Resuscitation
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Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. ⋯ Rapid responses may improve some meaningful outcomes, although these findings remain controversial. These systems may also improve care for patients at the end of life. Rapid response systems are expected to continue evolving with novel developments in monitoring technologies, risk prediction informatics, and work in human factors.
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A do-not-attempt-resuscitation order is issued when it is against the wishes of the patient that cardiopulmonary resuscitation is performed, or when the chance of good quality survival is minimal. Therefore it is essential for physicians to make an objective prearrest prediction of the outcome after an in-hospital cardiac arrest (IHCA). Our aim was external validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in a population based setting. ⋯ The GO-FAR score has satisfactory discrimination, but assessment of the calibration shows that neurologically intact survival is systematically underestimated. Therefore, only with caution should it without model update be taken into clinical practice in settings similar to ours.
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Shockable cardiac rhythms are associated with improved outcomes among out-of-hospital cardiac arrests (OHCA). Initial cardiac rhythm may also be predictive of a short preceding no-flow duration. We examined the relationship between no-flow duration and initial cardiac rhythm, which may demonstrate the urgency in rescuer response and assist with candidacy evaluation for extracorporeal-cardiopulmonary resuscitation (ECPR). ⋯ The odds of a shockable initial rhythm declined with each additional minute of no-flow time, highlighting the importance of early access to defibrillation. Among those with initial shockable rhythms, the preceding no-flow duration was highly likely to be under 10 min, which may inform decisions about ECPR candidacy among select patients with unwitnessed arrests.
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We investigated the national early warning scores (NEWSs) and related outcomes of patients in a tertiary referral center's multidisciplinary emergency department (ED). Patients were further categorized into three groups: triaged directly to intensive care unit (EDICU), triaged to general ward with later ICU admission (EDwardICU) and triaged to general ward (EDward). NEWSs and subsequent outcomes among these sub groups were compared. ⋯ ED-NEWS is independently associated with in-hospital and 30-day mortality with acceptable discrimination capability. Direct and late ICU admissions occurred with comparable NEWSs at admission.
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"All citizens of the world can save a life". With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative - World Restart a Heart (WRAH) - to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. ⋯ Besides schoolchildren education in CPR ("KIDS SAVE LIVES"), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.