Resuscitation
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Cardiac arrest recognition, ambulance dispatch and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) by emergency medical dispatch (EMD) are crucial for an optimal outcome of out-of-hospital cardiac arrest (OHCA). In EMD, crowding is caused by a mismatch between the number of emergency calls and the number of dispatchers available per shift. Crowding in the emergency department has been shown to decrease performance and outcomes; however, little is known about the effect of crowding in EMD. We aimed to evaluate the incidence of crowding in the EMD and the effect of emergency call crowding on dispatcher-assisted CPR instruction performance in OHCA calls. ⋯ Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher-assisted CPR instruction provision. Medical directors might consider a strategic approach to addressing crowding in EMD according to the crowding distribution.
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Observational Study
Capillary Refill Time as Part of an Early Warning Score for Rapid Response Team Activation is an Independent Predictor of Outcomes.
Capillary refill time (CRT) is easy, quick to perform and when prolonged in critical illness, correlates with progression of organ failure and mortality. It is utilized in our hospital's early warning score (EWS) as one of 11 parameters. We sought to define CRT's value in predicting patient outcomes, compared to the remaining EWS elements. ⋯ This is the first time CRT has been evaluated in RRT patients. Its measurement is easy to perform and proves useful as an assessment of adult patients at-risk for clinical decline. Its prolongation in our population was an independent predictor of mortality and the combined outcome. This study and others suggest that CRT should be considered further as a fundamental assessment of patients at-risk for clinical decline.
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Observational Study
Analysis of Visual Attention and Team Communications during Neonatal Endotracheal Intubations using Eye-tracking: An Observational Study.
Eye-tracking can be used to analyse visual attention (VA) of health care providers during clinical tasks. No study has examined eye-tracking during neonatal endotracheal intubation. We aimed to examine VA and team communications during endotracheal intubation using eye-tracking in the Neonatal Intensive Care Unit. ⋯ During neonatal intubations, 50% of VA was directed away from the infant. Team communications were non-standard. Eye-tracking can be used to analyse human performance during neonatal resuscitation.
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It remains unclear whether socioeconomic differences exist in post-resuscitation care in out-of-hospital cardiac arrests (OHCA). We aimed to examine socioeconomic differences in coronary procedures and survival after OHCA. ⋯ Higher-income patients were found associated with more performed coronary angiographies after OHCA, and higher odds for 30-day survival.