Incidence of in-hospital cardiac arrest at general wards before and after implementation of an early warning score

Abstract Background In order to reduce the incidence of in-hospital cardiac arrest (IHCA) at general wards, medical emergency teams (MET) were implemented in the Capital Region of Denmark in 2012 as the efferent part of a track and trigger system. The National Early Warning Score (NEWS) system became the afferent part. This study aims at investigating the incidence of IHCA at general wards before and after the implementation of the NEWS system. Material and methods We included patients at least 18 years old with IHCA at general wards in our hospital in the periods of 2006 to 2011 (pre-EWS group) and 2013 to 2018 (post-EWS group). Data was obtained from a local database and the National In-Hospital Cardiac Arrest Registry (DANARREST). We calculated incidence rate ratios (IRR) for IHCA at general wards with 95% confidence interval (95% CI). Odds ratios (OR) for return of spontaneous circulation (ROSC) and 30-day survival were also calculated with 95% CI. Results A total of 444 IHCA occurred before the implementation of NEWS at general wards while 494 IHCA happened afterwards. The incidence rate of IHCA at general wards was 1.13 IHCA per 1000 admissions in the pre-EWS group (2006–2011) and 1.11 IHCA per 1000 admissions in the post-EWS group (2013–2018). The IRR between the two groups was 0.98 (95% CI [0.86;1.11], p = 0.71). The implementation did not affect the chance of ROSC with a crude OR of 1.14 (95% CI [0.88;1.47], p = 0.32) nor did it change the 30-day survival with a crude OR 1.30 (95% CI [0.96;1.75], p = 0.09). Conclusion Implementation of the EWS system at our hospital did not decrease the incidence rate of in-hospital cardiac arrest at general wards.

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A Multicenter Validation Study of the Deep Learning-based Early Warning Score for Predicting in-hospital Cardiac Arrest in Patients Admitted to General Wards

10.21203/rs.3.rs-61577/v1 ◽

2020 ◽

Author(s):

Yeon Joo Lee ◽

Kyung-Jae Cho ◽

Oyeon Kwon ◽

Hyunho Park ◽

Yeha Lee ◽

...

Keyword(s):

Cardiac Arrest ◽

Deep Learning ◽

Early Warning ◽

Characteristic Curve ◽

Predictive Performance ◽

Early Warning Score ◽

Patients At Risk ◽

Key Aspects ◽

General Wards ◽

Hospital Cardiac Arrest

Abstract Background: The recently developed deep learning (DL)-based early warning score (DEWS) has shown a potential in predicting deteriorating patients. We aimed to validate DEWS in multiple centers and compare the prediction, alarming and timeliness performance with those of the modified early warning score (MEWS) to identify patients at risk for in-hospital cardiac arrest (IHCA).Methods: This retrospective cohort study included adult patients admitted to the general wards of five hospitals during a 12-month period. We validated DEWS internally at two hospitals and externally at the other three hospitals. The occurrence of IHCA within 24 hours of vital sign observation was the outcome of interest. We used the area under the receiver operating characteristic curve (AUROC) as the main performance metric.Results: The study population consisted of 173,368 patients (224 IHCAs). The predictive performance of DEWS was superior to that of MEWS in both the internal (AUROC: 0.860 vs. 0.754, respectively) and external (AUROC: 0.905 vs. 0.785, respectively) validation cohorts. At the same specificity, DEWS had a higher sensitivity than MEWS, and at the same sensitivity, DEWS had a lower mean alarm count than MEWS, with nearly half of the alarm rate in MEWS. Additionally, DEWS was able to predict more IHCA patients in the 24 to 0.5 hours before the outcome.Conclusion: Our study showed that DEWS was superior to MEWS in the three key aspects (IHCA predictive, alarming, and timeliness performance). This study demonstrates the potential of DEWS as an effective, efficient screening tool in rapid response systems (RRSs) to identify high-risk patients.

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A multicentre validation study of the deep learning-based early warning score for predicting in-hospital cardiac arrest in patients admitted to general wards

Resuscitation ◽

10.1016/j.resuscitation.2021.04.013 ◽

2021 ◽

Vol 163 ◽

pp. 78-85

Author(s):

Yeon Joo Lee ◽

Kyung-Jae Cho ◽

Oyeon Kwon ◽

Hyunho Park ◽

Yeha Lee ◽

...

