Abstract 461: Evaluation of the Impact of Additional Structured Cardiac Arrest Training on Internal Medicine Residents in a Community Hospital

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Abdullah Zoheb Azhar ◽  
Monil Majmundar ◽  
Shmuel Golfeyz ◽  
Tikal Kansara ◽  
Jonna Mercado ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Cardiac Arrest ◽  
Community Hospital ◽  
Life Support ◽  
Statistical Significance ◽  
Advanced Cardiac Life Support ◽  
Hospital Staff ◽  
The United States ◽  
Bivariate Analysis ◽  
The Impact

Introduction: There are approximately 200,000 cases of in-hospital cardiac arrest (IHCA) annually in the United States. Of these cases, only 40-50% achieve return of spontaneous circulation (ROSC) and only 20-30% are discharged. Though most hospital staff are trained in cardiac arrest resuscitation, a significant disparity in resuscitation has been noted between different hospital settings. We thus instituted additional structured cardiac arrest training in an Internal Medicine residency program, to supplement the biennial advanced cardiac life support (ACLS) training. Hypothesis: We hypothesized that institution of a dedicated structured cardiac arrest team (code team) in addition to monthly training for those on the team, would improve the confidence, skills, and leadership level, of residents at managing an IHCA situation. Methods: A structured code team with specific roles for each resident was instituted in a New York City-based community hospital. Training was guided by audio-visual lectures and then reinforced by performing mock cardiac arrest drills. Resident assessments were done pre and post-training through an anonymous standardized questionnaire. Summative measures of mean confidence, mean ACLS skills, and leadership were evaluated. Uni and bivariate analysis, and T-tests for statistical significance were performed using STATA 15 software. Results: Our sample of 32 residents showed an increase in mean learning scores across all the three domains. Confidence scores increased from 7.23 to 8.44, ACLS skills increased from 7.40 to 8.57 and leadership scores increased from 6.56 to 7.88. Paired T-tests demonstrated high significance (P<0.000). Conclusion: This study demonstrates the effectiveness of additional structured cardiac arrest training on confidence, skills, and leadership of resident physicians in an Internal Medicine program. The next phase of this study will be to re-evaluate knowledge and confidence at 3 and 6 months after training.

Abstract 275: Cardiac Arrest Etiology and Associated Cognitive Impairment in Survivors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Allison C Koller ◽  
Jon C Rittenberger ◽  
Thomas J Songer ◽  
Andrea L Rosso ◽  
Jessica E Salerno ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Statistical Significance ◽  
Cohort Analysis ◽  
Public Health Problem ◽  
The United States ◽  
Exam Score ◽  
Modifying Factors ◽  
The Impact ◽  
Normal Cognition ◽  
Moca Score

Background: Cardiac arrest is a significant public health problem, impacting over 500,000 people in the United States annually. The four major etiologies of arrest are cardiac, respiratory, traumatic, and other. The objective was to determine the impact of etiology on cognition in cardiac arrest survivors using the Montreal Cognitive Assessment (MOCA). Hypothesis: Cardiac arrest etiology impacts cognitive exam score, and patient demographics and characteristics modify that relationship. Methods: A retrospective cohort analysis was performed on all Pittsburgh Post Cardiac Arrest Service (PCAS) patients from 2012-18. Data were acquired through medical record review. T-tests, linear and logistic regression were used to assess the relationships between exam score and modifying factors. MOCA score was analyzed as a binomial variable using a pass/fail threshold of 26/30 points (86.7%) and above for normal cognition. For statistical significance, an alpha level of 0.05 was used. Results: In total, 192 patients completed the MOCA: 104 with cardiac etiology, 35 with respiratory, 4 with trauma, and 49 with other. Median age for all patients was 59.3 years, and 58% were male. Mean (SE) MOCA score for all patients was 72.8 (1.1) percent. When MOCA score was converted to a binomial indicator of normal cognition, respiratory, traumatic, and other etiologies were more likely to exhibit impairment than cardiac etiology arrest when age, sex, witnessed status, length of ICU stay and coma were controlled for (OR: 2.52, 3.43, 2.18 respectively). These findings were nullified when time from arrest to MOCA administration was included. Of the MOCA subcategories, delayed recall was the most severely impacted, with patients recalling an average of 1.67 of 5 words after 5 minutes. Additionally, respiratory arrests performed significantly worse than cardiac etiology arrests in attention (4.1 vs 4.9 points, p=0.004) and language domains (1.9 vs. 2.3, p=0.04). Conclusions: Respiratory, traumatic, and other etiologies were more likely to exhibit abnormal cognition on the MOCA than those with a cardiac etiology. The etiological findings were nullified when time to cognitive examination was controlled for. Timing appears to influence cognitive assessments more than etiology.

