ICU Management & Practice, Volume 17 - Issue 2, 2017
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Editorial
Cardiac Arrest
Cardiac Arrest
The “chain of survival” metaphor for improving outcomes from sudden cardiac arrest (CA) was first coined in the 1980s. Since adopted by the American Heart Association and the International Liaison Committee on Resuscitation amongst others, it is a useful tool to concentrate efforts on how to optimise every link in the chain to improve survival and neurologically intact outcomes for CA patients. Mortali...
News
Europe: Wide Variation in Severe Critical Events in Paediatric Anaesthesia
Europe: Wide Variation in Severe Critical Events in Paediatric Anaesthesia
A Europe-wide observational study of anaesthesia practice in children has shown wide variation in severe critical events and a higher incidence than previously understood. The study was run by the European Society of Anaesthesiology and the results are published in Lancet Respiratory Medicine. The Anaesthesia PRactice In Children Observational Trial (APRICOT) included data from 261 centres across 33...
Cardiac Arrest,Bystander CPR
Denmark: Increased Bystander CPR, Decreased Mortality in Out-of-Hospital Cardiac Arrest
A registry study from Denmark has investigated the 1-year risk of anoxic brain damage or nursing home admission and of mortality among patients who survived to day 30 after an out-of-hospital cardiac arrest. The risks were analysed according to whether bystander CPR or defibrillation was performed. The study is published in the New England Journal of Medicine. The number of survivors to 30 days in the...
Gender, Resuscitation Teams
Does Gender Matter in Resuscitation Teams?
A simulated study of cardiopulmonary resuscitation (CPR) that compared performance by male and female medical students found that the female students performed less efficiently and were less effective resuscitation team leaders. The researchers, from the University of Basel and University Hospital Basel, suggest that gender-specific training may be needed. The results are published in Critical Care Medicin...
Sepsis Detection, Sepsis Management, KLAS Report ,Sepsis,KLAS Research
Sepsis Detection and Management: New KLAS Report
Healthcare providers are increasingly turning to technology to detect sepsis and report on sepsis management. As most electronic medical record (EMR) providers do not offer easily deployed sepsis modules, healthcare providers report using solutions from infection control and surveillance vendors as well as specialised sepsis solutions. KLAS Research’s new report, Sepsis 2017: Which Vendors Can Help?, pro...
Brain Injury, Cardiac Arrest,Neurology
Reducing Brain Injury After Cardiac Arrest: American Academy of Neurology Practice Guideline
Therapeutic hypothermia (TH) (32-34°C for 24 hours) should be mandatory practice for patients who are comatose after being resuscitated from out-of-hospital cardiac arrest, if the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF), according to the American Academy of Neurology (AAN)’s newly published practice guideline Reducing brain injury followin...
Cardiac Arrest,Bystander CPR,Survival, Cost
Out-of-Hospital Cardiac Arrest: Bystander CPR Impact on Survival, Cost
Bystander cardiopulmonary resuscitation (CPR) is crucial to successful resuscitation following out-of-hospital cardiac arrest (OHCA). New research shows that bystander CPR was positively associated with long-term survival and appears cost-effective, with an incremental costeffectiveness ratio of USD48,044 per quality-adjusted life year (QALY).The findings are published in Resuscitation. Although early...
Point-of-View
MIC Evaluation,n Antimicrobial Stewardship
The Impact of Fast MIC Evaluation on Antimicrobial Stewardship: A Case Report
Recently antibiotic resistance has become a major public health issue with global dimensions, having a remarkable impact on morbidity, mortality and healthcare associated costs. Due to its increasing relevance, the “antibiotic resistance crisis” has entered the agenda of the WHO and other international agencies, scientific societies, governments and even the UN General Assembly. Dealing with an...
