Abstract 231: Preliminary Experience with Prehospital Pupillometry: A Prospective, Observational Study in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Joshua C Reynolds ◽  
Todd Chassee ◽  
Mark D Fankhauser ◽  
Amy Uber
Keyword(s):  
Observational Study ◽  
Test Performance ◽  
Prospective Observational Study ◽  
Objective Assessment ◽  
Patient Characteristics ◽  
Qualitative Assessment ◽  
Prognostic Information ◽  
Neurologic Recovery ◽  
Shockable Rhythm ◽  
Continuous Scale

Objective: Physiologic monitoring & neuroprognostication during resuscitation are relatively crude. Real time assessment of neurophysiology could be useful to guide resuscitative efforts. Objective assessment of the pupillary light reflex [PLR] is feasible during IHCA with a portable pupillometer, & PLR is associated with survival & neurologic outcome. We are conducting a prospective, observational study to assess the translational potential of pupillometry in the prehospital setting for OHCA. Hypotheses: Prehospital pupillometry is feasible & qualitative assessment of PLR is associated with patient outcomes. Methods: Portable pupillometers (NeurOptics, Inc) were deployed for subjects with EMS treated OHCA. Serial recordings were obtained during routine pulse checks until ROSC, termination, or hospital arrival. We qualified PLR as normal/abnormal/absent with Neurologic Pupillary Index (NPiTM), a continuous scale that combines facets of PLR (e.g. % change, velocity, latency). We reviewed prehospital & hospital records to identify patient characteristics & outcomes, tabulated data as means/medians/proportions, & estimated test performance characteristics. Results: From 2/14 - 6/14, a pupillometer was deployed to 38/58 (66%) patients with EMS treated OHCA (63 ± 16 years, 66% male, 33% witnessed, 54% bystander CPR, 11% shockable rhythm). Of 38 subjects, 21 (56%) were transported (19 ROSC & 2 CPR). At the time of submission, follow-up data were available on 27 (71%) patients (6 survived to admission, 4 had therapeutic hypothermia, 3 had cardiac catheterization, 1 survived to discharge with excellent neurologic recovery). In total, 385 readings were attempted (median 8.5 attempts/patient; IQR 6-12). Median 47% (IQR 25%, 67%) readings had usable data. Most (92%) patients had ≥1 usable reading and 9/38 (24%) had any PLR during resuscitation. Conclusion: Prehospital pupillometry is feasible & may yield prognostic information during resuscitation.

scholarly journals Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study

2020 ◽  
Author(s):  
Thomas Galetin ◽  
Mark Schieren ◽  
Benjamin Marks ◽  
Jerome Defosse ◽  
Erich Stoelben
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Test Performance ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Lung Resection ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Diagnostic Test Performance

Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.

Birth Lacerations in Different Genital Compartments and their Effect on Maternal Subjective Outcome: A Prospective Observational Study

2019 ◽  
Vol 223 (06) ◽  
pp. 359-368 ◽  
Author(s):  
Nina Kimmich ◽  
Vera Grauwiler ◽  
Anne Richter ◽  
Roland Zimmermann ◽  
Martina Kreft
Keyword(s):  
Observational Study ◽  
Genital Tract ◽  
Prospective Observational Study ◽  
Objective Assessment ◽  
Subjective Outcome ◽  
Perineal Tears ◽  
Psychological Impairment ◽  
Vertex Presentation ◽  
Maternal Impairment ◽  
The Right

Abstract Introduction Lacerations are common in vaginal births, but little is known about tears other than perineal tears and their association with maternal impairment. This study aimed to evaluate the frequency and distribution of birth lacerations and their association with maternal discomfort. Methods From 2/2015 to 12/2016, we conducted a prospective observational study on 140 women with singletons in vertex presentation at term, who gave birth vaginally in our center and were affected by a laceration. The lacerations were assigned objectively and subjectively to eight genital tract compartments. The presence and effect of lacerations on maternal health were assessed by questionnaires for the time before birth (T1), 1–4 days (T2), and 6–8 weeks postpartum (T3). Results The number of affected compartments was 1.33 objectively and 2.99 at T2 and 1.27 at T3 subjectively. The most affected compartment was the right perineum (73%) followed by the right inner posterior (21%) and the right outer anterior (14%) compartment. Subjective and objective assessment concurred in 83% at T2 and 69% of cases at T3. Overall, impairment of women was low, reversible, and not directly associated with the location of lacerations, although women were psychologically affected. Conclusion Birth lacerations predominantly appear at the right perineum. Physical impairment from these lacerations is generally low, reversible, and not directly associated with the location of lacerations, although psychological impairment is not negligible.

