Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100839
Anna Thorén , Mikael Andersson Franko , Eva Joelsson-Alm , Araz Rawshani , Thomas Kahan , Johan Engdahl , Martin Jonsson , Therese Djärv , Martin Spångfors
Aim
To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients.
Methods
Prospective, multi-centre study based on 830 complete cases. Data was collected by RRTs in 24 hospitals between October 2019, and January 2020. All NEWS 2 scores were uniformly calculated by the study team. Age was analysed as a continuous variable, in a spline regression model, and categorized into five different models, subsequently explored as additive variables to NEWS 2. The discriminative ability of NEWS 2 was evaluated using the Area under the receiver operating characteristics (AUROC).
Results
The discriminative ability of NEWS 2 alone in predicting 30-day mortality was weak. Adding age as a covariate improved the predictive performance (AUROC 0.66, 0.62–0.70 to 0.70, 0.65–0.73, p = 0.01, 95 % Confidence Interval). There were differences across age groups, with the best discriminative ability identified among patients aged 45-54 years. The 30- and 90-day mortality was 31% and 33% respectively.
Results
Adding age as a covariate improved the discriminative ability of NEWS 2 in the prediction of 30-day mortality among RRT-reviewed patients, with variations observed across age categories. The long- term prognosis of RRT-reviewed patients was poor.
{"title":"Exploring the impact of age on the predictive power of the National Early Warning score (NEWS) 2, and long-term prognosis among patients reviewed by a Rapid Response Team: A prospective, multi-centre study","authors":"Anna Thorén , Mikael Andersson Franko , Eva Joelsson-Alm , Araz Rawshani , Thomas Kahan , Johan Engdahl , Martin Jonsson , Therese Djärv , Martin Spångfors","doi":"10.1016/j.resplu.2024.100839","DOIUrl":"10.1016/j.resplu.2024.100839","url":null,"abstract":"<div><h3>Aim</h3><div>To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients.</div></div><div><h3>Methods</h3><div>Prospective, multi-centre study based on 830 complete cases. Data was collected by RRTs in 24 hospitals between October 2019, and January 2020. All NEWS 2 scores were uniformly calculated by the study team. Age was analysed as a continuous variable, in a spline regression model, and categorized into five different models, subsequently explored as additive variables to NEWS 2. The discriminative ability of NEWS 2 was evaluated using the Area under the receiver operating characteristics (AUROC).</div></div><div><h3>Results</h3><div>The discriminative ability of NEWS 2 alone in predicting 30-day mortality was weak. Adding age as a covariate improved the predictive performance (AUROC 0.66, 0.62–0.70 to 0.70, 0.65–0.73, <em>p</em> = 0.01, 95 % Confidence Interval). There were differences across age groups, with the best discriminative ability identified among patients aged 45-54 years. The 30- and 90-day mortality was 31% and 33% respectively.</div></div><div><h3>Results</h3><div>Adding age as a covariate improved the discriminative ability of NEWS 2 in the prediction of 30-day mortality among RRT-reviewed patients, with variations observed across age categories. The long- term prognosis of RRT-reviewed patients was poor.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100839"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are various theories regarding the ideal hand to be in contact with chest during chest compressions when healthcare professionals and medical students perform cardiopulmonary resuscitation (CPR). Our study aimed to compare the impact of preferred versus non-preferred hand placement on chest on the CPR quality.
Methodology
The volunteers were randomised to place their preferred (P)/non-preferred (NP) hand over sternum for the first session and switch hands for the second. Participants performed 2 min of uninterrupted chest compressions, followed by a 2-minute break and another 2 min of chest compressions on Laerdel QCPR Little Anne® mannequin with auditory feedback. The CPR parameters were analysed using QCPR mobile application. Comfort was assessed using 5-point Likert scale.
Results
Among the 82 volunteers, 51 participants (62.2%) preferred their dominant hand to be in contact with the chest. Comparable results were seen with mean QCPR score, rate of compression, mean depth and good recoil percentage. The NP set had higher adequate depth percentage (94.8 +/- 13.7) than the P set (92.3 +/- 19.9) (p = 0.042), but participants were more comfortable using their preferred hand over chest (p = 0.0001).
