A standardised rapid response system (RRS), called the “Between-the-Flags” (BTF) program, was implemented across a large health jurisdiction in Australia in 2010. The impact of RRS on emergency ...surgical admissions is unknown.
We linked the NSW Admitted Patient Data Collection (APDC) and the NSW Registry of Births, Deaths, and Marriages. We used a propensity score-based inverse-probability-weighting adjustment to estimated average treatment effects among treated subjects (prior-RRS hospitals vs prior-non-RRS hospitals) before the BTF implementation (2007–2008) and after (2010–2013).
Before BTF, prior-RRS hospitals had a lower rate of in hospital cardiopulmonary arrests (IHCA) (4.7 vs 7.8 per 1000 admissions, P < 0.001), a lower rate of IHCA related deaths (3.0 vs 4.4 per 1000 admissions, P = 0.03) compared with patients in prior-non-RRS hospitals. There were no significant differences in overall in-hospital mortality and 30-day mortality between the two cohorts. After BTF, there were no significant differences for IHCA (4.8 vs 5.5 per 1000 admissions, P = 0.081) and related death rates (2.4 vs 2.3 per 1000 admissions, P = 0.678) between the two cohorts. Hospital mortality, 30-day mortality improved across both prior-RRS and prior-non-RRS hospitals following the BTF implementation.
BTF program was associated with a significant reduction in IHCA and IHCA deaths for emergency surgical patients in prior-non-RRS hospitals but not in the prior-RRS hospitals. The overall hospital and 30-day mortality improved in both cohorts after BTF.
Summary
The effects of introducing Modified Early Warning scores to identify medical patients at risk of catastrophic deterioration have not been examined. We prospectively studied 1695 acute medical ...admissions. All patients were scored in the admissions unit. Patients with a Modified Early Warning score > 4 were referred for urgent medical and critical care outreach team review. Data was compared with an observational study performed in the same unit during the proceeding year. There was no change in mortality of patients with low, intermediate or high Modified Early Warning scores. Rates of cardio‐pulmonary arrest, intensive care unit or high dependency unit admission were similar. Data analysis confirmed respiratory rate as the best discriminator in identifying high‐risk patient groups. The therapeutic interventions performed in response to abnormal scores were not assessed. We are convinced that the Modified Early Warning score is a suitable scoring tool to identify patients at risk. However, outcomes in medical emergency admissions are influenced by a multitude of factors and so it may be difficult to demonstrate the score's benefit without further standardizing the response to abnormal values.
Patients with poor-grade subarachnoid hemorrhage have a very poor prognosis, especially those with cardiopulmonary arrest and/or bilateral dilated pupils. Therapeutic indications for patients with ...poor-grade subarachnoid hemorrhage vary depending on the institution; however, we perform clipping or coil embolization in these patients with very poor-grade subarachnoid hemorrhage if their vital signs are stable at the time of admission. In this study, we summarize the outcomes of 31 patients with poor-grade subarachnoid hemorrhage seen between January 2015 and April 2017. Among the 31 patients, 13 patients had cardiopulmonary arrest at the time of admission and/or prehospital, and 15 patients had bilateral dilated pupils. Among these 13 patients with cardiopulmonary arrest, seven patients underwent clipping or coil embolization because their vital signs could be stabilized. The functional outcomes of these seven patients were very poor: mRS 1 (1 patient), mRS 4 (1 patient), and mRS 5 (5 patients); however, all of these patients survived 30 days after the subarachnoid hemorrhage onset. Meanwhile, the other nine patients with unstable vital signs and who could therefore not undergo clipping or coil embolization died within 30 days after the subarachnoid hemorrhage onset.In conclusion, although the functional outcomes of patients with poor grade subarachnoid hemorrhage and cardiopulmonary arrest were very poor, a minority of these patients had good functional outcomes.
Various movement disorders have been described following hypoxic‐ischaemic brain injury. Here, we present a 72‐year‐old female patient who developed periodic opening and upward deviation of the eyes ...as an isolated clinical finding, within 24 hours after cardio‐pulmonary arrest. These movements were accompanied by burst‐suppression on EEG, and both clinical and electrophysiological findings were suppressed 18 hours after intravenous levetiracetam infusion. The strictly periodic nature of both EEG discharges and eye opening with vertical deviation suggest a cause due to either activation of a subcortical/brainstem pacemaker reciprocally stimulating the cortex, or, alternatively, post‐anoxic burst activity of viable cortical neural networks, somehow stimulating the relevant oculomotor nuclei. Together with previous similar cases, our case expands the spectrum of post‐resuscitation myoclonus syndromes with the addition of this rare isolated oculopalpebral subtype. Published with video sequence
We herein report on a case in which cardiopulmonary arrest (CPA) was caused due to tension pneumoperitoneum during upper gastrointestinal endoscopy, and the patient was successfully treated by ...carrying out prompt decompression. The patient was a 63-year-old male. He suffered from epigastralgia and had previously consulted another doctor. CPA took place during upper gastrointestinal endoscopy, and he was transported to our institute under cardiopulmonary resuscitation. Over-swelling of the jugular vein and abdominal distension were observed. He was diagnosed to have tension pneumoperitoneum, which occurred during upper gastrointestinal endoscopy. Tube drainage was carried out promptly. Soon after the treatment, his abdomen became flat and a return of spontaneous circulation was observed. He underwent an omental implantation repair and received intensive care after the surgery. The patient was discharged without any aftereffects. Tension pneumoperitoneum is a very rare disease and there are only a few reports on this occurrence. We should keep in mind that its occurrence requires a high degree of urgency. Moreover, a good prognosis may be possible by carrying out accurate BLS, making a timely diagnosis, and performing decompression promptly, even in cases of CPA.
A 40-year-old man called the emergency medical services (EMS) because of aggravated severe dyspnea at rest. When EMS arrived, he was alert and complaining of severe dyspnea, but he lost consciousness ...and entered cardio-pulmonary arrest during emergent transportation. On arrival at our hospital, he was still in cardio-pulmonary arrest. While we performed cardio-pulmonary resuscitation, a chest radiograph showed bilateral tension pneumothorax. We immediately performed bilateral thoracic drainage and, ten minutes later, spontaneous circulation returned. He was admitted to the intensive care unit for management. As his mental and performance status gradually improved, we performed surgery for bilateral pneumothorax on the 26th day of illness. His condition was favorable during the postoperative period, and he was transferred to another hospital for rehabilitation on the 73rd day of illness. Bilateral tension pneumothorax is relatively rare, and there are few reports of successful resuscitation after cardio-pulmonary arrest. As demonstrated by our case, rapid and appropriate medical treatment is necessary for survival.
Pediatric Early Warning (PEW) scoring tools effectively identify hospitalized children at risk for clinical deterioration. The study compared the predictability of three previously validated PEW ...scoring tools. A retrospective case-control design was used that identified the PEW System Score (H. Duncan, J. Hutchison, & C. Parshuram, 2006) as a stronger predictor of cardiopulmonary arrest (CPA) than either the PEW Tool (C. Haines, M. Perrott, & P. Weir, 2006) or the Bedside PEW System Score (C. Parshuram, J. Hutchison, & K. Middaugh, 2009). The PEW System Score (H. Duncan, J. Hutchison, & C. Parshuram, 2006) demonstrated a greater sensitivity (86.6%) and specificity (72.9%) at a score of five. The PEW System Score (H. Duncan, J. Hutchison, & C. Parshuram, 2006) could benefit healthcare providers in potentially averting CPA.
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