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Wagner H, Hardig BM, Rundgren M, Zughaft D, Harnek J, Götberg M, Olivecrona GK. Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts. Scand J Trauma Resusc Emerg Med 2016; 24:4. [PMID: 26795941 PMCID: PMC4721004 DOI: 10.1186/s13049-016-0198-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/08/2016] [Indexed: 11/21/2022] Open
Abstract
Background Resuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population. Methods Patients presenting at the cath lab with spontaneous circulation, suffering CA and requiring prolonged mechanical CC during cath lab procedures between 2009 and 2013 were included. Circumstances leading to CA, resuscitation parameters and outcomes were evaluated within this cohort. For comparison, patients needing prolonged manual CC in the cath lab in the pre-mechanical CC era were evaluated. Six-month and one year survival with a mechanical CC treatment strategy from 2004 to 2013 was also evaluated. Results Thirty-two patients were included between 2009 and 2013 (24 ST-elevation myocardial infarction (STEMI), 4 non-STEMI, 2 planned PCI, 1 angiogram and 1 intra-aortic counter pulsation balloon pump insertion). Twenty were in cardiogenic shock prior to inclusion. Twenty-five were successfully treated with PCI. Median mechanical CC duration for the total cohort (n = 32) was 34 min (range 5–90), for the 15 patients with circulation discharged from the cath-lab, 15 min (range 5–90), and for the eight discharged alive from hospital, 10 min (range 5–52). Twenty-five percent survived with good neurological outcome at hospital discharge. Ten patients treated with manual CC were included with one survivor. Discussion Eighty-seven percent of the patients included in the mechanical CC cohort had their coronary or cardiac intervention performed during mechanical CC with an 80 % success rate. This shows that the use of mechanical CC during an intervention does not seem to impair the interventional result substantially. The survival rate after one year was 87 %. Conclusions Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good.
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Affiliation(s)
- Henrik Wagner
- Department of Cardiology, Lund University, Lund, Sweden.
| | | | - Malin Rundgren
- Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
| | - David Zughaft
- Department of Cardiology, Lund University, Lund, Sweden.
| | - Jan Harnek
- Department of Cardiology, Lund University, Lund, Sweden.
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He F, Xu P, Wei ZH, Zhang J, Wang J. Complete Recovery With the Chain of Survival After a Prolonged (120 Minutes) Out-of-Hospital Cardiac Arrest Due to Brugada Syndrome: A Case Report. Medicine (Baltimore) 2015; 94:e1107. [PMID: 26166103 PMCID: PMC4504594 DOI: 10.1097/md.0000000000001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a crucial public health problem. To improve outcomes of patients after cardiac arrest, the American Heart Association promotes the concept of the chain of survival.We report a case of a 19-year-old man with no markedly past medical history who suffered from OHCA, and he was resuscitated with cardiopulmonary resuscitation, without interruption, during the rescue process for 120 minutes until return of spontaneous circulation (ROSC). Electrocardiogram on admission showed right bundle branch block and ST segment elevation in leads V1-V2, and the patient's uncle had experienced the same event and had received implantable cardioverter defibrillator (ICD) treatment. Therefore, the patient was diagnosed with Brugada syndrome. Postcardiac arrest care was performed after ROSC, including mild therapeutic hypothermia, hemodynamic monitoring and management, and ICD implantation, and then the patient completely recovered without any noticeable neurological or intellectual deficits in the follow-up examinations.Our case demonstrates that even after an OHCA with prolonged time (120 minutes) until ROSC, survival with a favorable neurological outcome is possible, provided implementation of an extremely effective rescue chain.