Conclusion
Rescuer performance during chest compressions may not be impacted by whether the preferred hand or non-preferred hand of the provider is in contact with sternum.
{"title":"Hands at work: A randomised cross-over mannequin-based trial exploring the impact of hand preference of health care professionals on effectiveness of chest compressions","authors":"Shivam Thaker , Savan Kumar Nagesh , Prithvishree Ravindra , Eesha Vilas Kharade , Nitish Reddy Lingala , Shambhavi Vivek Joshi , Sumanth Mallikarjuna Majgi , Shreya Das Adhikari","doi":"10.1016/j.resplu.2024.100849","DOIUrl":"10.1016/j.resplu.2024.100849","url":null,"abstract":"<div><h3>Aim and background</h3><div>There are various theories regarding the ideal hand to be in contact with chest during chest compressions when healthcare professionals and medical students perform cardiopulmonary resuscitation (CPR). Our study aimed to compare the impact of preferred versus non-preferred hand placement on chest on the CPR quality.</div></div><div><h3>Methodology</h3><div>The volunteers were randomised to place their preferred (P)/non-preferred (NP) hand over sternum for the first session and switch hands for the second. Participants performed 2 min of uninterrupted chest compressions, followed by a 2-minute break and another 2 min of chest compressions on Laerdel QCPR Little Anne® mannequin with auditory feedback. The CPR parameters were analysed using QCPR mobile application. Comfort was assessed using 5-point Likert scale.</div></div><div><h3>Results</h3><div>Among the 82 volunteers, 51 participants (62.2%) preferred their dominant hand to be in contact with the chest. Comparable results were seen with mean QCPR score, rate of compression, mean depth and good recoil percentage. The NP set had higher adequate depth percentage (94.8 +/- 13.7) than the P set (92.3 +/- 19.9) (p = 0.042), but participants were more comfortable using their preferred hand over chest (p = 0.0001).</div></div><div><h3>Conclusion</h3><div>Rescuer performance during chest compressions may not be impacted by whether the preferred hand or non-preferred hand of the provider is in contact with sternum.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100849"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100850
Raimund Lechner , Markus Isser , Willi Tröger , Valentin Schiessendoppler , Wolfgang Lederer , Frederik Eisendle
Trauma care prioritizes life-threatening conditions using the ABCDE algorithm based on the principle “treat first what kills first”. As for catastrophic hemorrhage, a leading preventable cause of death in trauma, modifications of this algorithm are necessary in specific cases. In cold climates, life-threatening hypothermia poses additional challenges. Rapid cooling of a patient’s core temperature, especially when immobile or poorly insulated, necessitates early prevention. Modified algorithms like the military MhARCH therefore prioritize hypothermia management alongside hemorrhage control in extreme conditions. This article advocates for the crABCDE approach in civilian rescue, emphasizing immediate hypothermia prevention in cold, wet, or high-altitude environments. Tailored protocols that consider environmental risks and patient factors are essential for improving outcomes in both military and civilian trauma care.
{"title":"The modified crABCDE treatment algorithm as recommendation in extreme cold","authors":"Raimund Lechner , Markus Isser , Willi Tröger , Valentin Schiessendoppler , Wolfgang Lederer , Frederik Eisendle","doi":"10.1016/j.resplu.2024.100850","DOIUrl":"10.1016/j.resplu.2024.100850","url":null,"abstract":"<div><div>Trauma care prioritizes life-threatening conditions using the ABCDE algorithm based on the principle “treat first what kills first”. As for catastrophic hemorrhage, a leading preventable cause of death in trauma, modifications of this algorithm are necessary in specific cases. In cold climates, life-threatening hypothermia poses additional challenges. Rapid cooling of a patient’s core temperature, especially when immobile or poorly insulated, necessitates early prevention. Modified algorithms like the military MhARCH therefore prioritize hypothermia management alongside hemorrhage control in extreme conditions. This article advocates for the crABCDE approach in civilian rescue, emphasizing immediate hypothermia prevention in cold, wet, or high-altitude environments. Tailored protocols that consider environmental risks and patient factors are essential for improving outcomes in both military and civilian trauma care.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100850"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100856
Katrine D. Brodersen , Søren R. Petersen , Kasper Bonnesen , Christian J. Terkelsen , Morten Schmidt
Aims
Cardiac arrest is registered in the Danish National Patient Registry (DNPR) with the International Classification of Diseases 10th revision code I46. However, it does not distinguish between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). We validated an algorithm to identify cardiac arrest subtypes (out-of-hospital vs. in-hospital).
