Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study*

Objectives: Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. Design: Single-center retrospective before-after study. Setting: Academic PICU. Patients: Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation. Intervention: Deployment of a postcardiac arrest clinical pathway and computerized order entry system. Measurements and Main Results: There were 380 patients included—163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0–6 and 6–24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significan...
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

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Source: Journal of Toxicology and Environmental Health Part A - Category: Environmental Health Authors: Source Type: research
Authors: Tsujioka S, Nozoe M, Kawano Y, Suematsu N, Kubota T Abstract A 70-year-old woman with situs inversus totalis underwent catheter ablation for atrial fibrillation and atrial flutter. Although her morphologic left atrium (LA) was enlarged, we performed cryoballoon ablation and liner radiofrequency ablation of the cava-tricuspid isthmus without mapping atrial arrhythmias. However, a different form of atrial tachycardia (AT) recurred. We performed catheter ablation a second time using a three-dimensional electroanatomic mapping system. AT was not terminated by the liner ablation at the roof of morphologic LA an...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
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Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Knee Source Type: research
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Source: Current Cardiology Reports - Category: Cardiology Source Type: research
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Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
AbstractPurpose of the reviewArrhythmias are a common complication of patients with single ventricle anatomy who undergo the Fontan operation. This review will address current management strategies for acute and chronic arrhythmias.Recent findingsAlterations to surgical techniques, newer antiarrhythmic medications, and improvements in catheter ablation procedures have improved the management of patients with arrhythmias following Fontan palliation.SummaryArrhythmias predict poor prognosis for Fontan patients. Early and aggressive management of arrhythmias improve patient outcomes. For bradyarrhythmias, management strategie...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity,...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
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Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
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Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
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Source: Pediatric Cardiology - Category: Cardiology Source Type: research
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