results. Which stress inducing factors? We can look around at some old hospitals and see they are noisy, confusing, ugly, monotonous, hard, cold, artificial, and dark; qualitative terms which can indicate what we shouldn...... in the navigation experience and wasted time of medical staff in providing directions. Space in hospitals: space can be divided into personal, social and outdoor space. Personal space: single rooms have been well documented in: admission length, mortality rates, comfort levels, sense of privacy, all users......’ satisfaction. Social space: attention to spatial qualities, volume and interior design in terms of encouraging physical contact between users in wards, waiting areas and semi-private rooms. Outdoor space: Landscape and gardens are not enough in themselves; they should be visible, centrally or strategically...

  8. Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

    L.M.W. van Venrooij; P.A.M. van Leeuwen; R. de Vos; M.M.M.J. Borgmeijer-Hoelen; B.A.J.M. de Mol

    2009-01-01

    Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospe

  9. Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)

    Lee, Andy Y; Moss, Arthur J; Ruwald, Martin H;

    2015-01-01

    effects on subsequent outcomes and benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Multivariate Cox models were used to determine the temporal influence of previous HF hospitalization on the end point of HF or death within all left bundle branch block implantable cardioverter-defibrillator...... (ICD) and CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial (n = 1,250) and to evaluate the clinical benefit of CRT-D implantation, comparing CRT-D patients with ICD patients within each previous HF hospitalization...

  10. Propensity-matched analysis of association between preoperative anemia and in-hospital mortality in cardiac surgical patients undergoing valvular heart surgeries

    Shreedhar S Joshi

    2015-01-01

    Full Text Available Introduction: Anaemia is associated with increased post-operative morbidity and mortality. We retrospectively assess the relationship between preoperative anaemia and in-hospital mortality in valvular cardiac surgical population. Materials and Methods: Data from consecutive adult patients who underwent valvular repair/ replacement at our institute from January 2010 to April 2014 were collected from hospital records. Anaemia was defined according to WHO criteria (hemoglobin <13g/dl for males and <12g/dl for females. 1:1 matching was done for anemic and non-anemic patients based on propensity for potentially confounding variables. Logistic regression was used to evaluate the relationship between anaemia and in-hospital mortality. MatchIt package for R software was used for propensity matching and SPSS 16.0.0 was used for statistical analysis. Results: 2449 patients undergoing valvular surgery with or without coronary artery grafting were included. Anaemia was present in 37.1% (33.91% among males & 40.88% among females. Unadjusted OR for mortality was 1.6 in anemic group (95% Confidence Interval [95% CI] - 1.041-2.570; p=0.033. 1:1 matching was done on the basis of propensity score for anaemia (866 pairs. Balancing was confirmed using standardized differences. Anaemia had an OR of 1.8 for mortality (95% CI- 1.042 to 3.094, P=0.035. Hematocrit of < 20 on bypass was associated with higher mortality. Conclusion: Preoperative anaemia is an independent risk factor associated with in-hospital mortality in patients undergoing valvular heart surgery.

  11. Acute Kidney Injury in ICU Patients Following Non-Cardiac Surgery at Masih Daneshvari Hospital: Joint Modeling Application

    Khoundabi, Batoul; Kazemnejad, Anoshirvan; Mansourian, Marjan; Kazempoor Dizaji, Mehdi; Hashemian, Seyed Mohammadreza

    2015-01-01

    Background: Admission to the intensive care unit (ICU) is often complicated by early acute kidney injury (AKI). AKI is associated with high rates of mortality and morbidity. Risk factors and incidence of AKI have been notably high following non-cardiac surgery in the past decade. The aim of this study was to determine the hazard rate of AKI, the effect of risk factors of AKI and also to assess the changes in urine output (UO) as a predictor of AKI using joint modeling in patients undergoing n...

  12. Comparison of effective doses between computed tomography cardiac angiography and conventional angiography at Pantai Hospital, Kuala Lumpur

    Mohamed, Faizal; Moin, F. H. A.

