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1.
Lancet Public Health ; 5(8): e428-e436, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32768435

RESUMO

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016. METHODS: We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry. National interventions introduced during this time included emergency services interventions, as well as dispatch-assisted CPR (introduced on July 1, 2012), a training programme for CPR and automated external defibrillators (April 1, 2014), and a first responder mobile application (myResponder; April 17, 2015). Using multilevel mixed-effects logistic regression, we modelled the likelihood of receiving bystander CPR with the increasing number of interventions, accounting for year as a random effect. FINDINGS: The Singapore registry contained 11 465 OHCA events between Jan 1, 2011, and Dec 31, 2016. Paediatric arrests, arrests witnessed by emergency medical services, and healthcare-facility arrests were excluded, and 6788 events were analysed. Bystander CPR was administered in 3248 (48%) of 6788 events. Compared with no intervention, likelihood of bystander CPR was not significantly altered by the addition of emergency medical services interventions (odds ratio [OR] 1·33 [95% CI 0·98-1·79]; p=0·065), but increased with implementation of dispatch-assisted CPR (3·72 [2·84-4·88]; p<0·0001), with addition of the CPR and automated external defibrillator training programme (6·16 [4·66-8·14]; p<0·0001), and with addition of the myResponder application (7·66 [5·85-10·03]; p<0·0001). Survival to hospital discharge increased after the addition of all interventions, compared with no intervention (OR 3·10 [95% CI 1·53-6·26]; p<0·0001). INTERPRETATION: National bystander-focused public health interventions were associated with an increased likelihood of bystander CPR, and an increased survival to hospital discharge. Understanding the combined impact of public health interventions might improve strategies to increase the likelihood of bystander CPR, and inform targeted initiatives to improve survival from OHCA. FUNDING: National Medical Research Council, Clinician Scientist Award, Singapore and Ministry of Health, Health Services Research Grant, Singapore.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Saúde Pública , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Sistema de Registros , Singapura/epidemiologia , Análise de Sobrevida
2.
Am J Hosp Palliat Care ; 37(10): 869-872, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32638632

RESUMO

BACKGROUND: With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC. METHODS: Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]). RESULTS: The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors (P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them (P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death. CONCLUSIONS: Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Paliativos , Pneumonia Viral/terapia , Diretivas Antecipadas , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Cuidados Paliativos/métodos , Pandemias , Equipe de Assistência ao Paciente , Resultado do Tratamento
4.
PLoS One ; 15(5): e0232999, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413089

RESUMO

AIMS: This study aims to test the association between the place-provider-matrix (PPM) of bystander cardiopulmonary resuscitation (CPR) and outcomes of out-of-hospital cardiac arrest (OHCA). METHODS: Adult patients with OHCA with a cardiac etiology from 2012 to 2017 in Korea were analyzed, excluding patients who had unknown information on place, type of bystander, or outcome. The PPM was categorized into six groups by two types of places (public versus home) and three types of providers (trained responder (TR), family bystander, and layperson bystander). Outcomes were survival to discharge and good cerebral performance category (CPC) of 1 or 2. Multivariable logistic regression analysis was performed to test the association between PPM group and outcomes with adjustment for potential confounders to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) (reference = Public-TR). RESULTS: A total of 73,057 patients were analyzed and were categorized into Public-TR (0.6%), Home-TR (0.3%), Public-Family (1.8%), Home-Family (79.8%), Public-Layperson (9.9%), and Home-Layperson (7.6%) groups. Compared with the Public-TR group, the AORs (95% CIs) for survival to discharge were 0.61 (0.35-1.05) in the Home-TR group, 0.85 (0.62-1.17) in the Public-Family group, 0.38 (0.29-0.50) in the Home-Family group, 1.12 (0.85-1.49) in the Public-Layperson group, and 0.42 (0.31-0.57) in the Home-Layperson group. The AORs (95% CIs) for good CPC were 0.58 (0.27-1.25) in the Home-TR group, 0.88 (0.61-1.27) in the Public-Family group, 0.38 (0.28-0.52) in the Home-Family group, 1.20 (0.87-1.65) in the Public-Layperson group, and 0.42 (0.30-0.59) in the Home-Layperson group. CONCLUSION: The OHCA outcomes of the Home-Family and Home-Layperson groups were worse than those of the Public-TR group. This finding suggests that OHCA occurring in private places with family or layperson bystanders requires a new strategy, such as dispatching trained responders to the scene to improve CPR outcomes.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Estudos Transversais , Serviços Médicos de Emergência , Feminino , Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Sistema de Registros , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
6.
West J Emerg Med ; 21(2): 449-454, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32191203

