- Email: [email protected]
Factors associated with survival after in-hospital cardiac arrest in Hong Kong
Correspondence / American Journal of Emergency Medicine 31 (2013) 873–885
883
Table 3 The 5 most popular emergency medicine journals for authors based on published articles in mainland China, Hong Kong, and Taiwan Rank
Mainland China
n
Hong Kong
n
Taiwan
n
1 2 3 4 5
The Journal of Trauma Injury The American Journal of Emergency Medicine Resuscitation Emergency Medicine Journal
123 97 52 26 20
Injury Emergency Medicine Journal Resuscitation European Journal of Emergency Medicine The Journal of Trauma
31 29 27 20 15
The American Journal of Emergency Medicine The Journal of Trauma Journal of Emergency Medicine Resuscitation Injury
333 273 106 86 82
Ling-ling Gao PhD, MSc, RN School of Nursing, Sun Yat-sen University, Guangzhou, China E-mail address: [email protected]
Factors associated with survival after in-hospital cardiac arrest in Hong Kong To the Editor,
http://dx.doi.org/10.1016/j.ajem.2013.01.032
References [1] ISI Journal Citation Reports, Institute for Scientific Information. Available at http:// isiknowledge.com; 2011. Accessed at October 19, 2012. [2] Wells WA. The returning tide: how China, the world's most populous country, is building a competitive research base. J Cell Biol 2007;176:376–401. [3] Zheng ML, Yang LL, Shen Y, Shu Q. Publications in ISI-indexed public health journals from mainland China, Hong Kong and Taiwan during 1999-2008. Med Sci Monit 2011;17(7):SR21–7. [4] Garfield E. The history and meaning of the journal impact factor. JAMA 2006;295:90–3. [5] Lee C, Shih C, Chang Y, Chaou C. The evolution of academic performance in emergency medicine journals: viewpoint from 2000 to 2009 Journal Citation Reports. Acad Emerg Med 2011;18:898–904.
The rate of return of spontaneous circulation (ROSC) for inhospital cardiac arrest (IHCA) is 15% to 60% and survival to discharge is 15% to 20% [1-6]. Monitoring for ventricular fibrillation or ventricular tachycardia (VF/VT) [1-10], early cardiopulmonary resuscitation (CPR) and defibrillation [11] and medical emergency teams [12] can significantly improve cardiac arrest outcomes. This study investigated the clinical variables associated with ROSC and survival to discharge after IHCA in Hong Kong. Ethical approval for this retrospective observational study was granted by our local research ethics committee. Data from January 1, 2008, to December 31, 2008, were extracted from Utstein format resuscitation records in Pamela Youde Nethersole Eastern Hospital (PYNEH) (1829-bedded tertiary regional hospital) and Prince of
Fig. 1. Outcome of patients with cardiac arrest in this study by Utstein style [13].
884
Correspondence / American Journal of Emergency Medicine 31 (2013) 873–885
Table Outcomes of resuscitation, grouped by factors
Total Mean age (±SD) Range CPR duration Range Male Arrest within 24 h of admission Arrest time 0700-1400 shift 1400-2100 shift 2100-0700 shift Specialties ICU/CCU Medical Orthopaedic Oncology Psychiatric Surgical MET activated Witnessed arrest Initial rhythm Shockable (VF/VT) Nonshockable Asystole PEA Unknown Cardiac cause From arrest to CPR Range Early drug administration (b2 min) Intubation From arrest to defibrillation Range
No ROSC
ROSC but died
Survival to discharge
Total (n = 431)
269 (62.4%) 73.5 (±12.3) 38-97 29.6 (±13.3) 1-90 172 (64.7%) 197 (65.9%)
139 (32.3%) 73.9 (±13.4) 24-97 18.8. (±14) 1-76 79 (29.7%) 93 (31.1%)
23 (5.3%) 70.8 (±10.9) 50-90 10.1 (±15.3) 0-68 15 (5.6%) 9 (3%)
431 (100%)
68 (60.2%) 80 (65.6%) 121 (61.7%)
37 (32.7%) 36 (29.6%) 66 (33.7%)
