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Fulltext Drowning in children in Iran: outcomes and prognostic factors

Mosayebi Z, Movahedian AH, Mousavi GA

Med J Malaysia, 2011 Aug;66(3):187-90.
PMID: 22111437

The aim of this study was to determine possible associations between some prognostic factors and drowning outcome. There were 47 drowning victims during the study period, of whom 39 (83%) survived and 8 (17%) died. All deaths occurred in children aged under 5 including 7 (87.5%) male and 1 (12.5%) female victims. Seven (87.5%) were Iranian and only one (12.5%) was from Afghanistan. Absence of vital signs at hospital arrival, need for resuscitation, GCS < 5 and acidosis all were associated with adverse outcome with a statistical significance (P < 0.05), but hypothermia was the only idependent predictor of poor outcome (OR 13.7; 95% CI 2.27 to 82.7 , P = 0.003). Since prognostic factors do not predict outcome with 100% accuracy, performing cardiopulmonary resuscitation at the scene and continuing it in the hospital can provide higher chances of recovery for the children.

Matched MeSH terms: Cardiopulmonary Resuscitation
Diaphragmatic hernia: an unusual cause of postpartum collapse

Sharifah H, Naidu A, Vimal K

BJOG, 2003 Jul;110(7):701-3.
PMID: 12842063
Matched MeSH terms: Cardiopulmonary Resuscitation
Clinical course and determination of brainstem death in a children's hospital

Goh AY, Mok Q

Acta Paediatr, 2004 Jan;93(1):47-52.
PMID: 14989439

AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.

Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature

Furui M, Dillon J, Akhtar KMA, Bin Ja'apar AN

J Surg Case Rep, 2020 Dec;2020(12):rjaa567.
PMID: 33425326 DOI: 10.1093/jscr/rjaa567

Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential. We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext Will they swim or sink? parental perception of water safety among their children

Noor Hamzani Farizan, Rosnah Sutan, Kulanthayan KC Mani

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):254-260.
MyJurnal

Introduction: The magnitude of drowning as one of the leading causes of death among children in Malaysia may have been underestimated. Little is known on the level of awareness on water safety among parents as it might be associated with appropriateness and adequacy of the supervision. This study aims to describe perceptions of water safety among parents of primary school children. Methods: A cross-sectional survey with 719 respondent conduct- ed to obtain information on parents self-reported on their children’s water-involved activity and swimming ability, self-estimated ability to rescue their child and perceptions of the risk of drowning and water safety for their children. Results: The result revealed that about 21.6% of respondents did not perceive drowning as one of the unintentional injury leading causes of death among children. Parents reported that their children had experienced a near- drown- ing incident (16.1%), and only 12.2% of the child had attended a formal swimming lesson. Majority of the parents did not involve in any water safety program (98.7%), can’t swim (61.6%), not been certified in CPR (87.3%) and not confident (87.3%) to perform resuscitation (CPR). Respondents also perceived their children could swim (42.1%), and they felt confident when their child in the water (45.6%). There were statistical differences between parents who reported their child had a near-drowning experience with their perception of children’s swimming ability. Conclu- sion: An exploration of parent’s perception of water safety provided an overview of the need for promoting aware- ness on drowning risk and water safety education in this country.

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext Prominent hardware post latarjet mimicking shoulder instability symptoms

Raymond DK Yeak, Nasir M Nizlan

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):342-344.
MyJurnal

A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs
and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate
Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and
clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthroscopy and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms
pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material
from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext Knowledge, awareness and practices on the risk factors of cardiovascular diseases among community in Gombak, Kuala Lumpur

Zulhabri Othman, Nur Asmidar Abdul Aleem, Muhammad Danial Che Ramli, Sarina Sariman, Haniza Harun, Marini Ab Rahman, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(101):72-81.
MyJurnal

