Background Outcomes in cardiac arrest remain suboptimal. Mechanical cardiopulmonary resuscitation ( CPR ) has not demonstrated clear clinical benefit; however, video review provides the capability to monitor CPR quality and provide constructive feedback to individuals and teams to improve their performance. The aim of our study was to evaluate cardiac arrest outcomes before and after initiation of a mechanical, team‐focused, video‐reviewed CPR intervention. Methods and Results In 2018, our emergency department began using mechanical CPR ; a new team‐focused strategy with nurse‐led Advanced Cardiovascular Life Support; and biweekly, multidisciplinary video review of cardiac arrests. A revised approach to resuscitation was generated from a performance improvement session, and in situ simulation was used to disseminate our approach. The primary outcome of this study was the return of spontaneous circulation rate before and after our mechanical, team‐focused, video‐reviewed CPR intervention. Secondary outcomes included survival to admission and discharge. Multivariable logistic regression modeling was used. The pre‐ and postintervention groups were similar at baseline. A total of 248 patients were included in our study (97 before and 151 after mechanical, team‐focused, video‐reviewed CPR). Return of spontaneous circulation was higher in the intervention group (41% versus 26%; P =0.014). There were nonsignificant increases in survival to admission (26% versus 20%; P =0.257) and survival to discharge (7% versus 3%; P =0.163). After controlling for covariates, the odds of return of spontaneous circulation remained higher after the intervention (odds ratio, 2.11; 95% CI , 1.14–3.89). Conclusions Implementation of our mechanical, team‐focused, video‐reviewed CPR intervention for cardiac arrest patients in our emergency department improved return of spontaneous circulation rates. Survival to hospital admission and discharge did not improve.
Piriformis syndrome, a myofascial pain disorder characterized by deep gluteal pain that radiates to the ipsilateral lower back and/or posterior thigh, is an underreported cause of low back pain frequently misdiagnosed in the emergency department (ED). Often refractory to oral pain medications, this syndrome can be debilitating. Ultrasound‐guided trigger point injection of the piriformis muscle can treat piriformis syndrome, but no previous reports exist in the emergency medicine literature. This case series describes 2 patients who presented to our emergency department with low back pain and were diagnosed with piriformis syndrome. Both patients received an ultrasound‐guided trigger point injection of the affected piriformis muscle with a significant reduction of pain at 15 minutes and 48 hours after the procedure.
Background: Our previous research demonstrated an improvement in ROSC after implementing a bundle including mechanical, team-focused, video-reviewed cardiopulmonary resuscitation (MTV-CPR) for cardiac arrest patients in our ED. The aims of this study are to assess trends in cardiac arrest outcomes and improvements in cardiac arrest performance measures after the implementation of our MTV-CPR intervention. Methods: In 2018, our ED began using mechanical CPR; a new team-focused strategy with nurse led ACLS; and biweekly video-review of cardiac arrests. The primary outcome of this study was to evaluate the annual trend in survival to discharge from 2017 (the year before implementing MTV-CPR) through 2019. Secondary outcomes included ROSC and survival to admission. The Cochrane-Armitage test was used to evaluate annual trends in outcomes over the 3-year study period. We also sought to determine if an improvement in cardiac arrest performance measures occurred over the two years of our MTV-CPR intervention using Wilcoxon rank sum and two-sample t-tests. Cardiac arrest performance measures are listed in the table. Results: The groups were similar at baseline over the 3-year study period. 291 patients were included in the study (96 in 2017, 96 in 2018, and 99 in 2019). Survival to discharge improved from 3.1% in 2017 to 5.2% in 2018 to 10.1% in 2019 (p= 0.043); ROSC improved from 26% to 41.7% to 40.4% (p=0.038); survival to admission went from 19.8% to 25% to 29.3% but was not significantly different (p=0.124). Results for cardiac arrest performance measures are reported in the table. There were significant reductions in time to bed transfer, rhythm determination, mechanical CPR placement, and duration of each chest compression interruption due to ultrasound. Conclusions: Implementation of our MTV-CPR intervention for cardiac arrest patients resulted in improved trends in survival to discharge and ROSC, as well as improvements in multiple cardiac arrest performance measures.
Introduction: Survival from cardiac arrest remains suboptimal. Pre-hospital studies demonstrate monitoring cardiopulmonary resuscitation (CPR) quality and utilizing team-focused resuscitation improve outcomes in cardiac arrest. Video review provides Emergency Departments (EDs) with the ability to monitor CPR quality and provide feedback to individuals and teams. We evaluated for improvement in the proportion of patients achieving return of spontaneous circulation (ROSC), survival-to-admission and discharge, pre and post-initiation of a cardiac arrest video review and team-focused mechanical CPR program. Methods: In 2018, our ED began a video review program of cardiac arrests, consisting of biweekly meetings with a multidisciplinary team; and mechanical CPR with the LUCAS ® 3. A revised team-focused approach to resuscitation was created using swim-lane diagrams and a priority payoff matrix. In-situ simulation was used to disseminate this new approach. Using data from 2017 as the pre-intervention group for comparison, we assessed for differences in outcomes after implementation of our intervention using χ 2 tests and multivariable logistic regression. Results: A total of 242 patients were analyzed; 106 (43.8%) pre-intervention and 136 (56.2%) post-intervention. Both groups were similar (Table). The proportion achieving ROSC increased from 26.5% to 41.6% post-intervention (p=0.019). There were non-significant increases in survival-to-admission (26.4% vs. 35.3%; p = 0.140) and survival-to-discharge (5.6% vs. 10.3%; p = 0.194) after our intervention. Controlling for age, sex, initial rhythm, witnessed arrest, and bystander CPR, the odds of ROSC were higher post-intervention (OR: 2.52; 95% CI: 1.08, 5.90). Conclusions: Implementation of a video review and team-focused mechanical CPR program increased ROSC in our ED. Our intervention may also improve survival-to-admission and discharge, but this study was underpowered to detect these differences.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.