Bernadette B. Hickey

Automated external defibrillators and in-hospital cardiac arrest: Patient survival and device performance at an Australian teaching hospital

AIMS To evaluate the effect of automated external defibrillators (AEDs) on patient survival and to describe the performance of AEDs after in-hospital cardiac arrest. METHODS Prospectively collected data were analysed for cardiac arrests in the general patient care areas of a teaching hospital during the 3 years before and the 3 years after the deployment of AEDs. The association between availability of an AED and survival to hospital discharge was assessed using multivariate logistic regression. AED performance during automated management of the initial rhythms was assessed using information captured by the AEDs. RESULTS There were 84 cardiac arrests in the AED period and 82 in the pre-AED period. Patient and event characteristics were similar in each period. The initial rhythm was shockable in 16% of cases. Return of spontaneous circulation was higher in the AED period (54% vs. 35%, P=0.02) but the proportion of hospital survivors in each period was similar (22% vs. 19%, P=0.56). The adjusted odds ratio for hospital survival when an AED was available was 1.22 (95% CI 0.53-2.84, P=0.64). An AED was applied in 77/84 (92%) possible cases. Median interruption to chest compressions was 12s (inter-quartile range 12-13). An automated shock was delivered in 8/13 (62%) possible cases. CONCLUSIONS Availability of AEDs was not independently associated with hospital survival. Shockable presenting rhythms were not common and, in keeping with the manufacturers specifications, the AEDs did not shock all potentially shockable rhythms. The hands-off time associated with automated rhythm management was considerable.

Factors relating to consent for organ donation: prospective data on potential organ donors

Obtaining family consent to organ donation is a significant obstacle to improving further Australian deceased organ donation rates. Currently, neither the consent rates for donors eligible to donate after circulatory death, nor factors that influence decision to decline or consent to donation in general are known in Australia.

KHA-CARI guideline: KHA-CARI adaptation of the KDIGO Clinical Practice Guideline for Acute Kidney Injury.

Department of Nephrology and The University of Melbourne Department of Medicine, St. Vincent’s Hospital, Intensive Care Unit, Austin Hospital, Organ and Tissue Donation Department and Intensive Care Unit, St Vincent’s Hospital, Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Monash Medical Centre, Melbourne, Victoria, Department of Renal Medicine, Royal Brisbane Women’s Hospital, Brisbane, Queensland, Department of Nephrology, Prince of Wales Hospital and Clinical School, Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Concord Clinical School and The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia; and Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand

Australian emergency doctors' and nurses' acceptance and knowledge regarding brain death: a national survey.

Healthcare staffs acceptance of brain death (BD) being a valid determination of death is essential for optimized organ and tissue donation (OTD) rates. Recently, resources to increase Australian OTD rates have been aimed at emergency departments (ED) as a significant missed donor potential was discovered.

Donation after cardiac death: Are Australian emergency clinicians supportive?

To improve organ donation processes and outcomes, many Australian hospitals have introduced donation after cardiac death (DCD) following the 2010 publication of the National Protocol for DCD. As emergency clinicians play a significant role in identifying potential DCD donors, it is critical to assess their support and knowledge. Although many support DCD, most are unaware of the protocol or procedures regarding DCD. Education is needed and desired by many emergency clinicians.

Donation after cardiac death

To improve organ donation processes and outcomes, many Australian hospitals have introduced donation after cardiac death (DCD) following the 2010 publication of the National Protocol for DCD. As emergency clinicians play a significant role in identifying potential DCD donors, it is critical to assess their support and knowledge. Although many support DCD, most are unaware of the protocol or procedures regarding DCD. Education is needed and desired by many emergency clinicians.

Donation after cardiac death: are Australian emergency clinicians supportive?: Brief Communications

To improve organ donation processes and outcomes, many Australian hospitals have introduced donation after cardiac death (DCD) following the 2010 publication of the National Protocol for DCD. As emergency clinicians play a significant role in identifying potential DCD donors, it is critical to assess their support and knowledge. Although many support DCD, most are unaware of the protocol or procedures regarding DCD. Education is needed and desired by many emergency clinicians.

Author reply: To PMID 23841760.

1 Marck CH, Neate SL, Weiland TJ, Hickey BB, Jelinek GA. Donation after cardiac death: are Australian emergency clinicians supportive? Intern Med J 2013; 43: 816–9. 2 Kennedy M, Kennedy J. Historical and ethical aspects of organ donation after induced cardiac death. Intern Med J 2013; 43 (Suppl 3): 4. 3 DeVita MA, Rade V, Snyder JV. Procuring organs from a non-heart-beating cadaver: a case report. Kennedy Inst Ethics J 1993; 3: 371–85.