scholarly journals Outcome of Cardiopulmonary Resuscitation In Frail Patients

2021 ◽  
Author(s):  
Elaine Camilleri ◽  
Juliet Camilleri ◽  
Luke Sultana ◽  
Nicole Sciberras ◽  
Mario Vassallo
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Small Population ◽  
Test Case ◽  
Frailty Status ◽  
Maltese Islands ◽  
Frail Patients ◽  
Comorbidity Index ◽  
One Year ◽  
Age Range ◽  
Hospital Cardiac Arrest

Abstract The concept of frailty is one which is gaining increasing attention due to its multifactorial constituents, and its impact on geriatric patient care. This retrospective analysis of cardiopulmonary resuscitation (CPR) in Maltese Hospitals aims to determine the significance of frailty in relation to CPR outcome in one calendar year. In this study, we analysed the outcome of cardiopulmonary resuscitation (CPR) in Maltese Hospitals for the year 2019 in relation to frailty status using the Charlson Comorbidity Index (CCI). 185 eligible patients were obtained from the CPR register after excluding patients <18years of age, peri-arrest cases, a test case, double-recorded CPR documents and patients with insufficient data recorded. From these 185 patients, the statistics were of 123 males and 62 females, with an age range of 26 years to 99 years. The median age was 78 years whilst mean age was 76.2 years. The majority of patients fell within CCI of 4-8 (143 patients), with the largest cohort obtaining a score of 6 (39 patients). The results highlight a low rate of ROSC (4.32%) irrespective of CCI score. However, when ROSC was achieved, survival to discharge was noted to be greater with lower CCI scores. Only 5 patients survived one year post discharge.This data is in keeping with other studies regarding CPR in frail patients, despite the use of other scores such as the Clinical Frailty Score. Smith et al’s study in Australian tertiary centres between 2008 and 2017 used the CCI, and points out a lower rate of discharge home in frail patients who survive an in-hospital cardiac arrest [1]. Limitations of our study include the small population, although exhaustive of the CPRs performed on the Maltese Islands in 2019.

scholarly journals Frailty status predicts futility of cardiopulmonary resuscitation in older adults

2020 ◽  
Author(s):  
Sarah E Ibitoye ◽  
Sadie Rawlinson ◽  
Andrew Cavanagh ◽  
Victoria Phillips ◽  
David J H Shipway
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Referral Hospital ◽  
Clinical Frailty Scale ◽  
Frailty Status ◽  
Frail Patients ◽  
Hospital Cardiac Arrest

Abstract Aim To determine if frailty is associated with poor outcome following in-hospital cardiac arrest; to find if there is a “frailty threshold” beyond which cardiopulmonary resuscitation (CPR) becomes futile. Methods Retrospective review of patients aged over 60 years who received CPR between May 2017 and December 2018, in a tertiary referral hospital, which does not provide primary coronary revascularisation. Clinical Frailty Scale (CFS) and Charlson Comorbidity Index were retrospectively assigned. Results Data for 90 patients were analysed, the median age was 77 (IQR 70-83); 71% were male; 44% were frail (CFS &gt; 4). Frailty was predictive of in-hospital mortality independent of age, comorbidity and cardiac arrest rhythm (OR 2.789 95% CI 1.145–6.795). No frail patients (CFS &gt; 4) survived to hospital discharge, regardless of cardiac arrest rhythm, whilst 13 (26%) of the non-frail (CFS ≤ 4) patients survived to hospital discharge. Of the 13 survivors (Age 72; range 61–86), 12 were alive at 1 year and had a good neurological outcome, the outcome for the remaining patient was unknown. Conclusion Frail patients are unlikely to survive to hospital discharge following in-hospital cardiac arrest, these results may facilitate clinical decision making regarding whether CPR may be considered futile. The Clinical Frailty Scale is a simple bedside assessment that can provide invaluable information when considering treatment escalation plans, as it becomes more widespread, larger scale observations using prospective assessments of frailty may become feasible.

scholarly journals Comorbidity and bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Heart ◽  
2020 ◽  
Vol 106 (14) ◽  
pp. 1087-1093
Author(s):  
Geir Hirlekar ◽  
Martin Jonsson ◽  
Thomas Karlsson ◽  
Maria Bäck ◽  
Araz Rawshani ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Multiple Logistic Regression ◽  
Multivariable Model ◽  
National Patient Registry ◽  
National Patient ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Comorbidity Index ◽  
Hospital Cardiac Arrest

​ObjectiveCardiopulmonary resuscitation (CPR) performed before the arrival of emergency medical services (EMS) is associated with increased survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to determine whether patients who receive bystander CPR have a different comorbidity compared with patients who do not, and to determine the association between bystander CPR and 30-day survival when adjusting for such a possible difference.​MethodsPatients with witnessed OHCA in the Swedish Registry for Cardiopulmonary Resuscitation between 2011 and 2015 were included, and merged with the National Patient Registry. The Charlson Comorbidity Index (CCI) was used to measure comorbidity. Multiple logistic regression was used to examine the effect of CCI on the association between bystander CPR and outcome.​ResultsIn total, 11 955 patients with OHCA were included, 71% of whom received bystander CPR. Patients who received bystander CPR had somewhat lower comorbidity (CCI) than those who did not (mean±SD: 2.2±2.3 vs 2.5±2.4; p<0.0001). However, this difference in comorbidity had no influence on the association between bystander CPR and 30-day survival in a multivariable model including other possible confounders (OR 2.34 (95% CI 2.01 to 2.74) without adjustment for CCI and OR 2.32 (95% CI 1.98 to 2.71) with adjustment for CCI).​ConclusionPatients who undergo CPR before the arrival of EMS have a somewhat lower degree of comorbidity than those who do not. Taking this difference into account, bystander CPR is still associated with a marked increase in 30-day survival after OHCA.