scholarly journals Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study

10.2196/15762 ◽  
2020 ◽  
Vol 8 (5) ◽  
pp. e15762
Author(s):  
Vittal Hejjaji ◽  
Ali O Malik ◽  
Poghni A Peri-Okonny ◽  
Merrill Thomas ◽  
Yuanyuan Tang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Mobile App ◽  
Absolute Difference ◽  
Quality Improvement Initiative ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.

scholarly journals The Value of Focused Echocardiography During Cardiac Arrest

2019 ◽  
Vol 35 (6) ◽  
pp. 484-490
Author(s):  
Julie White
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Medical Condition ◽  
Advanced Cardiac Life Support ◽  
The United States ◽  
Area Of Interest ◽  
Palpable Pulse ◽  
Life Threatening ◽  
Developing Area ◽  
Focused Echocardiography

Cardiac arrest is the absence of a centrally palpable pulse and no respiratory effort in an unresponsive patient. This often-lethal medical condition affects hundreds of thousands of people in the United States alone every year. Immediate intervention is crucial to provide the patient with any chance of survival. Advanced cardiac life support (ACLS) is the cornerstone therapy for cardiac arrest. Increased awareness and proper identification of life-threatening arrhythmias is critical, as it may lead to prompt medical treatment and improved mortality. The use of focused echocardiography, during a cardiac arrest, has been a developing area of interest over the past several years. The specific aim of this literature review was to emphasize the role of a focused echocardiogram and the valuable information that can be provided during a cardiac arrest.

scholarly journals Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Vittal Hejjaji ◽  
Ali O Malik ◽  
Poghni A Peri-Okonny ◽  
Merrill Thomas ◽  
Yuanyuan Tang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Mobile App ◽  
Absolute Difference ◽  
Quality Improvement Initiative ◽  
The Impact ◽  
Hospital Cardiac Arrest

BACKGROUND Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. OBJECTIVE The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. METHODS As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired <i>t</i> tests compared performance with and without the mobile app. RESULTS Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; <i>P</i>&lt;.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; <i>P</i>&lt;.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; <i>P</i>=.007). CONCLUSIONS This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P &lt; .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

scholarly journals COVID-19: Examining the case growth-rate due to Visitor vs Local Mobility using Machine Learning: A Study in the United States

2021 ◽  
Author(s):  
satya katragadda ◽  
ravi teja bhupatiraju ◽  
vijay raghavan ◽  
ziad ashkar ◽  
raju gottumukkala
Keyword(s):  
United States ◽  
Machine Learning ◽  
Statistical Significance ◽  
Disease Outbreaks ◽  
The United States ◽  
Mobile Phone Data ◽  
Infectious Disease Outbreaks ◽  
Local Mobility ◽  
Local Risk ◽  
The Impact

