Incidence and severity of respiratory insufficiency detected by transcutaneous carbon dioxide monitoring after cardiac surgery and intensive care unit discharge.

Patients undergoing coronary artery bypass surgery and/or heart valve surgery using a median sternotomy approach coupled with the use of cardiopulmonary bypass often experience pulmonary complications in the postoperative period. These patients are initially monitored in an intensive care unit (ICU) but after discharge from this unit to the ward they may still have compromised pulmonary function. This dysfunction may progress to significant respiratory failure that will cause the patient to return to the ICU. To investigate the severity and incidence of respiratory insufficiency once the patient has been discharged from the ICU to the ward, this study used transcutaneous carbon dioxide monitoring to determine the incidence of unrecognized inadequate ventilation in 39 patients undergoing the current standard of care. The incidence and severity of hypercarbia, hypoxia, and tachycardia in post-cardiac surgery patients during the first 24 hours after ICU discharge were found to be high, with severe episodes of each found in 38%, 79%, and 44% of patients, respectively.

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.

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.