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1

Out-of-Hospital Cardiac Arrest - Optimal Management.  

UK PubMed Central (United Kingdom)

Out-of-hospital cardiac arrest (OHCA) has attracted increasing attention over the past years because outcomes have improved impressively lately. The changes for neurological intact outcomes has been poor but several areas have achieved improving survival rates after adjusting their cardiac arrest care. The pre-hospital management is certainly key and decides whether a cardiac arrest patient can be brought back into a spontaneous circulation. However, the whole chain of resuscitation including the in-hospital care have improved also. This review describes aetiologies of OHCA, risk and potential protective factors and recent advances in the pre-hospital and in-hospital management of these patients.

Fröhlich GM; Lyon RM; Sasson C; Crake T; Whitbread M; Indermuehle A; Timmis A; Meier P

2012-11-01

2

Out of hospital cardiac arrest in Vienna: incidence and outcome.  

UK PubMed Central (United Kingdom)

AIM OF THE STUDY: To determine the incidence of out-of-hospital cardiac arrest and the survival rate of those patients who received CPR in the city of Vienna. METHODS: A cohort of patients with out-of-hospital cardiac arrests and who were treated by the Vienna Ambulance Service between January 1, 2009, and December 31, 2010, were followed up until either death or hospital discharge. The associations of survival and neurological outcome with their potential predictors were analysed using simple logistic regression models. Odds ratios were estimated for each factor. RESULTS: During the observation period, a total of 7030 (206.8/100,000 inhabitants/year) patients without signs of circulation were assessed by teams of the Vienna Ambulance Service, and 1448 adult patients were resuscitated by emergency medical service personnel. A sustained return of spontaneous circulation was reported in 361 (24.9%) of the treated patients, and in all 479 (33.0%) of the patients were taken to the emergency department. A total of 164 (11.3%) of the patients were discharged from the hospital alive, and 126 (8.7%) of the patients showed cerebral performance categories of 1 or 2 at the time of discharge. Younger age, an arrest in a public area, a witnessed arrest and a shockable rhythm were associated with a higher probability of survival to hospital discharge. CONCLUSION: Survival rates for out-of-hospital cardiac arrests remain low. Efforts should be focused on rapidly initiating basic life support, early defibrillation, and high-quality CPR by emergency medical services and state-of-the art post-resuscitation care.

Nürnberger A; Sterz F; Malzer R; Warenits A; Girsa M; Stöckl M; Hlavin G; Magnet IA; Weiser C; Zajicek A; Glück H; Grave MS; Müller V; Benold N; Hubner P; Kaff A

2013-01-01

3

Aminophylline in undifferentiated out-of-hospital asystolic cardiac arrest.  

UK PubMed Central (United Kingdom)

PRIMARY OBJECTIVE: To determine if the introduction of intravenous aminophylline, a nonspecific adenosine receptor antagonist, into the resuscitation algorithm of asystole will increase return of spontaneous circulation when used in undifferentiated prehospital cardiac arrest. METHODS: An urban, prehospital, prospective, randomized, double-blind, placebo-controlled trial of nonpregnant normothermic adults suffering nontraumatic out-of-hospital asystolic cardiac arrest. Subjects were treated in accordance with published advanced cardiac life support guidelines and standard pharmacotherapy. They were randomly assigned to receive either placebo or aminophylline along with the initial boluses of atropine and epinephrine. Cardiac rhythms and carotid pulses were monitored throughout the resuscitation. RESULTS: Eighty-two patients were entered into the trial. Forty-five patients were assigned to the placebo group and 37 received aminophylline. Nine of 45 controls (20%; 95% CI 10-35%) achieved return of spontaneous circulation compared to ten of 37 (27%; 95% CI 14-44%) in the aminophylline group. CONCLUSIONS: We were not able to show a statistically significant improvement in return of spontaneous circulation when aminophylline was given during the early resuscitation phase of undifferentiated asystolic cardiac arrest in the prehospital setting with this sample size.

Mader TJ; Smithline HA; Gibson P

1999-06-01

4

Out-of-hospital cardiac arrest in Cork, Ireland.  

UK PubMed Central (United Kingdom)

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) in Ireland accounts for approximately 5000 deaths annually. Little published evidence exists on survival from OHCA in this country to date. We aimed to characterise and describe 'presumed cardiac' OHCA in Cork City and County attended by the Ambulance Service. METHODS: Dispatch records, ambulance patient records and hospital records for a 1-year period were examined for patient demographics, OHCA characteristics, interventions and patient outcomes. RESULTS: There were 231 'presumed cardiac' OHCAs attended over the study period; 130 (56%) were in urban locations and 101 (44%) in rural. OHCAs were lay-witnessed in 20% (n=46), and 22% (n=50) received bystander CPR. Shockable rhythm was present in 36 cases (16%) on initial assessment, and there was no difference in presence of shockable rhythm between urban and rural OHCAs (18% vs 13%, p=0.31). Resuscitation was attempted in 176 cases (77.5%), of whom 27 (15%) achieved return of spontaneous circulation and 13 (7.4%) survived to leave hospital. Survival when the initial rhythm was shockable was 16.7% (6 of 36 patients). Despite longer response times for rural compared with urban OHCAs (median (IQR) 16.5 (11.0-23.5) vs 9 (7-12) min, p<0.001), survival to leave hospital alive where resuscitation was attempted was similar (7.4% vs 7.4%, p=0.99, respectively). CONCLUSION: A survival rate of 16.7% in shockable rhythms indicates scope for improvement which would influence the overall survival rate which was found to be 7.4%. Real-time feedback of performance and quality of the continuum of patient care through a clinical-quality cardiac arrest registry would monitor and incentivise such initiatives.

Henry K; Murphy A; Willis D; Cusack S; Bury G; O'Sullivan I; Deasy C

2013-06-01

5

Horses and Zebras: complex cardiac anatomy in a patient with out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

This case report describes a woman presenting after out-of-hospital cardiac arrest with several cardiac anomalies, including a form fruste of Ebstein's anomaly complicated by a large tricuspid valve vegetation. On autopsy, she proved to have unstable plaques in epicardial vessels that likely caused arrhythmic sudden cardiac death, a reminder that even in the presence of rare anomalies, common things are common.

Brown SM; Miller DV; Vezina D; Dean NC; Grissom CK

2011-04-01

6

Horses and Zebras: complex cardiac anatomy in a patient with out-of-hospital cardiac arrest.  

Science.gov (United States)

This case report describes a woman presenting after out-of-hospital cardiac arrest with several cardiac anomalies, including a form fruste of Ebstein's anomaly complicated by a large tricuspid valve vegetation. On autopsy, she proved to have unstable plaques in epicardial vessels that likely caused arrhythmic sudden cardiac death, a reminder that even in the presence of rare anomalies, common things are common. PMID:22022658

Brown, Samuel M; Miller, Dylan V; Vezina, Daniel; Dean, Nathan C; Grissom, Colin K

2011-04-01

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Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

AIM: Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases. MATERIAL AND METHODS: Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died > or =1 day later. RESULTS: A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% vs. 27%, p=0.001), and in hospitals that received > or =40 patients/year compared to those that received <40 (37% vs. 30%, p=0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for surviving subjects was shorter at hospitals performing cardiac catheterization (p<0.01). After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics. CONCLUSIONS: Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome.

Callaway CW; Schmicker R; Kampmeyer M; Powell J; Rea TD; Daya MR; Aufderheide TP; Davis DP; Rittenberger JC; Idris AH; Nichol G

2010-05-01

8

Receiving Hospital Characteristics Associated with Survival after Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

Aim Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases. Material and Methods Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died ? 1 day later. Results A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% versus 27%, p=0.001), and in hospitals that received ?40 patients / year compared to those that received <40 (37% vs 30%, p=0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for surviving subjects was shorter at hospitals performing cardiac catheterization (p<0.01).After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics. Conclusions Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome.

Callaway, Clifton W.; Schmicker, Robert; Kampmeyer, Mitch; Powell, Judy; Rea, Tom D.; Daya, Mohamud R.; Aufderheide, Thomas P.; Davis, Daniel P.; Rittenberger, Jon C.; Idris, Ahamed H.; Nichol, Graham

2010-01-01

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Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study  

DEFF Research Database (Denmark)

For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA.

Weeke, Peter; Folke, Fredrik

2010-01-01

10

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

DEFF Research Database (Denmark)

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

Weeke, Peter; Folke, Fredrik

2012-01-01

11

Characteristics and outcomes of pediatric out-of-hospital cardiac arrest by scholastic age category.  

UK PubMed Central (United Kingdom)

OBJECTIVES: There is a paucity of data examining nationwide population-based incidences and outcomes of pediatric out-of-hospital cardiac arrest. The objective of this study is to describe the detailed characteristics of pediatric out-of-hospital cardiac arrest by scholastic age category and to evaluate the impact of bystander cardiopulmonary resuscitation and public access-automated external defibrillators on the 1-month survival and favorable neurological status of pediatric out-of-hospital cardiac arrest patients. DESIGN: A nationwide, population-based, observational study. SETTING: Nationwide emergency medical system in Japan. PATIENTS: Out-of-hospital cardiac arrest patients aged ? 18 yr. MEASUREMENTS AND MAIN RESULTS: We identified 7,624 pediatric out-of-hospital cardiac arrest patients (? 18 yr old) from a nationwide population-based out-of-hospital cardiac arrest database in Japan from 2005 to 2008 and stratified them into five categories by scholastic age. The overall rates of 1-month survival and favorable neurological outcomes were 11.0% and 5.1%, respectively. Bystander cardiopulmonary resuscitation resulted in a significant improvement in both 1-month survival (odds ratio 2.81; 95% confidence interval 2.30-3.44) and favorable neurological outcomes (odds ratio 4.55; 95% confidence interval 3.35-6.18). Performing public access-automated external defibrillators had a significant effect on the 1-month survival rate (odds ratio 3.51; 95% confidence interval 1.81-6.81) and favorable neurological outcomes (odds ratio 5.13; 95% confidence interval 2.64-9.96). CONCLUSIONS: This study demonstrated that bystander cardiopulmonary resuscitation and public access-automated external defibrillators had a significant impact on the outcomes of pediatric out-of-hospital cardiac arrest. The improved survival associated with bystander cardiopulmonary resuscitation and public access-automated external defibrillators are clinically important and are of major public health importance for school-aged out-of-hospital cardiac arrest patients.

Akahane M; Tanabe S; Ogawa T; Koike S; Horiguchi H; Yasunaga H; Imamura T

2013-02-01

12

Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Most previous studies of pediatric out-of-hospital cardiac arrest have typically examined relatively small datasets from small study regions. Although several studies have reported the impact on adult out-of-hospital cardiac arrest, little information is available on the impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. We set out to examine the impact of cardiopulmonary resuscitation instruction by telephone dispatcher on the outcomes of pediatric out-of-hospital cardiac arrest. DESIGN: Population-based, observational study. SETTING: Japan-wide population-based setting. PATIENTS: We identified 1,780 pediatric out-of-hospital cardiac arrest patients (67.8% male) with witnessed collapse from a nationwide, population-based, out-of-hospital cardiac arrest database. INTERVENTION: None. MEASUREMENT AND MAIN RESULTS: We assessed the impact of telephone dispatcher assistance on the outcomes of 1-month survival rates and favorable neurologic status among the groups. The overall rate of bystander-performed chest compression and mouth-to-mouth ventilation among the witnessed pediatric out-of-hospital cardiac arrests were 39.5% and 25.6%, respectively. Telephone dispatcher assistance was offered in 28.4% of the witnessed pediatric out-of-hospital cardiac arrest cases and resulted in a significant increase in both chest compression (adjusted odds ratio 6.04; 95% confidence interval 4.72-7.72) and mouth-to-mouth ventilation (adjusted odds ratio 3.10; 95% confidence interval 2.44-3.95), and a significant improvement in 1-month survival rate (adjusted odds ratio 1.46; 95% confidence interval 1.05-2.03), but no significant effect on favorable neurologic outcomes at 1 month (adjusted odds ratio 1.15; 95% confidence interval 0.70-1.88). Potential confounding factors included age categories, sex, bystander type, cause of cardiac arrest, bystander cardiopulmonary resuscitation, and attempted defibrillation. CONCLUSIONS: Telephone dispatcher assistance could significantly increase bystander cardiopulmonary resuscitation among witnessed pediatric out-of-hospital cardiac arrests. Although there was only a small, nonsignificant effect on the improvement in favorable neurologic outcome at 1 month, the improved survival associated with telephone dispatcher assistance in pediatric out-of-hospital cardiac arrest is clinically important, and is of major public health importance. In cases where cardiac arrest was uncertain from the bystander's replies during the call to emergency medical services, telephone dispatcher assistance was not offered, which could affect the adjusted odds ratio of the present study.

Akahane M; Ogawa T; Tanabe S; Koike S; Horiguchi H; Yasunaga H; Imamura T

2012-05-01

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The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was e...

Ewy Gordon A

14

Long-Term Outcomes Following Pediatric Out-of-Hospital Cardiac Arrest*.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Pediatric out-of-hospital cardiac arrest is an uncommon event with measurable short-term survival to hospital discharge. For those who survive to hospital discharge, little is known regarding duration of survival. We sought to evaluate the arrest circumstances and long-term survival of pediatric patients who experienced an out-of-hospital cardiac arrest and survived to hospital discharge. DESIGN: Retrospective cohort study SETTING: : King County, WA Emergency Medical Service Catchment and Quaternary Care Children's Hospital PATIENTS: : Persons less than 19 years old who had an out-of-hospital cardiac arrest and were discharged alive from the hospital between 1976 and 2007. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,683 persons less than 19 years old were treated for pediatric out-of-hospital cardiac arrest in the study community, with 91 patients surviving to hospital discharge. Of these 91 survivors, 20 (22%) subsequently died during 1449 person-years of follow-up. Survival following hospital discharge was 92% at 1 year, 86% at 5 years, and 77% at 20 years. Compared to those who subsequently died, long-term survivors were more likely at the time of discharge to be older (mean age, 8 vs 1 yr), had a witnessed arrest (83% vs 56%), presented with a shockable rhythm (40% vs 10%), and had a favorable Pediatric Cerebral Performance Category of 1 or 2 (67% vs 0%). CONCLUSIONS: In this population-based cohort study evaluating the long-term outcome of pediatric survivors of out-of-hospital cardiac arrest, we observed that long-term survival was generally favorable. Age, arrest characteristics, and functional status at hospital discharge were associated with prognosis. These findings support efforts to improve pediatric resuscitation, stabilization, and convalescent care.

Michiels EA; Dumas F; Quan L; Selby L; Copass M; Rea T

2013-10-01

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Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe the current evidence on the frequency and nature of cognitive impairments in survivors of out-of-hospital cardiac arrest. DESIGN: Systematic review. DATA SOURCES: Pubmed, Embase, PsychInfo and Cinahl (1980-2006). No language restriction was imposed. REVIEW METHODS: The following inclusion criteria were used: participants had to be survivors of out-of-hospital cardiac arrest, 18 years or older, and there had to be least one cognitive outcome measure with a follow-up of 3 months or more. Case reports and qualitative studies were excluded. The articles were screened on title, abstract and full text by two reviewers. All selected articles were reviewed and assessed by two reviewers independently using a quality criteria list. RESULTS: Out of the 286 articles initially identified, 28 were selected for final evaluation. There was a high heterogeneity between the studies with regard to study design, number of participants, outcome measures and duration of follow-up. In general, the quality of the articles appeared low, with a few positive exceptions. The reported frequency of cognitive impairments in survivors of out-of-hospital cardiac arrest ranged from 6% to 100%. Memory problems were the most common cognitive impairment, followed by impairments in attention and executive functioning. Three high-quality prospective studies found that cognitive problems occurred in about half of the survivors of out-of-hospital cardiac arrest. CONCLUSION: There are few good studies on the frequency of cognitive impairments after out-of-hospital cardiac arrest. However, cognitive problems, in particular memory problems, seem common in survivors of out-of-hospital cardiac arrest.

Moulaert VR; Verbunt JA; van Heugten CM; Wade DT

2009-03-01

16

Paramedic activities, drug administration and survival from out of hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To examine the impact of administration of cardioactive drugs on the outcome from out of hospital cardiac arrest. DESIGN: Longitudinal observational cohort study with historical controls before and after the introduction of drug use in cardiac arrest by paramedics. SUBJECTS: Adult patients who had sustained an out of hospital cardiac arrest of cardiac aetiology and were treated by paramedics. SETTING: Edinburgh, Scotland. OUTCOME MEASURES: Return of spontaneous circulation, admission to and discharge from hospital. RESULTS: There was no significant difference in the demographics between Period 1 (prior to drug administration) and Period 2 (after). There was no difference in outcome between Period 1 and Period 2 for all three parameters, return of spontaneous output 30.1 versus 35%, admission to hospital 18.9 versus 24.5% and discharge 5.8 versus 6.5%. If the presenting rhythm of VF/pulseless VT alone was considered survival to hospital discharge was 12.1% in Period 1 and 10.3% in Period 2. CONCLUSION: The addition of cardioactive drug administration to the treatment of out of hospital cardiac arrest does not improve survival.

Mitchell RG; Guly UM; Rainer TH; Robertson CE

2000-01-01

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Outcomes of out-of-hospital cardiac arrest patients in Perth, Western Australia, 1996-1999.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: To describe the epidemiology and survival from out-of-hospital cardiac arrest. DESIGN: Longitudinal follow-up study from the time of paramedic attendance to 12 months later. SETTING: Perth, Western Australia (WA), a metropolitan capital city with an adult population of approximately one million people. METHOD: The St John Ambulance Australia (WA Ambulance Service Incorporated) cardiac arrest database was linked to the WA hospital morbidity and mortality data using probabilistic matching. INCIDENCE: Of 3730 cardiorespiratory arrests in 1996-1999, the age standardised rate of arrests of presumed cardiac origin, where resuscitation was attempted (n=1293) was 32.9 per 100000 person-years and 7.1 per 100000 person-years for bystander-witnessed VF/VT arrests. SURVIVAL: Survival to 28 days was 6.8% following all bystander-witnessed cardiac arrests; 10.6% following bystander-witnessed VF/VT arrests and 33% for paramedic-witnessed cardiac arrests. Logistic regression analysis showed an inverse association between ambulance response time interval and survival following all bystander-witnessed cardiac arrests (and VF/VT arrests). ONE YEAR SURVIVAL: 89% of bystander-witnessed cardiac arrest survivors and 92% of paramedic-witnessed cardiac arrests were still alive at 1 year post-arrest. CONCLUSION: The trends in occurrence and survival following out-of-hospital cardiac arrest in Perth, WA, are similar to those found elsewhere. There is an opportunity to strengthen the chain of survival by reducing the response time interval and increasing the use of bystander cardiopulmonary resuscitation (CPR). First-responder programs and public access defibrillation will need to be considered in the light of local demographics, location and the epidemiologic features of out-of-hospital cardiac arrest.

Finn JC; Jacobs IG; Holman CD; Oxer HF

2001-12-01

18

Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest is poorly evaluated. We analyse disease-specific and emergency care data in order to improve the recognition of subarachnoid haemorrhage as a cause of cardiac arrest. DESIGN: We searched a registry of cardiac arrest patients admitted after primarily successful resuscitation to an emergency department retrospectively and analysed the records of subarachnoid haemorrhage patients for predictive features. RESULTS: Over 8.5 years, spontaneous subarachnoidal haemorrhage was identified as the immediate cause in 27 (4%) of 765 out-of-hospital cardiac arrests. Of these 27 patients, 24 (89%) presented with at least three or more of the following common features: female gender (63%), age under 40 years (44%), lack of co-morbidity (70%), headache prior to cardiac arrest (39%), asystole or pulseless electric activity as the initial cardiac rhythm (93%), and no recovery of brain stem reflexes (89%). In six patients (22%), an intraventricular drain was placed, one of them (4%) survived to hospital discharge with a favourable outcome. CONCLUSIONS: Subarachnoid haemorrhage complicated by cardiac arrest is almost always fatal even when a spontaneous circulation can be restored initially. This is due to the severity of brain damage. Subarachnoid haemorrhage may present in young patients without any previous medical history with cardiac arrest masking the diagnosis initially.

Kürkciyan I; Meron G; Sterz F; Domanovits H; Tobler K; Laggner AN; Steinhoff N; Berzlanovich A; Bankl HC

2001-10-01

19

Cardiac resuscitation: Is an advanced airway harmful during out-of-hospital CPR?  

UK PubMed Central (United Kingdom)

In a new, observational study, survival and neurological outcome at 1 month after out-of-hospital cardiac arrest were worse in patients treated with an advanced airway than in those treated with bag–mask ventilation. These results contradict the common assumption that advanced airway management is associated with improved outcome.

Berg RA; Bobrow BJ

2013-04-01

20

In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study.  

UK PubMed Central (United Kingdom)

OBJECTIVES: : To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return of circulation (ROC) from either the in-hospital (IH) or the out-of-hospital (OH) setting and to determine whether significant differences related to pre-event, arrest event, early postarrest event characteristics, and outcomes exist that would be critical in planning a clinical trial of therapeutic hypothermia (TH). DESIGN: : Retrospective cohort study. SETTING: : Fifteen Pediatric Emergency Care Applied Research Network sites. PATIENTS: : Patients aged 24 hours to 18 years with either IH or OH CA who had a history of at least 1 minute of chest compressions and ROC for at least 20 minutes were eligible. INTERVENTIONS: : None. MEASUREMENTS AND MAIN RESULTS: : A total of 491 patients met study entry criteria with 353 IH cases and 138 OH cases. Major differences between the IH and OH cohorts were observed for patient prearrest characteristics, arrest event initial rhythm described, and arrest medication use. Several postarrest interventions were used differently, however, the use of TH was similar (<5%) in both cohorts. During the 0-12-hour interval following ROC, OH cases had lower minimum temperature and pH, and higher maximum serum glucose recorded. Mortality was greater in the OH cohort (62% vs. 51%, p = 0.04) with the cause attributed to a neurologic indication much more frequent in the OH than in the IH cohort (69% vs. 20%; p < 0.01). CONCLUSIONS: : For pediatric CA with ROC, several major differences exist between IH and OH cohorts. The finding that the etiology of death was attributed to neurologic indications much more frequently in OH arrests has important implications for future research. Investigators planning to evaluate the efficacy of new interventions, such as TH, should be aware that the IH and OH populations differ greatly and require independent clinical trials.

Moler FW; Meert K; Donaldson AE; Nadkarni V; Brilli RJ; Dalton HJ; Clark RS; Shaffner DH; Schleien CL; Statler K; Tieves KS; Hackbarth R; Pretzlaff R; van der Jagt EW; Levy F; Hernan L; Silverstein FS; Dean JM

2009-07-01

 
 
 
 
21

Can early cardiac troponin I measurement help to predict recent coronary occlusion in out-of-hospital cardiac arrest survivors?  

UK PubMed Central (United Kingdom)

OBJECTIVE: Recent guidelines recommend the immediate performance of a coronary angiography when an acute myocardial infarction is suspected as a cause of out-of-hospital cardiac arrest. However, prehospital factors such as postresuscitation electrocardiogram pattern or clinical features are poorly sensitive in this setting. We searched to evaluate if an early measurement of cardiac troponin I can help to detect a recent coronary occlusion in out-of-hospital cardiac arrest. DESIGN: Retrospective analysis of a prospective electronic registry database. SETTING: University cardiac arrest center. PATIENTS: Between January 2003 and December 2008, 422 out-of-hospital cardiac arrest survivors without obvious extra-cardiac cause have been consecutively studied. An immediate coronary angiography has been systematically performed. The primary outcome was the finding of a recent coronary occlusion. INTERVENTION: First, blood cardiac troponin I levels at admission were analyzed to assess the optimum cutoff for identifying a recent coronary occlusion. Second, a logistic regression was performed to determine early predictive factors of a recent coronary occlusion (including cardiac troponin I) and their respective contribution. MEASUREMENTS AND MAIN RESULTS: An ST-segment elevation was present in 127 of 422 patients (30%). During coronary angiography, a recent occlusion has been detected in 193 of 422 patients (46%). The optimum cardiac troponin I threshold was determined at 4.66 ng·mL(-1) (sensitivity 66.7%, specificity 66.4%). In multivariate analyses, in addition of smoking and epinephrine initial dose, cardiac troponin I (odds ratio 3.58 [2.03-6.32], p < .001) and ST-segment elevation (odds ratio 10.19 [5.39-19.26], p < .001) were independent predictive factors of a recent coronary occlusion. CONCLUSIONS: In this large cohort of out-of-hospital cardiac arrest patients, isolated early cardiac troponin I measurement is modestly predictive of a recent coronary occlusion. Furthermore, the contribution of this parameter even in association with other factors does not seem helpful to predict recent occlusion. As a result and given the high benefit of percutaneous coronary intervention for such patients, the dosage of cardiac troponin I at admission could not help in the decision of early coronary angiogram.

Dumas F; Manzo-Silberman S; Fichet J; Mami Z; Zuber B; Vivien B; Chenevier-Gobeaux C; Varenne O; Empana JP; Pène F; Spaulding C; Cariou A

2012-06-01

22

Early jugular bulb oxygenation monitoring in comatose patients after an out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the role of early jugular bulb oxygenation monitoring in comatose patients after cardiac arrest. DESIGN: Prospective sequential study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Thirteen patients comatose after out-of-hospital cardiac arrest. INTERVENTIONS: A standard hemodynamic protocol. MEASUREMENTS AND RESULTS: Jugular bulb oxygen saturation levels and oxygen extraction ratios could not discriminate between patients with good (6) and poor (7) cerebral outcome. This was also true for the jugular bulb-arterial lactate difference. Survivors had significantly higher overall oxygen transport values than non-survivors. CONCLUSIONS: Jugular bulb oxygenation monitoring during the first few hours after cardiac arrest cannot reliably discriminate between comatose patients with a good and poor cerebral outcome. Further studies with an extended monitoring period are thus required.

van der Hoeven JG; de Koning J; Compier EA; Meinders AE

1995-07-01

23

Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.  

UK PubMed Central (United Kingdom)

CONTEXT: Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration. OBJECTIVE: To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest. DESIGN, SETTING, AND PATIENTS: Prospective, randomized controlled trial of consecutive adult patients with out-of-hospital nontraumatic cardiac arrest treated within the emergency medical service system in Oslo, Norway, between May 1, 2003, and April 28, 2008. INTERVENTIONS: Advanced cardiac life support with intravenous drug administration or ACLS without access to intravenous drug administration. MAIN OUTCOME MEASURES: The primary outcome was survival to hospital discharge. The secondary outcomes were 1-year survival, survival with favorable neurological outcome, hospital admission with return of spontaneous circulation, and quality of CPR (chest compression rate, pauses, and ventilation rate). RESULTS: Of 1183 patients for whom resuscitation was attempted, 851 were included; 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no access to intravenous drug administration group. The rate of survival to hospital discharge was 10.5% for the intravenous drug administration group and 9.2% for the no intravenous drug administration group (P = .61), 32% vs 21%, respectively, (P<.001) for hospital admission with return of spontaneous circulation, 9.8% vs 8.1% (P = .45) for survival with favorable neurological outcome, and 10% vs 8% (P = .53) for survival at 1 year. The quality of CPR was comparable and within guideline recommendations for both groups. After adjustment for ventricular fibrillation, response interval, witnessed arrest, or arrest in a public location, there was no significant difference in survival to hospital discharge for the intravenous group vs the no intravenous group (adjusted odds ratio, 1.15; 95% confidence interval, 0.69-1.91). CONCLUSION: Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long-term survival. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00121524.

Olasveengen TM; Sunde K; Brunborg C; Thowsen J; Steen PA; Wik L

2009-11-01

24

Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Although measures of functional status are often advocated when assessing short-term survival following cardiac arrest, little is known about how these measures predict long-term prognosis. We sought to determine whether the Cerebral Performance Category (CPC) was associated with long-term outcome following resuscitation from out-of-hospital cardiac arrest. DESIGN: The study was a retrospective cohort investigation of adults who suffered out-of-hospital cardiac arrest in the study community between January 1, 2001 and December 31, 2009, and were successfully resuscitated and discharged alive from the hospital following the event. The CPC at the time of hospital discharge was ascertained through review of the hospital record. The primary outcome was survival following hospital discharge. Survival status was determined using state and national death indexes. We used Kaplan-Meier curves and Cox regression to evaluate the association between CPC and survival. MAIN RESULTS: Among the 980 eligible subjects, 606 of 980 (62%) had a CPC of 1; 227 of 980 (23%) had a CPC of 2; 97 of 980 (10%) had a CPC of 3; and 50 of 980 (5%) had a CPC of 4. There were 336 deaths during 3,713 person-years of follow-up. Overall, 1-year survival was 82% and 5-year survival was 64%. Favorable CPC predicted better long-term prognosis. Compared with CPC 1, the relative risk of survival was 0.61 (0.47-0.80) for CPC 2, 0.43 (0.31-0.59) for CPC 3, and 0.10 (0.06-0.15) for CPC 4. CONCLUSIONS: The CPC at hospital discharge is a useful surrogate measure of long-term survival and can be an informative tool for programmatic evaluation and research of resuscitation.

Phelps R; Dumas F; Maynard C; Silver J; Rea T

2013-05-01

25

A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

BACKGROUND The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest. METHODS We compared the use of an active ITD with that of a sham ITD in patients with out-of-hospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to hospital discharge with satisfactory function (i.e., a score of ?3 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating greater disability). RESULTS Of 8718 patients included in the analysis, 4345 were randomly assigned to treatment with a sham ITD and 4373 to treatment with an active device. A total of 260 patients (6.0%) in the sham-ITD group and 254 patients (5.8%) in the active-ITD group met the primary outcome (risk difference adjusted for sequential monitoring, ?0.1 percentage points; 95% confidence interval, ?1.1 to 0.8; P = 0.71). There were also no significant differences in the secondary outcomes, including rates of return of spontaneous circulation on arrival at the emergency department, survival to hospital admission, and survival to hospital discharge. CONCLUSIONS Use of the ITD did not significantly improve survival with satisfactory function among patients with out-of-hospital cardiac arrest receiving standard CPR. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)

Aufderheide, Tom P.; Nichol, Graham; Rea, Thomas D.; Brown, Siobhan P.; Leroux, Brian G.; Pepe, Paul E.; Kudenchuk, Peter J.; Christenson, Jim; Daya, Mohamud R.; Dorian, Paul; Callaway, Clifton W.; Idris, Ahamed H.; Andrusiek, Douglas; Stephens, Shannon W.; Hostler, David; Davis, Daniel P.; Dunford, James V.; Pirrallo, Ronald G.; Stiell, Ian G.; Clement, Catherine M.; Craig, Alan; Van Ottingham, Lois; Schmidt, Terri A.; Wang, Henry E.; Weisfeldt, Myron L.; Ornato, Joseph P.; Sopko, George

2011-01-01

26

A trial of an impedance threshold device in out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest. METHODS: We compared the use of an active ITD with that of a sham ITD in patients with out-of-hospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to hospital discharge with satisfactory function (i.e., a score of ?3 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating greater disability). RESULTS: Of 8718 patients included in the analysis, 4345 were randomly assigned to treatment with a sham ITD and 4373 to treatment with an active device. A total of 260 patients (6.0%) in the sham-ITD group and 254 patients (5.8%) in the active-ITD group met the primary outcome (risk difference adjusted for sequential monitoring, -0.1 percentage points; 95% confidence interval, -1.1 to 0.8; P=0.71). There were also no significant differences in the secondary outcomes, including rates of return of spontaneous circulation on arrival at the emergency department, survival to hospital admission, and survival to hospital discharge. CONCLUSIONS: Use of the ITD did not significantly improve survival with satisfactory function among patients with out-of-hospital cardiac arrest receiving standard CPR. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).

Aufderheide TP; Nichol G; Rea TD; Brown SP; Leroux BG; Pepe PE; Kudenchuk PJ; Christenson J; Daya MR; Dorian P; Callaway CW; Idris AH; Andrusiek D; Stephens SW; Hostler D; Davis DP; Dunford JV; Pirrallo RG; Stiell IG; Clement CM; Craig A; Van Ottingham L; Schmidt TA; Wang HE; Weisfeldt ML; Ornato JP; Sopko G

2011-09-01

27

Pathological features of witnessed out-of-hospital cardiac arrest presenting with ventricular fibrillation.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine which characteristic pathological features are predictive of the presenting rhythm and survival in victims of community cardiac arrest. DESIGN: Case-controlled retrospective autopsy study. SETTING: County of Nottinghamshire with a total population of 993 914 and an area of 2183 square kilometers. SUBJECTS: Between January 1, 1991 and December 31, 1994, 1535 witnessed cardiac arrests attended by the Nottinghamshire Ambulance Service, of which 1083 had an autopsy performed. RESULTS: Ischaemic heart disease accounted for 72.3% of cases with a further 3.6% of deaths from other cardiac causes and the remainder from non-cardiac causes. Old healed myocardial infarction was present in 39.4%, and visible fresh occlusive thrombus was found in 23.8% of cases overall. Logistic regression analysis of deaths from cardiac causes revealed that younger age (odds ratio of 0.98 (95% CI 0.97-0.99)), two vessel coronary artery disease (odds ratio of 1.65 (95% CI 1.08-2.52)) and heart weight greater than 500 grams (odds ratio of 1.56 (95% CI 1.12-2.17)) were found to be independent predictors of developing ventricular fibrillation compared to other rhythms of arrest. Being male, visible occlusive thrombus and having survived a previous myocardial infarction were found not to be independent variables. There were no outstanding pathological features in the 31 patients who survived to hospital admission and subsequently died, compared with non-survivors who were considered to have died from a cardiac cause. CONCLUSIONS: Among those who had a witnessed out-of-hospital cardiac arrest from a cardiac cause, increasing heart weight (the most likely cause of which is left ventricular hypertrophy), younger age and two vessel coronary artery disease appear to be much more important pathological features in the development of ventricular fibrillation than a previous myocardial infarction and fresh visible occlusive thrombus.

Soo LH; Gray D; Hampton JR

2001-12-01

28

Feasibility and Cardiac Safety of Inhaled Xenon in Combination With Therapeutic Hypothermia Following Out-of-Hospital Cardiac Arrest*.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. DESIGN: An open controlled and randomized single-centre clinical drug trial (clinicaltrials.gov NCT00879892). SETTING: A multipurpose ICU in university hospital. PATIENTS: Thirty-six adult out-of-hospital cardiac arrest patients (18-80 years old) with ventricular fibrillation or pulseless ventricular tachycardia as initial cardiac rhythm. INTERVENTIONS: Patients were randomly assigned to receive either mild therapeutic hypothermia treatment with target temperature of 33°C (mild therapeutic hypothermia group, n = 18) alone or in combination with xenon by inhalation, to achieve a target concentration of at least 40% (Xenon + mild therapeutic hypothermia group, n = 18) for 24 hours. Thirty-three patients were evaluable (mild therapeutic hypothermia group, n = 17; Xenon + mild therapeutic hypothermia group, n = 16). MEASUREMENTS AND MAIN RESULTS: Patients were treated and monitored according to the Utstein protocol. The release of troponin-T was determined at arrival to hospital and at 24, 48, and 72 hours after out-of-hospital cardiac arrest. The median end-tidal xenon concentration was 47% and duration of the xenon inhalation was 25.5 hours. The frequency of serious adverse events, including inhospital mortality, status epilepticus, and acute kidney injury, was similar in both groups and there were no unexpected serious adverse reactions to xenon during hospital stay. In addition, xenon did not induce significant conduction, repolarization, or rhythm abnormalities. Median dose of norepinephrine during hypothermia was lower in xenon-treated patients (mild therapeutic hypothermia group = 5.30?mg vs Xenon + mild therapeutic hypothermia group = 2.95?mg, p = 0.06). Heart rate was significantly lower in Xenon + mild therapeutic hypothermia patients during hypothermia (p = 0.04). Postarrival incremental change in troponin-T at 72 hours was significantly less in the Xenon + mild therapeutic hypothermia group (p = 0.04). CONCLUSIONS: Xenon treatment in combination with hypothermia is feasible and has favorable cardiac features in survivors of out-of-hospital cardiac arrest.

Arola OJ; Laitio RM; Roine RO; Grönlund J; Saraste A; Pietilä M; Airaksinen J; Perttilä J; Scheinin H; Olkkola KT; Maze M; Laitio TT

2013-09-01

29

Regional impact of cardiac arrest center criteria on out-of-hospital transportation practices  

Science.gov (United States)

Background Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-arrest (PA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PA protocols have been associated with improved outcomes. Objectives This study identified the PA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation. Secondly, this study determined the proportion of PA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria. Methods We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, non-trauma cardiac arrest patients for 16 EMS agencies transported with a pulse from 2006 to 2008. The proportions of patients transported to hospitals meeting three CAC criteria were compared: Criteria A (availability of CATH and TH), Criteria B (Criteria A, >200 CATHs per year, and a PA protocol), and Criteria C (Criteria B and a 24-hour intensivist). Results Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met Criteria A, 7 (22.6%) met criteria B, and 6 (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded due to transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 (66.1%) transported to hospitals meeting criteria C. Conclusions In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH) but those facilities receive 81% of PA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.

Martin-Gill, Christian; Dilger, Christopher P.; Guyette, Francis X.; Rittenberger, Jon C.; Callaway, Clifton W.

2012-01-01

30

Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To examine the independent relationship between effectiveness of bystander cardiopulmonary resuscitation (CPR) and survival following out-of-hospital cardiac arrest. DESIGN: Prospective observational cohort. SETTING: New York City. PARTICIPANTS: A total of 2071 consecutive out-of-hospital cardiac arrests meeting Utstein criteria. INTERVENTION: Trained prehospital personnel assessed the quality of bystander CPR on arrival at the scene. Satisfactory execution of CPR required performance of both adequate compressions and ventilations in conformity with current American Heart Association guidelines. MAIN OUTCOME MEASURE: Adjusted association between CPR effectiveness and survival. Survival was defined as discharge from hospital to home. RESULTS: Outcome was determined on all members of the inception cohort--none were lost to follow-up. When the association between bystander CPR and survival was adjusted for effectiveness of CPR in the parent data set (N = 2071), only effective CPR was retained in the logistic model (adjusted odds ratio [OR] = 5.7; 95% confidence interval [CI], 2.7 to 12.2; P < .001). Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02). After adjustment for witness status, initial rhythm, interval from collapse to CPR, and interval from collapse to advanced life support, effective CPR remained independently associated with improved survival (adjusted OR = 3.9; 95% CI, 1.1 to 14.0; P < .04). CONCLUSION: The association between bystander CPR and survival in out-of-hospital cardiac arrest appears to be confounded by CPR quality. Effective CPR is independently associated with a quantitatively and statistically significant improvement in survival.

Gallagher EJ; Lombardi G; Gennis P

1995-12-01

31

Predictors and Outcome of Early-Onset Pneumonia After Out-of-Hospital Cardiac Arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Early-onset pneumonia (EOP) after out-of-hospital cardiac arrest is frequently observed. Causative factors are loss of airway protection during cardiac arrest, pulmonary contusion, and emergency airway management. We assessed the incidence, risk factors, and clinical course of EOP, and evaluated the impact of an early exchange of the prehospitally inserted endotracheal tube (ETT). METHODS: In our retrospective analysis we included 104 consecutive subjects admitted to our ICU after out-of-hospital cardiac arrest between 2007 and 2012. All subjects underwent therapeutic hypothermia. We analyzed clinical course, inflammation indicators, Clinical Pulmonary Infection Score, occurrence of EOP, duration of ventilatory support, microbiological findings, and short-term outcome. RESULTS: Of the 104 subjects, 46.2% received an exchange of ETT directly after hospital admission. Neither ETT exchange nor observed aspiration were associated with elevated CPIS or EOP, nor with proof of microorganisms in respiratory secretions. We found no differences in duration of ventilatory support, PaO2/FIO2, ICU days, or outcome. C-reactive protein was significantly higher in subjects with aspiration (P = .046). Sex, age, smoking status, aspiration, cause of cardiac arrest, first detected heart rhythm, and use of supraglottic airways devices were not associated with EOP. Subjects with EOP had a longer need for ventilatory support (P = .005), higher tracheotomy rate (P = .03), longer ICU stay (P = .005), higher C-reactive protein (P < .001), higher body temperature (P = .003), higher Clinical Pulmonary Infection Score (P < .001), and lower PaO2/FIO2 (P = .008). CONCLUSIONS: The rate of EOP was not significantly influenced by the exchange of the preclinically inserted ETT, but was associated with longer need for mechanical ventilation and ICU stay.

Pabst D; Römer S; Samol A; Kümpers P; Waltenberger J; Lebiedz P

2013-09-01

32

Multicenter cohort study of out-of-hospital pediatric cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. METHODS: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. CONCLUSIONS: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.

Moler FW; Donaldson AE; Meert K; Brilli RJ; Nadkarni V; Shaffner DH; Schleien CL; Clark RS; Dalton HJ; Statler K; Tieves KS; Hackbarth R; Pretzlaff R; van der Jagt EW; Pineda J; Hernan L; Dean JM

2011-01-01

33

Temporal variation of out-of-hospital cardiac arrests in an equatorial climate  

Directory of Open Access Journals (Sweden)

Full Text Available Marcus EH Ong1, Faith SP Ng2, Susan Yap1, Kok Leong Yong1, Mary A Peberdy3, Joseph P Ornato41Department of Emergency Medicine, Singapore General Hospital, Singapore; 2Clinical Trials and Epidemiology Research Unit (now known as Singapore Clinical Research Institute), Singapore; 3Division of Cardiology, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USA; 4Department of Emergency Medicine, Virginia Commonwealth University – Medical College of Virginia, Richmond, VA, USAObjective: We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA) in an equatorial climate, which does not experience seasonal environmental change.Methods: We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a threeyear period. Data was analyzed using analysis of variance (ANOVA).Results: From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter) of events (ANOVA P = 0.71), monthly variation (P = 0.88) or yearly variation (P = 0.26). We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9–10 am.Conclusions: We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.Keywords: cardiopulmonary resuscitation, cardiac arrest, seasonal pattern, circadian pattern

Marcus EH Ong; Faith SP Ng; Susan Yap; et al

2010-01-01

34

An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. DESIGN: Randomized, controlled experimental trial. SETTING/TYPE OF PARTICIPANT: Animal laboratory using swine. INTERVENTIONS: Eighteen swine (17.8 to 23.7 kg) were sedated, intubated, anesthetized, and instrumented for monitoring of arterial and central venous pressures and ECG. Ventricular fibrillation was induced using a bipolar pacing catheter. Animals were randomized to treatment with the experimental algorithm or standard advanced cardiac life support therapy after eight minutes of untreated ventricular fibrillation. The experimental algorithm consisted of starting CPR; giving high-dose epinephrine (0.20 mg/kg), lidocaine (1.0 mg/kg), bretylium (5.0 mg/kg), and propranolol (0.5 to 1.0 mg) by peripheral IV; hyperventilating (20 to 25 breaths per minute); and delaying countershock (5 J/kg) 60 seconds after completion of drug delivery. Data were analyzed with the Student's t-test and Fisher's exact test. MEASUREMENTS AND MAIN RESULTS: Outcome variables were arterial and central venous pressures, return of spontaneous circulation, and one-hour survival. Hemodynamics were not different between groups during CPR. Return of spontaneous circulation occurred in seven of nine swine (77%) in the experimental algorithm group versus two of nine swine (22%) in the advanced cardiac life support group (P = .057). Four of nine swine (44%) in the experimental algorithm group survived to one hour versus none of the animals in the advanced cardiac life support group (P = .041). CONCLUSION: In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.

Menegazzi JJ; Davis EA; Yealy DM; Molner RL; Nicklas KA; Hosack GM; Honingford EA; Klain MM

1993-02-01

35

Prehospital Lactated Ringer's Solution Treatment and Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis  

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In a cohort of more than 500,000 individuals who experienced out-of-hospital cardiac arrest in Japan, Akihito Hagihara and colleagues studied whether administration of lactated Ringer's solution was associated with survival and functional outcomes.

Hagihara, Akihito; Hasegawa, Manabu; Abe, Takeru; Wakata, Yoshifumi; Nagata, Takashi; Nabeshima, Yoshihiro

36

Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

BACKGROUND In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. METHODS We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ?3, on a scale of 0 to 6, with higher scores indicating greater disability). RESULTS We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of ?0.2 percentage points (95% confidence interval, ?1.1 to 0.7; P = 0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. CONCLUSIONS Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.)

Stiell, Ian G.; Nichol, Graham; Leroux, Brian G.; Rea, Thomas D.; Ornato, Joseph P.; Powell, Judy; Christenson, James; Callaway, Clifton W.; Kudenchuk, Peter J.; Aufderheide, Tom P.; Idris, Ahamed H.; Daya, Mohamud R.; Wang, Henry E.; Morrison, Laurie J.; Davis, Daniel; Andrusiek, Douglas; Stephens, Shannon; Cheskes, Sheldon; Schmicker, Robert H.; Fowler, Ray; Vaillancourt, Christian; Hostler, David; Zive, Dana; Pirrallo, Ronald G.; Vilke, Gary M.; Sopko, George; Weisfeldt, Myron

2011-01-01

37

Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association-International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. METHODS: We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ?3, on a scale of 0 to 6, with higher scores indicating greater disability). RESULTS: We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of -0.2 percentage points (95% confidence interval, -1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. CONCLUSIONS: Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.).

Stiell IG; Nichol G; Leroux BG; Rea TD; Ornato JP; Powell J; Christenson J; Callaway CW; Kudenchuk PJ; Aufderheide TP; Idris AH; Daya MR; Wang HE; Morrison LJ; Davis D; Andrusiek D; Stephens S; Cheskes S; Schmicker RH; Fowler R; Vaillancourt C; Hostler D; Zive D; Pirrallo RG; Vilke GM; Sopko G; Weisfeldt M

2011-09-01

38

Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the prevalence of relative adrenal insufficiency in patients successfully resuscitated after cardiac arrest, and its prognostic role in post-resuscitation disease. DESIGN AND SETTING: A prospective observational single-center study in a medical intensive care unit. PATIENTS: 64 patients hospitalised in the intensive care unit after successful resuscitation for out-of-hospital cardiac arrest. MEASUREMENTS AND RESULTS: A corticotropin-stimulation test was performed between 12 and 24 h following admission: serum cortisol level was measured before and 60 min after administration of tetracosactide 250 microg. Patients with an incremental response less than 9 microg/dl were considered to have relative adrenal insufficiency (non-responders). Variables were expressed as medians and interquartile ranges. 33 patients (52%) had relative adrenal insufficiency. Baseline cortisol level was higher in non-responders than in responders (41 [27.2-55.5] vs. 22.8 [15.7-35.1] microg/dl respectively, P=0.001). A long interval before initiation of cardiopulmonary resuscitation was associated with relative adrenal insufficiency (5 [3-10] vs. 3 [3-5] min, P=0.03). Of the 38 patients with post-resuscitation shock, 13 died of irreversible multiorgan failure. The presence of relative adrenal insufficiency was identified as a poor prognostic factor of shock-related mortality (log-rank P=0.02). A trend towards higher mortality in non-responders was identified in a multivariate logistic regression analysis (odds ratio 6.77, CI 95% 0.94-48.99, P=0.058). CONCLUSIONS: Relative adrenal insufficiency occurs frequently after successful resuscitation of out-of-hospital cardiac arrest, and appears to be associated with a poor prognosis in cases of post-resuscitation shock. The role of corticosteroid supplementation should be evaluated in this setting.

Pene F; Hyvernat H; Mallet V; Cariou A; Carli P; Spaulding C; Dugue MA; Mira JP

2005-05-01

39

There is a difference in characteristics and outcome between women and men who suffer out of hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate whether there is a difference in characteristics and outcome in relation to gender among patients who suffer out of hospital cardiac arrest. DESIGN: Observational study. SETTING: The community of Göteborg. PATIENTS: All patients in the community of Göteborg who suffered out of hospital cardiac arrest between 1980 and 1996, and in whom cardiopulmonary resuscitation (CPR) was initiated. MAIN OUTCOME MEASURES: Factors at resuscitation and the proportion of patients being hospitalized and discharged from hospital. P values were corrected for age. RESULTS: The women were older than the men (median of 73 vs. 69 years; P < 0.0001), they received bystander-CPR less frequently (11 vs. 15%; P = 0.003), they were found in ongoing ventricular fibrillation less frequently (28 vs. 44%; P < 0.0001), and their arrests were judged to be of cardiac origin less frequently. In a multivariate analysis considering age, gender, arrest being due to a cardiac etiology, initial arrhythmia and by-stander initiated CPR, female gender appeared as an independent predictor for patients being brought to hospital alive (odds ratio 1.37; P = 0.001) but not for patients being discharged from hospital. CONCLUSION: Among patients who suffer out of hospital cardiac arrest with attempted CPR women differ from men being older, receive bystander CPR less frequently, have a cardiac etiology less frequently and are found in ventricular fibrillation less frequently. Finally female gender is associated with an increased chance of arriving at hospital alive.

Perers E; Abrahamsson P; Bång A; Engdahl J; Lindqvist J; Karlson BW; Waagstein L; Herlitz J

1999-04-01

40

Drowning related out-of-hospital cardiac arrests: characteristics and outcomes.  

UK PubMed Central (United Kingdom)

AIM: There are few studies on drowning-related out-of-hospital cardiac arrest (OHCA) in which patients are followed from the scene through to hospital discharge. This study aims to describe this population and their outcomes in the state of Victoria (Australia). METHODS: The Victorian Ambulance Cardiac Arrest Registry was searched for all cases of OHCA with a precipitating event of drowning attended by emergency medical services (EMS) between October 1999 and December 2011. RESULTS: EMS attended 336 drowning-related OHCA during the study period. Cases frequently occurred in summer (45%) and the majority of patients were male (70%) and adult (77%). EMS resuscitation was attempted on 154 (46%) patients. Of these patients, 41 (27%) survived to hospital arrival and 12 (8%) survived to hospital discharge (5 adults [6%] and 7 [12%] children). Few patients were found in a shockable rhythm (6%), with the majority presenting in asystole (79%) or pulse-less electrical activity (13%). An initial shockable rhythm was found to positively predict survival (AOR 48.70, 95% CI: 3.80-624.86) while increased EMS response time (AOR 0.73, 95% CI: 0.54-0.98) and salt water drowning (AOR 0.69, 95% CI: 0.01-0.84) were found to negatively predict survival. CONCLUSIONS: Rates of survival in OHCA caused by drowning are comparable to other OHCA causes. Patients were more likely to survive if they did not drown in salt water, had a quick EMS response and they were found in a shockable rhythm. Prevention efforts and reducing EMS response time are likely to improve survival of drowning patients.

Dyson K; Morgans A; Bray J; Matthews B; Smith K

2013-08-01

 
 
 
 
41

Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. Methods Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. Results A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n?=?46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n?=?100, 28.8%), problematic initial tube positioning (n?=?85, 24.5%), air leakage (n?=?61, 17.6%), vomitus/aspiration (n?=?44, 12.7%), and tube dislocation (n?=?17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being “Easy” (62.5%) or “Intermediate” (24.8%). Only 8.1% of the insertions were considered to be “Difficult”. Conclusions We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.

Sunde Geir A; Brattebø Guttorm; Ødegården Terje; Kjernlie Dag F; Rødne Emma; Heltne Jon-Kenneth

2012-01-01

42

Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT) as an airway management tool among adult out-of-hospital cardiac arrest (OHCA) patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. METHODS: Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. RESULTS: A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n?=?46, 13.3%), the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n?=?100, 28.8%), problematic initial tube positioning (n?=?85, 24.5%), air leakage (n?=?61, 17.6%), vomitus/aspiration (n?=?44, 12.7%), and tube dislocation (n?=?17, 4.9%) were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being "Easy" (62.5%) or "Intermediate" (24.8%). Only 8.1% of the insertions were considered to be "Difficult". CONCLUSIONS: We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.

