1
|
Pinto VL, Dezfulian C. If at First You Don't Get ROSC: Dose, Dose Again…. Crit Care Med 2024; 52:1481-1483. [PMID: 39145705 DOI: 10.1097/ccm.0000000000006364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Venessa L Pinto
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Houston, TX
| | - Cameron Dezfulian
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Houston, TX
- Department of Anesthesiology and Critical Care, Baylor College of Medicine, Houston, TX
| |
Collapse
|
2
|
Kienzle MF, Morgan RW, Reeder RW, Ahmed T, Berg RA, Bishop R, Bochkoris M, Carcillo JA, Carpenter TC, Cooper KK, Diddle JW, Federman M, Fernandez R, Franzon D, Frazier AH, Friess SH, Frizzola M, Graham K, Hall M, Horvat C, Huard LL, Maa T, Manga A, McQuillen PS, Meert KL, Mourani PM, Nadkarni VM, Naim MY, Pollack MM, Sapru A, Schneiter C, Sharron MP, Tabbutt S, Viteri S, Wolfe HA, Sutton RM. Epinephrine Dosing Intervals Are Associated With Pediatric In-Hospital Cardiac Arrest Outcomes: A Multicenter Study. Crit Care Med 2024; 52:1344-1355. [PMID: 38833560 PMCID: PMC11326980 DOI: 10.1097/ccm.0000000000006334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Data to support epinephrine dosing intervals during cardiopulmonary resuscitation (CPR) are conflicting. The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes. We hypothesized that dosing intervals less than 3 minutes would be associated with improved neurologic survival compared with greater than or equal to 3 minutes. DESIGN This study is a secondary analysis of The ICU-RESUScitation Project (NCT028374497), a multicenter trial of a quality improvement bundle of physiology-directed CPR training and post-cardiac arrest debriefing. SETTING Eighteen PICUs and pediatric cardiac ICUs in the United States. PATIENTS Subjects were 18 years young or younger and 37 weeks old or older corrected gestational age who had an index cardiac arrest. Patients who received less than two doses of epinephrine, received extracorporeal CPR, or had dosing intervals greater than 8 minutes were excluded. INTERVENTIONS The primary exposure was an epinephrine dosing interval of less than 3 vs. greater than or equal to 3 minutes. MEASUREMENTS AND MAIN RESULTS The primary outcome was survival to discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1-2 or no change from baseline. Regression models evaluated the association between dosing intervals and: 1) survival outcomes and 2) CPR duration. Among 382 patients meeting inclusion and exclusion criteria, median age was 0.9 years (interquartile range 0.3-7.6 yr) and 45% were female. After adjustment for confounders, dosing intervals less than 3 minutes were not associated with survival with favorable neurologic outcome (adjusted relative risk [aRR], 1.10; 95% CI, 0.84-1.46; p = 0.48) but were associated with improved sustained return of spontaneous circulation (ROSC) (aRR, 1.21; 95% CI, 1.07-1.37; p < 0.01) and shorter CPR duration (adjusted effect estimate, -9.5 min; 95% CI, -14.4 to -4.84 min; p < 0.01). CONCLUSIONS In patients receiving at least two doses of epinephrine, dosing intervals less than 3 minutes were not associated with neurologic outcome but were associated with sustained ROSC and shorter CPR duration.
Collapse
Affiliation(s)
- Martha F Kienzle
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tageldin Ahmed
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Robert Bishop
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Matthew Bochkoris
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Joseph A Carcillo
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Todd C Carpenter
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Kellimarie K Cooper
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - J Wesley Diddle
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Myke Federman
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA
| | - Richard Fernandez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Deborah Franzon
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Aisha H Frazier
- Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE
| | - Stuart H Friess
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Meg Frizzola
- Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE
| | - Kathryn Graham
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Mark Hall
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Christopher Horvat
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Leanna L Huard
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA
| | - Tensing Maa
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Arushi Manga
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI
| | - Peter M Mourani
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Maryam Y Naim
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Murray M Pollack
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC
| | - Anil Sapru
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA
| | - Carleen Schneiter
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Matthew P Sharron
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC
| | - Sarah Tabbutt
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA
| | - Shirley Viteri
- Department of Pediatrics, Nemours Children's Health, Delaware and Thomas Jefferson University, Wilmington, DE
| | - Heather A Wolfe
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
3
|
Wolf J, Buckley GJ, Rozanski EA, Fletcher DJ, Boller M, Burkitt-Creedon JM, Weigand KA, Crews M, Fausak ED. 2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR. J Vet Emerg Crit Care (San Antonio) 2024; 34 Suppl 1:44-75. [PMID: 38924633 DOI: 10.1111/vec.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps. DESIGN Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats. CONCLUSIONS These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.
