Browsing by Subject "Resuscitation"
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Item A descriptive study of the multidisciplinary healthcare experiences of inpatient resuscitation events(Elsevier, 2023-01-06) Varner-Perez, Shelley E.; Shelley E., Kelly A. L.; Banks, Sarah K.; Burke, Emily S.; Slaven, James E.; Morse, Gregory J.; Whitaker, Myra K.; Cottingham, Ann H.; Ahmed, Rami A.; Biostatistics, School of Public HealthBackground: In-hospital resuscitation events have complex and enduring effects on clinicians, with implications for job satisfaction, performance, and burnout. Ethically ambiguous cases are associated with increased moral distress. We aim to quantitatively describe the multidisciplinary resuscitation experience. Methods: Multidisciplinary in-hospital healthcare professionals at an adult academic health center in the Midwestern United States completed surveys one and six weeks after a resuscitation event. Surveys included demographic data, task load (NASA-TLX), overall and moral distress, anxiety, depression, and spiritual peace. Spearman's rank correlation was computed to assess task load and distress. Results: During the 5-month study period, the study included 12 resuscitation events across six inpatient units. Of 82 in-hospital healthcare professionals eligible for recruitment, 44 (53.7%) completed the one-week post-resuscitation event survey. Of those, 37 (84.1%) completed the six-week survey. Highest median task load burden at one week was seen for temporal demand, effort, and mental demand. Median moral distress scores were low, while "at peace" median scores tended to be high. There were no significant non-zero changes in task load or distress scores from weeks 1-6. Mental demand (r = 0.545, p < 0.001), physical demand (r = 0.464, p = 0.005), performance (r = -0.539, p < 0.001), and frustration (r = 0.545, p < 0.001) significantly correlated with overall distress. Performance (r = -0.371, p = 0.028) and frustration (r = 0.480, p = 0.004) also significantly correlated with moral distress. Conclusions: In-hospital healthcare professionals' experiences of resuscitation events are varied and complex. Aspects of task load burden including mental and physical demand, performance, and frustration contribute to overall and moral distress, deserving greater attention in clinical contexts.Item Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study(Wolters Kluwer, 2019-01) Roberts, Brian W.; Kilgannon, J. Hope; Hunter, Benton R.; Puskarich, Michael A.; Shea, Lisa; Donnino, Michael; Jones, Christopher; Fuller, Brian M.; Kline, Jeffrey A.; Jones, Alan E.; Shapiro, Nathan I.; Abella, Benjamin S.; Trzeciak, Stephen; Department of Emergency MedicineObjective: Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated post-resuscitation mean arterial blood pressure (MAP) is associated with neurological outcome. Design: Pre-planned analysis of a prospective cohort study. Setting: Six academic hospitals in the United States. Patients: Adult, non-traumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation (ROSC). Interventions: MAP was measured non-invasively after ROSC and every hour during the initial six hours after ROSC. Measures and Main Results: We calculated the mean MAP and a priori dichotomized subjects into two groups: mean MAP 70–90 and > 90 mmHg. The primary outcome was good neurological function, defined as a modified Rankin Scale (mRS) ≤ 3. The mRS was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean MAP > 90 mmHg. Good neurological function at hospital discharge occurred in 30% of patients in the entire cohort, and was significantly higher in patients with a mean MAP > 90 mmHg (42%) as compared to MAP 70–90 mmHg (15%) [absolute risk difference 27% (95% CI 17%−37%)]. In a multivariable Poisson regression model adjusting for potential confounders, mean MAP > 90 mmHg was associated with good neurological function, adjusted relative risk 2.46 (95% CI 2.09–2.88). Over ascending ranges of mean MAP, there was a dose-response increase in probability of good neurological outcome, with mean MAP > 110 mmHg having the strongest association, adjusted relative risk 2.97 (95% CI 1.86 – 4.76). Conclusions: Elevated blood pressure during the initial six hours after resuscitation from cardiac arrest was independently associated with good neurological function at hospital discharge. Further investigation is warranted to determine if targeting an elevated MAP would improve neurologic outcome after cardiac arrest.Item Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation(MDPI, 2024-06-04) Mende, Sarah; Ahmed, Syed; DeShea, Lise; Szyld, Edgardo; Shah, Birju A.; Pediatrics, School of MedicineBackground: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. Methods: This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. Results: An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. Conclusions: Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes.Item