8 (7.1%) 6 (4.9%) 9 (4.6%)
113 (26.2%) 122 (28.3%) 196 (45.5%)
32 (42.7%) 172 (64.4%) 24 (92.3%) 11 (78.6%) 0 30 (62.5%) 117 (67.6%) 149 (57.3%)
28 (37.3%) 89 (33.3%) 2 (7.7%) 2 (14.3%) 1 (100%) 17 (35.4%) 49 (28.3%) 89 (34.3%)
15 (20%) 6 (2.2%) 0 1 (7.1%) 0 1 (2.1%) 7 (4%) 22 (8.5%)
75 (17.4%) 267 (61.9%) 26 (6.0%) 14 (3.2%) 1 (0.2%) 48 (11.1%) 173 (40.1%) 260 (60.3%)
5 (20%)
8 (32%)
12 (48%)
160 (68.1%) 99 (61.5%) 4 (66.7%) 65 (55.6%) 0.45 (±1.35) 0-13 69 (50%) 160 (57.6%) 8 min 5-11
72 (30.6%) 56 (34.8%) 2 (33.3%) 33 (18.2%) 0.4 (±1.042) 0-5 50 (43.5%) 107 (38.5%) 2.2 min 0-12
3 (1.3%) 6 (3.7%) 0 19 (16.2%) 0.22 (±0.85) 0-4 9 (6.5%) 11 (4%) 2.3 min 0-19
25 (5.8%) 400 (92.8%) 235 (54.5%) 161 (37.4%) 6 (1.4%) 117 (27.1%)
24 - 97 0-90 266 (61.7%) 299 (69.4%)
138 (32%) 278 (64.5%)
Abbreviations: ICU, intensive care unit; CCU, cardiac care unit; MET, medical emergency team; PEA, pulseless electrical activity.
Wales Hospital (PWH) (1400-bedded university teaching hospital). Definitions were according to the 2004 Utstein template [13]. Inpatients 18 years or older with IHCA were included. If patient had more than 1 resuscitation attempt during the same admission, only the first attempt was included. The following patients were excluded: “do not resuscitate” patients; admissions after prehospital cardiac arrest; cardiac arrest in the operating room; traumatic cardiac arrests; and isolated respiratory arrest. Data were entered into Microsoft Excel, and statistical analyses were done with SPSS 16.0 for Windows (SPSS, Inc, Chicago, IL). Continuous variables were expressed as means
Fig. 2. From arrest to CPR duration (minutes).
and SD and compared with t tests. Categorical data were expressed as percentages and compared using χ 2 tests. Odds ratios (ORs) with 95% confidence intervals (CIs) were generated using univariate analysis to investigate the possible association between ROSC and survival to discharge and clinical variables. Variables were entered into multivariate logistic regression to determine independent predictors of ROSC and survival to discharge. Statistical significance was set at less than 0.05. A total of 3709 deaths were identified; 3225 patients were not resuscitated. A total of 484 resuscitation forms were completed. Fifty-three patients were excluded: 1 cardiac arrest in the operating room; 1 traumatic cardiac arrest; 6 isolated respiratory arrests; 24 prehospital cardiac arrests; 21 patients resuscitated more than once. One hundred fifty-six IHCAs were in PWH, and 275 were in PYNEH. Mean age was 73.6 years (range, 24-97 years; SD, 12.5). Fig. 1 shows the Utstein summary, the Table lists outcomes, and Fig. 2 shows the arrest duration with clinical outcome. Data on initial rhythm were missing in 6 patients (1.5%); these were analyzed in the nonshockable group. Following multiple logistic regression (stepwise backwards elimination of nonsignificant variables), 5 factors were statistically significant and associated with ROSC. These were orthopaedic ward admission (OR, 0.095; 95% CI, 0.019-0.474; P = .004), initial shockable rhythm (OR, 8.95; 95%CI, 2.93-27.36; P b .001), early drug administration (OR, 1.95; 95% CI, 1.25-3.04; P = .003), intubation (OR, 1.67; 95% CI, 1.05-2.65; P = .031), and CPR duration (OR, 0.92; 95% CI, 0.90-0.94; P b .001). Four factors were associated with survival to discharge: shockable rhythm (OR, 14.95; 95% CI, 4.18-53.45; P b .001), cardiac cause (OR, 10.75; 95% CI, 2.32-49.89; P = .002), witnessed/ monitored arrest (OR, 10.26; 95% CI, 1.01-104.43; P = .049), and CPR duration (OR, 0.91; 95% CI, 0.86-0.96; P = .001).