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Affiliation(s)
- Fei He
- From the Department of Emergency Medicine (FH, PX, JZ, JW); Department of Cardiology (Z-HW), Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Jiang L, Zhang JS. Mechanical cardiopulmonary resuscitation for patients with cardiac arrest. World J Emerg Med 2014; 2:165-8. [PMID: 25215003 DOI: 10.5847/wjem.j.1920-8642.2011.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 07/16/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although modern cardiopulmonary resuscitation (CPR) substantially decreases the mortality induced by cardiac arrest, cardiac arrest still accounts for over 50% of deaths caused by cardiovascular diseases. In this article, we address the current use of mechanical devices during CPR, and also compare the CPR quality between manual and mechanical chest compression. METHODS We compared the quality and survival rate between manual and mechanical CPR, and then reviewed the mechanical CPR in special circumstance, such as percutaneous coronary intervention, transportation, and other fields. RESULTS Compared with manual compression, mechanical compression can often be done correctly, and thus can compromise survival; can provide high quality chest compressions in a moving ambulance; enhance the flow of blood back to the heart via a rhythmic constriction of the veins; allow ventilation and CPR to be performed simultaneously. CONCLUSION Mechanical devices will be widely used in clinical practice so as to improve the quality of CPR in patients with cardiac arrest.
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Affiliation(s)
- Lei Jiang
- Department of Emergency Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin-Song Zhang
- Department of Emergency Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Implementation of mechanical chest compression in out-of-hospital cardiac arrest in an emergency medical service system. Am J Emerg Med 2013; 31:1196-200. [DOI: 10.1016/j.ajem.2013.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 11/21/2022] Open
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Abstract
Persistent cardiac arrest is often caused by coronary ischemia. Urgent revascularization during on-going resuscitation with the support of percutaneous left ventricular assist devices (PVAD) may be feasible and can have the potential to improve the prognosis. Transport during resuscitation is a challenge that may be overcome with the use of cardiopulmonary resuscitation devices. In the catheterization laboratory, rapid deployment of PVAD may reduce ischemia, contribute to electrical stabilization of the heart, and facilitate definite treatment with percutaneous coronary intervention. After revascularization, PVAD therapy may promote myocardial recovery and improve vital organ perfusion in a critical phase.
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Yu J, Ramadeen A, Tsui AKY, Hu X, Zou L, Wilson DF, Esipova TV, Vinogradov SA, Leong-Poi H, Zamiri N, Mazer CD, Dorian P, Hare GMT. Quantitative assessment of brain microvascular and tissue oxygenation during cardiac arrest and resuscitation in pigs. Anaesthesia 2013; 68:723-35. [PMID: 23590519 DOI: 10.1111/anae.12227] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 01/18/2023]
Abstract
Cardiac arrest is associated with a very high rate of mortality, in part due to inadequate tissue perfusion during attempts at resuscitation. Parameters such as mean arterial pressure and end-tidal carbon dioxide may not accurately reflect adequacy of tissue perfusion during cardiac resuscitation. We hypothesised that quantitative measurements of tissue oxygen tension would more accurately reflect adequacy of tissue perfusion during experimental cardiac arrest. Using oxygen-dependent quenching of phosphorescence, we made measurements of oxygen in the microcirculation and in the interstitial space of the brain and muscle in a porcine model of ventricular fibrillation and cardiopulmonary resuscitation. Measurements were performed at baseline, during untreated ventricular fibrillation, during resuscitation and after return of spontaneous circulation. After achieving stable baseline brain tissue oxygen tension, as measured using an Oxyphor G4-based phosphorescent microsensor, ventricular fibrillation resulted in an immediate reduction in all measured parameters. During cardiopulmonary resuscitation, brain oxygen tension remained unchanged. After the return of spontaneous circulation, all measured parameters including brain oxygen tension recovered to baseline levels. Muscle tissue oxygen tension followed a similar trend as the brain, but with slower response times. We conclude that measurements of brain tissue oxygen tension, which more accurately reflect adequacy of tissue perfusion during cardiac arrest and resuscitation, may contribute to the development of new strategies to optimise perfusion during cardiac resuscitation and improve patient outcomes after cardiac arrest.
