Antecedents to cardiac arrests in a hospital equipped with a medical emergency team (original) (raw)
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In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines
Australian Health Review, 2013
Objective. To evaluate cardiac arrest outcomes following the introduction of the Australian Resuscitation Council (ARC) 2006 amended guidelines for basic and advanced life support. Methods. A retrospective study of all consecutive cardiac arrests during a 3-year phase pre-implementation (2004-06) and a 3-year phase post-implementation (2007-09) of the ARC 2006 guidelines was conducted at a tertiary referral hospital in Brisbane, Australia.
Circulation. Cardiovascular quality and outcomes, 2015
Although the value of clinical registries has been well recognized in developed countries, their use for measuring the quality of emergency medical service care remains relatively unknown. We report the methodology and findings of a statewide emergency medical service surveillance initiative, which is used to measure the quality of systems of care for patients with out-of-hospital cardiac arrest. Between July 1, 2002, and June 30, 2012, data for adult out-of-hospital cardiac arrest cases of presumed cardiac cause occurring in the Australian Southeastern state of Victoria were extracted from the Victorian Ambulance Cardiac Arrest Registry. Regional and temporal trends in bystander cardiopulmonary resuscitation, event survival, and survival to hospital discharge were analyzed using logistic regression and multilevel modeling. A total of 32 097 out-of-hospital cardiac arrest cases were identified, of whom 14 083 (43.9%) received treatment by the emergency medical service. The risk-adju...
Nursing in Critical Care, 2007
Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests and unanticipated ICU admissions) in 90 hospitals [69 UK, 19 Australia and two New Zealand (ANZ)]. Sixty-eight hospitals reported primary events during the 3-day study period (50 UK, 16 Australia and two ANZ). Data on the availability of ICU/high-dependency unit (HDU) beds and cardiac arrest teams and medical emergency teams (METs) were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty per cent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and METs were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.
Critical Care Medicine, 2010
To determine the long-term impact of a medical emergency team on survival and to assess the utility of administrative data to monitor outcomes. Design: Prospective study of cardiac arrests and survival. Retrospective study of administrative data. Setting: University affiliated tertiary referral hospital in Melbourne, Australia. Patients: All patients admitted to hospital in three 6-month periods between 2002-2007 (prospective) and 1993-2007 (retrospective). Intervention: Implementation of a medical emergency team in November 2002. Measurements and Main Results: In the prospective analysis, rates of unexpected cardiac arrest and hospital mortality (referenced to 1000 patient-care days) were measured before (
Objective: To describe temporal trends in incidence of pre-hospital outcomes from adult out-of-hospital cardiac arrest (OHCA) of presumed cardiac aetiology attended by Queensland Ambulance Service (QAS) paramedics between 2002 and 2014, by age, gender, geographical remoteness and socio-economic status. Methods: Cases included in this retrospective cohort study were identified from the QAS OHCA Registry. Included cases were linked with Queensland Hospital Admitted Patient Data Collection and Queensland Death Registry. Population data were obtained from the Australian Bureau of Statistics to calculate incidence rates for each year. Analyses were undertaken by four mutually exclusive pre-hospital outcomes: (i) no resuscitation (No-Resus); (ii) resuscitation, no pre-hospital return of spontaneous circulation (No-ROSC); (iii) resuscitation, prehospital return of spontaneous circulation not sustained to hospital (Unsustained-ROSC); and (iv) resuscitation, pre-hospital return of spontaneous circulation sustained to hospital (Sustained-ROSC). Trends over time were analysed for crude and specific rates for total OHCA events and for each outcome. Results: Between 2002 and 2014, there were 30 560 OHCA cases. Crude incidence significantly increased over time for No-Resus and Sustained-ROSC, and significantly decreased for No-ROSC. These trends were reflected in major cities, inner and outer regional areas. There was a significant increase in Sustained-ROSC in remote areas, and no significant trends in very remote areas. Conclusion: Incidence of withholding resuscitation and ROSC sustained to hospital have independently increased over time. Factors of middle age, more rural location and lower socio-economic status should all be targeted in the development and implementation of future strategies.
Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry
BMJ Open, 2016
Introduction: Out-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry). Methods and analysis: The Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014.
The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest
Resuscitation, 2015
Patients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1-4h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality. We included adults from the Get With the Guidelines(®)- Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR)≤60 or ≥100min(-1), respiratory rate (RR)≤10 or >20min(-1) and systolic blood pressure (SBP)≤90mmHg) and severely abnormal (HR≤50 or ≥130min(-1), RR≤8 or ≥30min(-1) and SBP≤80mmHg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model. 7851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal ...
Resuscitation, 2002
To determine the incidence of avoidable cardiac arrest among patients who had received resuscitation in a district general hospital. To establish how location and individual or system factors influence avoidable cardiac arrest in order to develop an evidence-based preventive strategy. Methods: Expert panel review of case-notes from 139 consecutive adult in-hospital cardiac arrests over 1 year. Results: There were 32 348 adult admissions in 1999 with 1023 deaths. The cardiac arrest team was activated 139 times: 118 were for primary in-hospital cardiac arrest. The cardiac arrest rate excluding 'do not attempt resuscitation' (DNAR) cases was 3.8/1000 admissions. In 88.5% of deaths there was a DNAR policy. Survival to hospital discharge following resuscitation was 14%. Among the 118 cases, the panel unanimously agreed that 61.9% of arrests were potentially avoidable, rising to 68% when emergency department arrests were excluded (66 and 73% for majority opinion). Cardiac arrests were more likely at the weekend than during the week (P0/0.02). The odds of potentially avoidable cardiac arrest was 5.1 times greater for patients in general wards than critical care areas (P B/0.001); patients in critical care areas were more likely to survive (P B/0.001). The odds of potentially avoidable cardiac arrest was 12.6 times greater for patients nursed in a clinical area judged 'inappropriate' for their main complaint (P B/0.002, Fisher's exact test) compared to those nursed in 'appropriate' areas. The panel agreed that 100% of potentially avoidable arrests were judged to have received inadequate prior treatment. Clinical signs of deterioration in the preceding 24 h were not acted upon in 48%, and review was confined to a house officer in 45%. Conclusion: The majority of treated in-hospital cardiac arrests are potentially avoidable. Multiple system failures include delays and errors in diagnosis, inadequate interpretation of investigations, incomplete treatment, inexperienced doctors and management in inappropriate clinical areas. #
The American journal of emergency medicine, 2017
In-hospital cardiac arrests (IHCAs) are often preceded by abnormal vital signs. Preceding abnormal vital signs might lower the physiological reserve capacity and therefore decrease survival after an IHCA. To assess the preceding national early warning score (NEWS) and its relation to survival after an IHCA. All patients ≥18years suffering an IHCA at Karolinska University Hospital between 1st January 2014 and 31st December 2015 were included. Data regarding the IHCA, patient characteristics, calculated NEWS and 30-day survival were obtained from electronic patient records. Parameters included in NEWSs were assessed up to 12h before the IHCA. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with NEWSs of 0-4 points (low) versus those with at least 5 points (moderate) and 7 points (high). Adjustments included hospital site, sex, co-morbidities, first rhythm and locatio...