Collapse
Affiliation(s)
- Jacob Wolf
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Elizabeth A Rozanski
- Department of Clinical Sciences, Tufts University School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jamie M Burkitt-Creedon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Kelly A Weigand
- Cary Veterinary Medical Library, Auburn University, Auburn, Alabama, USA
- Flower-Sprecher Veterinary Library, Cornell University, Ithaca, New York, USA
| | - Molly Crews
- Department of Small Animal Clinical Sciences, Texas A&M University College of Veterinary Medicine & Biomedical Sciences, College Station, Texas, USA
| | - Erik D Fausak
- University Library, University of California, Davis, Davis, California, USA
| |
Collapse
|
4
|
Goodarzi A, Abdi A, Ghasemi H, Darvishi N, Jalali R. The outcomes of cardiopulmonary resuscitation and their predictors during the coronavirus 2019 pandemic in Iran. BMC Emerg Med 2023; 23:94. [PMID: 37605176 PMCID: PMC10441697 DOI: 10.1186/s12873-023-00860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can negatively affect different healthcare-related outcomes. Nonetheless, there is limited information about its effects on different healthcare-related outcomes. This study aimed at evaluating the outcomes of cardiopulmonary resuscitation (CPR) and their predictors during the COVID-19 pandemic in Iran. METHODS This cross-sectional study was conducted on 1253 patients who had undergone CPR in the emergency wards of teaching hospitals in the west of Iran from the beginning of the first wave to the end of the third epidemic wave of COVID-19 in Iran, between February 20, 2020, and January 20, 2021. Data were collected using the National CPR Documentation Forms developed based on the Utstein Style and routinely used for all patients with cardiac arrest (CA). The SPSS (v. 20.0) program was used to analyze the data through the Chi-square, Fisher's exact, and Mann-Whitney U tests and logistic regression analysis. RESULTS Participants' age mean was 64.62 ± 17.54 years. Age mean among participants with COVID-19 was eight years more than other participants. Most participants were male (64.09%) and had at least one underlying disease (64.99%). The total rates of the return of spontaneous circulation (ROSC) and CPR-discharge survival were respectively 15.3% and 3.8% among all participants, 20.25% and 5.17% among participants without COVID-19, and 8.96% and 2.04% among participants with COVID-19. The significant predictors of ROSC were age, affliction by COVID-19, affliction by underlying diseases, baseline rhythm, delay in epinephrine administration, and epinephrine administration time interval, while the significant predictors of CPR-discharge survival were age and baseline rhythm. CONCLUSIONS The total rates of ROSC and CPR-discharge survival were respectively 15.3% and 3.8% among all participants. The rates of ROSC and CPR to discharge survival among patients without COVID-19 are respectively 2.26 and 2.53 times more than the rates among patients with COVID-19.
Collapse
Affiliation(s)
- Afshin Goodarzi
- Department of Prehospital Emergency, School of paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
5
|
Ortmann LA, Reeder RW, Raymond TT, Brunetti MA, Himebauch A, Bhakta R, Kempka J, di Bari S, Lasa JJ. Epinephrine dosing strategies during pediatric extracorporeal cardiopulmonary resuscitation reveal novel impacts on survival: A multicenter study utilizing time-stamped epinephrine dosing records. Resuscitation 2023; 188:109855. [PMID: 37257678 PMCID: PMC10890910 DOI: 10.1016/j.resuscitation.2023.109855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe epinephrine dosing distribution using time-stamped data and assess the impact of dosing strategy on survival after ECPR in children. METHODS This was a retrospective study at five pediatric hospitals of children <18 years with an in-hospital ECPR event. Mean number of epinephrine doses was calculated for each 10-minute CPR interval and compared between survivors and non-survivors. Patients were also divided by dosing strategy into a frequent epinephrine group (dosing interval of ≤5 min/dose throughout the first 30 minutes of the event), and a limited epinephrine group (dosing interval of ≤5 min/dose for the first 10 minutes then >5 min/dose for the time between 10 and 30 minutes). RESULTS A total of 191 patients were included. Epinephrine was not evenly distributed throughout ECPR, with 66% of doses being given during the first half of the event. Mean number of epinephrine doses was similar between survivors and non-survivors the first 10 minutes (2.7 doses). After 10 minutes, survivors received fewer doses than non-survivors during each subsequent 10-minute interval. Adjusted survival was not different between strategy groups [OR of survival for frequent epinephrine strategy: 0.78 (95% CI 0.36-1.69), p = 0.53]. CONCLUSIONS Survivors received fewer doses than non-survivors after the first 10 minutes of CPR and although there was no statistical difference in survival based on dosing strategy, the findings of this study question the conventional approach to EPCR analysis that assumes dosing is evenly distributed.
Collapse
Affiliation(s)
- Laura A Ortmann
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX, USA
| | - Marissa A Brunetti
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam Himebauch
- Division of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rupal Bhakta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jessica Kempka
- Division of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Shauna di Bari
- Division of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Javier J Lasa
- Division of Cardiology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX, USA; Division of Critical Care, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
6
|
Wongtanasarasin W, Srisurapanont K, Nishijima DK. How Epinephrine Administration Interval Impacts the Outcomes of Resuscitation during Adult Cardiac Arrest: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020481. [PMID: 36675411 PMCID: PMC9860904 DOI: 10.3390/jcm12020481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Current guidelines for treating cardiac arrest recommend administering 1 mg of epinephrine every 3−5 min. However, this interval is based solely on expert opinion. We aimed to investigate the impact of the epinephrine administration interval (EAI) on resuscitation outcomes in adults with cardiac arrest. We systematically reviewed the PubMed, EMBASE, and Scopus databases. We included studies comparing different EAIs in adult cardiac arrest patients with reported neurological outcomes. Pooled estimates were calculated using the IVhet meta-analysis, and the heterogeneities were assessed using Q and I2 statistics. We evaluated the study risk of bias and overall quality using validated bias assessment tools. Three studies were included. All were classified as “good quality” studies. Only two reported the primary outcome. Compared with a recommended EAI of 3−5 min, a favorable neurological outcome was not significantly different in patients with the other frequencies: for <3 min, odds ratio (OR) 1.93 (95% CI: 0.82−4.54); for >5 min, OR 1.01 (95% CI: 0.55−1.87). For survival to hospital discharge, administering epinephrine for less than 3 min was not associated with a good outcome (OR 1.66, 95% CI: 0.89−3.10). Moreover, EAI of >5 min did not pose a benefit (OR 0.87, 95% CI: 0.68−1.11). Our review showed that EAI during CPR was not associated with better hospital outcomes. Further clinical trials are necessary to determine the optimal dosing interval for epinephrine in adults with cardiac arrest.
