27 results on '"Berg, Robert A."'
Search Results
2. Automated external defibrillators and survival after in-hospital cardiac arrest
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Chan, Paul S., Krumholz, Harlan M., Spertus, John A., Jones, Philip G., Cram, Peter, Berg, Robert A., Peberdy, Mary Ann, Nadkarni, Vinay, Mancini, Mary E., and Nallamothu, Brahmajee K.
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Implantable cardioverter-defibrillators -- Usage ,Cardiac arrest -- Care and treatment ,Cardiac patients -- Care and treatment - Abstract
The correlation existing between the automated external defibrillators (AEDs) and survival after in-hospital cardiac arrest is analyzed. The application of AEDs is not shown to enhance the survival of such patients.
- Published
- 2010
3. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest
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Bobrow, Bentley J., Spaite, Daniel W., Berg, Robert A., Stolz, Uwe, Sanders, Arthur B., Kern, Karl B., Vadeboncoeur, Tyler F., Clark, Lani L., Gallagher, John V., Stapezynski, J. Stephan, Lo Vecchio, Frank, Mullins, Terry J., Humble, Will O., and Ewy, Gordon A.
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Cardiac arrest -- Care and treatment ,Cardiac arrest -- Patient outcomes ,CPR (First aid) -- Patient outcomes ,Medical personnel -- Practice - Abstract
A study was conducted to evaluate and compare the survival rate in out-of-hospital cardiac arrest using compression-only (COCPR) by lay rescuers against conventional CPR. Results indicated that lay person COCPR resulted in higher survival rates in the case of such patients.
- Published
- 2010
4. Hospital-wide code rates and mortality before and after implementation of a rapid response team
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Chan, Paul S., Khalid, Adnan, Longmore, Lance S., Berg, Robert A., Kosiborod, Mikhail, and Spertus, John A.
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Market trend/market analysis ,Company business management ,Cardiac arrest -- Care and treatment ,Cardiac arrest -- Statistics ,Mortality -- United States ,Mortality -- Forecasts and trends ,Hospitals -- United States ,Hospitals -- Management - Abstract
A study was conducted to evaluate the rates of hospital-wide codes and mortality before implementation by a rapid response team intervention and after. Results indicated that rapid response team intervention did not impact hospital-wide code rates or mortality.
- Published
- 2008
5. Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest
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Bobrow, Bentley J., Clark, Lani L., Ewy, Gordon A., Chikani, Vatsal, Sanders, Arthur B., Berg, Robert A., Richman, Peter B., and Kern, Karl B.
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Company business management ,Cardiac resuscitation -- Health aspects ,Cardiac arrest -- Prevention ,Emergency medical services -- Management - Abstract
A study was conducted to determine whether minimally interrupted cardiac resuscitation (MICR) which is considered an alternate emergency medical procedure could improve the survival rate. MICR was found to improve the survival rate of cardiac patients.
- Published
- 2008
6. Survival from in-hospital cardiac arrest during nights and weekends
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Peberdy, Mary Ann, Ornato, Joseph P., Larkin, G. Luke, Braithwaite, R. Scott, Kashner, T. Michael, Carey, Scott M., Meaney, Peter A., Cen, Liyi, Berg, Robert A., Nadkarni, Vinay M., and Praestgaard, Amy H.
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Cardiac arrest -- Patient outcomes ,Cardiac arrest -- Risk factors ,Hospitals -- United States ,Hospitals -- Services - Abstract
A study to record if the outcomes after a cardiac arrest in hospital differed during nights and weekends as against days or evening and weekdays is conducted. Results show lower survival rates from cardiac arrests during nights and weekends.
- Published
- 2008
7. Viral DNAemia and DNA Virus Seropositivity and Mortality in Pediatric Sepsis.
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Cabler, Stephanie S., Storch, Gregory A., Weinberg, Jason B., Walton, Andrew H., Brengel-Pesce, Karen, Aldewereld, Zachary, Banks, Russell K., Cheynet, Valerie, Reeder, Ron, Holubkov, Richard, Berg, Robert A., Wessel, David, Pollack, Murray M., Meert, Kathleen, Hall, Mark, Newth, Christopher, Lin, John C., Cornell, Tim, Harrison, Rick E., and Dean, J. Michael
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- 2024
- Full Text
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8. Bystander cardiopulmonary resuscitation: concerns about mouth-to-mouth contact
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Locke, Catherine J., Berg, Robert A., Sanders, Arthur B., Davis, Melinda F., Milander, Melinda M., Kern, Karl B., and Ewy, Gordon A.