Sunde GA; Brattebø G; Odegården T; Kjernlie DF; Rødne E; Heltne JK

2012-01-01

43

Hanging-associated out-of-hospital cardiac arrests in Melbourne, Australia.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Hanging is an infrequent but devastating cause of out-of-hospital cardiac arrest (OHCA). We determine the characteristics and outcomes of hanging-associated OHCA in Melbourne Australia. METHODS: A 10-year retrospective case review of all adult hangings (aged ?16 years) associated with OHCA, was conducted using data from the Victorian Ambulance Cardiac Arrest Registry. RESULTS: Between 2000 and 2009, the emergency medical service (EMS) attended 33?178 adult OHCAs of which 1321 (4%) had hanging as the aetiology. The median age (IQR) of hanging-associated OHCA cases was 39 (29-51) years and 1162 were men (88%). The first recorded rhythm by EMS was asystole seen in 1276 (75.5%) patients, pulseless electrical activity (PEA) in 38 (13.4%) cases and ventricular fibrillation in 7 cases (0.5%). EMS attempted resuscitation in 208 (15.7%) patients of whom 61 (29.3%) achieved return of spontaneous circulation (ROSC) and were transported, and 7 (3.3%) survived to hospital discharge. Hanging-associated OHCAs were younger (median (IQR) 38 (29-51) years versus 74 (61-82) years, p<0.001), less likely to have a shockable rhythm (0.5% vs 17.2%, p<0.001), receive bystander cardiopulmonary resuscitation (14.1% vs 25.5%, p<0.001) or an attempted resuscitation by EMS (15.7% vs 36.1%, p<0.001) compared with OHCA cases with an aetiology of 'presumed cardiac' arrest. Multivariable logistic regression identified factors associated with EMS decision to attempt resuscitation; the adjusted OR (95% CI) for 'presence of bystander cardiopulmonary resuscitation' was 15.8 (10.70-23.30) and for 'witnessed arrest' was 5.26 (1.17-23.30). CONCLUSION: Attempted resuscitation was not always futile with a survival of 3.3%. A preventive focus is needed.

Deasy C; Bray J; Smith K; Bernard S; Cameron P

2013-01-01

44

Quality of survival after out-of-hospital cardiac arrest: predictive value of early neurologic evaluation.  

UK PubMed Central (United Kingdom)

One hundred and seventeen patients were admitted following out-of-hospital cardiac arrest. After initial neurologic evaluation, they were followed prospectively until discharge or death. Seventeen patients were alert when admitted. Of these, four died and 10 of 13 survivors were neurologically normal. One hundred of the patients were unresponsive; of these, 60 died. Of 40 survivors, 15 were neurologically normal, at discharge; 15 could perform some self-care but were confused, and 10 required total care. Absence of pupillary light reaction, oculocephalic reflexes, purposeful response to pain, and spontaneous respirations were associated with high mortality and more severe neurologic deficits. However, some patients with usually unfavorable signs recovered good neurologic function.

Earnest MP; Breckinridge JC; Yarnell PR; Oliva PB

1979-01-01

45

Out-of-hospital early defibrillation successfully challenges sudden cardiac arrest: the Piacenza Progetto Vita project.  

UK PubMed Central (United Kingdom)

BACKGROUND: Early defibrillation is the most important intervention influencing survival following sudden cardiac arrest (SCA). In order to improve public access to early defibrillation, in North America several experiences of out-of-hospital early defibrillation by non-medical volunteers have been successfully implemented and demonstrated to improve survival. METHODS: Since 1999, in Piacenza, we have established "Progetto Vita", the first experience of out-of-hospital early defibrillation by non-medical volunteers in a medium-size European city. Thirty-nine semiautomatic external defibrillators were placed in Piacenza, Italy (266,531 inhabitants) and distributed in 12 high-risk locations, 12 lay-staffed ambulances and 15 police-cars. A total of 1285 lay volunteers were trained by the emergency medical system to intervene in all cases of suspected SCA. RESULTS: During the first 15 months, 203 codes for suspected SCA were dispatched; 197 were confirmed SCA. The overall survival was 5.6% (11/197): survival improved from 2.9% (4/134) with emergency medical system intervention to 11.1% (7/63) when the "Progetto Vita" was activated (p < 0.05). The survival rate on "shockable" rhythm was 43.7% in the group of patients treated by volunteers vs 16.6% in those treated by emergency medical system aid (p = 0.05). CONCLUSIONS: The widespread use of semiautomatic external defibrillators allows early defibrillation by non-medical volunteers and more than triples the survival rate following out-of-hospital SCA.

Capucci A; Aschieri D; Piepoli MF

2002-12-01

46

Haemodynamic variables and functional outcome in hypothermic patients following out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

AIM OF THE STUDY: To evaluate the association between haemodynamic variables during the first 24h after intensive care unit (ICU) admission and neurological outcome in out-of-hospital cardiac arrest (OHCA) victims undergoing therapeutic hypothermia. METHODS: In a multi-disciplinary ICU, records were reviewed for comatose OHCA patients undergoing therapeutic hypothermia. The hourly variable time integral of haemodynamic variables during the first 24h after admission was calculated. Neurologic outcome was assessed at day 28 and graded as favourable or adverse based on the Cerebral Performance Category of 1-2 and 3-5. Bi- and multivariate regression models adjusted for confounding variables were used to evaluate the association between haemodynamic variables and functional outcome. RESULTS: 67/134 patients (50%) were classified as having favourable outcome. Patients with adverse outcome had a higher mean heart rate (73 [62-86] vs. 66 [60-78]bpm; p=0.04) and received noradrenaline more frequently (n=17 [25.4%] vs. n=9 [6%]; p=0.02) and at a higher dosage (128 [56-1004] vs. 13 [2-162] ?gh(-1); p=0.03) than patients with favourable outcome. The mean perfusion pressure (mean arterial blood pressure minus central venous blood pressure) (OR=1.001, 95% CI =1-1.003; p=0.04) and cardiac index time integral (OR=1.055, 95% CI=1.003-1.109; p=0.04) were independently associated with adverse outcome at day 28. CONCLUSION: Mean perfusion pressure and cardiac index during the first 24h after ICU admission were weakly associated with neurological outcome in an OHCA population undergoing therapeutic hypothermia. Further studies need to elucidate whether norepinephrine-induced increases in perfusion pressure and cardiac index may contribute to adverse neurologic outcome following OHCA.

Torgersen C; Meichtry J; Schmittinger CA; Bloechlinger S; Jakob SM; Takala J; Dünser MW

2013-06-01

47

Out-of-Hospital Cardiac Arrests and Outdoor Air Pollution Exposure in Copenhagen, Denmark  

DEFF Research Database (Denmark)

Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM10, PM2.5, coarse fraction of PM (PM10-2.5), ultrafine particle proxies, NOx, NO2, O3 and CO in Copenhagen, Denmark, for the period 2000–2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM2.5, lag3 of PM10, lag3 of PM10-2.5, lag3 of NOx and lag4 of CO. An IQR increase of PM2.5 and PM10 was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O3 slightly increased the association between OHCA and PM2.5 and PM10. No susceptible groups were identified.

Wichmann, Janine; Folke, Fredrik

2013-01-01

48

Out-of-hospital cardiac arrests and outdoor air pollution exposure in Copenhagen, Denmark  

DEFF Research Database (Denmark)

Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark, for the period 2000-2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM(2.5), lag3 of PM(10), lag3 of PM(10-2.5), lag3 of NO(x) and lag4 of CO. An IQR increase of PM(2.5) and PM(10) was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O(3) slightly increased the association between OHCA and PM(2.5) and PM(10). No susceptible groups were identified.

Wichmann, Janine; Folke, Fredrik

2013-01-01

49

Out-of-hospital cardiac arrests and outdoor air pollution exposure in Copenhagen, Denmark.  

UK PubMed Central (United Kingdom)

Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark, for the period 2000-2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM(2.5), lag3 of PM(10), lag3 of PM(10-2.5), lag3 of NO(x) and lag4 of CO. An IQR increase of PM(2.5) and PM(10) was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O(3) slightly increased the association between OHCA and PM(2.5) and PM(10). No susceptible groups were identified.

Wichmann J; Folke F; Torp-Pedersen C; Lippert F; Ketzel M; Ellermann T; Loft S

2013-01-01

50

Out-of-hospital cardiac arrest: the teaching of experience at the SAMU of Lyon.  

UK PubMed Central (United Kingdom)

Because of the improvement resuscitation techniques have shown since the 1960s and because of the development of the out-of-hospital medical care, a cardiac arrest is no longer synonymous with death in every case. However the cardiac arrest resuscitation is only relevant if its adverse consequences can be limited. That is mainly the neurological after-effects and the cellular anoxia. Therefore, the "Service d'Aide Medicale Urgente" (SAMU) of Lyon has been concentrating its research aiming at: (a) Shortening the duration of cardiopulmonary resuscitation to limit the cerebral anoxia. (b) Analysing and treating some of the causes responsible for the aggravation of anoxia. On the basis of several studies in Lyon, here are some suggestions: (1) The use of high doses of epinephrine that unables a better percentage of primary recoveries (47.5% vs. 39%) (P less than 0.05) and secondary recoveries (21.3% vs. 14.8%) (P less than 0.01) without modifying the qualitative survival at long term. (On the basis of: 5 mg intravenous bolus repeated every 3 min in case of asystole instead of 1 mg every 5 min as it is usually recommended). (2) The choice of a peripheral intravenous line instead of a central intravenous line each time it is possible for the administration of drugs since it is as efficient as the second one. (40.7% vs. 33.4%) (P:NS). (3) The alkalinisation of the prolonged cardiac arrest in order to keep the acid-base balance. Most of the survivors show a pH equal or superior to the normal standard. (On the basis of 1 mmol/kg of sodium bicarbonate if the cardiac arrest lasts for more than 10 min). (4) The abolition of the dextrose solution as maintaining infusion the patients who are in a "coma depasse" (brain death) after the resuscitation have an average glycemia superior to the survivors without after-effects. (19.7 vs. 14.8 mmol/l) (P less than 0.05). (5) The monitoring at once at the hospital of the intra-cranial pressure. It reveals the frequency of high pression at an early stage (superior to 15 mmHg in 51.1% of the cases) and the absence of favourable evolution in case of high intracranial pressure. At the moment the absence of consequences on the ICR of a calcium entry blocker (Nimodipine) is being studied. The first results do not seem to show any improvement of the cerebral survival. (6) The prophylactic treatment of septicemia with intestinal origin since they occur frequently and prove to be fatal.

Gueugniaud PY; Vaudelin T; Gaussorgues P; Petit P

1989-01-01

51

Out-of-hospital cardiac arrest: 10 years of progress in research and treatment.  

UK PubMed Central (United Kingdom)

Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to out-of-hospital cardiac arrest (OHCA). In Sweden, 5000-10 000 OHCAs occur annually. During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation (CPR) and defibrillation has increased, whereas survival has remained unchanged or even increased. Resuscitation of OHCA patients is based on the 'chain-of-survival' concept, including early (i) access, (ii) CPR, (iii) defibrillation, (iv) advanced cardiac life support and (v) post-resuscitation care. Regarding early access, agonal breathing, telephone-guided CPR and the use of 'track and trigger systems' to detect deterioration in patients' condition prior to an arrest are all important. The use of compression-only CPR by bystanders as an alternative to standard CPR in OHCA has been debated. Based on recent findings, guidelines recommend telephone-guided chest compression-only CPR for untrained rescuers, but trained personnel are still advised to give standard CPR with both compressions and ventilation, and the method of choice for this large group remains unclear and demands for a randomized study. Data have shown the benefit of public access defibrillation for dispatched rescuers (e.g. police and fire fighters) but data are not as strong for the use of automated defibrillators (AEDs) by trained or untrained rescuers. Postresuscitation, use of therapeutic hypothermia, the importance of specific prognostic survival factors in the intensive care unit and the widespread use of percutaneous coronary intervention have all been considered. Despite progress in research and improved treatment regimens, most patients do not survive OHCA. Particular areas of interest for improving survival include (i) identification of high-risk patients prior to their arrest (e.g. early warning symptoms and genes); (ii) increased use of bystander CPR training (e.g. in schools) and simplified CPR techniques; (iii) better identification of high-incidence sites and better recruitment of AEDs (via mobile phone solutions?); (iv) improved understanding of the use of therapeutic hypothermia; (v) determining which patients should undergo immediate coronary angiography on hospital admission; and (vi) clarifying the importance of extracorporeal membrane oxygenation during CPR.

Hollenberg J; Svensson L; Rosenqvist M

2013-06-01

52

Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

CONTEXT: Epinephrine is widely used in cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA). However, the effectiveness of epinephrine use before hospital arrival has not been established. OBJECTIVE: To evaluate the association between epinephrine use before hospital arrival and short- and long-term mortality in patients with cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS: Prospective, nonrandomized, observational propensity analysis of data from 417 188 OHCAs occurring in 2005-2008 in Japan in which patients aged 18 years or older had an OHCA before arrival of emergency medical service (EMS) personnel, were treated by EMS personnel, and were transported to the hospital. MAIN OUTCOME MEASURES: Return of spontaneous circulation before hospital arrival, survival at 1 month after cardiac arrest, survival with good or moderate cerebral performance (Cerebral Performance Category [CPC] 1 or 2), and survival with no, mild, or moderate neurological disability (Overall Performance Category [OPC] 1 or 2). RESULTS: Return of spontaneous circulation before hospital arrival was observed in 2786 of 15,030 patients (18.5%) in the epinephrine group and 23,042 of 402,158 patients (5.7%) in the no-epinephrine group (P < .001); it was observed in 2446 (18.3%) and 1400 (10.5%) of 13,401 propensity-matched patients, respectively (P < .001). In the total sample, the numbers of patients with 1-month survival and survival with CPC 1 or 2 and OPC 1 or 2, respectively, were 805 (5.4%), 205 (1.4%), and 211 (1.4%) with epinephrine and 18,906 (4.7%), 8903 (2.2%), and 8831 (2.2%) without epinephrine (all P <.001). Corresponding numbers in propensity-matched patients were 687 (5.1%), 173 (1.3%), and 178 (1.3%) with epinephrine and 944 (7.0%), 413 (3.1%), and 410 (3.1%) without epinephrine (all P <.001). In all patients, a positive association was observed between prehospital epinephrine and return of spontaneous circulation before hospital arrival (adjusted odds ratio [OR], 2.36; 95% CI, 2.22-2.50; P < .001). In propensity-matched patients, a positive association was also observed (adjusted OR, 2.51; 95% CI, 2.24-2.80; P < .001). In contrast, among all patients, negative associations were observed between prehospital epinephrine and long-term outcome measures (adjusted ORs: 1-month survival, 0.46 [95% CI, 0.42-0.51]; CPC 1-2, 0.31 [95% CI, 0.26-0.36]; and OPC 1-2, 0.32 [95% CI, 0.27-0.38]; all P < .001). Similar negative associations were observed among propensity-matched patients (adjusted ORs: 1-month survival, 0.54 [95% CI, 0.43-0.68]; CPC 1-2, 0.21 [95% CI, 0.10-0.44]; and OPC 1-2, 0.23 [95% CI, 0.11-0.45]; all P < .001). CONCLUSION: Among patients with OHCA in Japan, use of prehospital epinephrine was significantly associated with increased chance of return of spontaneous circulation before hospital arrival but decreased chance of survival and good functional outcomes 1 month after the event.

Hagihara A; Hasegawa M; Abe T; Nagata T; Wakata Y; Miyazaki S

2012-03-01

53

Identification of high-risk communities for unattended out-of-hospital cardiac arrests using GIS.  

UK PubMed Central (United Kingdom)

Improving survival rates for out of hospital cardiac arrest (OHCA) at the neighborhood level is increasingly seen as priority in US cities. Since wide disparities exist in OHCA rates at the neighborhood level, it is necessary to locate neighborhoods where people are at elevated risk for cardiac arrest and target these for educational outreach and other mitigation strategies. This paper describes a GIS-based methodology that was used to identify communities with high risk for cardiac arrests in Franklin County, Ohio during the period 2004-2009. Prior work in this area used a single criterion, i.e., the density of OHCA events, to define the high-risk areas, and a single analytical technique, i.e., kernel density analysis, to identify the high-risk communities. In this paper, two criteria are used to identify the high-risk communities, the rate of OHCA incidents and the level of bystander CPR participation. We also used Local Moran's I combined with traditional map overlay techniques to add robustness to the methodology for identifying high-risk communities for OHCA. Based on the criteria established for this study, we successfully identified several communities that were at higher risk for OHCA than neighboring communities. These communities had incidence rates of OHCA that were significantly higher than neighboring communities and bystander rates that were significantly lower than neighboring communities. Other risk factors for OHCA were also high in the selected communities. The methodology employed in this study provides for a measurement conceptualization of OHCA clusters that is much broader than what has been previously offered. It is also statistically reliable and can be easily executed using a GIS.

Semple HM; Cudnik MT; Sayre M; Keseg D; Warden CR; Sasson C

2013-04-01

54

Identification of high-risk communities for unattended out-of-hospital cardiac arrests using GIS.  

Science.gov (United States)

Improving survival rates for out of hospital cardiac arrest (OHCA) at the neighborhood level is increasingly seen as priority in US cities. Since wide disparities exist in OHCA rates at the neighborhood level, it is necessary to locate neighborhoods where people are at elevated risk for cardiac arrest and target these for educational outreach and other mitigation strategies. This paper describes a GIS-based methodology that was used to identify communities with high risk for cardiac arrests in Franklin County, Ohio during the period 2004-2009. Prior work in this area used a single criterion, i.e., the density of OHCA events, to define the high-risk areas, and a single analytical technique, i.e., kernel density analysis, to identify the high-risk communities. In this paper, two criteria are used to identify the high-risk communities, the rate of OHCA incidents and the level of bystander CPR participation. We also used Local Moran's I combined with traditional map overlay techniques to add robustness to the methodology for identifying high-risk communities for OHCA. Based on the criteria established for this study, we successfully identified several communities that were at higher risk for OHCA than neighboring communities. These communities had incidence rates of OHCA that were significantly higher than neighboring communities and bystander rates that were significantly lower than neighboring communities. Other risk factors for OHCA were also high in the selected communities. The methodology employed in this study provides for a measurement conceptualization of OHCA clusters that is much broader than what has been previously offered. It is also statistically reliable and can be easily executed using a GIS. PMID:22983677

Semple, Hugh M; Cudnik, Michael T; Sayre, Michael; Keseg, David; Warden, Craig R; Sasson, Comilla

2013-04-01

55

Prognostication after out-of-hospital cardiac arrest, a clinical survey  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Numerous parameters and tests have been proposed for outcome prediction in comatose out-of-hospital cardiac arrest survivors. We conducted a survey of clinical practice of prognostication after therapeutic hypothermia (TH) became common practice in Norway. Methods By telephone, we interviewed the consultants who were in charge of the 25 ICUs admitting cardiac patients using 6 structured questions regarding timing, tests used and medical specialties involved in prognostication, as well as the clinical importance of the different parameters used and the application of TH in these patients. Results Prognostication was conducted within 24–48 hours in the majority (72%) of the participating ICUs. The most commonly applied parameters and tests were a clinical neurological examination (100%), prehospital data (76%), CCT (56%) and EEG (52%). The parameters and tests considered to be of greatest importance for accurate prognostication were prehospital data (56%), neurological examination (52%), and EEG (20%). In 76% of the ICUs, a multidisciplinary approach to prognostication was applied, but only one ICU used a standardised protocol. Therapeutic hypothermia was in routine use in 80% of the surveyed ICUs. Conclusion Despite the routine use of TH, outcome prediction was performed early and was mainly based on prehospital information, neurological examination and CCT and EEG evaluation. Somatosensory evoked potentials appear to be underused and underrated, while the importance of prehospital data, CCT and EEG to appear to be overrated as methods for making accurate predictions. More evidence-based protocols for prognostication in cardiac arrest survivors, as well as additional studies on the effect of TH on known prognostic parameters are needed.

Busch Michael; Søreide Eldar

2008-01-01

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Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis.  

UK PubMed Central (United Kingdom)

AIMS: Although regular physical activity has beneficial cardiovascular effects, exercise can trigger an acute cardiac event. We aimed to determine the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) in the general population. METHODS AND RESULTS: We prospectively collected all OHCAs in persons aged 10-90 years from January 2006 to January 2009 in the Dutch province North Holland. The relation between exercise during or within 1 h before OHCA and outcome was analysed using multivariable logistic regression, adjusted for age, gender, location, bystander witness, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, initial rhythm, and Emergency Medical System response time. Of 2524 OHCAs, 143 (5.7%) were exercise related (7 ?35 years, 93% men). Exercise-related OHCA incidence was 2.1 per 100 000 person-years overall and 0.3 per 100 000 person-years in those ?35 years. Survival after exercise-related OHCA was distinctly better than after non-exercise related OHCA (46.2 vs. 17.2%) [unadjusted odds ratio (OR) 4.12; 95%CI 2.92-5.82; P < 0.001], even after adjustment for abovementioned variables (OR 2.63; 95%CI, 1.23-5.54; P = 0.01). In the 69 victims aged ?35 years, exercise was not associated with better survival: 14.3 vs. 17.7% in non-exercise-related OHCA (OR 0.77; 95%CI 0.08-7.08; P = 0.82). CONCLUSION: Exercise-related OHCA has a low incidence, particularly in the young. Cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis than non-exercise-related arrests in persons >35 years. This study establishes the favourable outcome of exercise-related OHCA and should have direct implications for public health programs to prevent exercise-related sudden death.

Berdowski J; de Beus MF; Blom M; Bardai A; Bots ML; Doevendans PA; Grobbee DE; Tan HL; Tijssen JG; Koster RW; Mosterd A

2013-10-01

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Effects of adrenaline on rhythm transitions in out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: We wanted to study the effects of intravenous (i.v.) adrenaline (epinephrine) on rhythm transitions during cardiac arrest with initial or secondary ventricular fibrillation/tachycardia (VF/VT). METHODS: Post hoc analysis of patients included in a randomised controlled trial of i.v. drugs in adult, non-traumatic out-of-hospital cardiac arrest patients who were defibrillated and had a readable electrocardiography recording. Patients who received adrenaline were compared with patients who did not. Cardiac rhythms were annotated manually using the defibrillator data. RESULTS: Eight hundred and forty-nine patients were included in the randomised trial of which 223 were included in this analysis; 119 in the adrenaline group and 104 in the no-adrenaline group. The proportion of patients with one or more VF/VT episodes after temporary return of spontaneous circulation (ROSC) was higher in the adrenaline than in the no-adrenaline group, 24% vs. 12%, P?=?0.03. Most relapses from ROSC to VF/VT in the no-adrenaline group occurred during the first 20?min of resuscitation, whereas patients in the adrenaline group experienced such relapses even after 20?min. Fibrillations from asystole or pulseless electrical activity, shock resistant VF/VT and the number of rhythm transitions per patient was higher in the adrenalin group compared with the no-adrenalin group: 90% vs. 69%, P?

Neset A; Nordseth T; Kramer-Johansen J; Wik L; Olasveengen TM

2013-09-01

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Evaluation of the outcome of out-of-hospital cardiac arrest resuscitation efforts in Denizli, Turkey.  

UK PubMed Central (United Kingdom)

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.

Erdur B; Ergin A; Turkcuer I; Ergin N; Parlak I; Serinken M; Bozkir M

2008-10-01

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Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest  

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Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA) is a common medical emergency with significant mortality and significant neurological morbidity. Helicopter emergency medical services (HEMS) may be tasked to OHCA. We sought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls. Method Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a 1-year period (1/9/2010-1/9/2011). All missions to cases of suspected OHCA, of presumed medical origin, were reviewed systematically. Results HEMS was activated 89 times to suspected OHCA. This represented 11% of the total HEMS missions. In 23 cases HEMS was stood-down en-route and in 2 cases the patient had not suffered an OHCA on arrival of HEMS. 25 patients achieved return-of-spontaneous circulation (ROSC), 13 (52%) prior to HEMS arrival. The HEMS team were never first on-scene. The median time from first collapse to HEMS arrival was 31 minutes (IQR 22–40). The median time from HEMS activation to arrival on scene was 17 minutes (IQR 11.5-21). 19 patients underwent pre-hospital anaesthesia, 5 patients had electrical or chemical cardioversion and 19 patients had therapeutic hypothermia initiated by HEMS. Only 1 post-OHCA patient was transported to hospital by air. The survival to discharge rate was 6.3%. Conclusion OHCA represents a significant proportion of HEMS call outs. HEMS most commonly attend post-ROSC OHCA patients and interventions, including pre-hospital anaesthesia and therapeutic hypothermia should be targeted to this phase. HEMS are rarely first on-scene and should only be tasked as a first response to OHCA in remote locations. HEMS may be most appropriately utilised in OHCA by only attending the scene if a patient achieves ROSC.

Lyon Richard M; Nelson Magnus J

2013-01-01

60

Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a common medical emergency with significant mortality and significant neurological morbidity. Helicopter emergency medical services (HEMS) may be tasked to OHCA. We sought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls. METHOD: Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a 1-year period (1/9/2010-1/9/2011). All missions to cases of suspected OHCA, of presumed medical origin, were reviewed systematically. RESULTS: HEMS was activated 89 times to suspected OHCA. This represented 11% of the total HEMS missions. In 23 cases HEMS was stood-down en-route and in 2 cases the patient had not suffered an OHCA on arrival of HEMS. 25 patients achieved return-of-spontaneous circulation (ROSC), 13 (52%) prior to HEMS arrival. The HEMS team were never first on-scene. The median time from first collapse to HEMS arrival was 31 minutes (IQR 22-40). The median time from HEMS activation to arrival on scene was 17 minutes (IQR 11.5-21). 19 patients underwent pre-hospital anaesthesia, 5 patients had electrical or chemical cardioversion and 19 patients had therapeutic hypothermia initiated by HEMS. Only 1 post-OHCA patient was transported to hospital by air. The survival to discharge rate was 6.3%. CONCLUSION: OHCA represents a significant proportion of HEMS call outs. HEMS most commonly attend post-ROSC OHCA patients and interventions, including pre-hospital anaesthesia and therapeutic hypothermia should be targeted to this phase. HEMS are rarely first on-scene and should only be tasked as a first response to OHCA in remote locations. HEMS may be most appropriately utilised in OHCA by only attending the scene if a patient achieves ROSC.

Lyon RM; Nelson MJ

2013-01-01

 
 
 
 
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Rapid epinephrine administration improves early outcomes in out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Early administration of epinephrine (Epi) improves outcomes in animal models of cardiac arrest, but there is limited time-dependent clinical data regarding its benefit. OBJECTIVE: Our objective was to assess whether timing of Epi administration was associated with improved outcomes after out of hospital cardiac arrest (OHCA). METHODS: We performed a retrospective analysis of a cardiac arrest database from a suburban EMS system from November 2005 to April 2011. Data was abstracted from EMS run sheets, including drug treatment, route and timing of drug administration, and other Utstein variables. Our primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes measured were survival to hospital admission and discharge. For analysis, data were dichotomized according to timing of Epi administration: early Epi group (defined as 911 call to Epi administration of ?10 min) and late Epi group (>10 min). Further, exploratory analyses were conducted looking at subgroups sorted by initial rhythm and whether the arrest was witnessed. Wilcoxon rank sum tests, chi-square tests, 95% confidence intervals, and multi-variable regression were used for statistical analysis. RESULTS: We reviewed 809 patients from study communities: 123 patients were excluded, leaving a sample size of 686 for study analysis. The mean time from 911-Epi was 14.3±5.5 min, with 155 (22.6%) receiving early Epi. Key arrest and treatment characteristics were similar between groups. Patients who received early Epi were more likely to have ROSC (32.9% vs. 23.4%, OR 1.59 (1.07, 2.38)), however, no significant increase in survival to admission or discharge was observed. Patients with an initial rhythm of PEA had an increased rate of ROSC (48.6% vs. 21.5%, OR 3.45 (1.56, 7.62)) but not survival to discharge (5.9% vs. 2.6%), OR 2.35 (0.38, 14.7) with early Epi. In a multivariable analysis of bystander witnessed arrests, early Epi was associated with a higher rate of ROSC (OR 3.20 (1.75, 5.88) but not survival to discharge (OR 1.48 (0.50, 4.36)). No improvement in ROSC or secondary outcomes was noted in patients with other arrest rhythms or un-witnessed arrest with Early Epi. CONCLUSIONS: Within the limitations of our study, this data suggests improved rates of ROSC with early Epi administration during OHCA resuscitation, but this study lacks adequate sample size to demonstrate impact on survival to discharge. Large prospective trials are needed to further delineate the benefit of early Epi administration in OHCA.

Koscik C; Pinawin A; McGovern H; Allen D; Media DE; Ferguson T; Hopkins W; Sawyer KN; Boura J; Swor R

2013-07-01

62

[Resuscitated victims of out-of-hospital cardiac arrest: is it always indicated emergent coronary angiography and revascularization?].  

UK PubMed Central (United Kingdom)

Out-of-hospital cardiac arrest with return of spontaneous circulation represents a great challenge even for advanced healthcare systems because of the high risk and frequency of this event. The most common cause of out-of-hospital cardiac arrest is an acute coronary syndrome, and noninvasive diagnostic tools are quite inadequate. The poor outcome observed so far seems to improve significantly when early treatment with hypothermia and myocardial revascularization is performed. Emergent coronary angiography and myocardial revascularization seem to be reasonable and appropriate therapeutic option not only for patients with ST-elevation myocardial infarction but also for other patient subsets.

Bonmassari R; Minchio E

2012-10-01

63

Out-of-hospital cardiac arrest outcomes stratified by rhythm analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Survival data for out-of-hospital cardiac arrest (OHCA) victims initially in PEA or asystole who convert to a shockable rhythm during attempted resuscitation, relative to an initial shockable rhythm, have never been previously reported. This study was done to assess OHCA outcomes among a large cohort of adults in the CARES dataset stratified by three rhythm categories: initial shockable (IS), converted shockable (CS), and never shockable (NS). METHODS: The study was IRB approved. All adult index events at participating sites (2005-2010) were study eligible. All patient data elements were provided. Odds ratios of CS and NS status for survival to hospital discharge were calculated via multivariate logistic regression that adjusted for demographics, site, resuscitation initiators, AED use, and other covariates. RESULTS: There were 40,274 OHCA records submitted to the CARES registry during the study period. After exclusions, our final sample size was 30,939 (7404 IS [23.9%], 3225 CS [10.4%], 20,310 NS [65.7%]). Raw survival rates of CS and NS patients were similar (4.7% vs. 4.1%, respectively; p=0.08) but significantly lower than IS patients (26.9%; p<0.001). The adjusted OR of survival to hospital discharge for CS was 0.17 (95% CI: 0.14, 0.20) and for NS it was 0.17 (95% CI: 0.15, 0.18) with IS as the referent. CONCLUSION: After OHCA, the survival rate for CS victims is significantly lower than for IS patients. These findings suggest that CS and IS are different entities and that alternatives to existing resuscitation algorithm tailored to patients with CS should be investigated.

Mader TJ; Nathanson BH; Millay S; Coute RA; Clapp M; McNally B

2012-11-01

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Epidemiology and Outcomes from Out-of-Hospital Cardiac Arrest in Children: The ROC Epistry-Cardiac Arrest  

Science.gov (United States)

BACKGROUND Population-based data for pediatric cardiac arrest are scant and largely from urban areas. The Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest is a population-based emergency medical services (EMS) registry of out-of-hospital non-traumatic cardiac arrest (OHCA). This study examined age-stratified incidence and outcomes of pediatric OHCA. We hypothesized that survival to hospital discharge is less frequent from pediatric OHCA than adult OHCA. METHODS AND RESULTS Design Prospective population-based cohort study. Setting Eleven US and Canadian ROC sites. Population Persons <20 years who a) receive CPR or defibrillation by emergency medical services (EMS) providers and/or receive bystander AED shock or b) pulseless but receive no EMS resuscitation between December 2005 and March 2007. Patients were a priori stratified into 3 groups: <1 year (infants, n = 277), 1–11 years (children, n = 154), and 12–19 years (adolescents, n = 193). The incidence of pediatric OHCA was 8.04/100,000 person-years (72.71 in infants, 3.73 in children, and 6.37 in adolescents) versus 126.52 for adults. Survival for all pediatric OHCA was 6.4% (3.3% for infants, 9.1% for children and 8.9% for adolescents) versus 4.5% for adults (P=0.03). Unadjusted odds ratio (95% CI) for pediatric survival to discharge compared with adults was 0.71 (0.37, 1.39) for infants, 2.11 (1.21, 3.66) for children, and 2.04 (1.24, 3.38) for adolescents. CONCLUSIONS This study demonstrates that the incidence of OHCA in infants approaches that observed in adults but is lower among children and adolescents. Survival to discharge was more common among children and adolescents than infants or adults.

Atkins, Dianne L.; Everson-Stewart, Siobhan; Sears, Gena K.; Daya, Mohamud; Osmond, Martin H.; Warden, Craig R.; Berg, Robert A.

2009-01-01

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A systematic review of air pollution and incidence of out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Studies have linked air pollution with the incidence of acute coronary artery events and cardiovascular mortality but the association with out-of-hospital cardiac arrest (OHCA) is less clear. AIM: To examine the association of air pollution with the occurrence of OHCA. METHODS: Electronic bibliographic databases (until February 2013) were searched. Search terms included common air pollutants and OHCA. Studies of patients with implantable cardioverter defibrillators and OHCA not attended by paramedics were excluded. Two independent reviewers (THKT and TAW) identified potential studies. Methodological quality was assessed by the Newcastle-Ottawa Scale. RESULTS: Of 849 studies, 8 met the selection criteria. Significant associations between particulate matter (PM) exposure (especially PM2.5) and OHCA were found in 5 studies. An increase of OHCA risk ranged from 2.4% to 7% per interquartile increase in average PM exposure on the same day and up to 4 days prior to the event. A large study found ozone increased the risk of OHCA within 3 h prior to the event. The strongest risk OR of 3.8-4.6% per 20 parts per billion ozone increase of the average level was within 2 h prior to the event. Similarly, another study found an increased risk of 18% within 2 days prior to the event. CONCLUSIONS: Larger studies have suggested an increased risk of OHCA with air pollution exposure from PM2.5 and ozone.

Teng TH; Williams TA; Bremner A; Tohira H; Franklin P; Tonkin A; Jacobs I; Finn J

2013-10-01

66

Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Because out-of-hospital cardiac arrests (OHCAs) due to a major trauma rarely present with shockable rhythms, the potential benefits of using automated external defibrillators (AEDs) at the scene of traumatic OHCAs have not been examined. METHODS: We conducted an observational, retrospective cohort study using an Utstein-style analysis in Tainan city, Taiwan. The enrollees were adult patients with traumatic OHCAs accessed by emergency medical technicians (EMTs) from January 1, 2004 to December 31, 2010. The exposure was the use or non-use of AEDs at the scene, as determined by the clinical judgment of the EMTs. The primary outcome evaluated was a sustained (?2h) return of spontaneous circulation (ROSC), and the secondary outcomes were prehospital ROSC, overall ROSC, survival to hospital admission, survival at one month and favorable neurologic status at one month. RESULTS: A total of 424 patients (313 males) were enrolled, of whom 280 had AEDs applied, and 144 did not. Only 25 (5.9%) patients had received bystander cardiopulmonary resuscitation (CPR), and merely 21 (7.5%) patients in the AED group presented with shockable rhythms. Compared to the non-AED group, the primary and secondary outcomes of the AED group were not significantly different, except for a significantly lower prehospital ROSC rate (1.1% vs. 4.9%, p<0.05). Multivariate analysis showed no significant interactions between the use of AEDs and other key variables. Use of the AED was not associated with sustained ROSC (OR 1.33; 95% CI 0.75-2.38, p=0.33). CONCLUSIONS: In a community with a low prevalence of shockable rhythms and administration of bystander CPR in patients with traumatic OHCA, we found no significant differences in the sustained ROSC between the AED and the non-AED groups. Considering scene safety and the possible interruption of CPR, we do not encourage the routine use of AEDs at the scene of traumatic OHCAs.

Lin CH; Chiang WC; Ma MH; Wu SY; Tsai MC; Chi CH

2013-05-01

67

A case-crossover analysis of out-of-hospital cardiac arrest and air pollution.  

UK PubMed Central (United Kingdom)

BACKGROUND: Evidence of an association between the exposure to air pollution and overall cardiovascular morbidity and mortality is increasingly found in the literature. However, results from studies of the association between acute air pollution exposure and risk of out-of-hospital cardiac arrest (OHCA) are inconsistent for fine particulate matter, and, although pathophysiological evidence indicates a plausible link between OHCA and ozone, none has been reported. Approximately 300 000 persons in the United States experience an OHCA each year, of which >90% die. Understanding the association provides important information to protect public health. METHODS AND RESULTS: The association between OHCA and air pollution concentrations hours and days before onset was assessed by using a time-stratified case-crossover design using 11 677 emergency medical service-logged OHCA events between 2004 and 2011 in Houston, Texas. Air pollution concentrations were obtained from an extensive area monitor network. An average increase of 6 µg/m(3) in fine particulate matter 2 days before onset was associated with an increased risk of OHCA (1.046; 95% confidence interval, 1.012-1.082). A 20-ppb ozone increase for the 8-hour average daily maximum was associated with an increased risk of OHCA on the day of the event (1.039; 95% confidence interval, 1.005-1.073). Each 20-ppb increase in ozone in the previous 1 to 3 hours was associated with an increased risk of OHCA (1.044; 95% confidence interval, 1.004-1.085). Relative risk estimates were higher for men, blacks, or those aged >65 years. CONCLUSIONS: The findings confirm the link between OHCA and fine particulate matter and introduce evidence of a similar link with ozone.

Ensor KB; Raun LH; Persse D

2013-03-01

68

Regional Variation in Survival Following Pediatric Out-of-Hospital Cardiac Arrest.  

UK PubMed Central (United Kingdom)

Background:?Although regional variation in outcome after adult out-of-hospital cardiac arrest (OHCA) is known, no clinical studies have assessed this in pediatric OHCA. Methods and Results:?This nationwide, prospective, population-based observation of the whole of Japan included consecutive OHCA patients with resuscitation attempt from January 2005 through December 2009. Primary outcome was 1-month survival with neurologically favorable outcome. Japan was divided into the following 7 regions as the largest administrative units: Hokkaido-Tohoku, Kanto, Tokai-Hokuriku, Kinki, Chugoku, Shikoku, and Kyushu-Okinawa. The outcome of pediatric OHCA was then compared between the regions. Multiple logistic regression analysis was used to adjust for other factors that were considered to influence the relationship between region and outcome. A total of 8,240 pediatric OHCA patients were registered during the study period. One-month survival with neurologically favorable outcome significantly differed by region: 2.5% (24/967) in Hokkaido-Tohoku (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI]: 0.94-2.90), 2.9% (47/1614) in Tokai-Hokuriku (AOR, 2.06; 95% CI: 1.28-3.31), 2.1% (26/1239) in Kinki (AOR, 1.45; 95% CI: 0.84-2.51), 3.4% (16/465) in Chugoku (AOR, 3.11; 95% CI: 1.62-6.00), 1.5% (4/259) in Shikoku (AOR, 0.79; 95% CI: 0.26-2.43), and 2.8% (27/974) in Kyushu-Okinawa (AOR, 2.15; 95% CI: 1.24-3.74) referred to Kanto (1.4%, 37/2722). Conclusions:?According to Japanese nationwide OHCA registry data there are significant regional variations in the outcome of pediatric OHCA.

Okamoto Y; Iwami T; Kitamura T; Nitta M; Hiraide A; Morishima T; Kawamura T

2013-07-01

69

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

Directory of Open Access Journals (Sweden)

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.

Yasunaga Hideo; Miyata Hiroaki; Horiguchi Hiromasa; Tanabe Seizan; Akahane Manabu; Ogawa Toshio; Koike Soichi; Imamura Tomoaki

2011-01-01

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Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Population-based data for pediatric cardiac arrest are scant and largely from urban areas. The Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest is a population-based emergency medical services registry of out-of-hospital nontraumatic cardiac arrest (OHCA). This study examined age-stratified incidence and outcomes of pediatric OHCA. We hypothesized that survival to hospital discharge is less frequent from pediatric OHCA than adult OHCA. METHODS AND RESULTS: This prospective population-based cohort study in 11 US and Canadian ROC sites included persons <20 years of age who received cardiopulmonary resuscitation or defibrillation by emergency medical service providers and/or received bystander automatic external defibrillator shock or who were pulseless but received no resuscitation by emergency medical services between December 2005 and March 2007. Patients were stratified a priori into 3 age groups: <1 year (infants; n=277), 1 to 11 years (children; n=154), and 12 to 19 years (adolescents; n=193). The incidence of pediatric OHCA was 8.04 per 100 000 person-years (72.71 in infants, 3.73 in children, and 6.37 in adolescents) versus 126.52 per 100,000 person-years for adults. Survival for all pediatric OHCA was 6.4% (3.3% for infants, 9.1% for children, and 8.9% for adolescents) versus 4.5% for adults (P=0.03). Unadjusted odds ratio for pediatric survival to discharge compared with adults was 0.71 (95% confidence interval, 0.37 to 1.39) for infants, 2.11 (95% confidence interval, 1.21 to 3.66) for children, and 2.04 (95% confidence interval, 1.24 to 3.38) for adolescents. CONCLUSIONS: This study demonstrates that the incidence of OHCA in infants approaches that observed in adults but is lower among children and adolescents. Survival to discharge was more common among children and adolescents than infants or adults.

Atkins DL; Everson-Stewart S; Sears GK; Daya M; Osmond MH; Warden CR; Berg RA

2009-03-01

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Persistent peripheral and microcirculatory perfusion alterations after out-of-hospital cardiac arrest are associated with poor survival.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate sublingual microcirculatory and peripheral tissue perfusion parameters in relation to systemic hemodynamics during and after therapeutic hypothermia following out-of-hospital cardiac arrest. DESIGN: Prospective observational study. SETTING: Intensive cardiac care unit at a university teaching hospital. SUBJECTS: We followed 80 patients, of whom 25 were included after out-of-hospital cardiac arrest. INTERVENTION: In all patients, we induced therapeutic hypothermia to 33°C during the first 24 hrs of admission. MEASUREMENTS AND MAIN RESULTS: Complete hemodynamic measurements were obtained directly on intensive cardiac care unit admission (baseline), during induced hypothermia (T1), directly after rewarming (T2), and another 24 hrs later (T3). In addition, the sublingual microcirculation was observed using sidestream dark-field imaging, and peripheral tissue perfusion was monitored with the peripheral perfusion index, capillary refill time, tissue oxygen saturation, and forearm-to-fingertip skin temperature gradient. During hypothermia, all sublingual microcirculatory parameters decreased significantly together with peripheral capillary refill time and the peripheral perfusion index, followed by a significant increase at T2. Changes in sublingual and peripheral tissue perfusion parameters were significantly related to changes in central body temperature, but not to changes in systemic hemodynamic variables such as cardiac index or mean arterial pressure. Surprisingly, these parameters were significantly lower in nonsurvivors (n=6) at admission and after rewarming. Persistent alterations in these parameters were related with the prevalence of organ dysfunction and were highly predictive of mortality. CONCLUSIONS: Following out-of-hospital cardiac arrest, the early postresuscitation phase is characterized by abnormalities in sublingual microcirculation and peripheral tissue perfusion, which are caused by vasoconstriction due to induced systemic hypothermia and not by impaired systemic blood flow. Persistence of these alterations is associated with organ failure and death, independent of systemic hemodynamics.

van Genderen ME; Lima A; Akkerhuis M; Bakker J; van Bommel J

2012-08-01

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Exploring gender differences and the "oestrogen effect" in an Australian out-of-hospital cardiac arrest population.  

UK PubMed Central (United Kingdom)

BACKGROUND: Recent studies have suggested gender differences in out-of-hospital cardiac arrests (OHCA) including outcomes favouring young women. We aimed to investigate these findings in an Australian OHCA population using the Victorian Ambulance Cardiac Arrest Registry (VACAR). METHODS AND RESULTS: The VACAR was searched for adult presumed cardiac OHCAs between 2003 and 2010 where Emergency Medical Services (EMS) attempted resuscitation. Gender and age differences in survival to hospital arrival and to hospital discharge were examined using logistic regression adjusting for known predictors of survival. There were 10,453 OHCA meeting inclusion criteria (863 aged between 18 and 44 years). Women were less likely to be younger, have a witnessed arrest, receive bystander CPR, arrest in a public place, have an initial shockable rhythm or receive transport to 24-h cardiac interventional hospital. After adjusting for differences in pre-hospital factors, women were more likely to survive to hospital arrival than men (aOR 3.47, 95% CI: 2.19-5.50), but no gender differences were seen in survival to hospital discharge either overall or specifically in women aged between 18 and 44 years. Both younger men and younger women were more likely to survive to hospital discharge compared to older men and women. CONCLUSION: Women were more likely to survive to hospital arrival despite less favourable baseline variables. However, this initial improvement in survival did not translate to better survival to hospital discharge either overall, or in women of a reproductive age. Further study is required to determine gender differences in the underlying causes of OHCA and in EMS transportation practices.

Bray JE; Stub D; Bernard S; Smith K

2013-07-01

73

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear. METHODS: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression. RESULTS: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome. CONCLUSIONS: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.

Kajino K; Iwami T; Kitamura T; Daya M; Ong ME; Nishiuchi T; Hayashi Y; Sakai T; Shimazu T; Hiraide A; Kishi M; Yamayoshi S

2011-01-01

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Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms.  

UK PubMed Central (United Kingdom)

BACKGROUND: Non-shockable arrest rhythms (pulseless electrical activity and asystole) represent an increasing proportion of reported cases of out-of-hospital cardiac arrest (OHCA). The prognostic significance of conversion from non-shockable to shockable rhythms during the course of resuscitation remains unclear. OBJECTIVE: To evaluate whether out-of-hospital cardiac arrest survival with initially non-shockable arrest rhythms is improved with subsequent conversion to shockable rhythms. METHODS: Secondary analysis of data in Epistry - Cardiac Arrest, an epidemiologic registry maintained by the Resuscitation Outcomes Consortium (ROC). This analysis includes OHCA events from December 1, 2005 through May 31, 2007 contributed by six US and two Canadian sites. For all EMS-treated adult (18 and older) cardiac arrest patients who presented with non-shockable cardiac arrest, we compared survival to hospital discharge between patients who did develop a shockable rhythm and those who did not based on receipt of subsequent defibrillation. Missing data were handled using multiple imputation. Multivariable logistic regression was used to adjust for potentially confounding variables. RESULTS: A total of 6556 EMS treated adult cardiac arrest cases presented in non-shockable rhythms. Survival to discharge in patients who converted to a shockable rhythm was 2.77% while survival in those who did not was 2.72% (p=0.92). After adjusting for confounders, conversion to a shockable rhythm was not associated with improved survival (OR 0.88, 95% CI: 0.60-1.30). CONCLUSION: For OHCA patients presenting in PEA/asystole, survival to hospital discharge was not associated with conversion to a shockable rhythm during EMS resuscitation efforts.

Thomas AJ; Newgard CD; Fu R; Zive DM; Daya MR

2013-09-01

75

Neurological recovery after out-of-hospital cardiac arrest: hospital admission predictors and one-year survival in an urban cardiac network experience.  

UK PubMed Central (United Kingdom)

Aim: The aim of the study was to detect early predictors of neurological recovery and evaluate one year survival related to neurological status at discharge in patients (pts) admitted after out of hospital cardiac arrest (OHCA). Methods: Sixty-three consecutive pts with OHCA from any cardiac cause, admitted to our cardiac intensive care unit, were classified according to survival and cerebral performance category (CPC) scale from 1 to 4 at hospital discharge. Pre-hospital and emergency room (ER) variables were analyzed to identify early predictors of neurological recovery as defined CPC=1-2. Results: Overall in-hospital survival was 60%. Sixty-eight and 32% of survivors were classified as CPC 1-2 and CPC 3-4 respectively. During one year follow-up 96% of patients classified as CPC 1-2 survived and 100% of CPC 3-4 died. Emergency crew witnessing, performance of cardio pulmonary resuscitation (CPR) by witnesses, the call for chest pain, no history of heart disease and a Glasgow coma scale (GCS) of ?9 on arrival to the ER, were more frequent in patients classified as CPC 1-2 and times from "OHCA to return of spontaneous circulation (ROSC)", from "emergency medical system (EMS) arrival to ROSC" and "first DC shock to ROSC" were also significantly shorter in these patients. The time of first DC shock to ROSC in pts who presented with rhythm in ventricular fibrillation and the time from OHCA to ROSC in pts with witnessed OHCA were an independent predictors of neurological recovery. Conclusion: Forty-one percent of pts admitted to our tertiary centre after OHCA were discharged with CPC 1-2 and at one year follow-up 96% of these were alive, while all pts classified as CPC 3-4 died. Easily documented information such as the time from OHCA to ROSC and the time of first shock to ROSC are early independent predictors of neurological recovery.

Corrada E; Mennuni MG; Grieco N; Sesana G; Beretta G; Presbitero P

2013-08-01

76

Chest compression-only cardiopulmonary resuscitation performed by lay rescuers for adult out-of-hospital cardiac arrest due to non-cardiac aetiologies.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Bystander CPR improves survival in patients with out-of-hospital cardiac arrest (OHCA). For adult sudden collapse, bystander chest compression-only CPR (COCPR) is recommended in some circumstances by the American Heart Association and European Resuscitation Council. However, adults who arrest from non-cardiac causes may also receive COCPR. Because rescue breathing may be more important for individuals suffering OHCA secondary to non-cardiac causes, COCPR is not recommended for these cases. We evaluated the relationship of lay rescuer COCPR and survival after OHCA from non-cardiac causes. METHODS: Analysis of a statewide Utstein-style registry of adult OHCA, during a large scale campaign endorsing COCPR for OHCA from presumed cardiac cause. The relationship between lay rescuer CPR (both conventional CPR and COCPR) and survival to hospital discharge was evaluated. RESULTS: Presumed non-cardiac aetiologies of OHCA accounted for 15% of all cases, and lay rescuer CPR was provided in 29% of these cases. Survival to hospital discharge occurred in 3.8% after conventional CPR, 2.7% after COCPR, and 4.0% after no CPR (p=0.85). The proportion of patients receiving COCPR was much lower in the cohort of OHCA from respiratory causes (8.3%) than for those with presumed cardiac OHCA (18.0%; p<0.001). CONCLUSIONS: In the setting of a campaign endorsing lay rescuer COCPR for cardiac OHCA, bystanders were less likely to perform COCPR on OHCA victims who might benefit from rescue breathing.

Panchal AR; Bobrow BJ; Spaite DW; Berg RA; Stolz U; Vadeboncoeur TF; Sanders AB; Kern KB; Ewy GA

2013-04-01

77

Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

To investigate the incidence of iatrogenic dyscarbia in survivors of out-of-hospital cardiac arrest treated with induced mild hypothermia.We performed a retrospective cohort study of the ventilatory management based on blood gas analyses of patients resuscitated from prehospital cardiac arrest. In the pilot phase, we assessed the ventilatory management in the patients treated in one university hospital during a 4-year study period. Subsequently, a more recent (1-year) retrospective cohort of resuscitated patients from all five Finnish university hospitals concerning the first 48h after hospital admission was analyzed. Core temperatures and temperature corrected (or non-corrected) blood gas analysis results with focus on carbon dioxide tension were analyzed. In addition, a survey was performed to investigate the ventilatory strategies in all Finnish hospitals providing mild hypothermia for cardiac arrest victims.The pilot cohort suggested a high incidence of hypo- or hyper-carbia during hypothermia treatment. In the multicenter patient population of 122 patients contributing a total of 1627 measurements, the PaCO(2) distribution was as follows: less than 4 kPa in 148 samples out of 1627 (9%), 4-4.6 kPa in 404 (25%), 4.7-6 kPa in 887 (55%) and more than 6 kPa in 188 samples (12%). There was a significant difference in the incidence of hypercarbia between the hospitals (p<0.05).We conclude that normocarbia was achieved/maintained only in approximately 55% of the samples. The incidence of hypo- or hyper-carbia (dyscarbia) was high (45%). This may predispose for serious derangements in the cerebral perfusion of the resuscitated patient. These results call for vigilance in adjustment of the ventilatory management to meet the needs of the patients treated with mild hypothermia.

