共查询到20条相似文献，搜索用时 15 毫秒
1.
Yu-Ri Park Joo Suk Oh Hyunho Jeong Jungtaek Park Young Min Oh Semin Choi Kyoung Ho Choi 《The American journal of emergency medicine》2018,36(4):660-664
Objectives
Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival.Methods
This prospective observational study and retrospective review included adult out-of-hospital cardiac arrest survivors who were treated by hypothermia-targeted temperature management. Serum NGAL was assessed at 0, 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was poor outcome at six months after cardiac arrest, defined as cerebral performance category score of 3–5. The secondary outcome was six-month mortality.Results
In total, 76 patients were analyzed. The patients with poor outcomes showed significantly higher NGAL levels at 24, 48 and 72 h after cardiac arrest than the patients with good outcomes. Long-term survival rates were significantly lower in the high-NGAL group than in the low-NGAL group at each time point. Subgroup analysis of patients who survived 72 h showed that only serum NGAL 72 h after cardiac arrest had prognostic value for long-term outcomes (area under the receiver operating characteristic curve = 0.72; p = 0.02).Conclusions
Post-cardiac arrest serum NGAL is associated with long-term outcomes and survival; particularly, three days post-cardiac arrest is the optimal time point for predicting long-term outcomes. However, the predictive power of NGAL is unsatisfactory, and it should be regarded as an additional prognostic modality. 相似文献2.
Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest
Win Wah Khin Lay Wai Pin Pin Pek Andrew Fu Wah Ho Omer Alsakaf Michael Yih Chong Chia Julina Md Noor Kentaro Kajino Nurun Nisa Amatullah De Souza Marcus Eng Hock Ong 《The American journal of emergency medicine》2017,35(2):206-213
Background
In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA.Methodology
This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models.Results
40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR = 6.10, 95% confidence interval/CI = 5.06–7.34) and subsequent conversion to shockable rhythm (OR = 2.00,95%CI = 1.10–3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses.Conclusion
Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy. 相似文献3.
Qiang Zhang Bo Liu Lianxing Zhao Zhijiang Qi Huan Shao Le An Chunsheng Li 《The American journal of emergency medicine》2017,35(10):1555-1560
Objective
The aim of this study was to conduct a meta-analysis to evaluate the efficacy of vasopressin-epinephrine compared to epinephrine alone in patients who suffered out-of-hospital cardiac arrest (OHCA).Methods
Relevant studies up to February 2017 were identified by searching in PubMed, EMBASE, the Cochrane Library, Wanfang for randomized controlled trials(RCTs) assigning adults with cardiac arrest to treatment with vasopressin-epinephrine (VEgroup) vs adrenaline (epinephrine) alone (E group). The outcome point was return of spontaneous circulation (ROSC) for patients suffering from OHCA. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.Results
Individual patient data were obtained from 5047 participants who experienced OHCA in nine studies. Odds ratios (ORs) were calculated using a random-effects model and results suggested that vasopressin-epinephrine was associated with higher rate of ROSC (OR = 1.67, 95% CI = 1.13–2.49, P < 0.00001, and total I2 = 83%). Subgroup showed that vasopressin-epinephrine has a significant association with improvements in ROSC for patients from Asia (OR = 3.30, 95% CI = 1.30–7.88); but for patients from other regions, there was no difference between vasopressin-epinephrine and epinephrine alone (OR = 1.07, 95% CI = 0.72–1.61).Conclusion
According to the pooled results of the subgroup, combination of vasopressin and adrenaline can improve ROSC of OHCA from Asia, but patients from other regions who suffered from OHCA cannot benefit from combination of vasopressin and epinephrine. 相似文献4.