RESUMO

INTRODUCTION: Emergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR). METHODS: The analysis included data from 2007-2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system. RESULTS: We found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%). CONCLUSION: It is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, respiratory, and cardiac diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Estado Terminal/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços de Saúde Suburbana/estatística & dados numéricos , Triagem/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
7.
South Med J ; 113(2): 55-58, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32016433

RESUMO

OBJECTIVES: Out-of-hospital cardiac arrest (OHCA) is rare in infants, with the cause of arrest often unknown upon presentation. Nonaccidental trauma is a potential etiology of OHCA among infants, but its occult presentation makes this etiology challenging to diagnose. In the absence of apparent injuries, identifying the need for trauma team activation is difficult during the initial resuscitation of infants with OHCA. METHODS: We performed a retrospective chart review of infants younger than 1 year old who presented to Children's National Health System from 2012 to 2016 with cardiopulmonary resuscitation in progress. Medical records and the trauma registry were reviewed for relevant resuscitation information. Autopsy records provided the cause and manner of death, contributing factors to death, and evidence of injury. RESULTS: Among 592 infants undergoing resuscitation during the study period, 34 infants (5.7%) presented in cardiac arrest. The average age on presentation was 101.2 days (standard deviation 78.7). Most of the patients (n = 32, 94.1%) died in the emergency department, with none surviving to discharge. Among the 32 infants for whom autopsy records were available, the cause of death was nonaccidental trauma in one patient (3.1%). CONCLUSIONS: Infant OHCA had poor outcomes, with trauma as a rare etiology. In the absence of external signs of injury or known injury mechanism, immediate trauma team presence was not beneficial for these infants during the initial resuscitation phase.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/etiologia , Traumatologia/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Determinação de Necessidades de Cuidados de Saúde , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros , Estudos Retrospectivos
8.
PLoS One ; 15(1): e0225939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967987

RESUMO

BACKGROUND: The incidence, prediction and mortality outcomes of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR) in surgical patients are under investigated and have not been studied concurrently in a single study. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program data between 2008 and 2012. Firth's penalized logistic regression was used to study the incidence and identify risk factors for intra- and postoperative CPR and 30-day mortality. simplified prediction model was constructed and internally validated to predict the studied outcomes. RESULTS: Among about 1.86 million non-cardiac operations, the incidence rate of intraoperative CPR was 0.03%, and for postoperative CPR was 0.33%. The 30-day mortality incidence rate was 1.25%. The incidence rate of events decreased overtime between 2008-2012. Of the 29 potential predictors, 14 were significant for intraoperative CPR, 23 for postoperative CPR, and 25 for 30-day mortality. The five strongest predictors (highest odd ratios) of intraoperative CPR were the American Society of Anesthesiologists (ASA) physical status, Systemic Inflammatory Response Syndrome (SIRS)/sepsis, surgery type, urgent/emergency case and anesthesia technique. Intraoperative CPR, ASA, age, functional status and end stage renal disease were the most significant predictors for postoperative CPR. The most significant predictors of 30-day mortality were ASA, age, functional status, SIRS/sepsis, and disseminated cancer. The predictions with the simplified five-factor model performed well and was comparable to the full prediction model. Postoperative cardiac arrest requiring CPR, compared to intraoperative, was associated with much higher mortality. CONCLUSIONS: The incidence of cardiac arrest requiring CPR in surgical patients decreased overtime. Risk factors for intraoperative CPR, postoperative CPR and perioperative mortality are overlapped. We proposed a simplified approach compromised of five-factor model to identify patients at high risk. Postoperative, compare to intraoperative, cardiac arrest requiring CPR was associated with much higher mortality.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Idoso , Análise de Variância , Feminino , Parada Cardíaca/diagnóstico , Humanos , Incidência , Período Intraoperatório , Funções Verossimilhança , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Risco
9.
J Clin Nurs ; 29(1-2): 221-227, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31633855

