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M A Brouwer

Publications and source records attributed to M A Brouwer.

4 recordsLinked to original sources
PubMed2003

[Resuscitations in the hospital: reporting using the Utstein-style form and a study of 183 patients in the St. Radboud University Medical Center, Nijmegen, the Netherlands, between 1997-2000].

OBJECTIVE: To evaluate the completion of the Utstein-style forms after cardiopulmonary resuscitation (CPR) in the St Radboud University Medical Center, Nijmegen (UMCN), the Netherlands, and to assess the outcomes of the CPR attempts. DESIGN: Retrospective, descriptive. METHOD: All Utstein-style forms used in the UMCN during the period 1 January 1997-31 December 2000 were examined. The data were supplemented with information from medical records. Resuscitation events initiated in the hospital were included, with the exception of those in the coronary care and intensive care units. RESULTS: 222 forms were completed, 183 of which related to in-hospital resuscitations: 104 men and 79 women with a median age of 65 years: (P25-P75: 49-75). On 148 forms (81%), the patient name, patient identifier and date of collapse were all reported. The cause of collapse was noted in 131 cases (72%). Cardiac condition during CPR was recorded in 126 cases (69%). The Glasgow coma score 10 minutes after CPR was recorded in 41 cases (22%), and 24 hours after CPR in 15 cases (8%). Information regarding follow-up was provided on 27 forms (15%): in all cases this concerned unsuccessful resuscitation. However, medical records revealed that CPR was initially successful in 105 patients (57%), and that 55 patients (30%) eventually survived to discharge. CONCLUSIONS: The variables on the Utstein-style form relating to the acute phase were poorly completed, and even fewer variables were completed for later phases. CPR was successful in 57% of the patients, and 30% left the hospital alive.

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PubMed1996

Influence of early prehospital thrombolysis on mortality and event-free survival (the Myocardial Infarction Triage and Intervention [MITI] Randomized Trial). MITI Project Investigators.

The Myocardial Infarction Triage and Intervention Trial of prehospital versus hospital administration of thrombolytic therapy markedly reduced hospital treatment times, but the 2 groups had similar outcomes. However, patients treated < 70 minutes from symptom onset had better short-term outcomes. The purpose of this study was to determine the long-term influence of very early thrombolytic treatment for acute myocardial infarction. A total of 360 patients were followed for vital status and cardiac-related hospital admissions over a period of 34 +/- 16 months. Patients enrolled in the trial had symptoms for < or = 6 hours, ST-segment elevation on the prehospital electrocardiogram, and no risk factors for serious bleeding. They received aspirin and recombinant tissue plasminogen activator either before or after hospital arrival. Primary end points in this study included long-term survival and survival free of death or readmission to the hospital for angina, myocardial infarction, congestive heart failure, or revascularization. Two-year survival was 89% for prehospital- and 91% for hospital-treated patients (p = 0.46). Event-free survival at 2 years was 56% and 64% for prehospital- and hospital-treated patients, respectively (p = 0.42). In patients treated < 70 minutes from symptom onset, 2-year survival was 98%, and it was 88% for those treated later (p = 0.12). Two-year event-free survival was 65% for patients treated early and 59% for patients treated later (p = 0.80). In this trial, poorer long-term survival was associated with advanced age, history of congestive heart failure, and coronary artery bypass surgery performed before the index hospitalization, but not with time to treatment.

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PubMed1995

Adverse long-term effects of reocclusion after coronary thrombolysis.

OBJECTIVES: This study sought to assess the long-term clinical consequences of reocclusion after coronary thrombolysis. BACKGROUND: After acute myocardial infarction successfully treated with thrombolysis, reocclusion occurs in approximately 30% of patients and leads to poorer in-hospital outcome. However, the long-term effects of reocclusion are unknown. METHODS: Three hundred patients with no history of coronary surgery and with a patent infarct-related artery at coronary angiography within 48 h after thrombolysis were enrolled in the Antithrombotics in the Prevention of Reocclusion in Coronary Thrombolysis (APRICOT) trial. At a mean (+/- SD) of 77 +/- 23 days after thrombolysis, 248 patients (87%) underwent follow-up angiography. Reocclusion was observed in 71 (29%) of 248 patients. To compare outcome between 71 patients with and 177 without reocclusion an analysis of event-free survival, defined as a clinical course without death, reinfarction and revascularization, was performed. RESULTS: Over a 3-year follow-up period, event-free survival was significantly better in patients without reocclusion: At 1 year it was 63% for patients with and 83% for those without reocclusion (p < 0.001). In the first year, two or more cardiac-related events occurred in 24% of patients with and 6% of those without reocclusion (p < 0.001). Patients with reocclusion had a markedly higher reinfarction and revascularization rate. At 1 year the reinfarction rate was 23% for patients with and 5% for those without reocclusion (p < 0.001). CONCLUSIONS: This analysis shows the adverse influence of reocclusion on long-term clinical outcome in relation to reinfarction and need for revascularization. To further optimize prognosis after thrombolysis, prevention of reocclusion should become a main priority. Future research should focus on the criteria and timing of elective revascularization procedures in the prevention of coronary reocclusion.

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