Hospital Length of Stay, Do Not Resuscitate Orders, and Survival for Post-Cardiac Arrest Patients in Michigan: A study for the CARES Surveillance Group

Resuscitation ◽  
2021 ◽  
Author(s):  
Robert A. Swor ◽  
Nai-Wei Chen ◽  
Jaemin Song ◽  
James H. Paxton ◽  
David A. Berger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

scholarly journals 1471. Evaluation of Antibiotic De-escalation in Post Cardiac Arrest Patients with Culture-Negative versus Culture-Positive Aspiration Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S737-S737
Author(s):  
Natasha R Herzig ◽  
Tara L Harpenau ◽  
Kevin M Wohlfarth ◽  
Alicia M Hochanadel
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Aspiration Pneumonia ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Cardiac arrest patients are often empirically treated for aspiration pneumonia with broad-spectrum antibiotics. Previous literature has shown no difference in clinical outcomes when discontinuing antimicrobial therapy for suspected aspiration pneumonia with negative respiratory cultures, but the application is limited in this population. This study aimed to assess antibiotic de-escalation practices for suspected aspiration pneumonia in post cardiac arrest patients with respiratory cultures and explore clinical outcomes. Methods This retrospective cohort conducted at a level 1 trauma center included adult out-of-hospital cardiac arrest patients who received antimicrobial therapy for suspected aspiration pneumonia. The primary endpoint was incidence of antibiotic de-escalation before day seven comparing culture-negative and culture-positive patients. De-escalation included discontinuation of methicillin-resistant Staphylococcus aureus (MRSA) coverage, Pseudomonas aeruginosa coverage, atypical coverage or all antibiotics when respective pathogens were not identified from microbiologic or serologic methods. Secondary endpoints included type of de-escalation and clinical outcomes. Results Eighty-six patients were included: 45 culture-negative and 41 culture-positive. Figure 1 depicts the breakdown of organisms isolated. Guideline-directed empiric therapy was used in 18.6% of patients, with the remainder receiving excessively broad empiric coverage. Antibiotic de-escalation before day seven occurred in 28 (80%) culture-negative patients and 32 (82%) culture-positive patients (p = 0.82), excluding patients who died before day seven. Providers frequently stopped unnecessary MRSA coverage in both groups. In-hospital mortality was higher in the group of patients without antibacterial de-escalation (62% vs. 33%, p=0.03), but hospital length of stay, ICU length of stay, and number of ventilator-free days were not different between groups. Figure 1: Epidemiology of Pathogens Isolated From Respiratory Cultures in Cardiac Arrest Patients Conclusion Culture results were not associated with antibiotic de-escalation in post cardiac arrest patients with suspected aspiration pneumonia. Opportunities exist for further de-escalation in this population, particularly patients with unnecessary pseudomonal coverage. Disclosures All Authors: No reported disclosures

Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors

Resuscitation ◽  
2017 ◽  
Vol 119 ◽  
pp. 99-106 ◽  
Author(s):  
Signe Riddersholm ◽  
Kristian Kragholm ◽  
Rikke Nørmark Mortensen ◽  
Marianne Pape ◽  
Carolina Malta Hansen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Cardiac Arrest

Abstract 155: Elevated Risk of Venous Thromboembolism in Patients Undergoing Targeted Temperature Management After Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Toishi Sharma ◽  
Jordan Kunkes ◽  
Waleed Ibrahim ◽  
David O Sullivan ◽  
Antonio B Fernandez
Keyword(s):  
Cardiac Arrest ◽  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Therapeutic Hypothermia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Temperature Management ◽  
Control Group ◽  
Study Group ◽  
Endovascular Cooling

Introduction: Therapeutic hypothermia (TH) reduces mortality and improves neurological outcomes after cardiac arrest. Cardiac arrest is considered a pro-thrombotic state. Endovascular cooling catheters may increase the risk of thrombosis. Therapeutic hypothermia (TH), however, increases fibrinolysis. These opposing effects may expose patients to both bleeding and venous thromboembolic risk during and after therapeutic hypothermia. The net effect in these patientsremains largely unexplored. Moreover, the exact rate of venous thromboembolism (VTE) is uncertain in these patients. We sought to determine the incidence and potential predictors of VTE in patients undergoing TH after cardiac arrest and compare it to a control group with similar risk of VTE. Methods: Single center retrospective analysis. Participants were age ≥18 years old, admitted to Hartford Hospital with out-of-hospital or in-hospital cardiac arrest, underwent TH between January 1, 2007 and April 30, 2019 with endovascular cooling catheter. A total of 562 patients who underwent TH (Study group) were compared to 304 matchedpatientstreated in the medical ICU with a diagnosis of ARDS (control group). This control group was based on presumed similarities in factors affecting VTE: intensive care setting, immobility, length of stay and likely presence of central venous catheters. Results: Patients who underwent TH had a significantly higher rate of VTE (6.6% vs 4.6%, p=0.006) and deep vein thrombosis (DVT) (2.3% vs 1.3%, p=0.011) when compared to control group. The rate of pulmonary embolism was higher in the TH group, but this was not statistically significant (2.5% and 1.0%, p=0.128). In multivariate analysis age, gender, race and hospital length of stay were not associated with development of VTE in the study group. Conclusion: Patients undergoing TH after cardiac arrest have statistically higher incidence of VTE and DVT compared to patients with ARDS. This risk is independent of age, gender, race or length of stay. Further research into additional independent predictors of VTE and DVT in this population may eventually guide the management and potential future interventions.

Abstract 264: Timing of In-Hospital Cardiac Arrest and Association with Survival to Discharge and Subsequent Length of Stay

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Kevin Kennedy ◽  
Paul Chan
Keyword(s):  
Cardiac Arrest ◽  
Length Of Stay ◽  
Regression Models ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models ◽  
Hierarchical Logistic Regression ◽  
The Mean ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: In-hospital cardiac arrest (IHCA) is common and often fatal. To date, the time from admission to IHCA has not been described, and the association between timing of cardiac arrest and likelihood of survival to discharge and subsequent hospital length of stay (LOS) is unknown. Methods: Within the national Get with the Guidelines Resuscitation registry, we identified 175,904 patients admitted between 2000 and 2013 with an IHCA. For each patient, the time from admission to IHCA was determined and categorized as early (7 days). Multivariable hierarchical logistic regression models examined the association between timing of IHCA and both survival to discharge and, among survivors, subsequent LOS from date of IHCA. Results: Overall, the mean and median times from admission to IHCA were 5.3 ± 6.3 days and 3 days (IQR: 1-8), respectively. Nearly half (83,811 [47.6%]) of patients had their IHCA 7 days from admission, respectively. After adjustment for patient and and cardiac arrest factors, cardiac arrests occurring later during the hospitalization were associated with modestly lower survival (reference: 7 days: adjusted OR 0.89 [0.86-0.92]; P<.01). However, this association pertained only to patients with a shockable IHCA (P for interaction between shockable and non-shockable rhythms: <0.001). Lastly, among those surviving to discharge, later timing of IHCA was associated with much longer subsequent LOS (reference: 7 days: 6.8 additional days [6.3-7.3]; P<0.001). Conclusion: Most IHCA occur after the first 72 hours of admission. Patients with IHCA >3 days from admission had significantly lower hospital survival and longer hospitalizations from the time of cardiac arrest.

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

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