Abstract Background: Travel patterns of humans play a major part in the spread of infectious diseases. This was evident in the geographical spread of COVID-19 in the United States. However, the impact of this mobility and the transmission of the virus due to local travel, compared to the population traveling across state boundaries, is unknown. This study evaluates the impact of local vs. visitor mobility in understanding the growth in the number of cases for infectious disease outbreaks. Methods: We use two different mobility metrics, namely the local risk and visitor risk extracted from trip data generated from anonymized mobile phone data across all 50 states in the United States. We analyzed the impact of just using local trips on infection spread and infection risk potential generated from visitors' trips from various other states. We used the Diebold-Mariano test to compare across three machine learning models. Finally, we compared the performance of models, including visitor mobility for all the three waves in the United States and across all 50 states. Results: We observe that visitor mobility impacts case growth and that including visitor mobility in forecasting the number of COVID-19 cases improves prediction accuracy by 34. We found the statistical significance with respect to the performance improvement resulting from including visitor mobility using the Diebold-Mariano test. We also observe that the significance was much higher during the first peak March to June 2020. Conclusion: With presence of cases everywhere (i.e. local and visitor), visitor mobility (even within the country) is shown to have significant impact on growth in number of cases. While it is not possible to account for other factors such as the impact of interventions, and differences in local mobility and visitor mobility, we find that these observations can be used to plan for both reopening and limiting visitors from regions where there are high number of cases.

scholarly journals Utilization of a Voice-Based Virtual Reality Advanced Cardiac Life Support Team Leader Refresher: Prospective Observational Study

10.2196/17425 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e17425
Author(s):  
Daniel Katz ◽  
Ronak Shah ◽  
Elizabeth Kim ◽  
Chang Park ◽  
Anjan Shah ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Life Support ◽  
Survival Rates ◽  
Cost Effective ◽  
Advanced Cardiac Life Support ◽  
The United States ◽  
Team Leader ◽  
Cost Comparison

Background The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of training are expensive, time consuming, and difficult to scale, which necessitates improvements in advanced cardiac life support (ACLS) training. Virtual reality (VR) has been proposed as an alternative or adjunct to high-fidelity simulation (HFS) in several environments. No evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills and demonstrate a cost comparison. Objective This study aimed to explore the utility of a voice-based VR ACLS team leader refresher as compared with HFS. Methods This prospective observational study performed at an academic institution consisted of 25 postgraduate year 2 residents. Participants were randomized to HFS or VR training and then crossed groups after a 2-week washout. Participants were graded on technical and nontechnical skills. Participants also completed self-assessments about the modules. Proctors were assessed for fatigue and task saturation, and cost analysis based on local economic data was performed. Results A total of 23 of 25 participants were included in the scoring analysis. Fewer participants were familiar with VR compared with HFS (9/25, 36% vs 25/25, 100%; P<.001). Self-reported satisfaction and utilization scores were similar; however, significantly more participants felt HFS provided better feedback: 99 (IQR 89-100) vs 79 (IQR 71-88); P<.001. Technical scores were higher in the HFS group; however, nontechnical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 (IQR 19-24) min shorter than HFS sessions, the National Aeronautics and Space Administration task load index scores for proctors were lower in each category, and VR sessions were estimated to be US $103.68 less expensive in a single-learner, single-session model. Conclusions Utilization of a VR-based team leader refresher for ACLS skills is comparable with HFS in several areas, including learner satisfaction. The VR module was more cost-effective and was easier to proctor; however, HFS was better at delivering feedback to participants. Optimal education strategies likely contain elements of both modalities. Further studies are needed to examine the utility of VR-based environments at scale.

No Implementation Without Representation: Real-Time Pharmacist Intervention Optimizes Rapid Diagnostic Tests for Bacteremia at a Small Community Hospital

2021 ◽  
pp. 001857872110375
Author(s):  
Brandon J. Tritle ◽  
Robert Watteyne ◽  
Abby Hickman ◽  
Todd J. Vento ◽  
Bert K. Lopansri ◽  
...  
Keyword(s):  
Real Time ◽  
Diagnostic Tests ◽  
Community Hospital ◽  
Statistical Significance ◽  
Pharmacist Intervention ◽  
Rapid Diagnostic Tests ◽  
Control Group ◽  
Small Community ◽  
The Impact ◽  
Small Community Hospital

