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Gamberini L, Del Giudice D, Tartaglione M, Allegri D, Coniglio C, Pastori A, Gordini G, Semeraro F. Logistic and cognitive-emotional barriers experienced by first responders when alarmed to get dispatched to out-of-hospital cardiac arrest events: a region-wide survey. Intern Emerg Med 2024; 19:813-822. [PMID: 38123905 DOI: 10.1007/s11739-023-03487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs' perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs' perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs' decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Antonio Pastori
- Settore Assistenza Ospedaliera, Direzione Generale Cura Della Persona, Salute E Welfare, Assessorato Politiche Per La Salute, Regione Emilia, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
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Pereira SJDS, Lee DH, Park JS, Kang C, Lee BK, Yoo IS, Lee IH, Kim M, Lee JG. Grey-to-White Matter Ratio Values in Early Head Computed Tomography (CT) as a Predictor of Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Based on Severity of Hypoxic-Ischemic Brain Injury. J Emerg Med 2024:S0736-4679(24)00113-6. [PMID: 38851906 DOI: 10.1016/j.jemermed.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/10/2024] [Accepted: 03/23/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Hypoxic-ischemic brain injury (HIBI) is a common complication of out-of-hospital cardiac arrest (OHCA). OBJECTIVES We investigated whether grey-to-white matter ratio (GWR) values, measured using early head computed tomography (HCT), were associated with neurologic outcomes based on the severity of HIBI in survivors of OHCA. METHODS This retrospective multicenter study included adult comatose OHCA survivors who underwent an HCT scan within 2 h after the return of spontaneous circulation. HIBI severity was assessed using the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) scale (low, moderate, and severe). Poor neurologic outcomes were defined as Cerebral Performance Categories 3 to 5 at 6 months after OHCA. RESULTS Among 354 patients, 27% were women and 224 (63.3%) had poor neurologic outcomes. The distribution of severity was 19.5% low, 47.5% moderate, and 33.1% severe. The area under the receiver operating curves of the GWR values for predicting rCAST severity (low, moderate, and severe) were 0.52, 0.62, and 0.79, respectively. The severe group had significantly higher predictive performance than the moderate group (p = 0.02). Multivariate logistic regression analysis revealed a significant association between GWR values and poor neurologic outcomes in the moderate group (adjusted odds ratio = 0.012, 95% CI 0.0-0.54, p = 0.02). CONCLUSIONS In this cohort study, GWR values measured using early HCT demonstrated variations in predicting neurologic outcomes based on HIBI severity. Furthermore, GWR in the moderate group was associated with poor neurologic outcomes.
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Affiliation(s)
- Sidonio J da Silva Pereira
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea; Emergency Department of Guido Valadares National Hospital, Avenida Dom. Martino Lopes, Culu Hun, Cristo Rey, Dili, Timor-Leste
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
| | - Changshin Kang
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea; Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - In Sool Yoo
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea; Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - In Ho Lee
- Department of Radiology, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Mijoo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jae Gwang Lee
- Department of Emergency Medicine, Konyang University Hospital, College of Medicine, Daejeon, Republic of Korea
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Paratz ED, Nehme E, Heriot N, Sundararajan V, Page G, Fahy L, Rowe S, Anderson D, Stub D, La Gerche A, Nehme Z. Sex disparities in bystander defibrillation for out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100532. [PMID: 38188595 PMCID: PMC10770583 DOI: 10.1016/j.resplu.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Methods A state-wide OHCA registry in Victoria, Australia collected data over twenty years (2002-2021) regarding rates of bystander interventions in OHCA. Characteristics and outcomes of each OHCA were compared with logistic regression according to sex and time (defined in two-year periods). Results 32,502 OHCAs were included (69.7% male). Both bystander CPR and defibrillation rates increased for females over time (p < 0.0001). There was no sex disparity in receipt of bystander CPR after adjustment for baseline differences. Females were less likely than males to receive bystander defibrillation, with sex disparity increasing from 2010 onwards (adjOR 0.26 (95%CI 0.09-0.80) in 2020-21 for females compared to males). Conclusion Initiatives to increase bystander CPR and defibrillation have resulted in higher overall rates of bystander interventions in the last two decades and no significant sex differences in provision of bystander CPR. However, females receive less bystander defibrillation than males, and sex disparity is increasing. Strategies to promote bystander defibrillation in females experiencing OHCA with a shockable rhythm should be a priority.
