Critical Care Providers’ Perceptions of the Use of Vasopressin in Cardiac Arrest

2005 ◽  
Vol 14 (6) ◽  
pp. 481-492
Author(s):  
Janie Heath ◽  
Dave Hanson ◽  
Rebecca Long ◽  
Nancy A. Crowell
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
The United States ◽  
Care Providers ◽  
First Line ◽  
Convenience Sample ◽  
Drug Of Choice ◽  
Line Drug

• Background Although published algorithms and guidelines list epinephrine and vasopressin as either/or choices for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, little is known about how critical care providers respond to this recommendation. • Objectives To assess the use of vasopressin as a first-line drug of choice for ventricular fibrillation and/or pulseless ventricular tachycardia and describe factors that may influence decision making for using vasopressin. • Methods A convenience sample from 4 academic medical centers in the United States was recruited to complete a 20-item survey on demographic factors such as year of last Advanced Cardiac Life Support (ACLS) provider course, specialty certification, predominant practice responsibility, and beliefs related to the use of vasopressin for cardiac arrest. Descriptive statistics, Pearson correlation analysis, and logistic regression were used to analyze the data. • Results A total of 214 critical care providers (80% registered nurses) completed the survey. Year of last ACLS course (r = −0.188, P = .006) was a significant demographic factor, and behavioral beliefs (attitude about using vasopressin) had the strongest relationship (r = 0.687, P < .001) and were the best predictor for intentions to use or recommend the use of vasopressin (beta=0.589, P<.001). • Conclusions Despite the recommendation for vasopressin as an agent equivalent to epinephrine for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, 63% of respondents used epinephrine as a first-line drug of choice. More research is needed to address the classification system for interpreting the quality of evidence that may influence practice.

Abstract 260: Regional Routing for Extracorporeal Membrane Oxygenation to Increase Survival From Refractory Ventricular Fibrillation/Ventricular Tachycardia Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nichole E Bosson ◽  
Amy H Kaji ◽  
James T Niemann ◽  
Shira Schlesinger ◽  
David Shavelle ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Extracorporeal Membrane Oxygenation ◽  
Neurologic Outcome ◽  
Transport Time ◽  
Regional System ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest ◽  
Actual Survival

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with refractory ventricular fibrillation/ventricular tachycardia (rVF/VT) out-of-hospital cardiac arrest (OHCA). Los Angeles County (LAC) operates a regional system of care for 10.2 million persons, routing patients with OHCA to the closest cardiac receiving center. The purpose of this study was to determine 1) the number of patients eligible and 2) the potential for increased neurologically intact survival routing patients with rVF/VT OHCA to ECMO-capable cardiac centers. Methods: This was a retrospective study utilizing LAC quality improvement databases. Patients 18-75 years treated by EMS from 2011-2017 for rVF/VT OHCA, defined as persistent VF/VT after 3 defibrillations, were included in the analysis. Actual survival with good neurologic outcome, defined as cerebral performance category (CPC) 1 or 2, was abstracted from the LAC OHCA Registry. Theoretical patient outcome with routing directly to an ECMO-capable center was determined by applying outcomes as described by the Minnesota Resuscitation Consortium (MRC) for rVF/VT transported for ECMO. Assumptions included the availability of ECMO within a 30-minute transport time, and similar proportions of patients meeting criteria for transport/cannulation and surviving with CPC 1-2 as the MRC cohort, 78% and 40% respectively. For the remaining patients, we assumed no change in outcome. We compared the actual to the theoretical outcome with regional ECMO to determine the annual increase in survival with good neurologic outcome. Results: During the 7-year study period, there were 1862 patients with rVT/VT OHCA with outcomes available for 1454 (78%) patients. Median age was 59 years (IQR 51-66); 76% were male. Actual survival with CPC 1-2 was 13% (187 patients). Theoretical survival with CPC 1-2 in a regional ECMO-capable system was 34% (495 patients); OR 3.5 (95%CI 2.9-4.2), p<0.0001 with ECMO routing versus without. Conclusion: Assuming ECMO availability within a 30-minute transport time throughout the regional system, routing patients with rVF/VT to ECMO-capable centers could improve survival with CPC 1-2 nearly three-fold and result in 44 additional patients/year with meaningful survival.

