Resuscitation
-
Observational Study
Factors influencing prehospital physicians' decisions to initiate advanced resuscitation for asystolic out-of-hospital cardiac arrest patients.
The decision to initiate or continue advanced life support (ALS) in out-of-hospital cardiac arrest (OHCA) could be difficult due to the lack of information and contextual elements, especially in non-shockable rhythms. This study aims to explore factors associated with clinicians' decision to initiate or continue ALS and the conditions associated with higher variability in asystolic patients. ⋯ Significant inter-physician variability in access to ALS could be present within the same EMS, especially among less experienced physicians, non-medical OHCA and in presence of signs of life during emergency call. This arbitrariness has been observed and should be properly addressed by EMS team members as it raises ethical issues regarding the disparity in treatment.
-
Respiratory mechanics, such as tidal volume (VT) and inspiratory pressures, may affect outcome in hospitalized patients with respiratory failure. Little is known about respiratory mechanics in the prehospital setting. ⋯ We observed that measuring respiratory mechanics in the prehospital setting was feasible. Tidal volumes were generally delivered within a safe range. Respiratory mechanics varied most significantly with active CPR with lower VTPBW and higher peak pressures, though did not seem to be affected by bag size. Future work might examine the relationship between respiratory mechanics and outcomes, which may identify opportunities to improve clinical outcomes.
-
Pulmonary hypertension (PH) has been associated with poor survival in multiple cardiopulmonary conditions, however its association with outcomes in cardiac arrest remains unknown. We aimed to evaluate the association of PH with survival and neurologic outcomes in adults with in-hospital cardiac arrest (IHCA). ⋯ In this contemporary registry of adults with IHCA, while PH was associated with a higher risk patient profile, it was not associated with survival or neurologic outcomes in this population.
-
To investigate how socioeconomic status was associated with the risk of in-hospital cardiac arrest in Denmark. ⋯ In this matched case-control study, high socioeconomic status was associated with lower odds of in-hospital cardiac arrest compared to low socioeconomic status. The findings were consistent across household income, household assets, and education and persisted after adjustment for comorbidities. Strategies are needed to address the socioeconomic inequalities observed in the risk of in-hospital cardiac arrest.