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Affiliation(s)
- J Yu
- Departments of Anaesthesia and Physiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Park CI, Roffi M, Bendjelid K, Bonvini RF. Percutaneous noncoronary interventions during continuous mechanical chest compression with the LUCAS-2 device. Am J Emerg Med 2012; 31:456.e1-3. [PMID: 22980369 DOI: 10.1016/j.ajem.2012.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chan-Il Park
- Division of Cardiology, Department of Internal Medicine, Geneva University Hospitals, Switzerland
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Mateos-Rodríguez AA, Navalpotro-Pascual JM, Del Rio Gallegos F, Andrés-Belmonte A. Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review. ACTA ACUST UNITED AC 2012; 15:164-9. [PMID: 22947689 DOI: 10.1016/j.aenj.2012.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.
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Affiliation(s)
- David Rodríguez-Arias
- Institute of Philosophy, Centre for Human and Social Sciences, Spanish National Research Council CSIC, 28037 Madrid, Spain.
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Serrano Moraza A, Del Nogal Sáez F, Alfonso Manterola F. [Coronary revascularization during cardiopulmonary resuscitation. The bridge code]. Med Intensiva 2012; 37:33-43. [PMID: 22402193 DOI: 10.1016/j.medin.2012.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/16/2011] [Accepted: 01/07/2012] [Indexed: 10/28/2022]
Abstract
Cardiac arrest is one of the major current challenges, due to both its high incidence and mortality and the fact that it leads to severe brain dysfunction in over half of the survivors. The so-called coronary origin Bridge Code is presented, based on the international resuscitation recommendations (2005, 2010). In accordance with a series of strict predictive criteria, this code makes it possible to: (1) select refractory CPR patients with a high or very high presumption of underlying coronary cause; (2) evacuate the patient using mechanical chest compressors [LucasTM, Autopulse®], maintaining coronary and brain perfusion pressures; (3) allow coronary revascularization access during resuscitation maneuvering (PTCA during ongoing CPR); (4) induce early hypothermia; and (5) facilitate post-cardiac arrest intensive care. In the case of treatment failure, the quality of hemodynamic support makes it possible to establish a second bridge to non-heart beating organ donation.
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Affiliation(s)
- A Serrano Moraza
- Medicina de Emergencia Basada en la Evidencia MEBE, España; Servicio de Urgencias Médicas Summa 112, Madrid
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Havel C, van Tulder R, Schreiber W, Haugk M, Richling N, Trimmel H, Malzer R, Herkner H. Randomized crossover trial comparing physical strain on advanced life support providers during transportation using real-time automated feedback. Acad Emerg Med 2011; 18:860-7. [PMID: 21843222 DOI: 10.1111/j.1553-2712.2011.01124.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Feedback devices provide verbal and visual real-time information on cardiopulmonary resuscitation (CPR) quality. Feedback devices can improve the quality of CPR during transportation. It remains unclear if feedback has an effect on the physical strain felt by providers during ongoing CPR. OBJECTIVES The objective was to assess the influence of real-time automated feedback on physical strain of rescuers during ongoing chest compressions in different means of transportation. METHODS The study was a randomized crossover trial comparing physical strain on advanced life support (ALS) providers during chest compressions using real-time automated feedback in different transport environments: 1) a moving ambulance and 2) a flying helicopter. The authors measured objective and subjective measures of physical strain and calculated the difference in the rate pressure product (RPP) after 8 minutes of external chest compressions. RESULTS There was no difference in the RPP (mean intraindividual difference = 21; 95% confidence interval [CI] = -1,438 to 1,480; p = 0.98) between using the feedback device versus no feedback. There was no significant interaction of vehicle type on the effect of feedback on the RPP. Feedback resulted in a significant mean perceived exertion reduction of a Borg scale score by 0.89 points (95% CI = 0.42 to 1.35; p < 0.001). For systolic and diastolic blood pressure, for serum lactate concentrations, and for the modified Nine Hole Peg Test (NHPT; measurement of fine motor skills), we found no statistically significant differences. CONCLUSIONS Feedback devices for CPR during transportation do not have an effect on objective components of physical strain, but decrease perceived exertion in experienced rescuers in an experimental setting.
