Clinical Question and Appraisal Evidence - Research Paper Example

? Clinical Question and Appraisal Evidence Clinical Question and Appraisal Evidence Module 4 Are the cooling processes immediately after resuscitation beneficial in the pre-hospital settings? A meta-analysis has been conducted by Cullen, Augenstine, Kaper, Tinkham and Utz in 2011 with a study title "therapeutic hypothermia initiated in the pre-hospital setting". Authors of the study have observed ventricular fibrillation as the major cause behind sudden cardiac deaths. From the present literature, authors have noted that if defibrillation is performed immediately after ventricular fibrillation victims of sudden cardiac death may survive with intact neurologic function (American Heart Association, 2011). As the research aims to study the success of the cooling process after resuscitation in the pre-hospital settings; thus, researchers have evaluated that hypothermia is induced in pre-hospital setting to deal with the comatose cardiac arrest patients. It has been found that many researches evidenced favorable results concerning induction of hypothermia after cardiac arrest to initiate and effectively practice the efficient method; it promotes the best neurological outcome at discharge suggested by professionals (American Heart Association, 2011; Link, Atkin, Passman, Halperin, & White, 2010). Authors of the study have included experiences and viewpoints of the participants (population) who had comparable baseline characteristics. Also, to deeply study the experience of the population authors had intended to explore if the body temperature decreases before the arrival of cardiac patient at the hospital; how it will impact the treatment procedure. So, they have explored that a decrease in patient's body temperature is positively effectively, safe and feasible for the health practitioners and also the cardiac arrest patient feel encouraging difference in his/her health condition (Nichol, Thomas, Callaway, & Hedge, 2008). Although, researchers have not intended to include adverse influence of induced hypothermia in the findings, but the meta-analysis reveals underpins that in some cases induced hypothermia can cause negative effects on heart rate, blood pressure, pulse oximetry and chest radiograph. Furthermore, from another outstanding piece of medical literature researchers have noted that decrease in core temperature of 0.8 degree Celsius can point out a quick infusion of greater volume, ice-cold intravenous fluid decrease temperature as soon as the patient arrived at the healthcare centre (Nichol, Thomas, Callaway, & Hedge, 2008). Also, researchers have included experiences of patients out of the hospital and effectiveness of the cooling process immediately after resuscitation. For the evidence (Kamarainen, Virkkunen, & Tenhunen, 2009) has been analyzed, which stated that hypothermia group was observed to experienced low temperature at the time, when they arrived at the hospital in comparison with the control group. With the analysis of this study, authors observed no negative influences of hemodynamic instability or pulmonary edema and this approach of the cooling process was proved to be safe and effective for better health outcomes of the cardiac patients. Review of Castren (2010) study helps authors to explore data related to pre-hospital intra-arrest transnasal evaporative cooling. This study evidenced the safety, feasibility, and cooling efficiency of induced hypothermia within pre-hospital settings. Additionally, positive impact of cooling on neurological experiences of the patient has also been witnessed by Castren (2010). However, Castren (2010) strongly considered that factors identified have adverse effects of the cooling procedures on blood pressures, heart rate, chest x-ray, and pulse oximetry. Other studies such as Kim, Olsufka, & Maynard (2007) also evidenced the safety and feasibility of pre-hospital cooling; however, this study strongly suggested that esophageal temperature is important to note down at randomization and upon the arrival of cardiac patient at emergency department of a healthcare centre. Though, patients might encounter anxiety and fear when they are given 4o C normal to randomized for pre-hospital cooling procedure. Undoubtedly, the temperature at hospital arrival can vary from patient to patient, but it has been confirmed through chest x-ray that there are no adverse effects of hemodynamic differentiated readings or pulmonary edema. This differentiation is based on initial rhythm while arrest. Kim, Olsufka, & Maynard (2007) study referred to by researchers to collect evidence that when ventricular fibrillation patients are subjected to cooling procedure soon after resuscitation in the pre-hospital setting they showed improvement in their health condition from the time of arrival to the time of discharge from the hospital (Kim, Olsufka, & Maynard, 2007). Concisely, authors of the given study evaluated that the intravenous infusion of 40 C normal saline to the patient of cardiac arrest at the time of arrival to the hospital for induction of hypothermia is undoubtedly, safe, convenient, and effective for the health outcomes and positive experiences of the patients within the pre-hospital settings. Therefore, in the concluding section of the study, authors have gained success by proving that cooling processes immediately after resuscitation are beneficial in the pre-hospital settings (Cullen, Augenstine, Kaper, Tinkhamd, & Utz, 2011). Module 5 Hypothermia after cardiac arrest should be further evaluated, a systematic review of randomized trials with meta-analysis and trial sequential analysis is a research study conducted by Nielsen, Friberg, Gluud, Herlitz and Wettersleve in 2010. In this study, researchers have taken references from numbers of studies to provide evidences regarding efficacy of hypothermia after cardiac arrest. Authors Pub Year Country Dependent Variables Independent Variables Study Design Sample Size/Site Sampling Method Data Collection Ages of Subjects Nielsen, Friberg, Gluud, Herlitz and Wettersleve 2010 Sweden Health risk for patients due to systematic and other errors Mild induced