Browsing by Subject "cardiopulmonary resuscitation"

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  • REAPPROPRIATE Study Grp; Druwe, Patrick; Benoit, Dominique D.; Nurmi, Jouni; Piers, Ruth; Hallikainen, Juhana; Suonsyrja, Timo; Kaartinen, Johanna (2020)
    OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts.
  • Irfan, Furqan B.; Castrén, Maaret; Bhutta , Zain A.; George, Pooja; Qureshi, Isma; Pathan, Sameer A.; Thomas, Stephen H.; Alinier, Guillaume; Shaikh, Loua A; Suwaidi, Jassim A; Singh, Rajvir; Shuaib, Ashfaq; Tariq, Tooba; McKenna, William J.; Cameron, Peter A.; Djarv, Therese (2021)
  • Nolan, Jerry P.; Maconochie, Ian; Soar, Jasmeet; Olasveengen, Theresa M.; Greif, Robert; Wyckoff, Myra H.; Singletary, Eunice M.; Aickin, Richard; Berg, Katherine M.; Mancini, Mary E.; Bhanji, Farhan; Wyllie, Jonathan; Zideman, David; Neumar, Robert W.; Perkins, Gavin D.; Castren, Maaret; Morley, Peter T.; Montgomery, William H.; Nadkarni, Vinay M.; Billi, John E.; Merchant, Raina M.; de Caen, Allan; Escalante-Kanashiro, Raffo; Kloeck, David; Wang, Tzong-Luen; Hazinski, Mary Fran (2020)
  • Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka T.; Litonius, Erik; Skrifvars, Markus B. (2021)
    BackgroundCardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital.MethodsThis single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital's ICU between 2005 and 2013. We stratified the study population into two age groups: 75 years. We compared interventions defined by the median daily therapeutic scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1-2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent associations between age group, mortality and neurological outcome.ResultsThis study included a total of 1,285 patients, of which 212 (16%) were >= 75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p
  • Holmström, Ester; Efendijev, Ilmar; Raj, Rahul; Pekkarinen, Pirkka; Litonius, Erik; Skrifvars, Markus (Helsingin yliopisto, 2021)
    Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ≥75 years. We compared interventions defined by the median daily therapeutic intervention scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were ≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI:2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.
  • Sanmark, Johan (Helsingfors universitet, 2015)
    Vid återupplivningar på HUCS Peijas sjukvårdsområde utlarmas såväl ambulans som läkarhelikopter. Denna undersökning jämför ambulanssjukvårdarnas och läkarhelikopterns läkares journalföring vid återupplivningssituationer under år 2011. Sammanlagt 85 patientfall identifierades och i 69 fall av dessa hittades såväl ambulansjournalen som läkarjournalen. I undersökningen framgick att det råder stora skillnader i dokumentationen mellan läkar- och ambulansjournalerna. Endast i 4 av 22 patienter som uppnått spontan circulation (ROSC) var ROSC-tiden samma i bägge journalerna. Också i de antecknade tidsintervallen för olika interventioner fanns stora diskrepanser. Endast i 1 fall av 69 var läkarens ankomsttid samma i bägge journalerna. Anteckning om säkrad luftväg saknades i 25 ambulansjournaler och 18 läkarjournaler. Den stora diskrepansen mellan journalerna var överraskande. Ifall man tyr sig till endast endera källan blir databortfallet stort och datans relevans och tillförlitlighet kan ifrågasättas. I fortsättningen borde journalerna utvecklas, så att journalföringen blir enklare och tillförlitligare.
  • Magliocca, Aurora; Olivari, Davide; De Giorgio, Dana; Zani, Davide; Manfredi, Martina; Boccardo, Antonio; Cucino, Alberto; Sala, Giulia; Babini, Giovanni; Ruggeri, Laura; Novelli, Deborah; Skrifvars, Markus B.; Hardig, Bjarne Madsen; Pravettoni, Davide; Staszewsky, Lidia; Latini, Roberto; Belloli, Angelo; Ristagno, Giuseppe (2019)
    Background-Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results-In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO2 and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC-generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end-tidal CO(2 )were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43 +/- 4 versus 18 +/- 4 mmHg; end-tidal CO2: 31 +/- 2 versus 19 +/- 2 mmHg, P Conclusions-This model adds evidence in favor of the use of mechanical devices to provide ongoing high-quality CC and tissue perfusion during ambulance transport.
  • Skrifvars, Markus B.; Ameloot, Koen; Grand, Johannes; Reinikainen, Matti; Hästbacka, Johanna; Niemelä, Ville; Hassager, Christian; Kjaergaard, Jesper; Åneman, Anders; Tiainen, Marjaana; Nielsen, Niklas; Ullen, Susann; Dankiewicz, Josef; Olsen, Markus Harboe; Jorgensen, Caroline Kamp; Saxena, Manoj; Jakobsen, Janus C. (2022)
    Background Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods This systematic review and meta-analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65-70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight-step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all-cause mortality, functional long-term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta-analysis, aggregate data meta-analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. Conclusions This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub-groups differences.
  • Böttiger, Bernd W.; Lockey, Andrew; Aickin, Richard; Carmona, Maria; Cassan, Pascal; Castren, Maaret; Rao, S. S. C. Chakra; De Caen, Allan; Escalante, Raffo; Georgiou, Marios; Hoover, Amber; Kern, Karl B.; Khan, Abdul Majeed S.; Levi, Cianna; Lim, Swee H.; Nadkarni, Vinay; Nakagawa, Naomi V.; Nation, Kevin; Neumar, Robert W.; Nolan, Jerry P.; Mellin-Olsen, Jannicke; Pagani, Jacopo; Sales, Monica; Semeraro, Federico; Stanton, David; Toporas, Cristina; van Grootven, Heleen; Wang, Tzong-Luen; Wijesuriya, Nilmini; Wong, Gillian; Perkins, Gavin D. (2020)
    Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. "All citizens of the world can save a life-CHECK-CALL-COMPRESS." With these words, the International Liaison Committee on Resuscitation launched the 2019 global "World Restart a Heart" initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, "CHECK-CALL-COMPRESS," will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.