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CPR (First aid) -- Usage ,First aid in illness and injury -- Study and teaching ,Health - Abstract
Background: Bystander cardiopulmonary resuscitation (CPR) is performed on only a small percentage of patients who suffer cardiac arrest. We conducted a study to elucidate attitudes toward and potential obstacles to performance of bystander CPR. Methods: Attitude survey of 975 people on the University Heart Center, University of Arizona, Tucson, mailing list. Participants were asked about their willingness to perform CPR under four conditions, with varying relationships (stranger vs relative or friend) and CPR techniques (chest compressions plus mouth-to-mouth ventilation [CC+V] vs chest compressions alone [CC]). Results: Participants rated willingness to perform CPR and concern about disease transmission. Both relationship and CPR technique affected willingness to respond. Only 15%would 'definitely' provide CC+V with strangers compared with 68% who would 'definitely' perform CC. Even with relatives or friends, only 74% would 'definitely' provide CC+V compared with 88% who would 'definitely' provide CC. Eighty-two percent of participants were at least 'moderately' concerned about disease transmission. Conclusion: Concerns regarding mouth-to-mouth ventilation appear to create substantial barriers to performance of bystander CPR. Intensified educational efforts and investigations of new approaches to bystander CPR are warranted.
- Published
- 1995
9. Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial.
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Spinella, Philip C., Tucci, Marisa, Fergusson, Dean A., Lacroix, Jacques, Hébert, Paul C., Leteurtre, Stéphane, Schechtman, Kenneth B., Doctor, Allan, Berg, Robert A., Bockelmann, Tina, Caro, J. Jaime, Chiusolo, Fabrizio, Clayton, Lucy, Cholette, Jill M., Guerra, Gonzalo Garcia, Josephson, Cassandra D., Menon, Kusum, Muszynski, Jennifer A., Nellis, Marianne E., and Sarpal, Amrita
- Abstract
Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial.Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children.Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded.Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group.Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death.Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34).Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells.Trial Registration: ClinicalTrials.gov Identifier: NCT01977547. [ABSTRACT FROM AUTHOR]- Published
- 2019
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10. Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States.
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Kirschen, Matthew P., Francoeur, Conall, Murphy, Marie, Traynor, Danielle, Zhang, Bingqing, Mensinger, Janell L., Ichord, Rebecca, Topjian, Alexis, Berg, Robert A., Nishisaki, Akira, and Morrison, Wynne
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- 2019
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11. Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest: Secondary Analysis of a Randomized Clinical Trial.
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Topjian, Alexis A., Telford, Russell, Holubkov, Richard, Nadkarni, Vinay M., Berg, Robert A., Dean, J. Michael, and Moler, Frank W.
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- 2018
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12. Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States.
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Naim, Maryam Y., Burke, Rita V., McNally, Bryan F., Song, Lihai, Griffis, Heather M., Berg, Robert A., Vellano, Kimberly, Markenson, David, Bradley, Richard N., and Rossano, Joseph W.
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- 2017
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13. Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights andWeekends.
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Bhanji, Farhan, Topjian, Alexis A., Nadkarni, Vinay M., Praestgaard, Amy H., Hunt, Elizabeth A., Cheng, Adam, Meaney, Peter A., and Berg, Robert A.
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- 2017
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14. Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival.