    2013-05-01

    This research studies two types of cardiac angiography procedures, namely Computed Tomography Cardiac Angiography (CTCA) and Conventional Angiography (CA). The following research was executed to estimate the difference of mean effective doses that the patients received through both procedures. The mean dose-length-product (DLP) from CTCA and mean dose-area-product (DAP) from CA were utilized in calculating the effective doses. The result shows that the mean effective dose for CTCA and CA are 1.71±0.59 mSv and 53.25±14.22 mSv respectively. This proves that the mean effective dose received by patients undergoing CA is higher than patients undergoing CTCA. According to t-test, both procedures differ significantly, with a difference amounting to p<0.0001. The increases of the effective dose that the patients received through CA procedure were influenced by exposure time, the coronary anatomical condition, the operator's experience, and the operation methods.

  13. A Study to Assess the Factors and Out of Pocket Expenditures in the Patients of Road Traffic Accidents Admitted in a Tertiary Care Hospital in a Central India District

    Srivastava DK

    2014-12-01

    Full Text Available Background: Road traffic injuries are estimated to be the eighth leading cause of death globally, with an impact similar to that caused by many communicable diseases, such as malaria. road traffic injuries are estimated to cost low- and middle-income countries between 1–2 % of their Gross Domestic Product (GDP, an estimate of about US$ 100 billion a year. Objectives: To study the epidemiological profile of Road Traffic Injuries among the patients admitted in a tertiary care centre and too find out the various out of pocket expenditure in the patients of Road Traffic Accidents. Material and Method: The present study was a hospital based Descriptive Prospective Study. A list of all the patients admitted due to Road Traffic Accident in last one week was obtained from the ward sisters of Orthopedic Department. All the selected participants were interviewed on the two fixed days. A pre tested structured open ended questionnaire was used for data collection. Results: Of the 48 participants interviewed, 34male and 14 females. Most common age group affected was 21-25 years followed by 16-20 years. The rate of accidents was most common on the weekends. The rate of accidents was more in users of two wheelers. Majority of the expenditure in the First week of admission was on the purchase of medicines followed by diagnosis. Majority of the victims also suffered huge financial loss due to loss of salary, closure of shop, loss due to daily wages etc. Conclusion: The present study hereby concludes that there is an urgent need for creating awareness about Road Traffic Accident. The study also concludes that majority of the out of pocket expenditure in the first week of admission is on the medication.

  14. A Unique Case of Cardiac Arrest following K2 Abuse

    Saif Ibrahim

    2014-01-01

    Full Text Available Sudden cardiac death (SCD accounts for up to 450,000 deaths every year in the United States (Zipes et al. (2006. Most cases of sudden cardiac death occur in subjects with no prior history of heart disease (Myerburg et al. (1998. The incidence of sudden death in a general population has been shown to increase contemporaneously with substance abuse (Phillips et al. (1999. The causative association of sudden death with cocaine, methadone, and volatile agents is well established (Adgey et al. (1995 and Isner et al. (1986. We describe a case of out-of-hospital cardiac arrest temporally related to abuse of the synthetic cannabinoid street drug known as K2. To our knowledge, there are no previously documented cases of sudden cardiac death associated with synthetic cannabinoids although they have been linked to myocardial infarction in teenagers despite normal coronary angiography (Mir et al. (2011.

  15. Availability and Utilization of Cardiac Resuscitation Centers

    Bryn E. Mumma

    2014-11-01

    Full Text Available Introduction: The American Heart Association (AHA recommends regionalized care following out-of-hospital cardiac arrest (OHCA at cardiac resuscitation centers (CRCs. Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods: We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD, and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5. We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results: Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13% met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26% of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52% admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65% responded to the survey; 69/70 (99%, 95% CI 92-100% reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI

  16. The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes.

    Hannan, Edward L; Cozzens, Kimberly; King, Spencer B; Walford, Gary; Shah, Nirav R