Collapse
Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
- Correspondence: ; Tel.: +1-279-2225217
| | - Karan Srisurapanont
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Daniel K. Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
| |
Collapse
|
7
|
Ramachandran S, Bruckner M, Kapadia V, Schmölzer GM. Chest compressions and medications during neonatal resuscitation. Semin Perinatol 2022; 46:151624. [PMID: 35752466 DOI: 10.1016/j.semperi.2022.151624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Prolonged resuscitation in neonates, although quite rare, may occur in response to profound intractable bradycardia as a result of asphyxia. In these instances, chest compressions and medications may be necessary to facilitate return of spontaneous circulation. While performing chest compressions, the two thumb method is preferred over the two finger technique, although several newer approaches are under investigation. While the ideal compression to ventilation ratio is still uncertain, a 3:1 ratio remains the recommendation by the Neonatal Resuscitation Program. Use of feedback mechanisms to optimize neonatal cardiopulmonary resuscitation (CPR) show promise and are currently under investigation. While performing optimal cardiac compressions to pump blood, use of medications to restore spontaneous circulation will likely be necessary. Current recommendations are that epinephrine, an endogenous catecholamine be used preferably intravenously or by intraosseous route, with the dose repeated every 3-5 minutes until return of spontaneous circulation. Finally, while the need for volume replacement is rare, it may be considered in instances of acute blood loss or poor response to resuscitation.
Collapse
Affiliation(s)
| | - Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Vishal Kapadia
- Division of Neonatology, UT Southwestern Medical Center at Dallas
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
8
|
Shaffner DH, Callaway CW. Epinephrine Administration Intervals: Seeing the Forest for the Trees. Am J Respir Crit Care Med 2021; 204:885-887. [PMID: 34411505 PMCID: PMC8534614 DOI: 10.1164/rccm.202107-1667ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Donald H Shaffner
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University Baltimore, Maryland
| | - Clifton W Callaway
- Department of Emergency Medicine University of Pittsburgh Pittsburgh, Pennsylvania
| |
Collapse
|
9
|
Kienzle MF, Morgan RW, Faerber JA, Graham K, Katcoff H, Landis WP, Topjian AA, Kilbaugh TJ, Nadkarni VM, Berg RA, Sutton RM. The Effect of Epinephrine Dosing Intervals on Outcomes from Pediatric In-Hospital Cardiac Arrest. Am J Respir Crit Care Med 2021; 204:977-985. [PMID: 34265230 DOI: 10.1164/rccm.202012-4437oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Animal studies of cardiac arrest suggest shorter epinephrine dosing intervals than currently recommended (every 3-5 minutes) may be beneficial in select circumstances. OBJECTIVES To evaluate the association between epinephrine dosing intervals and pediatric cardiac arrest outcomes. METHODS Single-center retrospective cohort study of children (<18 years of age) who received ≥1 minute of cardiopulmonary resuscitation and ≥2 doses of epinephrine for an index in-hospital cardiac arrest. Exposure was epinephrine dosing interval: ≤2 minutes (frequent epinephrine) vs. >2 minutes. Primary outcome was survival to hospital discharge with a favorable neurobehavioral outcome (Pediatric Cerebral Performance Category score 1-2 or unchanged). Logistic regression evaluated the association between dosing interval and outcomes; additional analyses explored duration of CPR as a mediator. In a subgroup, the effect of dosing interval on diastolic blood pressure was investigated. MEASUREMENTS AND MAIN RESULTS Between January 2011 and December 2018, 125 patients met inclusion/exclusion criteria; 33 (26%) received frequent epinephrine. Frequent epinephrine was associated with increased odds of survival with favorable neurobehavioral outcome (aOR 2.56; CI95 1.07, 6.14; p=0.036), with 66% of the association mediated by CPR duration. Delta diastolic blood pressure was greater after the second dose of epinephrine among patients who received frequent epinephrine (median [IQR] 6.3 [4.1, 16.9] vs. 0.13 [-2.3, 1.9] mmHg, p=0.034). CONCLUSIONS In patients who received at least two doses of epinephrine, dosing intervals ≤2 minutes were associated with improved neurobehavioral outcomes compared to dosing intervals >2 minutes. Mediation analysis suggests improved outcomes are largely due to frequent epinephrine shortening duration of CPR.
Collapse
Affiliation(s)
- Martha F Kienzle
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Ryan W Morgan
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Jennifer A Faerber
- The Children's Hospital of Philadelphia, 6567, CPCE, Philadelphia, Pennsylvania, United States
| | - Kathryn Graham
- The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care, Philadelphia, Pennsylvania, United States
| | - Hannah Katcoff
- The Children's Hospital of Philadelphia, 6567, Department of Biomedical and Health Informatics, Philadelphia, Pennsylvania, United States
| | - William P Landis
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Alexis A Topjian
- University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - Todd J Kilbaugh
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States
| | - Vinay M Nadkarni
- The Children's Hospital of Philadelphia, 6567, Anesthesia and Critical Care, Philadelphia, Pennsylvania, United States
| | - Robert A Berg
- The Children's Hospital of Philadelphia, 6567, Anesthesiology Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States
| | - Robert M Sutton
- The Children's Hospital of Philadelphia, 6567, Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States;
| |
Collapse
|
10
|
Fukuda T, Kaneshima H, Matsudaira A, Chinen T, Sekiguchi H, Ohashi-Fukuda N, Inokuchi R, Kukita I. Epinephrine dosing interval and neurological outcome in out-of-hospital cardiac arrest. Perfusion 2021; 37:835-846. [PMID: 34120526 DOI: 10.1177/02676591211025163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current guidelines for cardiopulmonary resuscitation (CPR) recommend that standard-dose epinephrine be administered every 3-5 minutes during cardiac arrest. However, there is a knowledge gap regarding the optimal epinephrine dosing interval. This study aimed to examine the association between epinephrine dosing intervals and outcomes after out-of-hospital cardiac arrest (OHCA). METHODS This was a nationwide population-based observational study using data from a Japanese government-led registry of OHCA, including patients who experienced OHCA in Japan from 2011 to 2017. We defined the epinephrine dosing interval as the time interval between the first epinephrine administration and return of spontaneous circulation in the prehospital setting, divided by the total number of epinephrine doses. The primary outcome was 1-month neurologically favorable survival. RESULTS A total of 10,965 patients (mean (SD) age, 75.8 (14.3) years; 59.8% male) were included. The median epinephrine dosing interval was 3.5 minutes (IQR, 2.5-4.5; mean (SD), 3.6 (1.8)). Only approximately half of the patients received epinephrine administration with a standard dosing interval, as recommended in the current CPR guidelines. After multivariable adjustment, compared with the standard dosing interval, neither shorter nor longer epinephrine dosing intervals were associated with neurologically favorable survival after OHCA (Short vs Standard: adjusted OR 0.87 [95%CI 0.66-1.15]; and Long vs Standard: adjusted OR 1.08 [95%CI 0.76-1.55]). Similar associations were observed in propensity score-matched analyses. CONCLUSIONS The epinephrine dosing interval was not associated with 1-month neurologically favorable survival after OHCA. Our findings do not deny the recommended epinephrine dosing interval in the current CPR guidelines.
