Abstract:
INTRODUCTION:Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important. Hypothesis/Problem This study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized. METHODS:This evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger. RESULTS:Fifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge. CONCLUSION:Recent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.
journal_name
Prehosp Disaster Medjournal_title
Prehospital and disaster medicineauthors
Cortez E,Panchal AR,Davis J,Zeeb P,Keseg DPdoi
10.1017/S1049023X15004987subject
Has Abstractpub_date
2015-10-01 00:00:00pages
452-6issue
5eissn
1049-023Xissn
1945-1938pii
S1049023X15004987journal_volume
30pub_type
杂志文章abstract::Introduction Vasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to ...
journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
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更新日期:2017-06-01 00:00:00
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章,评审
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更新日期:2006-01-01 00:00:00
abstract::Introduction The concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood. Problem In a process of improvement of response time, the impact of the patient's age on ambulance departure intervals was inves...
journal_title:Prehospital and disaster medicine
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更新日期:2016-12-01 00:00:00
abstract::The border area between Germany, Belgium, and The Netherlands includes a substantial number of cooperative forms in the urgent medical assistance sector. Collaboration usually takes place in densely populated areas with cities or villages situated on or in proximity to the border. In some regions, definitive borders a...
journal_title:Prehospital and disaster medicine
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doi:10.1017/s1049023x00001837
更新日期:2004-07-01 00:00:00
abstract:INTRODUCTION:Serotonin and sympathomimetic toxicity (SST) after ingestion of amphetamine-based drugs can lead to severe morbidity and death. There have been evaluations of the safety and efficacy of on-site treatment protocols for SST at music festivals. PROBLEM:The study aimed to examine the safety and efficacy of tr...
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abstract:INTRODUCTION:The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system. METHODS. This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private...
journal_title:Prehospital and disaster medicine
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doi:10.1017/s1049023x00041789
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:The effect of the severe acute respiratory syndrome (SARS) outbreak on the willingness of laypersons to provide bystander cardiopulmonary resuscitation (CPR) using standard CPR (SCPR) or compression-only CPR (CCPR) was evaluated. The preferred type of SCPR in the post-SARS era was assessed. METHODS:A descrip...
journal_title:Prehospital and disaster medicine
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abstract:INTRODUCTION:Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often a...
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abstract::In response to the International Liaison Committee on Resuscitation (ILCOR; Niel, Belgium) release of an updated recommendation related to out-of-hospital spinal immobilization (SI) practice in 2015, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (...
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journal_title:Prehospital and disaster medicine
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journal_title:Prehospital and disaster medicine
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更新日期:2001-07-01 00:00:00
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journal_title:Prehospital and disaster medicine
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更新日期:2018-10-01 00:00:00
abstract::Indonesia has had its share of natural and manmade disasters. From 1997 to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks. In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total of 224 persons have been killed, and 340 persons have been injured. Most of those killed or injur...
journal_title:Prehospital and disaster medicine
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abstract::On March 23, 2020, the United Nations (UN) made an Appeal for a Global Ceasefire following the Outbreak of Coronavirus. Despite this appeal, the Nagorno-Karabagh war was instigated on September 27, 2020. This Guest Editorial frames the conflict in the context of the UN appeal and by introducing a figure that plots sev...
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abstract::This report details the background, planning, and establishment of a mass-casualty management area for the Durban Moses Mabhida Stadium at the Natal Mounted Rifles base, by the Department of Health and the eThekwini Fire and Rescue Service, for the Fédération Internationale de Football Association (FIFA) 2010 Soccer W...
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journal_title:Prehospital and disaster medicine
pub_type: 杂志文章
doi:
更新日期:1999-07-01 00:00:00
abstract:INTRODUCTION:On 26 December 2004, an earthquake (9.0 Richter, 10 kilometers below the sea) near Sumatra, Indonesia, triggered a tsunami, which traveled at approximately 800 km per hour to strike the Indian coastline. The disaster response at a 100-bed hospital situated on the beach front (2,028 km from the epicenter) i...
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更新日期:2006-09-01 00:00:00
abstract:INTRODUCTION:The need to manage psychological symptoms after disasters can result in an increase in the prescription of psychotropic drugs, including antidepressants and anxiolytics. Therefore, an increase in the prescription of antidepressants and anxiolytics could be an indicator of general psychological distress in ...
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更新日期:2012-12-01 00:00:00
abstract:INTRODUCTION:On 26 December 2003, at 05:26 hours, an earthquake of magnitude 6.6 (Richter scale) caused a disaster in the Bam region of Southeastern Iran, which had a population of approximately 102,000. In this study, the clinical and laboratory features and therapeutic interventions in pediatric (three months to 14 y...
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更新日期:2009-09-01 00:00:00
abstract::Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a form of an infectious respiratory disease, discovered in November 2012 in Saudi Arabia. According to the World Health Organization (WHO; Geneva, Switzerland) reports, a total of 2,519 laboratory-confirmed cases and 866 MERS-CoV-related deaths were recorded a...
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更新日期:2020-08-01 00:00:00
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更新日期:2006-03-01 00:00:00
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更新日期:2016-12-01 00:00:00
abstract::Sudden onset disasters (SODs) have affected over 1.5 billion of the world's population in the past decade. During the same time, developing nations have faced a sustained increase in the burden of non-communicable disease (NCD) with extra pressure placed on health systems. The combined increase in SODs and the NCD epi...
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abstract:INTRODUCTION:Currently, there is no widely available method to evaluate an emergency department disaster plan. Creation of a standardized patient database and the use of a virtual, live exercise may lead to a standardized and reproducible method that can be used to evaluate a disaster plan. PURPOSE:A virtual, live exe...
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更新日期:2008-07-01 00:00:00