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Andersen, Lars W., Raymond, Tia T., Berg, Robert A., Nadkarni, Vinay M., Grossestreuer, Anne V., Kurth, Tobias, Donnino, Michael W., and American Heart Association’s Get With The Guidelines–Resuscitation Investigators
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INTUBATION ,CARDIAC arrest ,CARDIAC arrest in children ,HEALTH outcome assessment ,ARTIFICIAL respiration ,PEDIATRIC cardiology ,THERAPEUTICS ,RESPIRATORY insufficiency treatment ,BLOOD circulation ,HOSPITAL care ,PROBABILITY theory ,RESPIRATORY insufficiency ,SURVIVAL analysis (Biometry) ,TRACHEA intubation ,DISCHARGE planning ,TREATMENT effectiveness ,ACQUISITION of data ,DISEASE complications - Abstract
Importance: Tracheal intubation is common during pediatric in-hospital cardiac arrest, although the relationship between intubation during cardiac arrest and outcomes is unknown.Objective: To determine if intubation during pediatric in-hospital cardiac arrest is associated with improved outcomes.Design, Setting, and Participants: Observational study of data from United States hospitals in the Get With The Guidelines-Resuscitation registry. Pediatric patients (<18 years) with index in-hospital cardiac arrest between January 2000 and December 2014 were included. Patients who were receiving assisted ventilation, had an invasive airway in place, or both at the time chest compressions were initiated were excluded.Exposures: Tracheal intubation during cardiac arrest .Main Outcomes and Measures: The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and neurologic outcome. A favorable neurologic outcome was defined as a score of 1 to 2 on the pediatric cerebral performance category score. Patients being intubated at any given minute were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics.Results: The study included 2294 patients; 1308 (57%) were male, and all age groups were represented (median age, 7 months [25th-75th percentiles, 21 days, 4 years]). Of the 2294 included patients, 1555 (68%) were intubated during the cardiac arrest. In the propensity score-matched cohort (n = 2270), survival was lower in those intubated compared with those not intubated (411/1135 [36%] vs 460/1135 [41%]; risk ratio [RR], 0.89 [95% CI, 0.81-0.99]; P = .03). There was no significant difference in return of spontaneous circulation (770/1135 [68%] vs 771/1135 [68%]; RR, 1.00 [95% CI, 0.95-1.06]; P = .96) or favorable neurologic outcome (185/987 [19%] vs 211/983 [21%]; RR, 0.87 [95% CI, 0.75-1.02]; P = .08) between those intubated and not intubated. The association between intubation and decreased survival was observed in the majority of the sensitivity and subgroup analyses, including when accounting for missing data and in a subgroup of patients with a pulse at the beginning of the event.Conclusions and Relevance: Among pediatric patients with in-hospital cardiac arrest, tracheal intubation during cardiac arrest compared with no intubation was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding, these findings do not support the current emphasis on early tracheal intubation for pediatric in-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]- Published
- 2016
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15. Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest.
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Chan, Paul S., Berg, Robert A., Yuanyuan Tang, Curtis, Lesley H., Spertus, John A., Tang, Yuanyuan, and American Heart Association’s Get With the Guidelines–Resuscitation Investigators
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THERAPEUTIC hypothermia , *CARDIAC arrest , *HYPOTHERMIA , *HEART diseases , *CLINICAL trials , *THERAPEUTICS , *COMPARATIVE studies , *INDUCED hypothermia , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PROBABILITY theory , *RESEARCH , *RESEARCH funding , *SURVIVAL analysis (Biometry) , *TIME , *EVALUATION research , *DISCHARGE planning , *TREATMENT effectiveness , *ACQUISITION of data , *HOSPITAL mortality - Abstract
Importance: Therapeutic hypothermia is used for patients following both out-of-hospital and in-hospital cardiac arrest. However, randomized trials on its efficacy for the in-hospital setting do not exist, and comparative effectiveness data are limited.Objective: To evaluate the association between therapeutic hypothermia and survival after in-hospital cardiac arrest.Design, Setting, and Patients: In this cohort study, within the national Get With the Guidelines-Resuscitation registry, 26 183 patients successfully resuscitated from an in-hospital cardiac arrest between March 1, 2002, and December 31, 2014, and either treated or not treated with hypothermia at 355 US hospitals were identified. Follow-up ended February 4, 2015.Exposure: Induction of therapeutic hypothermia.Main Outcomes and Measures: The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurological survival, defined as a Cerebral Performance Category score of 1 or 2 (ie, without severe neurological disability). Comparisons were performed using a matched propensity score analysis and