Methods
From Aarhus University Hospital, Denmark, we sampled patients with a primary or secondary cardiac arrest discharge diagnosis during 2019–2023. The algorithm categorized these patients as OHCA if they (1) only had a single department course during their hospitalization or (2) had multiple department courses during their hospitalization but were discharged with a cardiac arrest diagnosis from the first department course. The algorithm categorized the remaining patients as IHCA. We randomly sampled 200 patients with algorithm-based OHCA (n = 100) and IHCA (n = 100). Using medical record review as the reference, we calculated positive predictive values (PPVs) with 95% confidence intervals (CIs).
Results
Cardiac arrest was confirmed in 192 of 200 cases, yielding a PPV for cardiac arrest overall of 96% (95% CI: 92–98%). The PPV was 87% (95% CI: 79–92%) for OHCA and 61% (95% CI: 51–70%) for IHCA. The results were robust in age and sex strata.
Conclusions
The validity of a cardiac arrest diagnosis in the DNPR was overall high. The algorithm to distinguish cardiac arrest subtypes showed a high PPV for OHCA but a poor PPV for IHCA.
{"title":"Validity of out-of-hospital and in-hospital cardiac arrest algorithms in the Danish National Patient Registry","authors":"Katrine D. Brodersen , Søren R. Petersen , Kasper Bonnesen , Christian J. Terkelsen , Morten Schmidt","doi":"10.1016/j.resplu.2024.100856","DOIUrl":"10.1016/j.resplu.2024.100856","url":null,"abstract":"<div><h3>Aims</h3><div>Cardiac arrest is registered in the Danish National Patient Registry (DNPR) with the International Classification of Diseases 10<sup>th</sup> revision code I46. However, it does not distinguish between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). We validated an algorithm to identify cardiac arrest subtypes (out-of-hospital vs. in-hospital).</div></div><div><h3>Methods</h3><div>From Aarhus University Hospital, Denmark, we sampled patients with a primary or secondary cardiac arrest discharge diagnosis during 2019–2023. The algorithm categorized these patients as OHCA if they (1) only had a single department course during their hospitalization or (2) had multiple department courses during their hospitalization but were discharged with a cardiac arrest diagnosis from the first department course. The algorithm categorized the remaining patients as IHCA. We randomly sampled 200 patients with algorithm-based OHCA (<em>n</em> = 100) and IHCA (<em>n</em> = 100). Using medical record review as the reference, we calculated positive predictive values (PPVs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Cardiac arrest was confirmed in 192 of 200 cases, yielding a PPV for cardiac arrest overall of 96% (95% CI: 92–98%). The PPV was 87% (95% CI: 79–92%) for OHCA and 61% (95% CI: 51–70%) for IHCA. The results were robust in age and sex strata.</div></div><div><h3>Conclusions</h3><div>The validity of a cardiac arrest diagnosis in the DNPR was overall high. The algorithm to distinguish cardiac arrest subtypes showed a high PPV for OHCA but a poor PPV for IHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100856"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100838
Janet E. Bray, Gavin D. Perkins
{"title":"Reply to locked vs. unlocked AED cabinets: The Western Australian perspective on improving accessibility and outcomes","authors":"Janet E. Bray, Gavin D. Perkins","doi":"10.1016/j.resplu.2024.100838","DOIUrl":"10.1016/j.resplu.2024.100838","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100838"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100859
Futoshi Nagashima , Satoshi Inoue , Tomohiro Oda , Tomohiro Hamagami , Tomoya Matsuda , Makoto Kobayashi , Akihiko Inoue , Toru Hifumi , Tetsuya Sakamoto , Yasuhiro Kuroda , The SAVE-J II study group
Introduction
Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly utilized for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of prehospital physician presence on the outcomes of ECPR-treated OHCA patients remains uncertain. This study aimed to evaluate whether the presence of prehospital physicians improves 30-day survival and favorable neurological outcomes in this population.
