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1.
Scand J Trauma Resusc Emerg Med ; 29(1): 129, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481521

RESUMO

BACKGROUND: The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. METHODS: In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. RESULTS: Only 28% of all tidal volumes conformed to the guidelines (400-800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. CONCLUSIONS: Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.


Assuntos
Avalanches , Reanimação Cardiopulmonar , Adulto , Estudos Cross-Over , Feminino , Humanos , Masculino , Manequins , Estudos Prospectivos , Adulto Jovem
2.
Nurs Open ; 8(3): 1108-1114, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482654

RESUMO

AIM: To explore the health workforce responses to COVID-19. DESIGN: Analysis of job advertisements. METHODS: We collected advertisements for healthcare jobs which were caused by and in response to COVID-19 between 4 March-17 April 2020 for the United States, Canada, United Kingdom, Australia and New Zealand. We collected information on the date of the advertisement, position advertised and location. We categorized job positions into three categories: frontline, coordination and decision support. RESULTS: We found 952 job advertisements, 72% of which were from the United States. There was a lag period between reported COVID-19-confirmed cases and job advertisements by several weeks. Nurses were the most advertised position in every country. Frontline workers were substantially more demanded than coordination or decision-support roles. Job advertisements are a novel data source which leverages a readily available information about how workforces respond to a pandemic. The initial phases of the response emphasise the importance of frontline workers, especially nurses.


Assuntos
COVID-19 , Reanimação Cardiopulmonar , Publicidade , Atenção à Saúde , Humanos , SARS-CoV-2 , Estados Unidos
3.
Scand J Trauma Resusc Emerg Med ; 29(1): 131, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496942

RESUMO

BACKGROUND: Witnessing an out-of-hospital cardiac arrest (OHCA) is a traumatic experience. This study analyses bystanders` psychological processing of OHCA. We examined the potential impact of bystanders performing resuscitation and the influence of the relationship between bystander and patient (stranger vs. family/friend of the patient) on the psychological processing. METHODS: A telephone interview survey with bystanders, who witnessed an OHCA of an adult patient was performed weeks after the event between December 2014 and April 2016. The semi-standardized questionnaire contained a question regarding the paramount emotion at the time of the interview. In a post-hoc analysis statements given in response were rated by independent researchers into the categories "signs of pathological psychological processing", "physiological psychological processing" and "no signs of psychological distress due to the OHCA". RESULTS: In this analysis 89 telephone interviews were included. In 27 cases (30.3%) signs of pathological psychological processing could be detected. Bystanders performing resuscitation had a higher rate of "no signs of psychological distress after witnessing OHCA" compared to those not resuscitating (54.7% vs. 26.7%, p < 0.05; relative risk 2.01; 95%CI 1.08, 3.89). No statistical significant differences in the psychological processing could be shown for gender, age, relationship to the patient, current employment in the health sector, location of cardiac arrest or number of additional bystanders. CONCLUSIONS: One out of three bystanders of OHCA suffers signs of pathological psychological processing. This was independent of bystander´s age, gender and relationship to the patient. Performing resuscitation seems to help coping with witnessing OHCA.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Adulto , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Inquéritos e Questionários , Telefone
4.
Artigo em Inglês | MEDLINE | ID: mdl-34444071

RESUMO

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43-3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28-7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02-0.08), age > 80 years (OR = 0.14, 95% CI: 0.09-0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06-0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP's decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Médicos , Adulto , Idoso de 80 Anos ou mais , Tomada de Decisões , Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos
5.
Artigo em Inglês | MEDLINE | ID: mdl-34444142

RESUMO

Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07-1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14-1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12-1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Índice de Massa Corporal , Humanos , Retorno da Circulação Espontânea , Taxa de Sobrevida
7.
Med Hypotheses ; 154: 110648, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34358920

