Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest.

PURPOSE: To improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes. PATIENTS AND METHODS: This was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported. RESULTS: The study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70-201) seconds and median (IQR) time to first defibrillation was 133 (82-264) seconds. Median (IQR) chest compression rate was 126 (119-131) per minute and chest compression fraction (CCF) was 78% (69-86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03). CONCLUSION: We established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.

A Cancer That Went Up in Smoke: Pulmonary Reaction to e-Cigarettes Imitating Metastatic Cancer.

e-Cigarettes have gained worldwide popularity as a substitute for smoking, but concern has been raised regarding the long-term effects associated with their use. We report a case of a 45-year-old female consumer of e-cigarettes who presented with 4 months of abdominal pain and fever. Initial imaging discovered multiple pulmonary nodules and liver lesions suspicious of widespread metastases; however, an extensive evaluation found no evidence of malignancy. Results of a lung biopsy revealed an area with multinucleated giant cells suggestive of a foreign body reaction to a lipophilic material. Upon cessation of e-cigarette use (known as vaping), the lung nodules disappeared, and the liver lesions regressed. Our case report suggests that vaping can induce an inflammatory reaction mimicking metastatic cancer.

[Data from automated external defibrillators provide important information on the quality of in-hospital resuscitation].

International guidelines recommend monitoring the outcome following in-hospital cardiac arrest. Using data from automatic external defibrillators (AED) prospectively collected during a three-year period in a regional hospital, we evaluated the treatment quality of resuscitation. Time to defibrillation was acceptable, but quality of chest compressions did not comply with current international recommendations. AED use led to a high fraction of time with no chest compressions. Survival to discharge was 11%. Consequently, training in basic and advanced life support of hospital staff has been modified.

[Registries of in-hospital cardiac arrest are a challenge in daily clinical practice]. / Registrering af hjertestop på hospital er en udfordring i den kliniske hverdag.

In-hospital cardiac arrest carries a poor prognosis. Registries of in-hospital cardiac arrest provide the opportunity to improve quality of care and conduct research of disease mechanisms and treatment. This paper describes the preliminary experience with systematic registration of in-hospital cardiac arrest at Aarhus University Hospital, Denmark. Data from 102 patients are presented and practical aspects and challenges of establishing a registry and implementing the collection of data in daily clinical practice are discussed.

Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.

The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is applicable in all clinical emergencies for immediate assessment and treatment. The approach is widely accepted by experts in emergency medicine and likely improves outcomes by helping health care professionals focusing on the most life-threatening clinical problems. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. Dissemination of knowledge and skills related to the ABCDE approach are therefore needed. This paper offers a practical "how-to" description of the ABCDE approach.

[Coronary angiography should be considered after out-of-hospital cardiac arrest]. / Koronarangiografi bør overvejes efter hjertestop uden for hospital.

Cardiac arrest has a poor prognosis. Ischaemic heart disease is the main cause of out-of-hospital cardiac arrest. This paper is a review of the essential studies on acute coronary angiography and angioplasty in post resuscitation care. No randomised studies were found. Observational studies support the use of acute angiography in ST-segment elevation myocardial infarction. The negative predictive value of ST-segment elevation can be low after out-of-hospital cardiac arrest, and acute angiography should be considered regardless of electrocardiographic findings.

Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study.

AIM OF THE STUDY: Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases. METHODS: We conducted a prospective, observational study of out-of-hospital cardiac arrest with non-traumatic etiology (>18 years of age) occurring from the 1st to the 31st of January 2009 and treated by the primary Danish emergency medical service operator, covering approximately 85% of the population. One hundred and ninety-one cases were eligible for analysis. Follow-up was up to one year or death. Quality of CPR was evaluated using measurements of transthoracic impedance. RESULTS: The majority of patients were treated by ambulances with ALS capability (54%). Interruptions in CPR related to loading of the patient into the emergency medical service vehicle were substantial, but independent of whether patients were managed by ALS or BLS capable units (222s versus 224s, P = 0.76) as were duration of interruptions during rhythm analysis alone (20s versus 22s, P = 0.33) and defibrillation (24s versus 26s, P = 0.07). CONCLUSIONS: Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.

