Resuscitation最新文献

Background and objectives: Advanced neonatal resuscitation interventions (ANRIs) are rarely performed for late preterm and term infants. However, healthcare providers in community hospitals may need to perform ANRIs, while having limited experience and resources. Understanding practice differences between hospitals of different levels of service (LoS) and rural/urban location may inform quality improvement. Our objective are to a) examine how hospital LoS and rural/urban location relate to ANRI rates in Alberta, Canada, a public health system with standardized Neonatal Resuscitation Program® training and b) describe trends in neonatal resuscitation interventions and outcomes.

Methods/design: All live births ≥ 34 weeks in Alberta from 2000 to 2020 were examined using retrospective, administrative data. Hospitals (n = 97) were categorized based on availability of delivery support, cesarian sections, pediatricians/obstetricians, and NICUs, then subcategorized by population and proximity to metropolitan centres. Rates of individual interventions or any ANRI were compared.

Results: 966,475 births were included. ANRI rates were: intubation for ventilation (0.8%), chest compression (0.2%), epinephrine (0.02%), any ANRI (0.95%). While ANRIs were lower in community hospitals and home births, with lower hospital level of service, intubation rates decreased and chest compressions rates increased. Level 1A (OR:4.52, 95% CI 3.59-5.62) and home births (OR:3.09, 95% CI 2.52-3.76) had much higher odds of chest compressions. No pattern was observed between rural/remote sites of similar LoS.

Conclusions: In this population study, there were higher chest compressions rates and lower intubation rates at hospitals without NICUs, despite standardized training. Reasons for this difference require further investigation.

Aim: This study aimed to investigate the associations between hypothermia and mortality or poor neurological outcome in a nationwide cohort of drowning patients with out-of-hospital cardiac arrest (OHCA).

Methods: This nationwide, registry-based cohort study reported in-hospital data on drowning patients with OHCA following the Utstein Style For Drowning. Drowning patients with OHCA were identified in the Danish Cardiac Arrest Registry from 2016 to 2021. The primary outcome was the rate of mortality or poor neurological outcome (corresponding to a modified Rankin Scale [mRS] score > 3) at 180 days after the drowning incident in patients with OHCA and accidental hypothermia (<35 °C) vs normothermia (≥35 °C).

Results: This study identified 118 drowning patients with OHCA and found an increased rate of mRS > 3 at 180 days after the drowning incident in the hypothermic group compared to the normothermic group (74% vs 18%, p < 0.001). The 180-day mortality (mRS = 6) was 69% in the hypothermic group compared to 16% in the normothermic group (p < 0.001). The hypothermic group had higher rates of ongoing CPR at hospital admission (45% vs 7%, p < 0.001), intensive care unit admission (70% vs 41%, p = 0.003), and mechanical ventilation during hospitalisation (78% vs 32%, p < 0.001) compared to the normothermic group.

Conclusion: Hypothermic drowning patients with OHCA had a higher risk of mortality or poor neurological outcome at 180 days compared to normothermic drowning patients with OHCA. This association may likely be explained by confounding factors such as prolonged submersion and cardiac arrest. Further research is warranted.

Background: The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined.

Methods: Cost analyses of PH-ECPR was performed utilizing current PH-ECPR trial, NSW Ambulance Cardiac Arrest Registry (CAR), geospatial modelling and in-hospital costings data. Markov modelling was completed to combine the PH-ECPR cost analysis with reported patient outcomes across multiple ECPR strategies. Bridging formulae from ECPR survivor cerebral performance category (CPC) scores were used to estimate cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs). Probabilistic Sensitivity Analysis was completed to assess the probability of cost effectiveness for base case and PH-ECPR strategy variations.

Results: Assuming a base case of 100 patients per year, with a 25% team allocation to ECPR, the average pre-hospital ECPR cost per patient was $12,741 and total of $88,656 AUD equating to approximately $44,000 per QALY. Addition of a conservative 10% kidney organ donation rate reduces the cost per QALY to $22,000. Patient survival rate, the proportion of time the pre-hospital ECPR team are allocated to ECPR and organ donation significantly impact PH-ECPR cost effectiveness.

Conclusion: Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness.

Aim: To determine the association between institutional experience with extracorporeal cardiopulmonary resuscitation (ECPR) and outcomes after out-of-hospital cardiac arrest (OHCA).

Methods: We analyzed data from the JAAM-OHCA registry, a nationwide multicenter database containing information on patients who experienced OHCA in Japan between June 2014 and December 2020. The study population consisted of patients with OHCA who were in cardiac arrest on hospital arrival and treated with extracorporeal membrane oxygenation (ECMO). Each patient was assigned a sequential number based on the order of initiation of ECPR at each facility. The primary outcome was 30-day survival and the secondary outcome was the interval between hospital admission and initiation of ECMO.

Results: Data for a total of 2,315 patients with OHCA and cardiac arrest on hospital arrival who were treated with ECPR at any of 87 facilities were analyzed. On admission, 1,047 patients had shockable rhythm and 1,268 had non-shockable rhythm. The 30-day survival rate was not significantly associated with the accumulated case volume of ECPR. The interval between hospital arrival and initiation of ECMO decreased significantly with increasing experience of ECPR (p < 0.001, Jonckheere-Terpstra test). In non-shockable cases, 30-day survival tended to improve with increasing experience of ECPR (p = 0.04, Cochran-Armitage trend test).

Conclusion: Increasing institutional experience of ECPR did not significantly improve 30-day survival after OHCA but was associated with a shorter interval between hospital arrival and initiation of ECMO. In patients with non-shockable OHCA, increasing experience of ECPR improved 30-day survival. (246/250 words).