2011 April 13

Vital signs: central line-associated blood stream infections–United States, 2001, 2008, and 2009.

MMWR Morb Mortal Wkly Rep Start a Discussion »

Apr 132011

Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009.

MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):243-8

Authors:

Health-care-associated infections (HAIs) affect 5% of patients hospitalized in the United States each year. Central line-associated blood stream infections (CLABSIs) are important and deadly HAIs, with reported mortality of 12%-25%. This report provides national estimates of the number of CLABSIs among patients in intensive-care units (ICUs), inpatient wards, and outpatient hemodialysis facilities in 2008 and 2009 and compares ICU estimates with 2001 data.

PMID: 21368740 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

A randomised control trial comparing two techniques for locating chest compression hand position in adult Basic Life Support.

Resuscitation Start a Discussion »

Apr 132011

A randomised control trial comparing two techniques for locating chest compression hand position in adult Basic Life Support.

Resuscitation. 2011 Mar 16;

Authors: Owen A, Harvey P, Kocierz L, Lewis A, Walters J, Hulme J

INTRODUCTION: Chest compressions performed correctly have the potential to increase survival post cardiac arrest. The 2005 European Resuscitation Council (ERC) guidelines altered and simplified instructions for hand position placement to increase the number of chest compressions performed. This randomised controlled trial compares chest compression efficacy (hand position and number of effective chest compressions) after training using the 2005 guidelines or the 2005 guidelines with a hand position modification based on 2000 ERC guidelines. METHODS: First year healthcare students at the University of Birmingham, United Kingdom, were randomly allocated to either '2005' or 'intervention' group immediately after passing a Basic Life Support (BLS) assessment to ERC standards. The 2005 group performed 2min of BLS on a SkillReporter™ manikin (Laerdal Medical, Stavanger, Norway). The intervention group received training on hand placement using landmark techniques from the 2000 ERC guidelines; emphasising rapid hand positioning. This group also performed 2min of BLS on a SkillReporter™ manikin. RESULTS: 82 students were assessed; 41 in the 2005 group and 41 in the intervention group. Average compression rate was 102 in the 2005 group and 104 in the intervention group (p=0.29). Average number of incorrect hand placements was 24 in the 2005 group and 9 in the intervention group (p=0.03). CONCLUSIONS: The use of landmark measurement techniques in hand placement for external chest compressions does not have a detrimental effect on the number of chest compressions performed during BLS and increases correct hand positioning.

PMID: 21481517 [PubMed - as supplied by publisher]

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The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation.

Resuscitation Start a Discussion »

Apr 132011

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation.

Resuscitation. 2011 Apr 7;

Authors: Fried DA, Leary M, Smith DA, Sutton RM, Niles D, Herzberg DL, Becker LB, Abella BS

OBJECTIVE: Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil ("leaning" or "incomplete recoil") has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. METHODS: This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. RESULTS: We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120s), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p<0.001). CONCLUSIONS: Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes.

PMID: 21482010 [PubMed - as supplied by publisher]

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Safety profile of tinzaparin versus subcutaneous unfractionated heparin in elderly patients with impaired renal function treated for acute deep vein thrombosis: The Innohep(®) in Renal Insufficiency Study (IRIS).

Thromb Res Start a Discussion »

Apr 132011

Safety profile of tinzaparin versus subcutaneous unfractionated heparin in elderly patients with impaired renal function treated for acute deep vein thrombosis: The Innohep(®) in Renal Insufficiency Study (IRIS).

Thromb Res. 2011 Apr 6;

Authors: Leizorovicz A, Siguret V, Mottier D

INTRODUCTION: Trials comparing the use of full dose unfractionated heparin (UFH) or low molecular weight heparins (LMWHs) in very elderly patients with impaired renal function are lacking. IRIS aimed to assess whether LMWH is at least as safe as UFH in this population. MATERIALS AND METHODS: The study included renally impaired patients ?70years with acute symptomatic lower limb deep vein thrombosis (DVT). Patients were randomized to initial treatment with either tinzaparin 175IU/kg once daily (n=269) or activated partial thromboplastin time-adjusted UFH twice daily (n=270). After acute management both groups received vitamin K antagonist to day 90. RESULTS: The trial was stopped prematurely due to a difference in mortality favoring the UFH group (11.5 vs. 6.3%; p=0.035). Rates of clinically relevant bleedings by day 90 were similar in the tinzaparin (11.9%) and UFH (11.9%) groups, as were rates of confirmed recurrent venous thromboembolism (VTE) (2.6 vs. 1.1%; p=0.34). As the mortality difference could not be explained by bleedings or recurrent VTE, a post-hoc analysis was performed. This identified six baseline characteristics significantly correlated with mortality, of which five were over-represented in the tinzaparin group. CONCLUSION: The IRIS study was a challenging study involving patients (mean age 83years) usually excluded from clinical studies, but its early termination has left questions unanswered. The mortality difference observed with tinzaparin vs. UFH in elderly, renally-impaired patients with DVT cannot be explained on the basis of bleedings or recurrent VTE, and may reflect an imbalance of mortality risk factors at baseline.