Correspondence / American Journal of Emergency Medicine 31 (2013) 873–885
Survival from IHCA is poor in Hong Kong. Early defibrillation is important [14]; delaying defibrillation by 2 minutes after cardiac arrest may decrease survival to discharge from 39% to 22% [15]. In this study, mean defibrillation time for patients with ROSC was 0.43 to 2.27 minutes (range, 0-19 minutes), compared with a mean of 8 minutes for those without ROSC. Several reports [1-4,11] suggest that automated external defibrillator use by nurses can shorten defibrillation times with improved results. During this study, the nurses' defibrillation training program had just started so defibrillation may have been delayed. Extending defibrillation training within Hong Kong could potentially improve IHCA outcomes. Of our patients, 60.3% had witnessed arrests, with 8.5% surviving. Monitored/witnessed arrests allow better outcomes because of more rapid recognition of IHCA [16]. The shortest mean CPR duration (10 minutes) was seen in the survival to discharge group. Shorter CPR duration is associated with shockable rhythms or other rapidly reversible factors. Patients with shockable rhythms were more likely to achieve ROSC and survival to discharge (52.2% of survivors to discharge had VF/VT). Although only 5.8% (25/431) presented with shockable rhythms, this constitutes 80% (20/25) of the ROSC and 48% (12/25) of the survival to discharge groups. However, shockable rhythms have resulted in ROSC in 76% and survival to discharge in 57% in Australia [2]. Early drug administration and intubation were associated with ROSC but not survival to discharge, in keeping with previous work [17]. The presence of the cardiac arrest team was not associated with increased survival, in keeping with other reports [18]. This study has the inherent limitations of being retrospective. Times recorded on the forms could differ due to interobserver variation. Because of the small sample, some significant factors may have been masked. In conclusion, outcomes of IHCA in Hong Kong are poor. Shockable rhythm, underlying cardiac cause, witnessed/monitored arrest, and short CPR duration are associated with survival to discharge.
Acknowledgments We thank Dr Warrance Chiu and Dr Bonnie Cheng, PYNEH, and Dr Florence Yap and Ms Carmen Ho, PWH, for assistance.
Jacky C. Chan MSc, RN Accident and Emergency Training Centre Ruttonjee Hospital & Tang Shiu Kin Hospital Hospital Authority of Hong Kong, Hong Kong T.W. Wong MBBS Accident and Emergency Department Pamela Youde Nethersole Eastern Hospital, Hong Kong
885
Colin A. Graham MD, MPH Accident and Emergency Medicine Academic Unit The Chinese University of Hong Kong, Trauma and Emergency Centre Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR E-mail address: [email protected]
http://dx.doi.org/10.1016/j.ajem.2013.02.005
References [1] Cohn AC, Wilson WM, Joshi SB, et al. Analysis of clinical outcomes following in hospital cardiac arrest. Intern Med J 2004;34:398–402. [2] Peter R, Boyde M. Improving survival after in-hospital cardiac arrest: The Australian experience. Am J Crit Care 2007;16:240–6. [3] Sandroni C, Nolan J, Cavallaro F, et al. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2007;33:237–45. [4] Skrifvars MB, Rosenberg PH, Finne P, et al. Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. Resuscitation 2003;56:275–82. [5] Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation 2000;47:125–35. [6] Fredriksson M, Aune S, Thoren AB, et al. In-hospital cardiac arrest—an Utstein style report of seven years experience from the Sahlgrenska University Hospital. Resuscitation 2006;68:351–8. [7] Chan WM. Towards a better outcome of cardiopulmonary resuscitation. Hong Kong Med J 2007;13:256–7. [8] Yap HY, Li TST, Tan KS, et al. Characteristics, management process, and outcome of patients suffering in-hospital cardiopulmonary arrests in a teaching hospital in Hong Kong. Hong Kong Med J 2007;13:258–65. [9] Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297–308. [10] Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295:50–7. [11] Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 2004;44: 846–52. [12] Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365:2091–7. [13] Jacobs I, Nadkarni V, and the International Liaison Committee on Resuscitation Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation. Circulation 2004;110(21):3385–97. [14] Herlitz J, Aune S, Bang A, et al. Very high survival among patients defibrillated at an early stage after in hospital ventricular fibrillation on ward with and without monitoring facilities. Resuscitation 2005;66:159–66. [15] Chan PS, Krumholz HM, Nichol G, et al. Delayed time to defibrillation after inhospital cardiac arrest. NEJM 2008;358:9–17. [16] Herlitz J, Bang A, Aune S, et al. Characteristics and outcome among patients suffering in-hospital cardiac arrests in monitored and non-monitored areas. Resuscitation 2001;48:125–35. [17] International Liaison Committee on Resuscitation. Part 4: adult basic life support. Circulation 2005;112:19–34. [18] Weng TI, Huang CH, Ma MHM, et al. Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team. Resuscitation 2004;60:137–42.
