Resuscitation
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Multicenter Study
Hospitals with More-active Participation in Conducting Standardized In-situ Mock Codes have Improved Survival After In-hospital Cardiopulmonary Arrest.
Why is this important?
In-hospital cardiac arrest (IHCA) training is an important component of both foundational and continuing medical education. Nonetheless patient survival after IHCA continues to vary across institutions, making it a priority for improvement.
What did they do?
Josey and team set out to identify whether greater hospital use of in-situ AHCI drills (‘in-situ mock codes’ - ISMC) was associated with improved IHCA survival. They measured both hospital-level simulation participation and IHCA discharge survival rates across 26 hospitals in their US multi-state non-profit health system.
And they found?
Hospitals with more active in-hospital cardiac arrest simulation training also had better IHCA survival (43% vs 32%, OR 0.62), even after adjusting for case-mix and acuity.
It is reasonable to conclude that better in-hospital code training leads to better basic & advanced life support and thus better IHCA survival – suggested, for example, by their observation of shorter time to defibrillation during arrest drills among high participation hospitals.
In fact they extraopated that each additional 1.1 drill/100 beds/year equated with one extra life saved. Interestingly the benefit of ISMC held up for large and medium-sized hospitals, but not small hospitals (=< 25 beds).
Be smart
Whether these results represent a direct casual effect of simulation training to improve survival, or an indirect effect of hospital safety culture on both simulation participation and patient survival, it is nonetheless an important result.
Plus a great example of studying a meaningful outcome (survival to discharge) instead of surrogate markers often employed in resuscitation and simulation research.
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Multicenter Study Observational Study
The effect of different target temperatures in targeted temperature management on neurologically favorable outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry).
It has been insufficiently investigated whether neurological function after out-of-hospital cardiac arrest (OHCA) would differ by 1 °C change in ordered target temperature of 33-36 °C among patients undergoing targeted temperature management (TTM) in the real-world setting. ⋯ In this population, we evaluated the difference in outcomes after adult OHCA patients received TTM by 1 °C change in ordered target temperature of 33-36 °C and demonstrated that there was no statistically significant difference in neurologically favorable outcomes after OHCA irrespective of target temperature.
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Observational Study
Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.
To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm. ⋯ Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.
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Although various quantitative methods have been developed for predicting neurological prognosis in patients with out-of-hospital cardiac arrest (OHCA), they are too complex for use in clinical practice. We aimed to develop a simple decision rule for predicting neurological outcomes following the return of spontaneous circulation (ROSC) in patients with OHCA using fast-and-frugal tree (FFT) analysis. ⋯ A simple decision rule developed via FFT analysis can aid clinicians in predicting neurological outcomes following ROSC in patients with OHCA.
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Multicenter Study Observational Study
End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation.
Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) >20 mmHg. ⋯ Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with survival to hospital discharge, and ETCO2 was not different in survivors versus non-survivors.