RESUMO

BACKGROUND: In the case of life-threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient. AIMS AND OBJECTIVES: The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia, over a six-year period. METHODS: A quantitative retrospective descriptive study of Code Blue emergencies over a six-year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE EQUATOR checklist was used for this study (see File S1). FINDINGS: The majority of Code Blue activations were male (59%, n = 127) and aged between 70 and 89 years of age (43%, n = 93). A Code Blue activation was more likely to occur at 08:00 hr, 14:00 hr or 22:00 hr, corresponding to the nurses' change in shift, with the majority of Code Blues (27.8%, n = 60) occurring in the emergency department. Cardiac arrest was the main activation criterion with 54.6% (n = 118) cases followed by respiratory arrest (14%, n = 32). Interestingly, 20% (n = 45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call. CONCLUSION: This project has produced several interesting findings surrounding Code Blue activations at one regional healthcare service which are not present in existing literature and is worthwhile for further investigation. RELEVANCE TO CLINICAL PRACTICE: Understanding Code Blue activation criteria, common timings (month, time of day) and patient demographics ensures clinicians can remain vigilant in watching for the signs of patient deterioration and improve staff preparedness Code Blue events.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Emergências/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitória , Adulto Jovem
10.
Healthc Manage Forum ; 33(1): 30-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31802724

RESUMO

Hospitals are facing an unprecedented level of change-with pressure from the general public to provide high-quality care and retain top talent by preventing burnout. How can they provide better patient care without overwhelming clinicians with more connected devices, alarming systems, and analytics solutions? Some challenges do not just cause harm to patients but they have a major economic impact on the financial health of the hospital. One problem for many hospitals is the growing number of "code blue" calls that warn clinicians a patient is in cardiac arrest. In this case study, you will learn the impacts of introducing an early warning system and its enabling technologies on Hamilton Health Sciences and why the underlying technology helped to produce positive results.


Assuntos
Reanimação Cardiopulmonar/métodos , Alarmes Clínicos , Tecnologia Biomédica , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/estatística & dados numéricos , Escore de Alerta Precoce , Humanos
11.
BMC Palliat Care ; 18(1): 93, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684934

RESUMO

BACKGROUND: In-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations. We tried to identify and characterize a potentially avoidable CPR in cancer patients who were hospitalized in hematology and oncology wards. METHODS: A potentially avoidable CPR was determined based on chemotherapy setting, disease status and clinical situation at the time when a cardiopulmonary arrest occurred, by using a consensus-driven medical records review of two physicians. RESULTS: One hundred thirty-seven patients among 12,437 patients hospitalized at hematology and oncology wards between March 2003 and June 2015 (1.1%) underwent a CPR. Eighty-eight patients (64.2%) were men. The majority of patients with a CPR had lung cancer (41, 29.9%), hematologic malignancy (24, 17.5%), stomach cancer (23, 16.8%) or lymphoma (20, 14.6%). A potentially avoidable CPR was identified in 51 patients (37.2%). In a multivariate analysis, advanced diseases and certain tumor types (e.g., lung cancer, lymphoma) were significant risk factors for a potentially avoidable CPR. Of patients who received a potentially avoidable CPR, 29 patients (56.9%) did not have a do-not-resuscitate documentation. A first return of spontaneous circulation rate (ROSC) and in-hospital survival rate (IHSR) were much lower in patients with a potentially avoidable CPR than those with a CPR that was not avoidable (ROSC: 39.2% vs 53.5%, P = 0.106; IHSR: 2.0% vs 12.8%, P = 0.032, respectively). CONCLUSIONS: A potentially avoidable CPR was common at hematology and oncology wards. A potentially avoidable CPR frequently occurred in advanced diseases and certain tumor types. Furthermore, cancer patients who received a potentially avoidable CPR showed the worse prognosis.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Hospitais/estatística & dados numéricos , Neoplasias/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Neoplasias Hematológicas/complicações , Cuidados Paliativos na Terminalidade da Vida , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Ordens quanto à Conduta (Ética Médica) , Fatores de Risco , Fatores Sexuais
12.
N Z Med J ; 132(1503): 75-82, 2019 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581184

