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Cardiac arrest emergency department

Maxime Duval, Kalyane Bach, Damien Masson, Camille Guimard, Philippe Le Conte, David Trewick
Objective: Severe hypocalcemia (Ca <1.9 mmol/L) is often considered an emergency because of a potential risk of cardiac arrest or seizures. However, there is little evidence to support this. The aim of our study was to assess whether severe hypocalcemia was associated with immediately life-threatening cardiac arrhythmias or neurological complications. Methods: A retrospective observational study was carried out over a 2 years period in the Adult Emergency Department (ED) of Nantes University Hospital...
August 31, 2018: Endocrine Connections
Jianting Song, Wenxiu Guo, Xiaoguang Lu, Xin Kang, Yi Song, Dianbo Gong
BACKGROUND: For many years, bystander cardiopulmonary resuscitation (BCPR) has been considered as a favorable factor to improve survival of out-of-hospital cardiac arrests (OHCAs). To examine the effect of BCPR on the survival of OHCAs and whether BCPR might also improve survival when the initial rhythm of OHCAs is limited, we performed a meta-analysis on published observational studies. METHODS: We did a systematic review to identify all studies published up to March, 2018, in any language, that reported the relation between BCPR and the survival of OHCAs...
October 11, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Min-Shan Tsai, Po-Ya Chuang, Chien-Hua Huang, Chao-Hsiun Tang, Ping-Hsun Yu, Wei-Tien Chang, Wen-Jone Chen
OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization...
October 10, 2018: Critical Care Medicine
Sean M Bell, David H Lam, Kathleen Kearney, Ravi S Hira
Ventricular fibrillation is a life-threatening cardiac arrhythmia that leads to a loss of cardiac function and sudden cardiac death. In this review, we summarize therapeutic interventions and guidelines for providers managing patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation in prehospital and emergency settings. Additionally, we review invasive management, including urgent coronary angiography, extracorporeal membrane oxygenation, and novel strategies for managing refractory ventricular fibrillation arrest...
August 2018: Cardiology Clinics
Ar-Aishah Dadeh, Banjaparat Nuanjaroan
Objective: To examine the initial level of lactate to predict sustained return of spontaneous circulation (ROSC) in nontraumatic out-of-hospital cardiac arrest (OHCA) patients. Materials and methods: This was a 30-month retrospective cohort study in an emergency department (ED) of a tertiary care hospital. The inclusion criteria were adult nontraumatic OHCA patients who came to the ED with ongoing chest compression. The primary outcome was initial serum lactate level at the ED to predict sustained ROSC in nontraumatic OHCA...
2018: Open Access Emergency Medicine: OAEM
Brian K Parker, Alexis Salerno, Brian D Euerle
We propose that transesophageal echocardiography (TEE) can be used to guide cardiac arrest resuscitation. We undertook a literature search (Medline and EMBase) to assess articles on that topic. Our search yielded 55 articles falling into 3 categories: TEE used in operating rooms, TEE used in emergency departments, and TEE used in other settings. In many cases, TEE changed the direction of the resuscitation; however, it is unclear whether TEE changed patient-oriented outcomes, such as neurologically intact survival...
October 2, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Michael R Kendall, Stuart Swadron, Leonardo C Clavijo, Anilkumar K Mehra, Antotreas Hindoyan, Ray V Matthews, David M Shavelle
BACKGROUND: Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients. OBJECTIVE: The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE...
October 2018: Journal of Invasive Cardiology
Emilie Gregers, Jesper Kjærgaard, Freddy Lippert, Jakob H Thomsen, Lars Køber, Michael Wanscher, Christian Hassager, Helle Søholm
BACKGROUND: The prognosis in refractory out-of-hospital cardiac arrest (OHCA) with ongoing cardiopulmonary resuscitation (CPR) at hospital arrival is often considered dismal. The use of extracorporeal cardiopulmonary resuscitation (eCPR) for perfusion enhancement during resuscitation has shown variable results. We aimed to investigate outcome in refractory OHCA patients managed conservatively without use of eCPR. METHODS: We included consecutive OHCA patients with refractory arrest or prehospital return of spontaneous circulation (ROSC) in the Copenhagen area in 2002-2011...
