Survival to intensive care unit discharge among in-hospital cardiac arrest patients by applying audiovisual feedback device.

AIMS: Survival rates after in-hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in-hospital cardiac arrest after discharge from the intensive care unit. METHODS AND RESULTS: This study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real-time feedback device. Parametric and semi-parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log-normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found. CONCLUSIONS: Implementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/ fraction of inspired oxygen (Fi O2) and partial pressure of alveolar oxygen (PAO2)/Fi O2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/Fi O2. Also, to determine the SpO2/Fi O2 and PAO2/Fi O2 values that correspond to PaO2/Fi O2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and Fi O2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/Fi O2 and PAO2/Fi O2 ratios could be predicted well from PaO2/Fi O2, described by the linear regression models SPO2/Fi O2 = 71.149 + 0.8PF and PAO2/Fi O2 = 38.098 + 2.312PF, respectively. According to the linear regression equation, a PaO2/Fi O2 ratio of 300 equaled an SPO2/Fi O2 ratio of 311 (R2 0.857, F 1035.742, < 0.0001) and a PAO2/Fi O2 ratio of 732 (R2 0.576, F 234.887, < 0.0001). The SPO2/Fi O2 threshold of 311 had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/Fi O2 threshold of 732 had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/ Fi O2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/ Fi O2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/Fi O2 of 300 correlating to an SPO2/ Fi O2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ Fi O2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) and partial pressure of alveolar oxygen (PAO2)/FiO2 may be used as effectivesurrogates for the partial pressure of arterial oxygen (PaO2)/FiO2. Also, to determine the SpO2/FiO2 and PAO2/FiO2values that correspond to PaO2/FiO2 thresholds for identifying acute respiratory distress syndrome (ARDS) inpatients following coronary artery bypass graft (CABG) surgery.Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital.Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2,PAO2, SaO2, and FiO2. Linear regression modeling was used to quantify the relationship between indices. Receiveroperating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values.Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validationcohort. The SPO2/FiO2 and PAO2/FiO2 ratios could be predicted well from PaO2/FiO2, described by the linearregression models SPO2/FiO2 = 71.149 + 0.8PF and PAO2/FiO2 = 38.098 + 2.312PF, respectively. According to the linearregression equation, a PaO2/FiO2 ratio of 300 equaled an SPO2/FiO2 ratio of 311 (R2 0.857, F 1035.742, &lt; 0.0001) anda PAO2/FiO2 ratio of 732 (R2 0.576, F 234.887, &lt; 0.0001). The SPO2/FiO2 threshold of 311 had 90% sensitivity, 80%specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/FiO2 threshold of 732had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/FiO2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/FiO2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/FiO2 of 300 correlating to an SPO2/FiO2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ FiO2 ratio may allow for early real-time rapid identification ofARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated withserial arterial blood gas measurements

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Abstract Objective To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) and partial pressure of alveolar oxygen (PAO2)/FiO2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/FiO2. Also, to determine the SpO2/FiO2 and PAO2/FiO2 values that correspond to PaO2/FiO2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and FiO2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/FiO2 and PAO2/FiO2 ratios could be predicted well from PaO2/FiO2, described by the linear regression models SPO2/FiO2-‰=-‰71.149-‰+-‰0.8PF and PAO2/FiO2-‰=-‰38.098-‰+-‰2.312PF, respectively. According to the linear regression equation, a PaO2/FiO2 ratio of 300 equaled an SPO2/FiO2 ratio of 311 (R2 0.857, F 1035.742, &lt;-‰0.0001) and a PAO2/FiO2 ratio of 732 (R2 0.576, F 234.887, &lt;-‰0.0001). The SPO2/FiO2 threshold of 311 had 90% sensitivity, 80% specificity, LR+-‰4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/FiO2 threshold of 732 had 86% sensitivity, 90% specificity, LR+-‰8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/FiO2 had excellent discrimination ability for mild ARDS (AUC-‰Â±-‰SE-‰=-‰0.92-‰Â±-‰0.017; 95% CI 0.889 to 0.947) as did PAO2/FiO2 (AUC-‰Â±-‰SE-‰=-‰0.915-‰Â±-‰0.018; 95% CI 0.881 to0.942). Conclusions PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/FiO2 of 300 correlating to an SPO2/ FiO2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ FiO2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Abstract Objective To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA). Methods We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical--surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angelâ„¢ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge. Results One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P-‰&lt;-‰0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P-‰&lt;-‰0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones. Conclusion Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge. Trial registration The study was registered with Clinicaltrials.gov ( NCT02845011 ), registered retrospectively on July 21, 2016

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

Objective: To determine if real-time compression feedback using a non-automated hand-held device improvespatient outcomes from in-hospital cardiac arrest (IHCA).Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA inthe mixed medical--surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standardmanual chest compressions or compressions performed with real-time feedback using the Cardio First Angelâ„¢ (CFA)device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes weresurvival to ICU and hospital discharge.Results: One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC wassignificantly improved in the CFA group (66.7% vs. 42.4%, P &lt; 0.001), as was survival to ICU discharge (59.8% vs. 33.6%)and survival to hospital discharge (54% vs. 28.4%, P &lt; 0.001). Outcomes were not affected by intra-group comparisonsbased on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-groupcomparisons of non-intubated patients, but not intubated ones.Conclusion: Use of the CFA compression feedback device improved event survival and survival to ICU and hospitaldischarge