Does Pre-Hospital Advanced Life Support Improve Survival in Out-of-Hospital Cardiac Arrest?

MedicalResearch.com Interview with:
Alexis Cournoyer MD
Université de Montréal
Hôpital du Sacré-Cœur de Montréal
Institut de Cardiologie de Montréal,
Montréal, Québec, Canada. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Out-of-hospital advanced cardiac life support (ACLS) is frequently provided to patients suffering from cardiac arrest.  This was shown to improve rates of return of spontaneous circulation, but there was no good evidence that it improved any patient-oriented outcomes.  Given the progress of post-resuscitation care, it was important to reassess if ACLS improved survival in out-of-hospital cardiac arrest.  Also, with the advent of extracorporeal resuscitation, a promising technique that needs to be performed relatively early in the course of the resuscitation and which seems to improve patients’ outcome, we wanted to evaluate if prolonged prehospital resuscitation with ACLS was effective in extracorporeal resuscitation candidates.

In this study, we observed, as was noted in previous study, that prehospital advanced cardiac life support  did not provide a benefit to patients regarding survival to discharge, but increased the rate of prehospital return of spontaneous circulation.  It also prolonged the delay before hospital arrival of around 15 minutes.  In the patients eligible for extracorporeal resuscitation, we observed the same findings.

Continue reading

Incidence of Sepsis Stable, But Mortality Remains High

MedicalResearch.com Interview with:

Dr. Chanu Rhee MD, Assistant Professor Therapeutics Research and Infectious Disease Epidemiology Group Department of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute Critical Care and Infectious Disease Physician Transplant/Oncology Infectious Disease service and Medical Intensive Care Unit at Brigham and Women’s Hospital

Dr. Rhee

Dr. Chanu Rhee MD, Assistant Professor
Therapeutics Research and Infectious Disease Epidemiology Group
Department of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute
Critical Care and Infectious Disease Physician
Transplant/Oncology Infectious Disease service and
Medical Intensive Care Unit at Brigham and Women’s Hospital 


MedicalResearch.com: What is the background for this study?

Response: Multiple studies suggest that the incidence of sepsis, the syndrome of life-threatening organ dysfunction caused by infection, is increasing over time, while mortality rates are decreasing.  However, reliably measuring sepsis incidence and trends is challenging because clinical diagnoses of sepsis are subjective and insurance claims data, the traditional method of surveillance, can be affected by changing diagnosis and coding practices over time.

In this study, my colleagues and I estimated the current U.S. burden of sepsis and trends using clinical data from the electronic health record systems of a large number of diverse hospitals. The findings, published in JAMA, challenge the use of claims data for sepsis surveillance and suggest that clinical surveillance using electronic health record data provides more objective estimates of sepsis incidence and outcomes.

Continue reading

Blood Biomarkers Signal Multiple Organ Dysfunction Syndrome After Critical Injuries

MedicalResearch.com Interview with:

Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London

Dr. Shepherd

Dr. Joanna Shepherd
Centre for Trauma Sciences
Blizard Institute
Queen Mary, University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital.  However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver.

We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours.  The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival.  By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared.

Continue reading

Rory’s Regulations: Faster Is Better When It Comes To Sepsis Care

MedicalResearch.com Interview with:

Christopher W. Seymour, M.D., M.Sc. Assistant professor of Critical Care Medicine and Emergency Medicine, and member of Clinical Research Investigation and Systems Modeling of Acute Illness University of Pittsburgh

Dr. Seymour

Christopher W. Seymour, M.D., M.Sc.
Assistant professor of Critical Care Medicine and Emergency Medicine, and member of Clinical Research Investigation and Systems Modeling of Acute Illness
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Following the tragic and widely publicized death of Rory Staunton, 12, from undiagnosed sepsis in 2012, New York became the first state to require that hospitals follow a protocol to quickly identify and treat the condition. The mandate led to widespread controversy in the medical community as to whether such steps would have saved Rory or anyone else’s life.

Rory’s Regulations require hospitals to follow protocols for early identification and treatment of sepsis, and submit data on compliance and outcomes. The hospitals can tailor how they implement the protocols, but must include a blood culture to test for infection, measurement of blood lactate (a sign of tissue stress) and administration of antibiotics within three hours of diagnosis—collectively known as the “three-hour bundle.”

We analyzed data from nearly 50,000 patients from 149 New York hospitals to scientifically determine if  Rory’s Regulations worked. We found that they did – 83 percent of the hospitals completed the bundle within the required three hours, overall averaging 1.3 hours for completion. For every hour that it took clinicians to complete the bundle, the odds of the patient dying increased by 4 percent.

Continue reading

Resistance to Carbapenem Antibiotics Doubled in Intensive Care Units

MedicalResearch.com Interview with:

Eilish McCann, PhD</strong> Director, Outcomes Research (Center for Observational and Real-World Evidence) Merck

Dr. Eilish McCann

Eilish McCann, PhD
Director, Outcomes Research (Center for Observational and Real-World Evidence)
Merck

MedicalResearch.com: What is the background for this study?