Cover Story : Cardiac Arrest
cardiac arrest, chain of survival, OHCA
Cardiac Arrest Management
The treatment of cardiac arrest has made significant progress over the last 10–15 years. This period marks a significant turning point, because the treatment of out-of-hospital cardiac arrest (OHCA) had often been considered an exercise in futility, with no improvement in outcome for the previous 30 years (Berdowski et al. 2010). In recent years, several investigators have documented marked improvements...
OHCA, cardiac arrest, prehopital
Prehospital Care for Cardiac Arrest: How to Improve Outcome
More patient lives have been saved after OHCA in recent years, but the numbers can improve further. Increased awareness, more education of laypersons and more first responders, in combination with reduced response times for the EMS and early defibrillation will save many lives The chances of surviving an out-of-hospital cardiac arrest (OHCA) and returning to a good life have increased in recent years,...
eCPR, extracorporeal cardiopulmonary resuscitation
Extracorporeal Cardiopulmonary Resuscitation: Who Could Benefit?
This article summarises the current ratio and scientific evidence on which cardiac arrest patients could benefit from extracorporeal cardiopulmonary resuscitation. Acute cardiac arrest has a dismal prognosis even when advanced cardiac life support is initiated without delay. Extracorporeal cardiopulmonary resuscitation (eCPR) refers to a technique which uses an extracorporeal life support system to re-...
cardiac arrest, resuscitation, hypercapnia, mechanical ventilation
Targeted Therapeutic Mild Hypercapnia After Cardiac Arrest
Cardiac arrest (CA) causes ischaemic brain injury and persistent cerebral hypoperfusion and cerebral hypoxia during the early post-resuscitation period. PaCO2 is the major physiological regulator of cerebral blood flow, is a modifiable component of care and mild hypercapnia may lead to improved neurological outcomes for resuscitated CA survivors. In order to evaluate the potential therapeutic role of PaCO2...
prognostication; out-of-hospital; cardiac arrest; resuscitation; targeted temperature management; therapeutic hypothermia
Prognostication Following Out-of-Hospital Cardiac Arrest
This article reviews the current evidence on prognostication after cardiac arrest. Post-resuscitation care has developed and evolved significantly since 2003, following recommendations by the Advanced Life Support task force of the International Liaison Committee on Resuscitation to implement therapeutic hypothermia (TH) in unconscious survivors following out-ofhospital cardiac arrest (OHCA) (Nolan et...
Resuscitation, Southern Africa, Botswana, CPR, training, education
Resuscitation in Resource-Poor Settings – A Southern Africa Experience
Worldwide, there are over 17 million cardiovascular deaths each year, and the prevalence of cardiovascular disease is increasing. Many regions in the world have seen mortality rates level off or improve; this is not the case for Sub-Saharan Africa (SSA). With only modest reductions in age-adjusted cardiovascular mortality, overshadowed by a blossoming and ageing population, increases in cardiovascular deat...
Resuscitation, Debriefing, Teams
Why You Should Always Debrief Your Resuscitations
Everyone who is active in resuscitation teams will admit: treating a patient in cardiac arrest is a challenge and often things will not go as you would like them to. This can lead to negative feelings when the resuscitation attempt has ended, either because the patient did not regain return of spontaneous circulation (ROSC) or the patient is transported to the cath lab for example. Negative feelings can le...
Matrix
mechanical ventilation, lung injury
Airway Pressure Release Ventilation: What's Good About It?
The use of APRV has many proposed benefits for patients with lung injury. However, quality evidence supporting the use of this technique is limited. This article summarises the purported benefits and limitations of routine use of the technique in the management of ARDS, and critically reviews the evidence supporting its use. Airway pressure release ventilation (APRV) was originally described in 1987 (D...
Hypoxia, High altitude, Microcirculation, Metabolism
High Altitude Research and its Relevance to Critical Illness
Critical illness can be considered as the body’s failure to compensate for severe pathophysiological ‘stress’. The result is a vicious circle of damage that ultimately ends in organ failure, permanent harm and, unfortunately for many, death. Fortunately, the human body is remarkably resilient. It has the ability to tolerate changes to its internal milieu and defend the cells that make up its vital or...
