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Abstracts / Resuscitation 96S (2015) 43157

The Q2 HRI report for 2014-15 highlighted a higher than average


number of resuscitation calls on day 1 following admission

Results: The case note reviews provided reassurances to the


organisation that the patients were in the right place for the right
care and that Nursing and Medical staff utilised NEWS effectively.
Identied areas for improvement are, the timeliness of medical
reviews and the lack of documented ceilings of care.
Conclusion: NCAA provides useful data which allows our organisation to benchmark, review and implement systems, which
ensure patients receive appropriate care commensurate with their
health requirements.
As a result of data analysis this organisation has seen a downward trend in futile resuscitation calls due to addressing these
identied issues.
Membership of NCAA may prove useful to other acute trusts by
improving the quality and appropriateness of patient care.13

References
1. Resuscitation Council (UK) and The Intensive Care National Audit and Research
Centre (ICNARC). National Cardiac Arrest Audit Report. Hull Royal Inrmary 01
April 2013 to 31 March 2014. Date of report 10/07/2014.
2. Resuscitation Council (UK) and The Intensive Care National Audit and Research
Centre (ICNARC). National Cardiac Arrest Audit Report. Castle Hill Hospital 01
April 2014 to 30 September 2014. Date of report 12/11/2014.
3. Resuscitation Council (UK) and The Intensive Care National Audit and Research
Centre (ICNARC). National Cardiac Arrest Audit Report. Hull Royal Inrmary 01
April 2014 to 30 September 2014. Date of report 11/11/2014.

http://dx.doi.org/10.1016/j.resuscitation.2015.09.344
AP248
Recognition & management of anaphylaxis: Are
we doing well enough?
Adam Swift , Nagaraja Ravishankar
Pennine Acute NHS Trust, Manchester, UK
Aim: Anaphylaxis can cause death from complications in the
airway, breathing or circulation. Death or permanent disability may
be avoidable if the condition is recognised promptly and managed
optimally.
Drugs used in critical care and anaesthesia are at increased risk
of causing anaphylaxis. It is therefore vital that staff are aware of
how to recognise the disorder, and guidelines on how to manage
patients with it.1
Methods: Over the course of two weeks, anaesthetic and theatre
staff at the Pennine Acute NHS Trust were surveyed anonymously.
The survey was modelled on guidelines from the Association of

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Anaesthetists of Great Britain and Ireland. Questions focused on


common causes, signs and symptoms, immediate and long term
management of anaphylaxis. The cohort included anaesthetic consultants, trainee & non-training grade anaesthetists and nursing
staff.
Results: 32 completed surveys were analysed. The most striking results related to knowledge of the long term management &
investigation of anaphylaxis. 94% of participants were unaware of
the different types of skin prick testing. 81% were unaware of any
testing other than skin prick testing. More acutely, 47% of participants were unable to say what blood bottle should be used for
mast cell tryptase sampling immediately after an attack, and 75%
of people were unable to say when the samples should be taken.
Discussion: As a result of this survey, we have recommended
the implementation of an anaphylaxis pack, including a owchart
detailing initial management, appropriate blood bottles labelled
with the correct timings, and a referral form to ensure patient follow up. It is our hope that this will improve the management of
patients who suffer anaphylaxis, and reduce the risk of subsequent
events.
Reference
1. Association of Anaesthetists of Great Britain and Ireland. Suspected anaphylactic
reactions associated with anaesthesia. Anaesthesia 2009;64:199211.

http://dx.doi.org/10.1016/j.resuscitation.2015.09.345
AP249
Survival of in hospital cardiac arrest related to
the changes of vital parameters measured by
the Modied Early Warning Score within 24 h
pre-arrest
Annika Englund , Eva Stuart
University hospital, Linkping, Sweden
Background: Clinical scoring systems such as the Modied Early
Warning Score (MEWS) are widely used for the clinical surveillance
of in-hospital patients. According to current policies in the use of
MEWS-score, changes in the scoring should result in changes in the
level of surveillance. MEWS, score consist of respiratory frequency,
pulse, systolic blood pressure, temperature and level of cerebral
function. It had been found that the majority of in-hospital cardiac
arrests are preceded by changes these parameters.
The aim of this study was to determine the correlation between
changes in MEWS-score in patients suffering cardiac arrest (CA)
within the preceeding 24, and one-months survival related to
changes in the pre-arrest MEWS-score.
Method: All patients suffering unexpected in-hospital CA in an
university hospital (600 beds) in 2013 and 2014 were included in
the study. Data regarding were retrieved form the Swedish national
registry for CA, and MEWS scores recollected by journal review at
24 and at 6 h pre-cardiac arrest. Statistical analysis was performed
by SPSS (IBM SPSS Statistics 20.0).
Results: A total of 125 unexpected cardiac arrests were registered. Mean age was 71 years (2397). 57% of the patients were
male. Overall one-month survival rate was 46%. The pre-CA MEWSscore at 6 h was improved compared to the 24 h value in 22%, was
unchanged in 44% and had deteriorated in 34% of the patients.
Among the scoring items in MEWS, respiratory rate and pulse
ranked the highest values at both 24 and 6 h pre-CA.
Among survivors of CA, MEWS had deteriorated in 23% and
improved in 17% pre-CA, whilst MEWS in non-survivors had deteriorated in 41% and improved in 26%. Mean pre-CA MEWS-score
at 6 h for survivors was 1.42 and for non-survivors 2.67 (p < 0.01).

