Resuscitation
-
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.
summary -
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.
-
Hypoxic-ischemic brain injury is the main cause of death and disability of comatose patients after cardiac arrest. Early and reliable prognostication is challenging. Common prognostic tools include clinical neurological examination and electrophysiological measures. Brain imaging is well established for diagnosis of focal cerebral ischemia but has so far not found worldwide application in this patient group. ⋯ CT derived grey-white matter ratio and MRI based measures of diffusivity and connectivity hold promise to improve outcome prediction after cardiac arrest. Prospective validation studies in a multivariable approach are needed to determine the additional value for the individual patient.
-
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.
-
Perinatal and neonatal deaths account for an increasing proportion of deaths under 5 years old. We present essential elements to reduce perinatal mortality, barriers to establishing these elements, and the role of developing emergency care systems. Essential elements for prompt perinatal and postnatal care are categorised based on care-seeking behaviours, access to a primary care facility and for the severely ill, access to advanced neonatal care. The role of emergency care systems is key to overcoming obstacles currently faced in countries with high perinatal and neonatal mortality rates.