Out-of-Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders:Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter-Defibrillator and Survival

Background Healthcare disparities for psychiatric patients are common. Whether these inequalities apply to postresuscitation management in out‐of‐hospital cardiac arrest (OHCA) is unknown. We investigated differences in in‐hospital cardiovascular procedures following OHCA between patients with and without psychiatric disorders. Methods and Results Using the Danish nationwide registries, we identified patients admitted to the hospital following OHCA of presumed cardiac cause (2001‐2015). Psychiatric disorders were identified using hospital diagnoses or redeemed prescriptions for psychotropic drugs. We calculated age‐ and sex‐standardized incidence rates and incidence rate ratios (IRRs) of cardiovascular procedures during post‐OHCA admission in patients with and without psychiatric disorders. Differences in 30‐day and 1‐year survival were assessed by multivariable logistic regression in the overall population and among 2‐day survivors who received acute coronary angiography (CAG). We included 7288 hospitalized patients who had experienced an OHCA: 1661 (22.8%) had a psychiatric disorder. Compared with patients without psychiatric disorders, patients with psychiatric disorders had lower standardized incidence rates for acute CAG (≤1 day post‐OHCA) (IRR, 0.51; 95% CI, 0.45–0.57), subacute CAG (2–30 days post‐OHCA) (IRR, 0.40; 95% CI, 0.30–0.52), and implantable cardioverter‐defibrillator implantation (IRR, 0.67; 95% CI, 0.48–0.95). Conversely, we did not detect differences in coronary revascularization among patients undergoing CAG (IRR, 1.11; 95% CI, 0.94–1.30). Patients with psychiatric disorders had lower survival even among 2‐day survivors who received acute CAG: (odds ratio of 30‐day survival, 0.68; 95% CI, 0.52–0.91; and 1‐year survival, 0.66; 95% CI, 0.50–0.88). Conclusions Psychiatric patients had a lower probability of receiving post‐OHCA CAG and implantable cardioverter‐defibrillator implantation compared with nonpsychiatric patients but the same probability of coronary revascularization among patients undergoing CAG. However, their survival was lower irrespective of angiographic procedures

Venturi-type injection system as a potential H2 mass transfer technology for full-scale in situ biomethanation

Industrial application of biomethanation is impeded by the slow development of cost effective technologies, which can supply the methanogenic archaea with H both effectively and at sufficient rates in large scale. This paper is the first to present developmental work of a H mass transfer technology in full-scale, investigating the H mass transfer potential of a venturi-type injector through injections of up to 33.5 m H into a 1200 m anaerobic digester under normal operation. The venturi system poses a potentially inexpensive system of in situ biogas upgrading, since it is easily installed on already existing anaerobic digesters. Experimental H consumption rates increased with H injection rates, and was clearly indicated to be limited by the gas-liquid mass transfer rate due to injection of large bubbles. Consumption of the unconverted H was increased by recirculation of the headspace gas, but at lower rates due to dilution of H with biogas. The incomplete H consumption gives the venturi system application in combination with ex situ methanation systems in its present form, but the system must be developed further in order to provide sufficient gas-liquid mass transfer efficiency in order to comprise a stand-alone biogas upgrading system