Introduction: Cardiovascular disease (CVD) is a group of disease which are related to the heart and its circulations. The main modifiable risk factors of the CVD disease are hypertension, hyperglycemia and obesity. This study aims to evaluate the knowledge, awareness and practice on cardiovascular disease risk factors among Gombak community in Kuala Lumpur. Methods: This was a cross-sectional study using self-administered questionnaire and anthropomet- ric measurement among 388 subjects in Gombak District, Kuala Lumpur. Descriptive data analysis and multivariate binary logistic regression were carried to identify demographic and factors associated. Results: The prevalence of the risk factors was high among study subjects, including obesity (24.2%), hypertension (42.3%) and hyperglycemia (26.8%). More than half (64.4%) of the study subjects having at least one of the risk factor. The multivariate binary logistic model factor illustrated that compare to Malays, Chinese were 37% less likely to have obesity (CPR=0.67; 95% Cl: 0.26-1.69). Gombak district community are more likely to have the knowledge on the CVD risk factor but lack of awareness and poor in practicing the prevention action. The Indian ethnic group was less likely to be aware (APR: 0.33, Cl: 0.05-2.31) and others bumiputera ethnic group were less likely to prevent (APR: 0.58, CI: 0.20-1.65) the risk of CVD. The Chinese ethnic less likely to have the knowledge (APR: 0.88, Cl: 0.35-2.22). Conclusion: Gom- bak community was more likely to have the knowledge but less likely to be aware and lack of practice of prevention of the risk factors of CVD.

Matched MeSH terms: Cardiopulmonary Resuscitation
Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA)

Chia MY, Lu QS, Rahman NH, Doctor NE, Nishiuchi T, Leong BS, et al.

Resuscitation, 2017 02;111:34-40.
PMID: 27923113 DOI: 10.1016/j.resuscitation.2016.11.019

BACKGROUND: There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes.
METHODS: All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged. Regression analysis was performed to identify factors associated with favourable neurologic outcomes.
RESULTS: 66,780 OHCAs were collected between January 2009 and December 2013; 3244 young OHCAs had resuscitation attempted by emergency medical services (EMS). 56.8% of patients had unwitnessed arrest; 47.9% were of traumatic etiology. 17.2% of patients (95% CI: 15.9-18.5%) had return of spontaneous circulation; 7.8% (95% CI: 6.9-8.8%) survived to one month; 4.6% (95% CI: 4.0-5.4%) survived with favourable neurologic outcomes. Factors associated with favourable neurologic outcomes include witnessed arrest (adjusted RR=2.42, p-value<0.0001), bystander CPR (adjusted RR=1.57, p-value=0.004), first arrest shockable rhythm (adjusted RR=27.24, p-value<0.0001), and cardiac etiology (adjusted RR=3.99, p-value<0.0001).
CONCLUSIONS: OHCA among young adults are not uncommon. Traumatic OHCA, occurring most frequently in young adults had dismal prognosis. First arrest rhythms of VF/VT/unknown shockable rhythm, cardiac etiology, bystander-witnessed arrest, and bystander CPR were associated with favourable neurological outcomes. The results of the study would be useful for planning preventive and interventional strategies, improving EMS, and guiding future research.

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext The Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network: what, where, why and how

Doctor NE, Ahmad NS, Pek PP, Yap S, Ong ME

Singapore Med J, 2017 07;58(7):456-458.
PMID: 28741005 DOI: 10.11622/smedj.2017057

Out-of-hospital cardiac arrest (OHCA) is a global health concern with an incidence rate of 50-60 per 100,000 person-years. To improve OHCA survival rates, several cardiac arrest registries have been set up in North America and Europe, such as the Resuscitation Outcomes Consortium, Cardiac Arrest Registry to Enhance Survival, Ontario Prehospital Advanced Life Support and European Registry of Cardiac Arrest. In Asia, however, there was previously no concerted effort in prehospital emergency care research owing to differences in prehospital emergency medical services systems, data collection methods and outcome reporting between countries. Recognising the need for a collaborative prehospital emergency care research group in Asia, researchers from seven countries in the Asia-Pacific region (including Japan, South Korea, Taiwan, Thailand, United Arab Emirates-Dubai, Singapore and Malaysia) established the Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network in 2010. This paper gives the overview, methodology and research accomplishments of the PAROS network.

Matched MeSH terms: Cardiopulmonary Resuscitation
The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Ng KT, Teoh WY

Prehosp Disaster Med, 2019 Oct;34(5):532-539.
PMID: 31455452 DOI: 10.1017/S1049023X19004758

INTRODUCTION: Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.
METHODS: A systematic review and meta-analysis were conducted using the following databases: MEDLINE, EMBASE, and CENTRAL, from their inception until October 2018. All the randomized controlled trials (RCTs) were included. Observational studies, case reports, case series, and non-systematic reviews were excluded.
RESULTS: Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received epinephrine during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%CI) of 4.25 (3.79-4.75), P

Matched MeSH terms: Cardiopulmonary Resuscitation
Knowledge and Confidence Level Among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected COVID-19 Patients: A Cross Sectional Study in Malaysia

Abd Samat AH, Isa MH, Sabardin DM, Jamal SM, Jaafar MJ, Hamzah FA, et al.