883
Table 3 The 5 most popular emergency medicine journals for authors based on published articles in mainland China, Hong Kong, and Taiwan Rank
Mainland China
n
Hong Kong
n
Taiwan
n
1 2 3 4 5
The Journal of Trauma Injury The American Journal of Emergency Medicine Resuscitation Emergency Medicine Journal
123 97 52 26 20
Injury Emergency Medicine Journal Resuscitation European Journal of Emergency Medicine The Journal of Trauma
31 29 27 20 15
The American Journal of Emergency Medicine The Journal of Trauma Journal of Emergency Medicine Resuscitation Injury
333 273 106 86 82
Ling-ling Gao PhD, MSc, RN School of Nursing, Sun Yat-sen University, Guangzhou, China E-mail address: [email protected]
Factors associated with survival after in-hospital cardiac arrest in Hong Kong To the Editor,
http://dx.doi.org/10.1016/j.ajem.2013.01.032
References [1] ISI Journal Citation Reports, Institute for Scientific Information. Available at http:// isiknowledge.com; 2011. Accessed at October 19, 2012. [2] Wells WA. The returning tide: how China, the world's most populous country, is building a competitive research base. J Cell Biol 2007;176:376–401. [3] Zheng ML, Yang LL, Shen Y, Shu Q. Publications in ISI-indexed public health journals from mainland China, Hong Kong and Taiwan during 1999-2008. Med Sci Monit 2011;17(7):SR21–7. [4] Garfield E. The history and meaning of the journal impact factor. JAMA 2006;295:90–3. [5] Lee C, Shih C, Chang Y, Chaou C. The evolution of academic performance in emergency medicine journals: viewpoint from 2000 to 2009 Journal Citation Reports. Acad Emerg Med 2011;18:898–904.
The rate of return of spontaneous circulation (ROSC) for inhospital cardiac arrest (IHCA) is 15% to 60% and survival to discharge is 15% to 20% [1-6]. Monitoring for ventricular fibrillation or ventricular tachycardia (VF/VT) [1-10], early cardiopulmonary resuscitation (CPR) and defibrillation [11] and medical emergency teams [12] can significantly improve cardiac arrest outcomes. This study investigated the clinical variables associated with ROSC and survival to discharge after IHCA in Hong Kong. Ethical approval for this retrospective observational study was granted by our local research ethics committee. Data from January 1, 2008, to December 31, 2008, were extracted from Utstein format resuscitation records in Pamela Youde Nethersole Eastern Hospital (PYNEH) (1829-bedded tertiary regional hospital) and Prince of
Fig. 1. Outcome of patients with cardiac arrest in this study by Utstein style [13].
884
Correspondence / American Journal of Emergency Medicine 31 (2013) 873–885
Table Outcomes of resuscitation, grouped by factors
Total Mean age (±SD) Range CPR duration Range Male Arrest within 24 h of admission Arrest time 0700-1400 shift 1400-2100 shift 2100-0700 shift Specialties ICU/CCU Medical Orthopaedic Oncology Psychiatric Surgical MET activated Witnessed arrest Initial rhythm Shockable (VF/VT) Nonshockable Asystole PEA Unknown Cardiac cause From arrest to CPR Range Early drug administration (b2 min) Intubation From arrest to defibrillation Range
No ROSC
ROSC but died
Survival to discharge
Total (n = 431)
269 (62.4%) 73.5 (±12.3) 38-97 29.6 (±13.3) 1-90 172 (64.7%) 197 (65.9%)
139 (32.3%) 73.9 (±13.4) 24-97 18.8. (±14) 1-76 79 (29.7%) 93 (31.1%)
23 (5.3%) 70.8 (±10.9) 50-90 10.1 (±15.3) 0-68 15 (5.6%) 9 (3%)
431 (100%)
68 (60.2%) 80 (65.6%) 121 (61.7%)
37 (32.7%) 36 (29.6%) 66 (33.7%)
8 (7.1%) 6 (4.9%) 9 (4.6%)
113 (26.2%) 122 (28.3%) 196 (45.5%)
32 (42.7%) 172 (64.4%) 24 (92.3%) 11 (78.6%) 0 30 (62.5%) 117 (67.6%) 149 (57.3%)
28 (37.3%) 89 (33.3%) 2 (7.7%) 2 (14.3%) 1 (100%) 17 (35.4%) 49 (28.3%) 89 (34.3%)
15 (20%) 6 (2.2%) 0 1 (7.1%) 0 1 (2.1%) 7 (4%) 22 (8.5%)
75 (17.4%) 267 (61.9%) 26 (6.0%) 14 (3.2%) 1 (0.2%) 48 (11.1%) 173 (40.1%) 260 (60.3%)
5 (20%)
8 (32%)
12 (48%)
160 (68.1%) 99 (61.5%) 4 (66.7%) 65 (55.6%) 0.45 (±1.35) 0-13 69 (50%) 160 (57.6%) 8 min 5-11
72 (30.6%) 56 (34.8%) 2 (33.3%) 33 (18.2%) 0.4 (±1.042) 0-5 50 (43.5%) 107 (38.5%) 2.2 min 0-12
3 (1.3%) 6 (3.7%) 0 19 (16.2%) 0.22 (±0.85) 0-4 9 (6.5%) 11 (4%) 2.3 min 0-19
25 (5.8%) 400 (92.8%) 235 (54.5%) 161 (37.4%) 6 (1.4%) 117 (27.1%)
24 - 97 0-90 266 (61.7%) 299 (69.4%)
138 (32%) 278 (64.5%)
Abbreviations: ICU, intensive care unit; CCU, cardiac care unit; MET, medical emergency team; PEA, pulseless electrical activity.
