Withdrawal of Life-Sustaining Therapy in Intensive Care Unit Patients Following Out-Of-Hospital Cardiac Arrest: An Australian Metropolitan ICU Experience

Abstract Objective: To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA).Methods: A retrospective review of ICU data from patient clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, clinical attributes and targeted temperature management were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 hours) and late (ICU length of stay ≥72 hours). Factors independently associated with WLST were determined by multivariable binary logistic regression using a backward elimination method, and results were depicted as odds ratios (OR) with 95% confidence intervals (CI).Results: The study selection criteria resulted in a cohort of 260 ICU patients post-OHCA, with a mean age of 58 years and the majority were males (178, 68%); 151 patients (58%) died, of which 145 (96%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 38.90, 95% CI 4.55–332.57; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day 3 post-OHCA was the strongest factor associated with delayed WLST (OR 91.59, 95% CI 11.66–719.18; p < 0.0001).Conclusion: The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day 3 post-OHCA are independently associated with WLST.

Download Full-text

Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919830896 ◽

2019 ◽

Vol 27 (3) ◽

pp. 155-161 ◽

Cited By ~ 1

Author(s):

Veerapong Vattanavanit ◽

Supattra Uppanisakorn ◽

Thanapon Nilmoje

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

American Heart Association ◽

American Heart ◽

Medical Intensive Care Unit ◽

Heart Association ◽

Temperature Management ◽

Medical Intensive Care ◽

Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

Download Full-text

In hospital cardiac arrest in Intensive Care Unit versus non Intensive Care Unit patients with COVID 19. A systematic review and meta analysis

10.1101/2021.05.08.21256885 ◽

2021 ◽

Author(s):

Georgios Mavrovounis ◽

Maria Mermiri ◽

Athanasios Chalkias ◽

Vishad Sheth ◽

Vasiliki Tsolaki ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Icu Patients ◽

Pooled Prevalence ◽

General Wards ◽

Hospital Cardiac Arrest

Aim: To estimate the incidence of in hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID 19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non ICU patients with COVID 19. Methods: We systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. Results: Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID 19 patients was 7% [95% CI: 4, 11%; P < 0.0001] and 44% [95% CI: 30, 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42, 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow up was 59% [95% CI: 37, 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. Conclusion: The incidence of IHCA amongst hospitalized COVID 19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

Download Full-text

Use of Multistate Models to Assess Prolongation of Intensive Care Unit Stay Due to Nosocomial Infection

Infection Control and Hospital Epidemiology ◽

10.1086/503375 ◽

2006 ◽

Vol 27 (5) ◽

pp. 493-499 ◽

Cited By ~ 96

Author(s):

J. Beyersmann ◽

P. Gastmeier ◽

H. Grundmann ◽

S. Bärwolff ◽

C. Geffers ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Nosocomial Infection ◽

Temporal Dynamics ◽

Control Measures ◽

Incidence Density ◽

Icu Patients ◽

Study Methods ◽

Icu Length Of Stay

Background.Reliable data on the costs attributable to nosocomial infection (NI) are crucial to demonstrating the real cost-effectiveness of infection control measures. Several studies investigating this issue with regard to intensive care unit (ICU) patients have probably overestimated, as a result of inappropriate study methods, the part played by NIs in prolonging the length of stay.Methods.Data from a prospective study of the incidence of NI in 5 ICUs over a period of 18 months formed the basis of this analysis. For describing the temporal dynamics of the data, a multistate model was used. Thus, ICU patients were counted as case patients as soon as an NI was ascertained on any particular day. All patients were then regarded as control subjects as long as they remained free of NI (time-to-event data analysis technique).Results.Admitted patients (n = 1,876) were observed for the development of NI over a period of 28,498 patient-days. In total, 431 NIs were ascertained during the study period (incidence density, 15.1 NIs per 1,000 patient-days). The influence of NI as a time-dependent covariate in a proportional hazards model was highly significant (P< .0001, Wald test). NI significantly reduced the discharge hazard (hazard ratio, 0.72 [95% confidence interval, 0.63-0.82])—that is, it prolonged the ICU stay. The mean prolongation of ICU length of stay due to NI ( ± standard error) was estimated to be 5.3 ± 1.6 days.Conclusions.Further studies are required to enable comparison of data on prolongation of ICU length of stay with the results of various study methods.

Download Full-text

Association of bystander interventions and hospital length of stay and admission to intensive care unit in out-of-hospital cardiac arrest survivors

Resuscitation ◽

10.1016/j.resuscitation.2017.07.014 ◽

2017 ◽

Vol 119 ◽

pp. 99-106 ◽

Cited By ~ 8

Author(s):

Signe Riddersholm ◽

Kristian Kragholm ◽

Rikke Nørmark Mortensen ◽

Marianne Pape ◽

Carolina Malta Hansen ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Cardiac Arrest

Download Full-text

Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/605722 ◽

2009 ◽

Vol 30 (10) ◽

pp. 952-958 ◽

Cited By ~ 43

Author(s):

Fernando Bellissimo-Rodrigues ◽

Wanessa Teixeira Bellissimo-Rodrigues ◽

Jaciara Machado Viana ◽

Gil Cezar Alkmim Teixeira ◽

Edson Nicolini ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Respiratory Tract Infections ◽

Icu Patients ◽

Oral Application ◽

Tract Infections

Objective.To evaluate the effectiveness of the oral application of a 0.12% solution of Chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.Design.The study design was a double-blind, randomized, placebo-controlled trial.Setting.The study was performed in an ICU in a tertiary care hospital at a public university.Patients.Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received Chlorhexidine (n = 98) and those who received a placebo (n = 96).Intervention.Oral rinses with Chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.Results.Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the Chlorhexidine and placebo groups. However, patients in the Chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).Conclusion.Oral application of a 0.12% solution of Chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.

Download Full-text

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619842004 ◽

2019 ◽

Vol 9 (7) ◽

pp. 779-787 ◽

Cited By ~ 5

Author(s):

Laust Obling ◽

Christian Hassager ◽

Charlotte Illum ◽

Johannes Grand ◽

Sebastian Wiberg ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Area Under The Curve ◽

Youden Index ◽

Cardiac Intensive Care Unit ◽

Infrared Pupillometry ◽

Cardiac Intensive Care ◽

Neurological Pupil Index ◽

Hospital Cardiac Arrest

Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

Download Full-text