Yun Zhang Chun-Sheng Li Xiao-Li Yuan Ji-Yang Ling Qiang Zhang Yong Liang Bo Liu Lian-Xing Zhao 《The American journal of emergency medicine》2018,36(11):2020-2028
Background
Recently, a series of studies have been conducted to investigate the association of the common biochemical biomarkers, such as serum lactate and creatinine, with clinical outcomes in cardiac arrest patients treated with extracorporeal membrane oxygenation (ECMO), however, the results were not consistent and the sample size of primary studies is limited. In the present study, we performed a systematic review and meta-analysis to summarize the associations.Methods
Relevant studies in English databases (PubMed, ISI web of science, and Embase) and Chinese databases (Wanfang and CNKI) up to January 2018 were systematically searched. Crude ORs or HRs from the included studies were extracted and pooled to summarize the associations of lactate and creatinine with clinical outcomes including survival and neurological outcomes in ECMO treated cardiac arrest patients.Results
17 papers containing 903 cases were included in the present meta-analysis study. After pooling all the eligible studies, we identified the significant associations of high lactate level with poor survival (N = 13, OR = 1.335, 95%CI = 1.167–1.527, P < 0.001) and poor neurological outcome (N = 2, HR = 1.058, 95%CI = 1.020–1.098, P = 0.002) in CA patients treated with ECMO and a slight significant association of high creatinine with poor survival was also found (N = 7, OR = 1.010, 95%CI = 1.002–1.018, P = 0.015).Conclusions
High serum lactate level was associated with poor survival and poor neurological outcome in CA patients treated with ECMO. Further well-designed studies with larger sample size should be conducted to confirm the results. 相似文献5.
Yong Hun Jung Byung Kook Lee Dong Hun Lee Sung Min Lee Yong Soo Cho Kyung Woon Jeung 《The American journal of emergency medicine》2017,35(2):268-273
Purpose
Obesity is a well-known risk factor in various health conditions. We analyzed the association between obesity and clinical outcomes, and its effect on targeted temperature management (TTM) practice for cardiac arrest survivors by calculating and classifying their body mass indexes (BMIs).Methods
We conducted a retrospective data analysis of adult comatose cardiac arrest survivors treated with TTM from 2008 to 2015. BMI was calculated and the cohort was divided into four categories based on the cut-off values of 18.5, 23.0, and 27.5 kg m? 2. The primary outcome was six-month mortality and the secondary outcomes were neurologic outcome at hospital discharge, cooling rate, and rewarming rate.Results
The study included 468 patients. Poor neurologic outcome at discharge and six-month mortality were reported in 311 (66.5%) and 271 (57.9%) patients, respectively. A multivariate logistic analysis showed that an overweight compared to normal BMI was associated with lower probability of six-month mortality (odds ratio [OR], 0.481; 95% confidence interval [CI], 0.274–0.846; p = 0.011) and poor neurologic outcome at discharge (OR, 0.482; 95% CI, 0.258–0.903; p = 0.023). BMI correlated with cooling rate (B, ? 0.073; 95% CI, ? 0.108 to ? 0.039; p < 0.001), but had no association with rewarming rate (B, 0.003; 95% CI, ? 0.001–0.008; p = 0.058).Conclusion
Overweight BMI compared to normal BMI classification was found to be associated with lower six-month mortality and poor neurologic outcome at discharge in cardiac arrest survivors treated with TTM. Higher BMI correlated with a slower induction rate. 相似文献6.
Ye Ma Lili Huang Lu Zhang Hai Yu Bin Liu 《The American journal of emergency medicine》2018,36(7):1270-1279
Background
Obesity as one of the risk factors for cardiovascular diseases increases mortality in general population. Several clinical studies investigated clinical outcomes in patients with different body mass index (BMI) after cardiac arrest (CA). Controversial data regarding BMI on clinical outcomes in those patients exist in those studies. Therefore, we conducted a meta-analysis to evaluate the effect of BMI on survival condition and neurological prognosis in those patients.Methods
We searched Pubmed, Embase, Ovid/Medline and EBM reviews databases for relational studies investigating the association between BMI and clinical outcomes of patients after CA. Seven studies involving 25,035 patients were included in this meta-analysis. Primary outcome was survival condition and secondary outcome was neurological prognosis. Three comparisons were conducted: underweight (BMI < 18.5) versus normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) versus normal weight and obese (BMI ≥ 30) versus normal weight.Results
Using normal weight patients as reference, underweight patients had a higher mortality (odds ratio [OR] 1.35; 95% confidence interval [CI] 1.10 to 1.66; P = 0.004; I2 = 17%). Overweight was associated with increased hospital survival (OR 0.80; 95% CI 0.65 to 0.98; P = 0.03; I2 = 62%) and better neurological recovery (OR 0.72; 95% CI 0.61 to 0.85; P < 0.001; I2 = 0%). No significant difference was found in clinical outcomes between obese and normal weight patients.Conclusions
Low BMI was associated with lower survival rate in CA patients. Overweight was associated with a higher survival rate and better neurological recovery. Clinical outcomes did not differ between obese and normal weight patients. Further studies are needed to explore the underlying mechanisms. 相似文献7.