Wales Hospital (PWH) (1400-bedded university teaching hospital). Definitions were according to the 2004 Utstein template [13]. Inpatients 18 years or older with IHCA were included. If patient had more than 1 resuscitation attempt during the same admission, only the first attempt was included. The following patients were excluded: “do not resuscitate” patients; admissions after prehospital cardiac arrest; cardiac arrest in the operating room; traumatic cardiac arrests; and isolated respiratory arrest. Data were entered into Microsoft Excel, and statistical analyses were done with SPSS 16.0 for Windows (SPSS, Inc, Chicago, IL). Continuous variables were expressed as means
Fig. 2. From arrest to CPR duration (minutes).
and SD and compared with t tests. Categorical data were expressed as percentages and compared using χ 2 tests. Odds ratios (ORs) with 95% confidence intervals (CIs) were generated using univariate analysis to investigate the possible association between ROSC and survival to discharge and clinical variables. Variables were entered into multivariate logistic regression to determine independent predictors of ROSC and survival to discharge. Statistical significance was set at less than 0.05. A total of 3709 deaths were identified; 3225 patients were not resuscitated. A total of 484 resuscitation forms were completed. Fifty-three patients were excluded: 1 cardiac arrest in the operating room; 1 traumatic cardiac arrest; 6 isolated respiratory arrests; 24 prehospital cardiac arrests; 21 patients resuscitated more than once. One hundred fifty-six IHCAs were in PWH, and 275 were in PYNEH. Mean age was 73.6 years (range, 24-97 years; SD, 12.5). Fig. 1 shows the Utstein summary, the Table lists outcomes, and Fig. 2 shows the arrest duration with clinical outcome. Data on initial rhythm were missing in 6 patients (1.5%); these were analyzed in the nonshockable group. Following multiple logistic regression (stepwise backwards elimination of nonsignificant variables), 5 factors were statistically significant and associated with ROSC. These were orthopaedic ward admission (OR, 0.095; 95% CI, 0.019-0.474; P = .004), initial shockable rhythm (OR, 8.95; 95%CI, 2.93-27.36; P b .001), early drug administration (OR, 1.95; 95% CI, 1.25-3.04; P = .003), intubation (OR, 1.67; 95% CI, 1.05-2.65; P = .031), and CPR duration (OR, 0.92; 95% CI, 0.90-0.94; P b .001). Four factors were associated with survival to discharge: shockable rhythm (OR, 14.95; 95% CI, 4.18-53.45; P b .001), cardiac cause (OR, 10.75; 95% CI, 2.32-49.89; P = .002), witnessed/ monitored arrest (OR, 10.26; 95% CI, 1.01-104.43; P = .049), and CPR duration (OR, 0.91; 95% CI, 0.86-0.96; P = .001).
