scholarly journals Tracheal Intubation in Out-Of-Hospital Setting is Associated With A High Failure Rate of The First Attempt: A Multicenter Prospective Study

2021 ◽  
Author(s):  
Michel Galinski ◽  
Marion Wrobel ◽  
Romain Boyer ◽  
Paul Georges Reuter ◽  
Mirko Ruscev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Adverse Events ◽  
Failure Rate ◽  
Hospital Setting ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
National Guidelines ◽  
Increased Risk

Abstract BackgroundTracheal intubation in an out-of-hospital setting is a frequent and potentially difficult procedure. The risk of adverse events increases dramatically with the number of attempts. The failure rate of the first intubation attempt ranges from 5 to 32% and the risk factors are unclear. We evaluated the failure rate of the first intubation attempt in an out-of-hospital setting and identified variables potentially associated with such failure.MethodsThis was an observational prospective multicenter study performed over 17 months and involving 10 prehospital emergency medical units. Airway management for patients who needed tracheal intubation followed the national guidelines. Rapid sequence intubation with a sedative and myorelaxant drugs was systematically performed for spontaneously breathing patients. After each tracheal intubation, the operator was required to provide, by completing a data-collection form, information on operator and patient characteristics and the environmental conditions during the intubation. The primary endpoint was failure of the first intubation attempt.ResultsDuring the study period, 1546 patients were analyzed, of whom 59% had cardiac arrest, and 486 intubations failed on the first attempt (31.4% [95% confidence interval = 30.2–32.6]). A multivariate analysis revealed that the following 7 of 28 factors were associated with an increased risk of a failed first intubation attempt: operator with fewer than 50 prior intubations, small inter-incisor space, limited extension of the head, macroglossia, ear/nose/throat tumor, cardiac arrest, and vomiting. The frequency of adverse events was 13.4% and increased with each additional attempt.ConclusionsThe failure rate of the first attempt was high. Most risk factors could be identified only at the moment of occurrence and were not easily anticipated. Finally, the risk of complications increased with the number of attempts.

scholarly journals Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

2020 ◽  
Vol 3 (1) ◽  
pp. e000084
Author(s):  
Elbert Johann Mets ◽  
Ryan Patrick McLynn ◽  
Jonathan Newman Grauer
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Adverse Events ◽  
General Surgery ◽  
Elective Surgery ◽  
Cohort Analysis ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Improvement Project ◽  
Increased Risk

BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

scholarly journals Risk factors for immune-related adverse events associated with anti-PD-1 pembrolizumab

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yeonghee Eun ◽  
In Young Kim ◽  
Jong-Mu Sun ◽  
Jeeyun Lee ◽  
Hoon-Suk Cha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Medical Center ◽  
Multivariate Regression Analysis ◽  
Study Data ◽  
Endocrine Disorders ◽  
Logistic Regression Models ◽  
Neutrophil Lymphocyte Ratio ◽  
Increased Risk ◽  
Clinically Significant

Abstract We investigated risk factors for immune-related adverse events (irAEs) in patients treated with anti-programmed cell death protein1 antibody pembrolizumab. A retrospective medical record review was performed to identify all patients who received at least one dose of pembrolizumab at Samsung Medical Center, Seoul, Korea between June 2015 and December 2017. Three hundred and ninety-one patients were included in the study. Data were collected on baseline characteristics, treatment details, and adverse events. Univariate and multivariate logistic regression models were used to identify risk factors for irAEs. Sixty-seven (17.1%) patients experienced clinically significant irAEs; most commonly dermatologic disorders, followed by pneumonitis, musculoskeletal disorders, and endocrine disorders. Fourteen patients (3.6%) experienced serious irAEs (grade ≥ 3). Most common serious irAEs were pneumonitis (2.3%). Four deaths were associated with irAEs, all of which were due to pneumonitis. In multivariate regression analysis, a higher body mass index (BMI) and multiple cycles of pembrolizumab were associated with higher risk of irAEs (BMI: odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01–1.16; pembrolizumab cycle: OR 1.15, 95% CI 1.08–1.22). A derived neutrophil-lymphocyte ratio (dNLR) greater than 3 at baseline was correlated with low risk of irAEs (OR 0.37, 95% CI 0.17–0.81). Our study demonstrated that an elevated BMI and higher number of cycles of pembrolizumab were associated with an increased risk of irAEs in patients treated with pembrolizumab. Additionally, increased dNLR at baseline was negatively correlated with the risk of developing irAEs.