Ann Acad Med Singap, 2020 Sep;49(9):643-651.
PMID: 33241252

INTRODUCTION: This study aims to evaluate the knowledge and confidence of emergency healthcare workers (EHCW) in facing the COVID-19 pandemic.
MATERIALS AND METHODS: A cross-sectional online study using a validated questionnaire was distributed to doctors (MD), assistant medical officers (AMO), and staff nurses (SN) at an urban tertiary Emergency Department. It comprised of 40 knowledge and 10 confidence-level questions related to resuscitation and airway management steps.
RESULTS: A total of 135 from 167 eligible EHCW were enrolled. 68.9% (n = 93) had high knowledge while 53.3% (n = 72) possessed high confidence level. Overall knowledge mean score was 32.96/40 (SD = 3.63) between MD (33.88±3.09), AMO (32.28±4.03), and SN (32.00±3.60), P= 0.025. EHCWs with a length of service (LOS) between 4-10 years had the highest knowledge compared to those with LOS <4-year (33.71±3.39 versus 31.21±3.19 P = 0.002). Airway-related knowledge was significantly different between the designations and LOS (P = 0.002 and P = 0.003, respectively). Overall, EHCW confidence level against LOS showed significant difference [F (2, 132) = 5.46, P = 0.005] with longer LOS showing better confidence. MD showed the highest confidence compared to AMO and SN (3.67±0.69, 3.53±0.68, 3.26±0.64) P = 0.049. The majority EHCW were confident in performing high-quality chest-compression, and handling of Personal Protective Equipment but less than half were confident in resuscitating, leading the resuscitation, managing the airway or being successful in first intubation attempt.
CONCLUSIONS: EHCW possessed good knowledge in airway and resuscitation of COVID-19 patients, but differed between designations and LOS. A longer LOS was associated with better confidence, but there were some aspects in airway management and resuscitation that needed improvement.

Matched MeSH terms: Cardiopulmonary Resuscitation/methods*
Fulltext A case of cardiac arrest due to air embolism during scoliosis surgery

Haji Mohd Amin MZ, Beng JTB, Young BTY, Faruk Seman NA, Ching TS, Chek WC

J Orthop Surg (Hong Kong), 2019 4 9;27(2):2309499019840083.
PMID: 30955449 DOI: 10.1177/2309499019840083

Cardiac arrest during scoliosis surgery is rare in idiopathic scoliosis. We present a case of cardiorespiratory collapse during corrective surgery in a young patient with idiopathic scoliosis. A diagnosis of venous air embolism was made by exclusion. A cardiorespiratory resuscitation was performed in supine position. Patient recovered without any sequelae and had operation completed 6 weeks later.

Matched MeSH terms: Cardiopulmonary Resuscitation/methods
Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest

Wah W, Wai KL, Pek PP, Ho AFW, Alsakaf O, Chia MYC, et al.

Am J Emerg Med, 2017 Feb;35(2):206-213.
PMID: 27810251 DOI: 10.1016/j.ajem.2016.10.042

BACKGROUND: In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA.
METHODOLOGY: This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models.
RESULTS: 40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR=6.10, 95% confidence interval/CI=5.06-7.34) and subsequent conversion to shockable rhythm (OR=2.00,95%CI=1.10-3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses.
CONCLUSION: Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy.

Matched MeSH terms: Cardiopulmonary Resuscitation/statistics & numerical data*
Epidemiology and outcome of paediatric out-of-hospital cardiac arrests: A paediatric sub-study of the Pan-Asian resuscitation outcomes study (PAROS)

Tham LP, Wah W, Phillips R, Shahidah N, Ng YY, Shin SD, et al.