Methods
This retrospective study analyzed data from the SAVE-J II study, a nationwide multicenter cohort of OHCA patients treated with ECPR in Japan. Patients were divided into two groups: prehospital physician absence and prehospital physician presence. Propensity score matching (PSM) was performed using six covariates (age, sex, witness status, presence of bystander CPR, initial heart rhythm, and location of cardiac arrest) to adjust for baseline differences. Sensitivity analyses included PSM with additional covariates (prehospital time and Low flow time), inverse probability of treatment weighting (IPTW), and varying matching ratios. Primary and secondary outcomes were 30-day survival and favorable neurological outcome (Cerebral Performance Category [CPC] 1–2), respectively.
Results
Of the 1,641 patients included, 448 were in the prehospital physician presence group and 1,193 in the prehospital physician absence group. Before PSM, 30-day survival rates were 28.2% (prehospital physician presence) vs. 25.7% (prehospital physician absence) (p = 0.350). After 1:1 PSM (6 covariates), the 30-day survival rate was significantly higher in the prehospital physician presence group (29.6%) compared to the prehospital physician absence group (22.7%) (p = 0.028), while favorable neurological outcomes showed no significant difference (prehospital physician presence: 14.5% vs. prehospital physician absence: 11.0%, p = 0.092). Sensitivity analyses confirmed the robustness of the findings, with 30-day survival consistently higher in the prehospital physician presence group across models, including 7-covariate PSM (31.8% vs. 23.0%, p = 0.009) and IPTW with 8 covariates (35.6% vs. 25.1%, p = 0.026). However, the 8-covariate IPTW model exhibited residual imbalance (SMD > 0.1 in four covariates). Favorable neurological outcomes did not show significant differences in any analysis.
Conclusions
Prehospital physician presence was associated with improved 30-day survival in OHCA patients undergoing ECPR. However, favorable neurological outcomes did not show significant improvement. These findings highlight the need for strategies to optimize low-flow time and explore the potential role of prehospital ECPR initiation. Further prospective studies are required to validate these findings and improve outcomes in this critical population.
{"title":"Effect of prehospital physician presence on Out-of-Hospital cardiac arrest (OHCA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR): A secondary analysis of the SAVE-J II study","authors":"Futoshi Nagashima , Satoshi Inoue , Tomohiro Oda , Tomohiro Hamagami , Tomoya Matsuda , Makoto Kobayashi , Akihiko Inoue , Toru Hifumi , Tetsuya Sakamoto , Yasuhiro Kuroda , The SAVE-J II study group","doi":"10.1016/j.resplu.2024.100859","DOIUrl":"10.1016/j.resplu.2024.100859","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly utilized for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of prehospital physician presence on the outcomes of ECPR-treated OHCA patients remains uncertain. This study aimed to evaluate whether the presence of prehospital physicians improves 30-day survival and favorable neurological outcomes in this population.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from the SAVE-J II study, a nationwide multicenter cohort of OHCA patients treated with ECPR in Japan. Patients were divided into two groups: prehospital physician absence and prehospital physician presence. Propensity score matching (PSM) was performed using six covariates (age, sex, witness status, presence of bystander CPR, initial heart rhythm, and location of cardiac arrest) to adjust for baseline differences. Sensitivity analyses included PSM with additional covariates (prehospital time and Low flow time), inverse probability of treatment weighting (IPTW), and varying matching ratios. Primary and secondary outcomes were 30-day survival and favorable neurological outcome (Cerebral Performance Category [CPC] 1–2), respectively.</div></div><div><h3>Results</h3><div>Of the 1,641 patients included, 448 were in the prehospital physician presence group and 1,193 in the prehospital physician absence group. Before PSM, 30-day survival rates were 28.2% (prehospital physician presence) vs. 25.7% (prehospital physician absence) (p = 0.350). After 1:1 PSM (6 covariates), the 30-day survival rate was significantly higher in the prehospital physician presence group (29.6%) compared to the prehospital physician absence group (22.7%) (p = 0.028), while favorable neurological outcomes showed no significant difference (prehospital physician presence: 14.5% vs. prehospital physician absence: 11.0%, p = 0.092). Sensitivity analyses confirmed the robustness of the findings, with 30-day survival consistently higher in the prehospital physician presence group across models, including 7-covariate PSM (31.8% vs. 23.0%, p = 0.009) and IPTW with 8 covariates (35.6% vs. 25.1%, p = 0.026). However, the 8-covariate IPTW model exhibited residual imbalance (SMD > 0.1 in four covariates). Favorable neurological outcomes did not show significant differences in any analysis.</div></div><div><h3>Conclusions</h3><div>Prehospital physician presence was associated with improved 30-day survival in OHCA patients undergoing ECPR. However, favorable neurological outcomes did not show significant improvement. These findings highlight the need for strategies to optimize low-flow time and explore the potential role of prehospital ECPR initiation. Further prospective studies are required to validate these findings and improve outcomes in this critical population.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100859"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100854
