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A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital.

ABSTRACT: Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at the Seoul National University Bundang Hospital. The primary outcome was the incidence of in-hospital CPR per 1000 inpatients in the Mon-Wed and Thu-Sun periods. Secondary outcomes included differences in the CPR incidence by time of day and season.In the study, 1195 cases of in-hospital CPR were included. The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun (mean: 0.595, 95% confidence interval [CI]: 0.564-0.626) than on Mon-Wed (mean: 0.505, 95% CI: 0.474-0.536, P?

SUBMITTER: Oh TK

PROVIDER: S-EPMC5944682 | biostudies-other | 2018 Feb

REPOSITORIES: biostudies-other

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A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital.

Oh Tak Kyu TK Park Young Mi YM Do Sang-Hwan SH Hwang Jung-Won JW Jo You Hwan YH Kim Jin Hee JH Jeon Young-Tae YT Song In-Ae IA

Medicine 20180201 6

Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at t ...[more]

PMID: 29419666

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Project description:Background The role of computed tomography (CT) scans after extracorporeal membrane oxygenation (ECMO) implantation in patients with refractory cardiac arrest has not been frequently investigated. Early CT scan findings may have many meaningful findings and contribute significantly to patients’ outcome. In this study, we sought to determine whether early CT scans in such patients indirectly improved in-hospital survival. Methods A computerized search of the electronic medical records systems of 2 ECMO centers was conducted. A total of 132 patients who had undergone extracorporeal cardiopulmonary resuscitation (ECPR) between September 2014 and January 2022 were included in the analysis. The patients were divided into 2 groups based on whether they underwent early CT scans (the treatment group) or did not undergo early CT scans (the control group). The findings of early CT scans and in-hospital survival were investigated. Results A total of 132 patients had undergone ECPR with 71 were male, 61were female and mean age: 48.0±14.3 years. Early CT scans did not improve patient’s in-hospital survival [hazard ratio (HR): 0.705; P=0.357]. Overall, a smaller proportion of patients survived in the treatment group (22.5%) than the control group (42.6%; P=0.013). In total, 90 patients were matched in terms of age, initial shockable rhythm, Sequential Organ Failure Assessment (SOFA) score, cardiopulmonary resuscitation (CPR) duration, ECMO duration, percutaneous coronary intervention, and cardiac arrest location. In the matched cohort, fewer patients survived in the treatment group (28.9%) than the control group (37.8%; P=0.371), but the difference was not significant. According to a log-rank test, in-hospital survival did not differ significantly before and after matching (P=0.69, and P=0.63, respectively). Thirteen patients (18.3%) had complications during transportation, among which a drop in blood pressure was the most common. Conclusions The in-hospital survival rate between treatment and control group was not different, however, early CT scan after ECPR could help clinicians to gain important information to guide clinical practice.

Project description:ObjectiveTo quantify time dependent probabilities of outcomes in patients after in-hospital cardiac arrest as a function of duration of cardiopulmonary resuscitation, defined as the interval between start of chest compression and the first return of spontaneous circulation or termination of resuscitation.DesignRetrospective cohort study.SettingMulticenter prospective in-hospital cardiac arrest registry in the United States.Participants348 996 adult patients (≥18 years) with an index in-hospital cardiac arrest who received cardiopulmonary resuscitation from 2000 through 2021.Main outcome measuresSurvival to hospital discharge and favorable functional outcome at hospital discharge, defined as a cerebral performance category score of 1 (good cerebral performance) or 2 (moderate cerebral disability). Time dependent probabilities of subsequently surviving to hospital discharge or having favorable functional outcome if patients pending the first return of spontaneous circulation at each minute received further cardiopulmonary resuscitation beyond the time point were estimated, assuming that all decisions on termination of resuscitation were accurate (that is, all patients with termination of resuscitation would have invariably failed to survive if cardiopulmonary resuscitation had continued for a longer period of time).ResultsAmong 348 996 included patients, 233 551 (66.9%) achieved return of spontaneous circulation with a median interval of 7 (interquartile range 3-13) minutes between start of chest compressions and first return of spontaneous circulation, whereas 115 445 (33.1%) patients did not achieve return of spontaneous circulation with a median interval of 20 (14-30) minutes between start of chest compressions and termination of resuscitation. 78 799 (22.6%) patients survived to hospital discharge. The time dependent probabilities of survival and favorable functional outcome among patients pending return of spontaneous circulation at one minute's duration of cardiopulmonary resuscitation were 22.0% (75 645/343 866) and 15.1% (49 769/328 771), respectively. The probabilities decreased over time and were <1% for survival at 39 minutes and <1% for favorable functional outcome at 32 minutes' duration of cardiopulmonary resuscitation.ConclusionsThis analysis of a large multicenter registry of in-hospital cardiac arrest quantified the time dependent probabilities of patients' outcomes in each minute of duration of cardiopulmonary resuscitation. The findings provide resuscitation teams, patients, and their surrogates with insights into the likelihood of favorable outcomes if patients pending the first return of spontaneous circulation continue to receive further cardiopulmonary resuscitation.

Project description: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. RESULTS:A total of 3992 OHCA patients with resuscitation attempts were included; in 2599, treatment was terminated prehospital, and 1393 (35%) were brought to the hospital either with ROSC (n?=?1285, 92%) or with refractory OHCA (n?=?108, 8%). Of patients brought in with refractory OHCA, 56 (52%) achieved ROSC in the emergency department. There were no differences between patients with refractory OHCA or prehospital ROSC with regard to age, sex, comorbidities, or etiology of OHCA. Time to emergency medical services (EMS) arrival was similar, whereas time to ROSC (when ROSC was achieved) was longer in refractory OHCA patients (EMS, 6 (5-9] vs. 7 [5-10] min, p?=?0.8; ROSC, 15 [9-22] vs. 27 [20-41] min, p?<?0.001). Independent factors associated with transport with refractory OHCA instead of prehospital termination of therapy were OHCA in public (OR, 3.6 [95% CI, 2.2-5.8]; p?<?0.001), witnessed OHCA (OR, 3.7 [2.0-7.1]; p?<?0.001), shockable rhythm (OR, 3.0 [1.9-4.7]; p?<?0.001), younger age (OR, 1.2 [1.1-1.2]; p?<?0.001), and later calendar year (OR, 1.4 [1.2-1.6]; p?<?0.001). Thirty-day survival was 20% in patients with refractory OHCA compared with 42% in patients with prehospital ROSC (p?<?0.001). Four of 28 refractory OHCA patients with duration of resuscitation >?60 min achieved ROSC. No difference in favorable neurological outcome in patients surviving to discharge was found (prehospital ROSC 84% vs. refractory OHCA 86%; p?=?0.7). CONCLUSIONS:Survival after refractory OHCA with ongoing CPR at hospital arrival was significantly lower than among patients with prehospital ROSC. Despite a lower survival, the majority of survivors with both refractory OHCA and prehospital ROSC were discharged with a similar degree of favorable neurological outcome, indicating that continued efforts in spite of refractory OHCA are not in vain and may still lead to favorable outcome even without eCPR.

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A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital.

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A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital.

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