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Affiliation(s)
- Elizabeth D. Paratz
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Emily Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
| | - Natalie Heriot
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital Melbourne, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | | | - Louise Fahy
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Stephanie Rowe
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
| | - Dion Stub
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
- Department of Cardiology, Alfred Health, 55 Commercial Rd., Prahran, VIC 3181, Australia
| | - Andre La Gerche
- HEART Lab, St Vincent’s Institute of Medical Research, 9 Princes St., Fitzroy, VIC 3065, Australia
- Department of Cardiology, St Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
- Cardiology Department, Baker Heart & Diabetes Institute, 75 Commercial Rd., Prahran, VIC 3181, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph St., Blackburn North, VIC 3130, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
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Nehme Z, Bray J. Defibrillation trials: POSED a challenge. Resusc Plus 2024; 17:100586. [PMID: 38419830 PMCID: PMC10900113 DOI: 10.1016/j.resplu.2024.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Australia
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, Australia
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Australia
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [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] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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6
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Bray JE, Ong MEH. Beyond numbers: The importance of detailing systems of care when reporting data on the emergency response systems for cardiac arrest. Resuscitation 2024; 195:110117. [PMID: 38220064 DOI: 10.1016/j.resuscitation.2024.110117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Affiliation(s)
- Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Australia; Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Australia.
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital Health Services and Systems Research, Duke-NUS Medical School, Singapore
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7
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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8
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Stancati JA, Owyang CG, Araos JD, Agarwal S, Grossestreuer AV, Counts CR, Johnson NJ, Morgan RW, Moskowitz A, Perman SM, Sawyer KN, Yuriditsky E, Horowitz JM, Kaviyarasu A, Palasz J, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2022 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2023; 12:e031530. [PMID: 38038192 PMCID: PMC10727320 DOI: 10.1161/jaha.123.031530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Every year the American Heart Association's Resuscitation Science Symposium (ReSS) brings together a community of international resuscitation science researchers focused on advancing cardiac arrest care. METHODS AND RESULTS The American Heart Association's ReSS was held in Chicago, Illinois from November 4th to 6th, 2022. This annual narrative review summarizes ReSS programming, including awards, special sessions and scientific content organized by theme and plenary session. CONCLUSIONS By exploring both the science of resuscitation and important related topics including survivorship, disparities, and community-focused programs, this meeting provided important resuscitation updates.
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Affiliation(s)
| | - Clark G. Owyang
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
- Division of Pulmonary and Critical Care MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
| | - Joaquin D. Araos
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNYUSA
| | - Sachin Agarwal
- Division of Neurocritical Care & Hospitalist NeurologyColumbia University Irving Medical CenterNew YorkNYUSA
| | | | | | - Nicholas J. Johnson
- Department of Emergency MedicineUniversity of WashingtonSeattleWAUSA
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWAUSA
| | - Ryan W. Morgan
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care MedicineChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Ari Moskowitz
- Division of Critical Care MedicineMontefiore Medical CenterBronxNYUSA
| | - Sarah M. Perman
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Kelly N. Sawyer
- Department of Emergency MedicineUniversity of PittsburghPittsburghPAUSA
| | - Eugene Yuriditsky
- Division of Cardiology, Department of MedicineNYU Langone HealthNew YorkNYUSA
| | - James M. Horowitz
- Division of Cardiology, Department of MedicineNYU Langone HealthNew YorkNYUSA
| | - Aarthi Kaviyarasu
- Department of Emergency Medicine, Center for Resuscitation ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Joanna Palasz
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
| | - Benjamin S. Abella
- Department of Emergency Medicine, Center for Resuscitation ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Felipe Teran
- Department of Emergency MedicineWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNYUSA
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9
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Mellett-Smith A, Couper K. Establishing an out-of-hospital cardiac arrest registry in China: a key first step to improving outcomes. Lancet Public Health 2023; 8:e908-e909. [PMID: 37722402 DOI: 10.1016/s2468-2667(23)00208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Adam Mellett-Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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10
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Descatha A, Savary D. Flying rescuers and doctors in an urban setting for cardiac arrest: Just a dream? Resuscitation 2023; 193:110023. [PMID: 37898472 DOI: 10.1016/j.resuscitation.2023.110023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, SFR ICAT, CAPTV CDC -Angers, France; Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Hofstra Univ, NY, USA.