September 29, 2018: Critical Care: the Official Journal of the Critical Care Forum
Masashi Okubo, Robert H Schmicker, David J Wallace, Ahamed H Idris, Graham Nichol, Michael A Austin, Brian Grunau, Lynn K Wittwer, Neal Richmond, Laurie J Morrison, Michael C Kurz, Sheldon Cheskes, Peter J Kudenchuk, Dana M Zive, Tom P Aufderheide, Henry E Wang, Heather Herren, Christian Vaillancourt, Daniel P Davis, Gary M Vilke, Frank X Scheuermeyer, Myron L Weisfeldt, Jonathan Elmer, Riccardo Colella, Clifton W Callaway
Importance: Emergency medical services (EMS) deliver essential initial care for patients with out-of-hospital cardiac arrest (OHCA), but the extent to which patient outcomes vary between different EMS agencies is not fully understood. Objective: To quantify variation in patient outcomes after OHCA across EMS agencies. Design, Setting, and Participants: This observational cohort study was conducted in the Resuscitation Outcomes Consortium (ROC) Epistry, a prospective multicenter OHCA registry at 10 sites in North America...
September 26, 2018: JAMA Cardiology
A Hernández-Tejedor, E Corral Torres, R de Elías Hernández, A San Juan Linares, M I Casado Flórez
OBJECTIVES: . The main purpose was to assess our emergency department's level of adherence to clinical practice guidelines (CPGs) for the diagnosis of pulmonary embolism in different age groups. The secondary aims were to study the utility and estimated the number of avoidable CT angiography with this approach of age-adjusted D-dimer concentrations in combination with the Wells score in the diagnosis of pulmonary embolism. MATERIAL AND METHODS: Retrospective observational study of a series of hemodynamically stable patients suspected of having pulmonary embolism in the emergency department of a tertiary care university hospital in 2012...
October 2018: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
Akihiro Hirakawa, Toshihiro Hatakeyama, Daisuke Kobayashi, Chika Nishiyama, Akiko Kada, Takeyuki Kiguchi, Takashi Kawamura, Taku Iwami
BACKGROUND: The quality of cardiopulmonary resuscitation (CPR) performed by emergency medical services (EMS) personnel affects patient outcomes after cardiac arrest. A CPR feedback device with an accelerometer mounted on a defibrillator can monitor the motion of the patient's sternum to display and record CPR quality in real time. To evaluate the utility of real-time feedback, debriefing, and retraining using a CPR feedback device outside of the hospital, an open-label, cluster randomized controlled trial will be conducted in five municipalities of Osaka Prefecture, Japan...
September 20, 2018: Trials
Matthew Oliver, Aaron A Adonopulos, Paul S Haber, Michael M Dinh, Tim Green, Tim Wand, Alexandre Vitte, Dane Chalkley
OBJECTIVE: The present study describes patients with acute behavioural disturbance presenting to the ED, the impact they have on the department and any complications that occur. METHODS: We performed a prospective observational study of adult patients (>17 years old) requiring parenteral sedation for acute behavioural disturbance over a 13 month period. Demographic data, mode of arrival, indication, drug type and dosing used for sedation were collected. Departmental data were recorded including the staff type and numbers involved and the condition of the department...
September 19, 2018: Emergency Medicine Australasia: EMA
Christopher Berry, Douglas Kupas, Mark Olaf, Anne Knorr, Andrea Berger
BACKGROUND: The approach to managing out-of-hospital cardiac arrest (OOHCA) has generally involved either minimal on-scene resuscitation to reduce time to arrival at hospital or extended care at the scene to increase the chance of return of spontaneous circulation (ROSC) before transport. This study compared patient outcomes across EMS agencies with respect to the duration of on-scene time. We hypothesized that EMS agencies with greater average time on-scene would have more favorable outcomes...
