Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Mar 2013
Review Meta AnalysisQuantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis.
Background- Evidence has accrued that cardiopulmonary resuscitation quality affects cardiac arrest outcome. However, the relative contributions of chest compression components (such as rate and depth) to successful resuscitation remain unclear. Methods and Results- We sought to measure the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome through systematic review and meta-analysis. ⋯ Likewise, survivors were significantly more likely to have received chest compression rates closer to 85 to 100 compressions per minute (cpm) than nonsurvivors (absolute mean difference from 85 cpm, -4.81 cpm; 95% confidence interval, -8.19 to -1.43 [P=0.005]; from 100 cpm, -5.04 cpm; 95% confidence interval, -8.44 to -1.65 [P=0.004]; n=6 studies; I(2)<49%; P for heterogeneity >0.2). No significant difference in no-flow fraction (n=7 studies) or ventilation rate (n=4 studies) was detected between survivors and nonsurvivors. Conclusions- Deeper chest compressions and rates closer to 85 to 100 cpm are significantly associated with improved survival from cardiac arrest.
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Circ Cardiovasc Qual · Mar 2013
Comparative StudyPerformance of the EuroSCORE models in emergency cardiac surgery.
Accurate risk-adjustment models are useful for clinical decision making and are important for minimizing any tendency toward risk-averse clinical practice. In cardiac surgery, emergency patients are potentially at greatest risk of inappropriate risk-averse clinical decisions. UK cardiac surgery outcomes are currently risk-adjusted with EuroSCORE models. The objective of this study was to assess the performance of the EuroSCORE models in emergency cardiac surgery. ⋯ Both EuroSCORE models demonstrated poor calibration and comparatively poor discrimination for emergency cardiac surgery. This has important implications when these models are used for clinical decision making or to adjust governance analyses.
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Circ Cardiovasc Qual · Mar 2013
Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries.
Preoperative management of patients with aortic stenosis (AS) who need noncardiac surgery (NCS) remains controversial. We sought to determine the impact of AS on the postoperative outcomes after NCS. ⋯ Presence of AS adversely affects postoperative outcomes among patients undergoing NCS, evidenced by a higher 30-day mortality and postoperative myocardial infarction after NCS.