Falkenbach P; Kämäräinen A; Mäkelä A; Kurola J; Varpula T; Ala-Kokko T; Perttilä J; Tenhunen J

2009-09-01

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Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest.  

Science.gov (United States)

To investigate the incidence of iatrogenic dyscarbia in survivors of out-of-hospital cardiac arrest treated with induced mild hypothermia.We performed a retrospective cohort study of the ventilatory management based on blood gas analyses of patients resuscitated from prehospital cardiac arrest. In the pilot phase, we assessed the ventilatory management in the patients treated in one university hospital during a 4-year study period. Subsequently, a more recent (1-year) retrospective cohort of resuscitated patients from all five Finnish university hospitals concerning the first 48h after hospital admission was analyzed. Core temperatures and temperature corrected (or non-corrected) blood gas analysis results with focus on carbon dioxide tension were analyzed. In addition, a survey was performed to investigate the ventilatory strategies in all Finnish hospitals providing mild hypothermia for cardiac arrest victims.The pilot cohort suggested a high incidence of hypo- or hyper-carbia during hypothermia treatment. In the multicenter patient population of 122 patients contributing a total of 1627 measurements, the PaCO(2) distribution was as follows: less than 4 kPa in 148 samples out of 1627 (9%), 4-4.6 kPa in 404 (25%), 4.7-6 kPa in 887 (55%) and more than 6 kPa in 188 samples (12%). There was a significant difference in the incidence of hypercarbia between the hospitals (p<0.05).We conclude that normocarbia was achieved/maintained only in approximately 55% of the samples. The incidence of hypo- or hyper-carbia (dyscarbia) was high (45%). This may predispose for serious derangements in the cerebral perfusion of the resuscitated patient. These results call for vigilance in adjustment of the ventilatory management to meet the needs of the patients treated with mild hypothermia. PMID:19586703

Falkenbach, Patrik; Kämäräinen, Antti; Mäkelä, Antti; Kurola, Jouni; Varpula, Tero; Ala-Kokko, Tero; Perttilä, Juha; Tenhunen, Jyrki

2009-07-07

79

Chest compressions before defibrillation for out-of-hospital cardiac arrest: A meta-analysis of randomized controlled clinical trials  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR) prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest. Methods Main outcome measures were survival to hospital discharge (primary endpoint), return of spontaneous circulation (ROSC), neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs). A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes. Results A total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979), survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686) or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979). For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092) but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min) point estimates pointed toward superiority of chest compression first (OR 1.45 [0.66-3.20]; P = 0.353), but the 95% CI again crossed 1.0. Conclusions Current evidence does not support the notion that chest compression first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest. It appears that both treatments are equivalent. However, subgroup analyses indicate that chest compression first may be beneficial for cardiac arrests with a prolonged response time.

Meier Pascal; Baker Paul; Jost Daniel; Jacobs Ian; Henzi Bettina; Knapp Guido; Sasson Comilla

2010-01-01

80

'Event tree' analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The British National Service Framework (NSF) for heart disease commended the 'Utstein style' for auditing out-of-hospital cardiac arrests. The NSF also set standards for pre-hospital treatment and response times. To increase the flexibility of Utstein, an 'event tree' technique is proposed as an audit tool. Event trees consist of nodes and branches on which numbers, percentages or probability values are entered. METHODS: Using the London Ambulance Service's (LAS) 1997 database on 3,759 out-of-hospital cardiac arrests, 2,772 arrests witnessed by lay bystanders or unwitnessed were analysed focusing on bystander cardiopulmonary resuscitation (BCPR) and response times. RESULTS: The Utstein template showed that witnessed arrests in ventricular fibrillation (VF) or ventricular tachycardia (VT) who had received BCPR achieved a return of spontaneous circulation (ROSC) in the field significantly more often than non-BCPR recipients-26 versus 16% (P=0.006). But the likelihood of being admitted to a hospital bed, and discharged alive, was only marginally better for BCPR recipients. To examine the influence of BCPR on the presenting rhythm an event tree showed that in 48% of witnessed BCPR cases the presenting rhythm was VF/VT, whereas, for witnessed non-BCPR cases, 27% were in VF/VT (P<0.0001). With unwitnessed arrests, 31% of BCPR cases were in VF/VT compared with 18% for non-BCPR cases (P<0.0001). Call to scene time was less than 8 min for 66% of all VF/VT arrests. CONCLUSION: The event trees, when combined with the Utstein template, demonstrated the importance of examining comprehensively datasets for both witnessed and unwitnessed cardiac arrests when monitoring performance standards. The analyses also emphasised the relevance of community programmes in Greater London for teaching basic life saving skills.

Dowie R; Campbell H; Donohoe R; Clarke P

2003-02-01

 
 
 
 
81

Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To test the hypothesis that the use of an automated external defibrillator by police and fire fighters results in higher discharge rates for out of hospital cardiac arrest. DESIGN: Controlled clinical trial with initial random allocation of automated external defibrillators to first responders in four of the eight participating regions; each region switched from control to experimental, and vice versa, every four months. SETTING: Amsterdam and surroundings, the Netherlands. PARTICIPANTS: Patients with witnessed out of hospital cardiac arrests, identified by the emergency medical system between January 2000 and January 2002. MAIN OUTCOMES MEASURES: Survival to hospital discharge; return of spontaneous circulation; admission to hospital. RESULTS: 243 patients (65% in ventricular fibrillation) were included in the experimental area and 226 patients (67% in ventricular fibrillation) in the control area. The median time interval between collapse and first shock was 668 seconds in the experimental area and 769 seconds in the control area (P < 0.001). 44 (18%) patients in the experimental area versus 33 (15%) patients in the control area were discharged (odds ratio 1.3 (95% confidence interval 0.8 to 2.2), P = 0.33), 139 (57%) experimental versus 108 (48%) control patients had return of spontaneous circulation (1.5 (1.0 to 2.2), P = 0.05), and 103 (42%) experimental versus 74 (33%) control patients were admitted (1.5 (1.1 to 1.6), P = 0.02). The median delay from receipt of call to dispatch of the ambulance was 120 seconds, and the delay to dispatch of the first responder was 180 seconds. CONCLUSIONS: Use of automated external defibrillators by first responders did not significantly increase survival to discharge from hospital, although it did improve return of spontaneous circulation and admission to hospital. Improved dispatch procedures should increase the success of programmes of first responders using external defibrillators.

van Alem AP; Vrenken RH; de Vos R; Tijssen JG; Koster RW

2003-12-01

82

Osborn waves during therapeutic hypothermia in a young ST-ACS patient after out-of-hospital cardiac arrest.  

Science.gov (United States)

A 37 year-old male patient was admitted to the intensive care unit after an out-of-hospital cardiac arrest due to ventricular fibrillation in a course of ST-segment elevation acute coronary syndrome. On admission, the patient was unconscious with a Glasgow Coma Scale (GCS) score of 5. A percutaneous coronary intervention and mild therapeutic hypothermia (HT), defined as maintaining body temperature between 32°C and 34°C, were performed. During HT on ECG, we observed Osborn waves, which resolved spontaneously after re-warming. After five days of recovery, the patient scored 15 on GCS and did not show any neurological deficits. PMID:23348543

Szyma?ski, Filip M; Karpi?ski, Grzegorz; P?atek, Anna E; Opolski, Grzegorz

2013-01-01

83

Osborn waves during therapeutic hypothermia in a young ST-ACS patient after out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

A 37 year-old male patient was admitted to the intensive care unit after an out-of-hospital cardiac arrest due to ventricular fibrillation in a course of ST-segment elevation acute coronary syndrome. On admission, the patient was unconscious with a Glasgow Coma Scale (GCS) score of 5. A percutaneous coronary intervention and mild therapeutic hypothermia (HT), defined as maintaining body temperature between 32°C and 34°C, were performed. During HT on ECG, we observed Osborn waves, which resolved spontaneously after re-warming. After five days of recovery, the patient scored 15 on GCS and did not show any neurological deficits.

Szyma?ski FM; Karpi?ski G; P?atek AE; Opolski G

2013-01-01

84

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

Directory of Open Access Journals (Sweden)

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.

Trygve Eftestøl; Martin Risdal; Joar Eilevstjønn; Petter A. Steen

2005-01-01

85

Examining the Contextual Effects of Neighborhood on Out-of-Hospital Cardiac Arrest and the Provision of Bystander Cardiopulmonary Resuscitation  

Science.gov (United States)

Objective To understand the association between neighborhood and individual characteristics in determining whether or not bystanders perform cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest (OHCA). Methods Between October 1, 2005 to November 30, 2008, 1,108 OHCA cases from Fulton County (Atlanta), Georgia were eligible for bystander CPR. We conducted multi-level non-linear regression analysis and derived Empirical Bayes estimates for bystander CPR by census tract. Results 279 (25%) cardiac arrest victims received bystander CPR. Provision of bystander CPR was significantly more common in witnessed events (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21 to 2.22, p value <0.001) and those that occurred in public locations (OR 1.67; 95% CI 1.16 to 2.40, p value <0.001). Other individual-level characteristics were not significantly associated with bystander CPR. Cardiac arrests in the census tracts that rank in the highest income quintile, as compared to the lowest income quintile were much more likely (OR 4.98; 95% CI 1.65 to 15.04) to receive bystander CPR. Conclusion Cardiac arrest victims in the highest income census tracts were much more likely to receive bystander CPR than in the lowest income census tracts, even after controlling for individual and arrest characteristics. Low-income neighborhoods may be particularly appropriate targets for community-based CPR training and awareness efforts.

Sasson, Comilla; Keirns, Carla C.; Smith, Dylan; Sayre, Michael; Macy, Michelle; Meurer, William; McNally, Bryan F.; Kellermann, Arthur L.; Iwashyna, Theodore J.

2013-01-01

86

Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise. HYPOTHESIS: Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH). MATERIALS AND METHODS: Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC< or =2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC. RESULTS: 10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P<0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P<0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P=0.554]. CONCLUSIONS: Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.

Kajino K; Iwami T; Daya M; Nishiuchi T; Hayashi Y; Kitamura T; Irisawa T; Sakai T; Kuwagata Y; Hiraide A; Kishi M; Yamayoshi S

2010-05-01

87

Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Preventable bystander delays following out-of-hospital cardiac arrest (OHCA) are common, and include bystanders inappropriately directing their calls for help. METHODS: We retrospectively extracted Utstein-style data from the Victorian Ambulance Cardiac Arrest Registry (VACAR) for adult OHCA occurring in Victoria, Australia, between July 2002 and June 2012. Emergency medical service (EMS) witnessed events were excluded. Cases were assigned into two groups on the basis of the first bystander call for help being directed to EMS. Study outcomes were: likelihood of receiving EMS treatment; survival to hospital, and; survival to hospital discharge. RESULTS: A total of 44,499 adult OHCA cases attended by EMS were identified, of which first bystander calls for help were not directed to EMS in 2,842 (6.4%) cases. Calls to a relative, friend or neighbour accounted for almost 60% of the total emergency call delays. Patient characteristics and survival outcomes were consistently less favourable when calls were directed to others. First bystander call to others was independently associated with older age, male gender, arrest in private location, and arrest in a rural region. The risk-adjusted odds of treatment by EMS (OR 1.33, 95% CI 1.20-1.48), survival to hospital (OR 1.64, 95% CI 1.37-1.96) and survival to hospital discharge (OR 1.64, 95% CI 1.13-2.36) were significantly improved if bystanders called EMS first. CONCLUSION: The frequency of inappropriate bystander calls following OHCA was low, but associated with a reduced likelihood of treatment by EMS and poorer survival outcomes.

Nehme Z; Andrew E; Cameron P; Bray JE; Meredith IT; Bernard S; Smith K

2013-09-01

88

Utility of pre-cordial thump for treatment of out of hospital cardiac arrest: a prospective study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Prospective data on pre-cordial thump (PT), one of the fastest possible resuscitative manoeuvres, are scant, particularly in out-of-hospital (OOH) cardiac arrest (CA). METHODS: In this study, conducted in the Pordenone-province (north-east Italy), suspected OOH-CA victims were connected to a cardiac monitor and, upon confirmation of CA, subjected to a swift PT before any other resuscitatory intervention, without notable delay in other procedures. Investigation targets were: (i) effects on heart rhythm, (ii) return of spontaneous circulation (ROSC), (iii) hospital discharge, (iv) presence of adverse effects. Outcomes were additionally grouped by presenting rhythms into ventricular tachyarrhythmias (CA(VF/VT)), pulseless electrical activity (CA(PEA)), and asystole (CA(AS)). RESULTS: Out of 144 OOH-CA cases, PT had no effect on heart rhythm in 138 patients (CA(VF/VT)-23/24; CA(PEA)-41/42; CA(AS)-74/78). In 112 of the 138 non-responders, ROSC was neither achieved by other interventions (CA(VF/VT)-13/23; CA(PEA)-38/41; CA(AS)-61/74); overall survival was 5.6% (CA(VF/VT)-16.7%; CA(PEA)-0%; CA(AS)-5.1%). PT caused ROSC in 3 patients with witnessed CA(AS) (time-to-intervention <3 min), representing one quarter of ROSC among witnessed CA victims. Survival of PT-induced ROSC patients (2/3) was certainly no worse than among PT-irresponsive ROSC patients (6 of 28). Overall, one quarter of patients, discharged from hospital, had been resuscitated by PT. No adverse effects of PT were observed. CONCLUSIONS: PT can be combined with standard resuscitatory interventions without significant time-delay or apparent side effects. PT efficacy in CA(VF/VT) and CA(PEA) is lacking. However, PT may offer potential for the increasing proportion of asystolic OOH-CA, in particular when witnessed.

Pellis T; Kette F; Lovisa D; Franceschino E; Magagnin L; Mercante WP; Kohl P

2009-01-01

89

Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest : A Nationwide Case-Time-Control Study  

DEFF Research Database (Denmark)

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, whereas no association was found for serotonin-norepinephrine reuptake inhibitors/noradrenergic and specific serotonergic antidepressants (SNRIs/NaSSAs; OR = 1.06, CI: 0.81-1.39). The increased risks were primarily driven by: citalopram (OR = 1.29, CI: 1.02-1.63) and nortriptyline (OR = 5.14, CI: 2.17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs.

Weeke, P; Jensen, A

2012-01-01

90

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

Directory of Open Access Journals (Sweden)

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.

Hayashi,Hoei; Ujike,Yoshihito

2005-01-01

91

Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE—To test the effect of a physician staffed advanced cardiac life support (ALS) system on patient outcome following out-of-hospital cardiac arrest.?DESIGN—Observational study.?SETTING—Two tier basic life support (BLS) and physician staffed ALS services in the midsized urban/suburban area of ...

Bottiger, B; Grabner, C; Bauer, H; Bode, C; Weber, T; Motsch, J; Martin, E

92

Functional outcomes and quality of life of young adults who survive out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Evaluating the quality of life of young adult survivors of out-of-hospital cardiac arrest (OHCA) is important as they are likely to have a longer life expectancy than older patients. The aim of this study was to assess their functional and quality of life outcomes. METHODOLOGY: The Victorian Ambulance Cardiac Arrest Registry records were used to identify survivors of OHCA that occurred between 2003 and 2008 in the 18-39 year-old age group. Survivors were administered a telephone questionnaire using Short Form (SF-12), EQ-5D and Glasgow Outcome Scale-Extended. Cerebral Performance Category (CPC) ascertained at hospital discharge from the medical record was recorded for the uncontactable survivors. RESULTS: Of the 106 young adult survivors, five died in the intervening years and 45 were not contactable or refused. CPC scores were obtained for 37 (74%) of those who did not take part in telephone follow-up, and 7 (19%) of these had a CPC ? 3 indicating severe cerebral disability. The median follow-up time was 5 years (range 2.7- 8.6 years) for the 56 (53%) patients included. Of these, 84% were living at home independently, 68% had returned to work, and only 11% reported marked or severe disability. The majority of patients had no problems with mobility (75%), personal care (75%), usual activities (66%) or pain/discomfort (71%). However, 61% of respondents reported either moderate (48%) or severe (13%) anxiety. CONCLUSIONS: The majority of survivors have good functional and quality of life outcomes. Telephone follow-up is feasible in the young adult survivors of cardiac arrest; loss to follow-up is common.

Deasy C; Bray J; Smith K; Harriss L; Bernard S; Cameron P

2013-07-01

93

Temporal variation of out-of-hospital cardiac arrests in an equatorial climate  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Marcus EH Ong1, Faith SP Ng2, Susan Yap1, Kok Leong Yong1, Mary A Peberdy3, Joseph P Ornato41Department of Emergency Medicine, Singapore General Hospital, Singapore; 2Clinical Trials and Epidemiology Research Unit (now known as Singapore Clinical Research Institute), Singapore; 3Division of Cardiol...

Marcus EH Ong; Faith SP Ng; Susan Yap; et al

94

Contribution of out-of-hospital factors to a reduction in cardiac arrest mortality after witnessed ventricular fibrillation or tachycardia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Mortality rates in Osaka for cardiac arrest after witnessed ventricular tachycardia (VT) or ventricular fibrillation (VF) have decreased dramatically. We sought to estimate the contribution of changes in out-of-hospital care to this decrease. METHODS: We applied a previously validated statistical model, IMPACT, to data obtained from the Utstein Osaka Project, which registers all cardiopulmonary arrests in Osaka. The outcome was death within the first month after the arrest. Sensitivity analysis was conducted by simulating an increase in the use of public access defibrillators (PADs). RESULTS: From 1999 through 2008, age- and sex-adjusted standardized 1-month mortality fell from 88.6% to 57.1%. There were 105 fewer deaths than expected in 2008 (295 deaths). The IMPACT model explained 62.5% of the decrease (67 deaths) in the 1-month mortality. The main contributors to the decrease in mortality were an increase in the use of biphasic waveform defibrillators, and a shortened time to first shock. These were partly offset by an increase in the administration of epinephrine by emergency medical services personnel. According to the simulation, an increase in PAD use from 1.9% to 34.4% would reduce mortality from the observed 57.1% to 49.5%. CONCLUSIONS: Modeling suggests that improvement in out-of-hospital care accounted for approximately 60% of the decline in deaths following witnessed VT or VF arrests in Osaka between 1999 and 2008. Increased usage of PADs could further improve these outcomes.

Nakamura F; Hayashino Y; Nishiuchi T; Kakudate N; Takegami M; Yamamoto Y; Yamazaki S; Fukuhara S

2013-06-01

95

An Utstein-style examination of out-of-hospital cardiac arrest patients in Saga Prefecture, Japan.  

UK PubMed Central (United Kingdom)

INTRODUCTION: The Utstein-style guidelines have been used in various countries around the world, because they are suitable for evaluating regional emergency medical systems (EMSs) for patients who have an out-of-hospital cardiac arrest (OHCA). This report examined the present status of treating OHCA in Saga Prefecture and examined policies that can contribute to improving the rate of the return of spontaneous circulation (ROSC). METHODS: This study examined 800 cases of OHCA by means of the Utstein-style guidelines submitted for medical control verification by firefighting organizations in Saga Prefecture from July 1, 2010, to June 30, 2011. The firefighting organizations were divided into 5 areas (A-E) according to each medical classification. The 5 areas were compared in terms of the ROSC rate and background factors (patient age and sex, cardiac arrest cause, place, witnesses, initial electrocardiogram [ECG], hospital ECG, prehospital medical treatment, transfer time, oral instruction, and bystander cardiopulmonary resuscitation [CPR]). RESULTS: The ROSC rate was significantly lower in areas D (24.2%) and E (26.8%). Age, sex, cardiac arrest cause, place, witnesses, initial ECG, hospital ECG, shock, and adrenaline administration did not differ significantly among the 5 areas. The response time was significantly shorter in areas A (8: 25), D (8: 07), and E (8: 12). There were significantly fewer examples of oral CPR instruction in area E (42.1%), and there were fewer examples of CPR in areas A (44.0%), D (41.9%), and E (37.9%). CPR was performed by lay person in approximately 70% of the cases in which oral instructions were provided, but it was not performed in 90% of cases in which no oral instructions were provided. CONCLUSIONS: The Utstein-style guidelines were used to clarify differences in the ROSC rate in Saga Prefecture, thus making improvements in regional EMSs possible. Improvements in the quality of oral instruction and a reexamination of the oral instruction manual are expected to improve the ROSC rate, in parallel with education in basic life support for lay person and in advanced cardiac life support for medical personnel. In addition, it is important to reaffirm the effectiveness of CPR and encourage the participation of lay person by providing instructions by telephone from an ambulance that is en route to the scene.

Iwamura T; Sakamoto Y; Kutsukata N; Nakashima A; Yamashita T; Nishimura Y; Koami H; Imahase H; Yahata M; Goto A

2013-01-01

96

Are the public ready for organ donation after out of hospital cardiac arrest?  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess Emergency Department (ED) relatives' and patients' opinions on: (1) discussing organ donation (OD) with relatives soon after ED death after cardiac arrest and (2) acceptability of organ preservation procedures both before and after discussion with relatives. METHODS: Questionnaire study; convenience sample. RESULTS: 200 questionnaires were completed. 37.5% of participants were male subjects; mean age was 40.4 (SD 16.9; range 15-85) years. There was no difference in the number willing to discuss OD after brainstem death in intensive care unit compared with circulatory death in the ED (72% vs 72%; p=0.146). The majority were willing to discuss OD soon after ED death after cardiac arrest (106; 54%). 41 (21%) were not willing and 43 (22%) had no strong views (n=198). Organ preservation procedures (groin tube insertion, continuation of mechanical cardiopulmonary resuscitation and continuation of ventilator) were acceptable to between 48% and 57% of respondents if performed before discussion with family increasing to an acceptability of between 64% and 69% after discussion with family. One in four respondents felt these procedures were not acceptable regardless of the timing of discussion with family and some felt these procedures were more acceptable if the patient was a registered organ donor. 122 (61%) patients wished to donate their organs after death but only 59 (30%) were registered donors. CONCLUSIONS: (1) The majority of patients and their relatives are not averse to OD being discussed shortly after ED death. (2) Organ preservation procedures are acceptable to many. Prior discussion and prior organ donor registration may improve acceptability.

Bruce CM; Reed MJ; MacDougall M

2013-03-01

97

Effect of Crew Size on Objective Measures of Resuscitation for Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

Background There is no consensus among emergency medical services (EMS) systems as to the optimal numbers and training of EMS providers who respond to the scene of prehospital cardiac arrests. Increased numbers of providers may improve the performance of cardiopulmonary resuscitation (CPR), but this has not been studied as part of a comprehensive resuscitation scenario. Objective To compare different all-paramedic crew size configurations on objective measures of patient resuscitation using a high-fidelity human simulator. Methods We compared two-, three-, and four- person all-paramedic crew configurations in the effectiveness and timeliness of performing basic life support (BLS) and advanced life support (ALS) skills during the first 8 minutes of a simulated cardiac arrest scenario. Crews were compared to determine differences in no-flow fraction (NFF) as a measure of effectiveness of CPR and time to defibrillation, endotracheal intubation, establishment of intravenous access, and medication administration. Results There was no significant difference in mean NFF among the two-, three-, and four-provider crew configurations (0.32, 0.26, and 0.27, respectively; p = 0.105). More three- and four-person groups completed ALS procedures during the scenario, but there was no significant difference in time to performance of BLS or ALS procedures among the crew size configurations for completed procedures. There was a trend toward lower time to intubation with increasing group size, though this was not significant using a Bonferroni-corrected p-value of 0.01 (379, 316, and 263 seconds, respectively; p = 0.018). Conclusion This study found no significant difference in effectiveness of CPR or in time to performance of BLS or ALS procedures among crew size configurations, though there was a trend toward decreased time to intubation with increased crew size. Effectiveness of CPR may be hindered by distractions related to the performance of ALS procedures with increasing group size, particularly with an all-paramedic provider model. We suggest a renewed emphasis on the provision of effective CPR by designated providers independent of any ALS interventions being performed.

Martin-Gill, Christian; Guyette, Francis X.; Rittenberger, Jon C.

2010-01-01

98

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

DEFF Research Database (Denmark)

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 defibrillering før ambulance ankomst. Sådanne strategier betegnes ’defibrillering med offentlig adgang’ (public access defibrillation (PAD)). Megen forskning har fokuseret på placering af og overlevelse med brug af AED i udvalgte områder, hvorimod der er meget begrænset viden om hvor udbredt AED’er bør være i det offentlige rum. Tilsvarende er der begrænset viden om hvor AED’er strategisk bør opsættes uden for hospital, når forekomst af hjertestop i området er ukendt. I denne afhandling fokuseres på analyser af hjertestop i boligområder og offentligt rum og har følgende formål: 1) At undersøge hvordan forskellige AED placeringsstrategier påvirker PAD i boligområder og det offentligt rum; 2) at estimere risikoen for hjertestop afhængig af et områdes geografiske- og demografiske karakteristika, hvilket kan tjene som rettesnor for hvor AED bør placeres strategisk udenfor hospital; 3) at undersøge om der er forskelle i patientkarakteristika afhængigt af hvor hjertestoppet forekommer (boligområde versus offentligt rum); 4) at estimere omkostnings-effektiviteten for PAD programmer i boligområder og det offentligt rum afhængigt af valgte AED placeringsstrategi. METODE OG RESULTATER I perioden 1994-2005 blev alle personer med hjertestop udenfor hospital registreret af Akutlægebilen i København. Det Europæiske Kvadratnet, et defineret og harmoniseret kvadratnet for hele Europa med standardiseret størrelse og lokalisering af alle kvadratnetceller, blev benyttet til optælling af hjertestop forekommet i hver enkelt 100x100-meter celle i København. Antallet af hjertestop i hver enkelt celle blev analyseret i forhold til cellens underliggende geografiske og demografiske karakteristika. I alt blev 4828 hjertestop inkluderet i studieperioden; 3554 (74%) forekom i boligområder og 1274 (26%) i offentligt rum. Hvis anbefalingerne for AED placering fra det Europæiske Råd for Genoplivning fulgtes (1 hjertestop hvert 2. år), ville dette kræve AED opsætning svarende til 1% af det samlede areal for København og medføre dækning af 20% af alle hjertestop i offentligt rum. En større dækningsgrad kunne opnås ved at følge anbefalingerne fra den Amerikanske Hjerteforening (1 hjertestop hvert 5. år). Dette ville kræve AED opsætning svarende til 10% af Københavns areal og medføre dækning af næsten 70% af samtlige hjertestop i offentligt rum. Endvidere påvistes en paradoksal AED placering i offentligt rum, hvor hovedparten af opsatte AED’er skete i områder med lav hjertestop forekomst. Baseret på simple, demografiske karakteristika for beboede områder (befolkningstæthed, gennemsnitsalder, gennemsnitlig indkomst og andelen med kort uddannelse) var det muligt at identificere områder med høj forekomst af hjertestop. Disse områder udgjorde mindre end 3% af alle boligområder men inkluderede op mod 9% af alle hjertestop i boligområder. Personer med hjertestop i boligområder havde imidlertid øget forekomst af karakteristika forbundet med dårlig prognose, herunder højere alder, mandligt køn, oftere hjertestop om natten, længere responstid for ambulance og mindre sandsynlighed for at have stødbar hjerterytme sammenlignet med hjertestop i offentligt rum. KONKLUSION Denne afhandling viser, at en stor andel af hjertestop i offentligt rum kan dækkes ved strategisk opsætning af AED’er indenfor et begrænset geografisk område. Såfremt AED opsætning styres af tilfældige lokale eller politiske initiativer, fandtes en stor risiko for paradoksal AED placering, hvor opsætning primært forekom i områder med lav hjertestop forekomst. Ved at benytte simple, demografiske karakteristika for beboede områder i København, var det muligt at identificere boligområder med høj forekomst af hjertestop. Hj

Folke, Fredrik

2010-01-01

99

Determining risk for out-of-hospital cardiac arrest by location type in a Canadian urban setting to guide future public access defibrillator placement.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: Automated external defibrillator use by lay bystanders during out-of-hospital cardiac arrest rarely occurs but can improve survival. We seek to estimate risk for out-of-hospital cardiac arrest by location type and evaluate current automated external defibrillator deployment in a Canadian urban setting to guide future automated external defibrillator deployment. METHODS: This was a retrospective analysis of a population-based out-of-hospital cardiac arrest database. We included consecutive public location, nontraumatic, out-of-hospital cardiac arrests occurring in Toronto from January 1, 2006, to June 30, 2010, captured in the Resuscitation Outcomes Consortium Epistry database. Two investigators independently categorized each out-of-hospital cardiac arrest and automated external defibrillator location into one of 38 categories. Total site counts in each location category were used to estimate average annual per-site cardiac arrest incidence and determine the relative automated external defibrillator coverage for each location type. RESULTS: There were 608 eligible out-of-hospital cardiac arrest cases. The top 5 location categories by average annual out-of-hospital cardiac arrests per site were race track/casino (0.67; 95% confidence interval [CI] 0 to 1.63), jail (0.62; 95% CI 0.3 to 1.06), hotel/motel (0.15; 95% CI 0.12 to 0.18), hostel/shelter (0.14; 95% CI 0.067 to 0.19), and convention center (0.11; 95% CI 0 to 0.43). Although schools were relatively lower risk for cardiac arrest, they represented 72.5% of automated external defibrillator-covered locations in the study region. Some higher-risk location types such as hotel/motel, hostel/shelter, and rail station were severely underrepresented with respect to automated external defibrillator coverage. CONCLUSION: We have identified types of locations with higher per-site risk for cardiac arrest relative to others. We have also identified potential mismatches between cardiac arrest risk by location type and registered automated external defibrillator distribution in a Canadian urban setting.

Brooks SC; Hsu JH; Tang SK; Jeyakumar R; Chan TC

2013-05-01

100

Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander.  

UK PubMed Central (United Kingdom)

UNLABELLED: BACKGROUND: A growing elderly population along with advances in equipment and approaches for pre-hospital resuscitation necessitates up-to-date information when developing policies to improve elderly out-of-hospital cardiac arrest (OHCA) outcomes. We examined the effects of bystander type (family or non-family) intervention on 1-month outcomes of witnessed elderly OHCA patients. METHODS: Data from a total of 85,588 witnessed OHCA events in patients aged ?65 years, which occurred from 2005 to 2008, were obtained from a nationwide population-based database. Patients were stratified into three age categories (65-74, 75-84, ?85 years), and the effects of bystander type (family or non-family) on initial cardiac rhythm, rate of bystander cardiopulmonary resuscitation (CPR), and 1-month outcomes were assessed. RESULTS: The overall survival rate was 6.9% (65-74 years: 9.8%, 75-84 years: 6.9%, ?85 years: 4.6%). Initial VF/VT was recorded in 11.1% of cases with a family bystander and 12.9% of cases with a non-family bystander. The rate of bystander CPR was constant across the age categories in patients with a family bystander and increased with advancing age categories in patients with a non-family bystander. Patients having a non-family bystander were associated with significantly higher 1-month rates of survival (OR: 1.26; 95% CI: 1.19-1.33) and favorable neurological status (OR: 1.47; 95% CI: 1.34-1.60). CONCLUSIONS: Elderly patient OHCA events witnessed by a family bystander were associated with worse 1-month outcomes than those witnessed by a non-family bystander. Healthcare providers should consider targeting potential family bystanders for CPR education to increase the rate and quality of bystander CPR.

Akahane M; Tanabe S; Koike S; Ogawa T; Horiguchi H; Yasunaga H; Imamura T

2012-01-01

 
 
 
 
101

Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Antiarrhythmic drugs like lidocaine are usually given to promote return of spontaneous circulation (ROSC) during ongoing out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation/tachycardia (VF/VT). Whether administering such drugs prophylactically for post-resuscitation care after ROSC prevents re-arrest and improves outcome is unstudied. METHODS: We evaluated a cohort of 1721 patients with witnessed VF/VT OHCA who did (1296) or did not receive prophylactic lidocaine (425) at first ROSC. Study endpoints included re-arrest, hospital admission and survival. RESULTS: Prophylacic lidocaine recipients and non-recipients were comparable, except for shorter time to first ROSC and higher systolic blood pressure at ROSC in those receiving lidocaine. After initial ROSC, arrest from VF/VT recurred in 16.7% and from non-shockable arrhythmias in 3.2% of prophylactic lidocaine recipients, 93.5% of whom were admitted to hospital and 62.4% discharged alive, as compared with 37.4%, 7.8%, 84.9% and 44.5%, of corresponding non-recipients (all p<0.0001). Adjusted for pertinent covariates, prophylactic lidocaine was independently associated with reduced odds of re-arrest from VF/VT, odds ratio, (95% confidence interval) 0.34 (0.26-0.44) and from nonshockable arrhythmias (0.47 (0.29-0.78)); a higher hospital admission rate (1.88, (1.28-2.76)) and improved survival to discharge (1.49 (1.15-1.95)). However in a propensity score-matched sensitivity analysis, lidocaine's only beneficial association with outcome was in a lower incidence of recurrent VF/VT arrest. CONCLUSIONS: Administration of prophylactic lidocaine upon ROSC after OHCA was consistently associated with less recurrent VF/VT arrest, and therapeutic equipoise for other measures. The prospect of a promising association between lidocaine prophylaxis and outcome, without evidence of harm, warrants further investigation.

Kudenchuk PJ; Newell C; White L; Fahrenbruch C; Rea T; Eisenberg M

2013-06-01

102

Paediatric out-of-hospital cardiac arrests in Melbourne, Australia: improved reporting by adding coronial data to a cardiac arrest registry.  

UK PubMed Central (United Kingdom)

AIM: We describe improved reporting of paediatric out-of-hospital cardiac arrest (OHCA) by adding coronial findings to a cardiac arrest registry. METHODS: Non-traumatic OHCA occurring in paediatric patients aged less than 16 years were identified using the Victorian Ambulance Cardiac Arrest Registry and available coronial findings reviewed. RESULTS: Between the years 2001 and 2009, emergency medical services (EMS) attended 26 974 non-traumatic OHCA of which 390 (1.4%) occurred in children less than 16 years of age. We successfully linked 301 patients with the coronial registry; excluding patients discharged alive from hospital (n=22) and patients with terminal illness (n=16), this represents 86% of OHCA attended by the ambulance. Agreement between the paramedic cause of OHCA and the coronial cause of death was 66.5% (? 0.16) for presumed cardiac, 74.4% (? 0.43) for sudden infant death syndrome (SIDS), 81.1% (? 0.17) for respiratory, 92.7% (? 0.18) for neurological and 98.3% (? 0.27) for drug overdose precipitants to OHCA. Undiagnosed congenital heart disease was a rare cause of OHCA (n=3, 1%). Intentional injury was found on autopsy in 13 cases; six cases were clinically thought to be SIDS and two cases presumed cardiac. Co-sleeping was found in 35 cases (39%) of SIDS. CONCLUSIONS: This study highlights the limitations associated with ascribing the cause of OHCA on the basis of clinical details. Improved reporting is possible by linkage with coronial data. Such robust data inform EMS service providers but also the wider healthcare system where preventive, diagnostic and treatment strategies can be maximised.

Deasy C; Hall D; Bray JE; Smith K; Bernard SA; Cameron P

2013-09-01

103

Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: Assisted ventilation may adversely affect out-of-hospital cardiac arrest outcomes. Passive ventilation offers an alternate method of oxygen delivery for these patients. We compare the adjusted neurologically intact survival of out-of-hospital cardiac arrest patients receiving initial passive ventilation with those receiving initial bag-valve-mask ventilation. METHODS: The authors performed a retrospective analysis of statewide out-of-hospital cardiac arrests between January 1, 2005, and September 28, 2008. The analysis included consecutive adult out-of-hospital cardiac arrest patients receiving resuscitation with minimally interrupted cardiopulmonary resuscitation (CPR) consisting of uninterrupted preshock and postshock chest compressions, initial noninvasive airway maneuvers, and early epinephrine. Paramedics selected the method of initial noninvasive ventilation, consisting of either passive ventilation (oropharyngeal airway insertion and high-flow oxygen by nonrebreather facemask, without assisted ventilation) or bag-valve-mask ventilation (by paramedics at 8 breaths/min). The authors determined adjusted neurologically intact survival from hospital and public records and by telephone interview and mail questionnaire. The authors compared adjusted neurologically intact survival between ventilation techniques by using generalized estimating equations. RESULTS: Among the 1,019 adult out-of-hospital cardiac arrest patients in the analysis, 459 received passive ventilation and 560 received bag-valve-mask ventilation. Adjusted neurologically intact survival after witnessed ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest was higher for passive ventilation (39/102; 38.2%) than bag-valve-mask ventilation (31/120; 25.8%) (adjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.3 to 4.6). Survival between passive ventilation and bag-valve-mask ventilation was similar after unwitnessed ventricular fibrillation/ventricular tachycardia (7.3% versus 13.8%; adjusted OR 0.5; 95% CI 0.2 to 1.6) and nonshockable rhythms (1.3% versus 3.7%; adjusted OR 0.3; 95% CI 0.1 to 1.0). CONCLUSION: Among adult, witnessed, ventricular fibrillation/ventricular tachycardia, out-of-hospital cardiac arrest resuscitated with minimally interrupted cardiac resuscitation, adjusted neurologically intact survival to hospital discharge was higher for individuals receiving initial passive ventilation than those receiving initial bag-valve-mask ventilation.

Bobrow BJ; Ewy GA; Clark L; Chikani V; Berg RA; Sanders AB; Vadeboncoeur TF; Hilwig RW; Kern KB

2009-11-01

104

Impact of delayed and infrequent administration of vasopressors on return of spontaneous circulation during out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Epinephrine and vasopressin are the only vasopressors associated with return of spontaneous circulation (ROSC). While current guidelines recommend rapid and frequent vasopressor administration during cardiac arrest, delays in their administration in the out-of- hospital setting remain a concern. OBJECTIVE: This study evaluated delays in vasopressor administration and their effect on field ROSC. METHODS: This retrospective review included all adult patients who experienced cardiac arrest of medical origin and received field resuscitative efforts among 10 emergency medical services (EMS) systems. Data were abstracted from the EMS medical record and included response time intervals, calculated first-dose and interdosing intervals of vasopressors, and ROSC. Data were analyzed using Mann-Whitney tests, chi-square tests, and t-tests, survival analysis, and logistic regression, with p ? 0.05 indicating significance. RESULTS: A total of 660 cardiac arrest patients were enrolled in the study. The mean EMS response time was 8.8 minutes; 52.7% of patients had witnessed cardiac arrests, 46.2% received bystander cardiopulmonary resuscitation (CPR), 23.0% had shockable initial rhythms, and 19.5% experienced field ROSC. In total, 1,913 doses of epinephrine and 111 doses of vasopressin were administered, with mean and 90th-percentile scene arrival-to-first drug intervals of 9.5 and 17 minutes, respectively. The mean and 90th-percentile interdosing intervals were 6.1 and 10 minutes, respectively. Patients experiencing ROSC had shorter scene arrival-to-first drug intervals than those without ROSC (8.1 vs. 9.8 min, p < 0.01), but there was no difference in the mean interdosing interval (6.8 vs. 6.0 min, p = 0.57). In the logistic regression analysis of ROSC, the adjusted odds ratio for call receipt-to-first drug interval ?10 minutes was 1.91 (p = 0.04). Patients receiving advanced airway control prior to vasopressor administration were less likely to have a call receipt-to-first drug interval within 10 minutes (4.0% vs. 17.3%, p < 0.01) and were less likely to attain ROSC (15.7% vs. 25.4%, p < 0.01). CONCLUSION: The interval between scene arrival and first administration of vasopressors is significantly shorter among patients who experience ROSC compared with those who do not. Airway control procedures delay vasopressor administration and reduce the likelihood of ROSC. Although the interdosing intervals of most patients were not consistent with current recommendations, there was no difference in the mean interdosing times between those who achieved ROSC and those who did not.

Cantrell CL Jr; Hubble MW; Richards ME

2013-01-01

105

Incidence of Re-arrest after Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

BACKGROUND Return of spontaneous circulation (ROSC) occurs in approximately 30% of EMS-treated out-of-hospital cardiac arrests (OHCA), however not all patients achieving ROSC survive to hospital arrival or discharge. The incidence of re-arrest (RA) before reaching the hospital is unknown, and the ECG waveform characteristics of prehospital RA rhythms have not been previously described. OBJECTIVES We sought to determine the incidence of RA in OHCA, to classify RA events by type, and to measure the time from ROSC to RA. We also conducted a preliminary analysis of the relationship between first EMS-detected rhythms and RA, as well as the effect of RA on survival. METHODS The Pittsburgh Regional Clinical Center of the NHLBI-sponsored Resuscitation Outcomes Consortium (ROC) provided cases from a population-based cardiac arrest surveillance program, ROC Epistry. Only OHCA cases of non-traumatic etiology with available and adequate ECG files were included. We analyzed defibrillator-monitor ECG tracings (Philips MRX), patient care reports (PCR) and defibrillator audio recordings from EMS-treated cases of OHCA spanning the period 2006 – 2008. We identified ROSC and RA through interpretation of ECG traces and audio recordings. RA events were categorized as ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), asystole, and pulseless electrical activity (PEA) based on ECG waveform characteristics. Proportions of RA rhythms were stratified by first EMS rhythm and compared using Pearson’s Chi Square test. Logistic regression was used to test the predictive relationship between RA and survival to hospital discharge. RESULTS ROSC occurred in 329/1199 patients (27.4% {95% CI: 25.0–30.0}) treated for CA. Of these, 113 had ECG tracings that were available and adequate for analysis. RA occurred in 41 patients (36.0%, {95% CI: 26–46%}), with a total of 69 RA events. Survival to hospital discharge in RA cases was 23.1% (11.1–39.3) compared to 27.8% (17.9–39.6) in cases without RA. RA event counts by type were: 17 VF (24.6%, {95% CI: 15.2–36.5%}), 20 pulseless VT (29.0%, {95% CI: 18.7–41.2%}), 26 PEA (37%, {95% CI: 26.3–50.2%}), and 6 asystole (8.8%, {95% CI: 3.3–18.0%}). RA was not predictive of survival to hospital discharge, however initial EMS rhythm was predictive of RA shockability. The overall median time from ROSC to RA among all events was 3.1 (1.6–6.3) minutes. CONCLUSION In this sample, the incidence of RA was 38%. Of cases experiencing RA 54% survived to hospital arrival. A time window on the order of minutes may be available for intervention prior to RA.

Salcido, David D.; Stephenson, Amanda M.; Condle, Joseph P.; Callaway, Clifton W.; Menegazzi, James J.

2011-01-01

106

A Review of Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest and Strategies for the Future.  

UK PubMed Central (United Kingdom)

BACKGROUND: It has been known for many years that interrupting chest compressions during cardiopulmonary resuscitation (CPR) from out-of-hospital cardiac arrest (OHCA) leads directly to negative outcomes. Interruptions in chest compressions occur for a variety of reasons, including provider fatigue and switching of compressors, performance of ventilations, placement of invasive airways, application of CPR devices, pulse and rhythm determinations, vascular access placement, and patient transfer to the ambulance. Despite significant resuscitation guideline changes in the last decade, several studies have shown that chest compressions are still frequently interrupted or poorly executed during OHCA resuscitations. Indeed, the American Heart Association has made great strides to improve outcomes by placing a greater emphasis on uninterrupted chest compressions. As highly trained health care providers, why do we still interrupt chest compressions? And are any of these interruptions truly necessary? OBJECTIVES: This article aims to review the clinical effects of both high-quality chest compressions and the effects that interruptions during chest compressions have clinically on patient outcomes. DISCUSSION: The causes of chest compression interruptions are explored from both provider and team perspectives. Current and future methods are introduced that may prompt the provider to reduce unnecessary interruptions during chest compressions. CONCLUSIONS: New and future technologies may provide promising results, but the greatest benefit will always be a well-directed, organized, and proactive team of providers performing excellent-quality and continuous chest compressions during CPR.

Souchtchenko SS; Benner JP; Allen JL; Brady WJ

2013-09-01

107

Increase in out-of-hospital cardiac arrest attended by the medical mobile intensive care units, but not myocardial infarction, during the 2003 heat wave in Paris, France.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To address the association between the 2003 heat wave in Paris (France) and the occurrence of out-of-hospital cardiac arrest. DESIGN: : An analysis of the interventions of the medical mobile intensive care units of the City of Paris for out-of-hospital cardiac arrest and prehospital myocardial infarctions, which were routinely and prospectively computerized from January 1, 2000, to December 31, 2005. SETTING: City of Paris, France. PATIENTS: Participants were consecutive victims of witnessed out-of-hospital cardiac arrest due to heart disease and of ST-segment elevation myocardial infarction (STEMI) aged >or=18 yrs, who were attended by the medical mobile intensive care units (MICUs) of the City of Paris from January 1, 2000, to December 31, 2005. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The numbers of out-of-hospital cardiac arrests and of STEMIs during the 2003 heat wave period (August 1 to August 14) were compared (Poisson regression analysis) with the respective average numbers during the same period in reference years 2000-2002 and 2004-2005 when there was no heat wave. Mean ages of the 3049 patients experiencing out-of-hospital cardiac arrest and the 2767 patients experiencing STEMI attended by the MICUs during the study period were 64.3 +/- 18.0 and 65.2 +/- 15.4, respectively, and two thirds were males. During the heat wave period, the number of out-of-hospital cardiac arrests (n = 40) increased 2.5-fold compared with the reference periods (n = 81 for 5 yrs; p < .001); this corresponded to an estimated relative rates of out-of-hospital cardiac arrests of 2.34 (95% confidence interval, 1.60-3.41), after adjustment for age and for gender. This increase was observed in both genders (p for interaction with gender = .48) but only in those who were aged >or=60 yrs (p for interaction with age = .005). No variation was found for myocardial infarctions during heat wave. CONCLUSIONS: These data suggest that a heat wave may be associated with an increased risk of sudden cardiac death in the population.

Empana JP; Sauval P; Ducimetiere P; Tafflet M; Carli P; Jouven X

2009-12-01

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The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: We assess whether an initiative to optimize out-of-hospital provider cardiopulmonary resuscitation (CPR) quality is associated with improved CPR quality and increased survival from out-of-hospital cardiac arrest. METHODS: This was a before-after study of consecutive adult out-of-hospital cardiac arrest. Data were obtained from out-of-hospital forms and defibrillators. Phase 1 included 18 months with real-time audiovisual feedback disabled (October 2008 to March 2010). Phase 2 included 16 months (May 2010 to September 2011) after scenario-based training of 373 professional rescuers and real-time audiovisual feedback enabled. The effect of interventions on survival to hospital discharge was assessed with multivariable logistic regression. Multiple imputation of missing data was used to analyze the effect of interventions on CPR quality. RESULTS: Analysis included 484 out-of-hospital cardiac arrest patients (phase 1 232; phase 2 252). Median age was 68 years (interquartile range 56-79); 66.5% were men. CPR quality measures improved significantly from phase 1 to phase 2: Mean chest compression rate decreased from 128 to 106 chest compressions per minute (difference -23 chest compressions; 95% confidence interval [CI] -26 to -19 chest compressions); mean chest compression depth increased from 1.78 to 2.15 inches (difference 0.38 inches; 95% CI 0.28 to 0.47 inches); median chest compression fraction increased from 66.2% to 83.7% (difference 17.6%; 95% CI 15.0% to 20.1%); median preshock pause decreased from 26.9 to 15.5 seconds (difference -11.4 seconds; 95% CI -15.7 to -7.2 seconds), and mean ventilation rate decreased from 11.7 to 9.5/minute (difference -2.2/minute; 95% CI -3.9 to -0.5/minute). All-rhythms survival increased from phase 1 to phase 2 (20/231, 8.7% versus 35/252, 13.9%; difference 5.2%; 95% CI -0.4% to 10.8%), with an adjusted odds ratio of 2.72 (95% CI 1.15 to 6.41), controlling for initial rhythm, witnessed arrest, age, minimally interrupted cardiac resuscitation protocol compliance, and provision of therapeutic hypothermia. Witnessed arrests/shockable rhythms survival was 26.3% (15/57) for phase 1 and 55.6% (20/36) for phase 2 (difference 29.2%; 95% CI 9.4% to 49.1%). CONCLUSION: Implementation of resuscitation training combined with real-time audiovisual feedback was independently associated with improved CPR quality, an increase in survival, and favorable functional outcomes after out-of-hospital cardiac arrest.

Bobrow BJ; Vadeboncoeur TF; Stolz U; Silver AE; Tobin JM; Crawford SA; Mason TK; Schirmer J; Smith GA; Spaite DW

2013-07-01

109

Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest-A systematic review and meta-analysis  

DEFF Research Database (Denmark)

INTRODUCTION: Out-of-hospital cardiac arrest has a poor prognosis. The main aetiology is ischaemic heart disease. AIM: To make a systematic review addressing the question: "In patients with return of spontaneous circulation following out-of-hospital cardiac arrest, does acute coronary angiography with coronary intervention improve survival compared to conventional treatment?" METHODS: Peer reviewed articles written in English with relevant prognostic data were included. Comparison studies on patients with and without acute coronary angiography were pooled in a meta-analysis. RESULTS: Thirty-two non-randomised studies were included of which 22 were case-series without patients with conservative treatment. Seven studies with specific efforts to control confounding had statistical evidence to support the use of acute coronary angiography following resuscitation from out-of-hospital cardiac arrest. The remaining 25 studies were considered neutral. Following acute coronary angiography, the survival to hospital discharge, 30 days or six months ranged from 23% to 86%. In patients without an obvious non-cardiac aetiology, the prevalence of significant coronary artery disease ranged from 59% to 71%. Electrocardiographic findings were unreliable for identifying angiographic findings of acute coronary syndrome. Ten comparison studies demonstrated a pooled unadjusted odds ratio for survival of 2.78 (1.89; 4.10) favouring acute coronary angiography. CONCLUSION: No randomised studies exist on acute coronary angiography following out-of-hospital cardiac arrest. An increasing number of observational studies support feasibility and a possible survival benefit of an early invasive approach. In patients without an obvious non-cardiac aetiology, acute coronary angiography should be strongly considered irrespective of electrocardiographic findings due to a high prevalence of coronary artery disease.

Moesgaard, Jacob; Ravkilde, Jan

2012-01-01

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Variation in Out-of-Hospital Cardiac Arrest Resuscitation and Transport Practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest  

Science.gov (United States)

Objectives To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry–Cardiac Arrest. Methods OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. Setting: Eight US and Canadian sites participating in the ROC Epistry–Cardiac Arrest. Population: Persons ? 20 years with OOHCA who a) received compressions or shock by EMS providers and/or received bystander AED shock or b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007. Results 23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58%, site range: 36-69%, p<0.0001). Of treated cases, 59% were transported (site range: 49-88%, p<0.0001). Transport was initiated in the absence of documented ROSC for 58% of transported cases (site range: 14-95%, p<0.0001). Of these transported cases, 8% achieved ROSC before hospital arrival (site range: 5-21%, p<0.0001) and 4% survived to hospital discharge (site range: 1-21%, p<0.0001). In cases with transport from the scene initiated after documented ROSC, 28% survived to hospital discharge (site range: 18-44%, p<0.0001). Conclusion Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.