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Affiliation(s)
- Christof Havel
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity. Resuscitation 2011; 82:155-9. [DOI: 10.1016/j.resuscitation.2010.10.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 08/30/2010] [Accepted: 10/29/2010] [Indexed: 11/23/2022]
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Liao Q, Sjöberg T, Paskevicius A, Wohlfart B, Steen S. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs. BMC Cardiovasc Disord 2010; 10:53. [PMID: 21029406 PMCID: PMC2987900 DOI: 10.1186/1471-2261-10-53] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 10/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005) for cardiopulmonary resuscitation (CPR). The aim of the present study was to compare manual CPR with LUCAS-CPR. METHODS 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8) or LUCAS-CPR (n = 8) was started and run for 20 minutes. Professional paramedics gave manual chest compression's alternating in 2-minute periods. Ventilation, one breath for each 10 compressions, was given to all animals. Defibrillation and, if needed, adrenaline were given to obtain a return of spontaneous circulation (ROSC). RESULTS The mean coronary perfusion pressure was significantly (p < 0.01) higher in the mechanical group, around 20 mmHg, compared to around 5 mmHg in the manual group. In the manual group 54 rib fractures occurred compared to 33 in the LUCAS group (p < 0.01). In the manual group one severe liver injury and one pressure pneumothorax were also seen. All 8 pigs in the mechanical group achieved ROSC, as compared with 3 pigs in the manual group. CONCLUSIONS LUCAS-CPR gave significantly higher coronary perfusion pressure and significantly fewer rib fractures than manual CPR in this porcine model.
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Affiliation(s)
- Qiuming Liao
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital/Lund, Lund, Sweden
| | - Trygve Sjöberg
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital/Lund, Lund, Sweden
| | - Audrius Paskevicius
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital/Lund, Lund, Sweden
| | - Björn Wohlfart
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital/Lund, Lund, Sweden
| | - Stig Steen
- Department of Cardiothoracic Surgery, Lund University and Skåne University Hospital/Lund, Lund, Sweden
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Cardiac arrest in the catheterisation laboratory: A 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010; 81:383-7. [DOI: 10.1016/j.resuscitation.2009.11.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/14/2009] [Accepted: 11/11/2009] [Indexed: 11/18/2022]
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Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: A report on 6 cases. Resuscitation 2010; 81:493-7. [DOI: 10.1016/j.resuscitation.2010.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/31/2010] [Accepted: 02/02/2010] [Indexed: 11/18/2022]
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Havel C, Schreiber W, Trimmel H, Malzer R, Haugk M, Richling N, Riedmüller E, Sterz F, Herkner H. Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback. Resuscitation 2010; 81:59-64. [DOI: 10.1016/j.resuscitation.2009.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 08/19/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Ischemic cardiac arrest represents a challenge for optimal emergency revascularization therapy. A percutaneous left ventricular assist device (LVAD) may be beneficial. OBJECTIVE To determine the effect of a percutaneous LVAD during cardiac arrest without chest compressions and to assess the effect of fluid loading. DESIGN Totally, 16 pigs randomized to either conventional or intensive fluid with LVAD support during ventricular fibrillation (VF). SETTING Acute experimental trial with pigs under general anesthesia. SUBJECTS Farm pigs of both sexes. INTERVENTIONS After randomization for fluid infusion, VF was induced by balloon occlusion of the proximal left anterior descending artery. LVAD and fluid were started after VF had been induced. MEASUREMENTS Brain, kidney, myocardial tissue perfusion, and cardiac index were measured with the microsphere injection technique at baseline, 3, and 15 minutes. Additional hemodynamic monitoring continued until 30 minutes. MAIN RESULTS At 15 minutes, vital organ perfusion was maintained without significant differences between the two groups. Mean cardiac index at 3 minutes of VF was 1.2 L x min(-1) x m2 (29% of baseline, p < 0.05). Mean perfusion at 3 minutes was 65% in the brain and 74% in the myocardium compared with baseline (p < 0.05), then remained unchanged during the initial 15 minutes. At 30 minutes, LVAD function was sustained in 11 of 16 animals (8 of 8 intensified fluid vs. 3 of 8 conventional fluid) and was associated with intensified fluid loading (p < 0.001). CONCLUSIONS During VF, a percutaneous LVAD may sustain vital organ perfusion. A potential clinical role of the device during cardiac arrest has yet to be established.
