Predictive value of pre-arrest albumin level with GO-FAR score in patients with in-hospital cardiac arrest

AbstractWe investigated whether combining the pre-arrest serum albumin level could improve the performance of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for predicting neurologic outcomes in in-hospital cardiac arrest patients. Adult patients who were admitted to a tertiary care hospital between 2013 and 2017 were assessed. Their pre-arrest serum albumin levels were measured within 24 h before the cardiac arrest. According to albumin levels, the patients were divided into quartiles and were assigned 1, 0, 0, and, − 2 points. Patients were allocated to the derivation (n = 419) and validation (n = 444) cohorts. The proportion of favorable outcome increased in a stepwise manner across increasing quartiles (p for trend < 0.018). Area under receiver operating characteristic curve (AUROC) of the albumin-added model was significantly higher than that of the original GO-FAR model (0.848 vs. 0.839; p = 0.033). The results were consistent in the validation cohort (AUROC 0.799 vs. 0.791; p = 0.034). Net reclassification indices of the albumin-added model were 0.059 (95% confidence interval [CI] − 0.037 to 0.094) and 0.072 (95% CI 0.013–0.132) in the derivation and validation cohorts, respectively. An improvement in predictive performance was found by adding the ordinal scale of pre-arrest albumin levels to the original GO-FAR score.

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Impact of Colistin Dosing on the Incidence of Nephrotoxicity in a Tertiary Care Hospital in Saudi Arabia

Antibiotics ◽

10.3390/antibiotics9080485 ◽

2020 ◽

Vol 9 (8) ◽

pp. 485 ◽

Cited By ~ 1

Author(s):

Reem Almutairy ◽

Waad Aljrarri ◽

Afnan Noor ◽

Pansy Elsamadisi ◽

Nour Shamas ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Cure ◽

Clinical Cure Rate ◽

Serum Albumin Level ◽

Tertiary Care ◽

Multivariable Analysis ◽

Severity Of Illness ◽

Albumin Level ◽

Care Hospital ◽

Cure Rate

Colistin therapy is associated with the development of nephrotoxicity. We examined the incidence and risk factors of nephrotoxicity associated with colistin dosing. We included adult hospitalized patients who received intravenous (IV) colistin for >72 h between January 2014 and December 2015. The primary endpoint was the incidence of colistin-associated acute kidney injury (AKI). The secondary analyses were predictors of nephrotoxicity, proportions of patients inappropriately dosed with colistin according to the Food and Drug Administration (FDA), European Medicines Agency (EMA), and Garonzik formula and clinical cure rate. We enrolled 198 patients with a mean age of 55.67 ± 19.35 years, 62% were men, and 60% were infected with multidrug-resistant organisms. AKI occurred in 44.4% (95% CI: 37.4–51.7). Multivariable analysis demonstrated that daily colistin dose per body weight (kg) was associated with AKI (OR: 1.57, 95% CI: 1.08–2.30; p = 0.02). Other significant predictors included serum albumin level, body mass index (BMI), and severity of illness. None of the patients received loading doses, however FDA-recommended dosing was achieved in 70.2% and the clinical cure rate was 13%. The incidence of colistin-associated AKI is high. Daily colistin dose, BMI, serum albumin level, and severity of illness are independent predictors of nephrotoxicity.

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Abstract 189: Time to Awakening in Women Compared to Men After Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.189 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Sarah M Perman ◽

Shelby Shelton ◽

Stacie L Daugherty ◽

Edward Havranek

Keyword(s):

Cardiac Arrest ◽

Tertiary Care ◽

Spontaneous Circulation ◽

Therapeutic Interventions ◽

Care Hospital ◽

Single Center ◽

Men And Women ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

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A Multicenter Validation Study of the Deep Learning-based Early Warning Score for Predicting in-hospital Cardiac Arrest in Patients Admitted to General Wards

10.21203/rs.3.rs-61577/v1 ◽

2020 ◽

Author(s):

Yeon Joo Lee ◽

Kyung-Jae Cho ◽

Oyeon Kwon ◽

Hyunho Park ◽

Yeha Lee ◽

...

Keyword(s):

Cardiac Arrest ◽

Deep Learning ◽

Early Warning ◽

Characteristic Curve ◽

Predictive Performance ◽

Early Warning Score ◽

Patients At Risk ◽

Key Aspects ◽

General Wards ◽

Hospital Cardiac Arrest

Abstract Background: The recently developed deep learning (DL)-based early warning score (DEWS) has shown a potential in predicting deteriorating patients. We aimed to validate DEWS in multiple centers and compare the prediction, alarming and timeliness performance with those of the modified early warning score (MEWS) to identify patients at risk for in-hospital cardiac arrest (IHCA).Methods: This retrospective cohort study included adult patients admitted to the general wards of five hospitals during a 12-month period. We validated DEWS internally at two hospitals and externally at the other three hospitals. The occurrence of IHCA within 24 hours of vital sign observation was the outcome of interest. We used the area under the receiver operating characteristic curve (AUROC) as the main performance metric.Results: The study population consisted of 173,368 patients (224 IHCAs). The predictive performance of DEWS was superior to that of MEWS in both the internal (AUROC: 0.860 vs. 0.754, respectively) and external (AUROC: 0.905 vs. 0.785, respectively) validation cohorts. At the same specificity, DEWS had a higher sensitivity than MEWS, and at the same sensitivity, DEWS had a lower mean alarm count than MEWS, with nearly half of the alarm rate in MEWS. Additionally, DEWS was able to predict more IHCA patients in the 24 to 0.5 hours before the outcome.Conclusion: Our study showed that DEWS was superior to MEWS in the three key aspects (IHCA predictive, alarming, and timeliness performance). This study demonstrates the potential of DEWS as an effective, efficient screening tool in rapid response systems (RRSs) to identify high-risk patients.