Outcome of Patch Test on Crack Sole among Bangladeshi Population

2020 ◽  
Vol 7 (2) ◽  
pp. 64-67
Author(s):  
Abu Sayeed Mohammad ◽  
Shahadat Hossain ◽  
Zulfiqur Hossain Khan
Keyword(s):  
Patch Test ◽  
Clinical History ◽  
Significant Morbidity ◽  
Exclusion Criteria ◽  
Study Population ◽  
Bangladeshi Population ◽  
One Year ◽  
Medical University ◽  
Age Range ◽  
Test Result

Background: Crack sole may produce significant morbidity among the physical labourer. Objective: The purpose of this study was to find out the patch test result in crack sole which was due to allergic contactants. Methodology: This test was conducted in the Department at Dermatology and Venereology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2001 to June 2002 for a period of one year. Patients with crack sole were selected as study population. All patients were asked about the details clinical history. Patch test was done by individually prepared alminium Finn Chamber mounted on scanpore tape. Result: A total number of 15 patients were recruited for this study after fulfilling the inclusion and exclusion criteria. The age range was 8 years to 70 years. Among 15 patients 3 patients were patch test positive remaining 12 patients were patch test negative. Two patient were female and one was male. Conclusion: In conclusion patch test is positive among the crack sole patients. Journal of Current and Advance Medical Research 2020;7(2): 64-67

Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

2021 ◽  
pp. 1-10
Author(s):  
Christopher Gaisendrees ◽  
Matias Vollmer ◽  
Sebastian G Walter ◽  
Ilija Djordjevic ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Pessoa Amorim ◽  
D Santos-Ferreira ◽  
A Azul Freitas ◽  
H Santos ◽  
A Belo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Wald Test ◽  
Invasive Procedures ◽  
Frailty Status ◽  
Frail Patients ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
St Elevation ◽  
Grace Score

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI &gt;25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine &gt;2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (&gt;3 cardiovascular drugs), admission haemoglobin &lt;10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI&gt;0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p&lt;0.001). Delayed angiography (&gt;72h) was more common among NSTEMI frail patients (p&lt;0.001), and radial access was less commonly used overall (p&lt;0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p&lt;0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p&lt;0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p&lt;0.05), their 1-year prognostic benefit remained unaffected (Wald test p&gt;0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p&lt;0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

Impact of ventricular assistance devices on patients submitted to heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Perez-Ortega ◽  
J Prats ◽  
E Querol
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiopulmonary Resuscitation ◽  
Heart Transplant ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Terminal Heart Failure ◽  
One Year ◽  
Ventricular Assistance

Abstract Background The introduction of veno-arterial extracorporeal life support (v-a ECLS) widens the spectrum of patients that can be included in the heart transplant program, some examples are extended myocardial infarction, fulminant myocarditis or advanced cardiac insufficiency. In addition to this, the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) extends even more the range of patients that can be benefitted of this therapy as a bridge to transplant. Purpose Our objective is to describe the incidence of v-a ECLS in those patients submitted to a heart transplant and to establish whether or not this technique increases the risk of mortality in this population. Methods Retrospective and descriptive statistical analysis of 82 consecutive patients submitted to heart transplant between 2015 and 2019 in a High Technology University Hospital. Demographic and clinical data, extracorporeal life support, extracorporeal cardiopulmonary resuscitation and assistance device type, together with survival at 30 days and one year were collected. Results 82 patients were transplanted during the study period distributed as follows: 47 (51.69%) were elective and 35 (48.1%) emergent being 25 (30.12%) of grade 1A and 10 (12.19%) of grade 1B. 52% had prior intra-aortic balloon contrapulsation. Patients transplanted under ECLS were 80% men and average age of 53 (SD 15) years old. The most prevalent diagnosis was acute myocardial infarction Killip IV (32%), followed by terminal heart failure (28%). 32% of the patients were under peripheral ECMO, 36% under left ventricular assistance, 20% under biventricular assist device, and 12% required ECPR. 72% of devices were implanted in the operating room and 16% in the ICU. The one-year survival of the sample was 88%. 2 patients died after transplantation (8%) during the first month, and 1 patient died within the first year. All three patients had terminal heart failure and the VAD implant was inserted electively Conclusions ECLS prior to cardiac transplantation allow selected patients to arrive alive to the transplant. The choice among devices is related to the diagnosis and expected duration of the therapy but we have not found in our series effects on subsequent mortality. Survival at one year in the subjects analysed is greater than the national registry of the last 10 years, although the tendency is to improve every year. This new scenario implies an increment of the complexity in the management of these patients and requires an special effort in terms of staff ratio and training. In our centre, the implementation of ECLS resulted in an increment of our staff and formative sessions. Funding Acknowledgement Type of funding source: None

scholarly journals Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 115
Author(s):  
Anne-Sophie Mangé ◽  
Arnaud Pagès ◽  
Sandrine Sourdet ◽  
Philippe Cestac ◽  
Cécile McCambridge
Keyword(s):  
Glycemic Control ◽  
Older Patients ◽  
Diabetes Management ◽  
Real Life ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Patients With Diabetes ◽  
Hba1c Target

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

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