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Friberg H, Rundgren M. Submersion, accidental hypothermia and cardiac arrest, mechanical chest compressions as a bridge to final treatment: a case report. Scand J Trauma Resusc Emerg Med 2009; 17:7. [PMID: 19232087 PMCID: PMC2650678 DOI: 10.1186/1757-7241-17-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 02/20/2009] [Indexed: 11/10/2022] Open
Abstract
Three young men were trapped in a car at the bottom of a canal at two meters depth, after losing control of their vehicle. They were brought up by rescue divers and found in cardiac arrest. One of three patients had return of spontaneous circulation (ROSC), at 47 min after the accident. This sole survivor had the longest submersion time of the three and he received continued mechanical chest compressions during transportation to the hospital. His temperature at admission was 26.9 degrees C, he was rewarmed to 33 degrees C and kept there for 24 h, followed by continued rewarming to normothermia. On day three, he woke up from coma and was discharged from the intensive care unit after one week. At follow-up six months later, he had a complete cerebral recovery but still had myoclonic twitches in the lower extremities. A mechanical device facilitates chest compressions during transportation and may be beneficial as a bridge to final treatment in the hospital. We recommend that comatose patients after submersion, accidental hypothermia and cardiac arrest are treated with mild hypothermia for 12-24 h.
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Affiliation(s)
- Hans Friberg
- Department of Anesthesia and Intensive Care, Lund University Hospital, Lund, Scania, Sweden.
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Experimental and clinical use of ongoing mechanical cardiopulmonary resuscitation during angiography and percutaneous coronary intervention. Crit Care Med 2008; 36:S405-8. [DOI: 10.1097/ccm.0b013e31818a7ee9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Physical strain on advanced life support providers in different out of hospital environments. Resuscitation 2008; 77:81-6. [DOI: 10.1016/j.resuscitation.2007.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/11/2007] [Accepted: 09/20/2007] [Indexed: 11/18/2022]
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Larsen AI, Hjørnevik AS, Ellingsen CL, Nilsen DWT. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. Resuscitation 2007; 75:454-9. [PMID: 17618034 DOI: 10.1016/j.resuscitation.2007.05.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 05/02/2007] [Accepted: 05/04/2007] [Indexed: 10/23/2022]
Abstract
Mechanical chest compression may be necessary to make coronary intervention possible during resuscitation. We report our experience using the Lund University Cardiac Arrest System (LUCAS, Jolife, Lund, Sweden) which is a gas-driven sternal compression device that incorporates a suction cup for active decompression. During the last 13 months LUCAS has been used in our catheterisation laboratory to maintain adequate organ perfusion pressure in 13 patients with cardiac arrest or severe hypotension and bradycardia (male/female ratio 1.6, mean age 59+/-19). The mean compression time was 105+/-60min (range 45-240), and the mean systolic and diastolic blood pressure obtained was 81+/-23 and 34+/-21mmHg, respectively. Angiography and eventually percutanous coronary intervention was possible in all cases during ongoing automatic chest compression. Three patients survived the procedure, but no patients were discharged alive. In two cases we found inadequate flow in the anterior descending artery, and in one case the invasive measurements revealed inadequate coronary perfusion pressure. There were no excessive intra-thoracic or intra-abdominal injuries. We conclude that the LUCAS device is suitable during cardiac catheterisation and intervention, and the device ensures an adequate systemic blood pressure in most patients without life-threatening injuries.
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Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Norway.
