PubMed Health⌕ Search

Biomedical subjects

M J Bonnin

Publications and source records attributed to M J Bonnin.

5 recordsLinked to original sources
PubMed1993

Survival in the elderly after out-of-hospital cardiac arrest.

OBJECTIVES: To evaluate the survival prognosis for the elderly (> or = 70 yrs of age) after out-of-hospital cardiac arrest in a large urban center, and to identify any specific differences in survival factors relative to those adults < 70 yrs of age. DESIGN: The study was a prospective, inception cohort study. SETTING: An urban population of approximately 2,000,000, served by one centralized municipal emergency medical services system. PATIENTS: All 986 adult victims (367 elderly and 619 younger patients) of primary cardiac arrest attended by the emergency medical services system over a 12-month period. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: All victims of out-of-hospital cardiac arrest occurring within a single, large, urban municipality were studied over a 12-month period. Each event was analyzed for age, sex, witnesses, bystander cardiopulmonary resuscitation, presenting electrocardiographic rhythm, paramedic response time, scene time, return of spontaneous circulation (pulses), and electrocardiographic rhythm on hospital arrival. Outcomes evaluated included inhospital admission (resuscitation) and successful discharge from the hospital (survival). Patients were followed until death or discharge from the hospital. Of 367 elderly cardiac arrest victims, 81 (22%) patients were successfully resuscitated and 24 (7%) patients survived. However, of 119 (32% of all elderly patients) patients who presented with ventricular fibrillation/tachycardia, 48 (40%) patients were resuscitated and 17 (14%) patients survived. These 17 patients with ventricular fibrillation/tachycardia accounted for 71% of all elderly survivors. During the same study period, there were 619 adult primary cardiac arrest victims < 70 yrs of age, 160 (26%) of whom were resuscitated and 73 (12%) of whom survived. Among the younger patients, 296 (48%) patients presented with ventricular fibrillation/tachycardia, of whom 110 (37%) were resuscitated and of whom 60 patients (20%) survived. Within the context of this study, survival rates for younger and older ventricular fibrillation/tachycardia patients were not significantly different. Also, among survivors, there were no other major differences in terms of established survival determinants. CONCLUSIONS: Survival chances for the elderly after out-of-hospital cardiac arrest are not bleak, and are reasonable if ventricular fibrillation/tachycardia is the presenting rhythm. Survival determinants are similar for younger and older adults.

Age Factors↗
PubMed1989

Outcomes in unsuccessful field resuscitation attempts.

To determine the outcomes of patients who did not regain vital signs after prehospital advanced cardiac life support, we studied adult patients who sustained nontraumatic out-of-hospital cardiac arrest. Our study consisted of a 20-month retrospective review of 244 charts beginning January 1986. Twelve patients were excluded for drug overdose, family request, or unavailable data. Of the remaining 232 patients, 51 had a rhythm and pulse on arrival at the emergency department. The record of each of the remaining 181 patients was analyzed for age, sex, location, witness, CPR initiator, advanced life support unit response time, initial field rhythm, and initial ECG rhythm. Outcome alternatives were dead in emergency department or hospital admission. All hospitalized patients were further evaluated for survival to discharge and neurologic status at discharge. Ten of the 181 patients (6%) who failed prehospital resuscitation survived to hospitalization, and one (0.6%) was discharged neurologically intact. Survival to hospital admission did not correlate with any of the variables studied except gender. The one patient who survived a failed prehospital resuscitation was not endotracheally intubated in the field. Our data support the practice of pronouncing adult nontraumatic cardiac arrest victims who fail to respond to advanced cardiac life support efforts in the field as dead at the scene.

Adolescent↗
PubMedDate not supplied

Utilization of the emergency department by patients with minor complaints.

Emergency departments (ED) are frequently utilized by patients with minor complaints. It has been a long-standing assumption in the medical community that this use was based on the inability of certain subgroups of the population to access primary care providers secondary to inability to pay. This study examines the use of the ED for minor complaints and the distribution of patients according to mode of payment. Our findings suggest that ED utilization for minor complaints is not, as previously believed, higher in patients with the inability to pay primary care providers. Rather, subsidized patients (Medicare/Medicaid) appear to use the ED equally for major and minor complaints, while there is an increased utilization by commercially insured patients for minor illnesses and injuries, and a lower rate in patients who are self-pay.

Emergency Service, Hospital↗
PubMedDate not supplied

Distinct criteria for termination of resuscitation in the out-of-hospital setting.

OBJECTIVE: To identify distinct criteria for appropriate on-scene termination of resuscitation efforts for out-of-hospital cardiac arrest when on-scene interventions fail to restore spontaneous circulation. DESIGN: For 18 months, all out-of-hospital cardiac arrests were evaluated prospectively for survival to hospital discharge and for all established survival predictors including age, gender, presenting cardiac rhythm, whether it was a witnessed event, performance of basic cardiopulmonary resuscitation by bystanders, and interval to paramedic arrival and return of spontaneous circulation (ROSC). SETTING: A large municipality with a single, centralized emergency medical services program. PATIENTS: All normothermic adults treated for out-of-hospital, unmonitored, primary cardiac arrest. INTERVENTIONS: Standard advanced cardiac life support provided at the scene by paramedics. MAIN OUTCOME MEASURES: The number and circumstances of patients achieving survival to hospital discharge following failure to achieve on-scene ROSC. RESULTS: Of 1461 consecutive primary cardiac arrests, 139 were monitored (paramedic witnessed), including 59 that occurred en route to the hospital. Of the 1322 unmonitored patients, 370 achieved ROSC at the scene. Only six (0.6%) of the 952 who did not achieve ROSC at the scene survived, and all six were readily identifiable as having persistent ventricular fibrillation. Excluding those patients with persistent ventricular fibrillation, all survivors achieved ROSC within 25 minutes after paramedic arrival. CONCLUSIONS: Excluding patients with persistent ventricular fibrillation, resuscitative efforts can be terminated at the scene when normothermic adults with unmonitored, out-of-hospital, primary cardiac arrest do not regain spontaneous circulation within 25 minutes following standard advanced cardiac life support. These criteria should now be validated in several large centers with high survival rates.

Aged↗