Re-arrest immediately after return of spontaneous circulation: A retrospective observational study of in-hospital cardiac arrest.

Background: Patients who achieve return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA) may re-arrest. This phenomenon has not been sufficiently investigated. The aim of this study was to examine the immediate (1-min) and short-term (20-min) risks of re-arrest in IHCA.

The Association of Racial Residential Segregation and Survival After Out-of-Hospital Cardiac Arrest in the United States.

Background: Residential segregation has been identified as drivers of disparities in health outcomes, but further work is needed to understand this association with clinical outcomes for out-of-hospital cardiac arrest (OHCA). We utilized Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine if there are differences in survival to discharge and survival with good neurological outcome, as well as likelihood of bystander CPR, using validated measures of racial, ethnic, and economic segregation.

Methods: We conducted a retrospective observational study using data from the Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine associations among adult OHCA patients.

Crossing the line: access to trauma care across state borders.

Objective: This study investigates the challenge posed by state borders by identifying the population, injury, and geographic scope of areas of the country where the closest trauma center is out-of-state, and by collating state emergency medical services (EMS) policies relevant to cross-border trauma transport.

Methods: We identified designated levels I, II, and III trauma centers using data from American Trauma Society. ArcGIS was used to map the distance between US census block groups and trauma centers to identify the geographic areas for which cross-border transport may be most expedient.

A National Assessment of EMS Performance at the Response and Agency Level.

Background: In 2019, the National EMS Quality Alliance (NEMSQA) established a suite of 11 evidence-based EMS quality measures, yet little is known regarding EMS performance on a national level. Our objective was to describe EMS performance at a response and agency level using the National EMS Information System (NEMSIS) dataset.

Methods: The 2019 NEMSIS research dataset of all EMS 9-1-1 responses in the United States was utilized to calculate 10 of 11 NEMSQA quality measures.

Racial and ethnic disparities in emergency department transfers to public hospitals.

Objective: To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences.

Data Sources And Study Setting: ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018).

Study Design: Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients.

Association of Racial Residential Segregation With Long-Term Outcomes and Readmissions After Out-of-Hospital Cardiac Arrest Among Medicare Beneficiaries.

Background The national impact of racial residential segregation on out-of-hospital cardiac arrest outcomes after initial resuscitation remains poorly understood. We sought to characterize the association between measures of racial and economic residential segregation at the ZIP code level and long-term survival and readmissions after out-of-hospital cardiac arrest among Medicare beneficiaries. Methods and Results In this retrospective cohort study, using Medicare claims data, our primary predictor was the index of concentration at the extremes, a measure of racial and economic segregation.

Non-shockable rhythms: A parametric model for the immediate probability of return of spontaneous circulation.

Background: Cardiac arrest can present with asystole, Pulseless Electrical Activity (PEA), or Ventricular Fibrillation/Tachycardia (VF/VT). We investigated the transition intensity of Return of spontaneous circulation (ROSC) from PEA and asystole during in-hospital resuscitation.

Materials And Methods: We included 770 episodes of cardiac arrest.

Using medicare claims to estimate risk-adjusted performance of Pennsylvania trauma centers.

Trauma centers use registry data to benchmark performance using a standardized risk adjustment model. Our objective was to utilize national claims to develop a risk adjustment model applicable across all hospitals, regardless of designation or registry participation. Patients from 2013-14 Pennsylvania Trauma Outcomes Study (PTOS) registry data were probabilistically matched to Medicare claims using demographic and injury characteristics.

Timing and Outcomes After Coronary Angiography Following Out-of-Hospital Cardiac Arrest Without Signs of ST-Segment Elevation Myocardial Infarction.

Background: There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described.

Objective: We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG.

Relationship of hepatitis C risk to hepatitis C test acceptance among adult patients participating in an ED hepatitis C screening programme.

Background: It is possible that adult ED patients consider their hepatitis C virus (HCV) risk factor history when deciding whether to accept HCV screening. To help address this question, we examined whether self-reporting any HCV risk was more common among ED patients who agreed than who declined HCV screening. Among ED patients who agreed to HCV screening, we also assessed if self-reporting any HCV risk was more common among those whose HCV antibody (Ab) and HCV viral load (VL) test results were positive.

Survival After Out-of-Hospital Cardiac Arrest: The Role of Racial Residential Segregation.

Racial and racialized economic residential segregation has been empirically associated with outcomes across multiple health conditions but not yet explored in relation to out-of-hospital cardiac arrest (OHCA). We sought to examine if measures of racial and economic residential segregation are associated with differences in survival to discharge after OHCA for Black and White Medicare beneficiaries. Utilizing age-eligible Medicare fee-for-service claims data from 2013 to 2015, we identified OHCA claims and determined survival to discharge.