Collapse
Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.,Department of Emergency and Critical Care Medicine, Toranomon Hospital, Tokyo, Japan
| | - Hirotsugu Kaneshima
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Aya Matsudaira
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takumi Chinen
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroshi Sekiguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoko Ohashi-Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Inokuchi
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
11
|
Baird A, Coppler PJ, Callaway CW, Dezfulian C, Flickinger KL, Elmer J. Rate of intra-arrest epinephrine administration and early post-arrest organ failure after in-hospital cardiac arrest. Resuscitation 2020; 156:15-18. [PMID: 32853724 DOI: 10.1016/j.resuscitation.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/15/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Data supporting epinephrine administration during resuscitation of in-hospital cardiac arrest (IHCA) are limited. We hypothesized that more frequent epinephrine administration would predict greater early end-organ dysfunction and worse outcomes after IHCA. METHODS We performed a retrospective cohort study including patients resuscitated from IHCA at one of 67 hospitals between 2010 and 2019 who were ultimately cared for at a single tertiary care hospital. Our primary exposure of interest was rate of intra-arrest epinephrine bolus administration (mg/min). We considered several outcomes, including severity of early cardiovascular failure (modeled using Sequential Organ Failure Assessment (SOFA) cardiovascular subscore), early neurological and early global illness severity injury (modeled as Pittsburgh Cardiac Arrest Category (PCAC)). We used generalized linear models to test for independent associations between rate of epinephrine administration and outcomes. RESULTS We included 695 eligible patients. Mean age was 62 ± 15 years, 416 (60%) were male and 172 (26%) had an initial shockable rhythm. Median arrest duration was 16 [IQR 9-25] min, and median rate of epinephrine administration was 0.2 [IQR 0.1-0.3] mg/min. Higher rate of epinephrine predicted worse PCAC, and lower survival in patients with initial shockable rhythms. There was no association between rate of epinephrine and other outcomes. CONCLUSION Higher rates of epinephrine administration during IHCA are associated with more severe early global illness severity.
Collapse
Affiliation(s)
- Andrew Baird
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick J Coppler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cameron Dezfulian
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katharyn L Flickinger
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | |
Collapse
|
12
|
Gul NH, Chatterjee S. Commentary: To epi or not to epi-that is the question. J Thorac Cardiovasc Surg 2020; 160:1524-1525. [PMID: 32622571 DOI: 10.1016/j.jtcvs.2020.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nabeel H Gul
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Subhasis Chatterjee
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
| |
Collapse
|
13
|
Mohr NM, Faine B. Epinephrine in Out-of-Hospital Cardiac Arrest: What Is the Role of the Timing Interval? Ann Emerg Med 2019; 74:807-808. [DOI: 10.1016/j.annemergmed.2019.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 11/29/2022]
|
14
|
The Association of the Average Epinephrine Dosing Interval and Survival With Favorable Neurologic Status at Hospital Discharge in Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2019; 74:797-806. [DOI: 10.1016/j.annemergmed.2019.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 11/18/2022]
|
15
|
Roubaud JC, Pelaccia T, Bartier JC, Schmitt J, Forato M. Pourquoi les médecins urgentistes ne respectent-ils pas les recommandations internationales relatives à l’administration d’adrénaline dans l’arrêt cardiaque ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : La prise en charge de l’arrêt cardiaque repose sur des recommandations internationales définissant notamment un schéma précis d’administration d’adrénaline. Chez les médecins exerçant la médecine d’urgence préhospitalière, il existe pourtant d’importantes variabilités interindividuelles concernant l’usage de l’adrénaline. L’objectif de cette étude était d’identifier les facteurs à l’origine du nonrespect des recommandations.
Matériel et méthodes : Nous avons mené une étude qualitative prospective et multicentrique fondée sur des entretiens individuels semi-structurés auprès de médecins urgentistes. Après retranscription, ils ont fait l’objet d’une analyse thématique par le premier auteur.
Résultats : Treize entretiens ont été menés. Ils ont permis de conclure qu’un non-respect des recommandations concernant l’administration de l’adrénaline était retrouvé chez sept médecins. Les interviewés expliquaient essentiellement ces écarts par une volonté de majorer les chances de succès de la réanimation (ce qui les conduisait à augmenter la posologie), ou bien en fin de réanimation, à vider la seringue d’adrénaline afin d’administrer un bolus final considéré comme la « dernière chance » pour le patient. Le poids du patient, les comorbidités et l’âge pouvaient également conduire à ajuster la posologie, tout comme le souhait de mettre en oeuvre une « réanimation d’attente », le niveau de connaissance des dernières recommandations par les praticiens ou leurs habitudes personnelles.
Conclusion : Il existe, chez les médecins urgentistes, une importante variabilité dans l’usage de l’adrénaline lors de la prise en charge préhospitalière de l’arrêt cardiaque. Ces écarts de pratique imposent la mise en oeuvre de mesures destinées à favoriser le respect des recommandations scientifiques.