Response: One of the most pressing challenges facing medicine today is the emergence of bacterial resistance to antibiotics. One area of high concern is the increasing prevalence of resistance to powerful antibiotics like carbapenems, as patients with infections due to carbapenem-resistant bacteria have very few alternate effective treatment options.

In this study we used real-world data from a Becton, Dickinson and Company electronic research data set to analyze over 140,000 bacterial isolates from patients at 342 hospitals across the United States, so that we could investigate where the burden of carbapenem resistance is most acute. Importantly analysis of real-world data in this way allows us to gain insights from a large number of hospitals, giving a broad and nationally representative picture of the resistance burden.

Continue reading

Review of Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

MedicalResearch.com Interview with:
Prof. Dr. Maja Mockenhaupt

Dept. of Dermatology
Medical Center – University of Freiburg
Deutschland / Germany

MedicalResearch.com: What is the background for this study?

Response: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse reactions that are associated with high morbidity and mortality. Primarily due to their rareness, therapeutic effects are often studied in observational settings. An evidence-based standardized treatment protocol for SJS/TEN is still missing.
Continue reading

More Talking, Less Machine Noise Important To Infant Brain in NICUs

MedicalResearch.com Interview with:

Bobbi Pineda, PhD Assistant professor of occupational therapy and of pediatrics Washington University School of Medicine St. Louis

Dr. Bobbi Pineda

Bobbi Pineda, PhD
Assistant professor of occupational therapy and of pediatrics
Washington University School of Medicine
St. Louis 

MedicalResearch.com: What is the background for this study?

Response: We published findings in 2014 from a study in which we investigated differences in outcome among preterm infants hospitalized in an open ward NICU compared to those hospitalized in a NICU private room.  In this study, we found that infants who were in the open ward had differences in brain structure by the time they were discharged from the hospital, and by age 2 years they had significantly better language outcomes than those in private rooms.  The study NICU is located in an urban area and cares for families who have a high risk of social challenges, resulting in rates of parent engagement that were not optimal.  However, such findings made us question if the sensory exposure, specifically auditory stimulation, may be significantly reduced in the private room and could explain our findings.

Continue reading

How Does Emergency Room Crowding Affect Care of Septic Patients?

MedicalResearch.com Interview with:

Anish Agarwal, MD, MPH The Hospital of the University of Pennsylvania Department of Emergency Medicine Philadelphia, PA

Dr. Anish Agarwal

Anish Agarwal, MD, MPH
The Hospital of the University of Pennsylvania
Department of Emergency Medicine
Philadelphia, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The morbidity and mortality of severe sepsis has been well studied and documented. An aggressive approach to protocolized care for patients suffering from severe sepsis and septic shock has been shown to improve mortality and should be started as early in the time course of a patient’s presentation. Emergency departments (ED) are designed to deliver time-sensitive therapies, however, they also may suffer from crowding due to multiple factors.

This study aimed to assess the impact of ED crowding upon critical interventions in the treatment of severe sepsis including time to intravenous fluids, antibiotics, and overall delivery of a protocolized bundle of care. The study found that as ED crowding increased, time to critical therapies significantly increased and the overall implementation of procotolized care decreased. More specifically as ED occupancy and total patient hours within the ED increased, time to intravenous fluids decreased and time to antibiotics increased as occupancy, hours, and boarding increased.

Continue reading

What Is Right Ratio of Patients to Critical Care Specialists in ICUs?

MedicalResearch.com Interview with:

Dr. Hayley B. Gershengorn, MD Associate Professor of Clinical Medicine, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Montefiore Medical Center Bronx, NY

Dr. Hayley Gershengorn

Dr. Hayley B. Gershengorn, MD
Associate Professor of Clinical Medicine, Department of Medicine (Critical Care)
Assistant Professor, The Saul R. Korey Department of Neurology
Montefiore Medical Center
Bronx, NY

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The patient-to-intensivist ratio across intensive care units is not standardized and whether the patient-to-intensivist ratio impacts patient outcome is not well established. I

n this study, we conducted a retrospective cohort analysis including 49,686 adults across 94 United Kingdom intensive care units. In this setting, a patient-to-intensivist ratio of 7.5 was associated with the lowest risk adjusted hospital mortality, with higher mortality at both higher and lower patient-to-intensivist ratios.

Continue reading

Sepsis Linked To High Rate of Hospital Readmissions

MedicalResearch.com Interview with:

Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh.

Dr. Yende

Sachin Yende, M.D., M.S., Associate professor
University of Pittsburgh School of Medicine’s departments of
Critical Care Medicine and Clinical and Translational and
Vice president of Critical Care at the VA Pittsburgh.

Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion

Dr. Mayr

Florian B. Mayr, M.D., M.P.H.
Faculty member in University of Pittsburgh
Department of Critical Care Medicine and the
Center for Health Equity Research and Promotion

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body’s response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs.

Continue reading