| | - Dominique Savary
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, SFR ICAT, CAPTV CDC, Angers, France; CHU Angers, Emergency Department, Angers, France.
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11
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Lugnet V, McDonough M, Gordon L, Galindez M, Mena Reyes N, Sheets A, Zafren K, Paal P. Termination of Cardiopulmonary Resuscitation in Mountain Rescue: A Scoping Review and ICAR MedCom 2023 Recommendations. High Alt Med Biol 2023; 24:274-286. [PMID: 37733297 DOI: 10.1089/ham.2023.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Lugnet, Viktor, Miles McDonough, Les Gordon, Mercedes Galindez, Nicolas Mena Reyes, Alison Sheets, Ken Zafren, and Peter Paal. Termination of cardiopulmonary resuscitation in mountain rescue: a scoping review and ICAR MedCom 2023 recommendations. High Alt Med Biol. 24:274-286, 2023. Background: In 2012, the International Commission for Mountain Emergency Medicine (ICAR MedCom) published recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue. New developments have necessitated an update. This is the 2023 update for termination of CPR in mountain rescue. Methods: For this scoping review, we searched the PubMed and Cochrane libraries, updated the recommendations, and obtained consensus approval within the writing group and the ICAR MedCom. Results: We screened a total of 9,102 articles, of which 120 articles met the inclusion criteria. We developed 17 recommendations graded according to the strength of recommendation and level of evidence. Conclusions: Most of the recommendations from 2012 are still valid. We made minor changes regarding the safety of rescuers and responses to primary or traumatic cardiac arrest. The criteria for termination of CPR remain unchanged. The principal changes include updated recommendations for mechanical chest compression, point of care ultrasound (POCUS), extracorporeal life support (ECLS) for hypothermia, the effects of water temperature in drowning, and the use of burial times in avalanche rescue.
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Affiliation(s)
- Viktor Lugnet
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Swedish Mountain Guides Association (SBO), Gällivare, Sweden
| | - Miles McDonough
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Emergency Medicine, UCSF Fresno, Fresno, California, USA
| | - Les Gordon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Langdale Ambleside Mountain Rescue Team, Ambleside, United Kingdom
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, United Kingdom
| | - Mercedes Galindez
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Internal Medicine, Hospital Zonal Ramón Carrillo, San Carlos de Bariloche, Argentina
- Comisión de Auxilio Club Andino Bariloche, San Carlos de Bariloche, Argentina
| | - Nicolas Mena Reyes
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Emergency Medicine, Sótero del Río Hospital, Santiago de Chile, Chile
- Grupo de Rescate Médico en Montaña (GREMM), Santiago, Chile
- Emegency Medicine Section, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison Sheets
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Emergency Medicine, Boulder Community Health, Boulder, Colorado, USA
- Wilderness Medicine Section, University of Colorado Health Sciences Center, Aurora, Colorado, USA
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Himalayan Rescue Association, Kathmandu, Nepal
- Department of Emergency Medicine, Stanford University Medical Center, Stanford, California, USA
- Alaska Native Medical Center, Anchorage, Alaska, USA
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Kloten, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
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Aqel S, Syaj S, Al-Bzour A, Abuzanouneh F, Al-Bzour N, Ahmad J. Artificial Intelligence and Machine Learning Applications in Sudden Cardiac Arrest Prediction and Management: A Comprehensive Review. Curr Cardiol Rep 2023; 25:1391-1396. [PMID: 37792134 PMCID: PMC10682172 DOI: 10.1007/s11886-023-01964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW This literature review aims to provide a comprehensive overview of the recent advances in prediction models and the deployment of AI and ML in the prediction of cardiopulmonary resuscitation (CPR) success. The objectives are to understand the role of AI and ML in healthcare, specifically in medical diagnosis, statistics, and precision medicine, and to explore their applications in predicting and managing sudden cardiac arrest outcomes, especially in the context of prehospital emergency care. RECENT FINDINGS The role of AI and ML in healthcare is expanding, with applications evident in medical diagnosis, statistics, and precision medicine. Deep learning is gaining