Collapse
|
16
|
Al-Mulhim MA, Alshahrani MS, Asonto LP, Abdulhady A, Almutairi TM, Hajji M, Alrubaish MA, Almulhim KN, Al-Sulaiman MH, Al-Qahtani LB. Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting. J Int Med Res 2019; 47:4272-4283. [PMID: 31311363 PMCID: PMC6753528 DOI: 10.1177/0300060519860952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest
(OHCA). However, whether epinephrine improves or adversely affects OHCA
outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine
administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the
Emergency Department at King Fahd University Hospital, Saudi Arabia between
2005 and 2015. The primary outcomes were mortality and survival rates until
discharge. The impact of epinephrine administration timing and frequency on
patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the
overall mean age of 50.4 ± 20.6 years. The overall survival rate until
hospital discharge was 12%. There was no statistically significant
difference between in gender, age, or time interval to the first epinephrine
dose in the survival and non-survival groups. Only the number of epinephrine
doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with
survivors. However, a causal relationship between OHCA patient survival and
epinephrine dose and time cannot be confirmed. Further studies are needed to
investigate whether the long-term outcomes in OHCA patients are influenced
by the timing and frequency of epinephrine administration.
Collapse
Affiliation(s)
- Mohammed A Al-Mulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Mohammed S Alshahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Laila Perlas Asonto
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Ahmad Abdulhady
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Talal M Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | | | - Mohammed A Alrubaish
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Khalid N Almulhim
- College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | | | - Layla B Al-Qahtani
- Children's Specialist Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
17
|
Madsen Hardig B, Kern KB, Wagner H. Mechanical chest compressions for cardiac arrest in the cath-lab: when is it enough and who should go to extracorporeal cardio pulmonary resuscitation? BMC Cardiovasc Disord 2019; 19:134. [PMID: 31159737 PMCID: PMC6547539 DOI: 10.1186/s12872-019-1108-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/17/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Treating patients in cardiac arrest (CA) with mechanical chest compressions (MCC) during percutaneous coronary intervention (PCI) is now routine in many coronary catheterization laboratories (cath-lab) and more aggressive treatment modalities, including extracorporeal CPR are becoming more common. The cath-lab setting enables monitoring of vital physiological parameters and other clinical factors that can potentially guide the resuscitation effort. This retrospective analysis attempts to identify such factors associated with ROSC and survival. METHODS In thirty-five patients of which background data, drugs used during the resuscitation and the intervention, PCI result, post ROSC-treatment and physiologic data collected during CPR were compared for prediction of ROSC and survival. RESULTS Eighteen (51%) patients obtained ROSC and 9 (26%) patients survived with good neurological outcome. There was no difference between groups in regards of background data. Patients arriving in the cath-lab with ongoing resuscitation efforts had lower ROSC rate (22% vs 53%; p = 0.086) and no survivors (0% vs 50%, p = 0.001). CPR time also differentiated resuscitation outcomes (ROSC: 18 min vs No ROSC: 50 min; p = 0.007 and Survivors: 10 min vs No Survivors: 45 min; p = 0.001). Higher arterial diastolic blood pressure was associated with ROSC: 30 mmHg vs No ROSC: 19 mmHg; p = 0.012). CONCLUSION Aortic diastolic pressure during CPR is the most predictive physiological parameter of resuscitation success. Ongoing CPR upon arrival at the cath-lab and continued MCC beyond 10-20 min in the cath-lab were both predictive of poor outcomes. These factors can potentially guide decisions regarding escalation and termination of resuscitation efforts.
Collapse
Affiliation(s)
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, Rm. 005145, Tucson, AZ, 85724, USA
| | - Henrik Wagner
- Department of Cardiology, Lund University, 22242, Lund, Sweden
| |
Collapse
|
18
|
Vasopressors during adult cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 139:106-121. [DOI: 10.1016/j.resuscitation.2019.04.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
|
19
|
Lundin A, Rylander C, Karlsson T, Herlitz J, Lundgren P. Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest. Resuscitation 2019; 140:64-71. [PMID: 31125581 DOI: 10.1016/j.resuscitation.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/31/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA). DESIGN Retrospective observational study. SETTING Analysis of data extracted from a national cardiac arrest registry. STUDY POPULATION Patients >18 years old with IHCA from January 2015 up to June 2017. OUTCOME MEASURES Primary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1-2. RESULTS Of 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline. CONCLUSIONS In our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.
Collapse
Affiliation(s)
- Andreas Lundin
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- Prehospen - Centre for Pre-Hospital Research, University of Borås, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Lundgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Prehospen- Centre for Pre-Hospital Research, University of Borås, Sweden
| |
Collapse
|
20
|
Pippi B, Merkel S, Staudt KJ, Teixeira ML, de Araújo BV, Zanette RA, Andrade SF, Fuentefria AM. Oral clioquinol is effective in the treatment of a fly model of
Candida
systemic infection. Mycoses 2019; 62:475-481. [DOI: 10.1111/myc.12888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/06/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Bruna Pippi
- Programa de Pós‐Graduação em Microbiologia Agrícola e do AmbienteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Simone Merkel
- Programa de Pós‐Graduação em Ciências Biológicas: Farmacologia e TerapêuticaUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Keli Jaqueline Staudt
- Programa de Pós‐Graduação em Ciências FarmacêuticasUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | | | - Bibiana Verlindo de Araújo
- Programa de Pós‐Graduação em Ciências FarmacêuticasUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Régis Adriel Zanette
- Programa de Pós‐Graduação em Ciências Biológicas: Farmacologia e TerapêuticaUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Saulo Fernandes Andrade
- Programa de Pós‐Graduação em Microbiologia Agrícola e do AmbienteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Programa de Pós‐Graduação em Ciências FarmacêuticasUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Alexandre Meneghello Fuentefria
- Programa de Pós‐Graduação em Microbiologia Agrícola e do AmbienteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Programa de Pós‐Graduação em Ciências FarmacêuticasUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| |
Collapse
|
21
|
Fothergill RT, Emmerson AC, Iyer R, Lazarus J, Whitbread M, Nolan JP, Deakin CD, Perkins GD. Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest. Resuscitation 2019; 138:316-321. [PMID: 30708076 DOI: 10.1016/j.resuscitation.2019.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/24/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. METHODS A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest. RESULTS Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. CONCLUSION Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.
