Hospital Variability of Out-of-Hospital Cardiac Arrest Survival
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. Prehospital Emergency Care
(Impact Factor: 1.76).
07/2008; 12(3):339-46. DOI: 10.1080/10903120802101330
Previous literature has identified patient and emergency medical services (EMS) system factors that are associated with survival of out-of-hospital cardiac arrest patients.
To determine variability in rates of survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients and to identify hospital-related factors associated with survival.
This was a retrospective, observational study of all adult (21 years or older) out-of-hospital Utstein criteria cardiac-etiology arrests treated by Milwaukee County EMS during the period 1995-2005 and surviving to hospital intensive care unit admission. The primary outcome measure was survival to hospital discharge. Logistic regression analysis was used to compare the odds of survival between hospitals, patient factors, and hospital factors.
1,702 patients at eight receiving hospitals were included in the study analyses. Hospital survival rates ranged from 29% to 42%. Patient and case factors associated with increased survival included younger age, male gender, nonwhite race, witnessed arrest in a public location, bystander cardiopulmonary resuscitation (CPR), a modest number of defibrillations, and initial cardiac rhythm of ventricular tachycardia. The only hospital characteristic correlated with survival was the number of beds per nurse. Patients admitted to a hospital with a ratio of beds to nurse less than 1.0 were over 1.5 times more likely to survive.
Survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients may vary by receiving hospital. A hospital's ratio of beds to nurse and several patient/case f actors are correlated with survival. Further research is warranted to investigate how this may affect resuscitation care, EMS transport policy, and research design.
Available from: Derek Delia
- "The incidence and survival from OHCA varies substantially across communities (Nichol et al., 2008). Survival also varies by hospital with the majority of that variation unexplained by patient characteristics (Herlitz et al., 2006; Liu et al., 2008; Carr et al., 2009b). Moreover, those who survive an OHCA often experience severe neurological impairment. "
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ABSTRACT: While national guidelines recommend the use of therapeutic hypothermia (TH) for the treatment of out-of-hospital cardiac arrest (OHCA), adoption of the technique has been slow. In addition, little is known about how TH is applied in practice. This study sought to characterize the adoption and implementation of TH by acute care hospitals in the state of New Jersey.
A survey of all 73 acute care hospitals in New Jersey was conducted to solicit information about TH adoption, application, and methods. Additional information was gained through a review of 18 written TH protocols (covering 21 hospitals).
After growing slowly from 2004 to 2008, TH use among New Jersey hospitals accelerated between 2009 and 2011. By 2011, 68.4% of New Jersey hospitals had a TH program in place, with an additional 13.6% indicating plans to begin one. Most hospitals indicated low volumes of OHCA patients (e.g., ≤10 per month). There was no relationship between OHCA volume and development of a TH program. The per hospital volume of OHCA patients receiving TH is even lower given the extensive patient exclusion criteria used by many facilities. TH hospitals vary widely in their TH exclusion criteria and cooling equipment and methods.
The vast majority of New Jersey hospitals are now organized to implement national TH guidelines for initial survivors of OHCA. However, limited volumes of OHCA cases per hospital and lack of uniformity on how the guidelines are implemented raise new questions about the effectiveness of current practice in postarrest care. More detailed analysis of TH volumes versus outcomes and comparative studies of TH techniques are required to optimize postarrest care.
Available from: hrcak.srce.hr
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ABSTRACT: Out-of-hospital cardiac arrest (OOHCA) is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS), or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post–cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible.
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ABSTRACT: Within the worldwide capacitor industry there is a wide range of synthesis techniques for producing the starting BaTiO<sub>3</sub> precursor, which is the primary component for X7R capacitor formulations. The intention of this study was to draw some inherent conclusions about advantages or disadvantages of certain synthesis techniques. Several dielectric compositions for high capacitance BME multilayer ceramic capacitor (MLCC) applications have been examined. These formulations are based on BaTiO<sub>3</sub> precursors that were synthesized from solid state as well as two oxalate methods. The focus of this work was to identify the influence that the host BaTiO<sub>3</sub> had on the reliability of the MLCC. The model proposed by Prokopowitz and Vaskas was used to characterize the reliability behavior. Analysis of the data shows that it is very difficult to predict how a particular BaTiO<sub>3</sub> precursor will work in a given BME formulation without actually producing the formulation and performing the appropriate testing. For the solid state based formulation the value obtained for η was much higher than expected where the E<sub>a</sub> was comparable to the values found in the literature. However, while the two oxalate based formulations behaved very differently from the solid state system, they behaved very similar to one another. For these systems, the η was in agreement with the values found in the literature but the E<sub>a</sub> was much higher than expected.
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