Zive, Dana; Koprowicz, Kent; Schmidt, Terri; Stiell, Ian; Sears, Gena; Van Ottingham, Lois; Idris, Ahamed; Stephens, Shannon; Daya, Mohamud

2011-01-01

111

Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest. METHODS: OOHCA patient, event, and scene characteristics were compared to identify variation in treatment and transport practices across sites. Findings were adjusted for site and standard Utstein covariates. Using logistic regression, these covariates were modeled to identify factors related to the initiation of transport without documented prehospital ROSC as well as survival in these patients. SETTING: Eight US and Canadian sites participating in the ROC Epistry-Cardiac Arrest. POPULATION: Persons ? 20 years with OOHCA who (a) received compressions or shock by EMS providers and/or received bystander AED shock or (b) were pulseless but received no EMS compressions or shock between December 2005 and May 2007. RESULTS: 23,233 OOHCA cases were assessed by EMS in the defined period. Resuscitation (treatment) was initiated by EMS in 13,518 cases (58%, site range: 36-69%, p < 0.0001). Of treated cases, 59% were transported (site range: 49-88%, p < 0.0001). Transport was initiated in the absence of documented ROSC for 58% of transported cases (site range: 14-95%, p < 0.0001). Of these transported cases, 8% achieved ROSC before hospital arrival (site range: 5-21%, p < 0.0001) and 4% survived to hospital discharge (site range: 1-21%, p < 0.0001). In cases with transport from the scene initiated after documented ROSC, 28% survived to hospital discharge (site range: 18-44%, p < 0.0001). CONCLUSION: Initiation of resuscitation and transport of OOHCA and the reporting of ROSC prior to transport markedly varies among ROC sites. This variation may help clarify reported differences in survival rates among sites and provide a target for identifying EMS practices most likely to enhance survival from OOHCA.

Zive D; Koprowicz K; Schmidt T; Stiell I; Sears G; Van Ottingham L; Idris A; Stephens S; Daya M

2011-03-01

112

A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2.  

UK PubMed Central (United Kingdom)

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is the most common, immediately life-threatening, medical emergency faced by ambulance crews. Survival from OHCA is largely dependent on quality of prehospital resuscitation. Non-technical skills, including resuscitation team leadership, communication and clinical decision-making are important in providing high quality prehospital resuscitation. We describe a pilot study (TOPCAT2, TC2) to establish a second tier, expert paramedic response to OHCA in Edinburgh, Scotland. METHODS: Eight paramedics were selected to undergo advanced training in resuscitation and non-technical skills. Simulation and video feedback was used during training. The designated TC2 paramedic manned a regular ambulance service response car and attended emergency calls in the usual manner. Emergency medical dispatch centre dispatchers were instructed to call the TC2 paramedic directly on receipt of a possible OHCA call. Call and dispatch timings, quality of cardiopulmonary resuscitation and return-of-spontaneous circulation were all measured prospectively. RESULTS: Establishing a specialist, second-tier paramedic response was feasible. There was no overall impact on ambulance response times. From the first 40 activations, the TC2 paramedic was activated in a median of 3.2 min (IQR 1.6-5.8) and on-scene in a median of 10.8 min (8.0-17.9). Bimonthly team debrief, case review and training sessions were successfully established. OHCA attended by TC2 showed an additional trend towards improved outcome with a rate of return of spontaneous circulation of 22.5%, compared with a national average of 16%. CONCLUSIONS: Establishing a specialist, second-tier response to OHCA is feasible, without impacting on overall ambulance response times. Improving non-technical skills, including prehospital resuscitation team leadership, has the potential to save lives and further research on the impact of the TOPCAT2 pilot programme is warranted.

Clarke S; Lyon RM; Short S; Crookston C; Clegg GR

2013-01-01

113

A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2.  

Science.gov (United States)

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is the most common, immediately life-threatening, medical emergency faced by ambulance crews. Survival from OHCA is largely dependent on quality of prehospital resuscitation. Non-technical skills, including resuscitation team leadership, communication and clinical decision-making are important in providing high quality prehospital resuscitation. We describe a pilot study (TOPCAT2, TC2) to establish a second tier, expert paramedic response to OHCA in Edinburgh, Scotland. METHODS: Eight paramedics were selected to undergo advanced training in resuscitation and non-technical skills. Simulation and video feedback was used during training. The designated TC2 paramedic manned a regular ambulance service response car and attended emergency calls in the usual manner. Emergency medical dispatch centre dispatchers were instructed to call the TC2 paramedic directly on receipt of a possible OHCA call. Call and dispatch timings, quality of cardiopulmonary resuscitation and return-of-spontaneous circulation were all measured prospectively. RESULTS: Establishing a specialist, second-tier paramedic response was feasible. There was no overall impact on ambulance response times. From the first 40 activations, the TC2 paramedic was activated in a median of 3.2 min (IQR 1.6-5.8) and on-scene in a median of 10.8 min (8.0-17.9). Bimonthly team debrief, case review and training sessions were successfully established. OHCA attended by TC2 showed an additional trend towards improved outcome with a rate of return of spontaneous circulation of 22.5%, compared with a national average of 16%. CONCLUSIONS: Establishing a specialist, second-tier response to OHCA is feasible, without impacting on overall ambulance response times. Improving non-technical skills, including prehospital resuscitation team leadership, has the potential to save lives and further research on the impact of the TOPCAT2 pilot programme is warranted. PMID:23364903

Clarke, Scott; Lyon, Richard M; Short, Steven; Crookston, Colin; Clegg, Gareth R

2013-01-30

114

The fast emergency vehicle pre-emption system improved the outcomes of out-of-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

PURPOSES: Ambulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST™) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST™ implementation reduced response times and improved OHCA outcomes. METHODS: Data was prospectively collected from 1161 OHCAs that were not witnessed by emergency medical technicians from April 1, 2003, to March 31, 2011. The study took place in Kanazawa city, where ambulances without FAST™ (non-FAST™-equipped) were being progressively replaced by new FAST™-equipped ambulances. OHCA data, including the response times recorded in seconds, were collected and compared between the FAST™-equipped and non-FAST™-equipped ambulances. OHCA outcomes were subsequently compared in the subgroup of OHCAs managed by emergency medical technicians without tracheal intubation or epinephrine administration. The primary end-point of this study was one-year (1-Y) survival. RESULTS: The median response time significantly differed between the FAST™-equipped and non-FAST™-equipped groups at 327 and 381 s, respectively. The 1-Y survival rates were 7.0% in the FAST™-equipped group and 2.8% in the non-FAST™-equipped group. Logistic regression analysis revealed that the dispatch of a FAST™-equipped ambulance was an independent factor for 1-Y survival (adjusted odds ratio = 3.077, 95% confidence interval = 1.180-9.350). CONCLUSIONS: The FAST™ implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city.

Tanaka Y; Yamada H; Tamasaku S; Inaba H

2013-10-01

115

The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest  

Science.gov (United States)

Objective To analyze whether urine output and urinalysis results are predictive of survival and neurologic outcomes in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods Information was obtained from 1,340 patients with non-traumatic OHCA who had achieved a sustained return of spontaneous circulation (ROSC). Factors that were associated with survival in the post-resuscitative period were evaluated. The association between urine output and fluid challenge in the early resuscitative period was analyzed and compared between the survivors and the non-survivors. The results of the initial urinalysis, including the presence of proteinuria and other findings, were used to evaluate the severity of vascular protein leakage and survival. The association between proteinuria and the neurologic outcomes of the survivors was also analyzed. The clinical features of capillary leakage were examined during the post-resuscitative period. Results Of the 1,340 patients, 312 survived. A greater urine output was associated with a higher chance of survival. The initial urine output increased in proportion to the amount of fluid that was administered during early resuscitation in the emergency department for the survivors but not for the non-survivors (p<0.05). In the initial urinalysis, proteinuria was strongly associated with survival, and severe proteinuria indicated significantly poorer neurologic outcomes (p<0.05 for both comparisons). Proteinuria was associated with a risk of developing signs of capillary leakage, including body mass index gain and pitting edema (both p<0.001). Conclusion The severity of proteinuria during the early post-resuscitative period was predictive of survival.

Teng, Tsung-Han; Lai, Shih-Chang; Yang, Mei-Chueh; Chiu, Chun-Wen; Chou, Chu-Chung; Chang, Chih-Yu; Yao, Yung-Chiao; Wu, Lan-Hsin; Wu, Han-Ping; Chen, Wen-Liang; Lin, Yan-Ren

2013-01-01

116

Out-of-Hospital Cardiac Arrest Surveillance - Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005-December 31, 2010. Morbidity and Mortality Weekly Report, Vol. 60, No. 8. Surveillance Summaries.  

Science.gov (United States)

Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs ou...

A. Crouch A. B. Perez A. L. Valderrama B. McNally C. Sasson K. Vellano M. Mehta P. W. Yoon R. Merritt R. Robb

2011-01-01

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Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Since 2003, we have routinely used percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) to treat patients < 80 years of age after out-of-hospital cardiac arrest (OHCA) related to ventricular fibrillation. The aim of our study was to evaluate the prognostic impact of routine PCI in association with MTH and the potential influence of age. METHODS: We studied 111 consecutive patients resuscitated successfully following OHCA related to shock-sensitive rhythm. They were divided into five groups according to age: < 45 years (n = 22, group 1), 45 to 54 years (n = 27, group 2), 55 to 64 years (n = 22, group 3), 65 to 74 years (n = 23, group 4) and ?75 years (n = 17, group 5). Emergency coronary angiography was performed in hemodynamically stable patients < 80 years old, regardless of the electrocardiogram pattern. MTH was targeted to a core temperature of 32°C to 34°C for 24 hours. RESULTS: Most patients (73%) had coronary heart disease, although its incidence in group 1 was lower than in other groups (41% versus 81%; P = 0.01). In group 1, all patients but one underwent coronary angiography, and 33% of them underwent associated PCI. In group 5, only 53% of patients underwent a coronary angiography and 44% underwent PCI. Overall in-hospital survival was 54%, ranging between 52% and 64% in groups 1 to 4 and 24% in group 5. Time from collapse to return of spontaneous circulation was associated with mortality (odds ratio (OR) = 1.05 (25th to 75th percentile range, 1.03 to 1.08); P < 0.001), whereas PCI was associated with survival (OR = 0.30 (25th to 75th percentile range, 0.11 to 0.79); P = 0.01). CONCLUSIONS: We suggest that routine coronary angiography with potentially associated PCI may favorably alter the prognosis of resuscitated patients with stable hemodynamics who are treated with MTH after OHCA related to ventricular fibrillation. Although age was not an independent cause of death, the clinical relevance of this therapeutic strategy remains to be determined in older people.

Cronier P; Vignon P; Bouferrache K; Aegerter P; Charron C; Templier F; Castro S; El Mahmoud R; Lory C; Pichon N; Dubourg O; Vieillard-Baron A

2011-01-01

118

A composite model of survival from out-of-hospital cardiac arrest using the Cardiac Arrest Registry to Enhance Survival (CARES).  

UK PubMed Central (United Kingdom)

OBJECTIVE: Using CARES data, to develop a composite multivariate logistic regression model of survival for projecting survival rates for out-of-hospital arrests of presumed cardiac etiology (OHCA). METHODS: This is an analysis of 25,975 OHCA cases (from October 1, 2005 to December 31, 2011) occurring before EMS/first responder arrival and involving attempted resuscitation by responders from 125 EMS agencies. RESULTS: The survival-at-hospital discharge rate was 9% for all cases, 16% for bystander-witnessed cases, 4% for unwitnessed cases, and 32% for bystander-witnessed pVT/VF cases. The model was estimated separately for each set of cases above. Generally, our first equation showed that joint presence of a presenting rhythm of pVT/VF and return of spontaneous circulation in the pre-hospital setting (PREHOSPROSC) is a substantial direct predictor of patient survival (e.g., 55% of such cases survived). Bystander AED use, and, for witnessed cases, bystander CPR and response time are significant but less sizable direct predictors of survival. Our second equation shows that these variables make an additional, indirect contribution to survival by affecting the probability of joint presence of pVT/VF and PREHOSPROSC. The model yields survival rate projections for various improvement scenarios; for example, if all cases had involved bystander AED use (vs. 4% currently), the survival rate would have increased to 14%. Approximately one-half of projected increases come from indirect effects that would have been missed by the conventional single-equation approach. CONCLUSION: The composite model describes major connections among predictors of survival, and yields specific projections for consideration when allocating scarce resources to impact OHCA survival.

Abrams HC; McNally B; Ong M; Moyer PH; Dyer KS

2013-08-01

119

Long enough to act? Symptom and behavior patterns prior to out-of-hospital sudden cardiac death.  

UK PubMed Central (United Kingdom)

BACKGROUND: Sudden cardiac death is a major cause of death in the United States. Most cases occur outside the hospital, yet little is known about the symptoms and actions of individuals who die before reaching the hospital. OBJECTIVE: The purpose of this study was to describe the symptoms, symptom management, and care-seeking patterns in sudden cardiac death victims. METHODS: This cross-sectional study used qualitative and quantitative data collection methods to obtain descriptions of symptoms and treatment-seeking delay from family members and bystanders (respondents) in 140 cases of sudden cardiac death due to presumed myocardial infarction. Decedents were identified from death certificate data from the state of Oregon in the United States. Respondents completed a survey of demographics and myocardial infarction symptoms and an in-depth interview. Narrative analysis was used to analyze qualitative data. RESULTS: Three behavior patterns or trajectory types were developed focusing on key characteristics of the symptom patterns, the meanings attributed to those symptoms, the actions taken by the decedents and their family members or bystanders, and the time course of events. Each case was categorized as 1 trajectory type. The trajectory types are Normal Day (n = 49), Something Not Right (n = 62), and Thought It Was Something Else (n = 29). The key distinction across the trajectory types is the perception and interpretation of symptoms and the resulting actions between symptom perception and death. CONCLUSIONS: This study is 1 of the first to describe what victims of sudden cardiac death are doing and thinking during the period between symptom onset and collapse. The trajectory types identified in this study suggest that misinterpretation of symptoms (the Something Not Right and Thought It Was Something Else groups) is common among victims and bystanders.

Rosenfeld A; Christensen V; Daya M

2013-03-01

120

Active surface cooling protocol to induce mild therapeutic hypothermia after out-of-hospital cardiac arrest: a retrospective before-and-after comparison in a single hospital.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate whether implementation of a therapeutic hypothermia protocol on arrival in a community hospital improved survival and neurologic outcomes in patients initially found to have ventricular fibrillation, pulseless electrical activity, or asystole, and then successfully resuscitated from out-of-hospital cardiac arrest. DESIGN: A retrospective study of patients who presented after implementation of a therapeutic hypothermia protocol compared with those who presented before the protocol was implemented. SETTING: Harborview Medical Center, Seattle, WA. PATIENTS: A total of 491 consecutive adults with out-of-hospital, nontraumatic cardiac arrest who presented between January 1, 2000 and December 31, 2004. INTERVENTIONS: An active cooling therapeutic hypothermia protocol, using ice packs, cooling blankets, or cooling pads to achieve a temperature of 32 degrees C to 34 degrees C was initiated on November 18, 2002 for unconscious patients resuscitated from cardiac arrest. MEASUREMENTS AND MAIN RESULTS: Demographics and outcomes were obtained from medical records and an emergency medical database. The primary outcomes were survival and favorable neurologic outcome at discharge associated with the therapeutic hypothermia protocol. An adjusted analysis was performed, using a multivariate regression. During the therapeutic hypothermia period, 204 patients were brought to the emergency department; of these 204 patients, 132 (65%) ultimately achieved temperatures of <34 degrees C. Of the 72 patients who did not achieve goal temperatures: 40 (20%) died in the emergency department or shortly after being admitted to the hospital, 15 (7%) regained consciousness, four (2%) had contraindications, 13 (6%) had temperature increase or did not have documented use of the therapeutic hypothermia protocol. In the prior period, none of the 287 patients received active cooling. Patients admitted in the therapeutic hypothermia period had a mean esophageal temperature of 34.1 degrees C during the first 12 hrs compared with 35.2 degrees C in the pretherapeutic hypothermia period (p < .01). Survival to hospital discharge improved in the therapeutic hypothermia period in patients with an initial rhythm of ventricular fibrillation (odds ratio, 1.88, 95% confidence interval, 1.03-3.45), however not in patients with nonventricular fibrillation (odds ratio, 1.17, 95% confidence interval, 0.66-2.05). In adjusted analysis, ventricular fibrillation patients during the therapeutic hypothermia period trended toward improved survival (odds ratio, 1.71, 95% confidence interval, 0.85-3.46) and had favorable neurologic outcome (odds ratio, 2.62, 95% confidence interval, 1.1-6.27) compared with the earlier period. This benefit was not observed in patients whose initial rhythm was pulseless electrical activity or asystole. CONCLUSIONS: The therapeutic hypothermia period was associated with a significant improvement in neurologic outcomes in patients whose initial rhythm was ventricular fibrillation, but not in patients with other rhythms.

Don CW; Longstreth WT Jr; Maynard C; Olsufka M; Nichol G; Ray T; Kupchik N; Deem S; Copass MK; Cobb LA; Kim F

2009-12-01

 
 
 
 
121

End-tidal carbon dioxide during out-of-hospital cardiac arrest resuscitation: comparison of active compression-decompression and standard CPR.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVES: To compare the maximal end-tidal carbon dioxide pressure (ETCO2 peak) values obtained during standard (S-CPR) and active compression-decompression CPR (ACD-CPR) during prolonged resuscitation in out-of-hospital cardiac arrest. DESIGN: Prospective, randomized crossover study. SETTING: City with a population of 3.5 million, served by an emergency medical service system providing advanced cardiac life support. PARTICIPANTS: Patients with nontraumatic out-of-hospital cardiac arrest. INTERVENTIONS: Patients were randomly assigned to receive first, for a period of 3 minutes, either ACD-CPR or S-CPR; then the two methods were alternated. ETCO2 was continuously monitored and computed. MEASUREMENTS AND RESULTS: Sixteen patients (48 +/- 20 years old) were included; in 12, return of spontaneous circulation was achieved, and 5 were admitted alive to the hospital. A statistically significant increase in ETCO2 peak was obtained with ACD-CPR (27.6 +/- 3 mm Hg) compared with S-CPR (15.6 +/- 2.2 mm Hg). No major adverse effect possibly related to ACD-CPR was observed. CONCLUSION: This prospective study suggests that ACD-CPR may improve cardiac output compared with S-CPR.

Orliaguet GA; Carli PA; Rozenberg A; Janniere D; Sauval P; Delpech P

1995-01-01

122

Successful use of therapeutic hypothermia in an opiate induced out-of-hospital cardiac arrest complicated by severe hypoglycaemia and amphetamine intoxication: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract The survival to discharge rate after unwitnessed, non-cardiac out-of-hospital cardiac arrest (OHCA) is dismal. We report the successful use of therapeutic hypothermia in a 26-year old woman with OHCA due to intentional poisoning with heroin, amphetamine and insulin. The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC. Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months. Conclusion According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.

Busch Michael; Søreide Eldar

2010-01-01

123

Impact of therapeutic hypothermia in the treatment of patients with out-of-hospital cardiac arrest from the J-PULSE-HYPO study registry.  

UK PubMed Central (United Kingdom)

BACKGROUND: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of therapeutic hypothermia (TH) remains unclear. METHODS AND RESULTS: A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6 ± 13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26 min. The target core temperature during TH was 33.9 ± 0.4°C and the mean duration of cooling was 31.5 ± 13.9 h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%. CONCLUSIONS: The J-PULSE-HYPO study registry showed a clinical aspect of TH.

Yokoyama H; Nagao K; Hase M; Tahara Y; Hazui H; Arimoto H; Kashiwase K; Sawano H; Yasuga Y; Kuroda Y; Kasaoka S; Shirai S; Yonemoto N; Nonogi H

2011-01-01

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Vigilance, awareness and a phone line: 20 years of expediting CPR for enhancing survival after out-of-hospital cardiac arrest. The 'SHL'-Telemedicine experience in Israel.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. We report the 1987-2007 experience of resuscitation of out-of-hospital cardiac arrest victims who were 'SHL'-Telemedicine subscribers and who underwent CPR by SHL-Telemedicine mobile intensive care units (MICUs) personnel or under their instructions. METHODS: 'SHL's records of MICU reports and specifics of CPR maneuvers and outcome of resuscitated patients, as recorded by its MICU physicians, were analyzed to determine whether the system enhanced survival. RESULTS: A total of 1810 'SHL'-Telemedicine subscribers (mean age 76+/-12 years [16-104], 67% males) were resuscitated after cardiac arrest, 597 (33%) were hospitalized and 279 (15.4%) were discharged alive. Factors associated with successful resuscitation included witnessed collapse and documented ventricular fibrillation upon MICU arrival. A history of diabetes, hyperlipidemia, stroke or advanced age adversely affected the outcome. Time from collapse to CPR initiation and duration of CPR correlated significantly with survival. Laymen instructed telephonically by the 'SHL'-Telemedicine center performed CPR on 121 patients: 13 (10%) survived to hospital discharge. CONCLUSIONS: 'SHL'-Telemedicine's policy of bi-monthly contact with its subscribers led to heightened awareness of warning signs and need for rapid summoning of medical assistance in the setting of out-of-hospital sudden cardiac arrest.

Birati EY; Malov N; Kogan Y; Yanay Y; Tamari M; Elizur M; Steinberg DM; Golovner M; Roth A

2008-12-01

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Usefulness of the D-dimer concentration as a predictor of mortality in patients with out-of-hospital cardiac arrest.  

Science.gov (United States)

During cardiac arrest and after cardiopulmonary resuscitation, activation of blood coagulation occurs, with a lack of adequate endogenous fibrinolysis. The aim of the present study was to determine whether the serum D-dimer concentration on admission is an independent predictor of all-cause mortality in patients with out-of-hospital cardiac arrest. We enrolled 182 consecutive patients (122 men, mean age 64.3 ± 15 years), who had presented to the emergency department from January 2007 to July 2012 because of out-of-hospital cardiac arrest. Information about the initial arrest rhythm, biochemical parameters, including the D-dimer concentration on admission, neurologic outcomes, and 30-day all-cause mortality were retrospectively collected. Of the 182 patients, 79 (43.4%) had died. The patients who died had had lower systolic (100 ± 39.6 vs 120.5 ± 26.9 mm Hg; p = 0.0004) and diastolic (58.3 ± 24.1 vs 74 ± 16.3 mm Hg; p 5,205 ?g/L (odds ratio 5.7, 95% confidence interval 1.22 to 26.69) and hemoglobin concentration (odds ratio 1.66, 95% confidence interval 1.13 to 2.43) were strong and independent predictors of all-cause mortality. In conclusion, patients with a higher D-dimer concentration on admission had a poorer prognosis. The D-dimer concentration was an independent predictor of all-cause mortality. PMID:23683952

Szymanski, Filip M; Karpinski, Grzegorz; Filipiak, Krzysztof J; Platek, Anna E; Hrynkiewicz-Szymanska, Anna; Kotkowski, Marcin; Opolski, Grzegorz

2013-05-16

126

The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. METHODS: We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95% confidence intervals. RESULTS: Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5%) had a DNR order placed in the first 24h after admission. These patients had decreased frequency of cardiac catheterization (1.1% vs. 4.3%), blood transfusion (7.6% vs. 11.2%), ICD placement (0.1% vs. 1.1%), and survival to discharge (5.2% vs. 21.6%, all p-values<0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95% CI 0.48-0.95; Black, OR 0.49, 95% CI 0.35-0.69). CONCLUSIONS: Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24h may be premature given the lack of early prognostic indicators after OHCA.

Richardson DK; Zive D; Daya M; Newgard CD

2013-04-01

127

Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call.  

UK PubMed Central (United Kingdom)

BACKGROUND: The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. METHODS AND RESULTS: During 8 months, voice recordings of 14,800 consecutive emergency calls were collected to audit content and cardiac arrest recognition. The presence of cardiac arrest during the call was assessed from the ambulance crew report. Included calls were placed by laypersons on site and did not involve trauma. Prevalence of cardiac arrest was 3.0%. Of the 285 cardiac arrests, 82 (29%) were not recognized during the call, and 64 of 267 suspected calls (24%) were not cardiac arrest. We analyzed a random sample (n=506) of 9230 control calls. Three-month survival was 5% when a cardiac arrest was not recognized versus 14% when it was recognized (P=0.04). If the dispatcher did not recognize the cardiac arrest, the ambulance was dispatched a mean of 0.94 minute later (P<0.001) and arrived 1.40 minutes later on scene (P=0.01) compared with recognized calls. The main reason for not recognizing the cardiac arrest was not asking if the patient was breathing (42 of 82) and not asking to describe the type of breathing (16 of 82). Normal breathing was never mentioned in true cardiac arrest calls. A logistic regression model identified spontaneous trigger words like facial color that could contribute to cardiac arrest recognition (odds ratio, 7.8 to 9.7). CONCLUSIONS: Not recognizing a cardiac arrest during emergency calls decreases survival. Spontaneous words that the caller uses to describe the patient may aid in faster and better recognition of a cardiac arrest.

Berdowski J; Beekhuis F; Zwinderman AH; Tijssen JG; Koster RW

2009-04-01

128

Factors Associated With Mortality in Out-of-hospital Cardiac Arrests Attended in Basic Life Support Units in the Basque Country (Spain).  

UK PubMed Central (United Kingdom)

INTRODUCTION AND OBJECTIVES: To describe the epidemiological characteristics of cardiac arrests attended in basic life support units in the Basque Country (Spain) and look for factors associated with failure of cardiopulmonary resuscitation. METHODS: We conducted an observational study during 18 months, including all out-of-hospital cardiopulmonary resuscitation provided by basic life support units. The variables defined in the Utstein-style were considered as independent and mortality as the dependent variable. We applied descriptive and analytical statistics and evaluated the magnitude of the association using a logistic regression model, which included variables with P<.05 in the bivariate analysis. RESULTS: Of 1050 cardiac arrests attended, 15.7% of patients were revived in situ. The presumed etiology was cardiac in 55.3% of cases and 71.4% occurred at home. Cardiopulmonary resuscitation was started before the arrival of the ambulance in 22.9% of cases and in 18.2% the rhythm of presentation was shockable. Variables associated with lower mortality were: shockable rhythms (relative risk=0.44; P=.003), patient aged<65 years (relative risk=0.44; P=.002), time to cardiopulmonary resuscitation<8 min (relative risk=0.56; P=.039), and out-of-home events (relative risk=0.55; P=.031). CONCLUSIONS: Cardiac arrest survival was low. Cardiopulmonary resuscitation before the arrival of the ambulance was rare. A shockable rhythm, age younger than 65 years, early cardiopulmonary resuscitation efforts, and a location away from home were associated with longer survival. It is necessary to develop strategies designed to reduce ambulance response time and educate the public in basic resuscitation. Full English text available from:www.revespcardiol.org/en.

Ballesteros-Peña S; Abecia-Inchaurregui LC; Echevarría-Orella E

2013-04-01

129

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

Directory of Open Access Journals (Sweden)

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.

Miranda Mafalda; Sousa Pedro J; Ferreira Jorge; Andrade Maria J; Gonçalves Pedro A; Romão Cristina

2009-01-01

130

Association of ozone and particulate air pollution with out-of-hospital cardiac arrest in Helsinki, Finland: evidence for two different etiologies.  

UK PubMed Central (United Kingdom)

Out-of-hospital cardiac arrest (OHCA) has been previously associated with exposure to particulate air pollution. However, there is uncertainty about the agents and mechanisms that are involved. We aimed to determine the association of gases and particulates with OHCA, and differences in pollutant effects on OHCAs due to acute myocardial infarction (AMI) vs those due to other causes. Helsinki Emergency Medical Services provided data on OHCAs of cardiac origin (OHCA_Cardiac). Hospital and autopsy reports determined whether OHCAs were due to AMI (OHCA_MI) or other cardiac causes (OHCA_Other). Pollutant data was obtained from central ambient monitors. A case-crossover analysis determined odds ratios (ORs) for hourly lagged exposures (Lag 0-3) and daily lagged exposures (Lag 0d-3d), expressed per interquartile range of pollutant level. For OHCA_Cardiac, elevated ORs were found for PM(2.5) (Lag 0, 1.07; 95% confidence interval (CI): 1.01-1.13) and ozone (O(3)) (Lag 2d, 1.18; CI: 1.03-1.35). For OHCA_MI, elevated ORs were found for PM(2.5) (Lag 0, 1.14; CI: 1.03-1.27; Lag 0d, 1.17; CI: 1.03-1.33), accumulation mode particulate (Acc) (Lag 0d, 1.19; CI: 1.04-1.35), NO (Lag 0d, 1.07; CI: 1.01-1.13), and ultrafine particulate (Lag 0d, 1.27; CI: 1.05-1.54). For OHCA_Other, elevated ORs were found only for O(3) (Lag 1d, 1.26; CI: 1.07-1.48; Lag 2d, 1.30; CI: 1.11-1.53). Results from two-pollutant models, with one of the pollutants either PM(2.5) or O(3), suggested that associations were primarily due to effects of PM(2.5) and O(3), rather than other pollutants. The results suggest that air pollution triggers OHCA via two distinct modes: one associated with particulates leading to AMI and one associated with O(3) involving etiologies other than AMI, for example, arrhythmias or respiratory insufficiency.

Rosenthal FS; Kuisma M; Lanki T; Hussein T; Boyd J; Halonen JI; Pekkanen J

2013-05-01

131

Usefulness of the D-Dimer Concentration as a Predictor of Mortality in Patients With Out-of-Hospital Cardiac Arrest.  

UK PubMed Central (United Kingdom)

During cardiac arrest and after cardiopulmonary resuscitation, activation of blood coagulation occurs, with a lack of adequate endogenous fibrinolysis. The aim of the present study was to determine whether the serum D-dimer concentration on admission is an independent predictor of all-cause mortality in patients with out-of-hospital cardiac arrest. We enrolled 182 consecutive patients (122 men, mean age 64.3 ± 15 years), who had presented to the emergency department from January 2007 to July 2012 because of out-of-hospital cardiac arrest. Information about the initial arrest rhythm, biochemical parameters, including the D-dimer concentration on admission, neurologic outcomes, and 30-day all-cause mortality were retrospectively collected. Of the 182 patients, 79 (43.4%) had died. The patients who died had had lower systolic (100 ± 39.6 vs 120.5 ± 26.9 mm Hg; p = 0.0004) and diastolic (58.3 ± 24.1 vs 74 ± 16.3 mm Hg; p <0.0001) blood pressure on admission. The deceased patients more often had had a history of myocardial infarction (32.9% vs 25.2%; p = 0.04) and less often had had an initial shockable rhythm (41.8% vs 60.2%; p = 0.02). The patients who died had had a significantly higher mean D-dimer concentration (9,113.6 ± 5,979.2 vs 6,121.6 ± 4,597.5 ?g/L; p = 0.005) compared with patients who stayed alive. On multivariate logistic regression analysis, an on-admission D-dimer concentration >5,205 ?g/L (odds ratio 5.7, 95% confidence interval 1.22 to 26.69) and hemoglobin concentration (odds ratio 1.66, 95% confidence interval 1.13 to 2.43) were strong and independent predictors of all-cause mortality. In conclusion, patients with a higher D-dimer concentration on admission had a poorer prognosis. The D-dimer concentration was an independent predictor of all-cause mortality.

Szymanski FM; Karpinski G; Filipiak KJ; Platek AE; Hrynkiewicz-Szymanska A; Kotkowski M; Opolski G

2013-08-01

132

Specific activity types at the time of event and outcomes of out-of-hospital cardiac arrest: a nationwide observational study.  

Science.gov (United States)

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group. PMID:23400043

Na, Sang Hoon; Shin, Sang Do; Ro, Young Sun; Lee, Eui Jung; Song, Kyoung Jun; Park, Chang Bae; Kim, Joo Yeong

2013-01-29

133

Specific activity types at the time of event and outcomes of out-of-hospital cardiac arrest: a nationwide observational study.  

UK PubMed Central (United Kingdom)

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group.

Na SH; Shin SD; Ro YS; Lee EJ; Song KJ; Park CB; Kim JY

2013-02-01

134

Assessing outcome of out-of-hospital cardiac arrest due to subarachnoid hemorrhage using brain CT during or immediately after resuscitation (Views : 23 times)  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives. The clinical course and outcome of out-of-hospital cardiopulmonary arrest (OHCPA) due to subarachnoid hemorrhage (SAH) is unclear. The objective of this study is to clarify them. Study design. Single- center, observational study. Setting. We usually perform a brain computed tomography (CT) in OHCPA patients who present without a clear etiology (42% of all OHCPA), such as trauma, to determine the cause of OHCPA and to guide treatment. Patients. The study included OHCPA patients without a clear etiology, who were transferred to our center and who underwent a brain CT during resuscitation. Methods of measurement. Patients' records were reviewed; initial cardiac rhythm, existence of a witness and bystander cardiopulmonary resuscitation efforts (CPR) were compared with patients' outcomes. Results. Sixty-six patients were enrolled. 72.7% achieved return of spontaneous circulation (ROSC), 71.2% were admitted, 30.3% survived more than 7 days, and 9.1. survived-to-discharge. In 41 witnessed OHCPA, 87.8% obtained ROSC, 85.4% were admitted, and 14.6% survived-to-discharge. All survivors were witnessed. In 25 non-witnessed OHCPA, 48% obtained ROSC and were admitted, and no patients were discharged. Initial cardiac rhythm was ventricular fibrillation (VF), pulseless electrical activity (PEA) and asystole in 3.0%, 39.4%, and 47.0%. In 2 VF patients 50.0% survived-to- discharge, and there was no survivor with PEA or asystole.Conclusion. This study shows a high rate of ROSC and admission in OHCPA patients with a SAH, and also reveals their very poor neurological outcome. We conclude that the detection of a SAH in OHCPA patients is important to determine the accurate frequency of SAH in this patient group and to guide appropriate treatment of all OHCPA patients.

Noriyuki Suzuki; Yoshihiro Moriwaki; Hiroshi Manaka; Koichi Hamada

2010-01-01

135

Evaluating the impact of air pollution on the incidence of out-of-hospital cardiac arrest in the Perth Metropolitan Region: 2000-2010.  

UK PubMed Central (United Kingdom)

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue. Several studies have found that an increased level of ambient particulate matter (PM) smaller than 2.5 microns (PM2.5) is associated with an increased risk of OHCA. We investigated the relationship between air pollution levels and the incidence of OHCA in Perth, Western Australia. METHODS: We linked St John Ambulance OHCA data of presumed cardiac aetiology with Perth air pollution data from seven monitors which recorded hourly levels of PM smaller than 2.5 and 10 microns (PM2.5/PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3). We used a case-crossover design to estimate the strength of association between ambient air pollution levels and risk of OHCA. RESULTS: Between 2000 and 2010, there were 8551 OHCAs that met the inclusion criteria. Of these, 5624 (65.8%) occurred in men. An IQR increase in the 24 and 48 h averages of PM2.5 was associated with 10.6% (OR 1.106, 95% CI 1.038 to 1.180) and 13.6% (OR 1.136, 95% CI 1.051 to 1.228) increases, respectively, in the risk of OHCA. CO showed a consistent association with increased risk of an OHCA. An IQR increase in the 4 h average concentration of CO was associated with a 2.2% (OR 1.022, 95% CI 1.002 to 1.042) increase in risk of an OHCA. When we restricted our analysis of CO to arrests occurring between 6:00 and 10:00, we found a 4.4% (95% CI 1.1% to 7.8%) increase in risk of an OHCA. CONCLUSIONS: Elevated ambient PM2.5 and CO are associated with an increased risk of OHCA.

Straney L; Finn J; Dennekamp M; Bremner A; Tonkin A; Jacobs I

2013-09-01

136

Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period.  

UK PubMed Central (United Kingdom)

BACKGROUND: The outcome of children with traumatic out-of-hospital cardiac arrest (OHCA) is poor, and the information regarding survival in the postresuscitative period is limited. The aim of this study was to determine the clinical features during the early postresuscitative period that may predict survival or neurologic outcomes in children with traumatic OHCA. METHODS: Information on 362 children (<19 years) who presented to the emergency departments of three medical centers and experienced traumatic OHCA during the study period (January 2003 to December 2010) were retrospectively included. The postresuscitative clinical features during the early postresuscitative period, defined as the first hour after achieving sustained return of spontaneous circulation, which correlated with survival and neurologic outcomes were analyzed. RESULTS: Among 152 children (42%) who achieved sustained return of spontaneous circulation, 34 (9.4%) survived to discharge, and 11 (3%) had good neurologic outcomes (Pediatric Cerebral Performance Category Scale, 1 or 2). Early postresuscitative clinical features, which reflected initial cardiac output and end-organ perfusion, can predict the chance of survival. Such features included the following: high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color (all p < 0.05). Initial Glasgow Coma Scale (GCS) score of greater than 7 predicted a good neurologic outcome in survivors (p = 0.008). CONCLUSION: Predictors of survival were high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color. Most importantly, initial GCS score of greater than 7 predicted a good neurologic outcome in survivors. LEVEL OF EVIDENCE: Prognostic study, level III.

Lin YR; Wu HP; Chen WL; Wu KH; Teng TH; Yang MC; Chou CC; Chang CF; Li CJ

2013-09-01

137

A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea.  

UK PubMed Central (United Kingdom)

BACKGROUND: The goal of this study is to better understand the trend in epidemiological features and the outcomes of emergency medical service (EMS)-assessed out-of-hospital cardiac arrest (OHCA) according to the community urbanization level: metropolitan, urban, and rural. METHODS: This study was performed within a nationwide EMS system with a single-tiered basic-to-intermediate service level and approximately 900 destination hospitals for eligible OHCA cases in South Korea (with 48 million people). A nationwide OHCA database, which included information regarding demographics, Utstein criteria, EMS, and hospital factors and outcomes, was constructed using the EMS run sheets of eligible cases who were transported by 119 EMS ambulances and followed by a medical record review from 2006 to 2010. Cases with an unknown outcome were excluded. The community urbanization level was categorized according to population size, with metropolitan areas (more than 500,000 residents), urban areas (100,000-500,000 residents), and rural areas (<100,000 residents). The primary end point was the survival to discharge rate. Age- and sex-adjusted survival rates (ASRs) and standardized survival ratios (SSRs) with 95% confidence intervals (CIs) were calculated compared to a standard population. The adjusted odds ratios (AORs) and 95% CIs for survival were calculated and adjusted for potential risk factors using stratified multivariable logistic regression analysis. RESULTS: There were 97,291 EMS-assessed OHCAs with 73,826 (75.9%) EMS-treated cases analyzed, after excluding the patients with unknown outcome (N=4172). The standardized incidence rate increased from 37.5 in 2006 to 46.8 in 2010 per 100,000 person-years for EMS-assessed OHCAs, and the survival rate was 3.0% for EMS-assessed OHCAs (3.3% for cardiac etiology and 2.3% for non-cardiac etiology) and 3.6% for EMS-treated OHCAs. Significantly different trends were found by urbanization level for bystander CPR, EMS performance, and the level of the destination hospital. The ASRs for survival were significantly improved by year in the metropolitan areas (3.6% in 2006 to 5.3% in 2010) but remained low in the urban areas (1.4% in 2006 to 2.3% in 2010) and very low in the rural areas (0.5 in 2006 and 0.8 in 2010). The SSRs (95% CIs) in the metropolitan areas were 1.19 (1.06-1.34) in 2006 and 1.77 (1.64-1.92) in 2010, whereas the SSRs were observed to be less than 1.00 during the five-year period in both urban and rural areas. The AORs (95% CIs) for survival significantly increased to 1.42 (1.22-1.66) in the metropolitan areas and to 1.58 (1.18-2.11) in the urban areas while not increasing in the rural areas, compared to the level of each group of areas in 2006. CONCLUSIONS: In this nationwide cohort study from 2006 to 2010, the standardized incidence rate and survival to discharge rate of EMS-assessed OHCAs increased annually in metropolitan and urban communities but did not increase in rural communities. Further investigations should be undertaken to improve the performance and outcomes in rural communities.

Ro YS; Shin SD; Song KJ; Lee EJ; Kim JY; Ahn KO; Chung SP; Kim YT; Hong SO; Choi JA; Hwang SO; Oh DJ; Park CB; Suh GJ; Cho SI; Hwang SS

2013-05-01

138

Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: long-term survival and neurological outcome.  

UK PubMed Central (United Kingdom)

BACKGROUND: Predictors of long-term outcome after ST-elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) are incompletely understood, including the influence of successful coronary reperfusion. METHODS: We analysed clinical and procedural data as well as 1-year outcome of 72 consecutive patients who underwent primary coronary intervention (PCI) after witnessed OHCA and STEMI and compared the results with 695 patients with STEMI and PCI, but without OHCA. Neurological recovery after OHCA was assessed using the Cerebral Performance Category (CPC) scale. RESULTS: PCI was successful in 83.3% after OHCA vs. 84.3% in the non-OHCA group (p=0.87). One-year mortality was 34.7% vs. 9.5% (p<0.001). 58.3% of the OHCA-patients showed complete neurological recovery (CPC 1) or moderate neurological disability (CPC 2). Another 6.9% showed severe cerebral disability (CPC 3) or permanent vegetative status (CPC 4). Delay from collapse until start of Advanced Cardiopulmonary Life Support (ACLS) was shorter for survivors with CPC status ?2 (median 1 min, range 0-11 min) compared to non-survivors or survivors with CPC status >2 (median 8 min, range 0-13 min), p<0.0001. Age-adjusted multivariate analysis identified 'unsuccessful PCI', 'vasopressors on admission' and 'start of ACLS after >6 min' as independent predictors of negative long-term outcome (death or CPC >2). CONCLUSIONS: Mortality is high in patients with STEMI complicated by OHCA - even though PCI was performed with the same success rate as in patients without OHCA. The majority of survivors had favourable neurological outcomes at 1 year, especially if advanced life support had been started within ?6 min and PCI was successful.

Zimmermann S; Flachskampf FA; Alff A; Schneider R; Dechant K; Klinghammer L; Stumpf C; Zopf Y; Loehr T; Brand G; Ludwig J; Daniel WG; Achenbach S

2013-06-01

139

Impaired fasting plasma glucose and type 2 diabetes are related to the risk of out-of-hospital sudden cardiac death and all-cause mortality.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of the study was to determine whether impaired fasting plasma glucose (FPG) and type 2 diabetes may be risk factors for sudden cardiac death (SCD). RESEARCH DESIGN AND METHODS: This prospective study was based on 2,641 middle-aged men 42-60 years of age at baseline. Impaired FPG level (?5.6 mmol/L) among nondiabetic subjects (501 men) was defined according to the established guidelines, and the group with type 2 diabetes included subjects (159 men) who were treated with oral hypoglycemic agents, insulin therapy, and/or diet. RESULTS: During the 19-year follow-up, a total of 190 SCDs occurred. The relative risk (RR) for SCD was 1.51-fold (95% CI 1.07-2.14, P = 0.020) for nondiabetic men with impaired FPG and 2.86-fold (1.87-4.38, P < 0.001) for men with type 2 diabetes as compared with men with normal FPG levels, after adjustment for age, BMI, systolic blood pressure, serum LDL cholesterol, smoking, prevalent coronary heart disease (CHD), and family history of CHD. The respective RRs for out-of-hospital SCDs (157 deaths) were 1.79-fold (1.24-2.58, P = 0.001) for nondiabetic men with impaired FPG and 2.26-fold (1.34-3.77, P < 0.001) for men with type 2 diabetes. Impaired FPG and type 2 diabetes were associated with the risk of all-cause death. As a continuous variable, a 1 mmol/L increment in FPG was related to an increase of 10% in the risk of SCD (1.10 [1.04-1.20], P = 0.001). CONCLUSIONS: Impaired FPG and type 2 diabetes represent risk factors for SCD.

Laukkanen JA; Mäkikallio TH; Ronkainen K; Karppi J; Kurl S

2013-05-01

140

Systematic review and meta-analysis of out-of-hospital cardiac arrest and race or ethnicity: black US populations fare worse.  

UK PubMed Central (United Kingdom)

Background: Several studies have reported racial/ethnic variation in out-of-hospital cardiac arrest (OOHCA) characteristics, which engendered varying conclusions. We performed a systematic review and meta-analysed the evidence for differences in OOHCA survival when considering the patient's race and/or ethnicity.Methods: We searched Medline and EMBASE databases up to and including 1 Oct 2011 for studies investigating racial/ethnic differences in OOHCA characteristics, supplemented by manual searches of bibliographies of relevant studies. We selected studies of any relevant design that measured OOHCA characteristics and stratified them by ethnic group. Two independent reviewers extracted information on the study population, including: race and/or ethnicity, location, age and OOHCA variables as per the Utsein template. We performed a meta-analysis of the studies comparing the black and white patients.Results: 1701 potentially relevant articles were identified in our systematic search. Of these, 22 articles describing original studies were reviewed after fulfilling our inclusion criteria. Although 19 studies (18 within the United States (US)) compared the black and white population, only 15 fulfilled our quality assessment criteria and were meta-analysed. Compared to white patients, black patients were less likely to receive bystander cardiopulmonary resuscitation (OR = 0.66, 95%CI = 0.55-0.78), have a witnessed arrest (OR = 0.77, 95%CI = 0.72-0.83) or have an initial ventricular fibrillation/ventricular tachycardia arrest rhythm (OR = 0.66, 95%CI = 0.58-0.76). Black patients had lower rates of survival following hospital admission (OR = 0.59, 95%CI = 0.48-0.72) and discharge (OR = 0.74, 95%CI = 0.61-0.90).Conclusion: Our work highlights the significant discrepancy in OOHCA characteristics and patient survival in relation to the patient's race, with the black population faring less well across all stages. Most studies compared black and white populations within the US, so research elsewhere and with other ethnic groups is needed. This review exposes an inequality that demands urgent action.

Shah KS; Shah AS; Bhopal R

2012-06-01

 
 
 
 
141

Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: An observational cohort study.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Few clinical trials have provided evidence that epinephrine administration after out-of-hospital cardiac arrest (OHCA) improves long-term survival. Here we determined whether prehospital epinephrine administration would improve 1-month survival in OHCA patients. METHODS: We analyzed the data of 209,577 OHCA patients; the data were prospectively collected in a nationwide Utstein-style Japanese database between 2009 and 2010. Patients were divided into the initial shockable rhythm (n=15,492) and initial non-shockable rhythm (n=194,085) cohorts. The endpoints were prehospital return of spontaneous circulation (ROSC), 1-month survival, and 1-month favorable neurological outcomes (cerebral performance category scale, category 1 or 2) after OHCA. We defined epinephrine administration time as the time from the start of cardiopulmonary resuscitation (CPR) by emergency medical services personnel to the first epinephrine administration. RESULTS: In the initial shockable rhythm cohort, the ratios of prehospital ROSC, 1-month survival, and 1-month favorable neurological outcomes in the non-epinephrine group were significantly higher than those in the epinephrine group (27.7% vs. 22.8%, 27.0% vs. 15.4%, and 18.6% vs. 7.0%, respectively; all p<0.001). However, in the initial non-shockable rhythm cohort, the ratios of prehospital ROSC and 1-month survival in the epinephrine group were significantly higher than those in the non-epinephrine group (18.7% vs. 3.0% and 3.9% vs. 2.2%, respectively; all p<0.001) and there was no significant difference between the epinephrine and non-epinephrine groups for 1-month favorable neurological outcomes (p=0.62). Prehospital epinephrine administration for OHCA patients with initial non-shockable rhythms was independently associated with prehospital ROSC (adjusted odds ratio [aOR], 8.83, 6.18, 4.32; 95% confidence interval [CI], 8.01-9.73, 5.82-6.56, 3.98-4.69; for epinephrine administration times <9 min, 10-19 min, and >20 min, respectively), with improved 1-month survival when epinephrine administration time was <20 min (aOR, 1.78, 1.29; 95% CI, 1.50-2.10, 1.17-1.43; for epinephrine administration times <9 min and 10-19 min, respectively), and with deteriorated 1-month favorable neurological outcomes (aOR, 0.63, 0.49; 95% CI, 0.48-0.80, 0.32-0.71; for epinephrine administration times 10-19 min and >20 min, respectively). CONCLUSIONS: Prehospital epinephrine administration for OHCA patients with initial non-shockable rhythms was independently associated with achievement of prehospital ROSC and had association with improved 1-month survival when epinephrine administration time was <20 min.

Goto Y; Maeda T; Goto YN

2013-09-01

142

Early brain computed tomography findings are associated with outcome in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest  

Science.gov (United States)

Background This study evaluated the association between the results of immediate brain computed tomography (CT) scans and outcome in patients who were treated with therapeutic hypothermia after cardiac arrest. The evaluation was based on the changes in the ratio of gray matter to white matter. Methods A total of 167 patients who were successfully resuscitated after cardiac arrest from March 2009 to December 2011 were included in this study. We selected 51 patients who received a brain CT scan within 1 hour after the return of spontaneous circulation (ROSC) and who had been treated with therapeutic hypothermia. Circular regions of measurement (10 mm2) were placed over regions of interest (ROIs), and the average attenuations in gray matter (GM) and white matter (WM) were recorded in the basal ganglia, at the level of the centrum semiovale and in the high convexity area. Three GM-to-WM ratios (GWRs) were calculated: one for the basal ganglia, one for the cerebrum and the average of the two. The neurological outcomes were assessed using the Cerebral Performance Category (CPC) scale at the time of hospital discharge, and a good neurological outcome was defined as a CPC score of 1 or 2. Results The average GWR was the strongest predictor of poor neurological outcome as determined using receiver operating characteristic curves (basal ganglia area under the curve (AUC)?=?0.716; cerebrum AUC?=?0.685; average AUC?=?0.747). An average GWR?cardiac arrest.

2013-01-01

143

A comparison of survival following out-of-hospital cardiac arrest in Sydney, Australia, between 2004-2005 and 2009-2010.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether survival following outof- hospital cardiac arrest (OHCA) in Sydney, Australia, improved between 2004-2005 and 2009-2010, and whether there was a change in incidence of OHCA. DESIGN: Retrospective study using the Ambulance Service of New South Wales and NSW Registry of Births, Deaths and Marriages databases. PARTICIPANTS AND SETTING: All patients who had an OHCA in the Sydney metropolitan area and who used the Ambulance Service of NSW between June 2009 and May 2010 (2009-2010), and between June 2004 and May 2005 (2004-2005). MAIN OUTCOME MEASURES: Survival to 90 days. Other outcome measures included the incidence of OHCA and survival to the day following OHCA, 28 days and 1 year following OHCA. Survival and incidence were also calculated according to initial electrocardiograph rhythm. RESULTS: Survival to 90 days was 12.3% in 2004-2005 and 10.2% in 2009-2010 (P = 0.015). In 2004-2005, the agestandardised incidence of OHCA was 52.6 events per 100 000 person-years (95% CI, 51.6-53.6 events per 100 000 person-years), and in 2009-2010 it was 48.4 events per 100 000 person-years (95% CI, 46.3-50.4 events per 100 000 person-years). In 2004-2005, the incidence of ventricular fibrillation (VF) was 31.3% (95% CI, 28.4%- 33.9%) and in 2009-2010 it was 22.1% (95% CI, 20.0%- 24.3%). CONCLUSION: There was no improvement in survival following OHCA in Sydney between 2004-2005 and 2009- 2010. There has been a decrease in overall survival from OHCA and a decrease in the overall age-standardised incidence of OHCA. The decrease in overall survival may be due to a decline in the incidence of VF.

Cheung W; Middleton P; Davies S; Tummala S; Thanakrishnan G; Gullick J

2013-09-01

144

The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). Results Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.