Estimating the weight of children in Nepal by Broselow, PAWPER XL and Mercy method(Zhejiang University School of Medicine, 2018) Shrestha, Karun; Subedi, Prakriti; Pandey, Oshna; Shakya, Likhita; Chhetri, Kailash; House, Darlene R.; Emergency Medicine, School of MedicineBACKGROUND: Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods (Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, Nepal. METHODS: This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10% (PW10) and 20% (PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual weight. RESULTS: The study included 813 children. The mean age was 4.2 years (ranging from 4 days to 14 years) with 60% male. The mean percentage error (MPE) for Broselow, PAWPER XL and Mercy were -1.0% (SD 11.8), 0.7% (10.5) and 4.2% (11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL (71.5%) followed by Broselow (63.2%) and Mercy (58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy respectively. CONCLUSION: The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.Item Facilitators of and barriers to successful teamwork during resuscitations in a neonatal intensive care unit(Springer Nature, 2019-07) Salih, Zeynep N. Inanc; Burke Draucker, Claire; Pediatrics, School of MedicineOBJECTIVE: Effective teamwork is essential in high-risk healthcare delivery environments. In this study, we aimed to identify facilitators of and barriers to successful teamwork during resuscitations in the NICU Study Design: 36 in-situ interprofessional simulation sessions were held in a level 4 NICU. Each session was followed by a debriefing where staff talked about the simulation scenario but also about their prior experiences during resuscitations in the NICU. Using content analysis, we analyzed the transcriptions of debriefings to address the study aims. RESULT: Participant responses yielded three major themes: communicating well, getting tasks done well, and working well together. Each main theme had subthemes. CONCLUSION: Teamwork is a complex process that is enhanced and hindered by a variety of factors. The factors identified in this study can be used to enhance relationship-based teamwork training programs. Future research is needed to determine which teamwork behaviors are most associated with patient outcomes.Item Fluid Response Evaluation in Sepsis Hypotension and Shock: A Randomized Clinical Trial(Elsevier, 2020) Douglas, Ivor S.; Alapat, Philip M.; Corl, Keith A.; Exline, Matthew C.; Forni, Lui G.; Holder, Andre L.; Kaufman, David A.; Khan, Akram; Levy, Mitchell M.; Martin, Gregory S.; Sahatjian, Jennifer A.; Seeley, Eric; Self, Wesley H.; Weingarten, Jeremy A.; Williams, Mark; Hansell, Douglas M.; Medicine, School of MedicineBackground: Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome. Research question: Will resuscitation that is guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes? Study design and methods: We conducted a prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom. Patients presented to EDs with sepsis that was associated hypotension and anticipated ICU admission. Intervention arm patients were assessed for fluid responsiveness before clinically driven fluid bolus or increase in vasopressors occurred. The protocol included reassessment and therapy as indicated by the passive leg raise result. The control arm received usual care. The primary clinical outcome was positive fluid balance at 72 hours or ICU discharge, whichever occurred first. Results: In modified intent-to-treat analysis that included 83 intervention and 41 usual care eligible patients, fluid balance at 72 hours or ICU discharge was significantly lower (-1.37 L favoring the intervention arm; 0.65 ± 2.85 L intervention arm vs 2.02 ± 3.44 L usual care arm; P = .021. Fewer patients required renal replacement therapy (5.1% vs 17.5%; P = .04) or mechanical ventilation (17.7% vs 34.1%; P = .04) in the intervention arm compared with usual care. In the all-randomized intent-to-treat population (102 intervention, 48 usual care), there were no significant differences in safety signals. Interpretation: Physiologically informed fluid and vasopressor resuscitation with the use of the passive leg raise-induced stroke volume change to guide management of septic shock is safe and demonstrated lower net fluid balance and reductions in the risk of renal and respiratory failure. Dynamic assessments to guide fluid administration may improve outcomes for patients with septic shock compared with usual care.Item Health Care System Distrust, Race, and Surrogate Decision-Making Regarding Code Status(Mary Ann Liebert, 2022-10-27) Na, Sang Yoon; Slaven, James E.; Burke, Emily S.; Torke, Alexia M.; Medicine, School of MedicinePurpose: Previous studies have shown that black patients are more likely to prefer life-sustaining treatments such as cardiopulmonary resuscitation at end-of-life (EOL) compared to non-Hispanic white patients. Given prior racial disparities in health care, distrust has