[ABCDE--a systematic approach to critically ill patients]. / ABCDE--systematisk tilgang til patienter med kritisk sygdom.

This systematic approach to the immediate assessment and treatment of the critically ill or injured patient is applicable in all clinical emergencies. The aim of the ABCDE approach is to facilitate immediate life-saving treatment and thus buy time for definite diagnosis and treatment by breaking down complex clinical situations into manageable parts. Application of the ABCDE approach may improve treatment quality.

[Rescue breathing is still a part of basic life support]. / Kunstigt åndedraet udgør fortsat en del af basal genoplivning.

Bystander cardiopulmonary resuscitation (CPR) consisting of mouth-to-mouth ventilation and chest compressions improves survival from cardiac arrest. Bystanders perform CPR only in a minority of cardiac arrests. To improve the number of bystanders initiating CPR, the American Heart Association recommends that laypersons omit rescue breathing and perform Hands-only CPR. In this paper studies on Hands-only CPR are reviewed. Currently, the evidence is insufficient to herald immediate changes to CPR guidelines and further research is warranted.

[Where is the automated external defibrillator? Development and education]. / Hvor er den automatiske eksterne defibrillator? Udvikling og uddannelse.

The International Liaison Committee on Resuscitation has presented a universal sign to indicate the presence of automated external defibrillators (AED). To disseminate the knowledge of this important signage, a review in a Danish context is presented. It is essential that the public in general and health care professionals in particular know where to locate on AEDs.

[In-hospital resuscitation with automated external defibrilliator]. / Genoplivning med automatisk ekstern defibrillator på hospital.

Early defibrillation is a determinant of survival in cardiac arrest. We report a Danish case of successful in-hospital resuscitation using an automated external defibrillator (AED). This case illustrates important aspects of implementation of in-hospital use of an AED, i.e. location of the AED, education of the staff, systematic registration and data collection and technical aspects of AED use. If in-hospital AED implementation is carefully executed, its use may provide a safe and effective way of obtaining early defibrillation.

[Insufficient implementation of guidelines for basic life support in Denmark]. / Mangelfuld implementering af retningslinjer for basal genoplivning i Danmark.

INTRODUCTION: Early bystander cardiopulmonary resuscitation (CPR) improves survival following out of hospital cardiac arrest. Bystanders perform basic life support in less than one third of witnessed cardiac arrests. Furthermore, the quality of CPR differs considerably. Unambiguous course material may improve education in resuscitation and further the provision and efficiency of CPR. In 2005 the European Resuscitation Council (ERC) published guidelines for adult basic life support. The objective of this investigation is to evaluate the adherence of Danish course material for laypeople to the ERC Guidelines. MATERIALS AND METHODS: Printed Danish course material is compared to the ERC Guidelines with respect to algorithm, resuscitation techniques and illustrations. RESULTS: The majority of the investigated material does not adhere to the ERC Guidelines, especially with regard to resuscitation techniques and illustrations. There were considerable discrepancies concerning airway management, recognition of cardiac arrest, activation of emergency medical services and chest compressions. CONCLUSION: We demonstrate substantial differences between Danish course material and the ERC Guidelines. This may have implications for CPR provided by bystanders.

Aorto-mitral inflammation in rheumatological disease: transoesophageal echocardiographic presentation.

Thickening of the aortic root and anterior mitral leaflet has been described in patients with aortic valve insufficiency associated with ankylosing spondylitis. We report identical findings made by transthoracic and transoesophageal echocardiography in three patients with inflammatory, non-infective aorto-mitral pathology as manifestation of various rheumatological disorders. All three patients had significant aortic valve incompetence. All three had thickened walls of the sinuses of Valsalvae and a thickened anterior mitral leaflet, in one case with chordal rupture. These findings were confirmed at open heart surgery, and further characterized by histological examination.