Rubertsson Sten; Silfverstolpe Johan; Rehn Liselott; Nyman Thomas; Lichtveld Rob; Boomars Rene; Bruins Wendy; Ahlstedt Björn; Puggioli Helena; Lindgren Erik; Smekal David; Skoog Gunnar; Kastberg Robert; Lindblad Anna; Halliwell David; Box Martyn; Arnwald Fredrik; Hardig Bjarne Madsen; Chamberlain Douglas; Herlitz Johan; Karlsten Rolf

2013-01-01

145

Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. "Prague OHCA study".  

UK PubMed Central (United Kingdom)

BACKGROUND: Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care. METHODS: This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines. PRIMARY OUTCOME: 6 months survival with good neurological outcome (Cerebral Performance Category 1-2). Secondary outcomes will include 30 day neurological and cardiac recovery. DISCUSSION: Authors introduce and offer a protocol of a proposed randomized study comparing a combined "hyperinvasive approach" to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. ETHICS AND REGISTRATION: The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under ClinicalTrials.gov identifier: NCT01511666.

Belohlavek J; Kucera K; Jarkovsky J; Franek O; Pokorna M; Danda J; Skripsky R; Kandrnal V; Balik M; Kunstyr J; Horak J; Smid O; Valasek J; Mrazek V; Schwarz Z; Linhart A

2012-01-01

146

Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care. Methods This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines. Primary outcome 6?months survival with good neurological outcome (Cerebral Performance Category 1–2). Secondary outcomes will include 30?day neurological and cardiac recovery. Discussion Authors introduce and offer a protocol of a proposed randomized study comparing a combined “hyperinvasive approach” to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. Ethics and registration The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under ClinicalTrials.gov identifier: NCT01511666.

Belohlavek Jan; Kucera Karel; Jarkovsky Jiri; Franek Ondrej; Pokorna Milana; Danda Jiri; Skripsky Roman; Kandrnal Vit; Balik Martin; Kunstyr Jan; Horak Jan; Smid Ondrej; Valasek Jaroslav; Mrazek Vratislav; Schwarz Zdenek; Linhart Ales

2012-01-01

147

Propoxyphene and the risk of out-of-hospital death.  

UK PubMed Central (United Kingdom)

PURPOSE: The opioid analgesic propoxyphene was withdrawn from the US market in 2010, motivated by concerns regarding fatality in overdose and adverse cardiac effects, including prolongation of the QT interval. These concerns were based on case reports, summary vital statistics, and surrogate endpoint studies. METHODS: Using the linked Tennessee Medicaid database (1992-2007), we conducted a retrospective cohort study that compared risk of sudden cardiac, medication toxicity, and total out-of-hospital death for propoxyphene users with that for comparable nonusers of any prescribed opioid analgesic and users of hydrocodone, an opioid with similar indications. Cohort members had 1,873,500 propoxyphene prescriptions, 1,873,500 matched nonuser control periods, and 936,750 matched hydrocodone prescriptions. RESULTS: Current propoxyphene users had no increased risk for sudden cardiac death (versus nonusers: hazard ratio [HR] = 1.00 [0.81-1.23]; versus current hydrocodone users: HR = 0.91 [0.68-1.21]) but did have increased risk for medication toxicity deaths (versus nonusers: HR = 1.85 [1.07-3.19], p = 0.027; versus current hydrocodone users: HR = 2.10 [0.87-5.10], p = 0.100). Because toxicity deaths were a small proportion of study deaths, total out-of-hospital mortality differed by less than 10% between the study groups and was not significantly elevated for propoxyphene (versus nonusers: HR = 1.09 [0.95-1.25]; versus current hydrocodone users: HR = 1.06 [0.87-1.29] ). CONCLUSIONS: Our findings support the concern that propoxyphene has greater toxicity in overdose but do not provide evidence that it increases the risk of sudden cardiac death.

Ray WA; Murray KT; Kawai V; Graham DJ; Cooper WO; Hall K; Michael Stein C

2013-04-01

148

Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group.  

Science.gov (United States)

The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event. PMID:18413503

Nichol, Graham; Rumsfeld, John; Eigel, Brian; Abella, Benjamin S; Labarthe, Darwin; Hong, Yuling; O'Connor, Robert E; Mosesso, Vincent N; Berg, Robert A; Leeper, Barbara Bobbi; Weisfeldt, Myron L

2008-04-14

149

[Accidental out-of-hospital deliveries.  

Science.gov (United States)

Unexpected out-of-hospital delivery accounts for 0.5% of the total number of delivery in France. The parturient is placed under constant multiparametric monitoring. Fetus heart rate is monitored thanks to fetal doppler. A high concentration mask containing a 50-to-50 percent mix of O2 and NO performs analgesia. Assistance of mobile pediatric service can be required under certain circumstances such as premature birth, gemellary pregnancy, maternal illness or fetal heart rate impairment. Maternal efforts should start only when head reaches the pelvic floor, only if the rupture of the membranes is done and the dilation is completed. The expulsion should not exceed 30min. Episiotomy should not be systematically performed. A systematic active management of third stage of labour is recommended. Routine care such as warming and soft drying can be performed when the following conditions are fulfilled: clear amniotic liquid, normal breathing, crying and a good tonus. Every 30seconds assessment of heart rate, breathing quality and muscular tonus then guide the care. The redaction of birth certificate is a legal obligation and rests with the attending doctor. PMID:23773899

Bouet, P-E; Chabernaud, J-L; Duc, F; Khouri, T; Leboucher, B; Riethmuller, D; Descamps, P; Sentilhes, L

2013-06-14

150

[Accidental out-of-hospital deliveries.  

UK PubMed Central (United Kingdom)

Unexpected out-of-hospital delivery accounts for 0.5% of the total number of delivery in France. The parturient is placed under constant multiparametric monitoring. Fetus heart rate is monitored thanks to fetal doppler. A high concentration mask containing a 50-to-50 percent mix of O2 and NO performs analgesia. Assistance of mobile pediatric service can be required under certain circumstances such as premature birth, gemellary pregnancy, maternal illness or fetal heart rate impairment. Maternal efforts should start only when head reaches the pelvic floor, only if the rupture of the membranes is done and the dilation is completed. The expulsion should not exceed 30min. Episiotomy should not be systematically performed. A systematic active management of third stage of labour is recommended. Routine care such as warming and soft drying can be performed when the following conditions are fulfilled: clear amniotic liquid, normal breathing, crying and a good tonus. Every 30seconds assessment of heart rate, breathing quality and muscular tonus then guide the care. The redaction of birth certificate is a legal obligation and rests with the attending doctor.

Bouet PE; Chabernaud JL; Duc F; Khouri T; Leboucher B; Riethmuller D; Descamps P; Sentilhes L

2013-06-01

151

Medical Conditions Associated with Out-of-Hospital Endotracheal Intubation  

Science.gov (United States)

OBJECTIVE While prior studies describe the clinical presentation of patients requiring paramedic out-of-hospital endotracheal intubation (ETI), limited data characterize the underlying medical conditions or comorbidities. We sought to characterize the medical conditions and comorbidities of patients receiving successful paramedic out-of-hospital ETI. METHODS We used Pennsylvania statewide EMS clinical data, including all successful ETIs performed during 2003–2005. Using multiple imputation triple-match algorithms, we probabilistically linked EMS ETI to statewide death and hospital admission data. Each hospitalization record contained one primary and up to eight secondary diagnoses, classified according to the International Classification of Diseases, Clinical Modification, ninth edition (ICD-9-CM). We determined the proportion of patients in each major ICD-9-CM diagnostic group and subgroup. We calculated the Charlson Comorbidity Index for each patient. Using binomial proportions with confidence intervals, we analyzed the data and combined imputed results using Rubin's method. RESULTS Across the imputed sets, we linked 25,733 (77.7% linkage) successful ETI to death or hospital records; 56.3% died before and 43.7% survived to hospital admission. Of the 14,479 deaths before hospital admission, most (92.7%, 95% CI: 92.5–93.3%) presented to EMS in cardiac arrest. Of the 11,255 hospitalized patents, the leading primary diagnoses were circulatory diseases (32.0%, 30.2–33.7%), respiratory diseases (22.8%, 21.9–23.7%), and injury or poisoning (25.2%; 22.7–27.8%). Prominent primary diagnosis subgroups included: asphyxia and respiratory failure (15.2%), traumatic brain injury and skull fractures (11.3%), acute myocardial infarction and ischemic heart disease (10.9%), poisoning, drug and alcohol disorders (6.7%), dysrhythmias (6.7%), hemorrhagic and non-hemorrhagic stroke (5.9%), acute heart failure and cardiomyopathies (5.6%), pneumonia and aspiration (4.9%), and sepsis, septicemia and septic shock (3.2%). Most of the admitted ETI patients had a secondary circulatory (70.8%), respiratory (61.4%), or endocrine, nutritional or metabolic secondary diagnosis (51.4%). The mean Charlson Index score was 1.6 (95% CI: 1.5–1.7). CONCLUSIONS The majority of successful paramedic ETI occur on patients with cardiac arrest, circulatory and respiratory conditions. Injury, poisoning and other conditions compromise smaller but important portions. ETI patients have multiple comorbidities. These findings may guide the systemic planning of paramedic airway management care and education.

Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Yealy, Donald M.; Lave, Judith R.

2011-01-01

152

Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching--taking the recommendations on reporting OHCA the Utstein style a step further  

DEFF Research Database (Denmark)

OBJECTIVES: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and potentially other health care providers. EMCC in many cases initiates the communication with experts in the referral hospital and provide added value to the post resuscitation care by providing advanced transport, logistics and follow up. In research there is a growing focus on the EMCC/EMDs impact on survival in OHCA. The lack of standards in reporting results from medical dispatching is an obstacle for thorough evaluation of results in this area and comparison of data. The objective for this paper is to introduce a framework for uniform reporting of the dispatching process for quality improvement, collecting and reporting data and exchanging information regarding OHCA.

Castrén, M; Bohm, K

2011-01-01

153

The use of statistical process control (risk-adjusted CUSUM, risk-adjusted RSPRT and CRAM with prediction limits) for monitoring the outcomes of out-of-hospital cardiac arrest patients rescued by the EMS system.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Based on previous experience from surgical surveillance, risk-adjusted cumulative sum (CUSUM)-type charts were applied to monitor out-of-hospital cardiac arrest (OHCA) patient mortality. MATERIALS AND METHODS: Data from 2356 OHCA patients were collected by the Taipei County Fire Bureau from June 2006 to November 2007. Logistic regression analysis was applied to create a risk-adjusted model. Next, a risk-adjusted CUSUM chart, a risk-adjusted resetting sequential probability ratio test chart and a cumulative risk-adjusted mortality with prediction limits chart were used to detect excess deaths of the OHCA patients rescued by the emergency medical service (EMS) system. RESULTS: The overall mortality rate, defined as having no return of spontaneous circulation, was 79.3%. These three charts signalled an increase in the death rate at similar sites, and also suggested a small process shift. Conclusion: A visual approach to EMS systems monitoring that combines the risk-adjusted cumulative sum, Risk-adjusted resetting sequential probability ratio test and cumulative risk-adjusted mortality with prediction limits charts was established. It was found that this approach can be effectively used by the EMS community to monitor OHCA outcomes in real time.

Chen TT; Chung KP; Hu FC; Fan CM; Yang MC

2011-02-01

154

Dispatch-assisted CPR: Where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller-dispatcher interactions during after out-of-hospital cardiac arrest using a novel call transcription technique.  

UK PubMed Central (United Kingdom)

BACKGROUND: Survival from out-of-hospital cardiac arrest (OHCA) is dependent on the chain of survival. Early recognition of cardiac arrest and provision of bystander cardiopulmonary resuscitation (CPR) are key determinants of OHCA survival. Emergency medical dispatchers play a key role in cardiac arrest recognition and giving telephone CPR advice. The interaction between caller and dispatcher can influence the time to bystander CPR and quality of resuscitation. We sought to pilot the use of emergency call transcription to audit and evaluate the holdups in performing dispatch-assisted CPR. METHODS: A retrospective case selection of 50 consecutive suspected OHCA was performed. Audio recordings of calls were downloaded from the emergency medical dispatch centre computer database. All calls were transcribed using proprietary software and voice dialogue was compared with the corresponding stage on the Medical Priority Dispatch System (MPDS). Time to progress through each stage and number of caller-dispatcher interactions were calculated. RESULTS: Of the 50 downloaded calls, 47 were confirmed cases of OHCA. Call transcription was successfully completed for all OHCA calls. Bystander CPR was performed in 39 (83%) of these. In the remaining cases, the caller decided the patient was beyond help (n=7) or the caller said that they were physically unable to perform CPR (n=1). MPDS stages varied substantially in time to completion. Stage 9 (determining if the patient is breathing through airway instructions) took the longest time to complete (median=59s, IQR 22-82s). Stage 11 (giving CPR instructions) also took a relatively longer time to complete compared to the other stages (median=46s, IQR 37-75s). Stage 5 (establishing the patient's age) took the shortest time to complete (median=5.5s, IQR 3-9s). CONCLUSION: Transcription of OHCA emergency calls and caller-dispatcher interaction compared to MPDS stage is feasible. Confirming whether a patient is breathing and completing CPR instructions required the longest time and most interactions between caller and dispatcher. Use of call transcription has the potential to identify key factors in caller-dispatcher interaction that could improve time to CPR and further research is warranted in this area.

Clegg GR; Lyon RM; James S; Branigan HP; Bard EG; Egan GJ

2013-09-01

155

Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation  

Directory of Open Access Journals (Sweden)

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 arrest situation, in a familiar or unknown victim and, moreover, fears that deter them from starting CPR are remarkably reduced.

Theodore Kapadohos; Virginia Karamali; Maria Polikandrioti; Maria Meidani

2008-01-01

156

Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: To determine neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA) and treatment with mild therapeutic hypothermia (MTH). METHODS: Seventy-three consecutive OHCA patients treated with MTH were retrospectively analyzed. Serum neuron-specific enolase (NSE) was measured 24, 48, and 72 h after admission. In patients with no motor response 48 h after termination of analgosedation (n = 40), clinical neurological examination and evoked potentials (EPs) were determined. Neurological outcome was assessed after 2 months based on the cerebral performance categories (CPC), and categorized as good (CPC 1-3) or poor (CPC 4 and 5). RESULTS: Forty-three patients had a CPC score of 1-3 and 30 patients had a CPC 4-5. The best predictive value for poor neurologic outcome was an increase of NSE by ?4.3 ng/mL between day 1 and day 2 (sensitivity 80 %, specificity 100 %, positive predictive value (PPV) 100 %, negative predictive value 86 %). Absolute NSE values were less reliable in the prediction of poor outcome with the highest sensitivity (88 %) and specificity (95 %) if values reached ?36.3 ng/mL on day 3. Somatosensory EPs (SSEPs) showed a specificity of 100 % and PPV of 100 %; however, sensitivity for evoked potentials was low (29 %). Intriguingly, two initially comatose patients with excessive NSE values (24 h NSE: 101 and 256 ng/mL, and 48 h NSE: 93 and 110 ng/mL, respectively) had physiological SSEPs and regained a CPC score of 1. CONCLUSION: In patients treated with MTH after OHCA changes in NSE are more suitable than its absolute serum levels for the prediction of poor neurologic outcome. Since unequivocal prediction of poor neurologic outcome is of utmost importance in these patients the decision to limit therapy must be based on several prediction tools with the highest PPV and specificity including SSEPs.

Huntgeburth M; Adler C; Rosenkranz S; Zobel C; Haupt WF; Dohmen C; Reuter H

2013-07-01

157

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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%, (more) 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. Abstract in english 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%, re (more) sponse 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 existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Aguilera-Campos, Andrea; Asensio-Lafuente, Enrique; Fraga-Sastrías, Juan Manuel

2012-02-01

158

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  

Directory of Open Access Journals (Sweden)

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 existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea Aguilera-Campos; Enrique Asensio-Lafuente; Juan Manuel Fraga-Sastrías

2012-01-01

159

[Out-of-hospital resuscitation in Israel 2000  

UK PubMed Central (United Kingdom)

The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, performed by mobile intensive cardiac care units of Magen David Adom (MDA) teams in the framework of a national survey conducted in the period February and March 2000. During the survey, MDA performed 539 resuscitations, 485 of which were performed by mobile intensive care units of MDA, and they constitute the study population of the present analysis. The average age of the patients was 70.5 years, and 68% were men. The mean response time of the mobile intensive care units was 10.3 minutes. In 14% of the cases, a bystander initiated basic cardiac life support before the arrival of the MDA team. Upon arrival of the resuscitation team, 242 patients (50%) had asystole, 19% ventricular tachycardia (VT)/ventricular fibrillation (VF), 13% pulseless electrical activity (PEA), and 18% had other severe arrhythmias. One hundred and ninety-nine patients (41%) were transferred alive to the hospital after successful resuscitation. Hospital summaries were obtained for 148 of these patients. The cause of cardiac arrest was cardiac in 64% of the cases and 48% of the patients who reached the hospital had a previous history of heart disease. Fifty-three patients (11%) were discharged alive from the hospital. Patients discharged alive were younger, more promptly resuscitated, 78% had a cardiac cause of death and 38% of them were in ventricular tachycardia/fibrillation when first seen by the resuscitation team. The rate of successful resuscitation to discharge in the sub-group with VT/VF was 21%, and only 4% for patients in asystole, which is in line with other studies. However, the rate of initiation of resuscitation by bystanders is low in Israel. These data may help the medical staff and the health policy providers in Israel.

Canetti M; Feigenberg Z; Caspi A; Leor J; Hod H; Green M; Hasin Y; Battler A; Garty M; Mittelman M; Porath A; Grossman E; Behar S

2004-11-01

160

[Out-of-hospital resuscitation in Israel 2000].  

Science.gov (United States)

The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, performed by mobile intensive cardiac care units of Magen David Adom (MDA) teams in the framework of a national survey conducted in the period February and March 2000. During the survey, MDA performed 539 resuscitations, 485 of which were performed by mobile intensive care units of MDA, and they constitute the study population of the present analysis. The average age of the patients was 70.5 years, and 68% were men. The mean response time of the mobile intensive care units was 10.3 minutes. In 14% of the cases, a bystander initiated basic cardiac life support before the arrival of the MDA team. Upon arrival of the resuscitation team, 242 patients (50%) had asystole, 19% ventricular tachycardia (VT)/ventricular fibrillation (VF), 13% pulseless electrical activity (PEA), and 18% had other severe arrhythmias. One hundred and ninety-nine patients (41%) were transferred alive to the hospital after successful resuscitation. Hospital summaries were obtained for 148 of these patients. The cause of cardiac arrest was cardiac in 64% of the cases and 48% of the patients who reached the hospital had a previous history of heart disease. Fifty-three patients (11%) were discharged alive from the hospital. Patients discharged alive were younger, more promptly resuscitated, 78% had a cardiac cause of death and 38% of them were in ventricular tachycardia/fibrillation when first seen by the resuscitation team. The rate of successful resuscitation to discharge in the sub-group with VT/VF was 21%, and only 4% for patients in asystole, which is in line with other studies. However, the rate of initiation of resuscitation by bystanders is low in Israel. These data may help the medical staff and the health policy providers in Israel. PMID:15603265

Canetti, M; Feigenberg, Z; Caspi, A; Leor, J; Hod, H; Green, M; Hasin, Y; Battler, A; Garty, M; Mittelman, M; Porath, A; Grossman, E; Behar, S

2004-11-01

 
 
 
 
161

[Aortic Valve-sparing Operation for Chronic Dissecting Aneurysm of the Sinus of Valsalva Associated with Redissection in a Young Woman Who Experienced Out-of-hospital Cardiac Arrest].  

UK PubMed Central (United Kingdom)

A 38-year-old woman was admitted to our hospital because she experienced cardiopulmonary arrest at her wedding;her cardiac beats were resumed 20 min after cardiopulmonary resuscitation performed by her relatives and hotel staffs. Enhanced computed tomography revealed acute aortic redissection in chronic dissecting aneurysm in the right sinus of Valsalva, which was believed to have occurred in the 4th month of pregnancy 2 years before. Echocardiography showed moderate aortic regurgitation. We performed aortic valve-sparing operation and ascending aortic replacement with partial remodeling of the right sinus of Valsalva. She returned to work 2 months later without high-order dysfunction.

Matsumoto M; Kubo Y; Kemmochi R; Yamasawa T; Oka T; Iwasaki J; Morimoto N; Hagioka S; Sugiyama J; Hagiya H

2013-08-01

162

Refibrillation during out-of-hospital arrest: A frequent event with clinical consequences  

Directory of Open Access Journals (Sweden)

Full Text Available The refibrillation was a frequent event in out-of-hospital cardiac arrest (OHCA). The number of recurrences of ventricular fibrillation (VF) is in inverse relationship with survival. In this article we discuss about causes and mechanism of refibrillation. The amiodarone and new technical solution (defibrillators that may allow continuous monitoring of the heart rhythm, while chest compressions continue and recommend defibrillation when refibrillation occurs) are promising new strategy to improve outcome of OHCA and recurrent VF.

RUDOLPH W. KOSTER

2010-01-01

163

[Hypothermia after cardiac arrest--daily trained clinical practice? A survey at northern Germany hospitals].  

UK PubMed Central (United Kingdom)

Hypothermia after out of hospital cardiac arrest should be clinical practice for years. But is it really meanwhile daily trained practice? A survey at northern German hospitals gives an answer to this question.

Heller G; Gräsner JT; Dörges V; Scholz J

2007-06-01

164

Cardiac myofibroblasts: cells out of balance. A new thematic series  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We are pleased to introduce a new thematic series dealing with cardiac fibrosis and its association with cardiovascular diseases. A wide variety of cardiovascular diseases are associated with cardiac fibrosis, which is now widely recognized to be not a secondary, but rather a primary contributor to cardiac dysfunction. The purpose of the current series of papers and reviews is to provide the reader with an up-to-date synopsis of the very latest research results and hypotheses that impact on cardiac fibrosis and disease.

Dixon Ian M C

2012-01-01

165

An automated CPR device compared with standard chest compressions for out-of-hospital resuscitation  

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Full Text Available Abstract Background Effective cardiopulmonary resuscitation and increased coronary perfusion pressures have been linked to improved survival from cardiac arrest. This study aimed to compare the rates of survival between conventional cardiopulmonary resuscitation (C-CPR) and automated CPR (A-CPR) using AutoPulse™ in adults following out-of-hospital cardiac arrest (OHCA). Methods This was a retrospective study using a matched case–control design across three regional study sites in Victoria, Australia. Each case was matched to at least two (maximum four) controls using age, gender, response time, presenting cardiac rhythm and bystander CPR, and analysed using conditional fixed-effects logistic regression. Results During the period 1 October 2006 to 30 April 2010 there were 66 OHCA cases using A-CPR. These were matched to 220 cases of OHCA involving the administration of C-CPR only (controls). Survival to hospital was achieved in 26% (17/66) of cases receiving A-CPR compared with 20% (43/220) of controls receiving C-CPR and the propensity score adjusted odds ratio [AOR (95% CI)] was 1.69 (0.79, 3.63). Results were similar using only bystander witnessed OHCA cases with presumed cardiac aetiology. Survival to hospital was achieved for 29% (14/48) of cases receiving A-CPR compared with 18% (21/116) of those receiving C-CPR [AOR?=?1.80 (0.78, 4.11)]. Conclusions The use of A-CPR resulted in a higher rate of survival to hospital compared with C-CPR, yet a tendency for a lower rate of survival to hospital discharge, however these associations did not reach statistical significance. Further research is warranted which is prospective in nature, involves randomisation and larger number of cases to investigate potential sub-group benefits of A-CPR including survival to hospital discharge.

Jennings Paul A; Harriss Linton; Bernard Stephen; Bray Janet; Walker Tony; Spelman Tim; Smith Karen; Cameron Peter

2012-01-01

166

Out-of-hospital quantitative monitoring of end-tidal carbon dioxide pressure during CPR.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: To assess the feasibility and potential usefulness of quantitative measurement of end-tidal carbon dioxide pressure (PETCO2) during out-of-hospital cardiac arrest. DESIGN: Emergency medical technician-paramedics (EMT-Ps) were instructed in the operation of a portable battery-powered capnograph, the sensor for which was attached to the endotracheal tube following intubation. This was a preliminary pilot study limited to defining feasibility and potential utility in a small group of patients. SETTING: City with population of 70,745 served by an advanced life support emergency medical services system. PARTICIPANTS: Initial group of four patients who experienced out-of-hospital cardiac arrest and who were treated by EMT-Ps trained in operation of the capnograph. INTERVENTIONS: As soon as possible following endotracheal intubation a mainstream sensor was connected to the endotracheal tube and digital and capnographic waveform data obtained for the remainder of the resuscitation. Data were stored in memory and subsequently retrieved for the entire event, with digital readings at eight-second intervals. RESULTS: Capnographic measurements were obtained immediately after endotracheal intubation in all four patients. The capnograph was operated without difficulty throughout the resuscitations. Changes in performance of chest compression or changes in cardiac rhythm were reflected immediately in changes in (PETCO2). Persistent excretion of carbon dioxide during pulselessness was observed in two patients, consistent with "pseudo-electromechanical dissociation." CONCLUSION: These preliminary pilot observations confirm the feasibility of quantitative capnography during out-of-hospital cardiac arrest and indicate that early institution of this noninvasive procedure may provide insight into pathophysiologic mechanisms such as pseudo-electromechanical dissociation and may also track changes in pulmonary blood flow during chest compressions or during spontaneous circulation.

White RD; Asplin BR

1994-01-01

167

Out-of-hospital noninvasive ventilation: epidemiology, technology and equipment  

Directory of Open Access Journals (Sweden)

Full Text Available Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children.

John Scott Baird; Thyyar M. Ravindranath

2012-01-01

168

Chronic memory impairment after cardiac arrest outside hospital.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To evaluate the nature, prevalence, and severity of chronic memory deficit in patients resuscitated after cardiac arrest outside hospital and to determine whether such deficits are related to duration of cardiac arrest. DESIGN: Case-control study. SUBJECTS: 35 survivors of cardiac arrest outside hospital and 35 controls matched for age and sex who had had acute myocardial infarction without cardiac arrest. MAIN OUTCOME MEASURES: Subjects assessed at least two months after index event for affective state (hospital anxiety and depression scale), premorbid intelligence (national adult reading test), short term recall (digit recall test), and episodic long term memory (Rivermead behavioural memory test). RESULTS: Cases and controls showed no difference in short term recall. Cases scored lower on Rivermead test than controls (mean (SD) score out of 24 points: 17.4 (5.4) v 21.8 (2.0), P < 0.001), particularly in subtests relating to verbal and spatial memory. Moderate or severe impairment was found in 37% of cases and in no controls. Severity of impairment of memory correlated significantly with measures of duration of cardiac arrest. This deficit was not significantly associated with subjects' age, interval from index event to assessment, occupation, measures of comorbidity, social deprivation, anxiety or depression scores, or estimated premorbid intelligence. CONCLUSIONS: Clinically important impairment of memory was common after cardiac arrest outside hospital. Improvement in response times of emergency services could reduce the severity of such deficits. With an increasing numbers of people expected to survive cardiac arrest outside hospital, rehabilitation of those with memory deficit merits specific attention.

Grubb NR; O'Carroll R; Cobbe SM; Sirel J; Fox KA

1996-07-01

169

Association of out-of-hospital criteria with need for hospital admission.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To validate high-risk historical and physiologic out-of-hospital criteria as predictors of the need for hospitalization following ED evaluation. METHODS: Consecutive patients entered into the Suffolk County advanced life support system were enrolled. Previously proposed historical and physiologic "high-risk" criteria for hospitalization were prospectively collected. Criteria were associated with the need for hospital admission following ED evaluation. RESULTS: 1,238 patients were enrolled; 391 were released from an ED after transport. Most patients (843/1,238; 68%) were admitted to a hospital; and four died in the ED. Factors associated with an increased likelihood of admission or death among the transported patients were: bradycardia (90% admitted, p < 0.02); hypotension (80%, p < 0.03); hypertension (89%, p < 0.03); and age > 55 years (81%, p < 0.0001). Unresponsiveness and other abnormal vital signs were not associated with admission on univariate analysis. Logistic regression analysis identified two other factors associated with admission or death: tachycardia (72% admitted, p < 0.01) and head injury (78% admitted, p < 0.001). CONCLUSIONS: Abnormal pulse or blood pressure, head injury, and age > 55 years are associated with patients' requiring hospital admission after accessing the emergency medical services system. These criteria may aid the design of out-of-hospital refusal-of-care policies.

Burstein JL; Hollander JE; Henry MC; Delagi R; Thode HC Jr

1995-10-01

170

Post-traumatic stress disorder symptomology associated with witnessing unsuccessful out-of-hospital cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The objective was to assess symptoms of post-traumatic stress disorder (PTSD) associated with witnessing unsuccessful out-of-hospital cardiopulmonary resuscitation (CPR) on a family member. METHODS: Adult family members of deceased, adult, nontraumatic out-of-hospital cardiac arrest victims who were transported to a large, Midwestern hospital were contacted by telephone beginning 1 month after the event. Subjects were dichotomized as to whether or not they were physically present during the patient's resuscitation. A structured interview obtained the patient's prearrest functioning, whether the family member witnessed or performed CPR, patient and family demographic data, key cardiac arrest events, and a measure of subject PTSD symptoms (PTSD Symptom Scale-Interview [PSS-I]). RESULTS: There were 34 witnesses and 20 nonwitnesses. Each group was similar in race, religion, age, gender, and relationship to the patient. Patients in each group were similar in prearrest functioning. Witnesses' total PTSD symptom scores were nearly two times higher than nonwitnesses (14.47 vs. 7.60, respectively; mean difference = 6.87, 95% confidence interval [CI] = 0.57 to 13.17). Two PSS-I subscales were higher for witnesses than nonwitnesses: Avoidance (5.41 vs. 2.25; mean difference = 3.16, 95% CI = 0.74 to 5.58) and Increased Arousal (4.26 vs. 2.20; mean difference = 2.06, 95% CI = 0.08 to 4.05), while Reexperiencing was not (4.79 vs. 3.15; mean difference = 1.64, 95% CI = -0.62 to 3.91). Linear regression analysis indicated that witnessing CPR of a loved one was associated with a mean increase of nearly 12 points on the PSS-I after controlling for the possibility of other potentially influential events and characteristics. Results were similar when CPR providers (n = 6) were removed from the witness group. CONCLUSIONS: Witnessing a failed CPR attempt of a loved one in an out-of-hospital location may be associated with displaying symptoms of PTSD in the early term of the bereavement period. While preliminary, these data suggest that the relationship exists even after controlling for other potential factors that may also affect the propensity for displaying such symptoms, such as the suddenness and location of the patient's cardiac arrest.

Compton S; Grace H; Madgy A; Swor RA

2009-03-01

171

What accounting leaves out of hospital financial management.  

Science.gov (United States)

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

Boles, K E; Glenn, J K

172

What accounting leaves out of hospital financial management.  

UK PubMed Central (United Kingdom)

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.

Boles KE; Glenn JK

1986-03-01

173

Cardiovascular collapse after return of spontaneous circulation in human out-of-hospital cardiopulmonary arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Animal studies describe cardiovascular collapse (CVC; hypotension or reoccurrence of cardiac arrest) after return of spontaneous circulation (ROSC) from cardiopulmonary arrest. Few studies describe CVC in humans. This study aimed to determine the occurrence of CVC in human out-of-hospital cardiopulmonary arrest (OHCA). METHODS: Using observational data from a site of the Resuscitation Outcomes Consortium, the study analysed treated, non-traumatic OHCA achieving initial ROSC. CVC was defined as post-ROSC hypotension (systolic blood pressure ?80 mm?Hg), post-ROSC administration of epinephrine, vasopressin or dopamine, or post-ROSC recurrent cardiac arrest. The time period from initial ROSC to emergency department (ED) arrival was measured. The prevalence of and elapsed time to post-ROSC CVC was determined, censoring cases at the point of ED arrival and comparing clinical characteristics between CVC and non-CVC cases. RESULTS: Of 1081 treated OHCA, ROSC occurred in 58 (5%; 95% CI 4% to 7%). CVC occurred in three cases of 58 ROSC (5%; 95% CI 1% to 14%), all due to recurrent cardiac arrest. The median ROSC to ED arrival time was 6 min (IQR 3-13 min). ROSC to CVC times were 1, 2 and 8 min. Patient sex, age, initial ECG rhythm, endotracheal intubation, bystander cardiopulmonary resuscitation and bystander automated external defibrillation were similar between CVC and non-CVC cases (p=0.11-1.00). CONCLUSIONS: In this series of treated OHCA, only a small fraction of patients experienced CVC after ROSC.

Chestnut JM; Kuklinski AA; Stephens SW; Wang HE

2012-02-01

174

In-hospital cardiac arrest: can we change something?  

UK PubMed Central (United Kingdom)

Cardiac arrest is classified as 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization.The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period.We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4?%), surgical (25.24?%) and neurosurgical patients (15.2?%) with many associated severe diseases. In 85.6?% of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67?% of the cases. However, in 14.6?% of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p?=?0.001), presence of cerebral ischemia (p?=?0.026) or cardiomyopathy (p?=?0.004) and duration of CPR (p?=?0.041). Initial survival was very low (14.6?%), and full recovery was accomplished in only eight patients out of 309 (2.59?%).Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success.

Ružman T; Tot OK; Ivi? D; Gulam D; Ružman N; Burazin J

2013-08-01

175

Are we running out of thoracic or cardiac surgeons? Demography of thoracic and cardiac surgeons in France in 2012.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The aim of the study was to accurately evaluate the inflow and outflow of thoracic and cardiac surgeons in France. METHODS: The French Society of Thoracic and Cardiovascular Surgery (SFCTCV) built a database of the surgeons involved in thoracic and/or cardiac surgery in France. It included all surgeons who perform cardiac or thoracic surgery regardless of the number of operations performed per year, whether or not they are members of the SFCTCV and all trainees once they have expressed an interest in thoracic and/or cardiac surgery. RESULTS: The database included 552 senior surgeons (professors, attending surgeons in public practice and attending surgeons in private practice) practicing cardiac and/or thoracic surgery. Of these, 206 practiced cardiac, 278 thoracic and 68 both. The 'inflow' includes 128 residents and 83 senior residents. Global analysis of age distribution showed a mean predictable outflow of 17.6 senior surgeons per year between 2013 and 2022. The 'inflow' of finishing senior residents for the next 5 years was 18 per year. The number of residents was 25 per year of residency. Cardiac surgeon 'outflow' was 7.7 per year and the inflow of finishing senior residents 10-11 per year. The difficult period will be 2015-19 with an excess of 5 finishing senior residents per year. Thoracic surgeon 'outflow' was 11.7 and inflow 10 per year. Gender distribution indicated an increasing feminization. The female proportion was 5, 23 and 31% among senior surgeons, senior residents and residents, respectively. CONCLUSIONS: France will not run out of cardiothoracic surgeons. The inflow compensates for the outflow of surgeons liable to stop their activity in the next 10 years.

Laskar M; Spinosi AM; Bendjebla Y; Moreau J; Dahan M

2013-04-01

176

Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To estimate the potential impact of public access defibrillators on overall survival after out of hospital cardiac arrest. DESIGN: Retrospective cohort study using data from an electronic register. A statistical model was used to estimate the effect on survival of placing public access defibrillators at suitable or possibly suitable sites. SETTING: Scottish Ambulance Service. SUBJECTS: Records of all out of hospital cardiac arrests due to heart disease in Scotland in 1991-8. MAIN OUTCOME MEASURES: Observed and predicted survival to discharge from hospital. RESULTS: Of 15 189 arrests, 12 004 (79.0%) occurred in sites not suitable for the location of public access defibrillators, 453 (3.0%) in sites where they may be suitable, and 2732 (18.0%) in suitable sites. Defibrillation was given in 67.9% of arrests that occurred in possibly suitable sites for locating defibrillators and in 72.9% of arrests that occurred in suitable sites. Compared with an actual overall survival of 744 (5.0%), the predicted survival with public access defibrillators ranged from 942 (6.3%) to 959 (6.5%), depending on the assumptions made regarding defibrillator coverage. CONCLUSIONS: The predicted increase in survival from targeted provision of public access defibrillators is less than the increase achievable through expansion of first responder defibrillation to non-ambulance personnel, such as police or firefighters, or of bystander cardiopulmonary resuscitation. Additional resources for wide scale coverage of public access defibrillators are probably not justified by the marginal improvement in survival.

Pell JP; Sirel JM; Marsden AK; Ford I; Walker NL; Cobbe SM

2002-09-01

177

Relationship between the hemoglobin level at hospital arrival and post-cardiac arrest neurologic outcome.  

UK PubMed Central (United Kingdom)

BACKGROUND: The hemoglobin (Hb) level is an essential determinant of oxygen delivery. The restoration of blood perfusion to vital organs and the capacity for oxygen delivery may be associated with ischemia and reperfusion injuries during cardiac arrest and after cardiac arrest. However, whether the Hb level is associated with neurologic outcome in post-cardiac arrest patients remains unclear. METHODS: Emergency medical service information and clinical demographics were compiled for witnessed out-of-hospital cardiac arrest patients with coma after the restoration of spontaneous circulation. The study end point was defined as a favorable neurologic outcome at 28 days. We evaluated the relationship between the Hb level at the time of hospital arrival and the neurologic outcome using univariate analyses and a multivariate logistic regression analysis. RESULTS: There were 137 witnessed cardiac arrest patients: 49 (35.7%) survived and 34 (24.8%) achieved a favorable neurologic outcome. Univariate analyses showed that the favorable outcome group was characterized as having a higher Hb level, a younger age, a higher percentage of male patients, and ventricular fibrillation as the initial cardiac rhythm. In a multivariate analysis adjusting for potential confounding factors, the Hb level at the time of hospital arrival (odds ratio, 1.26; 95% confidence interval, 1.00-1.58) was an independent predictor of a favorable neurologic outcome. CONCLUSION: A higher Hb level at the time of hospital arrival was associated with a favorable short-term neurologic outcome among post-cardiac arrest patients with a presumed cardiac etiology.

2012-06-01

178

Out-of-pocket costs for paediatric admissions in district hospitals in Kenya.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objective? To describe out-of-pocket costs of inpatient care for children under 5?years of age in district hospitals in Kenya. Methods? A total of 256 caretakers of admitted children were interviewed in 2-week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to ...

Barasa, EW; Ayieko, P; Cleary, S; English, M

179

Association between a hospital's rate of cardiac arrest incidence and cardiac arrest survival.  

UK PubMed Central (United Kingdom)

IMPORTANCE: National efforts to measure hospital performance in treating cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. OBJECTIVE: To describe the association between inpatient cardiac arrest incidence and survival rates. DESIGN: Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000, and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital's cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics. MAIN OUTCOMES AND MEASURES: The correlation between a hospital's incidence rate and case-survival rate for cardiac arrest. RESULTS: Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (interquartile range, 2.95-5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (interquartile range, 14.5%-22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (r, -0.16; P = .003). This relationship persisted after adjusting for patient characteristics (r, -0.15; P = .004). After adjusting for potential mediators of this relationship (ie, hospital characteristics), the relationship between incidence and case survival was attenuated (r, -0.07; P = .18). The one modifiable hospital factor that most attenuated this relationship was a hospital's nurse-to-bed ratio (r, -0.12; P = .03). CONCLUSIONS AND RELEVANCE: Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case mix. This relationship is partially mediated by measured hospital attributes. Performance measures focused on case-survival rates seem an appropriate first step in quality measurement for in-hospital cardiac arrest.

Chen LM; Nallamothu BK; Spertus JA; Li Y; Chan PS

2013-07-01

180

Disclosure of harmful medical errors in out-of-hospital care.  

UK PubMed Central (United Kingdom)

Safety experts and national guidelines recommend disclosing harmful medical errors to patients. Communicating with patients and families about errors respects their autonomy, supports informed decisionmaking, may decrease malpractice costs, and can enhance patient safety. Yet existing disclosure guidelines may not account for the difficulty in discussing out-of-hospital errors with patients. Emergency medical services (EMS) providers operate in unpredictable environments that require rapid interventions for patients with whom they have only brief relationships. EMS providers also have limited access to patient medical data and risk management resources, which can make conducting disclosure conversations even more difficult. In addition, out-of-hospital errors may be discovered only after the transition of care to the inpatient setting, further complicating the question of who should disclose the error. EMS organizations should support the disclosure of out-of-hospital errors by fostering a nonpunitive culture of error reporting and disclosure, as well as developing guidelines for use by EMS systems.

Lu DW; Guenther E; Wesley AK; Gallagher TH

2013-02-01

 
 
 
 
181

Increased survival despite a reduction in out-of-hospital ventricular fibrillation in north-east Italy.  

UK PubMed Central (United Kingdom)

BACKGROUND: We have reported the epidemiology and survival rate of out-of-hospital cardiac arrest (OOH-CA) in a north-east region of Italy previously, the Friuli-Venezia-Giulia Arrest Cooperative Study (FACS). We present the results of a second observational, prospective, multicentre study on OOH-CA victims in a local area in the same geographical Italian region. METHODS AND RESULTS: The area investigated, Pordenone province, is representative of the entire region studied in 1994. In the 1994 FACS study, the heterogeneous ambulance personnel, ranging from volunteers to registered nurses and physicians, were not all trained in basic life support and early defibrillation. In 2003 all rescuers had advanced cardiac life support (ACLS) skills. Moreover, in 2003 dispatch-guided CPR was used. The time from dispatch to defibrillation of victims of OOH-CA from cardiac aetiology was comparable between 1994 and 2003. However, the rate of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as presenting rhythm decreased significantly between 1994 and 2003 from 30.2% to 20.1% (p < 0.05). Despite this, survival to hospital discharge for VF/VT almost tripled (15.4% versus 41.0%; p < 0.05). Hospital discharge for asystole or pulseless electrical activity remained dismal (3.1% and 1.7%). CONCLUSIONS: Despite a reduction in the rate of VF/VT as presenting rhythm, survival was almost tripled. Manning all ambulances with professional emergency medical personnel and ACLS training together with dispatch-guided CPR may have contributed to the improvements observed in survival rates.

Kette F; Pellis T

2007-01-01

182

Guidance for ambulance personnel on decisions and situations related to out-of-hospital CPR.  

UK PubMed Central (United Kingdom)

Ethical guidelines on out-of-hospital cardio-pulmonary resuscitation (CPR) are designed to provide substantial guidance for the people who have to make decisions and deal with situations in the real world. The crucial question is whether it is possible to formulate practical guidelines that will make things somewhat easier for ambulance personnel. The aims of this article are to address the ethical aspects related to out-of-hospital CPR, primarily to decisions on not starting or terminating resuscitation attempts, using the views and experience of ambulance personnel as a starting point, and to summarise the key points in a practice guideline on the subject.

Ågård A; Herlitz J; Castrén M; Jonsson L; Sandman L

2012-01-01

183

Evidence from the scene: paramedic perspectives on involvement in out-of-hospital research.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: In the context of calls to develop better systems for out-of-hospital clinical research, we seek to understand paramedics' perceptions of involvement in research and the barriers and facilitators to that involvement. METHODS: This was a qualitative study using semistructured focus groups with 58 United Kingdom paramedics and interviews with 30 US firefighter-paramedics. The study focused on out-of-hospital research (trials of out-of-hospital treatment for stroke), whereby paramedics identified potential study subjects or obtained consent and administered study treatment in the field. Data were analyzed with a thematic and discourse approach. RESULTS: Three key themes emerged as significant facilitators and barriers to paramedic involvement in research: patient benefit, professional identity and responsibility, and time. Paramedics showed willingness and capacity to engage in research but also some reticence because of the perceived sacrifice of autonomy and challenge to their identity. Paramedics work in a time-sensitive environment and were concerned that research would increase time taken in the field. CONCLUSION: Awareness of these perspectives will help with development of out-of-hospital research protocols and potentially facilitate greater participation.

Burges Watson DL; Sanoff R; Mackintosh JE; Saver JL; Ford GA; Price C; Starkman S; Eckstein M; Conwit R; Grace A; Murtagh MJ

2012-11-01

184

[Out-of- pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7,318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Rocha-García A; Hernández-Peña P; Ruiz-Velazco S; Avila-Burgos L; Marín-Palomares T; Lazcano-Ponce E

2003-07-01

185

Microbial Contamination of Staff’s Hand while Going out of Hospital  

Directory of Open Access Journals (Sweden)

Full Text Available Background and Objective: Cross-transmission of microorganisms by the hands of health care workers is considered as a main transmission route of nosocomial infections. The aim of this study was to investigate the microbial contamination of health-care worker’s hands while going out of hospital. Material and Methods: Wearing the sterile glove with liquid culture, we obtained 100 Samples from the staff’s hands of three departments (clerical department, emergency ward and central laboratory) of Emam Reza hospital. After that, the samples were cultured. Results: Of all personnel, 40% have the habit of washing their hands. Of these, 95 percent wash their hands with water and soap, and 5 percent with alcohol rubs. Of 100 cultured samples, 90 have microorganisms including non-pathogen gram-positive bacillus (29%), coagulase-positive staphylococcus (39%), coagulase-negative staphylococcus (47%), Enterococci (3%), micrococcus (25%) and candida (3%). Contamination in those who had not washed their hands is 62.6% and in those who washed is 37.7% (P=0.04). Conclusion: Hands of health-care workers become progressively contaminated by the potential pathogens during daily activities. To reduce the rate of contamination, it is helpful if we ask staff to wash their hands while going out of hospital. Keywords: Microbial Flora; Hospital’s Staff; Hand Washing

Naderinasab, M. (PhD); Tayyebi Meibodi, N. (PhD); Nahidi, Y. (MD); Bakhshizadeh, A. (MD)

2013-01-01

186

Use of therapeutic hypothermia after in-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital cardiac arrest, whether use has increased over time, and to identify factors associated with its use. DESIGN: Multicenter, prospective cohort study. SETTING: A total of 538 hospitals participating in the Get With the Guidelines-Resuscitation database (2003-2009). PATIENTS: A total of 67,498 patients who had return of spontaneous circulation after in-hospital cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the initiation of therapeutic hypothermia. We measured the proportion of therapeutic hypothermia patients who achieved target temperature (32-34 °C) and were overcooled. Of 67,498 patients, therapeutic hypothermia was initiated in 1,367 patients (2.0%). The target temperature (32-34 °C) was not achieved in 44.3% of therapeutic hypothermia patients within 24 hours and 17.6% were overcooled. The use of therapeutic hypothermia increased from 0.7% in 2003 to 3.3% in 2009 (p < 0.001). We found that younger age (p < 0.001) and occurrence in a non-ICU location (p < 0.001), on a weekday (p = 0.005), and in a teaching hospital (p = 0.001) were associated with an increased likelihood of therapeutic hypothermia being initiated. CONCLUSIONS: After in-hospital cardiac arrest, therapeutic hypothermia was used rarely. Once initiated, the target temperature was commonly not achieved. The frequency of use increased over time but remained low. Factors associated with therapeutic hypothermia use included patient age, time and location of occurrence, and type of hospital.

Mikkelsen ME; Christie JD; Abella BS; Kerlin MP; Fuchs BD; Schweickert WD; Berg RA; Mosesso VN; Shofer FS; Gaieski DF

2013-06-01

187

Multicenter cohort study of in-hospital pediatric cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network. PATIENTS: Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. CONCLUSIONS: Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.

Meert KL; Donaldson A; Nadkarni V; Tieves KS; Schleien CL; Brilli RJ; Clark RS; Shaffner DH; Levy F; Statler K; Dalton HJ; van der Jagt EW; Hackbarth R; Pretzlaff R; Hernan L; Dean JM; Moler FW

2009-09-01

188

Prediction of 30-day cardiac-related-emergency-readmissions using simple administrative hospital data.  

UK PubMed Central (United Kingdom)

BACKGROUND: Control and reduction of cardiovascular-disease-related readmissions is clinically, logistically and politically challenging. Recent strategies focus on 30-day readmissions. A screening tool for the detection of potential cases is necessary to make further case management more efficient. METHODS: Cohort study. Hospital administrative data were analyzed in order to obtain information about cardiac-related hospitalizations from 2003 to 2009 at a Spanish academic tertiary care center. Predictor-variables of admissions that presented or did not present 30-day cardiac-related readmission were compared. A prediction model was constructed and tested on a validation sample. Model performance was assessed for all cardiac diseases and for 24 main-cardiac-disease-sets. RESULTS: The study sample was 35531 hospital-admissions. The model included 11 predictors: number of previous emergency admission in 180days, residence out of area, no procedure applied during hospitalization, major or minor therapeutic procedure applied during hospitalization, anemia, hypertensive disease, acute coronary syndrome, congestive heart failure, diabetes and renal disease. The performance indicators applied on all cardiac diseases were: C-statistic=0.75, Sensitivity=0.66, Specificity=0.70, Positive predictive value=0.10, Negative predictive value=0.98, Positive likelihood ratio=2.21 and Negative likelihood ratio=0.48. Diseases for discriminative prediction are: stenting, circulatory disorders, acute myocardial infarction and defibrillator and pacemaker implantation. CONCLUSIONS: This study provides a prediction model for 30-day cardiac-related diseases based on available administrative data ready to be integrated as a screening tool. It has reasonable validity and can be used to increase the efficiency of case management.

Wallmann R; Llorca J; Gómez-Acebo I; Ortega AC; Roldan FR; Dierssen-Sotos T

2013-04-01

189

[Out-of-hospital delivery. Experience of ten years in Jalisco, Mexico].  

UK PubMed Central (United Kingdom)

BACKGROUND: Birth without medical assistance, or outs hospitals is defined as one that occurs without the optimal medical and health care conditions for mother and son pairing. Frequency of this phenomenon is not known in Mexico. OBJECTIVE: To observe clinical outcomes, morbidity, mortality, epidemiological and geographical patterns. MATERIAL AND METHOD: A retrospective study including newborns of mothers who have had deliveries without medical assistance in accidental conditions, admitted to Unidad de Cuidados Intensivos Neonatales Externos, Hospital Civil de Guadalajara Fray Antonio Alcalde (Mexico). From January 2000 to December 2009. RESULTS: In 4,762 (100%) neonatal records evaluated, 582 (12%) were newborns birth for deliveries out of hospital. 314 (54%) female and 268 (46%) male, first mother's gravidity 195 (33%) and second o more gravidity 387 (68%) were registered. The Hospital stay average was 3-day. Discharge diagnoses: healthy 463 (79%), neonatal sepsis 16 (4%), respiratory distress 35 (6%), jaundice 33 (6%), pneumonia 12 (2%), metabolic disorders 13 (3%), other diagnoses 10 (2%). Place of births: 366 Guadalajara metropolitan area (63%), state of Jalisco, 180 (31%) other states of the Mexican Republic 36 (6%). Lambed at home 117 (20%), 52 bath home (9%), toilet bowl 29 (5%), car 128 (22%), road 58 (10%), hospital admission 104 (18%), Ambulance 42 (7%) Other 52 (9%). CONCLUSION: In our study we observed that 79% of the newborns were healthy. They are the third leading cause of admission to Neonatal Intensive Care Unit External. The most common neonatal complications were solved without consequence. No neonatal mortality cases were founded.

Avalos-Huízar LM; de la Torre-Gutiérrez M; López-Gallo L; García-Hernández H; Rodríguez-Medina D; Martínez-Verónica R; Herrera-García G; Gutiérrez-Padilla JA

2010-08-01

190

Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin.  

UK PubMed Central (United Kingdom)

BACKGROUND: We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED). METHODS AND RESULTS: In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%-99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%-99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%. CONCLUSIONS: Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays.

