In-hospital cardiac arrest: can we change something?

Ružman, Tomislav; Tot, Ozana Katarina; Ivić, Dubravka; Gulam, Danijela; Ružman, Nataša; Burazin, Jelena

doi:10.1007/s00508-013-0409-0

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…It has been assumed that the time of an arrest may influence survival rates following in-hospital cardiac arrest, with poorer results obtained for resuscitation performed during nonregular working hours 2,3,10. Nevertheless, previous studies did not consider that 24/7 in-hospital resuscitation teams might cause comparable conditions for victims of in-hospital cardiac arrests independent from the time of an arrest.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

Christ¹,

Dierschke²,

Auenmueller³

et al. 2014

IJGM

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ObjectivesLittle is known about the factors that influence survival following in-hospital resuscitation, but previous investigations have suggested that in-hospital resuscitations outside of regular working hours are associated with worse survival rates.Material and methodsIn-hospital cardiac arrest teams at our hospital were instructed to complete a questionnaire following every emergency call between July 2011 and June 2013. Data on all resuscitation attempts were collected and analyzed.ResultsA total of 65 in-hospital resuscitations were recorded in 42 males (64.6%) and 23 females (35.4%) (mean age 72.0±14.3 years). A total of 54 (83.1%) cardiac arrests were witnessed; seven (10.8%) showed a shockable rhythm at the time of the first ECG. Resuscitation attempts lasted 29.3±41.3 minutes, and 4.1±3.1 mg epinephrine was given. Return of spontaneous circulation could be achieved in 38 patients (58.5%); 29 (44.6%) survived the first day, 23 (35.4%) the seventh day, and 15 patients (23.1%) were discharged alive. Significantly more in-hospital resuscitations were obtained for those performed during non-regular working hours (P<0.001), with higher neuron-specific enolase levels at 72 hours after resuscitation during nonregular working hours (P=0.04). Patients who were discharged alive were significantly younger (P=0.01), presented more often with an initial shockable rhythm (P=0.04), and had a shorter duration of resuscitation (P<0.001) with the need of a lower dose of epinephrine (P<0.001).DiscussionSurvival rates following in-hospital resuscitation were poor at any time, but appear to depend less on time-dependent effects of the quality of resuscitation and more on time-dependent effects of recognition of cardiac arrests.

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Section: Discussionmentioning

confidence: 99%

Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

Christ¹,

Dierschke²,

Auenmueller³

et al. 2014

IJGM

View full text Add to dashboard Cite

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“…In the field of cardiopulmonary resuscitation (CPR) numerous improvements including electric defibrillation and closed chest cardiac massage were introduced but the survival of victims of cardiac arrest is still poor ( 1 ). European Resuscitation Council (ERC) has released new guidelines in 2010 based on the results of systematic reviews and clinical trials ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary Resuscitation, Chest Compression Only and Teamwork From the Perspective of Medical Doctors, Surgeons and Anesthesiologists

Krajina¹,

Kvolik²,

Steiner³

et al. 2015

Iran Red Crescent Med J

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Background:New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals.Objectives:We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims.Patients and Methods:An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant.Results:The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All doctors considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR.Conclusions:An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes.

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Survival after in-hospital cardiac arrest among cerebrovascular disease patients

Fehnel

Trepman

Steele

et al. 2018

Journal of Clinical Neuroscience

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Stroke is a leading cause of death and disability, and while preferences for cardiopulmonary resuscitation (CPR) are frequently discussed, there is limited evidence detailing outcomes after CPR among acute cerebrovascular neurology (inclusive of stroke, subarachnoid hemorrhage (SAH)) patients. Systematic review and meta-analysis of PubMed and Cochrane libraries from January 1990 to December 2016 was conducted among stroke patients undergoing in-hospital CPR. Primary data from studies meeting inclusion criteria at two levels were extracted: 1) studies reporting survival to hospital discharge after CPR with cerebrovascular primary admitting diagnosis, and 2) studies reporting survival to hospital discharge after CPR with cerebrovascular comorbidity. Meta-analysis generated weighted, pooled survival estimates for each population. Of 818 articles screened, there were 176 articles (22%) that underwent full review. Three articles met primary inclusion criteria, with an estimated 8% (95% Confidence Interval (CI) 0.01, 0.14) rate of survival to hospital discharge from a pooled sample of 561 cerebrovascular patients after in-hospital CPR. Twenty articles met secondary inclusion criteria, listing a cerebrovascular comorbidity, with an estimated rate of survival to hospital discharge of 16% (95% CI 0.14, 0.19). All studies demonstrated wide variability in adherence to Utstein guidelines, and neurological outcomes were detailed in only 6 (26%) studies. Among the few studies reporting survival to hospital discharge after CPR among acute cerebrovascular patients, survival is lower than general inpatient populations. These findings synthesize the limited empirical basis for discussions about resuscitation among stroke patients, and highlight the need for more disease stratified reporting of outcomes after inpatient CPR.

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In-hospital cardiac arrest: can we change something?

Cited by 5 publications

References 32 publications

Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation

Cardiopulmonary Resuscitation, Chest Compression Only and Teamwork From the Perspective of Medical Doctors, Surgeons and Anesthesiologists

Survival after in-hospital cardiac arrest among cerebrovascular disease patients

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