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Open accessJournal ArticleDOI: 10.1080/10903127.2020.1752868

Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?

04 Mar 2021-Prehospital Emergency Care (Informa UK Limited)-Vol. 25, Iss: 2, pp 171-181
Abstract: In out-of-hospital cardiac arrest (OHCA), 10–50% of patients have return of spontaneous circulation (ROSC) before hospital arrival. It is important to investigate the relation between time-to-ROSC ...

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Open accessJournal ArticleDOI: 10.1002/EMP2.12184
Michael Levy1, Karl B. Kern2, Dana Yost, Fred W. Chapman  +1 moreInstitutions (3)
04 Jul 2020-
Abstract: Objective The quality of cardiopulmonary resuscitation (CPR) affects outcomes from cardiac arrest, yet manual CPR is difficult to administer. Although mechanical CPR (mCPR) devices offer high quality CPR, only limited data describe their deployment, their interaction with standard manual CPR (sCPR), and the consequent effects on chest compression continuity and patient outcomes. We sought to describe the interaction between sCPR and mCPR and the impact of the sCPR-mCPR transition upon outcomes in adult out-of-hospital cardiac arrest (OHCA). Methods We analyzed all adult ventricular fibrillation OHCA treated by the Anchorage Fire Department (AFD) during calendar year 2016. AFD protocols include the immediate initiation of sCPR upon rescuer arrival and transition to mCPR, guided by patient status. We compared CPR timing, performance, and outcomes between those receiving sCPR only and those receiving sCPR transitioning to mCPR (sCPR + mCPR). Results All 19 sCPR-only patients achieved return of spontaneous circulation (ROSC) after a median of 3.3 (interquartile range 2.2-5.1) minutes. Among 30 patients remaining pulseless after sCPR (median 6.9 [5.3-11.0] minutes), transition to mCPR occurred with a median chest compression interruption of 7 (5-13) seconds. Twenty-one of 30 sCPR + mCPR patients achieved ROSC after a median of 11.2 (5.7-23.8) additional minutes of mCPR. Survival differed between groups: sCPR only 14/19 (74%) versus sCPR + mCPR 13/30 (43%), P = 0.045. Conclusion In this series, transition to mCPR occurred in patients unresponsive to initial sCPR with only brief interruptions in chest compressions. Assessment of mCPR must consider the interactions with sCPR.

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3 Citations


Open accessJournal ArticleDOI: 10.1016/J.MAYOCP.2020.10.009
Abstract: Infection by severe acute respiratory syndrome coronavirus 2 has led to cardiac complications including an increasing incidence of cardiac arrest. The resuscitation of these patients requires a conscious effort to minimize the spread of the virus. We present a best-practice model based in four guiding principles: (1) reduce the risk of exposure to the entire health care team; (2) decrease the number of aerosol generating procedures; (3) use a small resuscitation team to limit potential exposure; and (4) consider early termination of resuscitative efforts.

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Topics: Emergency department (54%), Resuscitation (54%)

2 Citations


Journal ArticleDOI: 10.1080/10903127.2021.1987596
Vincent N. Mosesso1Institutions (1)
Abstract: Dear Editor,I commend de Graaf et al. for exploring the effect of continuing resuscitation at the scene versus transporting to the hospital for patients in cardiac arrest in a rigorous and structur...

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28 results found


Open accessJournal ArticleDOI: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3
W. J. Youden1Institutions (1)
01 Jan 1950-Cancer
Topics: Index (economics) (50%)

7,056 Citations


Open accessJournal ArticleDOI: 10.1016/J.JCM.2016.02.012
Terry K. Koo1, Mae Y. Li1Institutions (1)
Abstract: Objective Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.

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6,924 Citations


Journal ArticleDOI: 10.1016/S0140-6736(75)92830-5
Bryan Jennett1, Michael R. Bond1Institutions (1)
01 Mar 1975-The Lancet
Abstract: Persisting disability after brain damage usually comprises both mental and physical handicap. The mental component is often the more important in contributing to overall social disability. Lack of an objective scale leads to vague and over-optimistic estimates of outcome, which obscure the ultimate results of early management. A five-point scale is described—death, persistent vegetative state, severe disability, moderate disability, and good recovery. Duration as well as intensity of disability should be included in an index of ill-health; this applies particularly after head injury, because many disabled survivors are young.

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6,648 Citations


Journal ArticleDOI: 10.1016/S0895-4356(96)00236-3
Peter Peduzzi1, John Concato2, John Concato1, Elizabeth Kemper1  +4 moreInstitutions (2)
Abstract: We performed a Monte Carlo study to evaluate the effect of the number of events per variable (EPV) analyzed in logistic regression analysis. The simulations were based on data from a cardiac trial of 673 patients in which 252 deaths occurred and seven variables were cogent predictors of mortality; the number of events per predictive variable was (252/7 =) 36 for the full sample. For the simulations, at values of EPV = 2, 5, 10, 15, 20, and 25, we randomly generated 500 samples of the 673 patients, chosen with replacement, according to a logistic model derived from the full sample. Simulation results for the regression coefficients for each variable in each group of 500 samples were compared for bias, precision, and significance testing against the results of the model fitted to the original sample. For EPV values of 10 or greater, no major problems occurred. For EPV values less than 10, however, the regression coefficients were biased in both positive and negative directions; the large sample variance estimates from the logistic model both overestimated and underestimated the sample variance of the regression coefficients; the 90% confidence limits about the estimated values did not have proper coverage; the Wald statistic was conservative under the null hypothesis; and paradoxical associations (significance in the wrong direction) were increased. Although other factors (such as the total number of events, or sample size) may influence the validity of the logistic model, our findings indicate that low EPV can lead to major problems.

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Topics: Sample variance (61%), Logistic regression (59%), Sample size determination (57%) ... show more

5,523 Citations


Open accessJournal ArticleDOI: 10.20982/TQMP.08.1.P023
Kevin A. Hallgren1Institutions (1)
01 Jan 2012-
Abstract: Many research designs require the assessment of inter-rater reliability (IRR) to demonstrate consistency among observational ratings provided by multiple coders. However, many studies use incorrect statistical procedures, fail to fully report the information necessary to interpret their results, or do not address how IRR affects the power of their subsequent analyses for hypothesis testing. This paper provides an overview of methodological issues related to the assessment of IRR with a focus on study design, selection of appropriate statistics, and the computation, interpretation, and reporting of some commonly-used IRR statistics. Computational examples include SPSS and R syntax for computing Cohen’s kappa and intra-class correlations to assess IRR.

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Topics: Inter-rater reliability (52%)

2,438 Citations