Resuscitation
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While cardiopulmonary resuscitation (CPR) chest compression fraction (CCF) is associated with out-of-hospital cardiac arrest (OHCA) outcomes, there is no standard method for the determination of CCF. We compared nine methods for calculating CCF. ⋯ CCF varies minimally with different calculation methods. Automated CCF determination may prove sufficient for evaluating CPR quality.
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Rapid Response Teams (RRTs) have been introduced into at least 60% of Intensive Care Unit (ICU) - equipped Australian hospitals to review deteriorating ward patients. Most studies have assessed their impact on patient outcome and less information exists on team composition or aspects of their calling criteria. ⋯ Our findings imply the likelihood of significant practice variation in relation to RRT composition, staff skill set and activation criteria between hospitals. We recommend improved resourcing of RRTs, training of the team members, and consideration for improved standardisation of calling criteria across institutions.
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Physiological track and trigger scores have an established role in enhancing the detection of critical illness in hospitalized patients. Their potential to identify individuals at risk of clinical deterioration in the pre-hospital environment is unknown. This study compared the predictive accuracy of the Modified Early Warning Score (MEWS) with current clinical practice. ⋯ Clinical judgement alone has a low sensitivity for critical illness in the pre-hospital environment. The addition of MEWS improves detection at the expense of reduced specificity. The optimal scoring system to be employed in this setting is yet to be elucidated.
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Whether mental stress negatively impacts team performance during cardio-pulmonary resuscitation (CPR) remains controversial; this may partly be explained by differences in stress measures used in previous studies. Our aim was to compare self-reported, biochemical and physiological stress measures in regard to CPR performance. ⋯ Self-reported stress (stress/overload) was the only predictor for low CPR performance. Biochemical measures showed no association, and physiological measures (heart rate) showed an inverse association, which may be due to physical activity, limiting its value as a mental stress marker in this acute setting.
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The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. ⋯ Young OHCA patients are more likely to be in contact with the healthcare services compared with an age and sex matched control population suggestive of traits that make them stand out from the general population.