Resuscitation, 2018 04;125:111-117.
PMID: 29421664 DOI: 10.1016/j.resuscitation.2018.01.040

BACKGROUND: The Pan Asian Resuscitation Outcomes Study (PAROS) is a retrospective study of out- of-hospital cardiac arrest(OHCA), collaborating with EMS agencies and academic centers in Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand and UAE-Dubai. The objectives of this study is to describe the characteristics and outcomes, and to find factors associated with survival after paediatric OHCA.
METHODS: We studied all children less than 17 years of age with OHCA conveyed by EMS and non-EMS transports from January 2009 to December 2012. We did univariate and multivariate logistic regression analyses to assess the factors associated with survival-to-discharge outcomes.
RESULTS: A total of 974 children with OHCA were included. Bystander cardiopulmonary resuscitation rates ranged from 53.5% (Korea), 35.6% (Singapore) to 11.8% (UAE). Overall, 8.6% (range 0%-9.7%) of the children survived to discharge from hospital. Adolescents (13-17 years) had the highest survival rate of 13.8%. 3.7% of the children survived with good neurological outcomes of CPC 1 or 2. The independent pre-hospital factors associated with survival to discharge were witnessed arrest and initial shockable rhythm. In the sub-group analysis, pre-hospital advanced airway [odds ratio (OR) = 3.35, 95% confidence interval (CI) = 1.23-9.13] was positively associated with survival-to-discharge outcomes in children less than 13 years-old. Among adolescents, bystander CPR (OR = 2.74, 95%CI = 1.03-7.3) and initial shockable rhythm (OR = 20.51, 95%CI = 2.15-195.7) were positive factors.
CONCLUSION: The wide variation in the survival outcomes amongst the seven countries in our study may be due to the differences in the delivery of pre-hospital interventions and bystander CPR rates.

Matched MeSH terms: Cardiopulmonary Resuscitation/statistics & numerical data*
Fulltext Neonatal resuscitation programme in Malaysia: an eight-year experience

Boo NY

Singapore Med J, 2009 Feb;50(2):152-9.
PMID: 19296030

The neonatal resuscitation programme (NRP) published by the American Academy of Paediatrics and American Heart Association was launched in Malaysia in 1996. This study aimed to review the outcome of NRP in Malaysia during the first eight years.

Matched MeSH terms: Cardiopulmonary Resuscitation/education*
Fulltext A study assessing the impact of different teaching modalities for pharmacy students in a Cardio-Pulmonary Resuscitation (CPR) course

Khan TM, Hassali MA, Rasool ST

Saudi Pharm J, 2013 Oct;21(4):375-8.
PMID: 24227957 DOI: 10.1016/j.jsps.2012.11.002

The current study aims to assess the effectiveness of different teaching methods adopted for the practical session of Cardio-Pulmonary Resuscitation (CPR). CPR training is one of the compulsory modules of the Public Health Pharmacy (PHP) course at Universiti Sains Malaysia. CPR training comprises of 10% of total marks of the PHP course. To test the effectiveness of the different teaching strategies, three groups were defined using a two-stage cohort distribution-i.e. based on grade point average (GPA) and different teaching modalities. Group One was instructed using images and PowerPoint lecture slides. Group Two was instructed using videos and PowerPoint lecture slides. Group Three was instructed using PowerPoint slides with white boards and videos. Students in Group Three were not provided with a hard/soft copy of the PowerPoint slides and were encouraged to write down all the information on their personal notebooks. A 20-item questionnaire was used to assess the students' understanding toward the CPR session. Data were analyzed using the Statistical Package for Social Science Students, SPSS version 13®. Based on the response attained, the comparison of the final score among the groups was undertaken using one way ANOVA. Twenty-seven students have participated in this study. Final evaluation using the questionnaire revealed that student's in Group Three had a better understanding of CPR (18.1 ± 1.5, p <0.001) than the other two. Students' note taking during the lecture and use of traditional chalkboard teaching were found significant to improve the students' understanding and learning in the CPR session.

Matched MeSH terms: Cardiopulmonary Resuscitation
Improving the self-confidence level of medical undergraduates during emergencies using high fidelity simulation

Muniandy RK, Nyein KK, Felly M

Med J Malaysia, 2015 Oct;70(5):300-2.
PMID: 26556119 MyJurnal

INTRODUCTION: Medical practice involves routinely making critical decisions regarding patient care and management. Many factors influence the decision-making process, and self-confidence has been found to be an important factor in effective decision-making. With the proper transfer of knowledge during their undergraduate studies, selfconfidence levels can be improved. The purpose of this study was to evaluate the use of High Fidelity Simulation as a component of medical education to improve the confidence levels of medical undergraduates during emergencies.
METHODOLOGY: Study participants included a total of 60 final year medical undergraduates during their rotation in Medical Senior Posting. They participated in a simulation exercise using a high fidelity simulator, and their confidence level measured using a self-administered questionnaire.
RESULTS: The results found that the confidence levels of 'Assessment of an Emergency Patient', 'Diagnosing Arrhythmias', 'Emergency Airway Management', 'Performing Cardio-pulmonary Resuscitation', 'Using the Defibrillator' and 'Using Emergency Drugs' showed a statistically significant increase in confidence levels after the simulation exercise. The mean confidence levels also rose from 2.85 to 3.83 (p<0.05).
CONCLUSION: We recommend further use of High Fidelity Simulation in medical education to improve the confidence levels of medical undergraduates.