examined for all cardiac arrests and separately for nonshockable (asystole and pulseless electrical activity) and shockable (ventricular fibrillation and pulseless ventricular tachycardia) cardiac arrests.Results: Overall, 1568 of 26 183 patients with in-hospital cardiac arrest (6.0%) were treated with therapeutic hypothermia; 1524 of these patients (mean [SD] age, 61.6 [16.2] years; 58.5% male) were matched by propensity score to 3714 non-hypothermia-treated patients (mean [SD] age, 62.2 [17.5] years; 57.1% male). After adjustment, therapeutic hypothermia was associated with lower in-hospital survival (27.4% vs 29.2%; relative risk [RR], 0.88 [95% CI, 0.80 to 0.97]; risk difference, -3.6% [95% CI, -6.3% to -0.9%]; P = .01), and this association was similar (interaction P = .74) for nonshockable cardiac arrest rhythms (22.2% vs 24.5%; RR, 0.87 [95% CI, 0.76 to 0.99]; risk difference, -3.2% [95% CI, -6.2% to -0.3%]) and shockable cardiac arrest rhythms (41.3% vs 44.1%; RR, 0.90 [95% CI, 0.77 to 1.05]; risk difference, -4.6% [95% CI, -10.9% to 1.7%]). Therapeutic hypothermia was also associated with lower rates of favorable neurological survival for the overall cohort (hypothermia-treated group, 17.0% [246 of 1443 patients]; non-hypothermia-treated group, 20.5% [725 of 3529 patients]; RR, 0.79 [95% CI, 0.69 to 0.90]; risk difference, -4.4% [95% CI, -6.8% to -2.0%]; P < .001) and for both rhythm types (interaction P = .88).Conclusions and Relevance: Among patients with in-hospital cardiac arrest, use of therapeutic hypothermia compared with usual care was associated with a lower likelihood of survival to hospital discharge and a lower likelihood of favorable neurological survival. These observational findings warrant a randomized clinical trial to assess efficacy of therapeutic hypothermia for in-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]- Published
- 2016
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16. Association Between Hospital Process Composite Performance and Patient Outcomes After In-Hospital Cardiac Arrest Care.
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Anderson, Monique L., Nichol, Graham, Dai, David, Chan, Paul S., Thomas, Laine, Al-Khatib, Sana M., Berg, Robert A., Bradley, Steven M., and Peterson, Eric D.
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- 2016
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17. Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest.
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Andersen, Lars W., Berg, Katherine M., Saindon, Brian Z., Massaro, Joseph M., Raymond, Tia T., Berg, Robert A., Nadkarni, Vinay M., and Donnino, Michael W.
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ADRENALINE ,CARDIAC arrest in children ,CARDIAC arrest ,THERAPEUTICS ,PEDIATRIC cardiology ,HOSPITAL mortality ,HOSPITAL care of children - Abstract
IMPORTANCE Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remains unknown. OBJECTIVE To determine whether time to first epinephrine dose is associated with outcomes in pediatric in-hospital cardiac arrest. DESIGN, SETTING. AND PARTICIPANTS We performed an analysis of data from the Get With the Guidelines-Resuscitation registry. We included US pediatric patients (age <18 years) with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least 1 dose of epinephrine. A total of 1558 patients (median age, 9 months [interquartile range [IQR], 13 days-5 years]) were included in the final cohort. EXPOSURE Time to epinephrine, defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome. A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale. RESULTS Among the 1558 patients, 487 (31.3%) survived to hospital discharge. The median time to first epinephrine dose was 1 minute (IQR, 0-4; range, 0-20; mean [SD], 2.6 [3.4] minutes). Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (multivariable-adjusted risk ratio [RR] per minute delay, 0.95 [95% Cl, 0.93-0.98]). Longer time to epinephrine administration was also associated with decreased risk of ROSC (multivariable-adjusted RR per minute delay, 0.97 [95% Cl, 0.96-0.99]), decreased risk of survival at 24 hours (multivariable-adjusted RR per minute delay, 0.97 [95% Cl, 0.95-0.99]), and decreased risk of survival with favorable neurological outcome (multivariable-adjusted RR per minute delay, 0.95 [95% Cl, 0.91-0.99]). Patients with time to epinephrine administration of longer than 5 minutes (233/1558) compared with those with time to epinephrine of 5 minutes or less (1325/1558) had lower risk of in-hospital survival to discharge (21.0% [49/233] vs 33.1% [438/1325]; multivariable-adjusted RR, 0.75 [95% Cl, 0.60-0.93]; P = .01). CONCLUSIONS AND RELEVANCE Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, delay in administration of epinephrine was associated with decreased chance of survival to hospital discharge, ROSC, 24-hour survival, and survival to hospital discharge with a favorable neurological outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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18. Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales.