Foot Pathology and Inappropriate Footwear as Risk Factors for Falls in a Subacute Aged-Care Hospital

2007 ◽  
Vol 97 (3) ◽  
pp. 213-217 ◽  
Author(s):  
Rebecca L. Jessup
Keyword(s):  
Risk Factors ◽  
Hospital Setting ◽  
Clinical Problem ◽  
Aged Care ◽  
Care Hospital ◽  
Increased Risk ◽  
Risk Of Falls ◽  
History Of ◽  
Risk Factors For Falls ◽  
Hospital Wards

Background: Falls are a major clinical problem in the hospital setting. This study examined the prevalence of foot pathology and footwear type likely to increase the risk of falls in two subacute-care hospital wards serving elderly patients. Methods: Two wards of a subacute aged-care hospital were selected for study. Patients were assessed for the presence of foot pathology, and their footwear was evaluated for characteristics identified in the literature as placing individuals at increased risk of falls. Results: Of 44 patients assessed, 98% had foot pathology, and 41% had foot pathology requiring podiatric medical management. Eighty-six percent of inpatients wore footwear that was likely to increase their risk of falls, with 66% wearing slippers or moccasins. Conclusions: The results of this study demonstrate the need for hospital inpatients who are identified as being at high risk for falling, or have a history of falls, to undergo an assessment of their foot pathology and footwear so that appropriate measures can be taken to address these risk factors. (J Am Podiatr Med Assoc 97(3): 213–217, 2007)

scholarly journals Risk factors for death in patients with non-infectious adverse events

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Gilcilene Oliveira Gadelha ◽  
Hémilly Caroline da Silva Paixão ◽  
Patricia Rezende do Prado ◽  
Renata Andréa Pietro Pereira Viana ◽  
Thatiana Lameira Maciel Amaral
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Cox Regression ◽  
Simplified Acute Physiology Score ◽  
Variable Number ◽  
Rank Test ◽  
Protection Factor ◽  
Saps 3 ◽  
Risk Of Death ◽  
Increased Risk

ABSTRACT Objetive: to identify risk factors for death in patients who have suffered non-infectious adverse events. Method: a retrospective cohort study with patients who had non-infectious Adverse Events (AE) in an Intensive Care Unit. The Kaplan Meier method was used to estimate the conditional probability of death (log-rank test 95%) and the risk factors associated with death through the Cox regression. Results: patients over 50 years old presented a risk 1.57 times higher for death; individuals affected by infection/sepsis presented almost 3 times the risk. Patients with a Simplified Acute Physiology Score III (SAPS3) greater than 60 points had four times higher risk for death, while those with a Charlson scale greater than 1 point had approximately two times higher risk. The variable number of adverse events was shown as a protection factor reducing the risk of death by up to 78%. Conclusion: patients who had suffered an adverse event and who were more than 50 years of age, with infection/sepsis, greater severity, i.e., SAPS 3>30 and Charlson>1, presented higher risk of death. However, the greater number of AEs did not contributed to the increased risk of death.

scholarly journals Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy

2021 ◽  
Vol 10 (13) ◽  
pp. 2752
Author(s):  
Michael Y. Henein ◽  
Ibadete Bytyçi ◽  
Rachel Nicoll ◽  
Rafik Shenouda ◽  
Sherif Ayad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Independent Predictor ◽  
International Study ◽  
Systemic Hypertension ◽  
Specific Work ◽  
Group I ◽  
Increased Risk ◽  
Northern Egypt ◽  
The Impact