Takayuki Otani Hirotaka Sawano Tomoaki Natsukawa Reiko Matsuoka Masaya Morita Yasuyuki Hayashi 《The American journal of emergency medicine》2017,35(5):685-691
Purpose
The aim of this study was to assess the usefulness of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting in-hospital mortality and neurological outcome of patients resuscitated after out-of-hospital cardiac arrest (OHCA).Methods
We retrospectively analyzed the data of patients admitted to our hospital between October 2009 and October 2015 with OHCA and shockable initial cardiac rhythm who were resuscitated via conventional cardiopulmonary resuscitation. We calculated the GRACE risk score on admission and assessed its usefulness in predicting in-hospital mortality and neurological outcome.Results
Among 91 patients, 42 (46%) had acute myocardial infarction (AMI), 19 (21%) died in-hospital, and 52 (57%) had favorable neurological outcome. Among all the study patients, GRACE risk score was lower in survivors than in non-survivors (median 211 [interquartile range 176–240] vs. 266 [219–301], p < 0.001, respectively) and in favorable than in unfavorable neurological outcome group (202 [167–237] vs. 242 [219–275], p < 0.001, respectively). Multivariate analysis showed significant association between GRACE risk score and favorable neurological outcome (odds ratio, 0.975; 95% confidence interval, 0.961–0.990). Areas under receiver-operating characteristic curves, that describe the accuracy of GRACE risk score in predicting in-hospital mortality and favorable neurological outcome, were both 0.79.Conclusion
GRACE risk score may predict the in-hospital mortality and neurological outcome associated with resuscitated patients with OHCA and shockable initial cardiac rhythm, regardless of the cause of arrest. 相似文献8.
Chenxi Dai Zhi Wang Liang Wei Gang Chen Bihua Chen Feng Zuo Yongqin Li 《The American journal of emergency medicine》2018,36(12):2242-2248
Objective
Early and reliable prediction of neurological outcome remains a challenge for comatose survivors of cardiac arrest (CA). The purpose of this study was to evaluate the predictive ability of EEG, heart rate variability (HRV) features and the combination of them for outcome prognostication in CA model of rats.Methods
Forty-eight male Sprague-Dawley rats were randomized into 6 groups (n = 8 each) with different cause and duration of untreated arrest. Cardiopulmonary resuscitation was initiated after 5, 6 and 7 min of ventricular fibrillation or 4, 6 and 8 min of asphyxia. EEG and ECG were continuously recorded for 4 h under normothermia after resuscitation. The relationships between features of early post-resuscitation EEG, HRV and 96-hour outcome were investigated. Prognostic performances were evaluated using the area under receiver operating characteristic curve (AUC).Results
All of the animals were successfully resuscitated and 27 of them survived to 96 h. Weighted-permutation entropy (WPE) and normalized high frequency (nHF) outperformed other EEG and HRV features for the prediction of survival. The AUC of WPE was markedly higher than that of nHF (0.892 vs. 0.759, p < 0.001). The AUC was 0.954 when WPE and nHF were combined using a logistic regression model, which was significantly higher than the individual EEG (p = 0.018) and HRV (p < 0.001) features.Conclusions
Earlier post-resuscitation HRV provided prognostic information complementary to quantitative EEG in the CA model of rats. The combination of EEG and HRV features leads to improving performance of outcome prognostication compared to either EEG or HRV based features alone. 相似文献9.
