Mediterranean Journal of Emergency Medicine & Acute Care

Introduction: The quality of care and patient outcome of out-of-hospital cardiac arrest (OHCA) are affected by different factors, one of which is the hospital teaching status. This study aims to assess the association between teaching status of hospitals and  survival rates.

Methods: This retrospective observational study utilized the Nationwide Emergency Department Sample (NEDS) database of the year 2014 (released in 2016). The study sample included OHCA 122,776 patients. Descriptive analysis was performed. Patients’ characteristics were compared according to the hospital teaching status. This was followed by a multivariate analysis to assess the impact of the hospital teaching status on the patients’ survival at hospital discharge after controlling for confounding factors.

Results: A total of 122,776 patients with OHCA were included in this study. The average age was 65.91 years with male predominance (61.7%). Around 62.1% of patients were admitted to metropolitan teaching hospitals. Overall survival to hospital discharge was 6.4%. Survival was higher in patients who were treated in a metropolitan teaching hospital in comparison with those who presented to a metropolitan non-teaching hospital (7.2 % versus 4.9%, p<0.001). After adjusting for confounders, patients’ survival to hospital discharge was similar in the two groups (teaching and non-teaching metropolitan hospitals) (OR=0.909, 95% CI 0.776 – 1.065).

Conclusion: In this study, there was no significant association between teaching status of US metropolitan hospitals and survival of OHCA patients. OHCA patients may be transferred to the nearest hospital regardless of teaching status in US metropolitan areas.

The cholinesterase activity (AcCh) assay finds an important place in the diagnosis of acute poisoning by cholinesterase inhibitor pesticides, allowing the indication and the efficacy evaluation of antidote treatment with atropine and oximes. AcCh is also a biomarker of effect in occupational exposure to cholinesterase inhibitor pesticides. However, some factors may disrupt AcCh levels and distort the interpretation of the assay results. Hence, the present review aimed to summarize the factors and the variations that may have an impact on the interpretation of AcCh. Indeed, butyrylcholinesterase and acetylcholinesterase are subject to wide physiological individual variations, such as to age, weight and height. Genetic and pathological state may also be factors influencing AcCh levels. The consumption of drugs and daily exposure to some toxicants may also disrupt the AcCh levels, either by direct action on the enzyme or by disrupting its synthesis. In addition, analytical variations and interferences are to be considered while interpreting the results. These variations could induce an underestimation or an overestimation of the cholinesterase activity levels and could lead to diagnostic errors. To conclude, the dosage of cholinesterase activity constitutes an important biomarker of effect in clinical and occupational toxicology. Its interpretation has to be done delicately, taking into consideration all the factors and variations that may influence it.