Resuscitation
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Patients suffering out-of-hospital cardiac arrest (OHCA) have a poor prognosis but survival among subgroups differs greatly. Previous studies have shown conflicting results on whether patient comorbidity affects outcome. The aim of this national study was to investigate the effect of comorbidity on outcome after OHCA in Sweden. ⋯ This large national study showed that increasing comorbidity decreased the chance of survival to 30 days in OHCA. This association remained after covariate adjustment.
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In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR. ⋯ There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.
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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.
summary -
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.