Predictors and rate of survival after Out-of-Hospital Cardiac Arrest.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major public health concern and encloses a wide spectrum of causes. The purpose of this study is to assess predictors and rate of survival at hospital discharge and long-term in the setting of OHCA. The secondary endpoint is to compare OHCA-survival outcomes of presumed ischemic versus non ischemic cause. METHODS: A retrospective cohort was conducted on 318 consecutive patients admitted for OHCA at Civilian Hospitals of Colmar between 2010 and 2019. Data concerning baseline characteristics, EKG, biological parameters, and coronary angiograms were collected. We observed the living status (alive or dead) of each of study's participants by March 2023. RESULTS: The observed survival rate was 34.3 % at hospital discharge and 26.7 % at 7.1-year follow up. The mean age of study population was 63 ± 16 years and 32.7 % were women. 65.7 % of OHCA-patients underwent coronary angiography that revealed a significant coronary artery disease (CAD) in half of study participants. Primary angioplasty was performed in 43.4 % of study population. The in-hospital mortality rate was significantly higher in those with RBBB (83.7 % vs. 62.5 %, p = 0.004), diabetes mellitus (84.2 % vs. 59.9 %, p < 0.001), arterial hypertension (72.2 % vs. 57.7 %, p = 0.007), peripheral arterial disease (79.2 % vs. 52.2 %, p = 0.031) whereas it was lower in case of anterior STEMI (43.9 % vs 71.4 %, p < 0.001), presence of obstructive CAD (52.2 % vs. 79.2 %, p < 0.001), primary angioplasty performance (48.6 % vs. 78.9 %, p < 0.001), initial shockable rhythm (43.8 % vs. 88.6 %, p < 0.001), initial chest pain (49.4 % vs. 71.5 %, p < 0.001). After adjusting on covariates, the Cox model only identified an initial shockable rhythm as independent predictor of survival at hospital discharge [HR = 0.185, 95 %CI (0.085-0.404), p < 0.001] and 7-year follow up [HR = 0.201, 95 %CI (0.082-0.492), p < 0.001]. The Kaplan-Meier and log Rank test showed a difference in survival outcomes between OHCA with versus without CAD (p < 0.001). CONCLUSION: The proportion of OHCA-survivors is small despite the development of emergency health care system. Initial shockable rhythm is the strong predictor of survival. OHCA of presumed coronary cause is associated with a better long-term survival outcome.

Pediatric preparedness of Lebanese emergency departments.

BACKGROUND: The pediatric preparedness of Lebanese Emergency Departments (EDs) has not been evaluated. STUDY OBJECTIVES: To describe the number, regional location, and characteristics of EDs in Lebanon providing care to children and to describe the staffing, equipment, and support services of these EDs. METHODS: We surveyed hospitals in Lebanon caring for children in an ED setting between September 2009 and September 2010. The survey was provided in English and Arabic and could be completed in person, by telephone, or on the Web. RESULTS: We identified 115 EDs that cared for children in Lebanon; 72 (63%) completed the survey, most of which were urban (54%). Ninety-three percent of the EDs had <20,000 total patient visits annually; children (variably defined) accounted for <29% of the patients at 89% of the sites. Physicians caring for children in the EDs had varied medical training; and a pediatrician was "usually involved" in the management of pediatric patients in 95% of the EDs. Only 27% of EDs had attending physicians present 24 h/day to care for children. Half of the hospitals had an intensive care unit that could care for children (48%). Most EDs had endotracheal tubes (95%) and intravenous catheters (90%) in all pediatric sizes. CONCLUSION: The emergency care of children in Lebanon is provided at numerous hospitals throughout the country, with a wide range of staffing patterns and available support services.

Implementation of an emergency department computer system: design features that users value.