Kuang-Chau Tsai Ray F. Lin Chieh Lee Ai-Hsien Li 《The American journal of emergency medicine》2018,36(7):1222-1230
Objective
This study aimed to develop a triage tool to more effectively triage possible ACS patients presenting to the emergency department (ED) before admission to a protocol-driven chest pain unit (CPU).Methods
Seven hundred ninety-three clinical cases, randomly selected from 7962 possible ACS cases, were used to develop and test an ACS triage model using cluster analysis and stepwise logistic regression.Results
The ACS triage model, logit (suspected ACS patient) = ? 5.283 + 1.894 × chest pain + 1.612 × age + 1.222 × male + 0.958 × proximal radiation pain + 0.962 × shock + 0.519 × acute heart failure, with a threshold value set at 2.5, was developed to triage patients. Compared to four existing methods, the chest-pain strategy, the Zarich's strategy, the flowchart, and the heart broken index (HBI), the ACS triage model had better performance.Conclusion
This study developed an ACS triage model for triaging possible ACS patients. The model could be used as a rapid tool in EDs to reduce the workloads of ED nurses and physicians in relation to admissions to the CPU. 相似文献10.
Brian H. Rowe Leeor Eliyahu Justin Lowes Lindsay A. Gaudet Jeremy Beach Martin Mrazik Garnet Cummings Donald Voaklander 《The American journal of emergency medicine》2018,36(12):2144-2151
Objectives
Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population.Methods
Patients >17 years old presenting meeting the World Health Organization's definition of concussion were recruited in one academic (Hospital 1) and two community (Hospitals 2 and 3) EDs in a Canadian city. A physician questionnaire and patient interviews documented recommendations given by emergency physicians. Bi-variable comparisons are reported using chi-square tests, t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods.Results
Overall, the study enrolled 250 patients. The median age was 35 (IQR: 23 to 49) and 52% were female. A variety of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR = 0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR = 0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR = 0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR = 0.11; 95% CI: 0.03 to 0.46).Conclusion
One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion. 相似文献11.
Christopher N. Kaufmann Adam P. Spira G. Caleb Alexander Lainie Rutkow Ramin Mojtabai 《The American journal of emergency medicine》2017,35(10):1414-1419
Objective
Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group.Methods
Data came from the 2004–2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication. DAWN also recorded the disposition (i.e., outcome) of the visit. Analyses focused on outcomes indicating a serious disposition defined as hospitalization, patient transfer or death. Using logistic regression, the association of BZD and nBZRA use with visit disposition was assessed after applying sample weights so as to be nationally representative of ED visits in the United States involving medications or illicit substances.Results
Nineteen percent of visits involving other sedative-hypnotics, 28% involving BZDs-only, 20% involving nBZRAs-only and 48% involving a combination of BZDs and nBZRAs resulted in a serious disposition. Compared to visits involving other sedative-hypnotics, visits involving BZDs-only had 66% greater odds (Odds Ratio [OR] = 1.66, 95% Confidence Interval [CI] = 1.37–2.01), and visits involving a combination of BZDs and nBZRAs had almost four times increased odds of a serious disposition (OR = 3.91, 95% CI = 2.38–6.41). Results were similar across age groups.Conclusions
Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications. 相似文献12.
Saee Byel Kang Kyung Su Kim Gil Joon Suh Woon Yong Kwon Kyoung Min You Min Ji Park Jung-In Ko Taegyun Kim 《The American journal of emergency medicine》2017,35(10):1457-1461
Background
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy.Methods
All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy.Results
Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge.Conclusions
Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy. 相似文献13.