    2012-06-19

    In 1988, the New York State Health Commissioner was confronted with hospital-level data demonstrating very large, multiple-year, interhospital variations in short-term mortality and complications for cardiac surgery. The concern with the extent to which these differences were due to variations in patients' pre-surgical severity of illness versus hospitals' quality of care led to the development of clinical registries for cardiac surgery in 1989 and for percutaneous coronary interventions in 1992 in New York. In 1990, the Department of Health released hospitals' risk-adjusted cardiac surgery mortality rates for the first time, and shortly thereafter, similar data were released for hospitals and physicians for percutaneous coronary interventions, cardiac valve surgery, and pediatric cardiac surgery (only hospital data). This practice is still ongoing. The purpose of this communication is to relate the history of this initiative, including changes or purported changes that have occurred since the public release of cardiac data. These changes include decreases in risk-adjusted mortality, cessation of cardiac surgery in New York by low-volume and high-mortality surgeons, out-of-state referral or avoidance of cardiac surgery/angioplasty for high-risk patients, alteration of contracting choices by insurance companies, and modifications in market share of cardiac hospitals. Evidence related to these impacts is reviewed and critiqued. This communication also includes a summary of numerous studies that used New York's cardiac registries to examine a variety of policy issues regarding the choice and use of cardiac procedures, the comparative effectiveness of competing treatment options, and the examination of the relationship among processes, structures, and outcomes of cardiac care. PMID:22698487

  17. The role of the immuno-inflammatory response in patients after cardiac arrest

    Samborska-Sablik, Anna; Sablik, Zbigniew; Gaszynski, Wojciech

    2011-01-01

    Introduction The aim of the research was to assess whether concentrations of inflammatory markers in blood of patients after cardiac arrest (CA) are related to their clinical state and survival. Material and methods Forty-six patients, aged 63 ±12 years, 21 of them after out-of-hospital CA and 25 after in-hospital CA, were enrolled in the study. Twenty-five patients survived and were discharged from hospital (CA-S); 21 died during hospitalization (CA-D). The clinical state of the patients was...

  18. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

    Lucieni Oliveira Conterno

    2014-04-01

    Full Text Available Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%, 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%, urinary tract infection (2.8%, pneumonia (2.3%, and bloodstream infection (1.7%. The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31, ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09, mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08, use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99. Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24. Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0, use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0, insulin use (OR 1.8; 95% CI 1.2 to 2.8, surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0 pneumonia (OR 4.3; 95% CI 2.1 to 8.9 and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2. Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

  19. Gasto de hogares durante la hospitalización de menores derechohabientes, con diagnóstico de leucemia, en dos hospitales en México Out-of-pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals

    Arnoldo Rocha-García

    2003-08-01

    Full Text Available OBJETIVO: Estimar el gasto de los hogares durante la primera hospitalización en 51 menores de 15 años de edad con leucemia, atendidos en dos hospitales del Instituto Mexicano del Seguro Social, en México durante 1997. MATERIAL Y MÉTODOS: Estudio transversal hecho en 1997 en el Distrito Federal y en León, Guanajuato. Se aplicó un cuestionario a los padres de 51 menores de 15 años de edad con diagnóstico de leucemia, hospitalizados por primera vez, en dos unidades del Instituto Mexicano del Seguro Social. Se capturó la información de los costos directos e indirectos enfrentados por los hogares durante esa primera hospitalización. Se aplicó el Indice de Precios al Consumidor (1997-2002 para expresar las estimaciones en precios de 2002. Se estimaron indicadores de gasto promedio y gastos catastróficos. Se establecieron los factores asociados, mediante un modelo de regresión lineal, utilizando el gasto total durante la hospitalización como variable dependiente. RESULTADOS: El costo promedio por paciente hospitalizado es de 7 318 pesos. El 86% corresponde a gastos asociados con la atención y 14% a costos indirectos. Para 14% de los hogares este gasto fue catastrófico. En 47% de los casos la erogación rebasó 100% de su ingreso disponible durante el periodo. Estos gastos se asociaron con lugar de residencia, nivel de ingreso y tipo de seguro. CONCLUSIONES: Ser derechohabiente de la seguridad social reduce los gastos de bolsillo por atención directa de los pacientes, pero no reduce los gastos complementarios, que pueden resultar onerosos para una elevada proporción de hogares. El costo de la primera hospitalización significó, en más de la mitad de los casos estudiados, el consumo de los ahorros, el endeudamiento o la venta de propiedades de los hogares, y dificultó la continuidad del tratamiento.OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in

  20. [An epidemiological study of cardiac emergency cases in the province of Florence and the Southeast Florence Hospital area].