Rubini Giménez M; Hoeller R; Reichlin T; Zellweger C; Twerenbold R; Reiter M; Moehring B; Wildi K; Mosimann T; Mueller M; Meller B; Hochgruber T; Ziller R; Sou SM; Murray K; Sakarikos K; Ernst S; Gea J; Campodarve I; Vilaplana C; Haaf P; Steuer S; Minners J; Osswald S; Mueller C

2013-07-01

191

A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality.  

UK PubMed Central (United Kingdom)

BACKGROUND: It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. METHODS: We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults >or=15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure 29 breaths/min, Glasgow Coma Scale score hospital) or hospital length of stay >2 days. RESULTS: Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale <11, and pulse oximetry <93%. Rule validation demonstrated sensitivity 72% (95% confidence interval: 70%-74%) and specificity 69% (95% confidence interval: 67%-72%). Inclusion of demographic and mechanism variables did not significantly improve performance measures. CONCLUSIONS: We were unable to omit or further restrict any ACSCOT step 1 physiologic measures in a decision rule practical for field use without missing high-risk trauma patients.

Newgard CD; Rudser K; Hedges JR; Kerby JD; Stiell IG; Davis DP; Morrison LJ; Bulger E; Terndrup T; Minei JP; Bardarson B; Emerson S

2010-02-01

192

Effectiveness and Safety of Fentanyl Compared with Morphine for Out-of-Hospital Analgesia  

Science.gov (United States)

Background Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration, and less histamine release. Objective To compare the effectiveness and safety of fentanyl with that of morphine. Methods This was a retrospective before-and-after study of a protocol change from morphine to fentanyl in an advanced life support emergency medical services system in January 2007. Charts from nine months prior to the change and for nine months afterward were abstracted by two reviewers using a standardized instrument. The first three months after the change were excluded. Effectiveness was measured by change in pain scores on a 0--10 scale. A priori-defined adverse events included out-of-hospital events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or vomiting, intubation, and use of antiemetic agents or naloxone. Emergency department charts were reviewed for initial pain scores and the same adverse events during the first two hours. Events clearly not attributable to the opioid were discounted. The changes in pain scores were also compared adjusting for confounders by multivariable linear regression. Results Three hundred fifty-five patients aged 13 to 99 years received morphine during the nine months before the protocol change and 363 received fentanyl following the washout period. Initial pain scores for morphine (8.1) and fentanyl (8.3) were comparable (95% confidence interval [CI] for difference -1.1 to 0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the difference 0.9 to 2.3). The mean decreases in pain score were similar between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference -0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients and 6.6% of the fentanyl patients experienced an adverse event in the field (CI for the difference -0.8 to 7.3%). The most common event was nausea, with a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference -0.1% to 6.5%). Conclusion Morphine and fentanyl provide similar degrees of out-of-hospital analgesia, although this was achieved with a higher dose of fentanyl. Both medications had low rates of adverse events, which were easily controlled.

Fleischman, Ross J.; Frazer, David G.; Daya, Mohamud; Jui, Jonathan; Newgard, Craig D.

2010-01-01

193

Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Fentanyl has several potential advantages for out-of-hospital analgesia, including rapid onset, short duration, and less histamine release. Objective. To compare the effectiveness and safety of fentanyl with that of morphine. METHODS: This was a retrospective before-and-after study of a protocol change from morphine to fentanyl in an advanced life support emergency medical services system in January 2007. Charts from nine months prior to the change and for nine months afterward were abstracted by two reviewers using a standardized instrument. The first three months after the change were excluded. Effectiveness was measured by change in pain scores on a 0-10 scale. A priori-defined adverse events included out-of-hospital events: respiratory rate <12 breaths/min, pulse oximetry <92%, systolic blood pressure <90 mmHg, any fall in Glasgow Coma Scale score, nausea or vomiting, intubation, and use of antiemetic agents or naloxone. Emergency department charts were reviewed for initial pain scores and the same adverse events during the first two hours. Events clearly not attributable to the opioid were discounted. The changes in pain scores were also compared adjusting for confounders by multivariable linear regression. RESULTS: Three hundred fifty-five patients aged 13 to 99 years received morphine during the nine months before the protocol change and 363 received fentanyl following the washout period. Initial pain scores for morphine (8.1) and fentanyl (8.3) were comparable (95% confidence interval [CI] for difference -1.1 to 0.3). Fentanyl patients received a higher equivalent dose of opioid (7.7 mg morphine equivalents for morphine, 9.2 mg for fentanyl, CI for the difference 0.9 to 2.3). The mean decreases in pain score were similar between the drugs (2.9 for morphine, 3.1 for fentanyl, CI for the difference -0.3 to 0.7). With regard to adverse events, 9.9% of the morphine patients and 6.6% of the fentanyl patients experienced an adverse event in the field (CI for the difference -0.8 to 7.3%). The most common event was nausea, with a rate of 7.0% for morphine vs. 3.8% for fentanyl (CI for the difference -0.1% to 6.5%). CONCLUSION: Morphine and fentanyl provide similar degrees of out-of-hospital analgesia, although this was achieved with a higher dose of fentanyl. Both medications had low rates of adverse events, which were easily controlled.

Fleischman RJ; Frazer DG; Daya M; Jui J; Newgard CD

2010-04-01

194

The cardiac children's hospital early warning score (C-CHEWS).  

UK PubMed Central (United Kingdom)

Inpatient pediatric cardiovascular patients have higher rates of cardiopulmonary arrests than other hospitalized children. Pediatric early warning scoring tools have helped to provide early identification and treatment to hospitalized children experiencing deterioration thus preventing arrests from occurring. However, the tools have rarely been used and have not been validated in the pediatric cardiac population. This paper describes the modification of a pediatric early warning scoring system for cardiovascular patients, the implementation of the tool, and its companion escalation of care algorithm on an inpatient pediatric cardiovascular unit.

McLellan MC; Connor JA

2013-04-01

195

Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital.  

UK PubMed Central (United Kingdom)

Purpose: To evaluate the feasibility, frequency of use, types of intervention and labor costs of a formal round-the-clock interventional radiology on-call service.Materials and Methods: In 11/2011 a formal and permanent out-of-hour interventional radiology rota in addition to the general radiology out-of-hour rota (OOHR) was established. We retrospectively screened the interventional radiology database for procedures completed outside regular working hours, reviewed all interventions and manually selected cases in which the on-call interventionist was called in from home. We determined the type, frequency of use and costs (€/year and procedure) of this service between 1/2012 and 12/2012. The referring physicians' (sub-) specialties were evaluated.Results: During the 12-month period, the on-call interventionists (n = 3) performed 92 procedures OOH. The procedures included angiography and hemorrhage control (n = 36, 39.1 %), angiography and intervention for acute limb ischemia (n = 25, 27.2 %), percutaneous biliary drainage (PTCD) (n = 10, 10.9 %), angiography for non-occlusive ischemia (n = 7, 7.6 %), and other (n = 14, 15.3 %). The total labor costs for the OOHR were € 42,312.21 (€ 32,982.60 lump sum for stand-by, € 9,329.61 for hours spent on procedures). The labor costs per procedure totaled € 459.92. The referring physicians' specialties were general/visceral (n = 25), vascular surgery (n = 24), internal medicine (n = 21), cardiac/thoracic vascular (n = 9), trauma surgery (n = 5), urology (n = 5), and anesthesiology (n = 3).Conclusion: A formal interventional OOHR is practicable in a university hospital setting. Most procedures were requested by general, vascular, and thoracic surgery as well as internal medicine with a focus on hemorrhage control, treatment of acute limb ischemia, and PTCD. The overall labor costs for the OOHR appear moderate.Key points:Citation Format:Goltz JP, Janssen H, Petritsch B et al. Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital. Fortschr Röntgenstr 2013; DOI: 10.1055/s-0033-1350401.

Goltz JP; Janssen H; Petritsch B; Kickuth R

2013-08-01

196

Planning recommendations for international emergency medicine and out-of-hospital care system development.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To present suggestions on planning for development of emergency medicine (EM) and out-of-hospital care in countries that are in an early phase of this process, and to provide basic background information for planners not already familiar with EM. METHODS: The techniques and programs used by the authors and others in assisting in EM development in other countries to date are described. CONCLUSIONS: Some aspects of EM system development have applicability to most countries, but other aspects must be decided by planners based on country-specific factors. Because of the very recent initiation of many EM system development efforts in other countries, to the authors' knowledge there have not yet been extensive evaluative reports of the efficacy of these efforts. Further studies are needed on the relative effectiveness and cost-benefit of different EM development efforts.

Holliman CJ; VanRooyen MJ; Green GB; Kirsch TD; Delooz HH; Clem KJ; Thomas TL; Davis MA; Wang E; Wolfson AB

2000-08-01

197

Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

CONTEXT: Advanced cardiac life support (ACLS) training was introduced to bring order and a systematic approach to the treatment of cardiac arrest by professional responders. In spite of the wide dissemination of ACLS training, it has been difficult to demonstrate improved outcome following such training. OBJECTIVE: To determine the value of formal ACLS training in improving survival from in-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS: A multi-center, prospective cohort study examined patient outcomes after resuscitation efforts by in-hospital rescue teams with and without ACLS-trained personnel. A total of 156 patients, experiencing 172 in-hospital cardiopulmonary arrest events over a 38-month period (January 1998 to March 2001) were studied. MAIN OUTCOME MEASURES: Primary endpoints included return of spontaneous circulation (ROSC), survival to hospital discharge, 30-day survival, and 1-year survival. RESULTS: The immediate success of resuscitation efforts for all patients was 39.7% (62/156). There was a significant increase in ROSC with ACLS-trained personnel (49/113; 43.4%) versus no ALCS-trained personnel (16/59; 27.1%; p=0.04). Likewise, patients treated by ACLS-trained personnel had increased survival to hospital discharge (26/82; 31.7% versus 7/34; 20.6%; p=0.23), significantly better 30-day survival (22/82; 26.8% versus 2/34; 5.9%; p<0.02), and significantly improved 1-year survival (18/82; 21.9% versus 0/34; 0%; p<0.002). CONCLUSION: The presence of at least one ACLS-trained team member at in-hospital resuscitation efforts increases both short and long-term survival following cardiac arrest.

Moretti MA; Cesar LA; Nusbacher A; Kern KB; Timerman S; Ramires JA

2007-03-01

198

[Registries of in-hospital cardiac arrest are a challenge in daily clinical practice].  

UK PubMed Central (United Kingdom)

In-hospital cardiac arrest carries a poor prognosis. Registries of in-hospital cardiac arrest provide the opportunity to improve quality of care and conduct research of disease mechanisms and treatment. This paper describes the preliminary experience with systematic registration of in-hospital cardiac arrest at Aarhus University Hospital, Denmark. Data from 102 patients are presented and practical aspects and challenges of establishing a registry and implementing the collection of data in daily clinical practice are discussed.

Vinther Krarup NH; Løfgren B; Hansen TK; Johnsen SP

2012-03-01

199

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

Directory of Open Access Journals (Sweden)

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.

De Korte-Verhoef Maria C; Pasman H Roeline W; Schweitzer Bart PM; Francke Anneke L; Onwuteaka-Philipsen Bregje D; Deliens Luc

2012-01-01

200

The prevalence of methicillin-resistant staphylococcus aureus among out-of-hospital care providers and emergency medical technician students.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We compared the methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among out-of-hospital care providers with greater than six months' experience in emergency medical services (EMS) care with that of emergency medical technician (EMT) students with two months or less of observation time as part of their clinical training. METHODS: We conducted a prospective study utilizing a convenience sample of out-of-hospital care providers and EMT students in an urban EMS system operating in the Midwest during October and November 2006. One hundred thirty-four out-of-hospital care providers and 152 EMT students were tested for MRSA susceptibility using the cefoxitin disk diffusion method. RESULTS: Contrary to our hypothesis, we did not find a statistically significant difference in MRSA nasal colonization between out-of-hospital care providers (4.5%; 95% confidence interval [CI] 1.0, 8.0) and EMT students (5.3%; 95% CI 1.7, 8.8). A subgroup analysis showed that among out-of-hospital care providers, paramedics had a higher rate of nasal colonization than EMTs (5.6% vs. 2.2%). CONCLUSION: We found that out-of-hospital care providers and EMT students had higher nasal colonization rates than the reported rate for the U.S. population (0.084% at the time the study was conducted and 1.5% currently). It is imperative that both groups adhere to infection control practices.

Miramonti C; Rinkle JA; Iden S; Lincoln J; Huffman G; Riddell E; Kozak MA

2013-01-01

 
 
 
 
201

Clinical problems in coronary disease are caused by wide variety of ischemic episodes that affect patients out of hospital.  

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Transient ischemia arising from proximal events in epicardial coronary arteries causes important symptoms, such as angina pectoris, and is usually studied in the hospital with provocative tests. However, Holter monitoring of ST-segment disturbances in patients out of the hospital has shown frequent ...

Selwyn, AP; Shea, MJ; Deanfield, JE; Wilson, RA; deLandsheere, C; Jones, T

202

Cardiac catheterization experience in hospitals without cardiovascular surgery programs.  

UK PubMed Central (United Kingdom)

In order to study the cardiac catheterization experience in hospitals without cardiovascular surgery programs, data was collected from all 8 Washington "satellite" laboratories over a 5-year period. There were 5 deaths (0.13%) during the 3878 coronary arteriography procedures. Of the 5, 4 had severe left main coronary artery lesions. Of these patients, 2 died during the 24-hour follow-up period after an uncomplicated study. This mortality rate is remarkably good considering that the 5-year period includes the early experience of 7 laboratories. There were 7 myocardial infarctions (0.18%) and 6 strokes (0.15%). The average number of coronary arteriograms done per angiographer during 1976 was 65. The experience of the Washington State "satellite" cardiac catheterization laboratories proves that the immediate availability of cardiovascular surgery and large case loads per angiographer are not necessary in order to safely perform cardiac catheterization and coronary arteriographic studies. Additional studies should be undertaken to determine the appropriate distribution of cardiac diagnostic facilities.

Hansing CE; Hammermeister K; Prindle K; Twiss R; Schwindt RR; Gowing B; Crecelaius TL; Robinson W

1977-01-01

203

Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial.  

UK PubMed Central (United Kingdom)

CONTEXT: Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI). OBJECTIVE: To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, randomized, placebo-controlled clinical trial involving 114 North American emergency medical services agencies within the Resuscitation Outcomes Consortium, conducted between May 2006 and May 2009 among patients 15 years or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less who did not meet criteria for hypovolemic shock. Planned enrollment was 2122 patients. INTERVENTION: A single 250-mL bolus of 7.5% saline/6% dextran 70 (hypertonic saline/dextran), 7.5% saline (hypertonic saline), or 0.9% saline (normal saline) initiated in the out-of-hospital setting. MAIN OUTCOME MEASURE: Six-month neurologic outcome based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ?4). RESULTS: The study was terminated by the data and safety monitoring board after randomization of 1331 patients, having met prespecified futility criteria. Among the 1282 patients enrolled, 6-month outcomes data were available for 1087 (85%). Baseline characteristics of the groups were equivalent. There was no difference in 6-month neurologic outcome among groups with regard to proportions of patients with severe TBI (GOSE ?4) (hypertonic saline/dextran vs normal saline: 53.7% vs 51.5%; difference, 2.2% [95% CI, -4.5% to 9.0%]; hypertonic saline vs normal saline: 54.3% vs 51.5%; difference, 2.9% [95% CI, -4.0% to 9.7%]; P = .67). There were no statistically significant differences in distribution of GOSE category or Disability Rating Score by treatment group. Survival at 28 days was 74.3% with hypertonic saline/dextran, 75.7% with hypertonic saline, and 75.1% with normal saline (P = .88). CONCLUSION: Among patients with severe TBI not in hypovolemic shock, initial resuscitation with either hypertonic saline or hypertonic saline/dextran, compared with normal saline, did not result in superior 6-month neurologic outcome or survival. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00316004.

Bulger EM; May S; Brasel KJ; Schreiber M; Kerby JD; Tisherman SA; Newgard C; Slutsky A; Coimbra R; Emerson S; Minei JP; Bardarson B; Kudenchuk P; Baker A; Christenson J; Idris A; Davis D; Fabian TC; Aufderheide TP; Callaway C; Williams C; Banek J; Vaillancourt C; van Heest R; Sopko G; Hata JS; Hoyt DB

2010-10-01

204

Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine whether out-of-hospital administration of hypertonic fluids would improve survival after severe injury with hemorrhagic shock. BACKGROUND: Hypertonic fluids have potential benefit in the resuscitation of severely injured patients because of rapid restoration of tissue perfusion, with a smaller volume, and modulation of the inflammatory response, to reduce subsequent organ injury. METHODS: Multicenter, randomized, blinded clinical trial, May 2006 to August 2008, 114 emergency medical services agencies in North America within the Resuscitation Outcomes Consortium. Inclusion criteria: injured patients, age ? 15 years with hypovolemic shock (systolic blood pressure ? 70 mm Hg or systolic blood pressure 71-90 mm Hg with heart rate ? 108 beats per minute). Initial resuscitation fluid, 250 mL of either 7.5% saline per 6% dextran 70 (hypertonic saline/dextran, HSD), 7.5% saline (hypertonic saline, HS), or 0.9% saline (normal saline, NS) administered by out-of-hospital providers. Primary outcome was 28-day survival. On the recommendation of the data and safety monitoring board, the study was stopped early (23% of proposed sample size) for futility and potential safety concern. RESULTS: ?: A total of 853 treated patients were enrolled, among whom 62% were with blunt trauma, 38% with penetrating. There was no difference in 28-day survival-HSD: 74.5% (0.1; 95% confidence interval [CI], -7.5 to 7.8); HS: 73.0% (-1.4; 95% CI, -8.7-6.0); and NS: 74.4%, P = 0.91. There was a higher mortality for the postrandomization subgroup of patients who did not receive blood transfusions in the first 24 hours, who received hypertonic fluids compared to NS [28-day mortality-HSD: 10% (5.2; 95% CI, 0.4-10.1); HS: 12.2% (7.4; 95% CI, 2.5-12.2); and NS: 4.8%, P < 0.01]. CONCLUSION: Among injured patients with hypovolemic shock, initial resuscitation fluid treatment with either HS or HSD compared with NS, did not result in superior 28-day survival. However, interpretation of these findings is limited by the early stopping of the trial. Clinical Trial Registration: Clinical Trials.gov, NCT00316017.

Bulger EM; May S; Kerby JD; Emerson S; Stiell IG; Schreiber MA; Brasel KJ; Tisherman SA; Coimbra R; Rizoli S; Minei JP; Hata JS; Sopko G; Evans DC; Hoyt DB

2011-03-01

205

Readmissions after ventricular assist device: etiologies, patterns, and days out of hospital.  

UK PubMed Central (United Kingdom)

BACKGROUND: Scarce literature exists describing the patterns of readmission after continuous flow left ventricular assist device (CF-LVAD) implantation. These carry significant cost and quality of life implications. We sought to describe the etiology and pattern of readmission among patients receiving CF-LVADs. METHODS: Frequency, reason, urgency, and duration of readmission as well as freedom from readmission were examined in a retrospective review of our institutional experience. As an indirect means of quality of life, the ratio of days out of hospital (OOH)/days alive with device was calculated. RESULTS: From 2006 to 2011, 71 adult patients implanted with a CF device were included. Indication for device implantation was bridge to transplant (n=19), potential bridge to transplant (n=25), or destination therapy (n=27). Length of support averaged 359 days. Total support time was 69.7 patient years. One hundred fifty-five readmissions accounted for a total of 1,659 hospital days. Fifty-six patients were readmitted during the study period. Median time to first readmission was 48 days (range 2 to 663 days). Median length of stay was 5 days. The single most common etiology for readmission was gastrointestinal bleeding accounting for 14% of readmissions. Readmissions were urgent (87%), elective (10%), or life-threatening (3%). Patients on the average enjoyed 92% of their time OOH. CONCLUSIONS: Patients undergoing CF-LVAD support are often readmitted within 6 months of discharge. Readmissions tend to be of short duration and the most common reason is for gastrointestinal bleeding. Importantly, following discharge after implant procedure, 51 patients spent at least 90% of days OOH.

Forest SJ; Bello R; Friedmann P; Casazza D; Nucci C; Shin JJ; D'Alessandro D; Stevens G; Goldstein DJ

2013-04-01

206

Cardiac catheterization laboratories: should every hospital have one?  

UK PubMed Central (United Kingdom)

It is obvious that times have changed. Cardiac catheterization laboratories are everywhere. The concerns that must be addressed continually are: 1. Patient safety and quality of patient care. 2. Access to emergency hospitalization. 3. The overseeing of these laboratories. 4. Physician conflict of interest. 5. Need for the laboratory in the region In order to add a new cardiac catheterization laboratory to any region, patient need must be documented. Patient need is the only justification for the development of a new laboratory. I fail to understand how the continuing development of new laboratories will decrease costs, and am concerned that more catheterization laboratories will mean more studies of patients with borderline indications for the procedure.

Conti CR

1991-06-01

207

Hospitalization in Tajikistan: determinants of admission, length of stay, and out-of-pocket expenditures. Results of a national survey.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess factors explaining hospitalization in Tajikistan and discuss policy implications for reforms in hospital care. METHODS: This study involves a secondary analysis of micro-data collected from a nationally-representative household survey conducted in Tajikistan in 2003. Three empirical models are employed: binomial logit regression for the admission to the hospital; zero truncated negative binomial (ZTNB) regression for the length of hospital stay; and ordinary least square (OLS) for the amount of out-of-pocket expenditures for hospitalization. FINDINGS: Variation in hospital admission is due to the differences in ability to pay, long-standing illness, gender, age, and educational level. Factors explaining out-of-pocket expenditures include ability to pay, having long-standing illness, and having surgery and receiving intensive care. The most important out-of-pocket expenditures are payments for pharmaceuticals and supplies. Finally, long hospital stay that is the result of outdated treatment protocols, rigid financial and management system, lack of funding, and weakness of primary and long-tem care. As a result, long time in inpatient care is mostly used ineffectively. CONCLUSION: Strategies to address the existing deficiencies include voluntary community-based health insurance for rural areas, targeted subsidized care for the neediest, improvements in procurement of pharmaceuticals and supplies, and rationalization of hospital primary and long-term care.

Habibov N

2010-07-01

208

Does induction of hypothermia improve outcomes after in-hospital cardiac arrest?  

UK PubMed Central (United Kingdom)

INTRODUCTION: Hypothermia improves neurologic recovery compared to normothermia after resuscitation from out-of-hospital ventricular fibrillation, but may or may not be beneficial for patients resuscitated from in-hospital cardiac arrest. Therefore, we evaluated the effect of induced hypothermia in a large cohort of patients with in-hospital cardiac arrest. METHODS: Retrospective analysis of multi-center prospective cohort of patients with in-hospital cardiac arrest enrolled in an ongoing quality improvement project. Included were adults with a pulseless event in an in-patient hospital ward of a participating institution who achieved restoration of spontaneous circulation between 2000 and 2009. The exposure of interest was induced hypothermia. The primary outcome was survival to discharge. The secondary outcome was neurological status at discharge. Analyses evaluated all eligible patients; those with a shockable rhythm; or those with endotracheal tube inserted after resuscitation; and the effect of no hypothermia versus hypothermia (lowest temperature>32 °C but ?34 °C) versus overcooled (?32 °C). Associations were assessed using propensity score methods. RESULTS: Included were 8316 patients with complete data, of whom 214 (2.6%) had hypothermia induced and 2521 (30%) survived to discharge. Of patients reported to receive hypothermia, only 40% were documented as achieving a temperature between 32 °C and 34 °C. Adjusted for known potential confounders using propensity score methods, induced hypothermia was associated with an odds ratio of survival of 0.90 (95% confidence interval: 0.65, 1.23; p-value=0.49) compared to no hypothermia. Induced hypothermia was associated with an odds ratio of neurologically-favorable survival of 0.93 (95% confidence interval: 0.65, 1.32; p-value=0.68) compared to no hypothermia. For patients with shockable first-recorded rhythm, induced hypothermia was associated with an odds ratio of survival of 1.43 (95% confidence interval: 0.68, 3.01; p-value=0.35) compared to no hypothermia. CONCLUSION: Hypothermia is induced infrequently in patients resuscitated from in-hospital cardiac arrest with only 40% achieving target temperatures. Induced hypothermia was not associated with improved or worsened survival or neurologically-favorable survival. The lack of benefit in this population may reflect lack of effect, inefficient application of the intervention, or residual confounding. High-quality controlled studies are required to better characterize the effect of induced hypothermia in this population.

Nichol G; Huszti E; Kim F; Fly D; Parnia S; Donnino M; Sorenson T; Callaway CW

2013-05-01

209

A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: This study reports the epidemiologic features, survival rates, and neurologic outcomes of the largest population-based series of pediatric out-of-hospital cardiopulmonary arrest patients with prospectively collected data. METHODS: Secondary analysis of data from a prospective, interventional trial of out-of-hospital pediatric airway management conducted from 1994 to 1997 (Gausche M, Lewis RJ, Stratton SJ, et al. JAMA. 2000;283:783-790). Consecutive out-of-hospital patients from 2 large urban counties in California <12 years old or 40 kg in bodyweight who were determined by paramedics to be pulseless and apneic were included. Main outcome measures included survival to hospital discharge, patient demographics, arrest etiology, arrest rhythm, event intervals, and neurologic outcomes. RESULTS: In 599 patients, 601 events were studied (54% were <1 year old, 58% were male). Return of spontaneous circulation was achieved in 29%; 25% were admitted to the hospital, and 8.6% (51) survived to hospital discharge. The most prevalent etiologies were sudden infant death syndrome and trauma; these resulted in relatively higher mortality. Respiratory etiologies and submersions followed; these resulted in relatively lower mortality. Twenty-six percent of the arrests were witnessed by citizens, and an additional 8% were witnessed by rescue personnel. Witnessed arrests had a higher survival rate (16%). Thirty-one percent of patients received bystander cardiopulmonary resuscitation, which was not demonstrated to result in improved survival rates. Arrest rhythms were asystole (67%), pulseless electrical activity (24%), and ventricular fibrillation (9%); children with the latter 2 rhythms had better survival rates. One third of the survivors (16 of 51) had good neurologic outcome, none of whom received >3 doses of epinephrine or were resuscitated for >31 minutes in the emergency department. CONCLUSIONS: The 8.6% survival rate after out-of-hospital pediatric cardiopulmonary arrest is poor. Administration of >3 doses of epinephrine or prolonged resuscitation is futile.

Young KD; Gausche-Hill M; McClung CD; Lewis RJ

2004-07-01

210

An unusual cause of cardiac arrest in a hospitalized patient.  

UK PubMed Central (United Kingdom)

We present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure. The patient presented with swelling of buccal cavity for which a biopsy was taken. Two days after the procedure, apparently normal patient suddenly presented at mid night with VT and VF, which were intractable requiring multiple DC shocks. During this period arterial blood gas analysis revealed severe acidosis. The circumstances led us to suspect poisoning as one of the cause for his medical condition. We looked for commonly available toxins. One of the commonly available toxins is hand sanitizer which contains Isopropyl alcohol, glycerin and perfume. Due to prolonged cardiac arrest and intractable arrhythmia patient had sustained hypoxic brain injury. Patient remained hemodynamically stable for next 9 days although his CNS status did not improve. Patient succumbed to sepsis on 9(th) day. Healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of IPA based hand sanitizers.

Shetty RK; Tumkur A; Bhat K; Chacko B

2013-01-01

211

The sounds of cardiac arrest: innovating to obtain an accurate record during in-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: To obtain an accurate audit during in-hospital cardiac arrest, following recommendations of the Utstein style and measuring time intervals between the different interventions, is difficult. OBJECTIVE: To assess whether the use of an audio recording system during in-hospital cardiac arrest resuscitation allows the register of more items during cardiopulmonary resuscitation. MATERIAL AND METHODS: Prospective observational study between January 2008 and December 2009. The population that were included, were hospitalized patients and non-hospitalized patients assisted by a cardiac arrest team, except for critical areas. An audio recording system with a timer was turned on when cardiac arrest team was alerted. Recordings were reviewed to fill in the items recommended by the Utstein style. Time intervals were calculated. Mean number of completed items per patient were compared between recorded and non-recorded cardiac arrest. RESULTS: 119 CA team alerts took place. 64 (53.7%) cases were real CA and 37 (57.8%) of them were properly recorded. A mean number of items per patient in recorded cardiac arrest cases were 18.18 (±3.2) vs. 15.96 (±4.1) in non-recorded cardiac arrest cases (p<0.05). In the recorded cases, mean times were: alert - arrival: 1.23 (±0.95)min; arrival - cardiopulmonary resuscitation initiation: 0.63 (±0.38)min; arrival - first defibrillation: 2.06 (±1.33)min; arrival - intubation: 8.42 (±4.64)min; arrival - first adrenaline: 3.30 (±1.98)min. CONCLUSIONS: The audio recording system permits the register of a larger number of items per patient during in-hospital cardiac arrest and allows measurement of time intervals between the different interventions during cardiopulmonary resuscitation.

Duran N; Riera J; Nuvials X; Ruiz-Rodriguez JC; Serra J; Rello J

2012-10-01

212

[Assessing the effect of compulsory ambulatory treatment orders on the time lapse out of hospitalization for patients suffering from schizophrenia].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Schizophrenia is the most severe mental disorder, characterized in many cases by poor insight and low adherence to drug treatment. In Israel, as in many countries, Laws have been Legislated to allow the issuance of compuLsory ambulatory treatment orders (CATO) to patients whose medical condition poses a risk to themselves or the environment. In the Limited existing literature, no conclusive evidence has been found on the efficacy of CATO on patients' outcome. METHODS AND AIMS: We examined the medical files of all the patients in "Shalvata" Mental Health Center, who were treated under the compulsory ambulatory treatment order during the years 2003-2010. We examined the effect of the CATO on the time Lapse out of hospitalization during a 3 year period before and after issuing the order. The study group was composed of 77 patients and each patient served as his own control. RESULTS: We conducted paired samples t-test and found that the average time lapse out of hospitalization after issuing CATO was higher (M = 426 days, SD = 3921 compared to the average time lapse out of hospitalization before issuing CATO (M = 345 days, SD = 366, N = 77), but the difference was not statistically significant (t = -1.34, p = 0.2). CONCLUSIONS: Our research shows that there was no significant beneficial effect of the CATO in the group of patients that we examined. We found that the average time lapse out of hospitalization did not increase significantly. Our study raises questions regarding the importance of the compulsory ambulatory treatment and its implementation measures.

Spinzy Y; Israel K

2012-03-01

213

EMS management of acute stroke--out-of-hospital treatment and stroke system development (resource document to NAEMSP position statement).  

UK PubMed Central (United Kingdom)

The American Heart Association estimates an annual incidence of stroke in the United States at 700,000, leading to over 150,000 deaths. Of all strokes, approximately 88% are ischemic and 12% are hemorrhagic. Almost half of all stroke deaths occur in the out-of-hospital environment. Within a given region, the emergency medical services (EMS) system has an important role in the management of the acute stroke patient. Decisions made by EMS personnel can affect treatment and contribute to the immediate, short-term, and long-term outcomes of the patient. Because the patient may require emergent treatment regardless if the stroke is ischemic or hemorrhagic, EMS personnel should manage all potential stroke patients in a time-dependent nature. Proper treatment and disposition of the stroke patient begins in the out-of-hospital environment, continues in the emergency department, and then extends to the inpatient admission. This article reviews the literature on the out-of-hospital treatment of stroke patients and the role of EMS in the development of stroke systems of care.

Millin MG; Gullett T; Daya MR

2007-07-01

214

Out-of-Hospital Decision-Making and Factors Influencing the Regional Distribution of Injured Patients in a Trauma System  

Science.gov (United States)

Background The decision-making processes used for out-of-hospital trauma triage and hospital selection in regionalized trauma systems remain poorly understood. The objective of this study was to understand the process of field triage decision-making in an established trauma system. Methods We used a mixed methods approach, including EMS records to quantify triage decisions and reasons for hospital selection in a population-based, injury cohort (2006 - 2008), plus a focused ethnography to understand EMS cognitive reasoning in making triage decisions. The study included 10 EMS agencies providing service to a 4-county regional trauma system with 3 trauma centers and 13 non-trauma hospitals. For qualitative analyses, we conducted field observation and interviews with 35 EMS field providers and a round-table discussion with 40 EMS management personnel to generate an empirical model of out-of-hospital decision making in trauma triage. Results 64,190 injured patients were evaluated by EMS, of whom 56,444 (88.0%) were transported to acute care hospitals and 9,637 (17.1% of transports) were field trauma activations. For non-trauma activations, patient/family preference and proximity accounted for 78% of destination decisions. EMS provider judgment was cited in 36% of field trauma activations and was the sole criterion in 23% of trauma patients. The empirical model demonstrated that trauma triage is driven primarily by EMS provider “gut feeling” (judgment) and relies heavily on provider experience, mechanism of injury, and early visual cues at the scene. Conclusions Provider cognitive reasoning for field trauma triage is more heuristic than algorithmic and driven primarily by provider judgment, rather than specific triage criteria.

Newgard, Craig D.; Nelson, Maria J.; Kampp, Michael; Saha, Somnath; Zive, Dana; Schmidt, Terri; Daya, Mohamud; Jui, Jonathan; Wittwer, Lynn; Warden, Craig; Sahni, Ritu; Stevens, Mark; Gorman, Kyle; Koenig, Karl; Gubler, Dean; Rosteck, Pontine; Lee, Jan; Hedges, Jerris R.

2011-01-01

215

Out-of-hospital decision making and factors influencing the regional distribution of injured patients in a trauma system.  

UK PubMed Central (United Kingdom)

BACKGROUND: The decision-making processes used for out-of-hospital trauma triage and hospital selection in regionalized trauma systems remain poorly understood. The objective of this study was to assess the process of field triage decision making in an established trauma system. METHODS: We used a mixed methods approach, including emergency medical services (EMS) records to quantify triage decisions and reasons for hospital selection in a population-based, injury cohort (2006-2008), plus a focused ethnography to understand EMS cognitive reasoning in making triage decisions. The study included 10 EMS agencies providing service to a four-county regional trauma system with three trauma centers and 13 nontrauma hospitals. For qualitative analyses, we conducted field observation and interviews with 35 EMS field providers and a round table discussion with 40 EMS management personnel to generate an empirical model of out-of-hospital decision making in trauma triage. RESULTS: A total of 64,190 injured patients were evaluated by EMS, of whom 56,444 (88.0%) were transported to acute care hospitals and 9,637 (17.1% of transports) were field trauma activations. For nontrauma activations, patient/family preference and proximity accounted for 78% of destination decisions. EMS provider judgment was cited in 36% of field trauma activations and was the sole criterion in 23% of trauma patients. The empirical model demonstrated that trauma triage is driven primarily by EMS provider "gut feeling" (judgment) and relies heavily on provider experience, mechanism of injury, and early visual cues at the scene. CONCLUSIONS: Provider cognitive reasoning for field trauma triage is more heuristic than algorithmic and driven primarily by provider judgment, rather than specific triage criteria.

Newgard CD; Nelson MJ; Kampp M; Saha S; Zive D; Schmidt T; Daya M; Jui J; Wittwer L; Warden C; Sahni R; Stevens M; Gorman K; Koenig K; Gubler D; Rosteck P; Lee J; Hedges JR

2011-06-01

216

Antecedents to cardiac arrests in a hospital equipped with a medical emergency team.  

UK PubMed Central (United Kingdom)

BACKGROUND: Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. OBJECTIVES: To determine what proportion of patients who had cardiac arrests had documented MET criteria before the arrest, and what proportion had a premorbid status suggesting they were unsuitable resuscitation candidates. DESIGN AND SETTING: Prospective observational study of cardiac arrests at the Austin Hospital, Melbourne, Australia, 1 April - 30 September 2010. Data were obtained from the patients' records and electronic "respond blue" database. MAIN OUTCOME MEASURES: Patients' premorbid medical condition and functional status; prior "not-for-resuscitation" (NFR) order; presence or absence of a MET call before cardiac arrest; time and rhythm of cardiac arrest; and in hospital mortality. RESULTS: 27 patients had a cardiac arrest during the study period, 22 of whom had no prior documented NFR order. Among these 22 patients, 18 (82%) had an initial rhythm of asystole or pulseless electrical activity, and 16 (73%) died in hospital. Fifty per cent of arrests were detected between midnight and 08:00. All six patients classified as unsuitable resuscitation candidates died in hospital, and there were trends for increased age and poorer functional status when compared with suitable candidates. A further six patients had documented MET criteria in the 6 hours before the arrest, but did not receive MET review. CONCLUSIONS: In this 6-month audit, about half the patients with cardiac arrest may have been unsuitable for resuscitation, or had objective warning signs that were not acted on. Further improvements in advanced care planning and optimisation of MET activation may further reduce cardiac arrest calls at our hospital.

Vetro J; Natarajan DK; Mercer I; Buckmaster JN; Heland M; Hart GK; Bellomo R; Jones DA

2011-09-01

217

A probabilistic neural network as the predictive classifier of out-of-hospital defibrillation outcomes.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Although modern defibrillators are nearly always successful in terminating ventricular fibrillation (VF), multiple defibrillation attempts are usually required to achieve return of spontaneous circulation (ROSC). This is potentially deleterious as cardiopulmonary resuscitation (CPR) must be discontinued during each defibrillation attempt which causes deterioration in the heart muscle and reduces the chance of ROSC from later defibrillation attempts. In this work defibrillation outcomes are predicted prior to electrical shocks using a neural network model to analyse VF time series in an attempt to avoid defibrillation attempts that do not result in ROSC. METHODS: The 198 pre-shock VF ECG episodes from 83 cardiac arrest patients with defibrillation conversions to different outcomes were selected from the Oslo ambulance service database. A probabilistic neural network model was designed for training and testing with a cross validation method being used for the better generalisation performance. RESULTS: We achieved an accuracy of 75% in overall prediction with a sensitivity of 84% and a specificity of 65% using VF ECG time series of an order of 1 s in length. CONCLUSION: Pre-shock VF ECG time series can be classified according to the defibrillation conversion to a return of spontaneous circulation (ROSC) or No-ROSC.

Yang Z; Yang Z; Lu W; Harrison RG; Eftestøl T; Steen PA

2005-01-01

218

Nonemergency PCI at hospitals with or without on-site cardiac surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain. METHODS: We enrolled patients with indications for nonemergency PCI who presented at hospitals in Massachusetts without on-site cardiac surgery and randomly assigned these patients, in a 3:1 ratio, to undergo PCI at that hospital or at a partner hospital that had cardiac surgery services available. A total of 10 hospitals without on-site cardiac surgery and 7 with on-site cardiac surgery participated. The coprimary end points were the rates of major adverse cardiac events--a composite of death, myocardial infarction, repeat revascularization, or stroke--at 30 days (safety end point) and at 12 months (effectiveness end point). The primary end points were analyzed according to the intention-to-treat principle and were tested with the use of multiplicative noninferiority margins of 1.5 (for safety) and 1.3 (for effectiveness). RESULTS: A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point. CONCLUSIONS: Nonemergency PCI procedures performed at hospitals in Massachusetts without on-site surgical services were noninferior to procedures performed at hospitals with on-site surgical services with respect to the 30-day and 1-year rates of clinical events. (Funded by the participating hospitals without on-site cardiac surgery; MASS COM ClinicalTrials.gov number, NCT01116882.).

Jacobs AK; Normand SL; Massaro JM; Cutlip DE; Carrozza JP Jr; Marks AD; Murphy N; Romm IK; Biondolillo M; Mauri L

2013-04-01

219

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

Directory of Open Access Journals (Sweden)

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.

Ricardo Navarro Vargas

2005-01-01

220

Electronic versus manual data processing: evaluating the use of electronic health records in out-of-hospital clinical research.  

UK PubMed Central (United Kingdom)

OBJECTIVES: ? The objective was to compare case ascertainment, agreement, validity, and missing values for clinical research data obtained, processed, and linked electronically from electronic health records (EHR) compared to "manual" data processing and record abstraction in a cohort of out-of-hospital trauma patients. METHODS: ? This was a secondary analysis of two sets of data collected for a prospective, population-based, out-of-hospital trauma cohort evaluated by 10 emergency medical services (EMS) agencies transporting to 16 hospitals, from January 1, 2006, through October 2, 2007. Eighteen clinical, operational, procedural, and outcome variables were collected and processed separately and independently using two parallel data processing strategies by personnel blinded to patients in the other group. The electronic approach included EHR data exports from EMS agencies, reformatting, and probabilistic linkage to outcomes from local trauma registries and state discharge databases. The manual data processing approach included chart matching, data abstraction, and data entry by a trained abstractor. Descriptive statistics, measures of agreement, and validity were used to compare the two approaches to data processing. RESULTS: ? During the 21-month period, 418 patients underwent both data processing methods and formed the primary cohort. Agreement was good to excellent (kappa = 0.76 to 0.97; intraclass correlation coefficient [ICC] = 0.49 to 0.97), with exact agreement in 67% to 99% of cases and a median difference of zero for all continuous and ordinal variables. The proportions of missing out-of-hospital values were similar between the two approaches, although electronic processing generated more missing outcomes (87 of 418, 21%, 95% confidence interval [CI] = 17% to 25%) than the manual approach (11 of 418, 3%, 95% CI = 1% to 5%). Case ascertainment of eligible injured patients was greater using electronic methods (n = 3,008) compared to manual methods (n = 629). CONCLUSIONS: ? In this sample of out-of-hospital trauma patients, an all-electronic data processing strategy identified more patients and generated values with good agreement and validity compared to traditional data collection and processing methods.

Newgard CD; Zive D; Jui J; Weathers C; Daya M

2012-02-01

 
 
 
 
221

Electronic Versus Manual Data Processing: Evaluating the Use of Electronic Health Records in Out-of-Hospital Clinical Research  

Science.gov (United States)

Objectives To compare case ascertainment, agreement, validity, and missing values for clinical research data obtained, processed, and linked electronically from electronic health records (EHR), compared to “manual” data processing and record abstraction in a cohort of out-ofhospital trauma patients. Methods This was a secondary analysis of two sets of data collected for a prospective, population-based, out-of-hospital trauma cohort evaluated by 10 emergency medical services (EMS) agencies transporting to 16 hospitals, from January 1, 2006 through October 2, 2007. Eighteen clinical, operational, procedural, and outcome variables were collected and processed separately and independently using two parallel data processing strategies, by personnel blinded to patients in the other group. The electronic approach included electronic health record data exports from EMS agencies, reformatting and probabilistic linkage to outcomes from local trauma registries and state discharge databases. The manual data processing approach included chart matching, data abstraction, and data entry by a trained abstractor. Descriptive statistics, measures of agreement, and validity were used to compare the two approaches to data processing. Results During the 21-month period, 418 patients underwent both data processing methods and formed the primary cohort. Agreement was good to excellent (kappa 0.76 to 0.97; intraclass correlation coefficient 0.49 to 0.97), with exact agreement in 67% to 99% of cases, and a median difference of zero for all continuous and ordinal variables. The proportions of missing out-of-hospital values were similar between the two approaches, although electronic processing generated more missing outcomes (87 out of 418, 21%, 95% CI = 17% to 25%) than the manual approach (11 out of 418, 3%, 95% CI = 1% to 5%). Case ascertainment of eligible injured patients was greater using electronic methods (n = 3,008) compared to manual methods (n = 629). Conclusions In this sample of out-of-hospital trauma patients, an all-electronic data processing strategy identified more patients and generated values with good agreement and validity compared to traditional data collection and processing methods.

Newgard, Craig D.; Zive, Dana; Jui, Jonathan; Weathers, Cody; Daya, Mohamud

2011-01-01

222

Cardiac Wounds at a Military Evacuation Hospital in Vietnam: a Review of One Year's Experience.  

Science.gov (United States)

An analysis of cardiac injuries over a 1 year period in an evacuation hospital in Vietnam is presented. Three hundred and fifity-three patients were seen with thoracic injuries, only 10 of whom had cardiac wounds (2.8 per cent). Nine lived, and 1 died. Mo...

I. Gielchinsky J. J. McNamara

1969-01-01

223

Emergencias extrahospitalarias: el paciente suicida Out-of-hospital emergencies: the suicidal patient  

Directory of Open Access Journals (Sweden)

Full Text Available Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismo ha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentes perspectivas y áreas de conocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional, descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación, tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. Conclusiones: El conocimientog del perfil del paciente suicida atendidos en diversas áreas permite conocer en mayor medida, los factores de riesgo de la conducta suicida, así como puede favorecer actuaciones preventivas futuras.Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give an overview to understand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the city of Madrid and are treated in the outpatient emergency area. Methods: Observational, descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, which have involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without the presence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledge of the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitate future preventive actions.

T. Pacheco Tabuenca; J.I. Robles Sánchez

2011-01-01

224

Emergencias extrahospitalarias: el paciente suicida/ Out-of-hospital emergencies: the suicidal patient  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismo ha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentes perspectivas y áreas de conocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, (more) el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional, descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación, tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. Conclusiones: El conocimientog del perfil del paciente suicida atendidos en diversas áreas permite conocer en mayor medida, los factores de riesgo de la conducta suicida, así como puede favorecer actuaciones preventivas futuras. Abstract in english Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give an overview to understand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the c (more) ity of Madrid and are treated in the outpatient emergency area. Methods: Observational, descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, which have involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without the presence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledge of the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitate future preventive actions.

Pacheco Tabuenca, T.; Robles Sánchez, J.I.

2011-12-01

225

The effect of cardiac rehabilitation with relaxation therapy on psychological, hemodynamic, and hospital admission outcome variables.  

UK PubMed Central (United Kingdom)

PURPOSE: To examine the effect of a cardiac rehabilitation program with relaxation therapy (CPRT) in comparison with cardiac rehabilitation alone on psychological stress, hemodynamic variables, cardiac risk factors, and cardiac-related hospital admissions in patients with coronary artery disease. METHODS: Patients (N = 81) were randomly assigned to either a 12-week cardiac rehabilitation program alone (CPA) or a CPRT. Perceived stress, blood pressure, heart rate, rate-pressure product value, total cholesterol level, body mass index, smoking status, and physical activity were recorded at baseline and following the 12-week intervention. Cardiac-related hospital admissions were analyzed in a 2-year follow-up. RESULTS: Perceived stress declined in both groups, although this improvement was significantly superior in the CPRT (31.5 +/- 4.9 vs 23.4 +/- 4.1; P hospital with cardiac-related problems, after adjusting for heart rate, blood pressure, smoking status, physical activity status, and total cholesterol (OR, 0.37; 95% CI, 0.045-2.98), was not significantly different between groups. CONCLUSIONS: Relaxation therapy was associated with a positive effect on psychological stress and hemodynamic variables beyond that promoted by cardiac rehabilitation alone.

Neves A; Alves AJ; Ribeiro F; Gomes JL; Oliveira J

2009-09-01

226

Administrative hospitalization database validation of cardiac procedure codes.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries. OBJECTIVES: To examine accuracy of cardiac procedure coding in administrative databases versus a prospective clinical registry. SAMPLE: We examined a total of 182,018 common cardiac procedures including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, valve surgery, and cardiac catheterization procedures during fiscal years 2005 and 2006 across 18 cardiac centers in Ontario, Canada. RESEARCH DESIGN: Accuracy of codes in the Canadian Institute for Health Information (CIHI) administrative databases were compared with the clinical registry of the Cardiac Care Network. RESULTS: Comparing 17,511 CIHI and 17,404 registry procedures for CABG surgery, the positive predictive value (PPV) of CIHI-coded CABG surgery was 97%. In 6229 CIHI-coded and 5885 registry-coded valve surgery procedures, the PPV of the administrative data source was 96%. Comparing 38,527 PCI procedures in CIHI to 38,601 in the registry, the PPV of CIHI was 94%. Among 119,751 CIHI-coded and 111,725 registry-coded cardiac catheterization procedures, the PPV of administrative data was 94%. When the procedure date window was expanded from the same day to ±1 days, the PPV was 96% (PCI) and exceeded 98% (CABG surgery), 97% (valve surgery), and 95% (cardiac catheterization). CONCLUSIONS: Using a clinical registry as the gold standard, the coding accuracy of common cardiac procedures in the CIHI administrative database was high.

Lee DS; Stitt A; Wang X; Yu JS; Gurevich Y; Kingsbury KJ; Austin PC; Tu JV

2013-04-01

227

Effect of Introducing the Mucosal Atomization Device for Fentanyl Use in Out-of-Hospital Pediatric Trauma Patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Pain associated with pediatric trauma is often under-assessed and under-treated in the out-of-hospital setting. Administering an opioid such as fentanyl via the intranasal route is a safe and efficacious alternative to traditional routes of analgesic delivery and could potentially improve pain management in pediatric trauma patients. OBJECTIVE: The study sought to examine the effect of introducing the mucosal atomization device (MAD) on analgesia administration as an alternative to intravenous fentanyl delivery in pediatric trauma patients. The hypothesis for the study is that the introduction of the MAD would increase the administration of fentanyl in pediatric trauma patients. METHODS: The research utilized a 2-group design (pre-MAD and post-MAD) to study 946 pediatric trauma patients (age <16) transported by a large, urban EMS agency to one of eight hospitals in Marion County, which is located in Indianapolis Indiana. Two emergency medicine physicians independently determined whether the patient met criteria for pain medication receipt and a third reviewer resolved any disagreements. A comparison of the rates of fentanyl administration in both groups was then conducted. RESULTS: There was no statistically significant difference in the rate of fentanyl administration between the pre-MAD (30.4%) and post-MAD groups (37.8%) (P = .238). A subgroup analysis showed that age and mechanism of injury were stronger predictors of fentanyl administration. CONCLUSION: Contrary to the hypothesis, the addition of the MAD device did not increase fentanyl administration rates in pediatric trauma patients. Future research is needed to address the barriers to analgesia administration in pediatric trauma patients. O'Donnell DP , Schafer LC , Stevens AC , Weinstein E , Miramonti CM , Kozak MA . Effect of introducing the mucosal atomization device for fentanyl use in out-of-hospital pediatric trauma patients. Prehosp Disaster Med. 2013;28(4):1-3 .

O'Donnell DP; Schafer LC; Stevens AC; Weinstein E; Miramonti CM; Kozak MA

2013-05-01

228

[Proactive bedside counseling of smokers hospitalized in cardiac intensive care unit].  

UK PubMed Central (United Kingdom)

AIM OF THE STUDY: To offer routine information on smoking cessation and bedside counseling to smokers admitted in cardiac intensive care unit. The objective is to encourage cessation and/or use of smoking cessation services after discharge. POPULATION AND METHODS: Thirty-three smokers were admitted in cardiac intensive care unit at the Georges Pompidou European hospital (HEGP) in Paris (France) from 1st March to June 30th 2010. Assessment of tobacco use and offer of counseling and follow-up visits during and after hospital stay. Evaluation of tobacco use by telephone at least six months after discharge. RESULTS: It was found that 30.3% of the patients stopped smoking, mostly without specialized help despite heavy smoking prior to hospitalization. They declared being impressed by their hospital stay. Motives for smoking among continuing smokers were mostly automatic smoking and stress relief. They had declined any smoking aid, despite subsequent hospital stays in cardiac intensive care. Three smokers with a severe profile had died at follow-up. Smokers followed-up at HEGP were in need of nicotine replacement therapy. More than six months after hospital discharge, nearly all smokers remembered being offered bedside counseling to stop smoking. CONCLUSION: This experience reveals the importance of routine bedside counseling for smoking cessation in cardiac intensive care unit. Smokers in this unit often continue smoking even though smoking hinders cardiac rehabilitation.