Abstract 146: Neurological Prognostication by Gender in Patients with Out-of-Hospital Cardiac Arrest Receiving Hypothermia Treatment

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Min Jung Kim ◽  
Sang Do Shin ◽  
William McClellan ◽  
Bryan McNally
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Rhythm ◽  
Age Groups ◽  
Patient Characteristics ◽  
Neurologic Outcome ◽  
Neurologic Recovery ◽  
Hypothermia Treatment ◽  
Shockable Rhythm ◽  
Gender And Age ◽  
Hospital Cardiac Arrest

Objectives: This study aimed to to examine whether neurologic recovery of out-of-hospital cardiac arrest patients receiving hypothermia treatment is enhanced for women of childbearing age. Methods: A cross-sectional analysis was conducted using a nationwide surveillance database in Korea of out-of-hospital cardiac arrest (OHCA) that occurred between 2008 and 2012. The exposure and outcomes studied were hypothermia treatment and neurologic outcome at discharge. Patient characteristics between hypothermia-treated and non-treated groups were compared. Multivariate logistic regression was used to account for the patient characteristics. The association was examined for each stratum of gender, age (<45, 45-65, and >65 years old), and initial cardiac rhythm. Cardiac rhythms were considered in two different categorizations: 1) shockable/non-shockable rhythm, and 2) VF.VT/PEA/asystole. Results: Crude analysis showed that women of childbearing ages treated with hypothermia had enhanced neurologic recovery than older aged women and all men. After adjusted, men had stronger association between hypothermia and good neurologic recovery than women. The highest association was found in men who are under 45 years of age and have shockable cardiac rhythm (OR=2.00 (1.26, 3.19)). The association between hypothermia and neurologic recovery was not statistically significant in all women. The magnitude of association decreased with age. Shockable rhythm was associated with better neurologic recovery than non-shockable rhythms in all gender and age groups. Using VF.VT/PEA/asystole categorization of cardiac rhythms, men consistently showed higher ORs than women. In all gender and age groups, having PEA rhythm was associated with better neurologic outcome than shockable rhythms (VF/VT) or asystole. Conclusion: The unadjusted association between hypothermia and neurologic recovery was the strongest in women of childbearing ages. After adjustment, men had a better neurologic outcome than women across all ages. Shockable rhythms were associated with enhanced neurologic recovery. Our results suggest that among OHCA patients, the effect of hypothermia treatment on neurologic recovery is greater for men, young ages, and having shockable cardiac rhythm.

scholarly journals Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study

2018 ◽  
Vol 5 (2) ◽  
pp. 662 ◽  
Author(s):  
Mohna M. Toro ◽  
Sheetal John ◽  
Atiya R. Faruqui
Keyword(s):  
Observational Study ◽  
Pain Score ◽  
Severe Pain ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Post Operative Pain ◽  
Surgery Department

Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery  [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.

scholarly journals Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuling Chen ◽  
Peng Yue ◽  
Ying Wu ◽  
Jia Li ◽  
Yanni Lei ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Indirect Effect ◽  
Prospective Observational Study ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA), a global health problem with a survival rate ranging from 2 to 22% across different countries, has been a leading cause of premature death for decades. The aim of this study was to evaluate the trends of survival after OHCA over time and its relationship with bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, return of spontaneous circulation (ROSC), and survived event. Methods In this prospective observational study, data of OHCA patients were collected following the “Utstein style” by the Beijing, China, Emergency Medical Service (EMS) from January 2011 (data from February to June in 2011 was not collected) to October 2016. Patients who had a cardiac arrest and for whom an ambulance was dispatched were included in this study. All cases were followed up to determine hospital discharge or death. The trend of OHCA survival was analyzed using the Chi-square test. The relationship among bystander CPR, initial shockable rhythm, ROSC, survived event, and OHCA survival rate was analyzed using multivariate path analyses with maximum standard likelihood estimation. Results A total of 25,421 cases were transferred by the Beijing EMS; among them, 5042 (19.8%) were OHCA (median age: 78 years, interquartile range: 63–85, 60.1% male), and 484 (9.6%) received bystander CPR. The survival rate was 0.6%, which did not improve from 2012 to 2015 (P = 0.569). Overall, bystander CPR was indirectly associated with an 8.0% (β = 0.080, 95% confidence interval [CI] = 0.064–0.095, P = 0.002) increase in survival rate. The indirect effect of bystander CPR on survival rate through survived event was 6.6% (β = 0.066, 95% CI = 0.051–0.081, P = 0.002), which accounted for 82.5% (0.066 of 0.080) of the total indirect effect. With every 1 increase in survived event, the possibility of survival rate will directly increase by 53.5% (β = 0.535, 95% CI = 0.512–0.554, P = 0.003). Conclusions The survival rate after OHCA was low in Beijing which has not improved between 2012 and 2015. The effect of bystander CPR on survival rate was mainly mediated by survived event. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002149 (2 May, 2012, retrospectively registered). http://www.chictr.org.cn/showproj.aspx?proj=7400

scholarly journals The Effect of Esophageal Stethoscope Insertion on the Cuff Pressure: a Prospective Observational Study