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Pollack, Murray M., Holubkov, Richard, Funai, Tomohiko, Clark, Amy, Moler, Frank, Shanley, Thomas, Meert, Kathy, Newth, Christopher J. L., Carcillo, Joseph, Berger, John T., Doctor, Allan, Berg, Robert A., Dalton, Heidi, Wessel, David L., Harrison, Rick E., Dean, J. Michael, and Jenkins, Tammara L.
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- 2014
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19. A Validated Prediction Tool for Initial of In-Hospital Cardiac Arrest.
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Chan, Paul S., Spertus, John A., Krumholz, Harlan M., Berg, Robert A., Yan Li, Sasson, Comilla, and Nallamothu, Brahmajee K.
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CARDIAC arrest ,HEART disease diagnosis ,HEART disease prognosis ,CARDIAC patients ,PROGNOSIS - Abstract
The article discusses a study that developed a simple, bedside prediction tool that provides accurate estimation of favorable neurological survival after in-hospital cardiac arrest. Findings show that the rates of favorable neurological survival were similar in the derivation cohort and validation cohort patients. Evidence suggests that the tool provides accurate prognostication after cardiac arrest for physicians, patients and families.
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- 2012
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20. Rapid Response Teams.
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Chan, Paul S., Jain, Renuka, Nailmothu, Brahmajee K., Berg, Robert A., and Sasson, Comilla
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HEALTH care teams ,MORTALITY ,HOSPITAL medical staff ,CARDIAC arrest prevention ,EVALUATION of medical care ,META-analysis - Abstract
The article presents a study that evaluates the efficiency of rapid response teams (RRTs) in the reduction of mortality rates and cardiopulmonary arrest in hospitals. It states that systemic reviews of studies from 1950 to 2008 were conducted. Results show that RRT reduced arrest outside intensive care unit (ICU) by 33.8% in adults and 37.7% in children, but was not associated with mortality. It concludes that though RRT has a broad appeal, it still lacks the evidence to support its efficiency.
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- 2010
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21. First Documented Rhythm and Clinical Outcome From In-Hospital Cardiac Arrest Among Children and Adults.
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Nadkarni, Vinay M., Larkin, Gregory Luke, Peberdy, Mary Ann, Carey, Scott M., Kaye, William, Mancini, Mary E., Nichol, Graham, Lane-Truitt, Tanya, Potts, Jerry, Ornato, Joseph P., and Berg, Robert A.
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CARDIAC arrest ,HOSPITAL care ,CHILD care ,HEART diseases ,CRITICAL care medicine ,VENTRICULAR fibrillation ,CARDIOPULMONARY system ,MEDICAL research evaluation - Abstract
Context: Cardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac arrests in children are typically asystole or PEA. Objective: To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes. Design, Setting, and Patients: A prospective observational study from a multicenter registry (National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36 902 adults ( 18 years) and 880 children (<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded. Main Outcome Measure: Survival to hospital discharge. Results: The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults (27% [236/880] vs 18% [6485/36 902]; adjusted odds ratio [OR], 2.29; 95% confidence interval [CI], 1.95-2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36 902) in adults (OR, 0.54; 95% CI, 0.44-0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults (OR, 1.20; 95% CI, 1.10-1.40; P = .006), whereas the prevalence of PEA was 24% (213) in children and 32% (11 963) in adults (OR, 0.67; 95% CI, 0.57-0.78; P<.001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge (24% [135/563] in children vs 11% [2719/24 987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23-3.32). Conclusions: In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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22. Factors Associated With Functional Impairment After Pediatric Injury.