    De Marinis, A; Buoncristiano, U; Pagni, E; Piacentino, V; Pailli, F; Santoro, G; Vergassola, R

    1980-05-01

    The national data provided by ANMCO in 1978 show a total of 2.5 m heart cases in Italy, including 1.5 m instances of ischaemic cardiopathy, and an annual incidence of 105,000 new cases of myocardial infarct. An assessment was made of the 1976 and 1977 pattern of "cardiological emergency cases" (ISTAT codes 402, 410-14, 427-29, 441, 450, 519, 997) in the province of Florence and two of its social and health consortia: 39 (municipalities of Dicomano, Londa, Pelago, Pontassieve, Rufina, S. Godenzo), and 51 (municipalities of Borgata Ripoli, Greve, Impruneta, S. Casciano, Tavarnelle). The records of the S. Maria Nuova, Florence Hospital were used for in-patient data, since this is the only hospital in the province with automatic filing by discharge diagnosis according to the ISTAT code. Mortality in emergency cases in the two consortia m and the province fell from 14.68% and 17.17% to 11.20% and 18.11% respectively in the two years. In both populations, the highest incidence was between 70 and 74 yr of age in 1976, and between 65 and 69 yr in 1977. In the case of infarct, mortality moved from 18.75 to 7.58% (consortia) and from 22.40% to 20.93% (province), with maximum incidences in 1976 between 70 and 74 yr (consortia and province), and in 1977 between 65 and 69 yr (province) and between 55 and 59 yr (consortia). Admissions were greatest in number on Mondays (peak hours: 11 a.m. to 4 p.m.) whereas no difference was noted between one month and another. The Hospital Resuscitation Centre, which serves the two consortia, received 45 emergency cases in 1977, including 25 infarct patients. Total mortality was 13.33% (infarct 20%). The slight numeric discrepancy between in the latter data and those held in the computer suggests that the ISTAT code may not be easy to use and not always employed by physicians in a rational manner. PMID:7219745

  1. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    Aimee M. Layton

    2014-01-01

    Full Text Available The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group and 53% (>31-day group of the time, education material was read 44% (1–30 and 53% (>31 of the time, and physical activity was reported 25% (1–30 and 42% (>31 of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients.

  2. An update on insertable cardiac monitors

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W

    2015-01-01

    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring...

  3. [Pre-hospital medicine and medical control system in Japan].

    Tanabe, Seizan

    2016-02-01

    It is necessary to treat the patient from the site of the emergency to raise a lifesaving rate of the patient. As a prime example would be out-of-hospital cardiac arrest. Once you start the treatment after hospital arrival, cardiac arrest patient can't be life-saving. It is necessary to start the chest compression, etc. from the site of the emergency. Medical care to be carried out on the scene of emergency is the pre-hospital care. In recent years, improvement of the pre-hospital care is remarkable in Japan. It is because of that the quantity and quality of the emergency life-saving technician are being enhanced. And also doctor-helicopter system have been enhanced. Medical control is a critical component of the improvement. PMID:26915258

  4. A novel program focused on women survivors who were enrolled in a cardiac arrest pathway.

    Herzog, Eyal; Tamis, Jacqueline; Aziz, Emad F; Shapiro, Janet M

    2013-03-01

    The number of cases of out-of-hospital cardiac arrest is estimated to be 300,000/year in the United States. Two landmark studies published in 2002 demonstrated that therapeutic hypothermia decreased mortality and improved neurological outcome after out-of-hospital cardiac arrest. Our institutional pathway for the management of survivors of cardiac arrest stresses teamwork involving multiple disciplines, including cardiology, critical care, nursing, neurology, infectious diseases, physical therapy, social work, and pastoral care. Involvement of the patients' families is critical in the understanding of the process and in the decision making and goals of care when neurological prognosis is poor. In a unique approach, we have included the survivors in the process. Our approach to quality improvement includes a yearly conference incorporating the voices of survivors and families. This conference serves as a means to review our experience, educate clinicians, involve all healthcare providers in the outcome, and provide a model of communication and professionalism to trainees. During review of our experience, we noted the small number of women undergoing therapeutic hypothermia, accounting for only 21% of all patients undergoing this therapy after cardiac arrest. This led to a conference that focused on cardiac disease and cardiac arrest in women. PMID:23411605

  5. Hope out of Poverty

    Davenport, Roy F.; Tolbert, Marsha; Myers-Oliver, Donna; Brissett, Julia M.; Roland, Annissa J.

