Crit Care Resusc
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Observational Study
Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital.
The role of extracorporeal membrane oxygenation (ECMO) for adults in regional centres with low numbers of patients receiving ECMO is unclear. A robust service delivery model may assist in the quality provision of ECMO. ⋯ Provision of ECMO in a tertiary regional hospital within a multifaceted clinical service model is feasible and safe. Partnership with a centre providing ECMO for a high number of patients during service development and delivery is desirable.
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Multicenter Study
Resource use, governance and case load of rapid response teams in Australia and New Zealand in 2014.
Rapid response teams (RRTs) are a mandatory element of Australian national health care policy. However, the uptake, resourcing, case load and funding of RRTs in Australian and New Zealand hospitals remain unknown. ⋯ In cases where data were known, ICU staff provided staff for most RRTs, and oversight for more than 80% of RRTs. However, additional funding for ICU RRT staff and dedicated doctors was relatively uncommon.
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Rapid response team (RRT) responders would benefit from training, to ensure competent and efficient management of the deteriorating patient. ⋯ There was unanimous agreement by participants for further development of a formalised RRT training course for responding to the deteriorating patient. Participants who were RRT educators also supported the development of an RRT train-the-trainer course.
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Several biological markers can predict outcomes in patients with subarachnoid haemorrhage (SAH), but markers to predict neurological deficit severity in patients with SAH and poor neurological condition have not yet been established. Soluble CD40 ligand (sCD40L) and platelet-derived growth factor (PDGF) are related to the systemic inflammatory response. ⋯ Our data suggest that sCD40L, PDGF-BB, WBC count, CRP and body temperature can predict the neurological outcome in patients with SAH and poor neurological condition.
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The long-term outcomes of patients with drug overdose admitted to the intensive care unit compared with those admitted to general wards have not been assessed. We aimed to compare the recurrence of overdose, mortality after hospital discharge, cause of death and quality-of-life scores (using the EQ-5D questionnaire) between the ICU patients and general ward patients. ⋯ ICU and general ward patients with overdose have similar, overwhelming prevalences of psychiatric disease, and similar outcome profiles. Such patients experience frequent overdoses and, despite being young, if admitted to the ICU, have a 10% 4-year mortality, with self-harm the dominant cause of death. Finally, among survivors who responded to the follow-up questionnaire, quality of life is poor.