Management Matters
Rounds, ICU, Multidisciplinary, Teams
How to Run Successful Rounds in the Intensive Care Unit
Rounds in the intensive care unit (ICU) allow for scheduled discussions in which healthcare providers review clinical information and develop care plans for critically ill patients. Despite this straightforward concept, there is widespread variability in numerous components of rounds. While some of these differences are culturally rooted and, as such, unavoidable, unintentional or unnecessary variability i...
ARDS, Patients, Families, Communication, ARDS Foundation, acute respiratory distress syndrome
From Independent Attorney to Critically Ill Patient
Life changed forever when Eileen Rubin was hospitalised with ARDS. After a slow recovery it was time to give something back, and Eileen went on to co-found the ARDS Foundation. “I can’t breathe. I think I’m dying.” Those were the words I gasped to my mother less than two days after being admitted to the Medical Intensive Care Unit on 2 June 1995. I was thirty-three years old. Immediately, m...
European Society of Anaesthesiology, Trainees, Anaesthesiologists, Europe
Anaesthesiology Trainees: We Are Also Intensivists!
In 2014, a few trainees from opposite corners of Europe had the somewhat bizarre idea that all anaesthesiology trainees should be able to communicate on a common platform. What followed was an almost immediate endorsement of this plan by the European Society of Anaesthesiology (ESA) Board of Directors, which led to the first European-wide survey on trainees´ needs, goals and expectations (Sobreira Fernand...
Airways, Equipment, Intubation
Standardised, Hospital-Wide Airway Trolleys
One of the main recommendations of the 4th National Audit Project of the UK Royal College of Anaesthetists and the Difficult Airway Society was that every intensive care unit (ICU) should have access to a difficult airway trolley, which should have the same content and layout as the one found in the operating department (Cook et al. 2011). At Royal North Shore Hospital in Sydney, Australia, we designed tro...
Teisberg, Wallace, Value Based Care, patients, best outcomes, service design
Five Reasons Why Value-Based Healthcare is Beneficial
Patient-centered care is becoming a major topic in healthcare. Many initiatives have begun focusing their care around patients and their medical conditions. This requires focusing on patient value (Porter and Teisberg 2006). When focusing on value for patients, a few challenges may arise. Firstly, the meaning of value for patients varies widely among stakeholders in healthcare. Secondly, not all patients r...
Interview
John B. West, respiratory physiology, Everest, altitude, oxygen
Reaching the Heights of Respiratory Physiology
Professor John B. West is a renowned respiratory physiologist and researcher. He joined the faculty of the University of California San Diego in 1969, where he is Distinguished Professor of Medicine and Physiology in the School of Medicine, where he still teaches first-year medical students. He is author of Respiratory physiology - the essentials, which has been translated into many languages, and is now i...
ICU Organisation,Jeremy Kahn
Evidenced-based ICU Organisation: Interview with Professor Jeremy Kahn
Jeremy Kahn is Professor of Critical Care, Medicine and Health Policy in the University of Pittsburgh School of Medicine and Graduate School of Public Health. As a core faculty member in the CRISMA Center in the Department of Critical Care Medicine, he directs the CRISMA Program on Critical Care Health Policy & Management. His research focuses on the organisation, management, and financing of critical...
Country Focus
Tunisia, Intensive Care
Intensive Care in Tunisia
According to the World Bank classification, Tunisia is considered a lower middle-income country, corresponding to a country with a Gross National Income (GNI) per capita between USD1,026 and USD4,035 (World Bank 2015). The economic growth of Tunisia has been slowed following the 2011 Arab Spring, which was initiated in this country. Despite economic and political constraints, which have been exacerbated by...
Agenda
agenda, Critical care events
Agenda
JUNE 2017 3-5 Euroanaesthesia 2017 Geneva, Switzerland 6-9 ESPNIC 2017 Lisbon, Portugal 8-9 Neurosciences in Intensive Care International Symposium Paris, France 12-13...