RESUMO

BACKGROUND: Last year, there were 2,000 out-of-hospital cardiac arrests (OHCA) in New Zealand, 74% received CPR but only 5.1% accessed an automated external defibrillator (AED). The average survival rate of OHCA is 13%. The aim of this study was to visit all 50 AED locations shown on www.hamiltoncentral.co.nz to assess their true availability and visibility to the public in the event of an OHCA. METHOD: All premises were visited and the first staff member encountered was asked if they were aware an AED was onsite, its location, hours of availability, if restricted access applied and whether it had been used. RESULTS: Of the 50 locations, three sites no longer exist and two AEDs were listed twice. Therefore, only 45 AEDs exist. Two sites had grossly inaccurate locations. Three AEDs (7%) were continuously available. Nine AEDs were accessible after 6pm at least one day of the week. Thirteen AEDs were available on weekends; however, five required swipe card access. None of the AEDs were located outdoors. CONCLUSION: Far fewer than 50 listed AEDs are freely available to the public, especially after 6pm and on weekends. Lack of signposting and restrictions to access would lead to delayed defibrillation. This important health issue needs addressing.


Assuntos
Desfibriladores/provisão & distribução , Cardioversão Elétrica , Serviços Médicos de Emergência , Acesso aos Serviços de Saúde/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Intervenção Médica Precoce/organização & administração , Intervenção Médica Precoce/normas , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Cardioversão Elétrica/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Humanos , Nova Zelândia/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Melhoria de Qualidade
13.
PLoS One ; 14(9): e0222873, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31568520

RESUMO

OBJECTIVE: To examine the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) among patients with cirrhosis. METHODS: We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without cirrhosis during 2009-2014 and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of cirrhosis following in-hospital CPR and predictors of short-term survival among cirrhosis hospitalizations. RESULTS: In-hospital CPR was reported in 2,511 and 51,969 hospitalizations with and without cirrhosis, respectively. The rate of in-hospital CPR (per 1,000 hospitalizations) was 7.6 and 4.0 among hospitalizations with and without cirrhosis, respectively. The corresponding rate of in-hospital CPR among decedents was 10.7% and 13.4%, respectively. Short-term survival following in-hospital CPR among hospitalizations with and without cirrhosis was 14.9% and 27.3%, respectively, and remained unchanged over time on adjusted analyses among the former (p = 0.1753), while increasing among the latter (p = 0.0404). Cirrhosis was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio [aOR] 0.55 [95% CI: 0.49-0.62]). Lack of health insurance (vs. Medicare) (aOR] 0.47 [95% CI: 0.34-0.67]) and sepsis ([aOR] 0.67 [95% CI: 0.53-85]) were associated with lower odds of short-term survival following in-hospital CPR among cirrhosis hospitalizations. CONCLUSIONS: The rate of in-hospital CPR was nearly 2-fold higher among hospitalizations with cirrhosis than among those without it, though it was used more selectively among the former. Short-term survival following in-hospital CPR remained markedly lower among cirrhosis hospitalizations, while progressively improving among those without cirrhosis. Strategies to increase access to health insurance and improve early identification and control of infection should be explored in future preventive and interventional efforts.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Transtornos Cerebrovasculares/epidemiologia , Insuficiência Cardíaca/epidemiologia , Cirrose Hepática/epidemiologia , Infarto do Miocárdio/epidemiologia , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Reanimação Cardiopulmonar/mortalidade , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/terapia , Comorbidade , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Cirrose Hepática/mortalidade , Cirrose Hepática/patologia , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Sepse/mortalidade , Sepse/patologia , Sepse/terapia , Análise de Sobrevida , Texas/epidemiologia
14.
An. pediatr. (2003. Ed. impr.) ; 91(4): 228-236, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186743

