https://genoplivning.dk/wp-content/uploads/2013/07/european-resuscitation-council-guidelines-for-resuscitation-2010-section-4-adult-advanced-life-support.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support

European Resuscitation Council Guidelines for Resuscitation 2015

Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation

ContextCardiac 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.ObjectiveTo 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 PatientsA 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 MeasureSurvival to hospital discharge.ResultsThe 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).ConclusionsIn 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.

https://jamanetwork.com/journals/jama/articlepdf/202135/JOC50156.pdf

First Documented Rhythm and Clinical Outcome From In-Hospital Cardiac Arrest Among Children and Adults

The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resus...

Cardiopulmonary resuscitation quality: Improving cardiac resuscitation outcomes both inside and outside the hospital: A consensus statement from the American heart association

ContextMost patients undergoing in-hospital cardiac resuscitation do not survive
to hospital discharge. In a previous study, we developed a clinical decision
aid for identifying all patients undergoing resuscitation who survived to
hospital discharge.ObjectiveTo validate our previously derived clinical decision aid.Design, Setting, and ParticipantsData from a large registry of in-hospital resuscitations at a community
teaching hospital in Georgia were analyzed to determine whether patients would
be predicted to survive to hospital discharge (ie, whether their arrest was
witnessed or their initial cardiac rhythm was either
ventricular tachycardia or ventricular fibrillation or
they regained a pulse during the first 10 minutes of chest compressions).
Data from 2181 in-hospital cardiac resuscitation attempts in 1987-1996 involving
1884 pulseless patients were analyzed.Main Outcome MeasureComparison of predictions based on the decision aid with whether patients
were actually discharged alive from the hospital.ResultsFor 327 resuscitations (15.0%), the patient survived to hospital discharge.
For 324 of these resuscitations, the patients were predicted to survive to
hospital discharge (sensitivity = 99.1%, 95% confidence interval, 97.1%-99.8%).
In 269 resuscitations, patients did not satisfy the decision aid and were
predicted to have no chance of being discharged from the hospital. Only 3
of these patients (1.1%) were discharged from the hospital (negative predictive
value = 98.9%), none of whom were able to live independently following discharge
from the hospital.ConclusionThis decision aid can be used to help physicians identify patients who
are extremely unlikely to benefit from continued resuscitative efforts.

http://columbiamedicine.org/education/r/CCU/Discontinuing%20Cardiac%20Arrest.pdf

Validation of a Clinical Decision Aid to Discontinue In-Hospital Cardiac Arrest Resuscitations

Twenty-one 10th graders selected as opinion leaders by their peers in a rural county in a southern state participated in a 36-hour peer-educator training program Students Together Against Negative Decisions (STAND) based on diffusion of innovations theory and the transtheoretical model. Comparison subjects received either a 22-hour leadership training course (n = 20) or no intervention (n = 45). STAND and comparison subjects completed a 154-item written knowledge, attitude, and behavior survey at the beginning of the training (Time 1), at the end of the training (Time 2), and again 8 months later (Time 3). One hundred and sixty-seven other 9th and 10th graders in the intervention county and 74 in the comparison county completed an abbreviated telephone interview at Time 1 and Time 3. At Time 3 STAND-trained peer educators reported significantly greater increases in AIDS Risk Behavior Knowledge (more than 4 times comparison groups), frequency of conversations with peers about birth control/condoms (+180% vs. +12%) and sexually transmitted diseases (STDs; +282% vs. -33%), condom use self efficacy (+16% vs. -1%), and consistent condom use (+28% vs. +15%). STAND teens also reported substantial favorable trends at Time 3, including increased condom use (+213% vs. +31%) and decreased unprotected intercourse (-30% vs. +29%). At Time 3 teens in the intervention county reported significantly greater increases in the number of people who talked with friends in the preceding 3 months about STDs (+39% vs. -19%) or with a parent/adult about sex (+6% vs. -37%). Intervention county teens also reported a substantial but nonsignificant 2.6-fold greater increase in condom use at last intercourse (+64% vs. +25%) but unfavorable changes in other risk behaviors. The STAND peer-educator training program appears to be an effective method for improving selected sexual knowledge, attitudes, and behaviors among participant teenagers in the rural South.

Students together against negative decisions (stand): evaluation of a school-based sexual risk reduction intervention in the rural South.

History and systems of social behaviour Methods of studying social behaviour The self Understanding others Interpersonal communication The nature of attitudes Persuasion and attitude change Social influence and personal control Affiliation, attraction, and love Aggression and violence Pro-social behaviour Behaviour in groups Behaviour between groups Social behaviour in the physical environment.

Social Psychology in the '90s

OBJECTIVE Assess the frequency and outcome of inhospital resuscitation and determine the relationship between patient age and survival and whether it is affected by initial rhythm. DESIGN Retrospective, single-institution, registry study of inhospital resuscitation. SETTING A 550-bed, tertiary-care, teaching hospital in Macon, GA. PATIENTS All admissions for which a resuscitation was attempted in the Medical Center of Central Georgia during the period of January 1, 1987 through December 31, 1993. The registry sample included 2,394 admissions, for which 2,813 resuscitation attempts were made; only the first resuscitation attempt during an admission was analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Rates of survival to discharge steadily increased from 24.4% in 1987 to 38.6% in 1993; the overall survival rate was 26.8%. Age, used as a continuous variable, was strongly related to survival (odds ratio = 0.984; p < .0001). Categorically, overall survival rates for pediatric, adult, and geriatric patients were 56.4%, 29.0%, and 24.0%, respectively. Survival rates also varied significantly (odds ratio = 0.469; p < .0001) among initial rhythms, i.e., supraventricular tachycardia (60.7%), ventricular tachycardia (57.6%), perfusing rhythms (49.84%), ventricular fibrillation (32.0%), pulseless electrical activity (14.6%), and asystole (9.1%). The relationship between age and survival did not change across the years included in the study, but did vary as a function of initial rhythm (p < .0001). Age was positively related to survival when initial rhythm was supraventricular tachycardia (p = .04), negatively related to survival when the initial rhythm was perfusing (p < .0001) or pulseless electrical activity (p = .0002), and not related to survival when the initial rhythm was ventricular tachycardia (p = .98), ventricular fibrillation (p = .14), or asystole (p = .21). CONCLUSIONS The relationship between patient age and a successful resuscitation attempt is not as simple as reported earlier. Whether age is related to increased or decreased survival, or is unrelated to survival, depends on the rhythm extant when resuscitation attempts begin. Survival rates were higher than most reported elsewhere and improved significantly over time. Multicentered studies are needed to determine whether these results are unique to the institution studied.

Resuscitation in the hospital: differential relationships between age and survival across rhythms.

Resuscitation in the hospital: relationship of year and rhythm to outcome

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