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Havel C, Schreiber W, Riedmuller E, Haugk M, Richling N, Trimmel H, Malzer R, Sterz F, Herkner H. Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene. Resuscitation 2007; 73:264-70. [PMID: 17276575 DOI: 10.1016/j.resuscitation.2006.09.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 09/06/2006] [Accepted: 09/11/2006] [Indexed: 11/25/2022]
Abstract
CONTEXT Transport of patients during resuscitation is a critical procedure. In both, ambulances and helicopters the quality of resuscitation is potentially hampered due to the movement of the vehicle and confined space. To date, however, no direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance has been made. OBJECTIVE Direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance. DESIGN The study was performed in July 2005 as a randomised cross-over trial comparing different environments for resuscitation. SETTING Medical University of Vienna. PARTICIPANTS Eleven European Resuscitation Council (ERC) approved health care professionals. INTERVENTIONS Interventions during resuscitation: (a) in a moving ambulance, (b) in a flying helicopter, were compared to those staying at the (c) scene (control). Each participant performed resuscitation in all three environments. MAIN OUTCOME MEASURES Quality of chest compression during resuscitation. RESULTS Compared to resuscitation at the scene, efficiency of chest compressions during a helicopter flight was 86% and 95% in the moving ambulance 95%. There were no differences in secondary outcomes (time without chest compression, total number of incorrect hand position relative to total compressions, and total number of incorrect pressure release relative to total compressions). CONCLUSIONS Resuscitation during transport is feasible and relatively efficient. There is some difference between the environments, but there is no relevant difference between helicopters and ambulances regarding the effectiveness of CPR.
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Affiliation(s)
- Christof Havel
- Department of Emergency Medicine, Medical University of Vienna, Waehringerguertel 18-20/6D, A-1090 Vienna, Austria
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Abstract
OBJECTIVE The purpose of this study is to review cardiopulmonary resuscitation hemodynamics and vital organ blood flow in animal models with the use of the impedance threshold device (ITD) and to correlate these findings with the results of human clinical trials. RESULTS Animal studies have demonstrated near normalization of cerebral blood flow and an increase between 50% and 100% in cardiac blood flow with use of the ITD. Coincident coronary perfusion pressure is significantly increased with the ITD. Results of human clinical trials generally reflect the data seen in animal models, with near normal blood pressure during active compression-decompression cardiopulmonary resuscitation and the ITD, near doubling of blood pressure with standard cardiopulmonary resuscitation plus the ITD, and significantly increased short-term survival rates. CONCLUSIONS Improved vital organ perfusion with ITD use during cardiopulmonary resuscitation is an important advance in resuscitation. Incorporation of the ITD into protocols that improve other aspects of the care of patients during cardiac arrest and after successful resuscitation should result in further benefit from the ITD.
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Affiliation(s)
- Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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26
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Abstract
Therapeutic hypothermia for cardiac arrest survivors has emerged as a highly effective means of improving neurologic outcome. There are a number of purported mechanisms by which it is felt to be effective, but the exact mechanism is unknown. This article reviews the biochemical mechanisms of injury occurring in cardiac arrest, as well as the avenues that hypothermia takes to combat this injury. It also reviews the animal model data in support of this, as well as the newer animal studies that may help to improve the field. Several human studies of hypothermia in cardiac arrest have been performed, and this article reviews these for their methods and shortcomings. Our currently recommended guidelines for performing therapeutic hypothermia are presented. With therapeutic hypothermia comes potential risks to the patient, primarily affecting cardiac, metabolic, and hematologic systems, and these risks and their management are discussed. Multiple methods of cooling exist, including selective cranial as well as systemic cooling by internal or external approaches. Finally, the article discusses the current research in the field of hypothermia for cardiac arrest and implications for future practice.
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Affiliation(s)
- David M Greer
- Massachusetts General Hospital, ACC 835, 55 Fruit Street, Boston, MA 02114, USA.