Muhammad Faisal Khan, Omer Shafiq, Asad Latif
{"title":"In-hospital cardiac arrest in middle-income settings: A comprehensive analysis of clinical profiles and outcomes of both adults and pediatrics","authors":"Muhammad Faisal Khan, Omer Shafiq, Asad Latif","doi":"10.1016/j.resplu.2024.100854","DOIUrl":"10.1016/j.resplu.2024.100854","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100854"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2024.100862
Michael C. Spaeder , Laura Lee , Chelsea Miller , Jessica Keim-Malpass , William G. Harmon , Sherry L. Kausch
Background
More than 90% of in-hospital cardiac arrests involving children occur in an intensive care unit (ICU) with less than half surviving to discharge. We sought to assess the association of the display of risk scores of cardiovascular and respiratory instability with the incidence of cardiac arrest in a pediatric ICU.
Methods
Employing supervised machine learning, we previously developed predictive models of cardiovascular and respiratory instability, incorporating real-time physiologic and laboratory data, to display risk scores for potentially catastrophic clinical events in the subsequent 12 h. Clinical implementation with risk scores displayed on large screen monitors in multiple areas throughout the ICU was finalized in July 2022. We compared the incidence of cardiac arrest events in the 18-months pre- and post-implementation.
Results
The cardiac arrest incidence rate dropped from 3.0 events (95% CI 2.0–4.4) to 2.4 events (95% CI 1.6–3.5) per 1000 patient days following implementation. We observed a 50% increase in the rate of cardiac arrest events where return of spontaneous circulation (ROSC) was achieved (p = 0.025). The incidence rate of cardiac arrest without ROSC dropped from 1.4 events (95% CI 0.7–2.4) to 0.4 events (95% CI 0.1–0.9) per 1000 patient days (incidence rate difference = 1.0 (95% CI 0.13–1.87), p = 0.01).
Conclusions
We observed a non-significant decrease in the rates of cardiac arrest events and an increase in the rate of cardiac arrests events where ROSC was achieved following the implementation of a predictive analytics display of risk scores.
{"title":"Incidence of cardiac arrest following implementation of a predictive analytics display in a pediatric intensive care unit","authors":"Michael C. Spaeder , Laura Lee , Chelsea Miller , Jessica Keim-Malpass , William G. Harmon , Sherry L. Kausch","doi":"10.1016/j.resplu.2024.100862","DOIUrl":"10.1016/j.resplu.2024.100862","url":null,"abstract":"<div><h3>Background</h3><div>More than 90% of in-hospital cardiac arrests involving children occur in an intensive care unit (ICU) with less than half surviving to discharge. We sought to assess the association of the display of risk scores of cardiovascular and respiratory instability with the incidence of cardiac arrest in a pediatric ICU.</div></div><div><h3>Methods</h3><div>Employing supervised machine learning, we previously developed predictive models of cardiovascular and respiratory instability, incorporating real-time physiologic and laboratory data, to display risk scores for potentially catastrophic clinical events in the subsequent 12 h. Clinical implementation with risk scores displayed on large screen monitors in multiple areas throughout the ICU was finalized in July 2022. We compared the incidence of cardiac arrest events in the 18-months pre- and post-implementation.</div></div><div><h3>Results</h3><div>The cardiac arrest incidence rate dropped from 3.0 events (95% CI 2.0–4.4) to 2.4 events (95% CI 1.6–3.5) per 1000 patient days following implementation. We observed a 50% increase in the rate of cardiac arrest events where return of spontaneous circulation (ROSC) was achieved (<em>p</em> = 0.025). The incidence rate of cardiac arrest without ROSC dropped from 1.4 events (95% CI 0.7–2.4) to 0.4 events (95% CI 0.1–0.9) per 1000 patient days (incidence rate difference = 1.0 (95% CI 0.13–1.87), <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>We observed a non-significant decrease in the rates of cardiac arrest events and an increase in the rate of cardiac arrests events where ROSC was achieved following the implementation of a predictive analytics display of risk scores.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100862"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.resplu.2025.100866
Hai-Bo Huang , Kui Sang , Ming Zhou , Lin Yi , Jiang-Qin Liu , Chuan-Zhong Yang , Brenda H.Y. Law , Georg M. Schmölzer , Po-Yin Cheung
Background
Neonatal resuscitation is stressful for healthcare professionals as measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Little is known regarding the perceived workload and associated factors among healthcare professionals including medical doctors (MDs) and nurses/midwives who have differences in training and experiences. We aimed to characterize and compare the perceived workload between MDs and nurses/midwives who provided neonatal resuscitation.