Background and Aims: The Coptic clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and to identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt, and Group III: Southern Egypt. Participants’ demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management, and major adverse events (MAEs), comprising death, or mechanical ventilation, were assessed. Results: Out of the 1570 clergy serving in 25 dioceses, 255 (16.2%) were infected. Their mean age was 49.5 ± 12 years and mean weekly number of liturgies was 3.44 ± 1.0. The overall prevalence rate was 16.2% and did not differ between Egypt as a whole and overseas (p = 0.23). Disease prevalence was higher in Northern Egypt clergy compared with Europe and USA combined (18.4% vs. 12.1%, p = 0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p = 0.09). Ten priests (3.92%) died of COVID-19-related complications, and 26 (10.2) suffered a MAE. The clergy from Southern Egypt were more obese, but the remaining risk factors were less prevalent compared with those in Europe and USA (p = 0.01). In multivariate analysis, obesity (OR = 4.180; 2.479 to 12.15; p = 0.01), age (OR = 1.055; 0.024 to 1.141; p = 0.02), and systemic hypertension (OR = 1.931; 1.169 to 2.004; p = 0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p < 0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Coptic clergy should be encouraged to follow the WHO recommendations for cardiovascular disease and COVID-19 prevention.

scholarly journals 515. Risk Factors for Death, Intubation and Cardiac Arrest among COVID-19 Patients Hospitalized in Eastern North Carolina

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S323-S324
Author(s):  
Adrian Pona ◽  
Yuxuan Mao ◽  
Rahim A Jiwani ◽  
Felix Afriyie ◽  
Jonathan Labbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Clinical Decision Making ◽  
Research Study ◽  
Scientific Research ◽  
Elevated Troponin ◽  
Research Support ◽  
Risk Of Death ◽  
Study Investigator ◽  
Increased Risk

Abstract Background Although majority of coronavirus disease 2019 (COVID-19) cases demonstrate mild to asymptomatic disease, COVID-19 can cause serious complications and death. However, risk factors for development of such complications are not well understood. The purpose of this study was to identify risk factors for intubation, cardiac arrest, and death in COVID-19 patients. Methods A retrospective chart review of COVID-19 subjects was conducted of the first 185 patients for whom we had complete data sets. Subjects were adult inpatients with a confirmed COVID-19 diagnosis who were hospitalized between March and May 2020 at Vidant Medical Center in Greenville, NC. Data including demographics, comorbidities, laboratory results, treatments, and outcomes were collected. Data were analyzed using logistic regression models and receiver operating characteristic curves in SAS 9.4. Results Of the first 185 subjects hospitalized for COVID-19, 26% of patients were intubated, 9% experienced cardiac arrest, and 17% died. Subjects who required intubation were more likely to exhibit elevated triglycerides, sepsis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), elevated troponin levels, altered mental status, leukocytosis, lymphopenia and elevated ferritin (P&lt; 0.05) (Table 1). Troponin elevation, ARDS, AKI and thrombocytopenia were risks for cardiac arrest (P&lt; 0.05) (Table 2). Risk of death was increased in those presenting with advanced age, critical or severe disease, lymphopenia or thrombocytopenia, and in those with history of coronary artery disease (CAD) (P&lt; 0.05) (Table 3). Patients presenting with AKI, elevated Troponin, ARDS, pressor requirements, critical disease, and sepsis were at increased risk of intubation, cardiac arrest, and death (P&lt; 0.05) (Tables 1–3). Table 1: Top non-ICU related risk factors for intubation ordered by AUC. Table 2: Top risk factors for cardiac arrest ordered by AUC. Table 3: Top risk factors for death ordered by AUC. Conclusion In this rapidly evolving pandemic, clinician awareness of risk factors for clinically significant outcomes such as intubation and mortality is essential. Assessment of risk factors like those highlighted in this study can aid in clinical decision-making and predicting patient outcomes. As more data becomes available we aim to develop a validated scoring system to assist clinicians in patient care. Disclosures Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator)