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Background Frequency Patterns in Standard Electroencephalography as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management

Journal of Clinical Medicine ◽

10.3390/jcm9041113 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1113

Author(s):

Youn-Jung Kim ◽

Min-Jee Kim ◽

Yong Seo Koo ◽

Won Young Kim

Keyword(s):

Cardiac Arrest ◽

Clinical Features ◽

Tertiary Care ◽

Cerebral Performance Category ◽

High Specificity ◽

Targeted Temperature Management ◽

Temperature Management ◽

Care Hospital ◽

Theta Waves ◽

Hospital Cardiac Arrest

We investigated the prognostic value of standard electroencephalography, a 30-min recording using 21 electrodes on the scalp, during the early post-cardiac arrest period, and evaluated the performance of electroencephalography findings combined with other clinical features for predicting favourable outcomes in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). This observational registry-based study was conducted at a tertiary care hospital in Korea using the data of all consecutive adult non-traumatic comatose OHCA survivors who underwent standard electroencephalography during TTM between 2010 and 2018. The primary outcome was a 6-month favourable neurological outcome (Cerebral Performance Category score of 1 or 2). Among 170 comatose OHCA survivors with median electroencephalography time of 22 h, a 6-month favourable neurologic outcome was observed in 34.1% (58/170). After adjusting other clinical characteristics, an electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 13.03 (95% confidence interval, 4.69–36.22) in multivariable logistic analysis. A combination of other clinical features (age < 65 years, initial shockable rhythm, resuscitation duration < 20 min) with an electroencephalography background with dominant alpha and theta waves increased predictive performance for favourable neurologic outcomes with a high specificity of up to 100%. A background with dominant alpha and theta waves in standard electroencephalography during TTM could be a simple and early favourable prognostic finding in comatose OHCA survivors.

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In-hospital cardiac arrest incidence and outcomes in the era of COVID-19: an observational study in a Singapore hospital

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00356-7 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ting Lyu ◽

Faheem Ahmed Khan ◽

Shanaz Matthew Sajeed ◽

Amit Kansal ◽

Monika Gulati Kansal ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Primary Outcome ◽

Hospital Admissions ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Code Blue ◽

Secondary Outcomes ◽

Hospital Cardiac Arrest

Abstract Background COVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period. Methods We conducted a retrospective study in a tertiary care hospital in Singapore. The study compared the incidence and outcomes of code blue activations over a 3-month period from March to May 2020 (COVID-19 period) with the same months in 2019 (pre-COVID-19 period). The primary outcome of the study was the rate of survival to hospital discharge for IHCA. The secondary outcomes included incidence of all code blue activation per 1000 hospital admissions, incidence of IHCA per 1000 hospital admissions. Outcomes The rate of survival to hospital discharge for IHCA was 5.88% in the COVID-19 period as compared to 10.0% in the pre-COVID-19 period [odds ratio (OR), 0.72; 95% confidence interval (CI), 0.26-1.95]. Compared to pre-COVID-19 period, there were more IHCA incidences per 1000 hospital admissions in the COVID-19 period (1.86 vs 1.03; OR, 1.81; 95% CI, 0.78-4.41). Conclusions The study observed a trend towards higher incidence of IHCA and lower rate of survival to hospital discharge during COVID-19 pandemic compared to pre-COVID-19 period.

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Long-term outcomes and predictors of survival after cardiopulmonary resuscitation for in-hospital cardiac arrest in a tertiary care hospital in Thailand

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s157483 ◽

2018 ◽

Vol Volume 14 ◽

pp. 583-589 ◽

Cited By ~ 3

Author(s):

Panita Limpawattana ◽

Wannaporn Aungsakul ◽

Chomchanok Suraditnan ◽

Anupol Panitchote ◽

Boonsong Patjanasoontorn ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Long Term Outcomes ◽

Hospital Cardiac Arrest

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Study of pre-hospital care of out of hospital cardiac arrest victims and their outcome in a tertiary care hospital in India

Indian Heart Journal ◽

10.1016/j.ihj.2021.02.004 ◽

2021 ◽

Author(s):

Rachana Bhat ◽

Prithvishree Ravindra ◽

Ankit Kumar Sahu ◽

Roshan Mathew ◽

William Wilson

Keyword(s):

Cardiac Arrest ◽

Hospital Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Hospital Cardiac Arrest

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Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.icon-2022.5776 ◽

2021 ◽

Vol 38 (ICON-2022) ◽

Author(s):

Faiza Ahmed ◽

Lubna Abbasi ◽

Nida Ghouri ◽

Muhammad Junaid Patel

Keyword(s):

Gender Differences ◽

Cardiac Arrest ◽

Tertiary Care Hospital ◽

Small Sample Size ◽

Tertiary Care ◽

Small Sample ◽

Care Hospital ◽

Cross Sectional ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic. Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period. Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (μ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%. Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 How to cite this:Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022;38(2):387-392. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5776 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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