Guillaume Gantois Erika Parmentier-Decrucq Thibault Duburcq Raphaël Favory Daniel Mathieu Julien Poissy 《The American journal of emergency medicine》2017,35(11):1672-1676
Introduction
Patients surviving a self-attempted hanging have a total neurological recovery in 57–77% of cases at hospital discharge, but no long-term data are available.Methods
In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12 months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2 + 3 + 4 (bad recovery) vs. CPC1 (good recovery).Results
Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12 months were obtained in 97 of the 136 surviving patients. At 6 months, in the CA group (n = 9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n = 88), 79 patients had normal neurological status at 6 months and 78 at 12 months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6 months were a CA at the hanging site (P = 0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P = 0.04), a lower initial Glasgow score (4 vs. 5; P = 0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P < 0.001).Conclusion
Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists. 相似文献14.
Jung-Man Lee Jiwon Lee Jin-Young Hwang Jee-Eun Chang Heyrim Kim Sohee Oh Eun-Ah Oh Seong-Won Min 《The American journal of emergency medicine》2017,35(5):743-748
Objective
Guidewire-induced arrhythmias that occur during central venous catheterization can progress to malignant arrhythmias in rare cases. This study compared the incidence of arrhythmia during central venous catheterization using three different depths of guidewire insertion into the right internal jugular vein.Methods
Sixty-nine patients undergoing elective surgery requiring central venous catheterization through the right internal jugular vein were enrolled in this double-blind, prospective, randomized, and controlled study. Patients were randomly allocated to receive guidewire insertions to 15 cm, 17.5 cm, or 20 cm before tissue dilation. Arrhythmic episodes were then monitored during dilation of the soft tissue.Results
A total of 29 patients (42%) experienced arrhythmic episodes during tissue dilation. The guidewire-induced arrhythmia rates of the 15 cm group, 17.5 cm group, and 20 cm group were 0.26 (95% confidence interval [CI] = 0.10, 0.48), 0.35 (95% CI = 0.16, 0.57), and 0.65 (95% CI = 0.43, 0.84), respectively. The incidence of arrhythmic episodes was higher in the 20 cm group than in the 15 cm (odds ratio [OR] = 5.31; 95% CI = 1.50, 18.84) and 17.5 cm (OR = 3.52; 95% CI = 1.05, 11.83) groups. There was no significant difference in arrhythmia rates between the 15 cm group and 17.5 cm group (p = 0.542).Conclusions
During central venous catheterization through the right internal jugular vein, inserting guidewires to depths of 15 or 17.5 cm before tissue dilation reduced the incidence of arrhythmic episodes compared to a depth of 20 cm. 相似文献15.
Yi-Chuan Chen Ming-Szu Hung Chia-Yen Liu Cheng-Ting Hsiao Yao-Hsu Yang 《The American journal of emergency medicine》2018,36(11):1998-2004
Background
Sodium bicarbonate administration is mostly restricted to in-hospital use in Taiwan. This study was conducted to investigate the effect of sodium bicarbonate on outcomes among patients with out-of-hospital cardiac arrest (OHCA).Methods
This population-based study used a 16-year database to analyze the association between sodium bicarbonate administration for resuscitation in the emergency department (ED) and outcomes. All adult patients with OHCA were identified through diagnostic and procedure codes. The primary outcome was survival to hospital admission and secondary outcome was the rate of death within the first 30 days of incidence of cardiac arrest. Cox proportional-hazards regression, logistic regression, and propensity analyses were conducted.Results
Among 5589 total OHCA patients, 15.1% (844) had survival to hospital admission. For all patients, a positive association was noted between sodium bicarbonate administration during resuscitation in the ED and survival to hospital admission (adjusted odds ratio [OR]: 4.47; 95% confidence interval [CI]: 3.82–5.22, p < 0.001). In propensity-matched patients, a positive association was also noted (adjusted OR, 4.61; 95% CI: 3.90–5.46, p < 0.001).Conclusions
Among patients with OHCA in Taiwan, administration of sodium bicarbonate during ED resuscitation was significantly associated with an increased rate of survival to hospital admission. 相似文献16.