Homocysteine, a predictor of cardiovascular adverse events in coronary artery disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
MR Santos ◽  
R Palma Dos Reis ◽  
A Pereira ◽  
F Mendonca ◽  
M Temtem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Increased Risk ◽  
Coronary Patients ◽  
Artery Disease ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf GENEMACOR Introduction After the diagnosis of coronary artery disease (CAD), traditional risk factors such as diabetes mellitus, dyslipidemia, hypertension and smoking have been used to assess the risk of major cardiovascular adverse events (MACE). However, despite reduction of these factors, presence of MACE remains high. It is necessary to identify other causal risk factors for MACE in coronary patients and increased plasma Homocysteine (Hcy) level seems to be a likely candidate. However, the influence of Hcy levels in the prognosis of coronary patients presents a limited knowledge. Objective To evaluate the influence of high level of Hcy in MACE (defined as a composite endpoint of cardiovascular death, acute myocardial infarction, stroke, admission for heart failure and need to revascularization) of coronary artery patients. Materials and Methods Study analyses of 1687 patients selected from GENEMACOR study population, with at least one &gt; 75% coronary stenosis by angiography. That population was divided in three terciles according to the Hcy level and the population of the 2nd tercil (Hcy 11.1-13.6mmol/L) was excluded. The end population of 1118 patients was a median age of 53.1 ± 7.9 years and 77.6% were men. We compared patients in the 1st (Hcy &lt; 11.1mmol/L) and 3rd tercil (Hcy &gt; 13.6mmol/L) during a mean follow up of 5.0 ± 4.8 years. Results 560 (50.1%) patients were included in the 1st tercil group (median age 51.6 ± 3 years, 72.0% men) and  558 (49.9%) patients were in the 3rd tercil group (median age 54.6 ± 3 years, 83.3% men). In our population, high levels of Hcy were associated with MACE (OR 1.43, 95% CI: 1.12-1.83, p 0.004). Conclusion  In our population a higher level of Hcy was associated with adverse prognosis and increased occurrence of MACE. Knowing that elevated homocysteine levels are associated with increased risk of MACE, in these patients is essential to have a more intensive therapeutic strategy.

Abstract 159: Immediate Transnasal Evaporative Cooling During Resuscitation from Cardiac Arrest: The Cool Before Airway Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Marie-Sophie Grave ◽  
Raphael van Tulder ◽  
Alexander Nürnberger ◽  
Stergios Fykatas ◽  
Dieter Sebald ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Evaporative Cooling ◽  
Safety Data ◽  
Hospital Setting ◽  
Eligibility Criteria ◽  
Early Application ◽  
Technical Problems ◽  
The Subject

BACKGROUND: Therapeutic hypothermia is an integral part of the standard resuscitation care. One method to induce therapeutic hypothermia is transnasal evaporative cooling. PURPOSE/AIMS: We wanted to demonstrate that transnasal evaporative cooling initiated prior to achieving a protected airway during CPR in an out-of-hospital setting is safe and feasible. METHODS: Transnasal evaporative cooling via the RhinoChill® (RC) System (BeneChill Inc. San Diego, CA, USA) was initiated prior to a protected airway after initiating cardiac resuscitation, and was continued until either the subject was declared dead, standard institutional systemic cooling methods were implemented or cooling equipment (oxygen and perfluorcarbone) was empty. The subject was monitored throughout the hypothermia period, and followed until either death or hospital discharge. Clinical assessments and clinically relevant adverse events were documented over this period of time. RESULTS: In total 21 patients were included in this trial. Four of them had to be excluded subsequently. One patient had been excluded due to a pre-existing secured airway, the others due to user errors. Finally, 17 patients (f=6; mean age 65.5 years, CI95%: 57.7-73.4) met all the eligibility criteria and were included for further investigation. Device-related adverse events occurred in only two patients, which were mild and had no consequence on the patient’s outcome. One was reversible nose-whitening and the other epistaxis. According to the filed reports of the EMS personnel, no severe technical problems occurred by using the RC device that led to a delay or the impairment of quality of the CPR. The most common observed interruption in the application was a short blockage of the device (n=12). In four cases the bag-valve-mask-ventilation wasn’t possible due to blockage or a sealing lack and in two cases a moderate orificial fluid spraying was observed during chest compressions. CONCLUSIONS/RECOMMENDATIONS: Early application of the RC device, during cardiac arrest in the out-of-hospital setting of Vienna, is feasible, safe and easy to handle and does not delay or hinder CPR, or establishment of a secure intubation. For efficacy and further safety data additional studies will be needed.

