Resuscitation plus最新文献

Background

Early defibrillation with an automated external defibrillator (AED) is a key element in the out-of-hospital cardiac arrest (OHCA) chain. However, a public automatic defibrillator (PAD) is often not easily accessible during emergency situations. Here, we have developed an AED-based alarm system together with a smartphone Hearing AED application (APP) that would activate registered public access AED within 300 m radius from the location of an OHCA event. It also alerts nearby related personnel to bring in the AED to the OHCA location for emergency assistance. The aim of this study is to determine if this novel Hearing AED alarm system shortens the AED delivery time.

Methods

This was a randomized controlled simulation study. Participants were randomly assigned to one of the 3 groups: (a) bystander group, (b) APP responder group, and (c) AED alarm responder in equal ratios. The bystanders were stationed at the OHCA scene, and must access a nearby AED by the instruction of the dispatcher of emergency medical services. APP responders were stationed within 300 m of the cardiac arrest scene, and were activated by the Hearing AED APP. The AED alarm responders were brought to AED location, and were activated by the AED-based alarm device mounted on an AED case. We measured the time taken to find and bring the nearby AED to the OHCA scene. The primary outcome was the total delivery time in each group. The secondary outcomes were times needed: (a) from the starting point to AED place, (b) from AED place to the OHCA scene, and (c) the operation time.

Results

We enrolled 90 participants in this study. The total AED delivery times were significantly different across the 3 groups. The shortest time was in the AED alarm responder group, compared with the other two groups. The median time from the starting point to AED was statistically shorter in the bystander group than in the APP responder group (116.0 sec, IQR 80.0–135.0 vs 159.0 sec, IQR 98.5–200.5, p = 0.029). In the analysis with the general linear model, we found statistically shorter total AED delivery time in the AED alarm responder group (β = -122.4, p = 0.004). In contrast, the APP responder group was associated with a markedly longer total AED delivery time (β = 104.6, P=0.016).

Conclusion

In this simulation study, the Hearing AED system contributed to shortening the AED delivery time. Further studies are needed to determine its validation in the real world situation in the future.

Aim

The systematic Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is a priority-based consensus approach for the primary assessment of all categories of critically ill or injured patients. The aims of this review are to provide a wide overview of all relevant literature about existing ABCDE assessment tools, adherence to the ABCDE approach and related outcomes of teaching or application of the ABCDE approach by healthcare professionals.

Methods

A comprehensive scoping review was conducted following the Joanna Briggs Institute guidelines and reported according to the PRISMA-ScR Checklist. An a priori protocol was developed. In March 2024, MEDLINE, EMBASE, CINAHL and Cochrane library were searched to identify studies describing healthcare professionals applying the ABCDE approach in either simulation settings or clinical practice. Two reviewers independently screened records for inclusion and performed data extraction.

Results

From n = 8165 results, fifty-seven studies met the inclusion criteria and reported data from clinical care (n = 27) or simulation settings (n = 30). Forty-two studies reported 39 different assessment tools, containing 5 to 36 items. Adherence to the approach was reported in 43 studies and varied from 18–84% in clinical practice and from 29–35% pre-intervention to 65–97% post-intervention in simulation settings. Team leader presence and attending simulation training improved adherence. Data on patient outcomes were remarkably scarce.

Conclusion

Many different tools with variable content were identified to assess the ABCDE approach. Adherence was the most frequently reported outcome and varied widely among included studies. However, association between the ABCDE approach and patient outcomes is yet to be investigated.

Introduction

After cardiac arrest and successful resuscitation patients often present with hypoxic-ischemic brain injury, which is a major cause of death due to poor neurological outcome. The development of a robust histopathological scoring system for the reliable and easy identification and quantification of hypoxic-ischemic brain injury could lead to a standardization in the evaluation of brain damage. We wanted to establish an easy-to-use neuropathological scoring system to identify and quantify hypoxic-ischemic brain injury.

Methods

The criteria for regular neurons, hypoxic-ischemic brain injury neurons and neurons with ischemic neuronal change (ischemic change neurons) were established in collaboration with specialized neuropathologists. Nine non-specialist examiners performed cell counting using the mentioned criteria in brain tissue samples from a porcine cardiac arrest model. The statistical analyses were performed using the interclass correlation coefficient for counting data and reliability testing.

Results

The inter-rater reliability for regular neurons (ICC 0.68 (0.42 – 0.84; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.87 (0.81 – 0.92; p < 0.001) showed moderate to excellent correlation while ischemic change neurons showed poor reliability. Excellent results were seen for intra-rater reliability for regular neurons (ICC 0.9 (0.68 – 0.97; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.99 (0.83 – 1; p < 0.001).

Conclusion

The scoring system provides a reliable method for the discrimination between regular neurons and neurons affected by hypoxic/ischemic injury. This scoring system allows an easy and reliable identification and quantification of hypoxic-ischemic brain injury for non-specialists and offers a standardization to evaluate hypoxic-ischemic brain injury after cardiac arrest.