    2007-01-01

    In "A Framework of Poverty," Ruby Payne (1998) itemizes the things that characterize poverty-stricken people. She talks about how hard it is for a person to move out of poverty. To not pass poverty on to another generation, one must have a vision. One must have a desire to achieve a better life or a strong support system. Schools must become the…

  6. Systematic review of pre-hospital outcomes for evidence-based evaluation of ambulance service care

    Phung, Viet-Hai; Coster, Joanne; Wilson, Richard; Turner, Janette; Booth, Andrew; Siriwardena, A Niroshan

    2013-01-01

    Background: Ambulance service performance measurement has previously focused on response times and survival (particularly from out-of-hospital cardiac arrest). The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted a systematic review of the international literature on quality measures and outcomes re...

  7. Pediatric Cardiac Arrest Due to Trauma.

    Kjellemo, Hugo; Hansen, Andreas E; Øines, Dennis A; Nilsen, Thor O; Wik, Lars

    2016-01-01

    Survival from pediatric cardiac arrest due to trauma has been reported to be 0.0%-8.8%. Some argue that resuscitation efforts in the case of trauma-related cardiac arrests are futile. We describe a successful outcome in the case of a child who suffered cardiac arrest caused by external traumatic airway obstruction. Our case illustrates how to deal with pediatric traumatic cardiac arrests in an out-of-hospital environment. It also illustrates how good clinical treatment in these situations may be supported by correct treatment after hospital admission when it is impossible to ventilate the patient to provide sufficient oxygen delivery to vital organs. This case relates to a lifeless child of 3-5 years, blue, and trapped by an electrically operated garage door. The first ambulance arrived to find several men trying to bend the frame and the door apart in order to extricate the child, who was hanging in the air with head and neck squeezed between the horizontally-moving garage door and the vertical door frame. One paramedic found a car jack and used it to push the door and the frame apart, allowing the lifeless child to be extricated. Basic life support was then initiated. Intubation was performed by the anesthesiologist without drugs. With FiO2 1.0 the first documented SaO2 was <50%. Restoration of Spontaneous Circulation was achieved after thirty minutes, and she was transported to the hospital. After a few hours she was put on venous-arterial ECMO for 5.5 days and discharged home after two months. Outpatient examinations during the rest of 2013 were positive, and the child found not to be suffering from any injuries, either physical or mental. The last follow-up in October 2014 demonstrated she had made a 100% recovery and she started school in August 2014. PMID:26930137

  8. Hypothermia improves outcome from cardiac arrest.

    Bernard, S A

    2005-12-01

    Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid

  9. Learning Out of Leaders

    Kerkyacharian, Gerard; Mougeot, Mathilde; Picard, Dominique; Tribouley, Karine

    2010-01-01

    This paper investigates the problem of selection and estimation in a high dimensional regression-type model. We propose a procedure with no optimization called LOL, for Learning Out of Leaders. LOL is an auto-driven algorithm with two thresholding steps. A first adaptive thresholding helps to select leaders among the initial regressors in such a way to reduce the dimensionality. Then a second thresholding follows the estimations and predictions performed by linear regression on the leaders. T...

  10. Learning Out of Leaders

    Mougeot, Mathilde; Picard, Dominique; Tribouley, Karine

    2010-01-01

    This paper investigates the estimation problem in a regression-type model. To be able to deal with potential high dimensions, we provide a procedure called LOL, for Learning Out of Leaders with no optimization step. LOL is an auto-driven algorithm with two thresholding steps. A first adaptive thresholding helps to select leaders among the initial regressors in order to obtain a first reduction of dimensionality. Then a second thresholding is performed on the linear regression upon the leaders...