Methods
In a prospectively designed, cellphone-based surveillance, perceived workload and stress of MDs and nurses/midwives during neonatal resuscitation was evaluated using a modified multi-dimensional NASA-TLX survey in three tertiary Neonatal Intensive Care Units in China. The NASA-TLX data on mental, physical, temporal demand, performance, effort, and frustration were independently rated by participants and collated to a composite score of all dimensions. Demographics of participants and deliveries were also collected for statistical analyses using univariate comparison and multiple linear regression.
Results
From 410 valid surveys (187 (46%) MDs; 223 (54%) nurses/midwives), significant differences were noted between MDs and nurses/midwives including working years and dimensional and overall NASA-TLX scores. While MDs had lower overall NASA-TLX scores than nurses, their scores were inversely related with simulation-based training. More team members presence during resuscitation was associated with higher NASA-TLX scores. Other independent factors associated with NASA-TLX scores included gestational age, Apgar score at 1 min, year of practice for MDs and all resuscitation questions asked by nurses/midwives.
Conclusions
MDs and nurses/midwives attending deliveries had different perceptions in workload and stress which could be lowered from simulation-based training in neonatal resuscitation.
{"title":"The perceived workload of first-line healthcare professionals during neonatal resuscitation","authors":"Hai-Bo Huang , Kui Sang , Ming Zhou , Lin Yi , Jiang-Qin Liu , Chuan-Zhong Yang , Brenda H.Y. Law , Georg M. Schmölzer , Po-Yin Cheung","doi":"10.1016/j.resplu.2025.100866","DOIUrl":"10.1016/j.resplu.2025.100866","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal resuscitation is stressful for healthcare professionals as measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Little is known regarding the perceived workload and associated factors among healthcare professionals including medical doctors (MDs) and nurses/midwives who have differences in training and experiences. We aimed to characterize and compare the perceived workload between MDs and nurses/midwives who provided neonatal resuscitation.</div></div><div><h3>Methods</h3><div>In a prospectively designed, cellphone-based surveillance, perceived workload and stress of MDs and nurses/midwives during neonatal resuscitation was evaluated using a modified multi-dimensional NASA-TLX survey in three tertiary Neonatal Intensive Care Units in China. The NASA-TLX data on mental, physical, temporal demand, performance, effort, and frustration were independently rated by participants and collated to a composite score of all dimensions. Demographics of participants and deliveries were also collected for statistical analyses using univariate comparison and multiple linear regression.</div></div><div><h3>Results</h3><div>From 410 valid surveys (187 (46%) MDs; 223 (54%) nurses/midwives), significant differences were noted between MDs and nurses/midwives including working years and dimensional and overall NASA-TLX scores. While MDs had lower overall NASA-TLX scores than nurses, their scores were inversely related with simulation-based training. More team members presence during resuscitation was associated with higher NASA-TLX scores. Other independent factors associated with NASA-TLX scores included gestational age, Apgar score at 1 min, year of practice for MDs and all resuscitation questions asked by nurses/midwives.</div></div><div><h3>Conclusions</h3><div>MDs and nurses/midwives attending deliveries had different perceptions in workload and stress which could be lowered from simulation-based training in neonatal resuscitation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"21 ","pages":"Article 100866"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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