Assessment of In-Hospital Cardiopulmonary Resuscitation Using Utstein Template in a University Hospital

Tok, Demet; Keleş, Gönül Tezcan; Toprak, Verda; Topçu, İsmet

doi:10.1620/tjem.202.265

Cited by 25 publications

(25 citation statements)

References 23 publications

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“…In Iran, the successful ROSC ratio and alive discharge rate are 32.8% and 12%, respectively 15 . Another study conducted in Turkey, in which DNAR orders are illicit and criminal offenses, found that ROSC was achieved in 27.2% of the patients, and among these patients, 10% were discharged from hospital 16 . In the present study, the ratios, ROSCs and alive discharge rates were lower than those in countries in which DNAR orders are routinely applied.…”

Section: Discussioncontrasting

confidence: 76%

Influences of “do-not-resuscitate order” prohibition on CPR outcomes

Gülaçtı

Lök

2016

Turkish Journal of Emergency Medicine

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ObjectivesThe aim of the study is to determine factors affecting the return of spontaneous circulation (ROSC) ratios, neurological outcomes at discharge, the ratio of living patients discharged from the hospital and due to Do not attempt resuscitation (DNAR) prohibition.Material and methodsThis is a retrospective observational study conducted on patients of cardiopulmonary resuscitation (CPR) performed in emergency department (ED) and intensive care units between February 2010 and February 2012.ResultsA total of 469 patients were evaluated, and 266 eligible patients who did not have DNAR orders were included in the study. Overall, 45.1% of the adult in-hospital cardiac arrest victims returned to spontaneous circulation, and 5.3% survived to hospital discharge. Of the patients who were discharged alive from the hospital, 33.3% were discharged in poor neurologic conditions of Cerebral Performance Category (CPC) score 3 or 4. The ROSC ratio was reduced for the patients with malignancies compared to the patients with other preexisting conditions (OR: 12.783; 95% CI 2.967–55.072; p = 0.000). None of the patients with malignancies were discharged alive from the hospital. Only one patient with end-stage disease was discharged alive from hospital, and this patient's CPC score was 4.Discussion and conclusionCPR has not increased the ROSC and alive discharge rates in patients with malignancy and end-state disease. DNAR order prohibition have been increased the futile CPR attempts. DNAR should be accepted as a human right that represents an honorable death option and whether a DNAR is order demanded should be specifically discussed with patients with malignancies and end-stage disease presenting to ED.

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Section: Discussioncontrasting

confidence: 76%

Influences of “do-not-resuscitate order” prohibition on CPR outcomes

Gülaçtı

Lök

2016

Turkish Journal of Emergency Medicine

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“…We selected the following candidate variables for the regression model that were previously demonstrated to be strong predictors of poor outcome in patients after cardiac arrest: initial cardiac rhythm (asystole or pulseless electric activity versus ventricular fibrillation/ventricular tachycardia) and prolonged duration of CPR (CPR duration >20 minutes). 1,[24][25][26][27][28] To also adjust the model for the possibility that hypocapnia represented a respiratory compensation for metabolic acidosis (which may be associated with poor outcome), we also added the presence of metabolic acidosis as a variable in the regression model, defined as one or more recorded base deficit ≤ −6 (based on previously published literature). 29 To ensure that the association between hypocapnia exposure and hypercapnia exposure remained independently associated with poor neurological outcome, after adjusting for additional candidate variables known to be predictors of poor outcome, we performed additional sensitivity analyses.…”

Section: Discussionmentioning

confidence: 99%

Association Between Postresuscitation Partial Pressure of Arterial Carbon Dioxide and Neurological Outcome in Patients With Post–Cardiac Arrest Syndrome

et al. 2013

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Background-Partial pressure of arterial CO 2 (PaCO 2 ) iS a regulator of cerebral blood flow after brain injury. Recent guidelines for the management of cardiac arrest recommend maintaining PaCO 2 at 40 to 45 mm Hg after successful resuscitation; however, there is a paucity of data on the prevalence of PaCO 2 derangements during the post-cardiac arrest period and its association with outcome. Methods and Results-We analyzed a prospectively compiled and maintained cardiac arrest registry at a single academic medical center. Inclusion criteria are as follows: age ≥18, nontrauma arrest, and comatose after return of spontaneous circulation. We analyzed arterial blood gas data during 0 to 24 hours after the return of spontaneous circulation and determined whether patients had exposure to hypocapnia and hypercapnia (defined as PaCO 2 ≤30 mm Hg and PaCO 2 ≥50 mm Hg, respectively, based on previous literature). The primary outcome was poor neurological function at hospital discharge, defined as Cerebral Performance Category ≥3. We used multivariable logistic regression, with multiple sensitivity analyses, adjusted for factors known to predict poor outcome, to determine whether post-return of spontaneous circulation hypocapnia and hypercapnia were independent predictors of poor neurological function. Of 193 patients, 52 (27%) had hypocapnia only, 63 (33%) had hypercapnia only, 18 (9%) had both hypocapnia and hypercapnia exposure, and 60 (31%) had no exposure; 74% of patients had poor neurological outcome. Hypocapnia and hypercapnia were independently associated with poor neurological function, odds ratio 2.43 (95% confidence interval, 1.04-5.65) and 2.20 (95% confidence interval, 1.03-4.71), respectively. Conclusions-Hypocapnia and hypercapnia were common after cardiac arrest and were independently associated with poor neurological outcome. These data suggest that PaCO 2 derangements could be potentially harmful for patients after resuscitation from cardiac arrest. 17 However, there is a paucity of clinical data on the subject of hypocapnia and hypercapnia during the post-ROSC period in adult patients. Specifically, it is unclear if exposure to hypocapnia and hypercapnia during the initial post-ROSC period is common and associated with neurological outcome.The objectives of this study were to determine the prevalence of hypocapnia and hypercapnia during the initial post-ROSC period and its association with neurological outcome among adult patients resuscitated from cardiac arrest. We hypothesized that hypocapnia and hypercapnia are common during the initial post-ROSC period and are both independently associated with poor neurological outcome. Methods SettingWe analyzed a prospectively compiled and maintained cardiac arrest registry at a single academic medical center, Cooper University Hospital in Camden, NJ. 18 We have prospectively collected data on all patients after cardiac arrest at our institution since 2009. We collect data pertaining to the index cardiac arrest event and outcomes consistent with the Utstein styl...