RESUMO

Objetivo: Describir los modos de muerte de los niños en las Unidades de Cuidados Intensivos Pediátricos (UCIP) en España y analizar las características de aquellos que fallecen tras decidir una limitación del esfuerzo terapéutico (LET). Métodos: Estudio retrospectivo multicéntrico mediante revisión de informes de alta de los pacientes fallecidos en 8 UCIPs españolas entre 2011 y 2017. Resultados: Se recogieron 337 fallecimientos, de los cuales 151 (50,7%) ocurrieron durante una decisión de LET, mientras que 114 (33,8%) fueron por reanimación cardiopulmonar indicada pero fallida (FRCP) y 52 (15,4%) por muerte cerebral. Los motivos más frecuentes de ingreso en los niños que luego fallecieron fueron cardíacos (32,6%) y respiratorios (22,6%). El 25,5% (86 casos) habían tenido ingresos previos, 253 (75.1%) padecían enfermedades crónicas y 78 (23,2%) presentaban al ingreso una discapacidad grave. La LET fue más frecuente en estos niños y en aquellos con cáncer. La LET consistió fundamentalmente en no iniciar la RCP en caso de parada cardíaca (45%), retirada de la ventilación mecánica (31.6%) y retirada de fármacos vasoactivos (21.6%). Conclusiones: En el momento actual al menos la mitad de los niños que fallecen en una UCIP en España lo hacen tras una decisión de LET, que es más frecuente en aquellos con ingresos previos, discapacidad grave, enfermedad crónica u oncológica. Los profesionales debemos ser conscientes de esta realidad y prepararnos para compartir las decisiones con las familias y ofrecer la mejor calidad asistencial posible a los niños al final de su vida


Objective: To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic efforts (LET). Method: A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. Results: A total of 337 deaths were recorded, of which 151 (50’7%) occurred after a decision of LET, while 114 (33’8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%). A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission. LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). Conclusions: At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Causas de Morte , Mortalidade da Criança , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Suspensão de Tratamento/estatística & dados numéricos , Reanimação Cardiopulmonar/estatística & dados numéricos , Tomada de Decisões , Parada Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Alta do Paciente , Estudos Retrospectivos , Espanha
15.
Educ. med. (Ed. impr.) ; 20(5): 272-279, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191829

RESUMO

INTRODUCCIÓN: La autoeficacia es una variable de relevancia reconocida en la práctica clínica y en la formación en reanimación cardiopulmonar (RCP). El objetivo de este estudio fue diseñar y validar una escala de autoeficacia general en RCP básica y avanzada para profesionales españoles con experiencia. MATERIALES Y MÉTODO: Se diseñó una escala con 29 ítems mediante procedimientos cualitativos y haciendo uso del juicio de expertos. La escala se aplicó mediante encuesta electrónica a una muestra de 1.400 profesionales de la salud con experiencia en RCP: médicos (31,5%), enfermeros (54,9%) y técnicos sanitarios (13,6%). RESULTADOS: La escala presentó una alta fiabilidad (α>0,92) al considerar la autoeficacia en RCP tanto básica como avanzada, en su análisis conjunto y por separado. En el análisis de componentes principales se obtuvieron soluciones conceptual y teóricamente consistentes, con una varianza explicada que oscila entre el 55% y el 70% y una estructura de uno o 2 factores, según las subescalas y los diferentes colectivos profesionales. Se obtuvo una correlación sustancial entre subescalas (r=0,80). DISCUSIÓN: Se dispone de una escala de autoeficacia general en RCP, con especificaciones para RCP básica y RCP avanzada, con suficientes garantías de fiabilidad y validez factorial, susceptibles de ser utilizadas de forma conjunta o por separado con profesionales españoles. La escala se propone como una herramienta útil para la docencia, tanto en formación inicial como continuada, que puede ser usada para diseñar, desarrollar y evaluar programas de aprendizaje específicos sobre competencias profesionales para realizar una RCP eficaz


