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CPR revisited : the current scenario in Malta

2025-01-16T09:22:19Z

Title: CPR revisited : the current scenario in Malta Abstract: Back in 2016, an editorial in the MMJ presented an overview of cardiopulmonary resuscitation (CPR) in Europe, and highlighted that approximately one person suffers a cardiac arrest every 45 seconds, totalling 2-3,000 per day and 350,000 per annum. The editorial confirmed that, in the majority of cases, cardiac arrest was fatal and <10% of victims of ‘out-of-hospital’ arrest survive to discharge from hospital. Indeed, heart disease is the leading cause of death and tops 3.3 million per annum in developed countries, with 50% of these patients suffering a sudden cardiac arrest. Most succumb at this stage but survival is often associated with significant neurological disability and an inferior quality of life compared with the pre-arrest state. Prompt and effective CPR, especially if associated with timely defibrillation in adults, delivered within 1-2 minutes of a cardiac arrest, may improve the chances of survival 3-4 fold. However, the ‘time to intervention’ is paramount and survival decreases by 10% for every minute delay in the initiation of CPR. Conversely, prompt initiation of effective bystander CPR will more than triple survival.

Are our acute coronary syndrome patients achieving better glycaemic control after admission? : a study

2025-01-16T09:21:42Z

Title: Are our acute coronary syndrome patients achieving better glycaemic control after admission? : a study Authors: Camilleri, Elaine; Buttigieg, Lisa Lauren; Caruana, Maryanne Abstract: BACKGROUND: Diabetes mellitus (DM) is a cardinal cardiovascular risk factor. Tight glycaemic control is advocated as part of primary and secondary cardiovascular disease prevention. The aim of this study was to investigate the impact of acute coronary syndrome (ACS) admission on subsequent glycaemic control in known type I/II DM patients.; METHODS: Patients were included if (a) known to have type I/type II DM prior to admission (b) admitted with ACS under the care of a cardiologist between January and December 2020 and (c) in possession of a haemoglobin A1c (HbA1c) result within 6 weeks of index admission (peri-admission) and a repeat result around 6 months thereafter (follow-up). Peri-admission and follow-up HbA1c levels were compared using Wilcoxon signed-rank test.; RESULTS: One hundred and seventy patients [124 (72.9%) male; mean age 67.88 ± 10.18 years] were included. During index admission, a change in DM treatment was performed in 80 (47.1%) patients, while a diabetology review was requested for 37 (21.8%) patients. A significant reduction in HbA1c levels was demonstrated following an ACS admission with a peri-admission median level of 7.5% (IQR 2.3%) to a follow-up median of 7.1% (IQR 1.7%) (Z statistic -4.145, p<0.001), although at 6 months 119/170 (70%) patients still had an HbA1c above the 6.5% target.; CONCLUSION: Changes in DM treatment and/or advice during ACS admission appear to have an initial beneficial impact on glycaemic control in known diabetics. Aggressive long-term control is necessary to ensure more effective risk reduction.

The effects of a weaning protocol in ITU

2025-01-16T09:20:23Z

Title: The effects of a weaning protocol in ITU Authors: Miceli Demajo, Audrey; Bugeja, Steve; Sciberras, Stephen C. Abstract: BACKGROUND: Protocol driven ventilator discontinuation procedures have reduced ventilator days for patients in Intensive Care Unit (ITU) and are associated with better patient prognosis. In order to improve successful extubations, a weaning protocol was created for the Mater Dei Hospital (MDH) ITU using evidence-based criteria.; AIM: The purpose of this audit was to assess whether implementation of a mechanical ventilation weaning protocol had an impact on successful extubations as well as improved clinician and nursing knowledge regarding weaning.; METHOD: A prospective study was carried out to assess successful extubations before and after implementation of a ventilation weaning protocol. Adult patients who were ventilated for more than 7 days were included in the study. A questionnaire about mechanical ventilation and weaning was distributed to ITU physicians and nurses before and after implementation of the weaning protocol.; RESULTS: We could not find any statistically significant differences in weaning success after the introduction of the weaning protocol. �� retention did not improve after usage of the protocol.; CONCLUSION: The introduction of an ITU weaning protocol at Mater Dei Hospital did not increase the number of successful extubations. Despite enhanced staff perception of weaning, a mechanical ventilation questionnaire did not improve retention of knowledge.

Time to fluid administration in paediatric diabetic ketoacidosis

2025-01-15T10:51:10Z

Title: Time to fluid administration in paediatric diabetic ketoacidosis Authors: Micallef, Maria; Grech, Francesca; Vella, John; Torpiano, John; Formosa, Nancy; Farrugia, Ruth Abstract: BACKGROUND: Diabetic ketoacidosis is a medical emergency and merits prompt fluid therapy. Our aim is to evaluate whether fluids are started within one hour of presentation to hospital for children with diabetic ketoacidosis.; METHODS: This is a retrospective study involving patients with diabetic ketoacidosis presenting to paediatric emergency department at Mater Dei Hospital between 2008 to 2017. Diabetic ketoacidosis was defined as per local protocol. Times at hospital presentation, medical visits in emergency department and wards and at start of fluid administration were recorded. Clinical and biochemical parameters for patients with start of fluids within one hour (Immediate Fluid Treatment) were compared to those with delayed fluid treatment; T-test was used for significance.; RESULTS: Sixty episodes were included, with 34 males (60.7%) and mean age 7.42 years. Fluids were started at a median of 95.5 (IQR: 70.5 - 128.3) minutes following presentation and were mainly started in the admitting ward. Only 18% of patients received fluids within one hour of presentation (n = 11). Bicarbonate and pH levels were significantly lower in these patients, at 7.87 vs 11.48 mmol/l (p = 0.027) and 7.07 vs 7.21 (p = 0.002) respectively, when compared to those with delayed fluid treatment. Significantly more patients in the immediate fluid treatment group needed fluid boluses (73% vs 29%, p = 0.0006).; CONCLUSION: Fluids were delayed more than one hour from presentation in most paediatric diabetic ketoacidosis patients. Consideration should be given to commencing fluids in the paediatric emergency department or expediting their ward transfer, to decrease this delay in starting treatment.