Collapse
Affiliation(s)
- Rachael T Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom.
| | - Amber C Emmerson
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, United Kingdom
| | - Rajeshwari Iyer
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, United Kingdom
| | - Johanna Lazarus
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, United Kingdom
| | - Mark Whitbread
- Medical Directorate, London Ambulance Service NHS Trust, London, United Kingdom
| | - Jerry P Nolan
- Bristol Medical School, University of Bristol, Bristol, BS8 1TH, United Kingdom; Royal United Hospital, Bath, BA3 1NG, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Charles D Deakin
- Respiratory BRU, University Hospital Southampton, SO16 6YD, United Kingdom; South Central Ambulance Service NHS Foundation Trust, Otterbourne, United Kingdom
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, United Kingdom
| |
Collapse
|
22
|
Towards long-acting adrenaline for cardiopulmonary resuscitation: Production and characterization of a liposomal formulation. Int J Pharm 2018; 557:105-111. [PMID: 30586629 DOI: 10.1016/j.ijpharm.2018.12.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/01/2023]
Abstract
The use of adrenaline in cardiopulmonary resuscitation is a long-standing medical procedure, recommended by several international guidelines. However, its unspecific action on adrenergic receptors and the need for repeated administrations pose serious concerns about its safety, the balance between benefits and risks being still under debate. To address this issue, a sustained release nano-formulation of adrenaline was developed. Adrenaline was encapsulated into PEGylated, anionic liposomes by a pH-driven loading technique. Particular attention was devoted to the prevention of oxidation of adrenaline by optimizing the preparative process and including an optimal amount of antioxidants in the formulation. The vesicles obtained were then characterized for size, zeta-potential, and lamellarity, while their morphology was described by cryo-TEM. The controlled release properties were confirmed by two different in vitro release-testing methods, and the biocompatibility was assayed on human endothelial cells in vitro.
Collapse
|
23
|
O'reilly M, Schmölzer GM. Evidence for vasopressors during cardiopulmonary resuscitation in newborn infants. Minerva Pediatr 2018; 71:159-173. [PMID: 30511562 DOI: 10.23736/s0026-4946.18.05452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An estimated 0.1% of term infants and up to 15% of preterm infants (2-3 million worldwide) need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite these interventions, infants receiving extensive resuscitation in the DR have a high incidence of mortality and neurologic morbidity. Successful resuscitation from neonatal cardiac arrest requires the delivery of high-quality chest compression using the most effective vasopressor with the optimal dose, timing, and route of administration during CPR. Current neonatal resuscitation guidelines recommend administration of epinephrine once CPR has started at a dose of 0.01-0.03 mg/kg preferably given intravenously, with repeated doses every 3-5 min until return of spontaneous circulation. This review examines the current evidence for epinephrine and alternative vasopressors during neonatal cardiopulmonary resuscitation.
Collapse
Affiliation(s)
- Megan O'reilly
- Center for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada.,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Georg M Schmölzer
- Center for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada - .,Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
24
|
Gough CJR, Nolan JP. The role of adrenaline in cardiopulmonary resuscitation. Crit Care 2018; 22:139. [PMID: 29843791 PMCID: PMC5975505 DOI: 10.1186/s13054-018-2058-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/10/2018] [Indexed: 11/10/2022] Open
Abstract
Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research.
Collapse
Affiliation(s)
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK. .,Resuscitation Medicine, Bristol Medical School, University of Bristol, Bristol, UK.
| |
Collapse
|
25
|
Kawase K, Ujiie H, Takaki M, Yamashita K. Clinical outcome of canine cardiopulmonary resuscitation following the RECOVER clinical guidelines at a Japanese nighttime animal hospital. J Vet Med Sci 2018; 80:518-525. [PMID: 29375087 PMCID: PMC5880836 DOI: 10.1292/jvms.17-0107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A set of evidence-based consensus guidelines for cardiopulmonary resuscitation (CPR) in dogs and cats (RECOVER guidelines) was published in 2012. The purpose of this study was to investigate the clinical outcomes of CPR
performed according to those guidelines in dogs. A total of 141 dogs with cardiopulmonary arrest (CPA) were identified and underwent CPR between January 2012 and December 2015 at the Sapporo Nighttime Animal Hospital.
CPR was performed according to no-consensus traditional veterinary CPR procedures in 68 dogs (TRADITIONAL group), and according to the RECOVER guidelines in 73 dogs (RECOVER group). There was no significant difference in
the age, body weight, or time from CPA identification to initiation of CPR between the TRADITIONAL and RECOVER groups (median [range]: 10 [0–16] vs. 11 [0–16] years; 6.6 [1.0–58.6] vs. 5.5 [1.1–30.4] kg; and 0 [0–30] vs.
0 [0–30] min, respectively). In the TRADITIONAL group, 12 dogs (17%) achieved a return of spontaneous circulation (ROSC), but none survived to hospital discharge. However, 32 dogs (43%) in the RECOVER group achieved
ROSC, and 4 dogs (5%) were discharged from the hospital. Incorporating the RECOVER guidelines into clinical practice significantly improved the ROSC rate (P<0.001). However, the rate of survival to
hospital discharge was still low. This may suggest that a superior intensive care unit that provides advanced post-CPA care could benefit veterinary CPR patients.