September 15, 2018: Prehospital Emergency Care
Patrick Druwé, Koenraad G Monsieurs, Ruth Piers, James Gagg, Shinji Nakahara, Evan Avraham Alpert, Hans van Schuppen, Gábor Élő, Anatolij Truhlář, Sofie A Huybrechts, Nicolas Mpotos, Luc-Marie Joly, Theodoros Xanthos, Markus Roessler, Peter Paal, Michael N Cocchi, Conrad BjØrshol, Monika Pauliková, Jouni Nurmi, Pascual Piñera Salmeron, Radoslaw Owczuk, Hildigunnur Svavarsdóttir, Conor Deasy, Diana Cimpoesu, Marios Ioannides, Pablo Aguilera Fuenzalida, Lisa Kurland, Violetta Raffay, Gal Pachys, Bram Gadeyne, Johan Steen, Stijn Vansteelandt, Peter De Paepe, Dominique D Benoit
INTRODUCTION: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. METHODS: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models...
September 12, 2018: Resuscitation
Stephen Mullen, Zöe Roberts, David Tuthill, Laura Owens, Johann Te Water Naude, Sabine Maguire
Pediatric autoresuscitation is extremely rare, with only 4 documented cases in the literature. The longest recorded time between stopping cardio pulmonary resuscitation (CPR) and return of spontaneous circulation is 2 minutes. We report a previously well 18-month-old who attended the emergency department after an unexplained cardiac arrest. After 10 cycles of CPR, resuscitation was stopped; 6 minutes later, the patient had a return of spontaneous circulation and was transferred to the pediatric intensive care unit...
September 11, 2018: Pediatric Emergency Care
Kimberly M Glerum, Steven M Selbst, P Divya Parikh, Mark R Zonfrillo
OBJECTIVES: This study aimed to provide an assessment of medical malpractice claims involving pediatric patients cared for in emergency department and urgent care settings. METHODS: We performed a retrospective review of all closed malpractice claims involving children (0-17 years old) originating from emergency department or urgent care centers from the Physician Insurers Association of America's Data Sharing Project database for a 15-year period (2001-2015). Reported data collected include medical specialty involved, medical diagnoses, chief medical factors, severity of resulting injury, claim disposition, average indemnity, and average defense costs...
September 11, 2018: Pediatric Emergency Care
Sunil K Nadar, Mohammed Mujtaba, Hafidh Al-Hadi, Muhammed Sadiq, Adil Al-Riyami, Mehar Ali, Hatim Al-Lawati
Objectives: Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman. Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman...
May 2018: Sultan Qaboos University Medical Journal
Marc Auerbach, Linda Brown, Travis Whitfill, Janette Baird, Kamal Abulebda, Ambika Bhatangar, Riad Lutfi, Marcie Gawel, Barbara Walsh, Khoon-Yen Tay, Megan Lavoie, Vinay Nadkarni, Robert Dudas, David Kessler, Jessica Katznelson, Sandeep Ganghadaran, Melinda Fiedor Hamilton
BACKGROUND AND OBJECTIVES: Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher volume hospitals, teaching hospitals and trauma centers. The primary objective of this paper was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation...
September 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Doo Hyo Lee, Jeong Ho Park, Seung Pill Choi, Jae Hoon Oh, Jung Hee Wee
PURPOSE: Drowning is one of the major causes of traumatic death. The impact of drowning in the elderly and patients who were not elderly will be different because of physiological differences. We wanted to analyze the clinical differences such as mortality, incidence rate of complications, degree of hypothermia and rate of cardiac arrest between elderly and adult drowning patients. METHODS: This study included drowning patients over 18 years old who came to an emergency department (ED) located on a riverside from September 1997 to July 2016...
August 29, 2018: American Journal of Emergency Medicine
Atsushi Kawaguchi, L Duncan Saunders, Yutaka Yasui, Allan DeCaen
BACKGROUND AND OBJECTIVES: The need to centralize patients for specialty care in the setting of regionalization may delay access to specialist services and compromise outcomes, particularly in a large geographic area. The aim of this study was to explore the effects of interhospital transferring of children requiring intensive care in a Canadian regionalization model. METHODS: A retrospective cohort design with a matched pair analysis was adopted to compare the outcomes in children younger than 17 years admitted to a pediatric intensive care unit (PICU) of a Canadian children's hospital by a specialized transport team (pediatric critical care transported [PCCT] group) and those children admitted directly to PICU from its pediatric emergency department (PED group)...
September 6, 2018: Journal of Intensive Care Medicine
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