Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study

Albert, Malin; Herlitz, Johan; Rawshani, Araz; Ringh, Mattias; Claesson, Andreas; Djärv, Therese; Nordberg, Per

doi:10.1136/bmjopen-2019-032264

Cited by 5 publications

(13 citation statements)

References 23 publications

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“…An aetiology of aspiration and cancer has previously been shown to have particularly low survival. 24 , 30 The treatment of the underlying cause in patients who suffer from cardiac arrest due to acute abdomen or aortic dissection, is immediate surgery. To perform surgery in a patient who recently was resuscitated after a cardiac arrest is high-risk performance and the low survival among these patients is thus not surprising.…”

Section: Discussionmentioning

confidence: 99%

“…As described in previous studies, the registration in the SRCR occurs in two steps. 24 The first part of the registration is performed by a nurse or physician who were present at the scene of the cardiac arrest. This part contains information regarding treatments given during the resuscitation, place of the cardiac arrest, critical delay times, initial rhythm, if the patient was monitored at the time of the arrest, and if the patient received ROSC.…”

Section: Methodsmentioning

confidence: 99%

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Aetiology and outcome in hospitalized cardiac arrest patients

Albert

Herlitz

Rawshani

et al. 2023

European Heart Journal Open

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Aims To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival. Methods Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance category scale 1-2) at discharge. Results Among, 4,320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (p < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13). Conclusion In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Aetiology and outcome in hospitalized cardiac arrest patients

Albert

Herlitz

Rawshani

et al. 2023

European Heart Journal Open

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“…For the next most critical outcome of survival to discharge, 6 observational studies in people were identified that addressed the PICO question (very low quality of evidence, downgraded for very serious indirectness and serious imprecision). [164][165][166][167][168][169] In human hospitals, hospitalization in an unmonitored ward is associated with lower frequency of survival to discharge after IHCPA. 164,165 One particular at-risk group that experienced IHCPA secondary to aspiration pneumonia had a lower frequency of survival to discharge when CPA occurred in an unmonitored area.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…[164][165][166][167][168][169] In human hospitals, hospitalization in an unmonitored ward is associated with lower frequency of survival to discharge after IHCPA. 164,165 One particular at-risk group that experienced IHCPA secondary to aspiration pneumonia had a lower frequency of survival to discharge when CPA occurred in an unmonitored area. 165 The primary factor leading to the decision to implement continuous ECG monitoring in human patients was ongoing myocardial infarction, which may limit the applicability of these findings to dogs and cats.…”

Section: Consensus On Sciencementioning

confidence: 99%

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

Brainard,

Lane,

Burkitt‐Creedon

et al. 2024

J Vet Emergen Crit Care

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ObjectiveTo systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to peri‐CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsThirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end‐tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.ConclusionsThe Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re‐arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra‐arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome‐relevant interventions.

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“…Practical issues are also a considerable barrier to PC delivery in the ICU [18][19][20]23,29,32]. These issues include limited time for administrative tasks and documentation, disagreement about goals of care between HCPs, differences in nursing and medical approaches, and administrative policy treatment.…”

Section: Practical Issuesmentioning

confidence: 99%

Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review

et al. 2022

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The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

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Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study

Cited by 5 publications

References 23 publications

Aetiology and outcome in hospitalized cardiac arrest patients

Aetiology and outcome in hospitalized cardiac arrest patients

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review

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