RESUMO

Aerosols generated from chest compressions and ventilation attempts in patients with cardiac arrest may cause airborne infections. Accordingly, the interim international resuscitation guidelines have restricted basic life support by lay rescuers to compression only and the use of an automated external defibrillator during the COVID-19 pandemic. Although these measures may diminish the risk of infection for laypersons, the missing respiratory support can be detrimental for patients with hypoxia-related cardiac arrest. To overcome this shortcoming we want to introduce a special tool that allows ventilation during barrier resuscitation by laypersons. We hypothesize that the application of a device made of a polyvinyl chloride shield with a centrally installed S-shaped ventilation pipe with integrated filter can provide adequate ventilation while concurrently protecting patient and rescuer from airborne agents. Aerosols from air leakage are removed by adhesion and drainage below the barrier. No specific training other than basic life support is needed. We suggest that a tool of this kind be considered essential equipment and stored together with disposable gloves in public access locations.


Assuntos
COVID-19 , Reanimação Cardiopulmonar , Parada Cardíaca , Humanos , Pandemias , SARS-CoV-2
8.
Medicina (Kaunas) ; 57(8)2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34441016

RESUMO

Severe hyperkalemia is a potentially life threatening cardiac emergency, especially in patients with renal failure, and can lead to fatal arrhythmias such as ventricular fibrillation or asystole, leading to cardiac arrest. We report a case of a 39-year-old woman who developed sudden cardiac arrest secondary to hyperkalemia (9.95 mEq/L) with renal insufficiency. Despite 20 min of cardiopulmonary resuscitation (CPR) and conventional treatment for hyperkalemia, the cardiac arrest persisted. Hemodialysis was then initiated via the right femoral vein during CPR, and the patient restored spontaneous heartbeat 40 min later. Hemodialysis should be considered in the course of CPR in severe hyperkalemia induced cardiac arrest if conventional therapies fail.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Hiperpotassemia , Adulto , Arritmias Cardíacas , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hiperpotassemia/complicações , Hiperpotassemia/terapia , Diálise Renal/efeitos adversos
9.
Medicine (Baltimore) ; 100(32): e26856, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397894

RESUMO

ABSTRACT: Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ±â€Š13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.


Assuntos
Reanimação Cardiopulmonar , Estado Terminal , Parada Cardíaca , Equipe de Respostas Rápidas de Hospitais , Hospitais Urbanos , Planejamento Antecipado de Cuidados/organização & administração , Idoso , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/organização & administração , Equipe de Respostas Rápidas de Hospitais/normas , Hospitais Urbanos/organização & administração , Hospitais Urbanos/normas , Humanos , Incidência , Japão/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Prognóstico , Medição de Risco
11.
Ned Tijdschr Geneeskd ; 1652021 05 10.
Artigo em Holandês | MEDLINE | ID: mdl-34346614

RESUMO

A prospective cohort study recently published in JAMA looked at the difference in survival to hospital discharge between intra-arrest transport vs continued on-scene resuscitation among patients with out-of-hospital cardiac arrest (OHCA). The conclusion of this study is that intra-arrest transport is associated with a lower survival compared to continuous on-site treatment. Research by the Amsterdam Resuscitation Study (ARREST) shows that in OHCA patients who are transported intra-arrest, survival decreases significantly if the time on-scene increases. Patients who are transported within 20 minutes have the highest chance of survival. This suggests that the decision for transport should be made early in the resuscitation process. National and regional circumstances (availability of a mobile medical team, distance to hospital etc.), and pre-hospital resuscitation treatments may make that different scenarios can be considered. In some scenarios extracorporeal cardiopulmonary resuscitation (eCPR) can be brought to the patient; in other scenarios the patient can be transported to the eCPR.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Hospitais , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Alta do Paciente , Estudos Prospectivos , Estudos Retrospectivos
12.
Ned Tijdschr Geneeskd ; 1652021 04 29.
Artigo em Holandês | MEDLINE | ID: mdl-34346627

RESUMO

BACKGROUND: The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives. AIM: To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding. METHODS: This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPR-directive, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire. RESULTS: A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. CONCLUSIONS: The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged ≥80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.