Collapse
Affiliation(s)
- Koudai Kawase
- Sapporo Nighttime Animal Hospital, Sapporo, Hokkaido 060-0062, Japan.,Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| | - Hazuki Ujiie
- Sapporo Nighttime Animal Hospital, Sapporo, Hokkaido 060-0062, Japan
| | - Motonori Takaki
- Sapporo Nighttime Animal Hospital, Sapporo, Hokkaido 060-0062, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8591, Japan
| |
Collapse
|
26
|
Hoyme DB, Patel SS, Samson RA, Raymond TT, Nadkarni VM, Gaies MG, Atkins DL. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation 2017; 117:18-23. [DOI: 10.1016/j.resuscitation.2017.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
|
27
|
Seecheran R, Seecheran V, Persad S, Lalla S, Seecheran NA. Contrast Media-Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report. J Investig Med High Impact Case Rep 2017; 5:2324709617712735. [PMID: 28607937 PMCID: PMC5455850 DOI: 10.1177/2324709617712735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023] Open
Abstract
Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs) have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies.
Collapse
Affiliation(s)
- Rajeev Seecheran
- The University of the West Indies, Mt. Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- North West Regional Health Authority, Port-of-Spain, Trinidad and Tobago
| | - Sangeeta Persad
- North West Regional Health Authority, Port-of-Spain, Trinidad and Tobago
| | - Sasha Lalla
- Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Naveen Anand Seecheran
- The University of the West Indies, Mt. Hope, Trinidad and Tobago.,Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| |
Collapse
|
28
|
Abstract
Epinephrine use in the delivery room for resuscitation of the newborn is associated with significant morbidity and mortality. Evidence for optimal dose, timing, and route of administration of epinephrine during neonatal resuscitation comes largely from extrapolated adult or animal literature. In this review, we provide the current recommendations for use of epinephrine during neonatal resuscitation and also the evidence behind these recommendations. In addition, we review the current proposed mechanism of action of epinephrine during neonatal resuscitation, review its adverse effects, and identify gaps in knowledge requiring urgent research.
Collapse
Affiliation(s)
- Vishal S. Kapadia
- Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myra H. Wyckoff
- Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
29
|
Pinto M, Solevåg AL, OʼReilly M, Aziz K, Cheung PY, Schmölzer GM. Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review. Neonatology 2017; 111:37-44. [PMID: 27522216 DOI: 10.1159/000447960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/24/2016] [Indexed: 11/19/2022]
Abstract
AIM Guidelines for newborn resuscitation state that if the heart rate does not increase despite adequate ventilation and chest compressions, adrenaline administration should be considered. However, controversy exists around the safety and effectiveness of adrenaline in newborn resuscitation. The aim of this review was to summarise a selection of the current knowledge about adrenaline during resuscitation and evaluate its relevance to newborn infants. METHODS A search in PubMed, Embase, and Google Scholar until September 1, 2015, using search terms including adrenaline/epinephrine, cardiopulmonary resuscitation, death, severe brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and adrenaline versus vasopressin/placebo. RESULTS Adult data indicate that adrenaline improves the return of spontaneous circulation (ROSC) but not survival to hospital discharge. Newborn animal studies reported that adrenaline might be needed to achieve ROSC. Intravenous administration (10-30 μg/kg) is recommended; however, if there is no intravenous access, a higher endotracheal dose (50-100 μg/kg) is needed. The safety and effectiveness of intraosseous adrenaline remain undetermined. Early and frequent dosing does not seem to be beneficial. In fact, negative hemodynamic effects have been observed, especially with doses ≥30 μg/kg intravenously. Little is known about adrenaline in birth asphyxia and in preterm infants, but observations indicate that hemodynamics and neurological outcomes may be impaired by adrenaline administration in these conditions. However, a causal relationship between adrenaline administration and outcomes cannot be established from the few available retrospective studies. Alternative vasoconstrictors have been investigated, but the evidence is scarce. CONCLUSION More research is needed on the benefits and risks of adrenaline in asphyxia-induced bradycardia or cardiac arrest during perinatal transition.
Collapse
Affiliation(s)
- Merlin Pinto
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alta., Canada
| | | | | | | | | | | |
Collapse
|
30
|
Morales-Cané I, Valverde-León MDR, Rodríguez-Borrego MA. Epinephrine in cardiac arrest: systematic review and meta-analysis. Rev Lat Am Enfermagem 2016; 24:e2821. [PMID: 27982306 PMCID: PMC5171778 DOI: 10.1590/1518-8345.1317.2821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/07/2016] [Indexed: 02/06/2023] Open
Abstract
Objective evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.
Collapse
Affiliation(s)
- Ignacio Morales-Cané
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Universidad de Córdoba, Córdoba, Spain
| | | | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Universidad de Córdoba, Córdoba, Spain. Hospital Universitario Reina Sofía, Córdoba, Spain
| |
Collapse
|
31
|
The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2016; 103:125-130. [DOI: 10.1016/j.resuscitation.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/16/2015] [Accepted: 12/16/2015] [Indexed: 11/22/2022]
|
32
|
Assar S, Husseinzadeh M, Nikravesh AH, Davoodzadeh H. The Success Rate of Pediatric In-Hospital Cardiopulmonary Resuscitation in Ahvaz Training Hospitals. SCIENTIFICA 2016; 2016:9648140. [PMID: 27293983 PMCID: PMC4884828 DOI: 10.1155/2016/9648140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 04/07/2016] [Accepted: 04/19/2016] [Indexed: 06/06/2023]
Abstract
Research Objective. This study determined the outcome of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest and factors influencing it in two training hospitals in Ahvaz. Method. Patients hospitalized in the pediatric wards and exposed to CPR during hospital stay were included in the study (September 2013 to May 2014). The primary outcome of CPR was assumed to be the return of spontaneous circulation (ROSC) and the secondary outcome was assumed to be survival to discharge. The neurological outcome of survivors was assessed using the Pediatric Cerebral Performance Category (PCPC) method. Results. Of the 279 study participants, 138 patients (49.4%) showed ROSC, 81 patients (29%) survived for 24 hours after the CPR, and 33 patients (11.8%) survived to discharge. Of the surviving patients, 16 (48.5%) had favorable neurological outcome. The resuscitation during holidays resulted in fewer ROSC. Multivariate analysis showed that longer CPR duration, CPR by junior residents, growth deficiency, and prearrest vasoactive drug infusion were associated with decreased survival to discharge (p < 0.05). Infants and patients with respiratory disease had higher survival rates. Conclusion. The rate of successful CPR in our study was lower than rates reported by developed countries. However, factors influencing the outcome of CPR were similar. These results reflect the necessity of paying more attention to pediatric CPR training, postresuscitation conditions, and expansion of intensive care facilities.