hypothermia (MIH) to reduce mortality and neurological impairment after out-of-hospital cardiac arrest. Retrospective design Five randomised trials (478 patients) were included. All trials had substantial risk of bias. Not defined Table review Not defined Atwood, Eisenberg, Herlitz, and Rea 2005 USA Incidence rate among patients treated EMS out of the hospital EMS treatment method, used out of the hospital to deal with the cardiac arrest Peer-reviewed articles from January 1980 to June 2004 were included Not defined as numbers of differed studies have been studied to explore the incidence due to EMS treatment Not defined Data has been collected from online sources to take reference of peer reviewed journal article Not defined Langhelle, Tyvold, Lexon, Hapnes, Sunde, Steen 2003 Norway Health outcomes of the cardiac patients after out of hospital treatment In hospital implemented methods of treatment aiming to bringing positive health changes among cardiac arrest. Retrospective design including studies of all those patients, who were admitted to hospital with a spontaneous circulation after OHCA. (1995-1999). Sampling size is not defined Not defined Relevant data has been taken from the past studies conducted during 1995-1999 within Norway. 18-70 Carr , Kahn Merchant Kramer, and Neumar 2009 USA Hospital-level variation in mortality of patients admitted to United States intensive care units (ICUs) with a diagnosis of cardiac arrest Variability in post-cardiac arrest care Multicentre clinical registry of ICU patients with cardiac arrest in the 2002-2005 4674 patients from 39 hospitals have been identified in the study Sample were taken from the clinical registry of admitted patients of cardiac arrest in the hospital Data taken from the medical records of the patients in the ICU 18-56 Herlitz, Bang, Gunnarsson, Engdahl, Karlson, Lindqvist, and Waagstein 2003 Sweden Changes and factors associated with survival of patients. Conditions suffered by the cardiac patients out of hospital and being hospitalized alive. Data on medical history and hospitalization were retrospectively recorded 5505 patients have been studied in this research Patients who have been suffering from cardiac arrest since more than 20 years have been considered in this study Data of patients recorded in the medical history has been obtained to draw relevant information Age group has not been defined, but authors have only mentioned that they took sample of the patient, who were under 70 years old. Terranova, Valli, Severgnini, Dell'Orto,and Maria 2006 USA Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation Interventions used during defibrillation. Design of this study is based on a 24 Months Retrospective Analysis 446 patients, given defibrillation treatment Samples were taken from a 24 months retrospective population. Data has been collected from medical records of out-of-hospital cardiac arrest between January 2003 and December 2004. Age group has not been defined in this study Jorgensen and Holm. 1998 Denmark Circulatory arrest of cardiovascular and pulmonary aetiology brain recovery Treatment method termed as cardiopulmonary resuscitation Field research 231 patients Sample method was simple as researchers have taken data from medical records of the patients Data has been taken from the medical history of the patient provided by the hospital authorities Age group of the patients is not defined Busto , Dietrich, Globus, and Ginsberg 1989 USA CA1 hippocampal ischemic neuronal injury Postischemic moderate hypothermia Retrospective study design has been adopted Sample size is not defined Not defined Data has been collected from the past researches closely related to the topic Age group is not defined Literature related to the topic shows a connection between hypothermia and its effective outcomes after cardiac arrest. The above presented studies help understand that there is a vast literature present on the use of hypothermia as an effective method of treatment and bring positive outcomes in health conditions of those, who are at higher risk of sudden death due to cardiac arrest. Reference List American Heart Association. (2011). AHA Statistical: heart disease and strole statistics. Circulation, 118-209. Atwood, C., Eisenberg, M., Herlitz, J., & Rea, T. (2005). Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation , 75–80. Carr, G., Kahn, M., Merchant, M., Kramer, A., & Neumar, W. (2009). Inter-hospital variability in post-cardiac arrest mortality. Resuscitation., 30-4. Castren, M. (2010). Intraarrest transnasal evaporation cooling:A randomized pre-hospital multicentre study . Circulation, 729-36. Cullen, D., Augenstine, D., Kaper, L., Tinkhamd, S., & Utz, D. (2011). Therapautic Hypothermia Initiated in the Pre-Hospital Setting. Advanced Emergency Nursing Journal, 314-321. Herlitz, J., Bang, A., & Gunnarsson, J. (2003). Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Goteborg, Sweden. Heart. Jorgensen, E., & Holm, S. (1998). The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation. , 111-22. Kamarainen, A., Virkkunen, I., & Tenhunen, J. (2009). Pre-Hospital therapeutic hypothermia for comatose survivors of cardiac arrest: A randomized controlled trial. Acta Anaethesiologica Scadinavica, 900-7. Kim, F., Olsufka, M. L., & Maynard, C. (2007). Pilot randomized clinical trial of pre-hospital induction of mild hypothermia in out of hospital cardiac arrest patients with a rapid infusion of 4 normal saline . Circulation, 3064-70. Langhelle, A., Tyvold, S., Lexow, K., & Hapnes, A. (2003). In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway. Resuscitation, 247-63. Link, M., Atkin, D., Passman, R., Halperin, H., & White, R. (2010). Part 6:Electrical therapies :Automated external defibrillators, defibrillation,cardioversion and pacing. Circulation, 706-19. Nichol, G., Thomas, E., Callaway, C., & Hedge, J. (2008). Regional variation in out of hospital cardiac arrest incidence and outcomes. The Journal of the American Medical Association, 1432-63. Terranova, P., Valli, P., Severgnini, B., & Dell'Orto, S. (2006). EarlyOutcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis. Indian Pacing Electrophysiol, 194–201. Read More