2020 ◽  
Author(s):  
Jee-Eun Chang ◽  
Jung-Man Lee ◽  
Jiwon Lee ◽  
Jin-Young Hwang ◽  
Tae Kyong Kim ◽  
...  
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Tracheal Tube ◽  
Prospective Observational Study ◽  
Cuff Pressure ◽  
Patient Characteristics ◽  
Pressure Change ◽  
The Mean ◽  
Almost All ◽  
Cuff Pressure Increase

Abstract Background: High cuff pressure can induce ischemic injury to the trachea. An esophageal stethoscope can increase the cuff pressure. The purpose of this study was to evaluate the effect of an esophageal stethoscope insertion on the cuff pressure.Methods: Patients, who were scheduled for surgeries under general anesthesia, were enrolled in this prospective observational study. After induction of anesthesia, an anesthesiologist intubated a tracheal tube into the patient’s trachea and inflated the cuff manually. Then, an investigator checked the initial cuff pressure using a manometer. Next, the cuff pressure was adjusted to 24-26 mmHg. The cuff pressure was rechecked after insertion of an esophageal stethoscope. We recorded the change in cuff pressure by esophageal stethoscope.Results: One hundred twelve patients completed this study. The cuff pressure increased by an esophageal stethoscope in almost all patients and the mean cuff pressure change was 3.0 ± 3.4 cmH2O in all patients. Among all subjects, cuff pressure change over 5 cmH2O was recorded in 24 patients. When we compared the patient characteristics between patients whose cuff pressure changed over 5 cmH2O with that of other patients, females were more affected by insertion of an esophageal stethoscope, in terms of cuff pressure increase.Conclusion: Esophageal stethoscope insertion could increase cuff pressure, and females are more affected by it. Therefore, anesthesiologists should check the cuff pressure with a manometer after insertion of an esophageal stethoscope and readjust the pressure appropriately.Trial registration: ClinicalTrials.gov Identifier NCT03375554, registered on 12 December 2017 (https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007N0H&selectaction=Edit&uid=U00026JX&ts=2&cx=-ivu5vz)

scholarly journals Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Carl Magnusson ◽  
Johan Herlitz ◽  
Christer Axelsson
Keyword(s):  
Observational Study ◽  
Emergency Medical Services ◽  
Medical History ◽  
Prospective Observational Study ◽  
Patient Characteristics ◽  
Critical Conditions ◽  
Initial Assessment ◽  
Level Of Care ◽  
Emergency Medical ◽  
Time Critical

Abstract Background Crowding in the emergency department (ED) is a safety concern, and pathways to bypass the ED have been introduced to reduce the time to definitive care. Conversely, a number of low-acuity patients in the ED could be assessed by the emergency medical services (EMS) as requiring a lower level of care. The limited access to primary care in Sweden leaves the EMS nurse to either assess the patient as requiring the ED or to stay at the scene. This study aimed to assess patient characteristics and evaluate the initial assessment by and utilisation of the ambulance triage system and the appropriateness of non-transport decisions. Methods A prospective observational study including 6712 patients aged ≥16 years was conducted. The patient records with 72 h of follow-up for non-transported patients were reviewed. Outcomes of death, time-critical conditions, complications within 48 h and final hospital assessment were evaluated. The Mann-Whitney U test, Fisher’s exact test, and Spearman’s rank correlation were used for statistical analysis. Results The median patient age was 66 years, and the most common medical history was a circulatory diagnosis. Males received a higher priority from dispatchers and were more frequently assessed at the scene as requiring hospital care. A total of 1312 patients (19.7%) were non-transported; a history of psychiatric disorders or no medical history was more commonly noted among these patients. Twelve (0.9%) of the 1312 patients not transported were later admitted with time-critical conditions. Full triage was applied in 77.4% of the cases, and older patients were triaged at the scene as an ‘unspecific condition’ more frequently than younger patients. Overall, the 30-day mortality was 4.1% (n = 274). Conclusions Age, sex, medical history, and presentation all appear to influence the initial assessment. A number of patients transported to ED could be managed at a lower level of care. A small proportion of the non-transported patients were later diagnosed with a time-critical condition, warranting improved assessment tools at the scene and education of the personnel focusing on the elderly population. These results may be useful in addressing resource allocation issues aiming at increasing patient safety.

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