4 - Reasons for Tracheal Intubation during In-hospital Cardiac Arrest: A Prospective Multicenter Study

Introduction: Measured quality of CPR is often substandard compared to guideline recommendations during adult in-hospital cardiac arrest. Aim: To investigate the self-perceived CPR quality, teamwork and communication and to identify the most frequently reported challenges experienced during in-hospital cardiac arrest. Methods: Prospective multicenter study including self-reported data from resuscitation attempts treated by cardiac arrest teams in 5 Danish hospitals (1 university hospital, 4 regional hospitals). Data from October 2016 to May 2018 was included. Following each resuscitation attempt, all cardiac arrest team members were questioned by an online questionnaire, specifically on perceived CPR quality, teamwork and communication on a Likert scale. In addition, challenges experienced during the resuscitation attempt were inquired. Results: Of 491 cardiac arrests, the cardiac arrest team was actively involved in 387 cases (79%). Of 2,271 questionnaires there were 1,639 responses (response rate: 72%). Overall, 87% agreed or partially agreed that the CPR quality was optimal, 89% agreed or partially agreed that the teamwork was optimal, and 88% agreed or partially agreed that the communication was optimal. The most frequently reported challenges experienced were: too many health care providers present in the room (26%), healthcare providers poorly placed relative to each other in the room during resuscitation (16%), lacking space for resuscitation equipment (16%), problems finding resuscitation equipment (14%), problems finding the location of cardiac arrest (5%), and other challenges (10%). Challenges with too many healthcare providers in the room were associated with the total amount of persons in the room (p<0.001), amount of non-team members present (P<0.001) but not the number of members on the cardiac arrest team (p=0.70). Conclusions: During in-hospital resuscitation, most cardiac arrest team members perceive that CPR quality, teamwork, and communication are optimal. However, Challenges during resuscitation are not uncommon and include overcrowding, lack of space and problems locating resuscitation equipment.

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Faculty Opinions recommendation of Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726802429.793524000 ◽

2016 ◽

Author(s):

Niranjan Kissoon ◽

Srinivas Murthy

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Hospital Cardiac Arrest

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Blood gas phenotyping and tracheal intubation timing in adult in-hospital cardiac arrest: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-89920-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chih-Hung Wang ◽

Meng-Che Wu ◽

Cheng-Yi Wu ◽

Chien-Hua Huang ◽

Min-Shan Tsai ◽

...

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Interaction Analysis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Optimal Time ◽

Hypercapnic Acidosis ◽

Blood Gas ◽

Regression Analyses ◽

Hospital Cardiac Arrest

AbstractTo investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. In total, 567 patients were included. Non-severe acidosis (pH≧7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63–12.95; p value = 0.004) and survival (OR: 3.25, 95% CI 1.72–6.15; p value < 0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35–7.45, PCO2: 35–45 mm Hg, HCO3− level: 22–26 mmol/L) × TTI ≦ 6.3 min (OR: 20.40, 95% CI 2.53–164.75; p value = 0.005) and non-severe acidosis × TTI ≦ 6.3 min (OR: 3.35, 95% CI 1.00–11.23; p value = 0.05) were associated with neurological recovery while metabolic acidosis × TTI ≦ 5.7 min (OR: 3.63, 95% CI 1.36–9.67; p value = 0.01) and hypercapnic acidosis × TTI ≦ 10.4 min (OR: 2.27, 95% CI 1.20–4.28; p value = 0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.

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Early Post-Rewarming Fever Is Associated with Favorable 6-Month Neurologic Outcomes in Patients with Out-Of-Hospital Cardiac Arrest: A Multicenter Registry Study

Journal of Clinical Medicine ◽

10.3390/jcm9092927 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2927

Author(s):

Hyoung Youn Lee ◽

Dong Hun Lee ◽

Byung Kook Lee ◽

Kyung Woon Jeung ◽

Yong Hun Jung ◽

...

Keyword(s):

Cardiac Arrest ◽

Confidence Interval ◽

Multicenter Study ◽

Odds Ratio ◽

Primary Outcome ◽

Temperature Management ◽

Registry Study ◽

Neurologic Outcomes ◽

Hospital Cardiac Arrest ◽

Multicenter Registry

We investigated the association between post-rewarming fever (PRF) and 6-month neurologic outcomes in cardiac arrest survivors. This was a multicenter study based on a registry of comatose adult (³ 18years) out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management between October 2015 to December 2018. PRF was defined as peak temperature ≥ 38.0 °C within 72 h after completion of rewarming, and PRF timing was categorized as within 24, 24–48, and 48–72 h epochs. The primary outcome was neurologic outcomes at six months after cardiac arrest. Unfavorable neurologic outcome was defined as cerebral performance categories three to five. A total of 1031 patients were included, and 642 (62.3%) had unfavorable neurologic outcomes. PRF developed in 389 (37.7%) patients in 72 h after rewarming: within 24 h in 150 (38.6%), in 24–48 h in 155 (39.8%), and in 48–72 h in 84 (21.6%). PRF was associated with improved neurologic outcomes (odds ratio (OR), 0.633; 95% confidence interval (CI), 0.416–0.963). PRF within 24 h (OR, 0.355; 95% CI, 0.191–0.659), but not in 24–48 h or 48–72 h, was associated with unfavorable neurologic outcomes. Early PRF within 24 h after rewarming was associated with favorable neurologic outcomes.

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