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“…The existence of previous cardiovascular diseases, occurrence of unwitnessed cardiac arrest, etiology, initial cardiac rhythm, ineffective cardiopulmonary resuscitation, prolonged cardiopulmonary resuscitation, lack of ongoing training of healthcare staff in cardiopulmonary resuscitation techniques, delays in defibrillation, inadequate emergency care structure and lack of adherence to care protocols for cardiac arrest by healthcare services may all have a crucial bearing on patient survival. 1,2 In the United States, over 300,000 individuals are admitted to emergency departments each year due to cardiac arrest. 3,4 In Brazil, approximately 200,000 cases of cardiac arrest occur each year, of which half occur within the hospital environment.…”

Section: Introductionmentioning

confidence: 99%

Cohort study on the factors associated with survival post-cardiac arrest

et al. 2015

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CONTEXT AND OBJECTIVE: Cardiac arrest is a common occurrence, and even with efficient emergency treatment, it is associated with a poor prognosis. Identification of predictors of survival after cardiopulmonary resuscitation may provide important information for the healthcare team and family. The aim of this study was to identify factors associated with the survival of patients treated for cardiac arrest, after a one-year follow-up period. DESIGN AND SETTING: Prospective cohort study conducted in the emergency department of a Brazilian university hospital. METHODS:The inclusion criterion was that the patients presented cardiac arrest that was treated in the emergency department (n = 285). Data were collected using the In-hospital Utstein Style template. Cox regression was used to determine which variables were associated with the survival rate (with 95% significance level). RESULTS: After one year, the survival rate was low. Among the patients treated, 39.6% experienced a return of spontaneous circulation; 18.6% survived for 24 hours and of these, 5.6% were discharged and 4.5% were alive after one year of follow-up. Patients with pulseless electrical activity were half as likely to survive as patients with ventricular fibrillation. For patients with asystole, the survival rate was 3.5 times lower than that of patients with pulseless electrical activity. CONCLUSIONS: The initial cardiac rhythm was the best predictor of patient survival. Compared with ventricular fibrillation, pulseless electrical activity was associated with shorter survival times. In turn, compared with pulseless electrical activity, asystole was associated with an even lower survival rate. RESUMO CONTEXTO E OBJETIVO:A parada cardiorrespiratória é comum e, mesmo com tratamentos de emergên-cia eficientes, associa-se a prognósticos ruins. A identificação de fatores preditores de sobrevivência após ressuscitação cardiopulmonar pode fornecer informações importantes para equipe de saúde e familiares. O objetivo deste estudo foi identificar fatores associados à sobrevivência, após um ano de seguimento, de pacientes atendidos em parada cardiorrespiratória. DESENHO E LOCAL: Estudo de coorte prospectivo realizado no serviço de emergência de um hospital universitário. MÉTODOS: O critério de inclusão foi o atendimento de paciente em parada cardiorrespiratória no serviço de emergência (n = 285). Os dados foram coletados por meio do modelo In-hospital Utstein Style. Para verificar quais variáveis associaram-se à sobrevida, utilizou-se regressão de Cox (nível de significância 95%). RESULTADOS: Após um ano, a sobrevida foi baixa. Dos pacientes atendidos, 39,6% tiveram retorno da circulação espontânea, 18,6% sobreviveram até as primeiras 24 horas, sendo que, destes, 5,6% obtiveram alta hospitalar e 4,5% permaneceram vivos após um ano de seguimento. Pacientes com atividade elétrica sem pulso apresentaram duas vezes menos chances de sobreviver que aqueles com fibrilação ventricular. Nos pacientes com assistolia, as taxas de sobrevida foram 3,5 menores qua...

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Assessment of In-Hospital Cardiopulmonary Resuscitation Using Utstein Template in a University Hospital

Cited by 25 publications

References 23 publications

Influences of “do-not-resuscitate order” prohibition on CPR outcomes

Influences of “do-not-resuscitate order” prohibition on CPR outcomes

Association Between Postresuscitation Partial Pressure of Arterial Carbon Dioxide and Neurological Outcome in Patients With Post–Cardiac Arrest Syndrome

Cohort study on the factors associated with survival post-cardiac arrest

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