INTRODUCTION: Self-efficacy is a relevant variable recognised in clinical practice and CPR training. The aim of this study was to develop and validate a scale of general self-efficacy in basic and advanced CPR for Spanish professionals with experience. MATERIALS AND METHODS: A scale with 29 items was designed using qualitative procedures and expert judgment. The scale was sent via e-mail to a sample of 1400 health professionals with experience in CPR: doctors (31.5%), nurses (54.9%), and health technicians (13.6%). RESULTS: A high internal consistency (Alpha above 0.92) was found in basic CPR self-efficacy as well as in advanced CPR, when analysed together and separately. In the Principal Component Analysis, conceptual and theoretically consistent solutions were obtained, with an explained variance ranging between 55% and 70%, and a structure of one or two factors, according to the subscales and the different professional groups. A substantial correlation was obtained between sub-scales (r=.80). DISCUSSION: A scale of general self-efficacy in CPR is available, with specifications for basic CPR and advanced CPR, with sufficient guarantees of reliability and with evidence of factorial validity to be used jointly or separately with Spanish professionals. The scale is proposed as a useful tool for teaching, both in initial and continuing training, which can be used to design, develop and evaluate specific learning programs on professional skills to perform effective CPR


Assuntos
Humanos , Masculino , Feminino , Adulto , Autoeficácia , Reanimação Cardiopulmonar/educação , Pessoal de Saúde/educação , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estudos Transversais , Sociedades Médicas/normas , Psicometria
16.
Croat Med J ; 60(4): 325-332, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31483118

RESUMO

AIM: To assess the effect of the time for emergency medical services (EMS) arrival on resuscitation outcome in the transition period of the EMS system in Istra County. METHODS: This retrospective study analyzed the data from 1440 patients resuscitated between 2011 and 2017. The effect of demographic data, period of the year, time for EMS arrival, initial cardiopulmonary resuscitation (CPR) provider, initial cardiac rhythm, and airway management method on CPR outcome was assessed with multivariate logistic regression. RESULTS: Survivors were younger than non-survivors (median of 66 vs 70 years, P<0.001) and had shorter time for EMS arrival (median of 6 vs 8 min, P<0.001). The proportion of non-survivors was significantly higher when initial basic life support (BLS) was performed by bystanders without training (83.8%) or when no CPR was performed before EMS team arrival (87.3%) than when BLS was performed by medical professionals (66.8%) (P<0.001). Sex, airway management, and tourist season had no effect on CPR outcome. CONCLUSION: Since the time for arrival and level of CPR provider training showed a significant effect on CPR outcome, further organizational effort should be made to reduce the time for EMS arrival and increase the number of individuals trained in BLS.


Assuntos
Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Croácia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Fatores de Tempo
17.
Crit Care Resusc ; 21(3): 180-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462205

RESUMO

BACKGROUND: Australian in-hospital cardiac arrest (IHCA) literature is limited, and mostly published before rapid response teams (RRTs). Contemporary data may inform strategies to improve IHCA outcomes. STUDY DESIGN: Prospective observational study of ward adult IHCAs in seven Australian hospitals. PARTICIPANTS AND OUTCOMES: IHCA was defined as unresponsiveness, no respiratory effort, and commencement of external cardiac compressions. Data included IHCA frequency, patient demographics, resuscitation management, intensive care unit (ICU) management, and hospital discharge status. RESULTS: There were 15 953 RRT calls, 185 896 multiday admissions and 159 IHCAs in 152 patients (median age, 71.5 years; interquartile range [IQR], 61.6-81.3 years). The median IHCA frequency was 0.62 IHCAs per 1000 multiday admissions (IQR, 0.50-1.19). Most patients (93.4%) were admitted from home, and 68.4% (104/152) were medical admissions. Eighty-two IHCAs (51.6%) occurred within 4 days of admission, and 66.0% (105/159) of initial rhythms were non-shockable. The median resuscitation duration was 6.5 minutes (IQR, 2.0-18.0 minutes) and adrenaline was the most common intervention (95/159; 59.8%). Death on the ward occurred in 30.2% of IHCAs (48/159), and 49.7% (79/159) were admitted to the ICU, where vasoactive medications (75.9%), ventilation (82.3%), and renal replacement therapy (29.1%) use was extensive. Overall, 92 patients (60.5%) died and 40 (26.3%) were discharged home. CONCLUSION: Among seven Australian hospitals, IHCAs were infrequent, mostly occurred in older medical patients early in the hospital admission. Most were non-shockable, ICU therapy was extensive and nearly two-thirds of patients died in hospital. Further strategies are needed to prevent and improve ICHA outcomes.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos
18.
Australas Emerg Care ; 22(4): 243-248, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31405626