Susie Cartledge Lahn D. Straney Janet E. Bray Rachel Mountjoy Judith Finn 《Collegian (Royal College of Nursing, Australia)》2018,25(3):303-306
Background
Residential aged care facilities are common locations for out-of-hospital cardiac arrests to occur, yet survival to hospital discharge is poor.Aim
This study aims to examine preferences and perceived outcomes of cardiopulmonary resuscitation among Australians receiving aged care.Methods
A brief survey was provided to 187 residential aged care facilities and 34 home care providers throughout Australia for completion by aged care residents. Respondents were asked to answer three questions about understanding and desire for cardiopulmonary resuscitation on a five-point scale (from strongly agreed to strongly disagreed).Findings
A total of 1985 residents in 163 residential aged care facilities across Australia, and 277 older Australians receiving care in the home from 24 providers responded. The majority of respondents were female (67.4%), and respondents in residential aged care facilities were significantly older (82.6% > 75 years) than those receiving care in the home (70.4% > 75 years) (p < 0.001). Among 2262 respondents over 80% expressed a good understanding of cardiopulmonary resuscitation and its implications. Over half of respondents desired cardiopulmonary resuscitation if they were to experience an out-of-hospital cardiac arrest, and the desire for cardiopulmonary resuscitation was strongly associated and correlated (Pearson’s R test = 0.759) with a view that they would likely fully recover.Conclusion
These findings highlight the need for older people to be better informed about cardiopulmonary resuscitation, including a clear understanding of what is involved in cardiopulmonary resuscitation and a realistic perception of outcomes. 相似文献17.
Louise Martinell Johan Herlitz Thomas Karlsson Niklas Nielsen Christian Rylander 《The American journal of emergency medicine》2017,35(11):1595-1600
Background
Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.Methods
Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.Results
Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71–5.29; p < 0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83–2.15; p = 0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88–2.22; p = 0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.Conclusion
Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders. 相似文献18.
Nooraldeen Al-Dury Araz Rawshani Johan Israelsson Anneli Strömsöe Solveig Aune Jens Agerström Thomas Karlsson Annica Ravn-Fischer Johan Herlitz 《The American journal of emergency medicine》2017,35(12):1839-1844
Aim
To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.Methods
Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49 years), middle-aged (50–64 years) and older (65 years and above). Comparisons between men and women were age adjusted.Results
The mean age was 72.7 years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.Conclusion
When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors. 相似文献19.
Troels Mygind-Klausen André Jæger Camilla Hansen Rasmus Aagaard Lise Qvirin Krogh Mette Amalie Nebsbjerg Kristian Krogh Bo Løfgren 《The American journal of emergency medicine》2018,36(7):1236-1241
Introduction
In-hospital cardiac arrest has a poor prognosis and often occurs in patients lying in a hospital bed. A bed mattress is a soft compressible surface that may decrease cardiopulmonary resuscitation (CPR) quality. Often hospital CPR training is performed with a manikin on the floor.Aim
To study CPR quality following realistic CPR training with a manikin in a bed compared with one on the floor.Methods
We conducted a randomised controlled study. Healthcare professionals were randomised to CPR training with a manikin in a hospital bed or one on the floor. Data on CPR quality was collected from manikins. The primary outcome measure was chest compression depth.Results
In total, 108 healthcare professionals (age: 40 years, female: 94%) were included. The mean chest compression depth was 39 mm (standard deviation (SD): 10), for the bed group compared with 38 mm (SD: 9) for the floor group, p = 0.49. A post hoc analysis showed that regardless of the training method, the participants who optimised their working position by jumping onto the bed or lowering the bed had a median chest compression depth of 39 mm (25th–75th percentiles: 33–45) compared with 29 mm (25th–75th percentiles: 23–41) for participants who did neither, p = 0.04.Conclusion
There was no significant difference in chest compression depth between healthcare professionals who trained CPR on a manikin in a hospital bed compared with one on the floor. Chest compression depth was too shallow in both groups. Irrespective of the training method, participants who optimised their working position performed deeper chest compressions. 相似文献20.
Diego G.D. Christofaro Breno Q. Farah Luiz Carlos M. Vanderlei Leandro D. Delfino William R. Tebar Mauro Virgílio G. de Barros Raphael M. Ritti-Dias 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(1):49-54