BACKGROUND: Electronic medical records (EMRs) can potentially improve the efficiency and effectiveness of patient care, especially in the emergency department (ED) setting. Multiple barriers to implementation of EMR have been described. One important barrier is physician resistance. The "ED Dashboard" is an EMR developed in a busy tertiary care hospital ED. Its implementation was exceptionally smooth and successful. STUDY OBJECTIVES: We set out to examine the design features used in the development of the system and assess which of these features played an important role in the successful implementation of the ED Dashboard. METHODS: An anonymous survey of users of the ED Dashboard was conducted in January and February 2009 to evaluate their perceptions of the degree of success of the implementation and the importance of the design features used in that success. Results were analyzed using SPSS software (SPSS Inc., Chicago, IL). RESULTS: Of the 188 end-users approached, 175 (93%) completed the survey. Despite minimal training in the use of the system, 163 (93%) perceived the system as easy or extremely easy to use. Users agreed that the design features employed were important contributors to the system's success. Being alerted when new test results were ready, the use of "most common" lists, and the use of color were features that were considered valuable to users. CONCLUSION: Success of a medical information system in a busy ED is, in part, dependent on careful attention to subtle details of system design.

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.

Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon.

BACKGROUND: Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction. Patient/proxy survey (20 questions) and chart review were completed. The responses to survey questions were "disagree," "neutral," or "agree" and were scored as one, two, or three with three corresponding to higher likelihood of EMS use. A total scale score ranging from 20 to 60 was created and transformed from 0% to 100%. Data were analyzed based on mode of presentation (EMS vs other). RESULTS: Among the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age for study population was 63.7 years (SD=18.8 years) with 56.5% males. Mean clinical severity score (Emergency Severity Index [ESI]) was 2.5 (SD=0.7) and mean pain score was 3.1 (SD=3.5) at ED presentation. Over one-half (58.8%) needed admission to hospital with 21.8% to an intensive care unit care level and with a mortality rate of 7.3%. Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment, advice from family, and unavailability of immediate private mode of transport (P≤.05). Functional screening, or requiring full assistance (OR=4.77; 95% CI, 1.85-12.29); acute symptoms onset ≤ one hour (OR=2.14; 95% CI, 1.08-4.26); and higher scale scores (OR=2.99; 95% CI, 2.20-4.07) were significant predictors of EMS use. Patients with lower clinical severity (OR=0.53; 95% CI, 0.35-0.81) and those with chest pain (OR=0.05; 95% CI, 0.02-0.12) or respiratory distress (OR=0.15; 95% CI, 0.07-0.31) using cardiac arrest as a reference were less likely to use EMS. CONCLUSION: Emergency Medical Services use in EMS priority conditions in Lebanon is low. Several predictors of EMS use were identified. Emergency Medical Services initiatives addressing underutilization should result from this proposed assessment of the perspective of the EMS system's end user. El Sayed M , Tamim H , Al-Hajj Chehadeh A , Kazzi AA . Emergency Medical Services utilization in EMS priority conditions in Beirut, Lebanon. Prehosp Disaster Med. 2016;31(6):621-627.

Out-of-hospital cardiac arrest survival in Beirut, Lebanon.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is used to evaluate the performance of the emergency medical service (EMS) system. Our study examined the characteristics and outcomes of OHCA cases presenting to a tertiary care center in Beirut, Lebanon. METHODS: A retrospective chart review of all adult OHCA patients admitted to the emergency department (ED) over a 3-year period was carried out. Data collection and analysis was performed using the Utstein guidelines. RESULTS: A total of 214 OHCA patients were presumed to have cardiac etiology; of them 205 (95.8%) underwent ED resuscitation. The mean age was 69±15.4 years. More than half of the patients (54.2%) were witnessed, but unfortunately the bystander cardiopulmonary resuscitation rate was low (4.2%). Most of them were transported by EMS (71.5%). An automatic external defibrillator was rarely used (0.9%). Asystole was the predominant presenting rhythm in ED (81.8%). Eleven patients (5.5%) survived to hospital discharge and five (45.4%) had good neurological outcome. CONCLUSION: The OHCA survival rate in Beirut, Lebanon, is low. Bystander cardiopulmonary resuscitation and early defibrillation should be prioritized to achieve better outcomes.