been proposed to explain these preferences. As many hospitalized older adults require surrogates to make medical decisions, we explored surrogates' code status preferences and the role of trust in these decisions. Methods: We conducted secondary analyses of an observational study of patient/surrogate dyads admitted to three hospitals in a Midwest metropolitan area. Distrust was assessed using the Revised Health Care System Distrust Scale. A single item asked the surrogate which code status they thought was best for the patient, full code or do not resuscitate. Results: We enrolled 350 patient/surrogate dyads (101 black; 249 white). In bivariate analysis, higher proportion of black surrogates preferred full code (62.4% vs. 38.3%, p=0.0001). After adjusting for trust and sociodemographic and psychological covariates, race was still significantly associated with preference for full code (adjusted odds ratio=2.13; 95% confidence interval: 1.16-3.92; p=0.0153). Surrogate race was not associated with distrust in bivariate or multivariable analysis, adjusting for sociodemographic and psychological covariates (p=0.3049). Conclusion: Although black race was associated with preferences for full code status, we observed no association between race and distrust. Differences in code status preference may be due to other factors related to race and culture. To ensure that patients are receiving EOL care that is consistent with their values, more work is needed to understand the cultural complexities behind EOL care preferences.Item Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?(Springer Nature, 2016-11-22) Bang, Akash; Patel, Archana; Bellad, Roopa; Gisore, Peter; Goudar, Shivaprasad S.; Esamai, Fabian; Liechty, Edward A.; Meleth, Sreelatha; Goco, Norman; Niermeyer, Susan; Keenan, William; Kamath-Rayne, Beena D.; Little, George A.; Clarke, Susan B.; Flanagan, Victoria A.; Bucher, Sherri; Jain, Manish; Mujawar, Nilofer; Jain, Vinita; Rukunga, Janet; Mahantshetti, Niranjana; Dhaded, Sangappa; Bhandankar, Manisha; McClure, Elizabeth M.; Carlo, Waldemar A.; Wright, Linda L.; Hibberd, Patricia L.; Pediatrics, School of MedicineBackground: The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities. Methods: We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training. Results: One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training). Conclusions: HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.Item Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center(MDPI, 2022-01-12) Lantry, James H.; Mason, Phillip; Logsdon, Matthew G.; Bunch, Connor M.; Peck, Ethan E.; Moore, Ernest E.; Moore, Hunter B.; Neal, Matthew D.; Thomas, Scott G.; Khan, Rashid Z.; Gillespie, Laura; Florance, Charles; Korzan, Josh; Preuss, Fletcher R.; Mason, Dan; Saleh, Tarek; Marsee, Mathew K.; Vande Lune, Stefani; Ayoub, Qamarnisa; Fries, Dietmar; Walsh, Mark M.; Emergency Medicine, School of MedicineModern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy-especially in austere or challenging environments-is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.Item Impact of an untrained CPR Coach in simulated pediatric cardiopulmonary arrest: A pilot study(Elsevier, 2020-12-01) Badke, Colleen M.; Friedman, Matthew L.; Harris, Z. Leah; McCarthy-Kowols, Maureen; Tran, Sifrance; Pediatrics, School of MedicineAim To determine if an untrained cardiopulmonary resuscitation (CPR) Coach, with no access to real-time CPR feedback technology, improves CPR quality. Methods This was a prospective randomized pilot study at a tertiary care children's hospital that aimed to integrate an untrained CPR Coach into resuscitation teams during simulated pediatric cardiac arrest. Simulation events were randomized to two arms: control (no CPR Coach) or intervention (CPR Coach). Simulations were run by pediatric intensive care unit (PICU) providers and video recorded. Scenarios focused on full cardiopulmonary arrest; neither team had access to real-time CPR feedback technology. The primary outcome was CPR quality. Secondary outcomes included workload assessments of the team leader and CPR Coach using the NASA Task Load Index and perceptions of CPR quality. Results Thirteen simulations were performed; 5 were randomized to include a CPR Coach. There was a significantly shorter duration to backboard placement in the intervention group (median 20s [IQR 0–27s] vs. 52s [IQR 38–65s], p=0.02). There was no self-reported change in the team leader's workload between scenarios using a CPR Coach compared to those without a CPR Coach. There were no significant changes in subjective CPR quality measures. Conclusions In this pilot study, inclusion of an untrained CPR Coach during simulated CPR shortened time to backboard placement but did not improve most metrics of CPR quality or significantly affect team leader workload. More research is needed to better assess the value of a CPR Coach and its potential impact in real-world resuscitation.