Emergency departments in the United States treating high proportions of patients with ambulatory care sensitive conditions: a retrospective cross-sectional analysis.

Background: One in nine emergency department (ED) visits by Medicare beneficiaries are for ambulatory care sensitive conditions (ACSCs). This study aimed to examine the association between ACSC ED visits to hospitals with the highest proportion of ACSC visits ("high ACSC hospitals) and safety-net status.

Methods: This was a cross-sectional study of ED visits by Medicare fee-for-service beneficiaries ≥ 65 years using 2013-14 claims data, Area Health Resources File data, and County Health Rankings.

Clinical factors associated with significant coronary lesions following out-of-hospital cardiac arrest.

Objectives: Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG.

Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization.

Importance: Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood.

Objective: To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization.

Nurtured in Nature: a Pilot Randomized Controlled Trial to Increase Time in Greenspace among Urban-Dwelling Postpartum Women.

Spending time in nature is associated with numerous mental health benefits, including reduced depression and improved well-being. However, few studies examine the most effective ways to nudge people to spend more time outside. Furthermore, the impact of spending time in nature has not been previously studied as a postpartum depression (PPD) prevention strategy.

In-hospital cardiac arrest in patients with coronavirus 2019.

Background: Coronavirus Disease 2019 (COVID-19) has caused over 1 200 000 deaths worldwide as of November 2020. However, little is known about the clinical outcomes among hospitalized patients with active COVID-19 after in-hospital cardiac arrest (IHCA).

Aim: We aimed to characterize outcomes from IHCA in patients with COVID-19 and to identify patient- and hospital-level variables associated with 30-day survival.

Association of Gun Violence With Emergency Department Visits for Stress-Responsive Complaints.

Study Objective: We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints.

Methods: In this location-based before-and-after neighborhood study, we examined variability in ED encounter volume for stress-responsive complaints after neighborhood shooting incidents around 2 academic hospitals. We included patients residing within 1/8- and 1/2-mile-diameter buffers around a shooting (place) if their ED encounter occurred 7, 30, or 60 days before or after the shooting (time).

Inpatient hospital performance is associated with post-discharge sepsis mortality.

Background: Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes.

Methods: Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014.

Socioeconomic disparities in layperson CPR training within a large U.S. city.

Aim Of The Study: We sought to understand how individual factors and neighborhood characteristics are associated with a layperson's likelihood of being trained in CPR. We hypothesized that higher socioeconomic status (educational attainment, and median household income (MHI)) would be associated with a higher likelihood of previous CPR training.

Methods: Through the Mobile CPR Project, a program providing hands-only CPR and AED education in Philadelphia, we surveyed participants regarding socioeconomic factors and prior CPR training.

Observing the stages of bystander intervention in virtual reality simulation.

Background: Understanding bystander reactions to an emergency is an important component of effective training. Four stages of bystander intervention (BI) have been previously described: noticing the situation as a problem, interpreting when it is appropriate to intervene, recognizing personal responsibility to intervene, and knowing how to intervene. Using virtual reality (VR) to simulate emergencies such as sudden cardiac arrest (SCA) can be used to study these stages.

Impact of adrenaline dose and timing on out-of-hospital cardiac arrest survival and neurological outcomes.

Study Objective: The 2015 ILCOR Advanced Cardiovascular Life Support Guidelines recommend intravenous adrenaline (epinephrine) as a crucial pharmacologic treatment during cardiac arrest resuscitation. Some recent observational studies and clinical trials have questioned the efficacy of its use and suggested possible deleterious effects on overall survival and long-term outcomes. This study aimed to describe the association between time and dose of adrenaline on return of spontaneous circulation (ROSC) and neurologic function.

Variability in survival and post-cardiac arrest care following successful resuscitation from out-of-hospital cardiac arrest.

Aim Of The Study: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania.

Methods: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival.

Using an Immersive Virtual Reality System to Assess Lay Provider Response to an Unannounced Simulated Sudden Cardiac Arrest in the Out-of-Hospital Setting.

Background: A sudden cardiac arrest (SCA) occurs when the heart abruptly stops beating; because of the nature of SCA, capturing data in the out-of-hospital setting from actual bystander response is difficult. Current technologies such as virtual reality (VR) allow the creation of scenarios programmed for heightened realism. No studies have used an immersive VR system to observe lay bystander response.

The association of layperson characteristics with the quality of simulated cardiopulmonary resuscitation performance.

Background: Few studies have examined the association of layperson characteristics with cardiopulmonary resuscitation (CPR) provision. Previous studies suggested provider characteristics, including age and gender, were associated with CPR quality, particularly chest compression (CC) depth. We sought to determine the association of subject characteristics, including age and gender with layperson CPR quality during an unannounced simulated CPR event.