Assuntos
Reanimação Cardiopulmonar , Ordens quanto à Conduta (Ética Médica) , Comunicação , Estudos Transversais , Hospitais , Humanos
13.
Scand J Trauma Resusc Emerg Med ; 29(1): 128, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461967

RESUMO

BACKGROUND: Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). METHODS: We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient's eventual outcome. RESULTS: N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < - 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). CONCLUSIONS: Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid-base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Serviço Hospitalar de Emergência , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Testes Imediatos , Estudos Retrospectivos
14.
Rev Med Suisse ; 17(746): 1341-1346, 2021 Aug 04.
Artigo em Francês | MEDLINE | ID: mdl-34397177

RESUMO

Restrictions on the management of out-of-hospital cardiac arrest during the COVID-19 pandemic have challenged the previous « more care is better care ¼ approach. By promoting both the reduction of no-flow delay and implementation of quality chest compressions, resuscitation guidelines have evolved in order to prevent neurological injury. At the same time, mechanical chest compression devices and extracorporeal membrane oxygenation (ECMO) have emerged, allowing for prolonged resuscitation. These new possibilities have made decision making more complex, while decision support tools have not evolved much. At each decision point, the futility of the measures envisaged must be considered. Better resuscitation for a better life means above all « choosing wisely ¼ whom to resuscitate.


Assuntos
COVID-19 , Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Pandemias , SARS-CoV-2
15.
Artigo em Inglês | MEDLINE | ID: mdl-34360379

RESUMO

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.


Assuntos
Reanimação Cardiopulmonar , Criança , Retroalimentação , Retroalimentação Sensorial , Humanos , Manequins , Pressão
16.
Scand J Trauma Resusc Emerg Med ; 29(1): 115, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380539

RESUMO

BACKGROUND: Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21-30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests. METHODS: We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey. RESULTS: The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status. CONCLUSIONS: The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system. TRIAL REGISTRATION: The trial was registered in clinicaltrials.gov (NCT02746640).


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/terapia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Suíça/epidemiologia , Resultado do Tratamento
17.
Scand J Trauma Resusc Emerg Med ; 29(1): 117, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34391466

RESUMO

BACKGROUND: This study aimed to compare and validate the out-of-hospital cardiac arrest (OHCA); cardiac arrest hospital prognosis (CAHP); non-shockable rhythm, unwitnessed arrest, long no-flow or long low-flow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause (NULL-PLEASE) clinical; post-cardiac arrest syndrome for therapeutic hypothermia (CAST); and revised CAST (rCAST) scores in OHCA patients treated with recent cardiopulmonary resuscitation strategies. METHODS: We retrospectively collected data on adult OHCA patients admitted to our emergency department between February 2015 and July 2018. OHCA, CAHP, NULL-PLEASE clinical, CAST, and rCAST scores were calculated based on the data collected. The predictive abilities of each score were tested using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS: We identified 236 OHCA patients from computer-based medical records and analyzed 189 without missing data. In OHCA patients without bystander witnesses, CAHP and OHCA scores were not calculated. Although the predictive abilities of the scores were not significantly different, the NULL-PLEASE score had a large AUC of ROC curve in various OHCA patients. Furthermore, in patients with bystander-witnessed OHCA, the NULL-PLEASE score had large partial AUCs of ROC from sensitivity 0.8-1.0 and specificity 0.8-1.0. CONCLUSIONS: The NULL-PLEASE score had a high, comprehensive predictive ability in various OHCA patients. Furthermore, the NULL-PLEASE score had a high predictive ability for good and poor neurological outcomes in patients with bystander-witnessed OHCA.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Humanos , Recém-Nascido , Parada Cardíaca Extra-Hospitalar/terapia , Prognóstico , Estudos Retrospectivos
18.
Scand J Trauma Resusc Emerg Med ; 29(1): 110, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344415