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Burd, Randall S., Jensen, Aaron R., VanBuren, John M., Richards, Rachel, Holubkov, Richard, Pollack, Murray M., Berg, Robert A., Carcillo, Joseph A., Carpenter, Todd C., Dean, J. Michael, Gaines, Barbara, Hall, Mark W., McQuillen, Patrick S., Meert, Kathleen L., Mourani, Peter M., Nance, Michael L., Yates, Andrew R., and Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Assessment of Health-Related Quality of Life and Functional Outcomes After Pediatric Trauma Investigators
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- 2021
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23. Bystander cardiopulmonary resuscitation.
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Locke, Catherine J. and Berg, Robert A.
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CARDIOPULMONARY resuscitation , *HEART failure treatment - Abstract
Examines patient attitudes toward the performance of bystander cardiopulmonary resuscitation (CPR) for cardiac arrest. Attitude survey of 975 people on the University Heart Center at the University of Arizona, Tucson; Concerns about mouth-to-mouth ventilation; Potential obstacles to performance of bystander CPR.
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- 1995
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24. Time Interval Data in a Pediatric In-Hospital Resuscitation Study-Reply.
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Berg, Robert A., Andersen, Lars W., and Donnino, Michael W.
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CARDIAC arrest , *CHILDREN'S hospitals , *CARDIOPULMONARY resuscitation , *RESUSCITATION - Published
- 2017
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25. Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs: A Randomized Clinical Trial.
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Sutton RM, Wolfe HA, Reeder RW, Ahmed T, Bishop R, Bochkoris M, Burns C, Diddle JW, Federman M, Fernandez R, Franzon D, Frazier AH, Friess SH, Graham K, Hehir D, Horvat CM, Huard LL, Landis WP, Maa T, Manga A, Morgan RW, Nadkarni VM, Naim MY, Palmer CA, Schneiter C, Sharron MP, Siems A, Srivastava N, Tabbutt S, Tilford B, Viteri S, Berg RA, Bell MJ, Carcillo JA, Carpenter TC, Dean JM, Fink EL, Hall M, McQuillen PS, Meert KL, Mourani PM, Notterman D, Pollack MM, Sapru A, Wessel D, Yates AR, and Zuppa AF
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- Adolescent, Blood Pressure, Child, Child, Preschool, Clinical Competence, Female, Heart Arrest complications, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Survival Analysis, Treatment Outcome, Cardiopulmonary Resuscitation education, Heart Arrest therapy, Nervous System Diseases etiology, Quality Improvement
- Abstract
Importance: Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes., Objective: To evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings., Design, Setting, and Participants: A parallel, hybrid stepped-wedge, cluster randomized trial (Improving Outcomes from Pediatric Cardiac Arrest-the ICU-Resuscitation Project [ICU-RESUS]) involving 18 pediatric intensive care units (ICUs) from 10 clinical sites in the US. In this hybrid trial, 2 clinical sites were randomized to remain in the intervention group and 2 in the control group for the duration of the study, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The index (first) CPR events of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were followed up to hospital discharge (final follow-up was April 30, 2021)., Intervention: During the intervention period (n = 526 patients), a 2-part ICU resuscitation quality improvement bundle was implemented, consisting of CPR training at the point of care on a manikin (48 trainings/unit per month) and structured physiologically focused debriefings of cardiac arrest events (1 debriefing/unit per month). The control period (n = 548 patients) consisted of usual pediatric ICU management of cardiac arrest., Main Outcomes and Measures: The primary outcome was survival to hospital discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline (score range, 1 [normal] to 6 [brain death or death]). The secondary outcome was survival to hospital discharge., Results: Among 1389 cardiac arrests experienced by 1276 patients, 1129 index CPR events (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included and 1074 were analyzed in the primary analysis. There was no significant difference in the primary outcome of survival to hospital discharge with favorable neurologic outcomes in the intervention group (53.8%) vs control (52.4%); risk difference (RD), 3.2% (95% CI, -4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). There was also no significant difference in survival to hospital discharge in the intervention group (58.0%) vs control group (56.8%); RD, 1.6% (95% CI, -6.2% to 9.7%); adjusted OR, 1.03 (95% CI, 0.73 to 1.47)., Conclusions and Relevance: In this randomized clinical trial conducted in 18 pediatric intensive care units, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing, compared with usual care, did not significantly improve patient survival to hospital discharge with favorable neurologic outcome among pediatric patients who experienced cardiac arrest in the ICU., Trial Registration: ClinicalTrials.gov Identifier: NCT02837497.
