scholarly journals 1284: DEVELOPMENT OF POST-CARDIAC ARREST CARE GUIDELINES ACROSS A QUATERNARY PEDIATRIC HEALTH SYSTEM

2021 ◽  
Vol 50 (1) ◽  
pp. 643-643
Author(s):  
Venessa Pinto ◽  
Kelli Irwin ◽  
Katherine Lemming ◽  
Jamie Causey ◽  
Jennifer Erklauer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health System ◽  
Pediatric Health ◽  
Care Guidelines

Abstract 86: Association Between Hospital Postresuscitative Performance and Clinical Outcomes in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dion Stub ◽  
Robert H Schmicker ◽  
Monique L Anderson ◽  
Eric D Peterson ◽  
Clifton W Callaway ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Status ◽  
Performance Metrics ◽  
Treatment Guidelines ◽  
Hospital Performance ◽  
Temperature Management ◽  
Performance Score ◽  
Resuscitation Guidelines ◽  
Care Guidelines ◽  
Hospital Cardiac Arrest

Context: Whilst performance measures have been extensively evaluated in conditions such as myocardial infarction, it remains unclear if adherence to post-resuscitation guidelines is associated with better outcome in patients hospitalized after out-of-hospital cardiac arrest (OHCA). Objectives: To assess whether survival and good functional status at discharge are associated with post-resuscitation performance score based on treatment guidelines for patients with OHCA, comprised of a) initiation of temperature management; b) target temperature 32 0 -34 0 C achieved; c) temperature management continued for more than 12 hours; d) coronary angiography performed within 24 hrs; e) life sustaining treatment not withdrawn prior to day 3. Methods: An observational analysis of hospital care in 111 North American hospitals, including 3252 patients enrolled in the Resuscitation Outcomes Consortium (ROC-PRIMED) study, between 2007 and 2009, following OHCA. Performance scores were calculated, utilizing opportunity based scoring, with each factor weighted equally and scaled from 0-1. Scores for individual patients were grouped at the hospital level, with hospitals divided for descriptive purposes into quartiles based on their median opportunity composite score. Results: Performance score varied widely (median [IQR] scores from lowest to highest hospital quartiles, 21% [20%-25%] vs 59% [55%-64%]. Adjusted survival to discharge increased with each quartile of performance score (lowest to highest: 16.2%, 20.8%, 28.5%, 34.8%, P <0.01). Similarly adjusted rates of good functional outcome improved (lowest quartile to highest: 8.3%, 13.8%, 22.2%, 25.9%, P<0.01). Hospital performance score were significantly associated with outcome after risk adjustment for established prehospital resuscitative factors (Highest versus lowest adherence quartile: adjusted OR of survival 1.64; 95% CI 1.13, 2.38) Conclusions: Increased survival and improved functional status at discharge are associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Measuring, reporting and improving hospital adherence to guideline-based performance metrics could improve outcomes following OHCA.

Abstract 309: A Novel Method to Predict Survival From Ventricular Fibrillation Arrest During Chest Compressions

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jason Coult ◽  
Lawrence D Sherman ◽  
Jennifer Blackwood ◽  
Heemun Kwok ◽  
Peter J Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Characteristic Curve ◽  
Amplitude Spectrum ◽  
Support Vector ◽  
Chest Compressions ◽  
Time Frequency ◽  
Model Combining ◽  
Spectrum Area ◽  
Care Guidelines