Correspondence / American Journal of Emergency Medicine 31 (2013) 873–885
Survival from IHCA is poor in Hong Kong. Early defibrillation is important [14]; delaying defibrillation by 2 minutes after cardiac arrest may decrease survival to discharge from 39% to 22% [15]. In this study, mean defibrillation time for patients with ROSC was 0.43 to 2.27 minutes (range, 0-19 minutes), compared with a mean of 8 minutes for those without ROSC. Several reports [1-4,11] suggest that automated external defibrillator use by nurses can shorten defibrillation times with improved results. During this study, the nurses' defibrillation training program had just started so defibrillation may have been delayed. Extending defibrillation training within Hong Kong could potentially improve IHCA outcomes. Of our patients, 60.3% had witnessed arrests, with 8.5% surviving. Monitored/witnessed arrests allow better outcomes because of more rapid recognition of IHCA [16]. The shortest mean CPR duration (10 minutes) was seen in the survival to discharge group. Shorter CPR duration is associated with shockable rhythms or other rapidly reversible factors. Patients with shockable rhythms were more likely to achieve ROSC and survival to discharge (52.2% of survivors to discharge had VF/VT). Although only 5.8% (25/431) presented with shockable rhythms, this constitutes 80% (20/25) of the ROSC and 48% (12/25) of the survival to discharge groups. However, shockable rhythms have resulted in ROSC in 76% and survival to discharge in 57% in Australia [2]. Early drug administration and intubation were associated with ROSC but not survival to discharge, in keeping with previous work [17]. The presence of the cardiac arrest team was not associated with increased survival, in keeping with other reports [18]. This study has the inherent limitations of being retrospective. Times recorded on the forms could differ due to interobserver variation. Because of the small sample, some significant factors may have been masked. In conclusion, outcomes of IHCA in Hong Kong are poor. Shockable rhythm, underlying cardiac cause, witnessed/monitored arrest, and short CPR duration are associated with survival to discharge.
Acknowledgments We thank Dr Warrance Chiu and Dr Bonnie Cheng, PYNEH, and Dr Florence Yap and Ms Carmen Ho, PWH, for assistance.
Jacky C. Chan MSc, RN Accident and Emergency Training Centre Ruttonjee Hospital & Tang Shiu Kin Hospital Hospital Authority of Hong Kong, Hong Kong T.W. Wong MBBS Accident and Emergency Department Pamela Youde Nethersole Eastern Hospital, Hong Kong
885
Colin A. Graham MD, MPH Accident and Emergency Medicine Academic Unit The Chinese University of Hong Kong, Trauma and Emergency Centre Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR E-mail address: [email protected]
http://dx.doi.org/10.1016/j.ajem.2013.02.005
References [1] Cohn AC, Wilson WM, Joshi SB, et al. Analysis of clinical outcomes following in hospital cardiac arrest. Intern Med J 2004;34:398–402. [2] Peter R, Boyde M. Improving survival after in-hospital cardiac arrest: The Australian experience. Am J Crit Care 2007;16:240–6. [3] Sandroni C, Nolan J, Cavallaro F, et al. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2007;33:237–45. [4] Skrifvars MB, Rosenberg PH, Finne P, et al. Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. Resuscitation 2003;56:275–82. [5] Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation 2000;47:125–35. [6] Fredriksson M, Aune S, Thoren AB, et al. In-hospital cardiac arrest—an Utstein style report of seven years experience from the Sahlgrenska University Hospital. Resuscitation 2006;68:351–8. [7] Chan WM. Towards a better outcome of cardiopulmonary resuscitation. Hong Kong Med J 2007;13:256–7. [8] Yap HY, Li TST, Tan KS, et al. Characteristics, management process, and outcome of patients suffering in-hospital cardiopulmonary arrests in a teaching hospital in Hong Kong. Hong Kong Med J 2007;13:258–65. [9] Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297–308. [10] Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295:50–7. [11] Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 2004;44: 846–52. [12] Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365:2091–7. [13] Jacobs I, Nadkarni V, and the International Liaison Committee on Resuscitation Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation. Circulation 2004;110(21):3385–97. [14] Herlitz J, Aune S, Bang A, et al. Very high survival among patients defibrillated at an early stage after in hospital ventricular fibrillation on ward with and without monitoring facilities. Resuscitation 2005;66:159–66. [15] Chan PS, Krumholz HM, Nichol G, et al. Delayed time to defibrillation after inhospital cardiac arrest. NEJM 2008;358:9–17. [16] Herlitz J, Bang A, Aune S, et al. Characteristics and outcome among patients suffering in-hospital cardiac arrests in monitored and non-monitored areas. Resuscitation 2001;48:125–35. [17] International Liaison Committee on Resuscitation. Part 4: adult basic life support. Circulation 2005;112:19–34. [18] Weng TI, Huang CH, Ma MHM, et al. Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team. Resuscitation 2004;60:137–42.