P5646Risk factor paradox in STEMI-related sudden cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Karam ◽  
S Bataille ◽  
E Marijon ◽  
A Loyeau ◽  
M Tafflet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Reference Group ◽  
Past History ◽  
Sudden Cardiac Arrest ◽  
St Segment Elevation ◽  
Increased Risk ◽  
Paris Area ◽  
Artery Disease ◽  
The Impact

Abstract Background Cardiovascular risk factors (CVRF) are associated with an increased risk of atherosclerosis and ST-segment elevation myocardial infarction (STEMI). Sudden cardiac arrest (SCA) is currently the most feared complication of STEMI. The impact of CVRF on the rate of SCA is still unknown. Purpose To assess the association between CVRF and pre-hospital SCA during acute STEMI. Methods Data were taken between 2006 and 2014 from the e-MUST study that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Characteristics of patients who presented SCA were compared to those of patients who did not, and multivariable logistic regression was developed including all variables that differed between the two groups, in order to identify characteristics associated with an increased risk of SCA. Results Over the study period, 13,253 STEMI patients were included (median age 60.1 [51.4 - 73.0], 78.1% males). Among them, 7,513 patients (58.1%) had ≥2 CVRF, 3,979 (30.8%) had 1 CVRF, and 1,432 (11.1%) did not present any CVRF. Pre-hospital SCA witnessed by emergency medical services occurred in 749 (5.6%) patients. SCA victims were younger compared to the non-SCA group (58.0 vs. 60.3 years (P<0.001), with a higher proportion of patients without known CVRF (17.2 vs. 10.7%, P<0.001). There was no statistical difference in sex ratio (77.5% vs. 78.2%, P=0.69) and presence of past history of coronary artery disease (18.7% vs. 19.5%, P=0.56). Patients with ≥2 CVRF had the lowest rate of SCA (4.6%), while the highest SCA rate occurred among patients without CVRF (8.9%). On multivariate analysis, the presence of ≥2 CVRF was associated with a twice-lower risk of SCA (OR 0.52, 95% CI 0.41–0.65, P<0.001, when the group without risk factors was taken as a reference group). Conclusion The prevalence of CVRF is high among patients presenting STEMI. However, once STEMI has occurred, presence of CVRF is associated with a lower rate of SCA per STEMI, creating a risk factor paradox in STEMI-related SCA.

The Lithium Toxic Patient in the Medical Hospital: Diagnostic and Management Dilemmas

1993 ◽  
Vol 23 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Dilip Ramchandani ◽  
Barbara A. Schindler
Keyword(s):  
Risk Factors ◽  
General Hospital ◽  
Clinical Picture ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Lithium Toxicity ◽  
Psychiatric Consultation ◽  
Diagnostic Skills ◽  
Increased Risk ◽  
Toxic Reactions

Objective: Patients with lithium toxicity can pose difficulties in diagnosis and management in the general hospital setting. The authors examined patients who were referred to the Psychiatric Consultation-Liaison Service with suspicion of lithium overdose to delineate and characterize medical and psychiatric risk factors for toxicity and to follow the course and resolution of their toxicity. Method: The authors reviewed the charts of patients with lithium levels >1.5 mEq/L who were admitted consecutively to a general hospital over an 18-month period. Results: Of twelve patients, eight were found to have developed lithium toxicity due to incidental and iatrogenic factors. These patients presented with a variety of confusing signs and symptoms. Hypothyroidism and coexisting organic illness contributed to the lack of clarity in their clinical picture. Conclusion: The widening scope of indication for lithium therapy leads to increased risk of toxic reactions which challenge the diagnostic skills of the consulting psychiatrist in a general hospital setting.

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