In-Hospital Cardiac Arrests and Resuscitation
A multi-centre observational study was conducted to report the duration of resuscitation for patients after an in-hospital cardiac arrest as well as to examine the relationship between resuscitation and neurologically intact survival to discharge.
See Also: ESA2016: Death by Resuscitation?
For the purpose of the study, the authors collated data from 40,563 non-survivors of in-hospital cardiac arrest in 573 hospitals. Patients were categorised on the basis of their chance of neurologically intact survival to hospital discharge. The categories were determined on the basis of the "Good Outcome Following Attempted Resuscitation" (GO-FAR) score which considers 13 pre-cardiac-arrest characteristics.
Findings show that the median duration of resuscitation effort was 19 min. The researchers found a correlation between median resuscitation duration and predicted chance of neurologically-intact survival. Those who received resuscitation for 7 min longer than the median had an above-average chance of neurologically-intact survival as compared to those who received a 16 min resuscitation.
The study also showed a wide variation in resuscitation practices. Approximately 40.4 percent of patients who had a very low chance of survival were resuscitated for longer than 19 min while 31.9 percent patients who had an above-average chance of survival were resuscitated for shorter than the median duration. These findings suggest that futile and prolonged resuscitation is being performed on a large number of patients while there are patients who are being withdrawn from life-saving resuscitation too soon.
Factors such as age, malignancy and existing heart failure were found to be correlated with below-median resuscitation in patients with above-average chance of neurologically-intact survival while factors such as shockable rhythm correlated with above-median resuscitation in patients with a very low chance of neurologically-intact survival. It thus appears that physicians may be placing emphasis on certain attributes and the decisions they are making may not be in the patient's best interest.
While the GO-FAR score may be a useful tool but it remains to be seen whether the model is effective enough to help physicians make accurate decisions regarding resuscitation. Patient preferences and concerns may play a role in resuscitation decisions and family members could also have an impact.
Overall, it is important to note that there are neurologically-intact survivors that are dying due to premature decisions to stop resuscitation. Using tools such as the GO-FAR score may be useful in making such decisions. Nevertheless, physicians need to look at the broader picture and consider all important factors before deciding whether to stop or continue resuscitation.
Image Credit: Wikimedia Commons
Published on : Tue, 31 Jan 2017
User experience enhanced by leading technologies With state-of-the-art screen technology, BeneVision N-Series patient monitors deliver clear, multi-color, wide-format displays for users to capture and review information at a glance. With...
Single Lumen Dual Port Nasogastric Feeding and Drainage Tube Designed for the ICU Compat Dualport is designed to help simplify gastric drainage and administration of nutrition, fluids and medications by the use of one single tube for both operations....
A high-end ventilator featured with 1080P HD wide screen, combines an intuitive customized UI with powerful assistive tools and modules. Operate with Ease In the modern busy clinical environment, ease of use is a fundamental requirement for all...
Intended to establish emergency airway access when endotracheal intubation cannot be performed. Features and benefits This comprehensive and compact set provides you with everything you need. Airway access is achieved by using the...
Intended to facilitate endotracheal intubation in patients where the visualisation of the glottis is inadequate. Features and benefits The blunt, angled tip can be passed blindly into the trachea when visualisation of the glottis is inadequate...