Background: Rapid diagnostic tests (RDTs) for bacteremia allow for early antimicrobial therapy modification based on organism and resistance gene identification. Studies suggest patient outcomes are optimized when infectious disease (ID)-trained antimicrobial stewardship personnel intervene on RDT results. However, data are limited regarding RDT implementation at small community hospitals, which often lack access to on-site ID clinicians. Methods: This study evaluated the impact of RDTs with and without real-time pharmacist intervention (RTPI) at a small community hospital with local pharmacist training and asynchronous support from a remote ID Telehealth pharmacist. Time to targeted therapy (TTT) in patients with bacteremia was compared retrospectively across 3 different time periods: a control without RDT, RDT-only, and RDT with RTPI. Results: Median TTT was significantly faster in both the RDT with RTPI and RDT-only groups compared with the control group (2 vs 25 vs 51 hours respectively; P < .001). TTT was numerically faster for RDT with RTPI compared with RDT-only but did not reach statistical significance ( P = .078). Median time to any de-escalation was significantly shorter for RDT with RTPI compared with both RDT-only (14 vs 33 hours; P = .012) and the control group (14 vs 45 hours; P < .001). Median length of stay was also significantly shorter in both RDT groups compared with the control group (4.0 vs 4.1 vs 5.5 hours; P = .013). Conclusion: This study supports RDT use for bacteremia in a small community hospital with ID Telehealth support, suggesting additional benefit with RTPI.

Abstract 19225: Impact of Change in Resuscitation Guidelines on National Out-of-hospital Cardiac Arrest Outcomes: Fulfilled Expectations?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shaker M Eid ◽  
Aiham Albaeni ◽  
Rebeca Rios ◽  
May Baydoun ◽  
Bolanle Akinyele ◽  
...  
Keyword(s):  
Time Series ◽  
Cardiac Arrest ◽  
Time Series Data ◽  
Statistical Significance ◽  
Interrupted Time Series ◽  
The United States ◽  
Series Data ◽  
National Database ◽  
Resuscitation Guidelines ◽  
Hospital Cardiac Arrest

Background: The intent of the 5-yearly Resuscitation Guidelines is to improve outcomes. Previous studies have yielded conflicting reports of a beneficial impact of the 2005 guidelines on out-of-hospital cardiac arrest (OHCA) survival. Using a national database, we examined survival before and after the introduction of both the 2005 and 2010 guidelines. Methods: We used the 2000 through 2012 National Inpatient Sample database to select patients ≥18 years admitted to hospitals in the United States with non-traumatic OHCA (ICD-9 CM codes 427.5 & 427.41). A quasi-experimental (interrupted time series) design was used to compare monthly survival trends. Outcomes for OHCA were compared pre- and post- 2005 and 2010 resuscitation guidelines release as follows: 01/2000-09/2005 vs. 10/2005-9/2010 and 10/2005-9/2010 vs. 10/2010-12/2012. Segmented regression analyses of interrupted time series data were performed to examine changes in survival to hospital discharge. Results: For the pre- and post- guidelines periods, 81600, 69139 and 36556 patients respectively survived to hospital admission following OHCA. Subsequent to the release of the 2005 guidelines, there was a statistically significant worsening in survival trends (β= -0.089, 95% CI -0.163 – -0.016, p =0.018) until the release of the 2010 guidelines when a sharp increase in survival was noted which persisted for the period of study (β= 0.054, 95% CI -0.143 – 0.251, p =0.588) but did not achieve statistical significance (Figure). Conclusion: National clinical guidelines developed to impact outcomes must include mechanisms to assess whether benefit actually occurs. The worsening in OHCA survival following the 2005 guidelines is thought provoking but the improvement following the release of the 2010 guidelines is reassuring and worthy of perpetuation.

Sign in / Sign up

Export Citation Format

Share Document