Resuscitation
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Observational Study
A single-centre observational cohort study of admission National Early Warning Score (NEWS).
Early warning scores are commonly used in hospitals to identify patients at risk of deterioration. The National Early Warning Score (NEWS) has recently been introduced to UK practice. However, it is not yet widely implemented. We aimed to compare NEWS to the early warning score currently used in our hospital--the Patient at Risk Score (PARS). ⋯ NEWS on admission is superior to PARS for identifying patients at risk of death or critical care admission within the first 2 days of hospital stay. Current guidelines advocate a threshold of 5 for triggering a clinical review. However, since a score of 3 or more was associated with a poor outcome, this recommendation should be reviewed. Both scores were poor predictors of hospital length of stay.
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Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution. ⋯ The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR.
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In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. ⋯ Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children.
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Randomized Controlled Trial Multicenter Study
Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest.
Survival varies among those resuscitated from out-of-hospital cardiac arrest (OHCA). Evidence-based performance measures have been used to describe hospital quality of care in conditions such as acute coronary syndrome and major trauma. It remains unclear if adherence to performance measures is associated with better outcome in patients hospitalized after OHCA. ⋯ Greater survival and favorable neurologic status at discharge were associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Consideration should be given to measuring, reporting and improving hospital adherence to guideline-based performance measures, which could improve outcomes following OHCA.
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Multicenter Study
Performance Improvement-Based Resuscitation Programme Reduces Arrest Incidence and Increases Survival from In-Hospital Cardiac arrest.
Traditional resuscitation training models are inadequate to achieving and maintaining resuscitation competency. This analysis evaluates the effectiveness of a novel, performance improvement-based inpatient resuscitation programme. ⋯ Implementation of a novel, performance improvement-based inpatient resuscitation programme was associated with a decrease in the incidence of cardiac arrest and improved clinical outcomes.