Keyword(s):

Cardiac Arrest ◽

Deep Learning ◽

Validation Study ◽

Early Warning ◽

Early Warning Score ◽

General Wards ◽

Hospital Cardiac Arrest

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Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_1462-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tae Yun Kim ◽

Sun Woo Lee ◽

Kyuseok Kim ◽

Joong Eui Rhee ◽

Sung Koo Jung

Keyword(s):

Cardiac Arrest ◽

Spontaneous Circulation ◽

National Registry ◽

Controlled Clinical Trial ◽

Emergency Medical Service System ◽

Short Term ◽

Combined Administration ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

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In-hospital cardiac arrest and preceding National Early Warning Score (NEWS): A retrospective case-control study

Clinical Medicine ◽

10.7861/clinmed.2019-0137 ◽

2020 ◽

Vol 20 (1) ◽

pp. 55-60 ◽

Cited By ~ 1

Author(s):

Martin Spångfors ◽

Mats Molt ◽

Karin Samuelson

Keyword(s):

Cardiac Arrest ◽

Early Warning ◽

Case Control Study ◽

Case Control ◽

Early Warning Score ◽

Retrospective Case ◽

National Early Warning Score ◽

Hospital Cardiac Arrest ◽

Control Study

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Abstract 2003: More Chest Compressions and Fewer Shocks Are Given During Out-of-Hospital Cardiac Arrest Resuscitation With the 2005 AHA Guidelines

Circulation ◽

10.1161/circ.116.suppl_16.ii_433-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Lynn J White ◽

Sarah A Cantrell ◽

Robert Cronin ◽

Shawn Koser ◽

David Keseg ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Survival Rates ◽

Automated Analysis ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Convenience Sample ◽

Care Protocol ◽

Before And After ◽

Hospital Cardiac Arrest

Introduction Long pauses without chest compressions (CC) have been identified in CPR provided by EMS professionals for out-of-hospital cardiac arrest (OOHCA). The 2005 AHA ECC CPR guidelines emphasize CC. The 2005 AHA Basic Life Support (BLS) for Healthcare Professionals (HCP) course introduced a training method with more CPR skills practice during the DVD based course. The purpose of this before/after study was to determine whether CC rates increased after introduction of the 2005 course. Methods This urban EMS system has 400 cardiac etiology OOHCA events annually. A convenience sample of 49 continuous electronic ECG recordings of VF patients was analyzed with the impedance channel of the LIFEPAK 12 (Physio-Control, Redmond WA) and proprietary software. A trained researcher verified the automated analysis. Each CC during the resuscitation attempt and pauses in CC before and after the first defibrillation shock were noted. The time of return of spontaneous circulation (ROSC) was determined by medical record review and onset of regular electrical activity without CC. Medical records were reviewed for outcome to hospital discharge. The EMS patient care protocol for VF was changed on July 1, 2006 to comply with the 2005 AHA ECC guidelines. Cases were grouped by the OOHCA date: 9/2004 to 12/31/2006 (pre) and 7/1/2006 to 4/21/2007 (post). EMS personnel began taking the 2005 BLS for HCP course during spring 2006. Monthly courses over 3 years will recertify 1500 personnel. Results 29 cases were analyzed from the pre group and 20 from the post group. Compressions per minute increased from a mean (±SD) of 47 ± 16 pre to 75 ± 33 post (P < 0.01). The mean count of shocks given per victim decreased from 4.5 ± 4.0 pre to 2.8 ± 1.8 post (P < 0.04). The CC pause before the first shock was unchanged (23.6 ± 18.4 seconds to 22.1 ± 17.9). but the CC pause following that shock decreased significantly from 48.7 ± 63.2 to 11.8 ± 22.5 (p=0.008). Rates of ROSC (55% pre, 50% post) and survival to discharge (15% pre, 13% post) were similar. Conclusion Following introduction of the 2005 BLS for HCP course and the EMS protocol change, the quality of CPR delivered to victims of OOHCA improved significantly compared with pre-2006 CPR. The sample size was too small to detect differences in survival rates.

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Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest

Journal of Intensive Care ◽

10.1186/s40560-016-0134-7 ◽

2016 ◽

Vol 4 (1) ◽

Cited By ~ 16

Author(s):

Isao Nishijima ◽

Shouhei Oyadomari ◽

Shuuto Maedomari ◽

Risa Toma ◽

Chisato Igei ◽

...

Keyword(s):

Cardiac Arrest ◽

Early Warning ◽

Early Warning Score ◽

Score System ◽

Hospital Cardiac Arrest

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Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽

10.1161/circ.140.suppl_2.483 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Mohinder Reddy Vindhyal ◽

Paul M Ndunda ◽

Shravani Vindhyal ◽

Brent Duran

Keyword(s):

Cardiac Arrest ◽

Vegetative State ◽

Fire Department ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Cardio Pulmonary Resuscitation ◽

Improved Outcomes ◽

Before And After ◽

Hospital Cardiac Arrest ◽

Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

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