- Published
- 2022
- Full Text
- View/download PDF
26. Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm.
- Author
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Hunt EA, Duval-Arnould JM, Bembea MM, Raymond T, Calhoun A, Atkins DL, Berg RA, Nadkarni VM, Donnino M, and Andersen LW
- Subjects
- Adolescent, Arrhythmias, Cardiac epidemiology, Child, Child, Preschool, Electric Countershock methods, Female, Heart Arrest epidemiology, Hospitalization statistics & numerical data, Humans, Infant, Male, Poisson Distribution, ROC Curve, Survival Analysis, Arrhythmias, Cardiac therapy, Electric Countershock statistics & numerical data, Heart Arrest therapy, Time Factors
- Abstract
Importance: Delayed defibrillation (>2 minutes) in adult in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Little is known about the timing and outcomes of defibrillation in pediatric IHCA., Objective: To determine whether time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm is associated with survival to hospital discharge., Design, Setting, and Participants: In this cohort study, data were obtained from the Get With The Guidelines-Resuscitation national registry between January 1, 2000, and December 31, 2015, and analyses were completed by October 1, 2017. Participants were pediatric patients younger than 18 years with an IHCA and a first documented rhythm of pulseless ventricular tachycardia or ventricular fibrillation and at least 1 defibrillation attempt., Exposures: Time between loss of pulse and first defibrillation attempt., Main Outcomes and Measures: The primary outcome was survival to hospital discharge. Secondary outcomes were return of circulation, 24-hour survival, and favorable neurologic outcome at hospital discharge., Results: Among 477 patients with a pulseless shockable rhythm (median [interquartile range] age, 4 years [3 months to 14 years]; 285 [60%] male), 338 (71%) had a first defibrillation attempt at 2 minutes or less after pulselessness. Children were less likely to be shocked in 2 minutes or less for ward vs intensive care unit IHCAs (48% [11 of 23] vs 72% [268 of 371]; P = .01]). Thirty-eight percent (179 patients) survived to hospital discharge. The median (interquartile range) reported time to first defibrillation attempt was 1 minute (0-3 minutes) in both survivors and nonsurvivors. Time to first defibrillation attempt was not associated with survival in unadjusted analysis (risk ratio [RR] per minute increase, 0.96; 95% CI, 0.92-1.01; P = .15) or adjusted analysis (RR, 0.99; 95% CI, 0.94-1.06; P = .86). There was no difference in survival between those with a first defibrillation attempt in 2 minutes or less vs more than 2 minutes in unadjusted analysis (132 of 338 [39%] vs 47 of 139 [34%]; RR, 0.87; 95% CI, 0.66-1.13; P = .29) or multivariable analysis (RR, 0.99; 95% CI, 0.75-1.30; P = .93). Time to first defibrillation attempt was also not associated with secondary outcome measures., Conclusions and Relevance: In contrast to published adult IHCA and pediatric out-of-hospital cardiac arrest data, no significant association was observed between time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm and survival to hospital discharge.
- Published
- 2018
- Full Text
- View/download PDF
27. Time Interval Data in a Pediatric In-Hospital Resuscitation Study-Reply.
- Author
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Andersen LW, Berg RA, and Donnino MW
- Subjects
- Child, Heart Arrest, Hospitals, Pediatric, Humans, Cardiopulmonary Resuscitation, Resuscitation
- Published
- 2017
- Full Text
- View/download PDF
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