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concept;
Early detection and intervention of
patients at risk of cardiac arrest
outside the ICU
External
Trauma hemorrhage, Intoxication etc
Etiology of OHCA
(Out-of-hospital Cardiac Arrest)
Definition
The Utstein-style definition of cardiac arrest
(2004);
the cessation of cardiac mechanical activity. . .
confirmed by the absence of a detectable pulse,
unresponsiveness and apnoea (or agonal respirations)
Problem;
majority of patients resuscitated successfully from IHCA die
before hospital discharge, and their prognosis has changed little
over the past 30 years
Ballew KA, Philbrick JT (1995) Causes of variation in reported in-hospital CPR survival: a critical review. Resuscitation
30:203215
Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T (2003)
Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of
Incidence
Incidence of 0.175 events/bed
annually over a total of 14,720
arrests in 287 American hospi- tals
(Peberdy et 2003)
Survival
Survival from cardiac arrest can be expressed in relation to time
as:
immediate (ROSC),
short-term (discharged alive from the hospital), and
long-term (612 months).
Results
Results:
Conclusions:
Best Practices
The best practices are divided into 3 temporal
sections
Pre-arrest, intra-arrest, and post-arrest.
The discussion for each period includes;
(1) a brief introduction,
(2) the structural aspects of the institutional response
(personnel, training, equipment),
(3) care pathways followed during the time interval
early identification,
focus on CPR and early defibrillation,
comprehensive post-arrest care, and
Conclusion
Outcome from IHCA is determined by pre, intra- and post-arrest
factors.
Some pre-arrest conditions are time-dependent disease such as
cancer, sepsis and renal failure are correlated with lower survival
Many in-hospital arrests are preceded by warning signs, which
should be identified early to enable treatment to prevent patient
deterioration.
Experience with specifically dedicated teams increased
awareness of warning signs by ward personnel
After cardiac arrest has occurred, better resuscitation, early
defibrillation and induced-hypothermia can improve survival.
Recent evidence that better CPR is associated with increased
resuscitation success should be translated into systematic
training and maintenance of skills among all healthcare providers.
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