Background

The Resuscitation Quality Improvement® (RQI) program is a competency-based approach that provides low dose, high frequency cardiopulmonary resuscitation (CPR) skills training. Limited research has evaluated its effectiveness with nursing students who need to be prepared to respond to cardiopulmonary emergencies despite their student status and to be competent in CPR as they transition into practice.

Objective

The objective of this multisite longitudinal study was to examine the maintenance of adult and infant compressions and ventilation skills by nursing students at 3 and 6 months following practice with real-time feedback using the RQI® program.

Methods

The effectiveness of brief practice of CPR skills at the RQI® simulation station on the maintenance of skills was analyzed with 238 nursing students from six universities across the United States. Participants completed three practice sessions, at baseline (month 0), 3 months, and 6 months. At baseline, they performed compressions and ventilation with a bag-valve mask on adult and infant manikins without feedback (pretest), followed immediately by a session integrating real-time, objective feedback (both audio and visual) on their performance. CPR practice on the manikins with feedback on performance was then repeated every 3 months.

Results

Practicing CPR skills at the RQI® simulation station every 3 months with real-time feedback enabled participants to maintain their compression and ventilation skills and improve them from baseline (month 0) to 6 months. There was no loss of skills among these participants. Median scores on the first attempt to compress and ventilate stayed above the minimum 75 % overall score that learners must achieve to be considered an adequate performance.

Conclusions

This study demonstrated that brief practice of CPR skills at the RQI® simulation station every 3 months with real-time feedback was highly effective for maintaining students’ competence in compressions and ventilation. Once the RQI® program is set up in a school, students could practice on their own as needed to maintain their skills.

Background

Out-of-hospital cardiac arrest (OHCA) is a major health concern in Europe, leading to significant morbidity and mortality. Survivors often suffer from cognitive deficits, anxiety, and depression, that affect significantly their quality of life. Current post-discharge care is inconsistent and frequently overlooks subtle but disabling symptoms. The ENFORCER trial aims to significantly enhance the health and quality of life of OHCA survivors by providing a comprehensive, accessible, and user-friendly internet-based lifestyle intervention.

Methods

ENFORCER is a multicentre, parallel group randomized controlled trial involving OHCA survivors aged 18–80 years with cognitive impairment or anxiety/depression measured through validated instruments.

Participants will be randomized 1:1 to the intervention or the control group. The intervention group will receive a one-year program via a secure web application, offering cognitive, emotional, and physical rehabilitation support. The control group will receive standard care.

The primary outcome is the difference in the proportion of patients without cognitive or emotional symptoms between the two groups after one year.

Secondary outcomes include changes in the level of patients’ cognitive and emotional symptoms, quality of life, sleep quality, sexual interest and satisfaction, and caregivers’ burden, quality of life, sleep quality and emotional symptoms in the two groups.

Discussion

The trial addresses the need for consistent post-discharge care, and the timely detection and treatment of cognitive and emotional problems. The internet-based approach allows to potentially reach many patients, ensuring cost-effectiveness and high adherence rates.

The study results could establish a standard for post-OHCA care, improving long-term recovery and quality of life for survivors.

Trial registration.

The trial is registered at clinicaltrials.gov (NCT06395558).

Aim

There is limited research on Out-of-hospital cardiac arrest (OHCA) in the Gulf Cooperation Council (GCC) and especially in Bahrain. This is the first study to describe the incidence, characteristics, and outcomes of OHCA in Bahrain.

Methods

This was a retrospective national observational study on OHCA patients in Bahrain using the Utstein framework for resuscitation. Data was collected between 1st July 2022 to 30th June 2023 from the electronic medical records of the only three governmental hospitals emergency departments (EDs) and National Ambulance (NA).

Results

The annual incidence of OHCA attended by (Emergency Medical Services) EMS was nearly 21 per 100,000 population. The majority were males (n = 228, 68.8 %) with median age of 65 years (IQR=49–78). Most OHCA cases were witnessed (n = 265, 81 %), with (n = 247, 76 %) happened at home/residence. Rates for bystander CPR was low (n = 122, 36.8 %) and bystander automated external defibrillator (AED) was not performed in any of the cases. The OHCA cases transported by the NA was (n = 314, 94.8 %), with median response time of 9 min (IQR=7–12). However, only (n = 20, 6.0 %) were witnessed by EMS, and (n = 7, 2.1 %) received EMS defibrillation for shockable rhythms. First monitored rhythms included shockable rhythm in (n = 28, 8.5 %) versus non-shockable rhythm in (n = 303, 91.5 %). In the EDs, return of spontaneous circulation was achieved in (n = 60, 18.1 %) cases. But survival rate to hospital discharge at 30-day was (n = 4, 1.2 %) and survival rate to hospital discharge with good neurological outcomes was (n = 0, 0 %). Conclusion: In Bahrain the estimated annual incidence of OHCA is 21 individuals per 100,000 population, with a very low survival rate. Solutions should focus on community-level CPR and AED training, evaluating OHCA care provided by EMS, and establishing OHCA registry.