RESUMO

BACKGROUND: Citizen responder programmes dispatch volunteer citizens to initiate resuscitation in nearby out-of-hospital cardiac arrests (OHCA) before the Emergency Medical Services (EMS) arrival. Little is known about the interaction between citizen responders and EMS personnel during the resuscitation attempt. In the Capital Region of Denmark, emergency physicians are dispatched to all suspected OHCAs. The aim of this study was to evaluate how emergency physicians perceived the collaboration with citizen responders during resuscitation attempts. METHOD: This cross-sectional study was conducted through an online questionnaire. It included all 65 emergency physicians at Copenhagen EMS between June 9 and December 13, 2019 (catchment area 1.8 million). The questionnaire examined how emergency physicians perceived the interaction with citizen responders at the scene of OHCA (use of citizen responders before and after EMS arrival, citizen responders' skills in cardiopulmonary resuscitation (CPR), and challenges in this setting). RESULTS: The response rate was 87.7% (57/65). Nearly all emergency physicians (93.0%) had interacted with a citizen responder at least once. Of those 92.5%(n = 49) considered it relevant to activate citizen responders to OHCA resuscitation, and 67.9%(n = 36) reported the collaboration as helpful. When citizen responders arrived before EMS, 75.5%(n = 40) of the physicians continued to use citizen responders to assist with CPR or to carry equipment. Most (84.9%, n = 45) stated that citizen responders had the necessary skills to perform CPR. Challenges in the collaboration were described by 20.7%(n = 11) of the emergency physicians and included citizen responders being mistaken for relatives, time-consuming communication, or crowding problems during resuscitation. CONCLUSION: Emergency physicians perceived the collaboration with citizen responders as valuable, not only for delivery of CPR, but were also considered an extra helpful resource providing non-CPR related tasks such as directing the EMS to the arrest location, carrying equipment and taking care of relatives.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Médicos , Estudos Transversais , Humanos , Parada Cardíaca Extra-Hospitalar/terapia
19.
Trials ; 22(1): 511, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332617

RESUMO

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. METHODS: This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. DISCUSSION: Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. TRIAL REGISTRATION: The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.


Assuntos
Oclusão com Balão , Reanimação Cardiopulmonar , Procedimentos Endovasculares , Parada Cardíaca Extra-Hospitalar , Choque Hemorrágico , Adulto , Aorta , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Estudos Multicêntricos como Assunto , Noruega , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação , Choque Hemorrágico/terapia
20.
BMJ Open ; 11(8): e049141, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400458

RESUMO

OBJECTIVES: While prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study was to describe OHCA in the Cape Town metropole, South Africa. DESIGN: Observational study with a retrospective descriptive design. SETTING: Cape Town metropole, Western Cape province, South Africa. PARTICIPANTS: All patients with OHCA for the period 1 January 2018-31 December 2018 were extracted from public and private emergency medical services (EMS) and described. OUTCOME MEASURES: Description of patients with OHCA in terms of demographics, treatment and short-term outcome. RESULTS: A total of 929 patients with OHCA received an EMS response in the Cape Town metropole, corresponding to an annual prevalence of 23.2 per 100 000 persons. Most patients were adult (n=885; 96.5%) and male (n=526; 56.6%) with a median (IQR) age of 63 (26) years. The majority of cardiac arrests occurred in private residences (n=740; 79.7%) and presented with asystole (n=322; 34.6%). EMS resuscitation was only attempted in 7.4% (n=69) of cases and return of spontaneous circulation (ROSC) occurred in 1.3% (n=13) of cases. Almost all patients (n=909; 97.8%) were declared dead on the scene. CONCLUSION: To our knowledge, this was the largest study investigating OHCA ever undertaken in Africa. We found that while the incidence of OHCA in Cape Town was similar to the literature, resuscitation is attempted in very few patients and ROSC-rates are negligible. This may be as a consequence of protracted response times, poor patient prognosis or an underdeveloped and under-resourced Chain of Survival in low- to middle-income countries, like South Africa. The development of contextual guidelines given resources and disease burden is essential.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos , África do Sul/epidemiologia
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