Background. Despite the recent advances in advanced cardiac life support (ACLS), there has been no significant improvement in survival among patients who undergo cardiac arrest. To date, there are no local guidelines on the requirements or standards of in-hospital cardiac arrest teams in the Philippines. In addition, there are still no studies on the outcomes of cardiac arrests among adult patients in a tertiary hospital in the Philippines. Objectives. The objective of this study is to investigate patient-, event-, and hospital-related factors associated with survival among adult patients who underwent in-hospital cardiac arrest in the service wards and intensive care units of a tertiary hospital. Methods. This is a prospective cross-sectional study conducted over three months in 2018. Patient-, event- and hospital-related data were collected from each patient with a cardiac arrest event who was referred to the cardiac arrest teams based on the modified Utstein form of reporting cardiac arrests. Survival to discharge from cardiac arrest was the main outcome. Results. The study included 119 patients, 47.9% male, with a mean age of 50.1 years (SD 16.7). Survival rate was 6.7%. The mean response time did not differ between survival group (1.46 minutes) and mortality group (1.82 minutes) (p value = 0.26). The presence of a shockable initial rhythm (3.6% vs 3/8; p value = 0.01), shorter lag time to initiation of electrical therapy (6.0 vs 9.3 ± 5.6 min; p value = 0.02), shorter time to establishment of an airway (2.75 ± 1.6 vs. 6.98 ± 5.2 min; p value = 0.01), and shorter duration of resuscitation (7 ± 4.6 vs. 13.0 ± 7.9 min; p value = 0.01) were significantly associated with survival. The presence of underlying illnesses is associated with higher mortality. The most common hospital-related problems identified were the need to cover long distances, delay in the call, and the lack of elevators. Conclusion. The survival rate of patients who underwent cardiac arrest and resuscitation by a cardiac arrest team is low. The initial presenting rhythm, lag time to initiation of electrical therapy, time to establishment of airway, duration of resuscitation, as well as the underlying disease can significantly affect survival. Streamlining the resources of the hospital to address these matters can have an impact on survival.
Advanced Cardiac Life Support ; Heart Arrest

OBJECTIVE: Head elevation at an angle of 30° during cardiopulmonary resuscitation (CPR) was hemodynamically beneficial compared to supine position in a previous porcine cardiac arrest experimental study. However, survival benefit of head-up elevation during CPR has not been clarified. This study aimed to assess the effect of head-up tilt position during CPR on 24-hour survival in a porcine cardiac arrest experimental model.METHODS: This was a randomized experimental trial using female farm pigs (n=18, 42±3 kg) sedated, intubated, and paralyzed on a tilting surgical table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support was performed in a position randomly assigned to either head-up tilt at 30° or supine with a mechanical CPR device, LUCAS-2, and an impedance threshold device, followed by 20 minutes of advanced cardiac life support in the same position. Primary outcome was 24-hour survival, analyzed by Fisher exact test.RESULTS: In the 8 pigs from the head-up tilt position group, one showed return of spontaneous circulation (ROSC); all eight pigs expired within 24 hours. In the eight pigs from the supine position group, six had the ROSC; six pigs survived for 24 hours and two expired. The head-up position group showed lower 24-hour survival rate and lower ROSC rate than supine position group (P<0.01).CONCLUSION: The use of head-up tilt position with 30 degrees during CPR showed lower 24-hour survival than the supine position.
Advanced Cardiac Life Support ; Agriculture ; Animal Experimentation ; Cardiopulmonary Resuscitation ; Electric Impedance ; Female ; Head ; Heart Arrest ; Humans ; Models, Theoretical ; Supine Position ; Survival Rate ; Swine ; Ventricular Fibrillation

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is used routinely for evaluating patients with major trauma. After a primary survey, the existence of hemoperitoneum or hemopericardium must be searched using FAST. Traditionally, hemopericardium can be assessed through the subcostal approach with the curved probe for the abdomen. On the other hand, satisfactory images (four chamber view) are difficult to obtain with this approach. METHODS: This was a prospective, single-center pilot study of an academic tertiary medical center. When FAST is performed on the patients, traditional FAST (subcostal approach with the curved probe) is generally conducted. During a FAST examination, the time consumed, numeric rating scale (NRS) for pain, and success rate of satisfactory images are recorded. After the traditional FAST was used, we used the curved probe like echo probe. The curved probe was positioned beside the left nipple with the probe marker opposite-sided (modified FAST) like the parasternal long-axis view of echocardiography. Finally, the existence of hemopericardium is confirmed using an echo probe. In this study, the consumed time, NRS, and success rate of satisfactory images were compared. RESULTS: The consumed time was shorter (57.4 vs. 71.2 seconds, P<0.001) and the pain score was lower (0.1 vs. 1.8, P<0.001) with the modified FAST compared to the traditional FAST. Satisfactory images were obtained in 23 cases (51%) with traditional FAST, whereas satisfactory images were obtained in 37 cases (82%) using modified FAST. CONCLUSION: Mvodified FAST is more accurate for the detection of hemopericardium than traditional FAST. The pain is less severe and the time consumed is shorter.
Abdomen ; Advanced Trauma Life Support Care ; Echocardiography ; Hand ; Hemoperitoneum ; Humans ; Nipples ; Pericardial Effusion ; Pilot Projects ; Prospective Studies ; Ultrasonography

OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.
Advanced Trauma Life Support Care ; Cardiopulmonary Resuscitation ; Epinephrine ; First Aid ; Hand ; Heart Arrest ; Humans ; Intubation ; Korea ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Retrospective Studies

PURPOSE: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. METHODS: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. RESULTS: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. CONCLUSION: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.
Cardiopulmonary Resuscitation ; Decision Making ; Divorce ; Electronic Health Records ; Heart ; Humans ; Intubation ; Life Support Care ; Logistic Models ; Lung Diseases ; Renal Dialysis ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers ; Ventilators, Mechanical

To explore the correlation of quality of life with self-care efficacy and social support in patients with nasopharyngeal carcinoma after radiotherapy.
 Methods: A total of 179 patients with nasopharyngeal carcinoma at 3 months after radiotherapy were surveyed using self-designed general information questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30 V3.0), Chinese-version of Strategies Used by People to Promote Health (C-SUPPH), and Perceived Social Support Scale (PSSS).
 Results: The score of cognitive function was the highest, while the score of social function was the lowest. The score of related symptoms was 22.21±10.24, the overall score for quality of life was 52.46±17.96, the score of self-care efficacy was 62.14±14.50, and the score of social support was 56.03±7.63. Self-care efficacy of patients with nasopharyngeal cancer after radiotherapy was positively correlated with 5 functional areas of quality of life and overall quality of life, and negatively correlated with relevant symptoms (P<0.01). Social support was positively correlated with physical function, social function and overall quality of life (P<0.01), and negatively correlated with relevant symptoms (P<0.05). Multiple regression analysis showed that self-care efficacy could predict 5 functional areas of life quality, relevant symptoms, overall quality of life and social support predicted social function in quality of life.
 Conclusion: Self-care efficacy and social support for patients with nasopharyngeal cancer after radiotherapy can affect their quality of life. Nursing staff should pay attention to improving the self-care efficacy of patients, guide them to actively seek or obtain social support, and in turn to improve their quality of life.
Humans ; Nasopharyngeal Carcinoma ; radiotherapy ; Nasopharyngeal Neoplasms ; radiotherapy ; Quality of Life ; Self Care ; Social Support

Trauma is a life-threatening "modern disease". The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital emergency medical services (EMS) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT) with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training.
China ; Emergency Medical Services ; Humans ; Life Support Care ; Traumatology ; education ; Wounds and Injuries ; therapy

OBJECTIVE: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. METHODS: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. RESULTS: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36–6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03–0.81). CONCLUSION: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation ; Defibrillators ; Education ; Emergencies* ; Emergency Medicine* ; Hand ; Heart Arrest* ; Incidence ; Intensive Care Units ; Retrospective Studies ; Sodium Bicarbonate

PURPOSE: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. METHODS: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. RESULTS: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. CONCLUSION: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.
Advanced Cardiac Life Support ; Antidotes ; Blood Pressure ; Hand ; Heart Arrest ; Hemodynamics ; Humans ; Inhalation ; Lactic Acid ; Mortality ; Multiple Organ Failure ; Perfusion ; Poisoning* ; Respiratory Insufficiency ; Shock ; Ventilators, Mechanical

PURPOSE: The purpose of this study was to examine the effects of integrated psychoeducational program for distress management of newly diagnosed patients with breast cancer. METHODS: A quasi-experimental trial was conducted. The participants consisted of 47 female patients with breast cancer assigned to an intervention group (n=25) and control group (n=22). The intervention group participated in integrated psychoeducational program, consisting of individual face-to-face education and telephone-delivered health-coaching sessions. Data were collected at three time points: pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). Study instruments were Distress thermometer, Supportive Care Needs Survey Short Form 34 and Functional Assessment of Cancer Therapy-Breast. RESULTS: Compared with the control group, breast cancer patients in the intervention group reported lower distress and supportive care needs than the control group. The intervention group reported higher quality of life (QOL) overall and higher emotional well-being than the control group. CONCLUSION: These findings indicate that the integrated psychoeducational program is an effective intervention for reducing distress and supportive care needs and increasing QOL of newly diagnosed patients with breast cancer. Oncology nurses need to provide psychoeducational intervention to support patients with breast cancer in managing their distress and helping them adjust to their life.
Breast Neoplasms* ; Breast* ; Education ; Female ; Follow-Up Studies ; Humans ; Quality of Life ; Self Care ; Social Support ; Stress, Psychological ; Thermometers