Background: Quantitative measures of the ventricular fibrillation (VF) electrocardiogram (ECG) such as Amplitude Spectrum Area (AMSA) assess myocardial physiology and predict cardiac arrest outcomes, offering the potential to guide resuscitation care. Guidelines recommend minimally-interrupted chest compressions (CCs) during resuscitation, but CCs corrupt the ECG and must be paused for analysis. We therefore sought to develop a novel measure to predict survival without requiring CC pause. Methods and Results: Five-second VF ECG segments were collected with CCs and without CCs prior to 2755 defibrillation shocks in 1151 patients with out-of-hospital cardiac arrest. The cohort was divided into a training set to develop the measure and a test set to evaluate performance. Using segments from 460 training patients, we designed an adaptive filter to remove CC artifacts based on chest impedance and ECG characteristics, derived novel time-frequency and amplitude features of the filtered VF ECG, and trained a Support Vector Machine (SVM) model combining these novel features to predict survival with favorable neurologic status. In 691 test cases, area under the receiver operating characteristic curve (AUC) for predicting survival using the SVM was 0.74 (95% CI: 0.71-0.77) with CCs and 0.74 (95% CI: 0.71-0.76) without CCs (Figure 1). By comparison, AUC for predicting survival using AMSA was 0.70 (95% CI: 0.67-0.73) with CCs (p=0.001 for difference versus SVM) and 0.73 (95% CI: 0.71-0.76) without CCs (p=0.68 for difference versus SVM). Conclusions: VF waveform measures such as AMSA predict functional survival when obtained during ongoing CCs, but prognostic performance is reduced compared to CC-free analysis. However, an SVM-based measure combining novel VF waveform features enabled similar prediction with and without CCs. Machine learning combinations of features optimized for use during CCs may thus afford a means for VF prognosis during uninterrupted CCs.

scholarly journals Clinical documentation of in-hospital cardiac arrest in a large national health system

Resuscitation ◽  
2017 ◽  
Vol 112 ◽  
pp. e9-e10 ◽  
Author(s):  
Devraj Sukul ◽  
Lee A. Kamphuis ◽  
Theodore J. Iwashyna ◽  
Steven M. Bradley ◽  
Paul S. Chan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
Clinical Documentation ◽  
Hospital Cardiac Arrest

Health system costs of in-hospital cardiac arrest

Resuscitation ◽  
2002 ◽  
Vol 54 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Heather Gage ◽  
Gary Kenward ◽  
Timothy J. Hodgetts ◽  
Nick Castle ◽  
N. Ineson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Health System ◽  
Hospital Cardiac Arrest

Practices and Perceptions of Face Mask Use in a Pediatric Health System During the COVID-19 Pandemic

2021 ◽  
pp. respcare.08944
Author(s):  
L Denise Willis ◽  
Austin Lovenstein ◽  
Beverly J Spray ◽  
Michele Honeycutt ◽  
Marlene Walden
Keyword(s):  
Health System ◽  
Face Mask ◽  
Pediatric Health

scholarly journals Inability to Recruit Adolescents for a Vaping Cessation Clinical Trial Within a Large Pediatric Health System

2021 ◽  
Author(s):  
Brian P Jenssen ◽  
Chloe Hannan ◽  
Mary Kate Kelly ◽  
Thomas Ylioja ◽  
Robert A Schnoll ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Health System ◽  
Pediatric Health

scholarly journals Demographic Characteristics Among Members of Patient Family Advisory Councils at a Pediatric Health System

2021 ◽  
Vol 8 ◽  
pp. 237437352110496
Author(s):  
Amanda Montalbano ◽  
Sheryl Chadwick ◽  
DeeJo Miller ◽  
Kathryn Taff ◽  
Evelyn Donis De Miranda ◽  
...  
Keyword(s):  
Health System ◽  
Demographic Characteristics ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Pediatric Health ◽  
Experience Of Care ◽  
Advisory Councils ◽  
System Leaders ◽  
Inclusive Excellence ◽  
Board Representation

Patient Family Advisory Councils (PFACs) are groups of patients, families, and clinical health system leaders collaborating to improve the quality, safety, and experience of care. Best practices encourage PFAC membership to reflect the diversity of the communities served. A cross-sectional survey was conducted from September 2019 to January 2020 collecting demographic characteristics of the members of a pediatric health system's 17 PFACs. Of the 93 respondents (71.5%), notable inequities were racial (4.8% adult PFAC members vs. 17.4% patients were Black) and financial (adult PFAC median annual income was >$100,000 compared to the community median $77,589). The governing family advisory board used this information to codesign interventions to achieve the ideal state of inclusive excellence by identifying barriers for participation for the Black community, recruiting and retaining diverse board members, and continuous monitoring to maintain a diverse board representation.

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