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Abstracts / Resuscitation 96S (2015) 43157

Survival rates related to pre-CA MEWS were 77% (MEWS 0), 48%
(MEWS 1), 32.1% (MEWS 23), and 15.8% (MEWS >3) respectively.
Conclusion: MEWS-score has been shown to be a reliable
instrument to identify deterioration in ill patients. Unexpected CA
was not preceded by changes in MEWS in 44% of the patients, limiting the value of MEWS for the prediction of CA. Both improvement
and deterioration in MEWS-score pre-cardiac arrest seem to be
related to worse survival rate after CA. A correlation between higher
MEWS-values and CA-mortality seems to exist.15

References
1. Churpek M, Yuen T, Edelson J. Risk stratications of hospitalized patients on the
wards. Chest 2013;143:175865.
2. Churpek M, Yuen T, Huber M, et al. Predicting cardiac arrest on the wards. Chest
2012;141:11706.
3. McGaughey J, Alderdice F, Fowler R, et al. Outreach and early warning systems
(EWS) for the prevention of intensive care admission and death of critically ill
adult patients on general hospital wards (review). Cochrane Database Syst Rev
2007;3, http://dx.doi.org/10.1002/14651858.CD005529.pub2.
4. Nurmi J, Harjola VP, Nolan J, et al. Observations and warning signs prior to cardiac
arrest. Should a medical emergency team intervene earlier? Acta Anaesthesiol
Scand 2005;49:7026.
5. Subbe CP, Williams L, Fligelstone L, et al. Does earlier detection of critically ill patients on surgical wards lead to better outcomes. R Coll Surg Engl
2005;87:22632.

http://dx.doi.org/10.1016/j.resuscitation.2015.09.346

Prognostication
AP250
Validation of the base decit delta in trauma
patients. Parc Tauli Hospital, Sabadell,
Barcelona, Spain
Esteban Garcia Padilla, Andres Felipe Garcia
, Juan Jose Zancajo, Carmen Colilles
Lodono
Calvet
Parc Tauli Hospital, Sabadell/Barcelona, Spain
Purpose of the study: The BISS its a survival probability model
proven in Netherland, it shows to be objective; our study goal is to
validate the BISS in our patients.
Materials and methods: Observational, descriptive and
prospective study including patients admitted as a trauma code
in our hospital between November 2008 and March 2014. We
start calculating the main anatomical and physiological scales, base
decit delta and survival probability models. Later we compare
the base decit delta between those who survived and those who
didnt, correlating that value with the scales and the survival probability models. Finally we measure the area under the curve (AUC)
of BISS and TRISS ROC curves comparing them.
Results: The study includes 467 patients with a medium ISS of
17.55. The base decit delta was signicantly superior in the group
who didnt survive and it correlates signicantly with the mortality.
As well a high base decit delta correlates with a low RTS, a high ISS
and a low survival probability. In order to validate the BISS we use
only 238 patients who had all available values required to calculate
the BISS and TRISS, then we calculate a new coefcients for the BISS
using logistic regression. For each new coefcient we calculate a
new condence interval (CI 0.95) assuming equally if this interval
includes the original model coefcient. Obtaining the AUC of the
BISS ROC curve greater than the TRISS (0.946 Vs 0.932). Once we
compare the two models we found no differences between them,
validating the BISS in our patients.
Conclusions: The BISS, being a objective valuation allows
the consecution of a most realistic survival probability result. Its

application in all hospitals would allow the comparison between


results of the institutions, comparing mortality, survival, injury
gravity and the quality of the instituted programs, widening the
security margin in the attention of those patients.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.347
AP251
Correlation of blood gas analysis with outcome
of out-of-hospital cardiac arrest patients
Jonghwan Shin 1 , Se Jong Lee 1, , Joonghee Kim 2 ,
Kyuseok Kim 2 , Yong Su Lim 3 , Hui Jai Lee 3 , Young
Ju Son 1
1 Seoul National University Boramae Medical Center,
Seoul, Republic of Korea
2 Seoul National University Bundang Hospital,
Gyeongi-do, Republic of Korea
3 Gachon University Gil Hospital, Incheon, Republic
of Korea

Objectives: Cardiac arrest was suddenly occurred and cardiopulmonary resuscitation (CPR) usually sustained lesser than
30 min. There was no objective laboratory evidence to make a
decision to stop resuscitation effort during the CPR. The aim of
present study was to investigate the relationship of the blood
gas analysis and outcome of out of hospital cardiac arrest (OHCA)
patients.
Methods: This was a retrospective, multi-center, registry-based
study including 2734, non-traumatic OHCA patients. Database was
collected from January 2008 to December 2014. Univariate and
multivariable analysis was used to elucidate factors associated with
survival discharge and neurologic prognosis.
Results: Among the value of blood gas analysis, pH was signicantly correlated with survival discharge and favourable neurologic
outcome (Cerebral Performance Categories 1 and 2 at 1-months
follow up) in univariate analysis. Multivariate logistic regression
analysis demonstrated that signicant predictors of survival discharge included witness arrest, gender, therapeutic hypothermia,
Coronary angiography and pH. Favourable neurologic outcome was
associated with shockable rhythm, therapeutic hypothermia, Coronary angiography and pH. There was no favourable neurologic
outcome at pH < 6.80.
Conclusion: The pH value of blood gas analysis during the CPR
in OHCA patient was related to survival discharge and neurologic
prognosis.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.348
AP252
False memories and illusions of success?
Medical healthcare professionals claims of
having seen a patient returning to normal
activity after cardiopulmonary resuscitation
Fernanda Duarte 1, , Sharon Einav 2 , Joseph
Varon 1
1
2

University General Hospital, Houston, TX, USA


Shaare Tzedek Medical Center, Jerusalem, Israel

Purpose of the study: The so-called TV effect has been shown


to provide a false sense of positive outcome in victims of cardiac
arrest depicted in television shows. The purpose of this study was
to assess if false memories are created regarding cardiopulmonary
resuscitation (CPR) among health care providers.