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Quality of post arrest care does not differ by time of day at a specialized resuscitation center.

Uray T, Sterz F, Weiser C, Schreiber W, Spiel A, Schober A, Stratil P, Mayr FB - Medicine (Baltimore) (2015)

Bottom Line: In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36).Survival and good neurologic outcome at 12 months did not differ between day and night admissions.Our results may support the concept of specialized post arrest care centers.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.

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Volume of admissions by hour of day.
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Figure 2: Volume of admissions by hour of day.

Mentions: Table 1 compares characteristics of patients hospitalized after OHCA with ROSC. Of 1720 patients admitted during the study period, we identified 1059 patients equal to or older than 18 years of age who regained ROSC after an OHCA (Figure 1). Of those patients, 490 (46%) were admitted between 8 am and 4 pm (day) and 569 (54%) were admitted during night (4:01 pm to 7:59 am) (Figure 2). Patients admitted at night were slightly younger compared with those admitted during daytime (56 vs. 60 years, P < 0.001). The proportion of males was similar in both groups (74% vs. 74%, P = 0.96). Mean body mass index (BMI) was similar in both groups (27 for daytime vs. 27 for nighttime admissions, P > 0.05), as was the proportion of current smokers (30% for daytime vs. 30% for nighttime admissions, P > 0.05). The overall burden and distribution of comorbid conditions were similar among patients admitted during daytime vs. nighttime (53% of daytime admissions vs. 54% of nighttime admissions had at least 1 documented comorbid condition, P = 0.62). Most prevalent were hypertension, coronary artery disease, diabetes, and previous history of myocardial infarction (Table 1). Overall, 28% of patients had documented home medications, and the proportion of patients who were noted to take antiplatelet drugs or antilipid drugs did not differ by day vs. night (8% vs. 7% for antiplatelet therapy and 6% vs. 5% for antilipid therapy, respectively; both P > 0.05).


Quality of post arrest care does not differ by time of day at a specialized resuscitation center.

Uray T, Sterz F, Weiser C, Schreiber W, Spiel A, Schober A, Stratil P, Mayr FB - Medicine (Baltimore) (2015)

Volume of admissions by hour of day.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554053&req=5

Figure 2: Volume of admissions by hour of day.
Mentions: Table 1 compares characteristics of patients hospitalized after OHCA with ROSC. Of 1720 patients admitted during the study period, we identified 1059 patients equal to or older than 18 years of age who regained ROSC after an OHCA (Figure 1). Of those patients, 490 (46%) were admitted between 8 am and 4 pm (day) and 569 (54%) were admitted during night (4:01 pm to 7:59 am) (Figure 2). Patients admitted at night were slightly younger compared with those admitted during daytime (56 vs. 60 years, P < 0.001). The proportion of males was similar in both groups (74% vs. 74%, P = 0.96). Mean body mass index (BMI) was similar in both groups (27 for daytime vs. 27 for nighttime admissions, P > 0.05), as was the proportion of current smokers (30% for daytime vs. 30% for nighttime admissions, P > 0.05). The overall burden and distribution of comorbid conditions were similar among patients admitted during daytime vs. nighttime (53% of daytime admissions vs. 54% of nighttime admissions had at least 1 documented comorbid condition, P = 0.62). Most prevalent were hypertension, coronary artery disease, diabetes, and previous history of myocardial infarction (Table 1). Overall, 28% of patients had documented home medications, and the proportion of patients who were noted to take antiplatelet drugs or antilipid drugs did not differ by day vs. night (8% vs. 7% for antiplatelet therapy and 6% vs. 5% for antilipid therapy, respectively; both P > 0.05).

Bottom Line: In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36).Survival and good neurologic outcome at 12 months did not differ between day and night admissions.Our results may support the concept of specialized post arrest care centers.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.

Show MeSH
Related in: MedlinePlus