RESUMO

BACKGROUND: A multitude of Australian hospitals use non-clinical staff to assist with chest compressions and ancillary duties during cardiopulmonary resuscitation. Whilst few studies have focused on psychological implications for non-clinical staff, research into other groups indicates that a lack of attention to psychological support may adversely impact individual wellbeing, team functioning and clinical performance. The aim of this study was to explore how non-clinical workers were psychologically affected during cardiopulmonary resuscitation and factors that might mitigate adverse psychological effects. METHODS: This study utilised a qualitative descriptive methodology involving semi-structured, face to face interviews to investigate the experiences of non-clinical staff involved in cardiopulmonary resuscitation. Data was collected using semi-structured interviews and a validated Post Traumatic Stress rating scale. RESULTS: The study found that all 12 participants had experienced critical incident stress symptoms following their involvement in resuscitation attempts, though only one had ongoing evidence of Post Traumatic Stress Disorder. Participants felt that they needed more psychological preparation and that post-incident debriefs had been helpful but inconsistently provided and facilitated. Peer support was seen as the most significant factor in mitigating the psychological impact of critical incidents. CONCLUSION: This study shows that the development and formalisation of peer support networks for non-clinical health staff warrants serious consideration. The study also indicates that non-clinical members of resuscitation teams may benefit from more psychological preparation and support with self-care.


Assuntos
Atitude do Pessoal de Saúde , Reanimação Cardiopulmonar/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Intervenção na Crise , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais de Ensino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/psicologia , Grupo Associado , Recursos Humanos em Hospital/psicologia , Apoio Social , Inquéritos e Questionários , Centros de Atenção Terciária
20.
Hosp Pediatr ; 9(6): 455-459, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31147385

RESUMO

BACKGROUND: The clinical spectrum of pediatric acute myocarditis ranges from minimal symptoms with intact hemodynamics to rapid cardiovascular collapse and death. We sought to identify factors on initial presentation associated with subsequent hemodynamic compromise. METHODS: We performed a retrospective cohort study of patients with acute myocarditis at a freestanding pediatric hospital from 2007 to 2016. We defined 2 cohorts: high-acuity patients with hemodynamic compromise defined as requiring inotropic or vasoactive medications, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, ventricular assist devices, or transplant or who died and low-acuity patients without these interventions. We collected the first recorded set of vital signs, symptoms, laboratory values, and chest radiograph, electrocardiogram, and echocardiography results. Univariate analysis was performed, and 2 multivariable logistic regression models were created to discriminate between cohorts. RESULTS: A total of 74 patients were included: 33 high acuity and 41 low acuity. There were significant differences in demographics, symptoms, and physical examination, laboratory, electrocardiogram, and echocardiography findings between high- and low-acuity cohorts. Multivariable logistic regression models were highly discriminate in predicting those in the high-acuity cohort. The first model included presence of tachycardia, tachypnea, creatinine, and cardiomegaly on chest radiograph (area under the curve = 0.913). The second model added the presence of pericardial effusion to the above variables (area under the curve = 0.964). CONCLUSIONS: Models based on factors available at initial presentation with acute myocarditis are predictive of subsequent hemodynamic compromise. If our results can be validated in a multicenter study, these models may help disposition patients with suspected acute myocarditis (with those who meet model criteria being admitted to centers capable of rapidly providing extracorporeal membrane oxygenation, ventricular assist devices, and heart transplant evaluation).


Assuntos
Reanimação Cardiopulmonar , Cardiotônicos/uso terapêutico , Miocardite , Medição de Risco/métodos , Choque/diagnóstico , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Hemodinâmica , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Masculino , Modelos Estatísticos , Miocardite/mortalidade , Miocardite/fisiopatologia , Miocardite/terapia , Gravidade do Paciente , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Choque/etiologia , Choque/terapia , Estados Unidos
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