Abstract 153: Does the Revision of Resuscitation Guidelines Improve the Outcome of In-Hospital Cardiac Arrest?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Akihiro Miyake ◽  
Hiroshi Nonogi ◽  
Yoshihisa Fujimoto ◽  
Shinsuke Fujiwara ◽  
Takaki Naito ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Rapid Response ◽  
Rapid Response System ◽  
International Consensus ◽  
Response System ◽  
Shockable Rhythm ◽  
Resuscitation Guidelines ◽  
General Wards ◽  
Hospital Cardiac Arrest

Background: Resuscitation guidelines have been improved every five years using ILCOR international consensus and outcomes for out-of-hospital cardiac arrest improved. However, it remained unknown whether the outcome of in-hospital cardiac arrest has improved. The purpose of this research is to compare the outcomes of multicenter registrations in Japan and to consider the role of rapid response system (RRS). Methods: We compared the two multicenter prospective registrations for adult in-hospital cardiac arrest conducted in Japan. We compared the outcome of Japanese Registry of CPR (J-RCPR,12 hospitals) conducted in the "Guideline 2005" era and Japanese Registry for Survey Of in-hospital Resuscitation Trial (J-RESORT,8 hospitals) conducted in the "Guidelines 2010" era. We searched the number of hospitals participating in the rapid response system multicenter collaborative research (RRS) conducted in Japan. Results: J-RCPR had 491 cases, mean age 71 ± 15 years old, male 63%(311/491), J-RESORT 284 cases, mean age 72 ± 17 years old, male 68%(193/284). ROSC rate was 64.7% (318/491), 77.5% (220/284), respectively (p<0.05). The survival rate after 24 hours was 49.8% (245/491), 50.7% (144/284) (NS), the survival rate after 30 days was 27.8% (137/491), 33.1% (94/284) (NS), and the favorable neurological outcome rate (CPC 1 or CPC 2) was 21.4% (105/491), 22.9% (65/284) (NS), respectively. The proportion of witnessed cardiac arrest was 77.2% (379/491), 81.7% (232/284) (NS), the location of incidence in general wards was 54.0% (265/491), 46.1% (131/284) (NS), and the shockable rhythm was 28.1% (138/491), 22.5% (64/284) (NS), respectively. In both registries, the median interval from the occurrence of cardiac arrest to the initiation of resuscitation was 0 min. The proportion of participating hospitals to RRS was only 6 facilities in 2013 and increased to 41 facilities in 2016, but still less than 1% of the total number of hospitals in Japan. Conclusion: This study showed no improvement in the outcome of in-hospital cardiac arrest and very few hospitals using RRS during the past 10 years. To improve the outcome of the in-hospital cardiac arrest, it is necessary to investigate the nation-wide status of in-hospital cardiac arrest and the effectiveness of RRS.

In-hospital cardiac arrest epidemiology in a mature rapid response system

2017 ◽  
Vol 78 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Daryl Jones ◽  
Inga Mercer ◽  
Melodie Heland ◽  
Karen Detering ◽  
Sam Radford ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Rapid Response ◽  
Rapid Response System ◽  
Response System ◽  
Hospital Cardiac Arrest

scholarly journals Clinical Observation Research on the Application of Rapid Response System in General Wards

2021 ◽  
Author(s):  
Yan Wang ◽  
Haiyan Wu ◽  
Chang Liu ◽  
Suping Ran ◽  
Baoyu Wang
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Observation ◽  
Blood Purification ◽  
Rapid Response ◽  
Call Rate ◽  
Vasoactive Drugs ◽  
Rapid Response System ◽  
Organ Function ◽  
Response System ◽  
General Wards

Abstract Objective Observe and analyze the effect of the criticall rapid response system in general wards.Methods Analyze the data of CROT cases initiated in 2016-2019, and statistically analyze the reasons for the initiation, on-site treatment, the outcomes of patients, and the number of organ function support of patients transferred to ICU. Results A total of 312 cases were initiated in 43 months. The top three reasons for initiation were: unconsciousness (29.79%), respiratory distress (19.17%), and hypotension (18.60%). The effective call rate was 91.99%, and only 68.27% were transferred to ICU. Mechanical ventilation (89.67%), blood purification (85.92%), and vasoactive drugs (82.16%) were applied in ICU. Conclusions The critical rapid response system can guarantee the safety of inpatients in general wards, but the activatiaon characteristics are worthy of further discussion.

Abstract 165: Hospital Variation in Time to Administration of Epinephrine After Cardiac Arrest With Initial Non-shockable Rhythm

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Rohan Khera ◽  
Paul S Chan ◽  
Michael W Donnino ◽  
Saket Girotra ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Inverse Correlation ◽  
Poor Performance ◽  
Patient Characteristics ◽  
Hospital Performance ◽  
Epinephrine Administration ◽  
Shockable Rhythm ◽  
Hospital Variation ◽  
Hospital Cardiac Arrest

Background: For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods: Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (>18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge. Results: Among the 548 hospitals, there was substantial variation in rates of delayed epinephrine administration (median 13.5%, range: 0%- 53.8%). The odds of delay in epinephrine administration were 61% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.61; 95% C.I. 1.54 - 1.67). After adjusting for patient characteristics, the median risk-standardized survival rate for non-shockable in-hospital cardiac arrests was 12.1% and varied significantly across hospitals (range: 5.2% to 30.9%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized survival rate for cardiac arrests due to non-shockable rhythm (ρ= -0.23, P<0.0001). Compared to hospitals in the best quartile, risk-standardized survival was 17.4% lower at hospitals in the worst quartile of delayed epinephrine administration (13.8% vs. 11.4%, P<0.0001, Figure). Conclusions: Although delays in epinephrine administration following in-hospital cardiac arrest are common, there is substantial hospital variation in rates of delayed epinephrine administration. Hospitals with high rates of delayed epinephrine administration were found to have lower rates of risk-adjusted survival. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improvement in outcomes.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

scholarly journals Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032264
Author(s):  
Malin Albert ◽  
Johan Herlitz ◽  
Araz Rawshani ◽  
Mattias Ringh ◽  
Andreas Claesson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Survival Rate ◽  
Observational Study ◽  
Pulmonary Aspiration ◽  
Secondary Outcome ◽  
Failure Group ◽  
Hospitalised Patients ◽  
General Wards ◽  
Hospital Cardiac Arrest

ObjectiveTo study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.DesignA retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).SettingThe SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.ParticipantsThe study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).Primary and secondary outcome measuresPrimary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.ResultsIn the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).ConclusionsIn-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.

scholarly journals The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: a nationwide database analysis

2021 ◽  
Author(s):  
Yoshiki Sento ◽  
◽  
Masayasu Arai ◽  
Yuji Yamamori ◽  
Shinsuke Fujiwara ◽  
...  
Keyword(s):  
Postoperative Management ◽  
Rapid Response ◽  
Rapid Response System ◽  
Low Oxygen ◽  
Hospital Emergency ◽  
Database Analysis ◽  
Fluid Bolus ◽  
Serious Adverse Events ◽  
Response System ◽  
General Wards

Abstract Purpose Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management. Methods This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan. We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non-postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary. Results There were 609 (12.7%) postoperative patients among the total patients in the registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non-postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%. Conclusion Approximately, 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group.

Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

2019 ◽  
Vol 43 (2) ◽  
pp. 178
Author(s):  
The Concord Medical Emergency Team Study Investigators
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Structured Interviews ◽  
Emergency Team ◽  
Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P&lt;0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

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

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