Background

Currently there are no established benefits from the continuous monitoring of vital signs, and the optimal time period for respiratory rate measurement is unknown.

Setting

Low resource Ugandan hospital,

Methods

Prospective observational study. Respiratory rates of acutely ill patients were continuously measured by a piezoelectric device for up to seven hours after admission to hospital.

Results

22 (5.5%) out of 402 patients died within 7 days of hospital admission. The highest c-statistic of discrimination for 7-day mortality (0.737 SE 0.078) was obtained after four hours of continuously measured respiratory rates transformed into a weighted respiratory rate score (wRRS). After seven hours of measurement the c-statistic of the wRRS fell to 0.535 SE 0.078. 20% the patients who died within seven days did not have an elevated National Early Warning Score (NEWS) on admission but were identified by the 4-hour wRRS. None of the 88 patients whose average respiratory rate remained between 12 and 20 bpm throughout four hours of observation died within 7 days of admission. A simple predictive model that included the four-hour wRRS, Shock Index and altered mental status had a c-statistic for 7-day in-hospital mortality of 0.843 SE. 0.057.

Conclusion

Four hours of continuously measured respiratory rates was the observation period that best predicted 7-day in-hospital mortality. After four hours the discrimination of a weighted respiratory rate score deteriorated rapidly.

Introduction

The role of palliative care services in patients with cardiac arrest complicating acute pulmonary embolism has been infrequently studied.

Methods

All adult admissions with pulmonary embolism complicating cardiac arrest were identified using the National Inpatient Sample (2016–2020). The primary outcome of interest was the utilization of palliative care services. Secondary outcomes included predictors of palliative care utilization and its association of with in-hospital mortality, do-not-resuscitate status, discharge disposition, length of stay, and total hospital charges. Multivariable regression analysis was used to adjust for confounding.

Results

Between 01/01/2016 and 12/31/2020, of the 7,320 admissions with pulmonary embolism complicating cardiac arrest, 1229 (16.8 %) received palliative care services. Admissions receiving palliative care were on average older (68.1 ± 0.9 vs. 63.2 ± 0.4 years) and with higher baseline comorbidity (Elixhauser index 6.3 ± 0.1 vs 5.6 ± 0.6) (all p < 0.001). Additionally, this cohort had higher rates of non-cardiac organ failure (respiratory, renal, hepatic, and neurological) and invasive mechanical ventilation (all p < 0.05). Catheter-directed therapy was used less frequently in the cohort receiving palliative care, (2.8 % vs 7.9 %; p < 0.001) whereas the rates of systemic thrombolysis, mechanical and surgical thrombectomy were comparable. The cohort receiving palliative care services had higher in-hospital mortality (85.7 % vs. 69.1 %; adjusted odds ratio 2.20 [95 % CI 1.41–3.42]; p < 0.001). This cohort also had higher rates of do-not-resuscitate status and fewer discharges to home, but comparable hospitalization costs and length of hospital stay.

Conclusions

Palliative care services are used in only 16.8 % of admissions with cardiac arrest complicating pulmonary embolism with significant differences in the populations, suggestive of selective consultation.

Background

Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality globally, with survival outcomes remaining poor particularly in many low- and middle-income countries. We aimed to establish a pilot OHCA registry in Karachi, Pakistan to provide insights into OHCA patient demographics, pre-hospital and in-hospital care, and outcomes.

Methods

A multicenter longitudinal study was conducted from August 2015-October 2019 across 11 Karachi hospitals, using a standardized Utstein-based survey form. Data was retrospectively obtained from medical records, patients, and next-of-kin interviews at hospitals with accessible medical records, while hospitals without medical records system used on-site data collectors. Demographics, arrest characteristics, prehospital events, and survival outcomes were collected. Survivors underwent follow-up at 1 month, 6 months, 1 year, and 5 years.

Results

In total, 1068 OHCA patients were included. Mean age was 55 years, 61.1 % (n = 653) male. Witnessed arrests accounted for 94.9 % of the cases (n = 1013), whereas 89.4 % of the cases (n = 955) were transported via non-EMS. Bystander CPR was performed in 10.3 % (n = 110) cases whereas pre-hospital defibrillation performed in 0.4 % (n = 4). In-hospital defibrillation was performed in 9.9 % (n = 106) cases despite < 5 % shockable rhythms. Overall survival to discharge was 0.75 % (n = 8). Of these 8 patients, 7 patients survived to 1-year and 2 to 5-years. Neurological outcomes correlated with long-term survival.

Conclusion

OHCA survival rates are extremely low, necessitating public awareness interventions like CPR training, developing robust pre-hospital systems, and improving in-hospital emergency care through standardized training programs. This pilot registry lays the foundation for implementing interventions to improve survival and emergency medical infrastructure.