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Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G, Baubin M, Dirks B, Wenzel V. Erweiterte Reanimationsmaßnahmen für Erwachsene (ALS). Notf Rett Med 2006; 9:38-80. [PMID: 32834772 PMCID: PMC7371819 DOI: 10.1007/s10049-006-0796-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J. P. Nolan
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - C. D. Deakin
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - J. Soar
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - B. W. Böttiger
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - G. Smith
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
| | - M. Baubin
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
| | - B. Dirks
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm
- Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Prittwitzstraße 43, 89075 Ulm
| | - V. Wenzel
- Klinik für Anästhesie und allgemeine Intensivmedizin, Universität, Innsbruck, Österreich
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28
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Vatsgar TT, Ingebrigtsen O, Fjose LO, Wikstrøm B, Nilsen JE, Wik L. Cardiac arrest and resuscitation with an automatic mechanical chest compression device (LUCAS) due to anaphylaxis of a woman receiving caesarean section because of pre-eclampsia. Resuscitation 2006; 68:155-9. [PMID: 16221521 DOI: 10.1016/j.resuscitation.2005.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
We report a case of anaphylaxis with pulseless electrical activity (PEA)(verified by ECG and a radial intra-arterial line) in a 30-year-old woman who received 3G Promiten (dextran-1) and a prophylactic intra-venous infusion of Macrodex (dextran) for postoperative thromboembolism during caesarean section for pre-eclampsia in the 24th week of gestation. Manual chest compressions, followed by mechanical chest compressions (LUCAS, Jolife, Lund, Sweden), were performed for 50min before restoration of spontaneous circulation (ROSC). She awoke the next day with no sequelae. She had some suction cup marks on the sternum but otherwise no complications of the chest compressions. At follow up by phone 1 month later, she and her baby were doing well.
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29
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Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G. European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005; 67 Suppl 1:S39-86. [PMID: 16321716 DOI: 10.1016/j.resuscitation.2005.10.009] [Citation(s) in RCA: 606] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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Steen S, Sjöberg T, Olsson P, Young M. Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 2005; 67:25-30. [PMID: 16159692 DOI: 10.1016/j.resuscitation.2005.05.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 05/22/2005] [Indexed: 11/26/2022]
Abstract
Lund University Cardiopulmonary Assist System (LUCAS) is a new gas-driven CPR device providing automatic chest compression and active decompression. This is a report of the first 100 consecutive cases treated with LUCAS due to out-of-hospital cardiac arrest (58% asystole, 42% ventricular fibrillation (VF)). Safety aspects were also investigated and it was found that LUCAS can be used safely regarding noise levels and oxygen concentrations within the ambulance. A crash test (10G) showed no displacement of the device from the manikin. Of the 71 patients with witnessed cardiac arrest, 39% received bystander CPR. In those 28 patients where LUCAS-CPR was initiated more than 15 min after the ambulance alarm and in the 29 unwitnessed cases, none survived for 30 days. Of the 43 witnessed cases treated with LUCAS within 15 min, 24 had VF and 15 (63%) of these cases achieved a stable return of spontaneous circulation (ROSC) and 6 (25%) of them survived with a good neurological recovery after 30 days; 5 (26%) of the 19 patients with asystole achieved ROSC and 1 (5%) survived for over 30 days. One patient where ROSC could not be achieved was transported with on-going LUCAS-CPR to the catheter laboratory and after PCI for an occluded LAD a stable ROSC occurred, but the patient never regained consciousness and died 15 days later. To conclude, establishment of an adequate cerebral circulation as quickly as possible after cardiac arrest is mandatory for a good outcome. In this report patients with a witnessed cardiac arrest receiving LUCAS-CPR within 15 min from the ambulance call had a 30-day survival of 25% in VF and 5% in asystole, but if the interval was more than 15 min, there were no 30-day survivors.
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Affiliation(s)
- Stig Steen
- Department of Cardiothoracic Surgery, Heart Lung Division, University Hospital of Lund, SE-221 85 Lund, Sweden
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31
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In this issue. Resuscitation 2005. [DOI: 10.1016/j.resuscitation.2005.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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