Baha M; Le Faou AL

2011-08-01

229

Survival from in-hospital cardiac arrest: the potential impact of infection.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study was to examine the relationship between outcome from cardiac arrest and infection status at the time of in-hospital cardiac arrest. DESIGN: This was a retrospective database review from a single resuscitation service supporting two major hospitals. SETTING: Two urban University Hospitals in London. PATIENTS: Data from 1436 in-patient cardiac arrest were available for analysis. INTERVENTIONS: Nil. MEASUREMENTS AND RESULTS: Patients were classified into infected or non-infected groups by the resuscitation audit process and the hospitals diagnostic coding unit. Survival was followed according to the in-hospital Utstein timepoints. In addition, the data were examined by presenting the cardiac rhythm. Age and length of prior hospitalisation were recorded. Infection associated diagnoses appear to be increasing in prevalence. Initial survival from cardiac arrest was not affected by infection status, but this did have a substantial impact on chance of leaving the initial hospital (odds ratio 0.52, confidence intervals 0.3-0.8), or being discharged to home (odds ratio 0.48, confidence intervals 0.4-0.8). The outcome from ventricular fibrillation/pulseless ventricular tachycardia was worse for infected patients (odds ratio for home discharge 0.37, confidence intervals 0.2-0.9), although initial survival was not significantly different. CONCLUSIONS: Infection may be becoming an increasingly important association with cardiac arrest in the hospitalised population. Initial survival from cardiac arrest is the same as for non-infected patients, but longer term survival is much poorer. Long-term survival from ventricular fibrillation or pulseless ventricular tachycardia is relatively poor, in spite of similar initial success.

Treanor G; Spearpoint K; Brett S

2005-01-01

230

Prehospital Sepsis Project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Severe sepsis and septic shock are common and often fatal medical problems. The Prehospital Sepsis Project is a multifaceted study that aims to improve the out-of-hospital care of patients with sepsis by means of education and enhancement of skills. The objective of this Project was to assess the knowledge and attitudes in the principles of diagnosis and management of sepsis in a cohort of United States out-of-hospital care providers. METHODS: This was cross-sectional study. A 15-item survey was administered via the Web and e-mailed to multiple emergency medical services list-servers. The evaluation consisted of four clinical scenarios as well as questions on the basics of sepsis. For intra-rater reliability, the first and the fourth scenarios were identical. Chi-square and Fisher's Exact testing were used to assess associations. Relative risk (RR) was used for strength of association. Statistical significance was set at .05. RESULTS: A total of 226 advanced EMS providers participated with a 85.4% (n = 193) completion rate, consisting of a 30.7% rural, 32.3% urban, and 37.0% suburban mix; 82.4% were paramedics and 72.5% had worked in EMS >10 years. Only 57 (29.5%) participants scored both of the duplicate scenarios correctly, and only 19 of the 193 (9.8%) responded to all scenarios correctly. Level of training was not a predictor of correctly scoring scenarios (P = .71, RR = 1.25, 95% CI = 0.39-4.01), nor was years of service (P = .11, RR = 1.64, 95% CI = 0.16-1.21). CONCLUSIONS: Poor understanding of the principles of diagnosis and management of sepsis was observed in this cohort, suggesting the need for enhancement of education. Survey items will be used to develop a focused, interactive Web-based learning program. Limitations include potential for self-selection and data accuracy.

Báez AA; Hanudel P; Perez MT; Giraldez EM; Wilcox SR

2013-04-01

231

[Thyroid cardiac diseases in the African hospital milieu: experience of the Principal Hospital of Dakar, Senegal  

UK PubMed Central (United Kingdom)

The incidence of cardiomyopathy associated with hyperthyroidism in black Africa is unclear. A prospective study was carried out at the Principal Hospital in Dakar, Senegal to systematically screen for thyrocardiac disease using cardiologic examinations including electrocardiography and ultrasound in a series of 15 men and 35 women with hyperthyroidism. Cardiac manifestations were detected in 3 men and 8 women including right ventricular insufficiency in 9 cases, left ventricular insufficiency and angor in one. After treatment of hyperthyroidism, atrial fibrillation disappeared in two cases and angor in one. Isolated dilated hypokinetic cardiomyopathy observed in 6 patients was the most common ultrasound finding and disappeared after treatment of thyroid dysfunction in 5. Manifestations occurred in two patients with mitro-aortic valve disease and one patient with isolated aortic valve disease. Based on these findings, the incidence of cardiomyopathy in patients with hyperthyroidism in Senegal was estimated to be 22 per 100 cases. This is similar to the incidence reported in industrialized countries. However the age of occurrence is lower and rheumatic valve disease was the most common associated cardiopathy.

Thiam M; Mbaye PS; Camara P; Cloatre G; Perret JL

1999-01-01

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[Thyroid cardiac diseases in the African hospital milieu: experience of the Principal Hospital of Dakar, Senegal].  

Science.gov (United States)

The incidence of cardiomyopathy associated with hyperthyroidism in black Africa is unclear. A prospective study was carried out at the Principal Hospital in Dakar, Senegal to systematically screen for thyrocardiac disease using cardiologic examinations including electrocardiography and ultrasound in a series of 15 men and 35 women with hyperthyroidism. Cardiac manifestations were detected in 3 men and 8 women including right ventricular insufficiency in 9 cases, left ventricular insufficiency and angor in one. After treatment of hyperthyroidism, atrial fibrillation disappeared in two cases and angor in one. Isolated dilated hypokinetic cardiomyopathy observed in 6 patients was the most common ultrasound finding and disappeared after treatment of thyroid dysfunction in 5. Manifestations occurred in two patients with mitro-aortic valve disease and one patient with isolated aortic valve disease. Based on these findings, the incidence of cardiomyopathy in patients with hyperthyroidism in Senegal was estimated to be 22 per 100 cases. This is similar to the incidence reported in industrialized countries. However the age of occurrence is lower and rheumatic valve disease was the most common associated cardiopathy. PMID:10546193

Thiam, M; Mbaye, P S; Camara, P; Cloatre, G; Perret, J L

1999-01-01

233

Reminiscence on the municipal out-of-hospital Maternity unit and the Motherhood Home in Novi Sad  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. Out-of-Hospital Maternity Unit. One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women’s health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. Motherhood Home. After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children’s health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. Epilogue. The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

Dobanova?ki Dušanka; Breberina Milan; Vujoševi? Božica; Pe?anac Marija; Žakula Nenad; Trajkovi? Veli?ko

2013-01-01

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Association of out-of-hospital advanced airway management with outcomes after traumatic brain injury and hemorrhagic shock in the ROC hypertonic saline trial.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Prior studies suggest adverse associations between out-of-hospital advanced airway management (AAM) and patient outcomes after major trauma. This secondary analysis of data from the Resuscitation Outcomes Consortium Hypertonic Saline Trial evaluated associations between out-of-hospital AAM and outcomes in patients suffering isolated severe traumatic brain injury (TBI) or haemorrhagic shock. METHODS: This multicentre study included adults with severe TBI (GCS ?8) or haemorrhagic shock (SBP ?70 mm Hg, or (SBP 71-90 mm Hg and heart rate ?108 bpm)). We compared patients receiving out-of-hospital AAM with those receiving emergency department AAM. We evaluated the associations between airway strategy and patient outcomes (28-day mortality, and 6-month poor neurologic or functional outcome) and airway strategy, adjusting for confounders. Analysis was stratified by (1) patients with isolated severe TBI and (2) patients with haemorrhagic shock with or without severe TBI. RESULTS: Of 2135 patients, we studied 1116 TBI and 528 shock; excluding 491 who died in the field, did not receive AAM or had missing data. In the shock cohort, out-of-hospital AAM was associated with increased 28-day mortality (adjusted OR 5.14; 95% CI 2.42 to 10.90). In TBI, out-of-hospital AAM showed a tendency towards increased 28-day mortality (adjusted OR 1.57; 95% CI 0.93 to 2.64) and 6-month poor functional outcome (1.63; 1.00 to 2.68), but these differences were not statistically significant. Out-of-hospital AAM was associated with poorer 6-month TBI neurologic outcome (1.80; 1.09 to 2.96). CONCLUSIONS: Out-of-hospital AAM was associated with increased mortality after haemorrhagic shock. The adverse association between out-of-hospital AAM and injury outcome is most pronounced in patients with haemorrhagic shock.

Wang HE; Brown SP; Macdonald RD; Dowling SK; Lin S; Davis D; Schreiber MA; Powell J; van Heest R; Daya M

2013-01-01

235

Use of the out-of-hours emergency dental service at two south-east London hospitals  

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Full Text Available Abstract Background Prior to the introduction of the 2006 NHS dental contract in England and Wales, general dental practitioners (GDPs) were responsible for the provision of out-of-hours (OOH) emergency dental services (EDS); however there was great national variation in service provision. Under the contractual arrangements introduced 1st April 2006, local commissioning agencies became formally responsible for the provision of out-of-hours emergency dental services. This study aimed to examine patients' use of an out-of-hours emergency dental service and to determine whether the introduction of the 2006 national NHS dental contract had resulted in a change in service use, with a view to informing future planning and commissioning of care. Methods A questionnaire was administered to people attending the out-of-hours emergency dental service at two inner city London hospitals over two time periods; four weeks before and six months after the introduction of the dental contract in April 2006. The questionnaire explored: reasons for attending; dental registration status and attendance; method of access; knowledge and use of NHS Direct; satisfaction with the service; future preferences for access and use of out-of-hours dental services. Data were compared to determine any impact of the new contract on how and why people accessed the emergency dental service. Results The response rate was 73% of attendees with 981 respondents for the first time period and 546 for the second. There were no significant differences between the two time periods in the gender, age, ethnic distribution or main language of service users accessing the service. Overall, the main dental problem was toothache (72%) and the main reason for choosing this service was due to the inability to access another emergency dental service (42%). Significantly fewer service users attended the out-of-hours emergency dental service during the second period because they could not get an appointment with their own dentist (p = 0.002 from 28% to 20%) and significantly more service users in the second period felt the emergency dental service was easier to get to than their own dentist (P = 0.003 from 8% to 14%). Service users found out about the service from multiple sources, of which family and friends were the most common source (30%). In the second period fewer service users were obtaining information about the service from dental receptionists (P = 0.002 from 14% to 9%) and increased use of NHS Direct for a dental problem was reported (P = 0.002 from 16% to 22%) along with more service users being referred to the service by NHS Direct (P = 0.02 from 19% to 24%). The most common preference for future emergency dental care was face-to-face with a dentist (79%). Conclusion This study has provided an insight into how and why people use an out-of-hours emergency dental service and has helped to guide future commissioning of these services. Overall, the service was being used in much the same way both before and after the 2006 dental contract. Significantly more use was being made of NHS Direct after April 2006; however, informal information networks such as friends and family remain an important source of information about accessing emergency dental services.

Austin Rupert; Jones Kate; Wright Desmond; Donaldson Nora; Gallagher Jennifer E

2009-01-01

236

Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review.  

UK PubMed Central (United Kingdom)

ABSTRACT: INTRODUCTION: This systematic review is focused on the in-hospital mortality and neurological outcome of survivors after prehospital resuscitation following trauma. Data were analyzed for adults/pediatric patients and for blunt/penetrating trauma. METHODS: A systematic review was performed using the data available in Ovid Medline. 476 articles from 1/1964 - 5/2011 were identified by two independent investigators and 47 studies fulfilled the requirements (admission to hospital after prehospital resuscitation following trauma). Neurological outcome was evaluated using the Glasgow outcome scale. RESULTS: 34 studies/5391 patients with a potentially mixed population (no information was found in most studies if and how many children were included) and 13 paediatric studies/1243 children (age ? 18 years) were investigated. The overall mortality was 92.8% (mixed population: 238 survivors, lethality 96.7%; paediatric group: 237 survivors, lethality 86.4% = p < 0.001).Penetrating trauma was found in 19 studies/1891 patients in the mixed population (69 survivors, lethality: 96.4%) and in 3 pediatric studies/91 children (2 survivors lethality 97.8%).44.3% of the survivors in the mixed population and 38.3% in the group of children had a good neurological recovery. A moderate disability could be evaluated in 13.1% in the mixed population and in 12.8% in children. A severe disability was found in 29.5% of the survivors in the mixed patients and in 38.3% in the group of children. A persistent vegetative state was the neurological status in 9.8% in the mixed population and in 10.6% in children.For each year prior to 2010, the estimated log-odds for survival decreased by 0.022 (95%-CI: [0.038;0.006]). When jointly analyzing the studies on adults and children, the proportion of survivors for children is estimated to be 17.8% (95%-CI: [15.1%;20.8%]). The difference of the paediatric compared to the adult proportion is significant (p < 0.001). CONCLUSIONS: Children have a higher chance of survival after resuscitation of an out-of-hospital traumatic cardiac arrest compared to adults but tend to have a poorer neurological outcome at discharge.

Zwingmann J; Mehlhorn AT; Hammer T; Bayer J; Südkamp NP; Strohm PC

2012-07-01

237

Nutritional Status of the Cardiac Patients Hospitalized in Cardiology Ward of Alzahra Hospital and its Comparison with Healthy Eating Index  

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Full Text Available Cardiovascular diseases are getting epidemic due to social reconstruction, technology advancement and over population in urban areas, inappropriate food habits and immobility. This study has tried to define the indexes of healthy nutrition in cardiac patients hospitalized in cardiac ward of Alzahra hospital and to compare it with Healthy Eating Index (HEI). Healthy Eating Index has been also designed to evaluate diet quality in different societies. This is a descriptive analytical study conducted cross-sectionally in cardiac patients hospitalized in cardiac ward of Alzahra hospital in Isfahan, Iran. Nutritional status was investigated by completing the last three days dietary Recalls. Nutritional index was calculated based on food pyramid guidelines, fat calorie percentage from total calorie, intake of saturated fats percentage and cholesterol, calcium, Iron and food variation. The range of this index was from 0-10 so the total score was 100. Calculation of this index was made with respect to the data of nutrition intakes compared to healthy food index. The score of food variation was defined by routine food intake in the society. The score of nutrition index was categorized into three groups of lower than 50 (weak), 51-80 (needs a change and improvement) and over 81 (good). Mean comparison test was used to compare healthy food index with nutrients intake and the number of servings of food pyramid guidelines. Mean age of cardiac patients was 65.5±7.9 and the nutrition index score were 36.3 in males and 35.7 in females. The intake servings from food pyramid in patients with good index score was significantly higher compared to other groups (p0.5). Pearson correlation test showed that there was no significant association between age and nutrition variation, calcium, vegetables and bread (p>0.5). Level of education had a significant direct association with food variation, Iron, meat and fruit intake (p<0.5) but not with other items (p<0.5). 73.2% of diet should be changed and improved while in 3.3% it was good. 23.5% followed weak food pattern. Healthy food index is an appropriate tool to evaluate nutrition quality of cardiac patients. The diet in most of the cardiac patients needs improvement and changes in appropriate food education is essential.

N. Bahreini; M. Entezari; A. Hassansadeh; M. Ganjalideshti; M. Jalali

2007-01-01

238

Long-term outcomes in elderly survivors of in-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge. METHODS: We linked data from a national registry of inpatient cardiac arrests with Medicare files and identified 6972 adults, 65 years of age or older, who were discharged from the hospital after surviving an in-hospital cardiac arrest between 2000 and 2008. Predictors of 1-year survival and of readmission to the hospital were examined. RESULTS: One year after hospital discharge, 58.5% of the patients were alive, and 34.4% had not been readmitted to the hospital. The risk-adjusted rate of 1-year survival was lower among older patients than among younger patients (63.7%, 58.6%, and 49.7% among patients 65 to 74, 75 to 84, and ?85 years of age, respectively; P<0.001), among men than among women (58.6% vs. 60.9%, P=0.03), and among black patients than among white patients (52.5% vs. 60.4%, P=0.001). The risk-adjusted rate of 1-year survival was 72.8% among patients with mild or no neurologic disability at discharge, as compared with 61.1% among patients with moderate neurologic disability, 42.2% among those with severe neurologic disability, and 10.2% among those in a coma or vegetative state (P<0.001 for all comparisons). Moreover, 1-year readmission rates were higher among patients who were black, those who were women, and those who had substantial neurologic disability (P<0.05 for all comparisons). These differences in survival and readmission rates persisted at 2 years. At 3 years, the rate of survival among survivors of in-hospital cardiac arrest was similar to that of patients who had been hospitalized with heart failure and were discharged alive (43.5% and 44.9%, respectively; risk ratio, 0.98; 95% confidence interval, 0.95 to 1.02; P=0.35). CONCLUSIONS: Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge. (Funded by the American Heart Association and the National Heart, Lung, and Blood Institute.).

Chan PS; Nallamothu BK; Krumholz HM; Spertus JA; Li Y; Hammill BG; Curtis LH

2013-03-01

239

Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

OBJECTIVE:--To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest. DESIGN AND SETTING:--Randomized controlled trial in a university-affiliated hospital. PATIENTS:--Patients experiencing in-hospital cardiac arrest during a 6-month period. INTERVENTIONS:--Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min. MAIN OUTCOME MEASURES:--The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge. RESULTS:--During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%, P = .007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%, P = .02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant). CONCLUSIONS:--We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials.

Sack JB; Kesselbrenner MB; Bregman D

1992-01-01

240

The safety of performing diagnostic cardiac catheterizations in a mobile catheterization laboratory at primary care hospitals.  

UK PubMed Central (United Kingdom)

The benefits of mobile cardiac catheterization laboratories include keeping patients closer to their families, communities, local hospitals, and primary care physicians while receiving services comparable to those available at tertiary centers. However, there are very few studies regarding the safety of performing cardiac catheterization in mobile laboratories at remote locations. Thus, the authors performed an observational study of 1,775 consecutive patients undergoing a diagnostic cardiac catheterization in a mobile catheterization laboratory at primary care hospitals served by the Appleton Heart Institute (AHI) from August 1, 1991, to December 31, 1998. Twenty-three percent (1,775/7,637) of all AHI diagnostic cases in this time period were performed in the mobile catheterization laboratory. Urgent transfer to the tertiary care facility via ambulance or helicopter was used for 2.3% of patients (n = 41). The overall complication rate was 1.2% (n = 21). Of the patients who underwent cardiac catheterization in the mobile laboratory, 32.6% (n = 579) were subsequently referred for interventional or surgical revascularization. There were no deaths. Cardiac catheterizations can be performed safely in a mobile laboratory at primary care hospitals, provided that immediate transfer is available for those in need of urgent intervention or revascularization and that unstable patients are not studied in the mobile laboratory.

Peterson LF; Peterson LR

2004-09-01

 
 
 
 
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Hospital Utilization in Adults with Single Ventricle Congenital Heart Disease and Cardiac Arrhythmias.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The study sought to identify the impact of cardiac arrhythmias on hospitalizations in adults with single ventricle (SV) congenital heart disease (CHD). BACKGROUND: Surgical advances have dramatically improved survival in patients with CHD. Cardiac arrhythmias and sudden cardiac death are common in adults with CHD. METHODS & RESULTS: Data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database were used to identify patients ? 18 years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV), and a cardiac arrhythmia. Primary and secondary diagnoses, length of stay (LOS), hospital charges, and interventional procedures were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and clinical outcomes among the three subgroups (HLHS, TA, and CV). Interactions of charges with arrhythmia and admission year were examined using ANOVA. There were 642 admissions in 424 patients with SV CHD and an arrhythmia diagnosis. A single arrhythmia diagnosis was present in 454 admissions (71%). Total hospital charges were $80.7 Million with mean charge per admission of $127,296±243,094. The mean charge per hospital day was $16,653±17,516 and increased across the study period (p<0.01). Arrhythmia distributions were impacted by SV anatomic subtype (p<0.001). Hospital resource utilization was significantly different among arrhythmia groups (p<0.001). CONCLUSIONS: In adults with SV CHD, arrhythmias are affected by SV anatomic subtype and impact adversely upon hospital resource utilization. This article is protected by copyright. All rights reserved.

Collins RT 2nd; Fram RY; Tang X; Robbins JM; Sutton MS

2013-09-01

242

Small-volume resuscitation with HBOC-201: effects on cardiovascular parameters and brain tissue oxygen tension in an out-of-hospital model of hemorrhage in swine.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Hemoglobin-based oxygen carriers, such as HBOC-201, offer several potential advantages over conventional resuscitation solutions or banked blood in the acute treatment of hemorrhagic shock. While previous studies with some hemoglobin solutions revealed vasoactive effects resulting in decreased oxygen delivery, these investigations were performed without directly measuring vital tissue oxygenation. The authors tested the hypothesis that a small-volume bolus of HBOC-201 would improve and sustain brain tissue oxygen tension (PbrO(2)) without adverse effects on cardiovascular end-points, when used in an acute out-of-hospital hemorrhage model. METHODS: Male Yorkshire swine (n = 7) were hemorrhaged to a mean arterial pressure (MAP) of 40 mm Hg while monitoring standard hemodynamic parameters. In addition, Clark-type polarographic probes were directly inserted into brain tissue to measure PbrO(2). Following institution of high-flow oxygen (FiO(2) = 1.0), resuscitation was performed with a bolus infusion of HBOC-201 (6 mL/kg). Swine were observed for two hours. RESULTS: Cardiac output (CO), MAP, pulmonary artery diastolic pressure (PAD), and PbrO(2) all decreased significantly with hemorrhage (p < 0.05). Immediately following resuscitation with HBOC-201 (mean volume = 239 mL), MAP and CO were restored to 83% and 84% of baseline levels, respectively. PbrO(2) increased significantly after treatment with HBOC-201, surpassing baseline levels by 66%. PAD rose above baseline levels during observation, but this increase was not significantly different from baseline levels (24.0 mm +/- 4.1 vs. 22.7 mm +/- 7.4). CONCLUSIONS: Small-volume resuscitation with HBOC-201 rapidly restored hemodynamic parameters and PbrO(2) following severe hemorrhage without detrimental vasoactive effects and without compromise to directly monitored brain tissue oxygenation. The results of this preliminary study demonstrate that HBOC-201 could potentially improve current resuscitation measures and that further investigations with HBOC-201 are warranted.

Lee SK; Morabito D; Hemphill JC; Erickson V; Holcroft JJ; Derugin N; Knudson MM; Manley GT

2002-10-01

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Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team--a prospective multi-centre analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The number of palliative care patients who live at home and have non-curable life-threatening diseases is increasing. This is largely a result of modern palliative care techniques (e.g. specialised out-of-hospital palliative medical care services), changes in healthcare policy and the availability of home care services. Accordingly, pre-hospital emergency physicians today are more likely to be involved in out-of-hospital emergency treatment of palliative care patients with advanced disease. METHODS: In a prospective multi-centre study, we analysed all palliative emergency care calls during a 24-month period across four emergency services in Germany. Participating pre-hospital emergency physicians were rated according to their expertise in emergency and palliative care as follows--group 1: pre-hospital emergency physicians with high experience in emergency and palliative medical care, group 2: pre-hospital emergency physicians with high experience in emergency medical care but less experience in palliative medical care and group 3: pre-hospital emergency physicians with low experience in palliative and emergency medical care. RESULTS: During the period of interest, the centres received 361 emergency calls requiring a response to palliative care patients (2.8% of all 12,996 emergency calls). Ten percent of all patients were treated by group 1; 42% were treated by group 2 and 47% were treated by group 3. There was a statistically significant difference in the treatment of palliative care patients (e.g. transfer to hospital, symptom control, end-of-life decision) as a result of the level of expertise of the investigated pre-hospital emergency physicians (p< 0.01). CONCLUSIONS: In Germany, out-of-hospital emergency medical treatment of palliative care patients depends on the expertise in palliative medical care of the pre-hospital emergency physicians who respond to the call. In our investigation, best out-of-hospital palliative medical care was given by pre-hospital emergency physicians who had significant expertise in palliative and emergency medical care. Our results suggest that it may be necessary to take the core principles of palliative care into consideration when conducting out-of-hospital emergency medical treatment of palliative care patients.

Wiese CH; Bartels UE; Marczynska K; Ruppert D; Graf BM; Hanekop GG

2009-12-01

244

The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals  

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Full Text Available Background. Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway. Design and methods. With data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender. Results. 12,982 persons aged 30-87 years participated, 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers. Conclusions. Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.

Anne Helen Hansen; Peder A. Halvorsen; Olav Helge Førde

2012-01-01

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Efficacy of the EZ-IO® needle driver for out-of-hospital intraosseous access - a preliminary, observational, multicenter study  

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Full Text Available Abstract Background Intraosseous (IO) access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO® in the prehospital setting. Methods During a 24-month period, all cases of prehospital IO access using the EZ-IO® needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device. Results 77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications) and paramedics (n = 5 applications). Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement). The majority of users (92%) were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied), provided a median score of 10 (range 1-10). Conclusions The EZ-IO® needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

Schalk Richard; Schweigkofler Uwe; Lotz Gösta; Zacharowski Kai; Latasch Leo; Byhahn Christian

2011-01-01

246

Physico-chemical stability and sterility of previously prepared saline infusion solutions for use in out-of-hospital emergencies.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The topic of this research was to determine whether out-of-hospital emergency teams could make use of previously prepared saline solutions (SS). The objective was to discover the physical, chemical and sterility characteristics of previously prepared saline infusions stored in ambulances and ascertain how long they remained in optimum condition. METHOD: Randomised clinical trial, triple blind, where study units consisted of saline solutions prepared with an infusion system and a three-way valve. The duration of the study was 12 months. Six intervention groups were designed on the basis of time of exposure and location. Samples consisted of 672 units. Twelve microbiological cultures were made and the pH, density, viscosity and CINa concentration were determined. We compared hypotheses with four models of linear regression for the variables and a model of logistic regression for the variables. A value of P < 0.05 was considered significant. RESULTS: We obtained results from 669 saline solutions (98.82%). Neither multivariant analysis nor ANOVA tests showed any significant association for a power greater than 99% with regard to the physical-chemical characteristics. The model of logistic regression also did not find any significant association for sterility. Colonisation was present in 1.7% of the 8,028 cultures made and more than 5 CFU per millilitre was found in only two cases. CONCLUSION: There is no evidence to suggest that recently prepared saline infusion solutions are any different from a physical-chemical and sterility point of view than those exposed for 24, 48, or 72 h. It was concluded that use can be made of previously prepared saline solutions with a guarantee their stability and sterility.

Péculo Carrasco JA; Cosano Prieto I; Gómez Escorza J; Avecilla Sánchez JL; Casal Sánchez Mdel M; Rodríguez Bouza M

2004-08-01

247

Prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in pakistan.  

Science.gov (United States)

Objective: This study examined the prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in Pakistan.Methods: All patients admitted to a cardiac unit of a tertiary care hospital in Pakistan over a period of eight weeks were evaluated with clinical interview using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, Hospital Anxiety and Depression Scale (HADS), and Quality of Life (QoL) scale.Results: One hundred patients entered the study. Sixty eight met the criteria for either major depressive disorder, generalized anxiety disorder, or both. A total of 87.5 percent of the entire female sample met the criteria for either a depressive disorder, an anxiety disorder or both. Patients with higher scores on HADS anxiety subscale had longer duration of cardiac illness. Patients with depression and anxiety had poor quality of life on the four domains of QoL scale.Conclusions: This study shows high prevalence of major depressive disorder and generalized anxiety disorder in cardiac patients in Pakistan. Being female, a housewife, and a widow are high risk factors for developing depression and/or anxiety in this population, requiring close monitoring. PMID:19727293

Dogar, Imtiaz Ahmad; Khawaja, Imran S; Azeem, Muhammad Waqar; Awan, Huma; Ayub, Afshan; Iqbal, Javed; Thuras, Paul

2008-02-01

248

Prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in pakistan.  

UK PubMed Central (United Kingdom)

Objective: This study examined the prevalence and risk factors for depression and anxiety in hospitalized cardiac patients in Pakistan.Methods: All patients admitted to a cardiac unit of a tertiary care hospital in Pakistan over a period of eight weeks were evaluated with clinical interview using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, Hospital Anxiety and Depression Scale (HADS), and Quality of Life (QoL) scale.Results: One hundred patients entered the study. Sixty eight met the criteria for either major depressive disorder, generalized anxiety disorder, or both. A total of 87.5 percent of the entire female sample met the criteria for either a depressive disorder, an anxiety disorder or both. Patients with higher scores on HADS anxiety subscale had longer duration of cardiac illness. Patients with depression and anxiety had poor quality of life on the four domains of QoL scale.Conclusions: This study shows high prevalence of major depressive disorder and generalized anxiety disorder in cardiac patients in Pakistan. Being female, a housewife, and a widow are high risk factors for developing depression and/or anxiety in this population, requiring close monitoring.

Dogar IA; Khawaja IS; Azeem MW; Awan H; Ayub A; Iqbal J; Thuras P

2008-02-01

249

Particulate air pollution and hospital admissions for cardiac diseases in potentially sensitive subgroups.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although numerous studies have provided evidence of an association between ambient air pollution and acute cardiac morbidity, little is known regarding susceptibility factors. METHODS: We conducted a time-stratified case-crossover study in 9 Italian cities between 2001 and 2005 to estimate the short-term association between airborne particles with aerodynamic diameter <10 ?m (PM10) and cardiac hospital admissions, and to identify susceptible groups. We estimated associations between daily PM10 and all cardiac diseases, acute coronary syndrome, arrhythmias and conduction disorders, and heart failure for 167,895 hospitalized subjects ? 65 years of age. Effect modification was assessed for age, sex, and a priori-defined hospital diagnoses (mainly cardiovascular and respiratory conditions) from the previous 2 years as susceptibility factors. RESULTS: The increased risk of cardiac admissions was 1.0% (95% confidence interval [CI] = 0.7% to 1.4%) per 10 ?g/m PM10 at lag 0. The effect was slightly higher for heart failure (lag 0, 1.4% [0.7% to 2.0%]) and acute coronary syndrome (lag 0-1, 1.1% [0.4% to 1.9%]) than for arrhythmias (lag 0, 1.0% [0.2% to 1.8%]). Women were at higher risk of heart failure (2.0% [1.2% to 2.8%]; test for interaction, P = 0.022), whereas men were at higher risk of arrhythmias (1.9% [0.8% to 3.0%]; test for interaction, P = 0.020). Subjects aged 75-84 years were at higher risk of admissions for coronary events (2.6% [1.5% to 3.8%]; test for interaction, P = 0.001). None of the identified chronic conditions was a clear marker of susceptibility. CONCLUSIONS: An important effect of PM10 on hospitalizations for cardiac diseases was found in Italian cities. Sex and older age were susceptibility factors.

Colais P; Faustini A; Stafoggia M; Berti G; Bisanti L; Cadum E; Cernigliaro A; Mallone S; Pacelli B; Serinelli M; Simonato L; Vigotti MA; Forastiere F

2012-05-01

250

Relation Between Cardiac Troponins And In-Hospital Mortality In Right-Sided Stroke Patients  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: The association between acute ischemic strokes and cardiovascular disturbances has been established previously. The insula of the right cerebral hemisphere may have a major role in cardiac autonomic control. We investigated if elevated troponin T (cTnT) and troponin I (cTnI), the specific biomarkers of cardiac damage, are independent predictors of in-hospital mortality in right-sided stroke patients. Materials and Methods: Sixty-six patients with acute ischemic right hemispheric involvement who were admitted to a university hospital during an eight-month period were included in this prospective observational clinical study. The levels of cardiac biomarkers were measured and compared with the in-hospital mortality rates. Results: Hospital mortality was significantly higher in patients with cTnT>0.1 ng/ml (4 [44.4%] vs 5 [8.8%]; p=0.016) but not in patients with cTnI>1.5 ng/ml (3 [33.3%] vs 6 [10.5%]; p=0.098). Initial National Institute of Health Stroke Scale (NIHSS) scores and Glasgow Coma Scale scores were also significantly higher in patients who were dead in-hospital (median: 16 vs 6; p=0.00, and median: 11 vs 15; p=0.007, respectively). Logistic regression analysis have revealed that elevated cTnT values and NIHSS scores at admission were independent predictors of death in-hospital (p=0.04, [OR 0.03, 95% CI 0.0-0.8]; p=0.046, [OR 2.8, 95% CI 1.082-7.433, respectively). Conclusion: We conclude that elevated CTnT, but not CTnI, may be an independent predictor of in-hospital mortality in acute ischemic right-sided stroke patients.

R?dvan AT?LLA; Özge DUMAN; Filiz KURALAY; Sedat YANTURALI; Metin Ç?ÇEK; Metin MAN?SALI; Ba?ak Bingöl ÇAKIRLI; Cenker EKEN

2008-01-01

251

Course of body weight from hospitalization to exit from cardiac rehabilitation.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Overweight is highly prevalent among cardiac rehabilitation (CR) participants. The purpose of this study was to assess the course of body weight change after an acute coronary event, from hospitalization through completion of CR. METHODS: Body weight was measured inhospital at the time of admission for the index cardiac event (hospitalization), at CR entry, and at exit from CR. RESULTS: The study population consisted of 181 patients who entered into outpatient CR and completed up to 36 sessions. The average age, weight, and body mass index at baseline were 65.2 ± 10.9 years, 85.2 ± 16.2 kg, and 29.6 ± 4.4, respectively. Body weight decreased from hospitalization to CR entry (2.5 ± 3.0 kg) and from CR entry to CR exit (2.4 ± 4.3 kg) (P < .86). The mean total weight loss from hospitalization to CR exit was 4.8 ± 4.8 kg. Forty-nine overweight individuals attended 4 behavioral weight loss sessions during CR. Compared with participants who did not, behavioral weight loss classes attendees lost more weight from hospital admission to CR exit (8.1 ± 4.4 vs 3.6 ± 4.4 kg) and during CR (5.6 ± 4.1 vs 1.2 ± 3.8 kg) (both, P < .0001). CONCLUSIONS: Cardiac patients lose significant weight between hospitalization and CR entry. Nearly half of the total weight loss that patients experienced from hospitalization to CR exit occurred prior to CR entry. Overall, overweight individuals lose nearly 5 kg or 6% of their weight. Our results suggest that a behavioral weight loss intervention delivered through CR helps sustain weight loss observed during the early convalescence period prior to CR entry and promotes weight loss during CR.

Savage PD; Lakoski SG; Ades PA

2013-09-01

252

Pre-hospital cardiac arrest in acute coronary syndromes: insights from the global registry of acute coronary events and the canadian registry of acute coronary events.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Cardiac arrest in acute coronary syndromes (ACS) is associated with high morbidity and mortality. We examined the clinical characteristics, contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest. METHODS: The Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events enrolled 14,010 ACS patients in 1999-2008. We compared the clinical characteristics, in-hospital treatment and outcomes between patients with and without pre-hospital cardiac arrest. RESULTS: Overall, 206 (1.4%) patients had cardiac arrest prior to hospital presentation. ACS patients with pre-hospital cardiac arrest were less frequently treated with aspirin, ?-blocker, angiotensin-converting enzyme inhibitors, and statins within the first 24 h of presentation, but the use of cardiac procedures was similar compared to the group without cardiac arrest. Patients with pre-hospital cardiac arrest had significantly higher rates of in-hospital adverse events. Factors independently associated with pre-hospital cardiac arrest included male gender, current smoker status, tachycardia, higher Killip class and ST-segment deviation. CONCLUSION: ACS patients with pre-hospital cardiac arrest continue to have more in-hospital complications and higher mortality. Their use of evidence-based medical therapies was lower but the use of cardiac procedures was similar compared to the group without cardiac arrest. Better utilization of evidence-based therapies in these patients may translate into improved outcomes.

Li Q; Goodman SG; Yan RT; Gore JM; Polasek P; Lai K; Baer C; Goldberg RJ; Pinter A; Ahmad K; Kornder JM; Yan AT

2013-01-01

253

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

International Nuclear Information System (INIS)

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)

2010-01-01

254

Logistic regression model to predict outcome after in-hospital cardiac arrest: validation, accuracy, sensitivity and specificity.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To develop and validate a logistic regression model to identify predictors of death before hospital discharge after in-hospital cardiac arrest. DESIGN: Retrospective derivation and validation cohorts over two 1 year periods. Data from all in-hospital cardiac arrests in 1986-87 were used to derive a logistic regression model in which the estimated probability of death before hospital discharge was a function of patient and arrest descriptors, major underlying diagnosis, initial cardiac rhythm, and time of year. This model was validated in a separate data set from 1989-90 in the same hospital. Calculated for each case was 95% confidence limits (C.L.) about the estimated probability of death. In addition, accuracy, sensitivity, and specificity of estimated probability of death and lower 95% C.L. of the estimated probability of death in the derivation and validation data sets were calculated. SETTING: 560-bed university teaching hospital. PATIENTS: The derivation data set described 270 cardiac arrests in 197 inpatients. The validation data set described 158 cardiac arrests in 120 inpatients. INTERVENTIONS: none. MEASUREMENTS AND RESULTS: Death before hospital discharge was the main outcome measure. Age, female gender, number of previous cardiac arrests, and electrical mechanical dissociation were significant variables associated with a higher probability of death. Underlying coronary artery disease or valvular heart disease, ventricular tachycardia, and cardiac arrest during the period July-September were significant variables associated with a lower probability of death. Optimal sensitivity and specificity in the validation set were achieved at a cut-off probability of 0.85. CONCLUSIONS: Performance of this logistic regression model depends on the cut-off probability chosen to discriminate between predicted survival and predicted death and on whether the estimated probability or the lower 95% C.L. of the estimated probability is used. This model may inform the development of clinical practice guidelines for patients who are at risk of or who experience in-hospital cardiac arrest.

Dodek PM; Wiggs BR

1998-03-01

255

Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests.  

UK PubMed Central (United Kingdom)

BACKGROUND: Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests. METHODS AND RESULTS: We examined the effect of CPR duration for pediatric in-hospital cardiac arrests from the Get With The Guidelines-Resuscitation prospective, multicenter registry of in-hospital cardiac arrests. We included 3419 children from 328 U.S. and Canadian Get With The Guidelines-Resuscitation sites with an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma. Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes. Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute. Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes. Among survivors, favorable neurological outcome occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes. Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively. CONCLUSIONS: CPR duration was independently associated with survival to hospital discharge and neurological outcome. Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.

Matos RI; Watson RS; Nadkarni VM; Huang HH; Berg RA; Meaney PA; Carroll CL; Berens RJ; Praestgaard A; Weissfeld L; Spinella PC

2013-01-01

256

In-hospital refractory cardiac arrest treated with extracorporeal membrane oxygenation: A tertiary single center experience.  

Science.gov (United States)

Abstract We retrospectively assessed the experience of our tertiary care center on the use of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in 16 adult patients with refractory cardiac arrest. Cardiac arrest was due to acute coronary syndrome in 10 patients (62.5%), Takotsubo Syndrome in 1 patient (6.25%), dilated cardiomyopathy in 4 (25%) patients and massive pulmonary embolism in 1 patient (6.25%). The device was implanted in the catheterization laboratory in 14 patients (87.5%), in the operating room in 1 patient (6.25%) and in the emergency department in 1 patient (6.25%). During support, 7 patients were submitted to percutaneous coronary intervention, while coronary artery bypass grafting was performed in 1 patient, and cardiac surgery for repair of left ventricular wall rupture was performed in 1 patient. The device was successfully weaned in 6 patients (37.5%), among whom 2 patients died and 4 patients (25%) were discharged alive. In our institution 2/16 (12.5%) patients treated with VA-ECMO for refractory cardiac arrest survived to hospital discharge neurologically intact, and a good neurological function was observed in 3/16 (18.8%) at six-month follow-up. PMID:23915221

Lazzeri, Chiara; Sori, Andrea; Bernardo, Pasquale; Picariello, Claudio; Gensini, Gian Franco; Valente, Serafina

2013-08-05

257

[Causes of perinatal deaths in children delivered out of hospital in material collected by Chair and Department of Forensic Medicine, Medical University of Warsaw].  

UK PubMed Central (United Kingdom)

The study focused on cases of perinatal deaths of infants delivered out of hospital. The objective of the investigation was to determine the number of such cases in the Warsaw region, focusing in particular on suspected infanticides, evaluate the most frequent causes of death of children born out of hospital and determine possibilities and limitations of autopsies performed in neonates. The material comprised autopsy reports pertaining to 27 forensic perinatal postmortem examinations performed at the Chair and Department of Forensic Medicine, Warsaw Medical University, Poland, in the years 2001-2008. Determination of cause of death was possible in more than half of the cases. The most frequent cause of death was prematurity. A congenital malformation was seen in one neonate only. The most common factor that hindered determination of cause of death was advanced putrefaction, as well as unavailability of the placenta for examinations noted in more than 50% of the cases.

Borowska-Solonynko A; Krajewski P

2011-04-01

258

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative.  

UK PubMed Central (United Kingdom)

Abstract Emergency medical service (EMS) is frequently called to care for a seriously ill patient with a life-threatening or life-limiting illness. The seriously ill include both the acutely injured patients (for example in mass casualty events) and those who suffer from advanced stages of a chronic disease (for example severe malignant pain). EMS therefore plays an important role in delivering realistic, appropriate, and timely care that is consistent with the patient's wishes and in treating distressing symptoms in those who are seriously ill. The purpose of this article is to; 1) review four case scenarios that relate to palliative care and may be commonly encountered in the out-of-hospital setting and 2) provide a road map by suggesting four things to do to start an EMS-palliative care initiative in order to optimize out-of-hospital care of the seriously ill and increase preparedness of EMS providers in these difficult situations. Key Words: Collaboration; emergency medical service; integration; out of hospital; palliative care.

Lamba S; Schmidt TA; Chan GK; Todd KH; Grudzen CR; Weissman DE; Quest TE

2013-10-01

259

Integrating Palliative Care in the Out-of-Hospital Setting: Four Things to Jump-Start an EMS-Palliative Care Initiative.  

Science.gov (United States)

Abstract Emergency medical service (EMS) is frequently called to care for a seriously ill patient with a life-threatening or life-limiting illness. The seriously ill include both the acutely injured patients (for example in mass casualty events) and those who suffer from advanced stages of a chronic disease (for example severe malignant pain). EMS therefore plays an important role in delivering realistic, appropriate, and timely care that is consistent with the patient's wishes and in treating distressing symptoms in those who are seriously ill. The purpose of this article is to; 1) review four case scenarios that relate to palliative care and may be commonly encountered in the out-of-hospital setting and 2) provide a road map by suggesting four things to do to start an EMS-palliative care initiative in order to optimize out-of-hospital care of the seriously ill and increase preparedness of EMS providers in these difficult situations. Key Words: Collaboration; emergency medical service; integration; out of hospital; palliative care. PMID:23968313

Lamba, Sangeeta; Schmidt, Terri A; Chan, Garrett K; Todd, Knox H; Grudzen, Corita R; Weissman, David E; Quest, Tammie E

2013-08-22

260

In-hospital cardiac arrest: is outcome related to the time of arrest?  

UK PubMed Central (United Kingdom)

BACKGROUND: Whether outcome from in-hospital cardiopulmonary resuscitation (CPR) is poorer when it occurs during the night remains controversial. This study examined the relationship between CPR during the various hospital shifts and survival to discharge. METHODS: CPR attempts occurring in a tertiary hospital with a dedicated, certified resuscitation team were recorded prospectively (Utstein template guidelines) over 24 months. Medical records and patient characteristics were retrieved from patient admission files. RESULTS: Included were 174 in-hospital cardiac arrests; 43%, 32% and 25% in morning evening and night shifts, respectively. Shift populations were comparable in demographic and treatment related variables. Asystole (p < 0.01) and unwitnessed arrests (p = 0.05) were more common during the night. Survival to discharge was poorer following night shift CPR than following morning and evening shift CPR (p = 0.04). When asystole (being synonymous with death) was excluded from the analysis, the odds of survival to discharge was not higher for witnessed compared to unwitnessed arrest but was 4.9 times higher if the cardiac arrest did not occur during the night shift (p = 0.05, logistic regression). The relative risk of eventual in-hospital death for patients with return of spontaneous circulation (ROSC) following night shift resuscitation was 1.9 that of those with ROSC following morning or evening resuscitation (Cox regression). CONCLUSIONS: Although unwitnessed arrest is more prevalent during night shift, resuscitation during this shift is associated with poorer outcomes independently of witnessed status. Further research is required into the causes for the increased mortality observed after night shift resuscitation.

Matot I; Shleifer A; Hersch M; Lotan C; Weiniger CF; Dror Y; Einav S

2006-10-01

 
 
 
 
261

Comparison of radiation doses in permanent cardiac pacemaker implantation in three Greek hospitals  

International Nuclear Information System (INIS)

[en] Full text: Permanent cardiac pacemaker implantation is a simple Interventional Cardiology (IC) procedure during which fluoroscopy is employed for aiding in the manipulations required for the successful placement of the pacemaker. However, it is also known that these procedures involve high radiation doses due to long fluoroscopy times. During the SENTINEL European project, radiation doses were measured in three major hospitals in Greece in order to: (1) investigate the levels of dose imparted to the patient, (2) explore the various factors that could have an impact on patient dose, and finally (3) compare the results of this study to corresponding values found in the recent literature. One hundred and eighty four (184) patients participated in the study, 24 of which were treated in Hospital A, 52 in Hospital B and 108 in Hospital C. The radiation dose imparted to the patient was measured in terms of dose area product (DAP) measured in Gycm2 by using DAP meters, all calibrated according to the National Protocol of the National Radiation Protection Board (NRPB) of the United Kingdom. Other patient data collected were the following: age (A), weight (W), height (H), body mass index (BMI), which is the ratio of patient weight in kilogram (kg) to square height in meters (m) (BMI = W/H2), the kilovoltage (kVp) and the fluoroscopy time (T). It was found that results did not exhibit a normal distribution in any of the hospitals and, therefore, DAP and T were calculated in terms of median values. According to our results, median values of DAP and T were: 6.7 Gycm2 and 2.6 min (Hospital A), 9.0 Gycm2 and 3.0 min (Hospital B), 7.7 Gycm2 and 6.5 min (Hospital C). It appears that Hospital A gave the lowest dose to the patient with the lowest fluoroscopy time. However, at comparable fluoroscopy time with Hospital A and even less than half the fluoroscopy time of Hospital C, Hospital B presented the highest DAP. The results show that probably its X ray equipment is calibrated in higher dose rate than the other two hospitals. The correlation between every patient clinical and technical factor collected (W, H, BMI, kVp and T) and DAP were investigated separately. No correlation was found between DAP and patient weight, height or BMI. No correlation was also found between DAP and kilovoltage. Finally, significant correlation was found in all three hospitals between DAP and T (r=0.72 Hospital A, r=0.87 Hospital B, r=0.87 Hospital C). Comparison of results with recent literature such as those reported by the National Radiation Protection Board (NRPB) (27 Gycm2 and 10.7 min) showed that radiation doses are lower for all three Greek hospitals. The results of the study showed that comparable radiation doses are given in the three hospitals participating in the study. These doses are lower than internationally established reference levels. It was found that patient dimensions do not affect patient radiation dose. The limitation of the study was that the X ray equipment dose rate was not investigated in detail to explain small differences between hospitals and this should be done in the near future. (author)

2006-01-01

262

Quality of in-hospital cardiac arrest calls: a prospective observational study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. DESIGN: Prospective observational study. SETTING: Three National Health Service acute hospitals in England. PARTICIPANTS: Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which required activation of the hospital resuscitation team between 1 December 2009 and 30 April 2010. MAIN OUTCOME MEASURES: Emergency call duration, emergency team dispatch time, diagnostic accuracy of emergency call (sensitivity/specificity), thematic analysis of emergency call, patient outcomes (return of spontaneous circulation and survival to hospital discharge). RESULTS: There were 426 adult resuscitation team activations. There was variability in emergency call duration ranging from 6 to 92 s (median 15 s; IQR 12-19). The sensitivity and specificity of calls for a CA was 91% (86.4-94.6%) and 62% (55.5-68.7%), respectively. Sensitivity did not change with call duration but specificity increased from 38% (25.8-51.0%) for the shortest calls to 82% (69.5-89.6%) for longer calls; p=0.03. The return of spontaneous circulation rate was 38% for calls when the patient was confirmed as in CA upon arrival of the resuscitation team. Survival to hospital discharge rates was higher in patients with shorter call durations (26%) than calls with longer call duration (12%); p=0.028. Five themes emerged identifying reasons for the increased call delay. CONCLUSION: There is variability in duration and diagnostic accuracy of in-hospital emergency calls. This is associated with delayed activation of the emergency response. The attempt to differentiate between ME and CA is a source of confusion. A single clinical emergency response for CA and ME calls may provide a more focused and timely emergency response.

Akhtar N; Field RA; Greenwood L; Davies RP; Woolley S; Cooke MW; Perkins GD

2012-03-01

263

Hospital variation in transfusion and infection after cardiac surgery: a cohort study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Transfusion practices in hospitalised patients are being re-evaluated, in part due to studies indicating adverse effects in patients receiving large quantities of stored blood. Concomitant with this re-examination have been reports showing variability in the use of specific blood components. This investigation was designed to assess hospital variation in blood use and outcomes in cardiac surgery patients. Methods We evaluated outcomes in 24,789 Medicare beneficiaries in the state of Michigan, USA who received coronary artery bypass graft surgery from 2003 to 2006. Using a cohort design, patients were followed from hospital admission to assess transfusions, in-hospital infection and mortality, as well as hospital readmission and mortality 30 days after discharge. Multilevel mixed-effects logistic regression was used to calculate the intrahospital correlation coefficient (for 40 hospitals) and compare outcomes by transfusion status. Results Overall, 30% (95 CI, 20% to 42%) of the variance in transfusion practices was attributable to hospital site. Allogeneic blood use by hospital ranged from 72.5% to 100% in women and 49.7% to 100% in men. Allogeneic, but not autologous, blood transfusion increased the odds of in-hospital infection 2.0-fold (95% CI 1.6 to 2.5), in-hospital mortality 4.7-fold (95% CI 2.4 to 9.2), 30-day readmission 1.4-fold (95% CI 1.2 to 1.6), and 30-day mortality 2.9-fold (95% CI 1.4 to 6.0) in elective surgeries. Allogeneic transfusion was associated with infections of the genitourinary system, respiratory tract, bloodstream, digestive tract and skin, as well as infection with Clostridium difficile. For each 1% increase in hospital transfusion rates, there was a 0.13% increase in predicted infection rates. Conclusion Allogeneic blood transfusion was associated with an increased risk of infection at multiple sites, suggesting a system-wide immune response. Hospital variation in transfusion practices after coronary artery bypass grafting was considerable, indicating that quality efforts may be able to influence practice and improve outcomes.

Rogers Mary AM; Blumberg Neil; Saint Sanjay; Langa Kenneth M; Nallamothu Brahmajee K

2009-01-01

264

Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona.  

UK PubMed Central (United Kingdom)

This paper sets out an empirical model of learning with forgetting and uses it to estimate how much hospital quality improves with experience. The size of the learning effect and the depreciation rate are estimated for two cardiac procedures in Maryland and Arizona. Models are estimated using patient survival as the outcome of interest. The results show that learning does not appear to be a factor in hospital quality for either procedure or for surgery generally. From a policy standpoint, based on these results, regulations in Maryland that seek to concentrate these two procedures among a small number of providers could not be justified on the grounds that higher volume would increase the quality of care.

Sfekas A

2009-06-01

265

Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona.  

