scholarly journals Neuroprognostication of Cardiac Arrest Patients: Outcomes of Importance

2017 ◽  
Vol 38 (06) ◽  
pp. 775-784
Author(s):  
Tobias Cronberg
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Survival Rates ◽  
High Quality ◽  
Cognitive Difficulties ◽  
Cardiac Arrest Survivor ◽  
Chain Of Survival ◽  
Quality Decision ◽  
Improved Methods

AbstractDuring the last two decades, survival rates after cardiac arrest have increased while the fraction of patients surviving with a severe neurological disability or vegetative state has decreased in many countries. While improved survival is due to improvements in the whole “chain of survival,” improved methods for prognostication of neurological outcome may be of major importance for the lower disability rates. Patients who are resuscitated and treated in intensive care will die mainly from the withdrawal of life-sustaining (WLST) therapy due to presumed poor chances of meaningful neurological recovery. To ensure high-quality decision-making and to reduce the risk of premature withdrawal of care, implementation of local protocols is crucial and should be guided by international recommendations. Despite rigorous neurological prognostication, cognitive impairment and related psychological distress and reduced participation in society will still be relevant concerns for cardiac arrest survivors. The commonly used outcome measures are not designed to provide information on these domains. Follow-up of the cardiac arrest survivor needs to consider the cardiovascular burden as an important factor to prevent cognitive difficulties and future decline.

scholarly journals Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Abdul H. Qazi ◽  
Paul S. Chan ◽  
Yunshu Zhou ◽  
Mary Vaughan-Sarrazin ◽  
Saket Girotra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Similar Proportion ◽  
Large Improvement ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: A hospital’s risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time. Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines–Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012–2013) and two follow-up periods (2014–2015 and 2016–2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals’ at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline. Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.

Initial Development of a Tool to Measure Implementation of Community Change to Improve Out-of-Hospital Cardiac Arrest

2019 ◽  
pp. 1-8
Keyword(s):  
Cardiac Arrest ◽  
Survival Data ◽  
Survival Rates ◽  
Implementation Process ◽  
Positive Association ◽  
Community Change ◽  
Initial Development ◽  
Reduction Methods ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Background: The Resuscitation Academy (RA) is a training and community change program to assist communities in implementing activities to improve survival after out-of-hospital cardiac arrest. The purpose of this paper is to present data on the development of an implementation index to measure community progress in achieving survival reduction. Methods: Community representatives who attended the RA in Seattle, WA (n=258) completed an on-line survey asking about achievement of the chain of survival program components, presented in the RA, and the most helpful things that supported communities in implementing these activities. Survival data in the Cardiac Arrest Surveillance (CARES) database was used to examine the association between implementation of chain of survival components and cardiac arrest survival rates in those agencies participating CARES. Results: The15-item scale was easily implemented in online form. Internal consistency, measured by an alpha coefficient, was 0.78. Time since RA participation was significantly related to implementation index score, indicating potential to measure change. An overall implementation index showed a positive association with independently measured survival (p < 0.001). Conclusions: These data indicate that the implementation index has acceptable properties for measuring community change in the area of implementation of cardiac survival efforts. Areas for improvement include further work on measurement and documentation of the implementation process in communities, and considering tailored feedback using the tool as way of providing assistance for communities struggling to implement this program.

Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Yunshu Zhou ◽  
Paul Chan ◽  
Saket Girotra
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Time Intervals ◽  
Hierarchical Regression Model ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( > 25 percentile points) at 26.8% and by at least 2 quartiles ( > 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

scholarly journals New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

Medicina ◽  
2010 ◽  
Vol 46 (9) ◽  
pp. 571 ◽  
Author(s):  
Andrius Pranskūnas ◽  
Paulius Dobožinskas ◽  
Vidas Pilvinis ◽  
Živilė Petkevičiūtė ◽  
Nedas Jasinskas ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Current Trends ◽  
Resuscitation Guidelines ◽  
Chain Of Survival ◽  
Meta Analyses

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

scholarly journals Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
B. Y. Gravesteijn ◽  
M. Schluep ◽  
H. F. Lingsma ◽  
R. J. Stolker ◽  
H. Endeman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Of Care ◽  
The Netherlands ◽  
Odds Ratio ◽  
Vegetative State ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Case Mix ◽  
Hospital Cardiac Arrest

Abstract Background Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. Methods A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. Results After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). Conclusion In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

Outcomes after sudden cardiac arrest in sports centres with and without on-site external defibrillators

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1344-1349 ◽  
Author(s):  
Daniela Aschieri ◽  
Diego Penela ◽  
Valentina Pelizzoni ◽  
Federico Guerra ◽  
Anna Chiara Vermi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Tragic Event ◽  
Period Data ◽  
Neurologically Intact ◽  
Sports Activities

ObjectiveSudden cardiac arrest (SCA) is a rare but tragic event during amateur sports activities. Our aim is to analyse whether availability of automated external defibrillators (AEDs) in amateur sports centres could impact on SCA survival.MethodsThis is an observational study. During an 18-year period, data regarding exercise-related SCA in sports centres were prospectively collected. Survival rates and time to response were compared between centres with an AED already available and centres where an AED was not already present.ResultsOut of 252 sports facilities, 207 (82%) acquired an AED during follow-up while 45 (18%) did not. From 1999 to 2014, there were 26 SCAs (24 (92%) men, 54±17 years old) with 15 (58%) of them in centres with on-site AED. Neurologically intact survival rates were 93% in centres with on-site AED and 9% in centres without (P<0.001). Presence of on-site AED, presence of shockable rhythm, first assistance by a lay bystander and time to defibrillation were all related to neurological intact survival, but the presence of on-site AED was the only independent predictor in the multivariate analysis. The use of on-site AED resulted in a lower time to first shock when compared with emergency medical system-delivered AED (3.3±1.4min vs 7.3±3.2 min; P=0.001).ConclusionsThe presence of on-site AEDs is associated with neurologically intact survival after an exercise-related SCA. Continuous efforts are recommended in order to introduce AEDs in sports and fitness centres, implement educational programmes and increase common awareness about SCA.

scholarly journals First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Iris Oving ◽  
◽  
Siobhan Masterson ◽  
Ingvild B.M. Tjelmeland ◽  
Martin Jonsson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Police Officers ◽  
Survival Rates ◽  
European Countries ◽  
Future Research ◽  
Comprehensive Overview ◽  
Taxi Drivers ◽  
First Response ◽  
Chain Of Survival ◽  
Hospital Cardiac Arrest

Abstract Background In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. Methods A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. Results Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. Conclusions Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a ‘one-size fits all’ FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.

Confronting the practice of surgery on differentiated thyroid cancer with current guidelines in Germany

2005 ◽  
Vol 44 (05) ◽  
pp. 185-191 ◽  
Author(s):  
H. Wieler ◽  
S. Birtel ◽  
E. Ostwald-Lenz ◽  
K. P. Kaiser ◽  
H. P. Becker ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Survival Rates ◽  
Perioperative Morbidity ◽  
Referral Hospitals ◽  
Principles Of Treatment ◽  
Current Guidelines ◽  
Papillary Microcarcinomas ◽  
Retrospective Multicenter Study

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.

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