Resuscitation
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Comparative Study
'Do not attempt resuscitation'--do standardised order forms make a clinical difference above hand-written note entries?
To quantify any effect of Standardised Order Forms (SOFs), versus hand-written note entries for 'Do Not Attempt Resuscitation'--on the selection and survival of remaining cardiopulmonary resuscitation (CPR) attempts. ⋯ The introduction of SOFs for DNAR orders was associated with a significantly longer duration of CPR (on average by 3-4min) but no difference in overall number, demographics or type of arrest or survival in the remaining CPR attempts.
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A growing body of evidence suggests that variability in post-cardiac arrest care contributes to differential outcomes of patients with initial return of spontaneous circulation after cardiac arrest. We examined hospital-level variation in mortality of patients admitted to United States intensive care units (ICUs) with a diagnosis of cardiac arrest. ⋯ We demonstrate hospital-level variation in severity adjusted mortality among patients admitted to the ICU after cardiac arrest. We identify a volume-outcome relationship showing lower mortality among patients admitted to ICUs that treat a high volume of post-cardiac arrest patients. Prospective studies should identify hospital-level and patient care factors that contribute to post-cardiac arrest survival.
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To review the characteristics and outcome of cardiopulmonary resuscitation in children at a rural hospital in Kenya. ⋯ Cardiopulmonary arrest after admission has a very poor prognosis in our hospital. Infectious diseases are the main underlying causes of arrest. If a child fails to respond to the basic tenements of PALS within 15 min then it is unlikely that further efforts to sustain life will be fruitful in hospitals where ventilation facilities are not present.
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Comparative Study
Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest.
Cardiac arrest patients with initial non-shockable rhythm progressing to shockable rhythm have been reported to have inferior outcome to those remaining non-shockable. We wanted to confirm this observation in our prospectively collected database, and assess whether differences in cardiopulmonary resuscitation (CPR) quality could help to explain any such difference in outcome. ⋯ Progressing from initial non-shockable rhythms to a shockable rhythm was associated with improved outcome after OHCA. This occurred despite more pauses in chest compressions in the shockable group, probably related to defibrillation attempts.