For every 10,000 patients, existing practice resulted in 1118 (95% Uncertainty Interval 1117 to 1119) additional urgent transports to hospital and subsequent emergency treatments. There were 93 (95% Uncertainty Interval 66 to 120) extra inpatient bed days used, and 3 fewer deaths (95% Uncertainty Interval 2 to 4) in comparison to using the protocol.
The findings provide some evidence for adopting the Termination of Resuscitation protocol. This policy could lead to a reduction in costs and non-beneficial hospital admissions, however there may be a small increase in the number of avoidable deaths.
The findings provide some evidence for adopting the Termination of Resuscitation protocol. This policy could lead to a reduction in costs and non-beneficial hospital admissions, however there may be a small increase in the number of avoidable deaths.
Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses.
Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for
number PPV delivered, number
PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon sigV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.
Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied.
To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces.
Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs.
Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location.
Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
To show whether adding blood glucose to the National Early Warning Score (NEWS) parameters in a machine learning model predicts 30-day mortality more precisely than the standard NEWS in a prehospital setting.
In this study, vital sign data prospectively collected from 3632 unselected prehospital patients in June 2015 were used to compare the standard NEWS to random forest models for predicting 30-day mortality. The NEWS parameters and blood glucose levels were used to develop the random forest models. Predictive performance on an unknown patient population was estimated with a ten-fold stratified cross-validation method.
All NEWS parameters and blood glucose levels were reported in 2853 (79%) eligible patients. Within 30 days after contact with ambulance staff, 97 (3.4%) of the analysed patients had died. The area under the receiver operating characteristic curve for the 30-day mortality of the evaluated models was 0.682 (95% confidence interval [CI], 0.619-0.744) for the standard NEWS, 0.735 (95% CI, 0.679-0.787) for the random forest-trained NEWS parameters only and 0.758 (95% CI, 0.705-0.807) for the random forest-trained NEWS parameters and blood glucose. The models predicted secondary outcomes similarly, but adding blood glucose into the random forest model slightly improved its performance in predicting short-term mortality.
Among unselected prehospital patients, a machine learning model including blood glucose and NEWS parameters had a fair performance in predicting 30-day mortality.
Among unselected prehospital patients, a machine learning model including blood glucose and NEWS parameters had a fair performance in predicting 30-day mortality.
Fast arrival of the cardiac arrest team (CAT) is associated with improved survival after in-hospital cardiac arrest however little is known about how we can minimize delays in CAT arrival. This study aimed to investigate differences in the cardiac arrest call procedures in Danish hospitals and identify causes for adverse events delaying the CAT arrival.
This nationwide study surveyed all public somatic hospitals in Denmark with a CAT. We searched for all patient safety incidences related to the cardiac arrest call procedure during a two-year period. CAY10444 antagonist Two researchers reviewed all incidents and categorized the cause as either human, technical, or not possible to classify, and whether the incident caused a delay of the CAT arrival.
In total, 36 hospitals (78%) responded and all hospitals used a telephone number, a CAT activation button or both for activation of the CAT. We found 131 reports describing an event related to activation of the CAT of which 87 incidents (66%) caused a definite delay in CAT arrival.CAY10444 antagonist
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