Matched MeSH terms: Cardiopulmonary Resuscitation
Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients

Ng YY, Wah W, Liu N, Zhou SA, Ho AF, Pek PP, et al.

Resuscitation, 2016 May;102:116-21.
PMID: 26970031 DOI: 10.1016/j.resuscitation.2016.03.002

BACKGROUND: The incidence of out-of-hospital cardiac arrest (OHCA) in women is thought to be lower than that of men, with better outcomes in some Western studies.
OBJECTIVES: This study aimed to investigate the effect of gender on OHCA outcomes in the Pan-Asian population.
METHODOLOGY: This was a retrospective, secondary analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data between 2009 and 2012. We included OHCA cases which were presumed cardiac etiology, aged 18 years and above and resuscitation attempted by emergency medical services (EMS) systems. We used multi-level mixed-effects logistic regression models to account for the clustering effect of individuals within the country. Primary outcome was survival to hospital discharge.
RESULTS: We included a total of 40,159 OHCA cases, 40% of which were women. We found that women were more likely to be older and have an initial non-shockable arrest rhythm; they were more likely to receive bystander cardio-pulmonary resuscitation (CPR). The univariate analysis showed that women were significantly less likely to have return of spontaneous circulation (ROSC) at scene or in the emergency department (ED), and had lower rates of survival-to-admission and discharge, and poorer overall and cerebral performance outcomes. There was however, no significant gender difference on outcomes after adjustment of other confounders. Women in the reproductive age group (age 18-44 years) were significantly more likely to have ROSC at scene or in the ED, higher rates of survival-to-admission and discharge, and have better overall and cerebral performance outcomes after adjustment for differences in baseline and pre-hospital factors. Menopausal women (age 55 years and above) were less likely to survive to admission after adjusting for other pre-hospital characteristics but not after age adjustment.
CONCLUSION: Differences in survival outcomes between reproductive and menopausal women highlight a need for further investigations into the plausible social, pathologic or hormonal basis.
KEYWORDS: Gender; Out-of-hospital cardiac arrest; Registry

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext How can we improve code blue training for non-paediatricians: an experience from students-conducted assessment in national clinical skills conference

Khoo, Erwin Jiayuan, Kutzsche, Stefan

Malaysian Journal of Paediatrics and Child Health, 2018;24(1):27-42.
MyJurnal

Introduction: Training of all health personnel involved in paediatric care is a key determinant of successful outcome during paediatric emergencies. We aimed to identify the need for paediatric Mock Code Blue skills training among non-paediatricians in a pre-hospital setting through checklist assessment of their performance. Methods: A paediatric septic shock and cardiac arrest Mock Code Blue pre-hospital scenarios were presented for non-paediatricians during a National Clinical Skills Conference. Eight medical student assessors and four clinical facilitators were involved in this training. Participants were expected to be able to demonstrate the skills and teamwork necessary to managepaediatric emergencies according to the learning outcomes. Results: A total of 97 delegates participated in a facilitated paediatric Mock Code Blue for multidisciplinary groups of health personnel. Outcome measures showed a significant lack of communication and team work skills, and weakness in “closing the loop” as barriers to successful resuscitation. Conclusion: We recommend Mock Code Blue simulation training to be offered regularly to all groups of healthcare providers involved in paediatric and neonatal care while not overlooking the emphasis on non-technical skills.

Matched MeSH terms: Cardiopulmonary Resuscitation
Fulltext Cardiopulmonary resuscitation: would you do it?

Liew SM

Malays Fam Physician, 2006;1(2):91-93.
PMID: 27570598 MyJurnal

Recommend that the following measures be applied universally: CPR training should emphasize the very low risk of disease transmission. Training in the use of barrier mask should be included; Oral barrier devices should be made freely available in hospital and in public areas e.g. hotels, theaters, health clubs and restaurants. A survey among health personnel in Malaysia conducted in 2005 found that nearly half of the 4989 subjects were either not confident at all or unsure about their ability in giving first-aid and CPR.13 The investigators however did not look at fear of infection in particular.

Matched MeSH terms: Cardiopulmonary Resuscitation

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