RESUMEN
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.
RESUMEN
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.
Asunto(s)
Reanimación Cardiopulmonar , Cardioversión Eléctrica , Paro Cardíaco/terapia , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/normas , Reanimación Cardiopulmonar/estadística & datos numéricos , Desfibriladores , Documentación/normas , Cardioversión Eléctrica/mortalidad , Cardioversión Eléctrica/normas , Cardioversión Eléctrica/estadística & datos numéricos , Femenino , Paro Cardíaco/mortalidad , Masaje Cardíaco/normas , Masaje Cardíaco/estadística & datos numéricos , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Estudios Prospectivos , Calidad de la Atención de Salud , Estudios Retrospectivos , Tasa de Supervivencia , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
Accelerated diagnostic evaluation of patients referred on suspicion of ischaemic heart disease was introduced at Vejle Hospital in 2007. This article describes the diagnostic algorithm used and the course of the 270 patients who were referred to the clinic. A total of 20% of the patients were found to have no need for further testing at the first examination, 32% were referred to coronary angiography, 33% to coronary CT angiography, 7% to myocardial perfusion imaging and 8% to exercise testing. 88% of patients achieved a diagnosis within 21 days from the first clinical examination.