Science.gov (United States)

This paper sets out an empirical model of learning with forgetting and uses it to estimate how much hospital quality improves with experience. The size of the learning effect and the depreciation rate are estimated for two cardiac procedures in Maryland and Arizona. Models are estimated using patient survival as the outcome of interest. The results show that learning does not appear to be a factor in hospital quality for either procedure or for surgery generally. From a policy standpoint, based on these results, regulations in Maryland that seek to concentrate these two procedures among a small number of providers could not be justified on the grounds that higher volume would increase the quality of care. PMID:18702083

Sfekas, Andrew

2009-06-01

266

Predictive Value of Myocardial Performance Index for Cardiac Events in Patients Hospitalized for First Myocardial Infarction  

Directory of Open Access Journals (Sweden)

Full Text Available We sought to assess the ability of The Myocardial Performance Index (MPI), measured at entry, to predict in-hospital cardiac adverse events in a series of patients with first Acute Myocardial Infarction (AMI). A complete 2-dimential and Doppler echocardiographic examination was performed within 24 h of arrival at the coronary care department in 78 patients (61 men and 17 women; mean age 58±2 years) with first AMI. Patients were divided later into 2 groups according to their in-hospital course: group 1 comprised 46 patients with an uneventful course and group 2 comprised 32 patients with a complicated in-hospital course (death, heart failure, arrhythmias, post-AMI angina or Re MI). There were no significant differences between the 2 groups with regard to history of hypertension, diabetes mellitus, hypercholesterolemia, cardiac enzymes and response to thrombolytic, however patients with lateral MI more commonly had events (26 vs. 15%; p= 0.01) and those who received thrombolytic had less events (32 vs. 66%; p=0.01). Echocardiographic findings showed significant difference in Left Ventricle Ejection Fraction (LVEF) (40±8% vs. 33±2%; p=0.005) between two groups; however, MPI showed no significant difference between two groups (0.50±0.14 vs. 0.47±0.16; p= 0.43) and we did not find any cut point with acceptable sensitivity and specificity for predicting in-hospital complications. E wave acceleration time at 91ms showed a sensitivity of 87 and specificity of 78 and in factor analysis the component comprising of LVEF, Left Ventricle End-Systolic Diameter (LVESD), ratio of early to late peak velocities (E/A), E-wave Deceleration Time (EDT), Isovolumic Relaxation Time (IVRT) showed sensitivity of 87 and specificity of 67%. Our findings suggest that in the acute phase of AMI, the MPI measured in admission cannot be a useful to predict which patients are at high risk for in-hospital cardiac events.

Mehrnoush Toufan; Amir-Reza Sajjadieh

2008-01-01

267

Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL: A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS: A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION: This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.

Mateos-Rodríguez AA; Navalpotro-Pascual JM; Del Rio Gallegos F; Andrés-Belmonte A

2012-08-01

268

[Hit by lightning out of the blue].  

UK PubMed Central (United Kingdom)

HISTORY AND CLINICAL FINDINGS: A group of six hikers were hit by lightning out of the blue sky. The biggest harm was done to a 29-year-old man (size: 190 cm) while walking along a high spruce. He experienced a seizure with consecutive sinus tachycardia and hypertensive dysregulation. One year later he still complained about reduced physical strength. The other five hikers had less severe injuries. INVESTIGATIONS: Burns were detectable in five of six patients. Elevated creatine kinase and myoglobin were indicative for myolysis. Renal parameters were normal. DIAGNOSIS, THERAPY AND COURSE: All patients were treated with intravenous fluid and electrolyte substitution during transport to hospital. Two patients were additionally treated with metroprolol. CONCLUSION: Cardiac arrhythmias, usually tachycardia, myolysis, and seizures require early treatment with beta blockers, sufficient fluid supply, and antiepileptics. In patients with cardiac arrest after a lightning injury immediate cardiac resuscitation is crucial.

Duppel H; Löbermann M; Reisinger EC

2009-06-01

269

The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The validity of using adult physiologic criteria to triage injured children in the out-of-hospital setting remains unproven. Among children meeting adult field physiologic criteria, we assessed the availability of physiologic information, the incidence of death or prolonged hospitalization, and whether age-specific criteria would improve the specificity of the physiologic triage step. METHODS: We analyzed a prospective, out-of-hospital cohort of injured children aged < or =14 years collected from December 2005 through February 2007 by 237 emergency medical services (EMS) agencies transporting to 207 acute care hospitals (trauma and nontrauma centers) in 11 sites across the United States and Canada. Inclusion criteria were standard adult physiologic values: systolic blood pressure (SBP) < or =90 mmHg, respiratory rate < 10 or > 29 breaths/min, Glasgow Coma Scale (GCS) score < or =12, and field intubation attempt. Seven physiologic variables (including age-specific values) and three demographic and mechanism variables were included in the analysis. "High-risk" children included those who died (field or in-hospital) or were hospitalized > 2 days. The decision tree was derived and validated using binary recursive partitioning. RESULTS: Nine hundred fifty-five children were included in the analysis, of whom 62 (6.5%) died and 117 (12.3%) were hospitalized > 2 days. Missing values were common, ranging from 6% (respiratory rate) to 53% (pulse oximetry), and were associated with younger age and high-risk outcome. The final decision rule included four variables (assisted ventilation, GCS score < 11, pulse oximetry < 95%, and SBP > 96 mmHg), which demonstrated improved specificity (71.7% [95% confidence interval (CI) 66.7-76.6%]) at the expense of missing high-risk children (sensitivity 76.5% [95% CI 66.4-86.6%]). CONCLUSIONS: The incidence of high-risk injured children meeting adult physiologic criteria is relatively low and the findings from this sample do not support using age-specific values to better identify such children. However, the amount and pattern of missing data may compromise the value and practical use of field physiologic information in pediatric triage.

Newgard CD; Rudser K; Atkins DL; Berg R; Osmond MH; Bulger EM; Davis DP; Schreiber MA; Warden C; Rea TD; Emerson S

2009-10-01

270

Changing patterns of investigation and treatment of cardiac failure in hospital.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the investigation and treatment of cardiac failure in 1995 and to compare this with management in 1992. DESIGN: Retrospective consecutive case study. SETTING: University teaching hospital. SUBJECTS: All patients (n = 265) discharged from Aberdeen Royal Infirmary in the first quarter (January 1-31 March) of 1995 with a diagnosis of congestive cardiac failure, left ventricular failure, or heart failure (unspecified). These correspond to the International Classification of Diseases 9th revision codings of 428.0, 428.1, and 428.9 respectively. METHODS: Sociodemographic and clinical data were extracted from the case notes of the above subjects and compared with similar data from the final six months of 1992. MAIN OUTCOME MEASURES: The use of echocardiography in confirming the diagnosis and delineating the aetiology of heart failure and the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of patients diagnosed as having heart failure and without contraindications to these agents. RESULTS: The number of patients discharged in 1995 with a diagnosis including cardiac failure had increased by 55.7% since 1992. The use of echocardiography had also risen from 36.6% to 72% (P < 0.0001) with an associated increase in the proportion of patients discharged on treatment with an ACE inhibitor (40% in 1992 v 55.1% in 1995: P < 0.001). The doses of ACE inhibitors used had also increased significantly (P < 0.001). Most patients with cardiac failure continue to be treated by general physicians, who are less likely to use echocardiography (P < 0.01) or prescribe an ACE inhibitor (P < 0.05) than cardiologists. CONCLUSIONS: There is increasing recognition, more thorough investigation, and improved treatment of heart failure. Despite this there are grounds for concern, both in terms of the adequacy of management and resource implications.

Hillis GS; Al-Mohammad A; Wood M; Jennings KP

1996-11-01

271

The value of cardiac markers in predicting the hospital mortality of ischemic stroke patients  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: Stroke is the third leading cause of the deaths after heart diseases and cancer which also resulting with neurological disability. The mortality and morbidity secondary to stroke can be reduced by the early diagnosis and treatment of these patients in emergency department (ED). There may be an increase in D-dimer and cardiac markers in the ischemic stroke and this increase is related to adverse outcome. The aim of this study was to determine the validity of D-dimer and cardiac markers in predicting the in-hospital mortality in ischemic stroke patients. Materials and Methods: This prospective study was performed in an ED of a university hospital with the patients diagnosed to have ischemic stroke between October 2006 and March 2007. D-dimer, creatine kinase-myocardial band (CK-MB), Troponine-I and myoglobin levels of the study patients during the admission were studied and the relation between them and mortality was evaluated. Results: A total of 100 patients were included into the study and 53% of them were male. 59% of the patients had hypertension, 42% atherosclerosis, 33% ischemic cardiac disease, 21% diabetes mellitus, 20% atrial fibrillation, 6% cerebrovascular diseases and 4% had a history of trans-ischemic attack. Thirty four (34%) patients died in the hospital during the study period. D-dimer (2510.21±327.16 vs 1283.85±174.23; p=0.000), CK-MB (9.51±3.01 vs 4.32±0.89; p=0.04) and myoglobin (238.87±31.13 vs 114.42±15.23; p=0.00) levels were significantly higher in the mortality group. Tn-I levels were high in four patients. And the patients who died had higher Tn-I levels (1.33±0.91 vs 0.12±0.56), however this difference did not reach to a statistical significance (p=0.069). Furthermore, the initial Glasgow Coma Scale score were significantly lower in the mortality group (median: 12 vs 15; p=0.000). Conclusion: D-dimer, myoglobin, CK-MB and the low GCS scores are related to in-hospital mortality in ischemic stroke patients. Further studies with larger sample sizes are needed in order to reveal the validity of Tn-I in ischemic stroke patients to predict mortality.

Mehtap GÜRGER; Mehmet Nuri BOZDEM?R; Mustafa YILDIZ; Murat GÜRGER; Mehmet ÖZDEN; Zülkif BOZGEY?K; Mustafa Necati DA?LI

2008-01-01

272

Bleeding peptic ulcer occurring in hospitalized patients: analysis of predictive and risk factors and comparison with out-of-hospital onset of hemorrhage.  

UK PubMed Central (United Kingdom)

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 +/- 15 years versus 59 +/- 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.

Loperfido S; Monica F; Maifreni L; Paccagnella A; Famà R; Dal Pos R; Sartori C

1994-04-01

273

[Conditions for the survival of combat casualties in overseas operations: procedure and experience from the Afghan out-of-hospital theater].  

UK PubMed Central (United Kingdom)

Recent conflicts have led the French Army Health Service to specify the setting condition for the survival of combat casualties in overseas operations. The majority of them are victims of explosion injuries, and an early and effective control of bleeding is the primary means of improving survival. A procedure called "Combat Rescue" is taught. This chronological procedure favours external haemostasis and led to specific equipment, in particular a tourniquet and a haemostatic bandage of high efficiency. It is applied in recent years on the Afghan out-of-hospital theatre. A very front medical presence, which is systematic during evacuations, is a feature of the French Army Health Service operations support.

Palmier B

2012-04-01

274

The Impact of Prehospital Continuous Positive Airway Pressure on the Rate of Intubation and Mortality from Acute Out-of-hospital Respiratory Emergencies.  

UK PubMed Central (United Kingdom)

Abstract Background. Previous studies have demonstrated decreased rates of intubation and mortality with prehospital use of continuous positive airway pressure (CPAP). We sought to validate these findings in a larger observational study. Methods. We conducted a before and after observational study of consecutive patients transported by emergency medical services (EMS) during the 12 months before and the 12 months following implementation of a prehospital CPAP protocol for acute respiratory distress. Included were all patients transported by EMS meeting preestablished criteria indicative of acute respiratory distress and CPAP use (patient's problem specified as cardiac, respiratory distress, respiratory disease, or congestive heart failure [CHF]; age ? 12 years; chest sounds documented as wheezes or rales; Glascow Coma Scale [GCS] ? 11; respiratory rate ? 24 breaths per minute; systolic blood pressure ? 90 mmHg; and oxygen saturation < 90%). Data were abstracted from ambulance call reports (ACRs) and hospital records. All cases in which "do not resuscitate" (DNR) was documented on the patient chart or ACR or whose in-hospital outcome (death or discharge) was unknown were excluded. Results. In all, 442 patients met the above criteria. The mean (SD) age was 73.0 (13.9) years, and 51.5% were women. In-hospital mortality rates did not differ for these patients: 17/228 (7.5%) in the before group and 17/214 (7.9%) in the after group (p = 0.85). In-hospital intubation rates were similar for both groups (12.7 vs. 14.5%, p = 0.59). An analysis of the subgroup that had a hospital diagnosis of chronic obstructive pulmonary disease (COPD), CHF, or pulmonary edema (n = 273) showed mortality was somewhat lower in the before group (3/138, 2.2%) than in the after group (8/135, 5.9%) (p = 0.13). In-hospital intubation rates were also similar for both groups in this subgroup analysis (11.6 vs. 9.6%, p = 0.61). Conclusion. In contrast to previous studies, we were unable to demonstrate a decrease in intubation or mortality related to the use of prehospital CPAP. Our findings may be specific to our EMS system but suggest that further large-scale, randomized, controlled trials may be warranted to firmly establish the benefit of prehospital CPAP. Key words: airway; continuous positive airway pressure; emergency medical services; paramedic.

Cheskes S; Turner L; Thomson S; Aljerian N

2013-10-01

275

How do hospital administrators perceive cardiac rehabilitation in a publicly-funded health care system?  

UK PubMed Central (United Kingdom)

BACKGROUND: Patient and provider-related factors affecting access to cardiac rehabilitation (CR) have been extensively studied, but health-system administration factors have not. The objectives of this study were to investigate hospital administrators' (HA) awareness and knowledge of cardiac rehabilitation (CR), perceptions regarding resources for and benefit of CR, and attitudes toward and implementation of inpatient transition planning for outpatient CR. METHODS: A cross-sectional and observational design was used. A survey was administered to 679 HAs through Canadian and Ontario databases. A descriptive examination was performed, and differences in HAs' perceptions by role, institution type and presence of within-institution CR were compared using t-tests. RESULTS: 195 (28.7%) Canadian HAs completed the survey. Respondents reported good knowledge of what CR entails (mean=3.42±1.15/5). Awareness of the closest site was lower among HAs working in community versus academic institutions (3.88±1.24 vs. 4.34±0.90/5 respectively; p=.01). HAs in non-executive roles (4.77±0.46/5) perceived greater CR importance for patients' care than executives (4.52±0.57; p=.001). HAs perceived CR programs should be situated in both hospitals and community settings (n=134, 71.7%). CONCLUSIONS: HAs value CR as part of patients' care, and are supportive of greater CR provision. Those working in community settings and executives may not be as aware of, or less-likely to value, CR services. CR leaders from academic institutions might consider liaising with community hospitals to raise awareness of CR benefits, and advocate for it with the executives in their home institutions.

Grace SL; Scarcello S; Newton J; O'Neill B; Kingsbury K; Rivera T; Chessex C

2013-01-01

276

Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: The association between postoperative hyponatremia (Na < 135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. STUDY DESIGN: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. RESULTS: Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p < 0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p < 0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m(2), p = 0.01), higher EuroSCORE (median, 15% vs 6%, p < 0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p < 0.001), and peripheral vascular disease (16% vs 12%, p < 0.001). Hyponatremia increased overall (24% vs 18.2%, p < 0.001) and late mortality (18.6% vs 13.9%, p < 0.001) and length of stay (LOS; 11 vs 7 days, p < 0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p < 0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p < 0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p < 0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p < 0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001). CONCLUSIONS: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.

Crestanello JA; Phillips G; Firstenberg MS; Sai-Sudhakar C; Sirak J; Higgins R; Abraham WT

2013-06-01

277

Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia.  

UK PubMed Central (United Kingdom)

AIM: To describe relatives' experiences during the next of kin's hospital stay after surviving a cardiac arrest (CA) treated with hypothermia at an intensive care unit (ICU). METHODS: Twenty relatives were interviewed when the person having suffered the CA was discharged from hospital, 1.5 to 6 weeks post-CA. Data were analysed using qualitative content analysis. RESULTS: Three themes are described: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. Relatives found it difficult to assimilate the medical information and wanted it in written form. They wanted honest and clear information about their next of kin's condition and prognosis. They lacked rehabilitation plans after discharge from the medical ward. Relatives felt a need to maintain telephone contact with family members and friends, which was time-consuming. They felt guilty and had a conscience about these feelings. Relatives felt uncertain about the future, but still hopeful. CONCLUSION: Relatives asked for more information and individual rehabilitation plans. Booklets describing CA, the ICU stay and continuing care and rehabilitation directed at both the patients and their relatives are needed. Follow-up visits to the ICU staff, for both patients and relatives, need to be arranged. Hospitals should consider having a rehabilitation plan for this group of patients, which is presented by a team of healthcare professionals and that focuses on the individual's situation, including the consequences of their heart disease and brain damage.

Larsson IM; Wallin E; Rubertsson S; Kristoferzon ML

2013-08-01

278

The Impact of Prehospital Continuous Positive Airway Pressure on the Rate of Intubation and Mortality from Acute Out-of-hospital Respiratory Emergencies.  

Science.gov (United States)

Abstract Background. Previous studies have demonstrated decreased rates of intubation and mortality with prehospital use of continuous positive airway pressure (CPAP). We sought to validate these findings in a larger observational study. Methods. We conducted a before and after observational study of consecutive patients transported by emergency medical services (EMS) during the 12 months before and the 12 months following implementation of a prehospital CPAP protocol for acute respiratory distress. Included were all patients transported by EMS meeting preestablished criteria indicative of acute respiratory distress and CPAP use (patient's problem specified as cardiac, respiratory distress, respiratory disease, or congestive heart failure [CHF]; age ? 12 years; chest sounds documented as wheezes or rales; Glascow Coma Scale [GCS] ? 11; respiratory rate ? 24 breaths per minute; systolic blood pressure ? 90 mmHg; and oxygen saturation DNR) was documented on the patient chart or ACR or whose in-hospital outcome (death or discharge) was unknown were excluded. Results. In all, 442 patients met the above criteria. The mean (SD) age was 73.0 (13.9) years, and 51.5% were women. In-hospital mortality rates did not differ for these patients: 17/228 (7.5%) in the before group and 17/214 (7.9%) in the after group (p = 0.85). In-hospital intubation rates were similar for both groups (12.7 vs. 14.5%, p = 0.59). An analysis of the subgroup that had a hospital diagnosis of chronic obstructive pulmonary disease (COPD), CHF, or pulmonary edema (n = 273) showed mortality was somewhat lower in the before group (3/138, 2.2%) than in the after group (8/135, 5.9%) (p = 0.13). In-hospital intubation rates were also similar for both groups in this subgroup analysis (11.6 vs. 9.6%, p = 0.61). Conclusion. In contrast to previous studies, we were unable to demonstrate a decrease in intubation or mortality related to the use of prehospital CPAP. Our findings may be specific to our EMS system but suggest that further large-scale, randomized, controlled trials may be warranted to firmly establish the benefit of prehospital CPAP. Key words: airway; continuous positive airway pressure; emergency medical services; paramedic. PMID:23805890

Cheskes, Sheldon; Turner, Linda; Thomson, Sue; Aljerian, Nawfal

2013-06-27

279

Vasopressin for in-hospital pediatric cardiac arrest: results from the American Heart Association National Registry of Cardiopulmonary Resuscitation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe the landscape of vasopressin uses reported to the American Heart Association National Registry of cardiopulmonary resuscitation (CPR) and test the hypothesis that vasopressin use will be associated with improved return of a sustained circulation (ROSC) following in-hospital pediatric cardiac arrest. DESIGN: Multicentered, national registry of in-hospital CPR. SETTING: One hundred seventy-six North American Hospitals reporting to registry from October 1999 to November 2004. PATIENTS: Totally, 1293 consecutive pediatric patients with pulseless cardiac arrest meeting criteria for analysis identified from a registry of all patients resuscitated for cardiac arrest. Inclusion criteria were age <18 years, chest compressions and/or defibrillation, in-hospital location, and documented resuscitation record. INTERVENTIONS: None. MEASUREMENTS AND OUTCOMES: Prearrest, event, cardiopulmonary resuscitation, and postresuscitation variables were collected. Primary outcome variable was ROSC >20 minutes. Secondary survival outcomes included 24 hour, discharge and favorable neurologic survival on hospital discharge. Descriptive, univariate, and multivariable analysis to evaluate the association of vasopressin with survival outcomes were performed. RESULTS: Only 5% of patients received vasopressin in this review. Vasopressin was most often given in a pediatric hospital (57%) and in and intensive care setting (76.6%). Patients who were given vasopressin had longer arrest duration (median 37 minutes) vs. those who did not (24 minutes) (p = 0.004). In multivariate analysis, vasopressin was associated with worse ROSC but no difference in 24 hours or discharge survival. CONCLUSION: Vasopressin was given infrequently in in-hospital cardiac arrest. It was most likely to be given in an intensive care setting, and in a pediatric hospital. Multivariate analysis shows an association with vasopressin use and worse ROSC.

Duncan JM; Meaney P; Simpson P; Berg RA; Nadkarni V; Schexnayder S

2009-03-01

280

Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Despite ongoing efforts to improve the quality of pediatric resuscitation, it remains unknown whether survival in children with in-hospital cardiac arrest has improved. METHODS AND RESULTS: Between 2000 and 2009, we identified children (<18 years of age) with an in-hospital cardiac arrest at hospitals with >3 years of participation and >5 cases annually within the national Get With The Guidelines-Resuscitation registry. Multivariable logistic regression was used to examine temporal trends in survival to discharge. We also explored whether trends in survival were attributable to improvement in acute resuscitation or postresuscitation care and examined trends in neurological disability among survivors. Among 1031 children at 12 hospitals, the initial cardiac arrest rhythm was asystole and pulseless electrical activity in 874 children (84.8%) and ventricular fibrillation and pulseless ventricular tachycardia in 157 children (15.2%), with an increase in cardiac arrests due to pulseless electrical activity over time (P for trend <0.001). Risk-adjusted rates of survival to discharge increased from 14.3% in 2000 to 43.4% in 2009 (adjusted rate ratio per year, 1.08; 95% confidence interval, 1.01-1.16; P for trend=0.02). Improvement in survival was driven largely by an improvement in acute resuscitation survival (risk-adjusted rates: 42.9% in 2000, 81.2% in 2009; adjusted rate ratio per year: 1.04; 95% confidence interval, 1.01-1.08; P for trend=0.006). Moreover, survival trends were not accompanied by higher rates of neurological disability among survivors over time (unadjusted P for trend=0.32), suggesting an overall increase in the number of survivors without neurological disability over time. CONCLUSIONS: Rates of survival to hospital discharge in children with in-hospital cardiac arrests have improved over the past decade without higher rates of neurological disability among survivors.

Girotra S; Spertus JA; Li Y; Berg RA; Nadkarni VM; Chan PS

2013-01-01

 
 
 
 
281

Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients. METHODS: Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study. RESULTS: According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of > 3 units. CONCLUSION: RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery.Trial registration: Clinicaltrials.gov identifier: NCT01021631.

Galas FR; Almeida JP; Fukushima JT; Osawa EA; Nakamura RE; Silva CM; de Almeida EP; Auler JO Jr; Vincent JL; Hajjar LA

2013-03-01

282

Use of an Electronic Decision Support Tool Improves Management of Simulated In-Hospital Cardiac Arrest.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Adherence to Advanced Cardiac Life Support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA. METHODS: After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists. Results: Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p< 0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors v. 3.8 errors, p< 0.012). CONCLUSION: Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.

Field LC; McEvoy MD; Smalley JC; Clark CA; McEvoy MB; Rieke H; Nietert PJ; Furse CM

2013-09-01

283

Incidence rate of pressure sores after cardiac surgery during hospitalization and its relevant factors  

Directory of Open Access Journals (Sweden)

Full Text Available   Background : This study was conducted to assess incidence rate sores after cardiac surgery during hospitalization and its relevant factors, also discussed differences between sore and burn as a result of unstandard connections of electrocautery system in operating room.   Surgical patients because of risk factors that exist in operating room, have more potential to develop pressure sore than general acut patients. Pressure sores and burn may both occur in the intraoperative environments and are often difficult for personnel to differentiate upon postoperative inspection.   Methods : This descriptive cross-sectional study was conducted on 333 patients in 6 month, who were operated in Shaheed Rajaei Cardiovascular Medical &Research Center. Samples were selected Unrandomly.Demographic information, pre-intra-post operation (ICU and surgical ward) were collected by questionnaire.Data were analyzed using software SPSS15 and descriptive statistical tests.   Results: Incidence rate of pressure sores after cardiac surgery was 21.3%.71 patients were involved with pressure sores , 67 cases in ICU and 4 cases after admission in ward.68(95.7%)were first degree and 3(4.2%)were second degree.This Shows meaning relationship with,sex,hypertension, myocardial infarction , intraoperative Hypoxemia ,Using mattress postoperatively,inotropic drugs,blood pressure<80mmhg,reoperation,decreased hematocrit and albumin,hospitalization and duration of staying in ward.More skin damage were seen after operation in ICU immediately or in the first 24 hours.   Conclusion: It is worthful to control comorbidities before, during and after operation.Incidence of pressure sores can be minimized by providing enough perfusion during operation, using silicon mattress on bed of operating room, using mattress and changing position especially during stay in ICU,also paying attention to nutritional states and other known factors in study. Electrocautery system of operating rooms must always and periodically be checked, also taking care of probably burns to prevent from converting into pressure sores is very important.

Alireza Alizadeh Ghavidel; Sima Bashavard; Hooman Bakhshandeh Abkenar; Mohammad Mehdi Payghambari

2012-01-01

284

Cardiac care quality indicators: a new hospital-level quality improvement initiative for cardiac care in Canada.  

UK PubMed Central (United Kingdom)

Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.

Gorzkiewicz V; Lacroix J; Kingsbury K

2012-01-01

285

Permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room: an analysis of hospital charges and complications.  

UK PubMed Central (United Kingdom)

Permanent pacemakers may be implanted in operating rooms, special procedure laboratories, or cardiac catheterization laboratories. Previous investigators have shown no difference in efficacy or complications in the operating room versus the cardiac catheterization laboratory. We retrospectively analyzed the hospital bills of 30 patients undergoing permanent pacemaker implantation at our institution. Group I was 15 consecutive patients implanted in the operating room and group II was 15 consecutive patients implanted in the cardiac catheterization laboratory, all by the same operators. Hospital charges that were specific to the site of implantation were analyzed. Physician charges for implantation, anesthesiologist, and radiologist charges were not analyzed. There were no in-hospital complications in either group. The mean charges for group I were $1,856.00 and group II were $1,075.00 (P < 0.001). We conclude that implantation of permanent pacemakers in the cardiac catheterization laboratory is associated with significantly lower hospital charges compared to implantation in the operating room and has an equally low complication rate.

Stamato NJ; O'Toole MF; Enger EL

1992-12-01

286

Variation in the type, rate, and selection of patients for out-of-hospital airway procedures among injured children and adults.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The objective was to compare the type, rate, and selection of injured patients for out-of-hospital airway procedures among emergency medical services (EMS) agencies in 10 sites across North America. METHODS: The authors analyzed a consecutive patient, prospective cohort registry of injured adults and children with an out-of-hospital advanced airway attempt, collected from December 1, 2005, through February 28, 2007, by 181 EMS agencies in 10 sites across the United States and Canada. Advanced airway procedures were defined as orotracheal intubation, nasotracheal intubation, supraglottic airway, or cricothyrotomy. Airway procedure rates were calculated based on age-specific population values for the 10 sites and the number of injured patients with field physiologic abnormality (systolic blood pressure of < or = 90 mm Hg, respiratory rate of <10 or >29 breaths/min, Glasgow Coma Scale [GCS] score of < or = 12). Descriptive measures were used to compare patients between sites. RESULTS: A total 1,738 patients had at least one advanced airway attempt and were included in the analysis. There was wide variation between sites in the types of airway procedures performed, including orotracheal intubation (63% to 99%), supraglottic airways (0 to 27%), nasotracheal intubation (0 to 21%), and cricothyrotomy (0 to 2%). Use of rapid sequence intubation (RSI) varied from 0% to 65%. The population-adjusted rates of field airway intervention (by site) ranged from 1.2 to 22.8 per 100,000 adults and 0.2 to 4.0 per 100,000 children. Among trauma patients with physiologic abnormality, some sites performed airway procedures in almost 50% of patients, while other sites used these procedures in fewer than 10%. There was also large variation in demographic characteristics, physiologic measures, mechanism of injury, mode of transport, field cardiopulmonary resuscitation, and unadjusted mortality among airway patients. CONCLUSIONS: Among 10 sites across North America, there was wide variation in the types of out-of-hospital airway procedures performed, population-based rates of airway intervention, and the selection of injured patients for such procedures.

Newgard CD; Koprowicz K; Wang H; Monnig A; Kerby JD; Sears GK; Davis DP; Bulger E; Stephens SW; Daya MR

2009-12-01

287

The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest. DESIGN: Randomized controlled trial with blinding of allocation using a sealed container. SETTINGS: (1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities. PATIENTS: A total of 1784 adults who had cardiac arrest. INTERVENTION: Patients received either standard or ACD CPR throughout resuscitation. MAIN OUTCOME MEASURES: Survival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE). RESULTS: All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n = 368) and ACD (n = 405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P = .89), in survival until hospital discharge (11.4% vs 10.4%; P = .64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n = 510) and ACD (n = 501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P = .48), in survival to hospital discharge (3.7% vs 4.6%; P = .49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR. CONCLUSIONS: ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.

Stiell IG; Hébert PC; Wells GA; Laupacis A; Vandemheen K; Dreyer JF; Eisenhauer MA; Gibson J; Higginson LA; Kirby AS; Mahon JL; Maloney JP; Weitzman BN

1996-05-01

288

Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban Level I trauma center.  

UK PubMed Central (United Kingdom)

STUDY OBJECTIVE: We determine the association between emergency medical services (EMS) out-of-hospital times and mortality in trauma patients presenting to an urban Level I trauma center. METHODS: We conducted a secondary analysis of a prospective cohort registry of trauma patients presenting to a Level I trauma center during a 14-year period (1996 to 2009). Inclusion criteria were patients sustaining traumatic injury who presented to an urban Level I trauma center. Exclusion criteria were extrication, missing or erroneous out-of-hospital times, and intervals exceeding 5 hours. The primary outcome was inhospital mortality. EMS out-of-hospital intervals (scene time and transport time) were evaluated with multivariate logistic regression. RESULTS: There were 19,167 trauma patients available for analysis, with 865 (4.5%) deaths; 16,170 (84%) injuries were blunt, with 596 (3.7%) deaths, and 2,997 (16%) were penetrating, with 269 (9%) deaths. Mean age and sex for blunt and penetrating trauma were 34.5 years (68% men) and 28.1 years (90% men), respectively. Of those with Injury Severity Score less than or equal to 15, 0.4% died, and 26.1% of those with a score greater than 15 died. We analyzed the relationship of scene time and transport time with mortality among patients with Injury Severity Score greater than 15, controlling for age, sex, Injury Severity Score, and Revised Trauma Score. On multivariate regression of patients with penetrating trauma, we observed that a scene time greater than 20 minutes was associated with higher odds of mortality than scene time less than 10 minutes (odds ratio [OR] 2.90; 95% confidence interval [CI] 1.09 to 7.74). Scene time of 10 to 19 minutes was not significantly associated with mortality (OR 1.19; 95% CI 0.66 to 2.16). Longer transport times were likewise not associated with increased odds of mortality in penetrating trauma cases; OR for transport time greater than or equal to 20 minutes was 0.40 (95% CI 0.14 to 1.19), and OR for transport time 10 to 19 minutes was 0.64 (95% CI 0.35 to 1.15). For patients with blunt trauma, we did not observe any association between scene or transport times and increased odds of mortality. CONCLUSION: In this analysis of patients presenting to an urban Level I trauma center during a 14-year period, we observed increased odds of mortality among patients with penetrating trauma if scene time was greater than 20 minutes. We did not observe associations between increased odds of mortality and out-of-hospital times in blunt trauma victims. These findings should be validated in an external data set.

McCoy CE; Menchine M; Sampson S; Anderson C; Kahn C

2013-02-01

289

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

Directory of Open Access Journals (Sweden)

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.

Moore Hannah C; de Klerk Nicholas; Jacoby Peter; Richmond Peter; Lehmann Deborah

2012-01-01

290

The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less.  

UK PubMed Central (United Kingdom)

BACKGROUND: Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury. OBJECTIVES: To explore the relationship between out-of-hospital intubation attempts and outcome among trauma patients with Glasgow Coma Scale (GCS) scores ? 8 across sites participating in the Resuscitation Outcomes Consortium (ROC). METHODS: The ROC Epistry-Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify emergency medical services (EMS)-treated patients with GCS scores ? 8. Multiple logistic regression was used to explore the association between intubation attempts and vital status at discharge, adjusting for the following covariates: age, gender, GCS score, hypotension, mechanism of injury, and ROC site. Sites were then stratified by frequency of intubation attempts and chi-square test for trend was used to associate the frequency of intubation attempts with outcome. RESULTS: A total of 1,555 patients were included in this analysis; intubation was attempted in 758 of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 2.13-3.98, p < 0.01). However, sites with higher rates of attempted intubation had lower mortality across all trauma victims with GCS scores ? 8 (OR 1.40, 95% CI 1.15-1.72, p < 0.01). CONCLUSIONS: Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ? 8. Coma Scale score.

Davis DP; Koprowicz KM; Newgard CD; Daya M; Bulger EM; Stiell I; Nichol G; Stephens S; Dreyer J; Minei J; Kerby JD

2011-04-01

291

[Circadian rhythm and time variations in out-hospital sudden cardiac arrest].  

UK PubMed Central (United Kingdom)

OBJECTIVES: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). DESIGN: A retrospective descriptive study was made. PATIENTS: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. VARIABLES ANALYZED: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8 hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. RESULTS: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8 hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16 h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7 min and 8.0 min, respectively, without differences between periods. CONCLUSIONS: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods.

López-Messa JB; Alonso-Fernández JI; Andrés-de Llano JM; Garmendia-Leiza JR; Ardura-Fernández J; de Castro-Rodríguez F; Gil-González JM

2012-08-01

292

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

UK PubMed Central (United Kingdom)

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 Studies. DESIGN: organisational ethnographic case studies, including interviews with professionals, key stakeholders, women and partners, observations of service processes and document review. SETTING: a maximum variation sample of four maternity services in terms of configuration, region and population characteristics. All were selected from the Birthplace cohort study sample as services scoring 'best' or 'better' performing in the Health Care Commission survey of maternity services (HCC 2008). PARTICIPANTS: professionals and stakeholders (n=86), women (64), partners (6), plus 50 observations and 200 service documents. FINDINGS: each service experienced challenges in providing an integrated service to support choice of place of birth. Deployment of community midwives was a particular concern. Community midwives and managers expressed lack of confidence in availability to cover home birth care in particular, with the exception of caseload midwifery and a 'hub and spoke' model of care. Community midwives and women's interviews indicated that many lacked home birth experience and confidence. Those in midwifery units expressed higher levels of support and confidence. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: maternity services need to consider and develop models for provision of a more integrated model of staffing across hospital and community boundaries.

McCourt C; Rayment J; Rance S; Sandall J

2012-10-01

293

Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department.  

UK PubMed Central (United Kingdom)

CONTEXT: Emergency department (ED) physicians often are uncertain about where in the hospital to triage patients with suspected acute cardiac ischemia. Many patients are triaged unnecessarily to intensive or intermediate cardiac care units. OBJECTIVE: To determine whether use of a clinical decision rule improves physicians' hospital triage decisions for patients with suspected acute cardiac ischemia. DESIGN AND SETTING: Prospective before-after impact analysis conducted at a large, urban, US public hospital. PARTICIPANTS: Consecutive patients admitted from the ED with suspected acute cardiac ischemia during 2 periods: preintervention group (n = 207 patients enrolled in March 1997) and intervention group (n = 1008 patients enrolled in August-November 1999). INTERVENTION: An adaptation of a previously validated clinical decision rule was adopted as the standard of care in the ED after a 3-month period of pilot testing and training. The rule predicts major cardiac complications within 72 hours after evaluation in the ED and stratifies patients' risk of major complications into 4 groups--high, moderate, low, and very low--according to electrocardiographic findings and presence or absence of 3 clinical predictors in the ED. MAIN OUTCOME MEASURES: Safety of physicians' triage decisions, defined as the proportion of patients with major cardiac complications who were admitted to inpatient cardiac care beds (coronary care unit or inpatient telemetry unit); efficiency of decisions, defined as the proportion of patients without major complications who were triaged to an ED observation unit or an unmonitored ward. RESULTS: By intention-to-treat analysis, efficiency was higher in the intervention group (36%) than the preintervention group (21%) (difference, 15%; 95% confidence interval [CI], 8%-21%; P<.001). Safety was not significantly different (94% in the intervention group vs 89%; difference, 5%; 95% CI, -11% to 39%; P =.57). Subgroup analysis of intervention-group patients showed higher efficiency when physicians actually used the decision rule (38% vs 27%; difference, 11%; 95% CI, 3%-18%; P =.01). Improved efficiency was explained solely by different triage decisions for very low-risk patients. Most surveyed physicians (16/19 [84%]) believed that the decision rule improved patient care. CONCLUSIONS: Use of the clinical decision rule had a favorable impact on physicians' hospital triage decisions. Efficiency improved without compromising safety.

Reilly BM; Evans AT; Schaider JJ; Das K; Calvin JE; Moran LA; Roberts RR; Martinez E

2002-07-01

294

Appropriate documentation of confirmation of endotracheal tube position and relationship to patient outcome from in-hospital cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine the rate of appropriate documentation of endotracheal tube (ET) position confirmation in the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) and to determine whether outcomes of patients who experience in-hospital cardiac arrest differ in relation to documentation rate. DESIGN: Analysis of data from the GWTG-R, a prospective observational registry of in-hospital cardiac arrest and resuscitation. SETTING: Database containing clinical information from the 507 hospitals participating in the GWTG-R. PATIENTS: Adults resuscitated after in-hospital cardiac arrest. MEASUREMENTS: The rate of appropriate documentation of ET position confirmation, defined as the use of capnography or an esophageal detector device (EDD); relationship between appropriate documentation of ET position confirmation and return of spontaneous circulation (ROSC) or survival to hospital discharge. Proportions with 95% CI are reported for prevalence data. Binary logistic regression was used to determine the relationship between appropriate documentation of ET position confirmation and outcome (ROSC, survival to hospital discharge). Adjusted and unadjusted odds ratios are reported. MAIN RESULTS: Of the 176,054 patients entered into the GWTG-R database, 75,777 had an ET placed. For 13,263 (17.5%) of these patients, ET position confirmation was not documented in the chart. Auscultation alone was documented in 19,480 (25.7%) cases. Confirmation of ET position by capnography or EDD was documented in 43,034 (56.8%) cases. ROSC occurred in 39,063 (51.6%), and 13,474 (17.8%) survived to discharge. Patients whose ET position was confirmed by capnography or EDD were more likely to have ROSC (adjusted OR 1.229 [1.179, 1.282]) and to survive to hospital discharge (adjusted OR 1.093 [1.033, 1.157]). CONCLUSION: Documentation of ET position confirmation in patients who experience cardiac arrest is suboptimal. Appropriate documentation of ET position confirmation in the GWTG-R is associated with greater likelihood of ROSC and survival to hospital discharge.

Phelan MP; Ornato JP; Peberdy MA; Hustey FM

2013-01-01

295

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  

Directory of Open Access Journals (Sweden)

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 two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social -IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7 318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Arnoldo Rocha-García; Patricia Hernández-Peña; Silvia Ruiz-Velazco; Leticia Avila-Burgos; Teresa Marín-Palomares; Eduardo Lazcano-Ponce

2003-01-01

296

The ins and outs of caveolar signaling. m2 muscarinic cholinergic receptors and eNOS activation versus neuregulin and ErbB4 signaling in cardiac myocytes.  

Science.gov (United States)

Endothelial cells constitutively express the NOS isoform eNOS, which generates NO in response to specific extracellular signals to regulate vascular smooth muscle tone, vascular permeability, and platelet adhesion, among other actions. In addition to coronary vascular and endocardial endothelium, both atrial and ventricular myocytes express eNOS, the activation of which is also dependent on specific intracellular and extracellular signals. eNOS is targeted in cardiac myocytes to caveolae in plasma membranes and, in the case of cardiac myocytes, possibly T-tubular membranes as well. eNOS targeting to caveolae in cardiac myocytes requires co-translational myristoylation and subsequent palmitoylation for efficient targeting of the enzyme to the specialized lipid microdomains characteristic of caveolae. Although eNOS also contains a caveolin binding motif, this is insufficient for correct targeting of eNOS to caveolae. Recent evidence obtained from ventricular myocytes of mice with targeted disruption of the eNOS gene indicates that the lack of functional eNOS interrupts muscarinic cholinergic control of ICa-L in these cells. eNOS-/- mice are hypertensive and develop cardiac hypertrophy as they age, and these animals also exhibit an accelerated degree of vascular remodeling in response to injury. Reconstitution experiments confirm both the essential role of eNOS in coupling m2 AchR signaling to the control of ICa-L and myocyte automaticity and the importance of eNOS subcellular localization within caveolae in mediating this signal transduction pathway. It appears that translocation into caveolae is essential for signaling. However, this is not the case with all receptors associated with caveolae. PMID:10415516

Feron, O; Zhao, Y Y; Kelly, R A

1999-06-30

297

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  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 d (more) el 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. Abstract in english OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social -IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospita (more) lized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7 318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Rocha-García, Arnoldo; Hernández-Peña, Patricia; Ruiz-Velazco, Silvia; Avila-Burgos, Leticia; Marín-Palomares, Teresa; Lazcano-Ponce, Eduardo

2003-08-01

298

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

UK PubMed Central (United Kingdom)

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.

Sodhi K; Singla MK; Shrivastava A

2011-10-01

299

Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information. DESIGN: External review of paediatric cardiac surgical outcomes in England (HES) and all UK units (CCAD), as derived from each database. SETTING: Congenital heart surgery centres in the United Kingdom. DATA SOURCES: HES for congenital heart surgery and corresponding information from CCAD for the period 1 April 2000 to 31 March 2002. HES was restricted to the 11 English centres; CCAD covered all 13 UK centres. MAIN OUTCOME MEASURE: Mortality within 30 days of open heart surgery in infants aged under 12 months. RESULTS: In a direct comparison for the years when data from the 11 English centres were available from both databases, HES omitted between 5% and 38% of infants operated on in each centre. A median 40% (range 0-73%) shortfall occurred in identification of deaths by HES. As a result, mean 30 day mortality was underestimated at 4% by HES as compared with 8% for CCAD. In CCAD, between 1% and 23% of outcomes were missing in nine of 11 English centres used in the comparison (predominantly those for overseas patients). Accordingly, CCAD mortality could also be underestimated. Oxford provided the most complete dataset to HES, including all deaths recorded by CCAD. From three years of CCAD, Oxford's infant mortality from open cardiac surgery (10%) was not statistically different from the mean for all 13 UK centres (8%), in marked contrast to the conclusions drawn from HES for two of those years. CONCLUSIONS: Hospital episode statistics are unsatisfactory for the assessment of activity and outcomes in congenital heart surgery. The central cardiac audit database is more accurate and complete, but further work is needed to achieve fully comprehensive risk stratified mortality data. Given unresolved limitations in data quality, commercial organisations should reconsider placing centre specific or surgeon specific mortality data in the public domain.

Westaby S; Archer N; Manning N; Adwani S; Grebenik C; Ormerod O; Pillai R; Wilson N

2007-10-01

300

The association between age of hospitalized patients and the delivery of advanced cardiac life support.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the extent of variability in the administration of advanced cardiac life support (ACLS) and to determine if age is associated with variability. DESIGN: Retrospective cohort. SETTING: Urban teaching hospital. PATIENTS: One hundred twenty-two adult inpatients without a "do-not resuscitate" order who suffered cardiopulmonary arrest during 1993. MEASUREMENTS AND MAIN RESULTS: Of the total, 35 (29%) survived the arrest and 87 (71%) died. Among the nonsurvivors, two patients received no ACLS and six were not intubated, despite the inclusion of intubation in all ACLS protocols. Of the 87 nonsurvivors, 31 had a single electrocardiographic rhythm during their arrest and should have had similar ACLS trials. However, the 9 nonsurvivors with ventricular fibrillation received a range of 0 to 17 interventions, the 11 with electromechanical dissociation received 1 to 22, and the 11 with asystole received 0 to 14. Based on a protocol-derived definition of a minimal trial of ACLS (a "short ACLS trial") for all 87 nonsurvivors, age greater than 75 was associated with receiving a short trial. Dependent functional status and being on a medical service were also associated with a short ACLS trial. In a logistic regression model including these variables as covariates, age remained significantly associated with a short ACLS trial; odds ratio, 9.71 (95% confidence interval 1.68, 56.1). CONCLUSIONS: Wide variability exists in the administration of ACLS at the studied site. The finding that some patients receive no ACLS suggests that physicians at this site may be making bedside determinations of the likelihood of its benefit based on individual patient characteristics. The association between older age and short ACLS trials among all nonsurvivors suggests that age is most important of these characteristics.

Fried TR; Miller MA; Stein MD; Wachtel TJ

1996-05-01

 
 
 
 
301

[Distribution and appropriateness of hospital admissions, resource utilization in the Italian intensive cardiac care units. The BLITZ-3 study].  

UK PubMed Central (United Kingdom)

BACKGROUND: The BLITZ-3 study prospectively evaluated the epidemiology of hospital admissions, the patterns of care and the most important comorbidities in intensive cardiac care unit (ICCU) patients. METHODS: Distribution and level of appropriateness of hospital admissions in relation to type of ICCU were analyzed (type A, 32%, without cardiac cath lab or cardiac surgery; type B, 49%, with cath lab; type C, 19%, with both cath lab and cardiac surgery). The caseload was estimated on the basis of different levels of mortality risk during the ICCU stay: high (>5.1%), intermediate (0.7-5.1%), low (< or = 0.7%). RESULTS: A total of 6986 consecutive patients admitted to 332 ICCUs were enrolled. A median number of 19 patients (interquartile range 15-26) was admitted to each center during the 14 days of enrollment; 28% of the ICCUs admitted more than 25 patients, 48% between 15 and 25, and 24% less than 15. A higher number of type A ICCUs admitted less than 15 patients (p<0.0001), whereas a higher number of type C ICCUs admitted more than 25 patients (p<0.0001). Hospital admissions for ST-elevation myocardial infarction occurred more frequently in type B or C ICCUs (p<0.0001), whereas hospital admission for heart failure mostly occurred in type A ICCUs (p<0.0001). The number of patients not undergoing reperfusion (p<0.0001) or treated with thrombolytic therapy (p<0.0001) was higher in the type A ICCUs. Coronary revascularization with primary percutaneous coronary intervention was performed more frequently in type B and C ICCUs (p<0.0001). Similarly, patients hospitalized for acute coronary syndrome underwent coronary angiography (p<0.0001) and percutaneous coronary intervention more frequently in type B and C ICCUs (p<0.0001). Prevalence of low-risk rather than intermediate- or high-risk patients was higher in type A ICCUs (p<0.05), and prevalence of high- or intermediate-risk patients was higher in type C ICCUs (p<0.05). CONCLUSIONS: The results of the BLITZ-3 study should lead the Italian cardiological community to reflect upon the needed number of ICCUs, the role of Spoke centers for their integration in the interhospital network, and inappropriate hospital admissions for low-risk conditions.

Visconti LO; Scorcu G; Cassin M; Casella G; Chinaglia A; Conte MR; Fradella G; Lucci D; Maggioni AP; Pirelli S; Chiarella F

2011-01-01

302

Fighting cardiac arrest: Automated external defibrillator  

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Full Text Available Ventricular tachyarrhythmias - Ventricular fibrillation (VF) and Ventricular tachycardia (VT) account for most of out-of-hospital sudden cardiac arrests. Defibrillation is the specific therapy for VF/pulseless VT. Time to defibrillation is the most important determinant of survival from these cardiac arrests. Automated external defibrillator (AED) has largely replaced the conventional defibrillator in Basic life support (BLS) programmes for out-of-hospital cardiac arrests. AED use by trained laypersons in the community as part of Public Access Defibrillation (PAD) programmes has significantly reduced time to defibrillation and increased survival. AED is now being stipulated for home use in people at high risk of sudden cardiac death. AED placement is also recommended in all areas of hospital. Physicians and Intesivists should strive to familiarize the medical fraternity in our country with AED use so that PAD programmes can be launched in the near future.

Kumar V; Adhikari K; Singh Y

2003-01-01

303

Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas aeruginosa in an Indian Cardiac Hospital.  

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Full Text Available Out of the 5933 samples collected a total of 51 isolates of pseudomonas aeruginosa were collected consecutively between 26-December-2010 to 28-February-2011 from different patients. The total of 51 positive isolates consists both of pediatric as well as adult patients. The study was therefore carried out using bothmanual (Kirby-Bauer method) as well as automated (Vitek2 system) method to determine the Antimicrobial susceptibility pattern of pseudomonas aeruginosa isolates from in-patients and out-patients attending the microbiology section of the hospitals. The isolation rate of Pseudomonas aeruginosa was found to be 8.5% out of the total positive samples which were analyzed. In my study, notable sensitivity (100%) to P.aeruginosa was observed against Aztreonam while it was found to be different in case of a study carried out in India earlier which observed Carbepenems with 19.40% resistance. In the study colistin showed the highest (100%) sensitivity followed by Amikacin against P. aeruginosa , which is in corroboration with an earlier report published from India. Amikacin seems to be a promising therapy for Pseudomonal infection. Hence, its use should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. The sensitivity of Pseudomonas aeruginosa towards Imipenem is found to be 35.294% and towards Meropenem is 41.176%, which is different in case of the earlier study from India. An effective national and state level antibiotic policy and draft guidelines should be introduced to preserve the effectiveness of antibiotics and for better patient management.

S.Meenakumari; Shikha Verma; Anam Absar; Abhishek Chaudhary

2011-01-01

304

Utility of admission cardiac troponin and "Ischemia Modified Albumin" measurements for rapid evaluation and rule out of suspected acute myocardial infarction in the emergency department  

Science.gov (United States)

Objective To assess if the combination of cardiac troponin (cTn) and Ischemia Modified Albumin (IMA) can be used for early exclusion of acute myocardial infarction (AMI). Methods Prospective consecutive admissions to the emergency department (ED) with undifferentiated chest pain were assessed clinically and by electrocardiography. A total of 539 patients (335 men, 204 women; median age 51.9 years) considered at low risk of AMI had blood drawn on admission. If the first sample was less than 12?hours from onset of chest pain, a second sample was drawn two hours later, at least six hours from onset of chest pain. Creatine kinase MB isoenzyme (CKMB) mass was measured on the first sample and CKMB mass and cTnT on the second sample. An aliquot from the first available sample was frozen and subsequently analysed for IMA. If cTnT had not been measured on the original sample cTnI was measured (n?=?189). Results Complete data were available for 538/539 patients. IMA or cTn was elevated in the admission sample of all patients with a final diagnosis of AMI (n?=?37) with IMA alone elevated in 2/37, cTn alone in 19/37, and both in 16/37. In 173/501 patients in whom AMI was excluded both tests were negative. In the non?AMI group 22 patients had elevation of both IMA and cTn in the initial sample, suggesting ischaemic disease. Conclusion Admission measurement of cardiac troponin plus IMA can be used for early classification of patients presenting to the ED to assist in patient triage.

Collinson, P O; Gaze, D C; Bainbridge, K; Morris, F; Morris, B; Price, A; Goodacre, S

2006-01-01

305

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

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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.

Syed Wamique Yusuf; Jaya D. Bathina; Suhail Qureshi; Husnu Evren Kaynak; Jose Banchs; Jonathan C. Trent; Vinod Ravi; Iyad N. Daher; Joseph Swafford

2012-01-01

306

Cardiac arrest in children  

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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.

Tress Erika; Kochanek Patrick; Saladino Richard; Manole Mioara

2010-01-01

307

Fluid balance and cardiac function in septic shock as predictors of hospital mortality.  

UK PubMed Central (United Kingdom)

CONCLUSIONS: Our data confirms the importance of fluid balance and cardiac function as outcome predictors in patients with septic shock. A clinical t