Collapse
Affiliation(s)
- Shideh Assar
- Pediatric Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Mohsen Husseinzadeh
- Pediatric Department, Abuzar Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran
| | | | - Hannaneh Davoodzadeh
- Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Medical Research Center, Jundishapur Health Development Co., Tehran, Iran
| |
Collapse
|
33
|
Hardig BM, Götberg M, Rundgren M, Götberg M, Zughaft D, Kopotic R, Wagner H. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study. Resuscitation 2016; 101:77-83. [PMID: 26876006 DOI: 10.1016/j.resuscitation.2016.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND This porcine study was designed to explore the effects of repetitive intravenous adrenaline doses on physiologic parameters during CPR. METHODS Thirty-six adult pigs were randomised to four injections of: adrenaline 0.02 mg(kgdose)(-1), adrenaline 0.03 mg(kgdose)(-1) or saline control. The effect on systolic, diastolic and mean arterial blood pressure, cerebral perfusion pressure (CePP), end tidal carbon dioxide (ETCO2), arterial oxygen saturation via pulse oximetry (SpO2), cerebral tissue oximetry (SctO2), were analysed immediately prior to each injection and at peak arterial systolic pressure and arterial blood gases were analysed at baseline and after 15 min. RESULT In the group given 0.02 mg(kgdose)(-1), there were increases in all arterial blood pressures at all 4 pressure peaks but CePP only increased significantly after peak 1. A decrease in ETCO2 following peak 1 and 2 was observed. SctO2 and SpO2 were lowered following injection 2 and beyond. In the group given a 0.03 mg(kgdose)(-1), all ABP's increased at the first 4 pressure peaks but CePP only following 3 pressure peaks. Lower ETCO2, SctO2 and SpO2 were seen at peak 1 and beyond. In the two adrenaline groups, pH and Base Excess were lower and lactate levels higher compared to baseline as well as compared to the control. CONCLUSION Repetitive intravenous adrenaline doses increased ABP's and to some extent also CePP, but significantly decreased organ and brain perfusion. The institutional protocol number: Malmö/Lund Committee for Animal Experiment Ethics, approval reference number: M 192-10.
Collapse
Affiliation(s)
| | | | - Malin Rundgren
- Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | | | - David Zughaft
- Department of Cardiology, Lund University, Lund, Sweden
| | | | - Henrik Wagner
- Department of Cardiology, Lund University, Lund, Sweden
| |
Collapse
|
34
|
Lundin A, Djärv T, Engdahl J, Hollenberg J, Nordberg P, Ravn-Fischer A, Ringh M, Rysz S, Svensson L, Herlitz J, Lundgren P. Drug therapy in cardiac arrest: a review of the literature. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:54-75. [DOI: 10.1093/ehjcvp/pvv047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023]
|
35
|
Pan J, Zhu JY, Kee HS, Zhang Q, Lu YQ. A review of compression, ventilation, defibrillation, drug treatment, and targeted temperature management in cardiopulmonary resuscitation. Chin Med J (Engl) 2015; 128:550-4. [PMID: 25673462 PMCID: PMC4836263 DOI: 10.4103/0366-6999.151115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Important studies of cardiopulmonary resuscitation (CPR) techniques influence the development of new guidelines. We systematically reviewed the efficacy of some important studies of CPR. Data Sources: The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1964 to 2014. Study Selection: Original articles and critical reviews about CPR techniques were selected for review. Results: The survival rate after out-of-hospital cardiac arrest (OHCA) is improving. This improvement is associated with the performance of uninterrupted chest compressions and simple airway management procedures during bystander CPR. Real-time feedback devices can be used to improve the quality of CPR. The recommended dose, timing, and indications for adrenaline (epinephrine) use may change. The appropriate target temperature for targeted temperature management is still unclear. Conclusions: New studies over the past 5 years have evaluated various aspects of CPR in OHCA. Some of these studies were high-quality randomized controlled trials, which may help to improve the scientific understanding of resuscitation techniques and result in changes to CPR guidelines.
Collapse
Affiliation(s)
| | | | | | | | - Yuan-Qiang Lu
- Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| |
Collapse
|
36
|
|
37
|
Abstract
PURPOSE OF REVIEW Whereas there is clear evidence for improved survival with cardiopulmonary resuscitation (CPR) and defibrillation during cardiac arrest management, there is today lacking evidence that any of the recommended and used drugs lead to any long-term benefit for the patients. In this review, we try to discuss our current view on why advanced life support (ALS) today can be performed without the use of drugs, and instead gain all focus on improving the tasks we know improve survival: CPR and defibrillation. RECENT FINDINGS Previous and recent cardiac arrest drug studies have been reviewed. These are mostly consisting of retrospective register data, some experimental data and a few new randomized trials. The alternative drug-free ALS concept is also discussed with relevant studies. SUMMARY There is currently no evidence to support any specific drugs during cardiac arrest. Good-quality CPR, early defibrillation and goal-directed postresuscitation care is more important. Healthcare systems should not prioritize implementation of unproven drugs before good quality of care can be documented. More drug studies are indeed required, and future research needs to incorporate better diagnostic tools to test more specific and tailored therapies that account for underlying causes and individual responsiveness.
Collapse
|
38
|
McIntyre RL, Hopper K, Epstein SE. Assessment of cardiopulmonary resuscitation in 121 dogs and 30 cats at a university teaching hospital (2009-2012). J Vet Emerg Crit Care (San Antonio) 2014; 24:693-704. [DOI: 10.1111/vec.12250] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Robin L. McIntyre
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Kate Hopper
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- William R. Pritchard Veterinary Medical Teaching Hospital; Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| |
Collapse
|