PMID: 21477846 [PubMed - as supplied by publisher]

Link to Article at PubMed

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes.

Am J Cardiol Start a Discussion »

Apr 132011

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes.

Am J Cardiol. 2011 Apr 7;

Authors: Nam CW, Hur SH, Cho YK, Park HS, Yoon HJ, Kim H, Chung IS, Kim YN, Kim KB, Doh JH, Koo BK, Tahk SJ, Fearon WF

Patients still present with drug-eluting stent (DES) failure despite an angiographically successful implantation. The aim of the present study was to investigate the relation between the fractional flow reserve (FFR) measured after DES implantation and the clinical outcomes at 1 year. A total of 80 patients (mean age 62 years, 74% men, 99 DESs) underwent coronary pressure measurement at maximum hyperemia after successful DES implantation. The composite of major adverse cardiac events (MACE), including death, myocardial infarction, and ischemia-driven target vessel revascularization was evaluated at 1 year. The patients were divided into 2 groups (low-FFR group, FFR ?0.90 and high-FFR group, FFR >0.90) according to the median FFR. The mean poststent percent diameter stenosis was 11 ± 5% in the low-FFR group and 12 ± 3% in the high-FFR group (p = 0.31). Left anterior descending coronary artery lesions were more frequent in the low-FFR group than in the high-FFR group (82% vs 55%, p = 0.02). The mean stent length was greater in the low-FFR group than in the high-FFR group (38 ± 18 vs 28 ± 13 mm, p = 0.01). Six cases (7.5%) of MACE occurred during the 1-year follow-up. The rate of MACE was 12.5% in the low-FFR group and 2.5% in the high-FFR group (p <0.01). Receiver operating characteristic curves revealed 0.90 as the best cutoff of FFR after DES implantation for the prediction of 1-year MACE. In conclusion, a poststent FFR of ?0.90 correlated with a greater adverse event rate at 1 year.

PMID: 21481828 [PubMed - as supplied by publisher]

Link to Article at PubMed

Comparison of Outcome of Recurrent Versus First ST-Segment Elevation Myocardial Infarction (from National Israel Surveys 1998 to 2006).

Am J Cardiol Start a Discussion »

Apr 132011

Comparison of Outcome of Recurrent Versus First ST-Segment Elevation Myocardial Infarction (from National Israel Surveys 1998 to 2006).

Am J Cardiol. 2011 Apr 9;

Authors: Shotan A, Blondheim DS, Gottlieb S, Kazatsker M, Frimerman A, Shochat M, Garty M, Boyko V, Behar S, Meisel SR,

Patients with recurrent acute myocardial infarction (AMI), who represent ?35% of hospitalized patients with AMI, are at an increased risk of complications and death. Our study purpose was to compare the treatment and outcome of patients hospitalized with recurrent acute ST-segment elevation myocardial infarction (STEMI) from 1998 to 2006 with those of patients with a first STEMI. We performed 5 biennial nationwide 2-month surveys during 1998 to 2006, collecting data prospectively from all patients hospitalized for AMI or acute coronary syndrome in all 25 coronary care units in Israel. The present cohort included 4,543 patients with STEMI, 3,679 (76%) with first and 864 (24%) with recurrent STEMI. The patients with recurrent STEMI were older (66 ± 13 vs 62 ± 13 years), had greater rates of diabetes, hypertension, and previous angina, had a worse Killip class on admission, and experienced more in-hospital complications. The all-cause hospital crude mortality rate was 8.1% in patients with recurrent STEMI versus 5.5% in those with a first STEMI (adjusted odds ratio 1.71 95% confidence interval 1.19 to 2.44), and the 1-year mortality rate was 18.9% versus 10.9%, respectively (hazard ratio 1.85, 95% confidence interval 1.41 to 2.43). From 1998 to 2006, an insignificant trend toward a 1-year mortality reduction among patients with recurrent STEMI was seen and those with a first STEMI had a significant mortality decrease. In conclusion, patients admitted for recurrent STEMI have worse in-hospital and 1-year outcomes that did not improve during the study period. An improved therapeutic approach is needed for these high-risk patients.

PMID: 21482416 [PubMed - as supplied by publisher]

Link to Article at PubMed

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