Transgender Intimate Partner Violence and Help-Seeking Patterns

2019 ◽  
pp. 088626051988017 ◽  
Author(s):  
Victoria Kurdyla ◽  
Adam M. Messinger ◽  
Milka Ramirez
Keyword(s):  
Intimate Partner Violence ◽  
Health Care Providers ◽  
Sexual Minority ◽  
Partner Violence ◽  
Help Seeking ◽  
The United States ◽  
Intimate Partner ◽  
Self Report ◽  
Care Providers ◽  
Convenience Sample

Intimate partner violence (IPV) against transgender individuals is highly prevalent and impactful, and thus research is needed to examine the extent to which survivors are able to reach needed assistance and safety. To our knowledge, no U.S.-based quantitative studies have explored transgender utilization patterns and perceptions regarding a broad range of help-giving resources (HGRs). The present article fills this gap in the literature by exploring help-seeking attitudes and behaviors of a convenience sample of 92 transgender adults and 325 cisgender sexual minority adults in the United States. Results from an online questionnaire indicate that, among the subsample experiencing IPV ( n = 187), help-seeking rates were significantly higher among transgender survivors (84.1%) than cisgender sexual minority survivors (67.1%). In addition, transgender survivors most commonly sought help from friends (76.7%), followed by mental health care providers (39.5%) and family (30.2%), whereas formal HGRs such as police, IPV telephone hotlines, and survivor shelters had low utilization rates. Among all transgender participants, IPV survivors were significantly less likely than nonsurvivors to perceive family, medical doctors, and survivor hotlines as helpful HGRs for other survivors in general. Finally, transgender survivors were significantly less likely than nonsurvivors to self-report a willingness to disclose any future IPV to family. Although replication with larger, probability samples is needed, these findings suggest that friends often represent the primary line of defense for transgender survivors seeking help, and thus bystander intervention trainings and education should be adapted to address not just cisgender but also transgender IPV. Furthermore, because most formal HGR types appear to be underutilized and perceived more negatively by transgender survivors, renewed efforts are needed to tailor services, service advertising, and provider trainings to the needs of transgender communities. Directions for future research are reviewed.

scholarly journals An Ancillary Central Catheter Emergency Support Service Team Staffed by Surgical Personnel Improves Workflow During the Coronavirus Disease 2019 Crisis

2020 ◽  
pp. 155335062097118
Author(s):  
Steven P. Schulberg ◽  
Omkaar Jaikaran ◽  
Derek Lim ◽  
Ryan P. Robalino ◽  
Ronak Patel ◽  
...  
Keyword(s):  
New York ◽  
Critical Care ◽  
Learning Experience ◽  
The United States ◽  
Support Service ◽  
Service Access ◽  
City Hospital ◽  
Care Providers ◽  
Central Catheter ◽  
Novel Coronavirus

Background. The SARS-CoV-2 novel coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to urban health centers across the United States. Many hospitals are reallocating resources to best handle the influx of critical patients. Methods. At our New York City hospital, we developed the ancillary central catheter emergency support service (ACCESS), a team for dedicated central access staffed by surgical residents to assist in the care of critical COVID-19 patients. We conducted a retrospective review of all patients for whom the team was activated. Furthermore, we distributed a survey to the critical care department to assess their perceived time saved per patient. Results. The ACCESS team placed 104 invasive catheters over 10 days with a low complication rate of .96%. All critical care providers surveyed found the service useful and felt it saved at least 30 minutes of procedural time per patient, as patient to critical care provider ratios were increased from 12 patients to one provider to 44 patients to one provider. Conclusions. The ACCESS team has helped to effectively redistribute surgical staff, provide a learning experience for residents, and improve efficiency for the critical care team during this pandemic.

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