ABSTRACT
A recent study in NEJM (DOSE-VF) showed that administering two consecutive defibrillation shocks with two separate defibrillators improves outcomes for patients with out-of-hospital cardiac arrest (OHCA). This approach was used when a shockable rhythm persisted after three standard shocks, raising the question of new strategies to improve survival for patients with persistent ventricular fibrillation (VF). In the Netherlands, there are around 8,000 OHCA cases annually, with 49% attributed to shockable rhythms. Prompt defibrillation is crucial, but some patients do not respond effectively to it. They may experience rapid VF recurrence or refractory VF, both associated with reduced survival rates. The current European resuscitation protocol emphasizes high-quality chest compressions, early defibrillation, and addressing reversible causes. The DOSE-VF study demonstrated the effectiveness of double sequential external defibrillation (DSED) in improving survival, spontaneous circulation, and neurological outcomes. Techniques such as changing pad positions, increasing initial shock energy, and pad compression can enhance energy transfer. However, implementing double sequential shocks in practice is challenging, requiring two separate defibrillators. The limited effect of this intervention may not warrant changes to extensively trained resuscitation protocols.
Subject(s)
Out-of-Hospital Cardiac Arrest , Ventricular Fibrillation , Humans , Ventricular Fibrillation/therapy , Netherlands , Out-of-Hospital Cardiac Arrest/therapy , Resuscitation , ThoraxABSTRACT
BACKGROUND: In patients under <40 years, traditional cardiovascular (CV)-risk factors are a less likely cause of acute coronary syndromes (ACS) compared to older counterparts. AIMS: To estimate the prevalence of essential thrombocytosis (ET), a hematological disorder and less-prevalent risk factor, in young patients presenting with ACS. METHODS: We constructed a retrospective database of all patients <40 years (n=271) that had consecutively undergone coronary angiography (CAG) after their first ACS within our hospital within the last ten years (2010-2020) and had known thrombocyte counts (n=241). Patients with thrombocytes >450x10*9/L were screened for this hematological disorder. RESULTS: In our database, we identified 15 subjects with thrombocytosis. One was previously known as ET. Of the remaining 14 patients, five were considered reactive/secondary thrombocytosis, and four were lost to follow-up, four were eventually diagnosed with ET, one remains uncertain. The diagnosis was newly established before the initiation of this study in two patients (average delay: six years). Two patients were identified as a result of this study. Conclusion: With a prevalence of at least 2.1%, ET appears not uncommon in patients <40 years with ACS. Moreover, screening patients with ACS and elevated thrombocytes yielded a novel diagnosis of ET in 27% of patients. The diagnosis was initially missed in all cases. Since the timing of revascularization should be adjusted to thrombocyte count/initiation of ET therapy to prevent thrombotic complications, cardiologists should know, recognize and screen for this pathology in ACS-patients, notably in those with absent traditional CV-risk factors: an 'ACS-protocol' aimed at less-prevalent risk factors could support this.
ABSTRACT
Knowledge regarding preventable hospital readmissions is scarce. Our aim was to compare the clinical characteristics of potentially preventable readmissions (PPRs) with non-PPRs. Additionally, we aimed to identify risk factors for PPRs. Our study included readmissions within 30 days after discharge from 1 of 7 hospital departments. Preventability was assessed by multidisciplinary meetings. Characteristics of the readmissions were collected and 23 risk factors were analyzed. Of the 1120 readmissions, 125 (11%) were PPRs. PPRs occurred equally among different departments (p = 0.21). 29.6% of PPRs were readmitted by a practitioner of a different medical specialty than the initial admission (IA) specialist. The PPR group had more readmissions within 7 days (PPR 54% vs. non-PPR 44%, p = 0.03). The median LOS was 1 day longer for PPRs (p = 0.16). Factors associated with PPR were higher age (p = 0.004), higher socio-economic status (p = 0.049), fewer prior hospital admissions (p = 0.004), and no outpatient visit prior to readmission (p = 0.025). This study found that PPRs can occur at any department in the hospital. There is not a single type of patient that can easily be pinpointed to be at risk of a PPR, probably due to the multifactorial nature of PPRs.