prominence in radiomics and population health for disease risk prediction. There's a significant focus on the integration of AI and ML in prehospital emergency care, particularly in using ML algorithms for predicting outcomes in COVID-19 patients and enhancing the recognition of out-of-hospital cardiac arrest (OHCA). Furthermore, the combination of AI with automated external defibrillators (AEDs) shows potential in better detecting shockable rhythms during cardiac arrest incidents. AI and ML hold immense promise in revolutionizing the prediction and management of sudden cardiac arrest, hinting at improved survival rates and more efficient healthcare interventions in the future. Sudden cardiac arrest (SCA) continues to be a major global cause of death, with survival rates remaining low despite advanced first responder systems. The ongoing challenge is the prediction and prevention of SCA. However, with the rise in the adoption of AI and ML tools in clinical electrophysiology in recent times, there is optimism about addressing these challenges more effectively.
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Affiliation(s)
- Sarah Aqel
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ayah Al-Bzour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Faris Abuzanouneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Noor Al-Bzour
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jamil Ahmad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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Schnaubelt S, Krammel M. PULS - Austrian Cardiac Arrest Awareness Association: An overview of a multi-tiered and multi-facetted regional initiative to save lives. Resusc Plus 2023; 15:100453. [PMID: 37645620 PMCID: PMC10461014 DOI: 10.1016/j.resplu.2023.100453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Out-of-hospital cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) still leads to dismal outcomes worldwide. The crucial gap between cardiac arrest and advanced life support can only be filled by bystander-CPR. However, knowledge and willingness of the public towards basic life support (BLS) remain low. Global and national initiatives for awareness building and CPR training have produced promising improvements, but an additional focus on regional initiatives might be necessary to truly implement change. Methods and results In order to support other like-minded groups, we present a "coming of age" narrative review of PULS - Austrian Cardiac Arrest Awareness Association, along with a future outlook and "lessons learned". Interviews with past and present employees, members, and functionaries were conducted by the authors. Additionally, the organization's archives were assessed. Conclusion Following current guidelines and the Utstein formula of survival, building a system to save lives is essential to achieve progress concerning cardiac arrest survival and outcomes. As kinds of "regional offices" of global resuscitation efforts, a network of individual local initiatives and organizations such as PULS can carry the respective messages, engage with local key figures of implementation, and keep up perpetual work for cardiac arrest awareness and BLS education.
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Affiliation(s)
- Sebastian Schnaubelt
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Mario Krammel
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Emergency Medical Service Vienna, Austria
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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Song SR, Kim KH, Park JH, Song KJ, Shin SD. Association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest. Am J Emerg Med 2023; 65:24-30. [PMID: 36580697 DOI: 10.1016/j.ajem.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest (OHCA). METHODS This retrospective observational study included OHCA patients who visited the emergency departments (EDs) between October 2015 and June 2021. The study groups were categorized according to the prehospital airway type: endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BVM). The primary outcome was good oxygenation: partial pressure of oxygen (PaO2) ≥ 60 mmHg on the first arterial blood gas (ABG) test. The secondary outcome was good ventilation: partial pressure of carbon dioxide (PaCO2) ≤ 45 mmHg. Multivariate logistic regression was conducted to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI). RESULTS A total of 7,372 patients were enrolled during the study period: 1,819 patients treated with BVM, 706 with ETI, and 4,847 who underwent SGA. In multivariable logistic regression analysis for good oxygenation outcomes, the ETI group showed a higher AOR than the BVM group (AOR [95% CIs]: 1.30 [1.06-1.59] in ETI and 1.05 [0.93-1.20] in SGA groups). Regarding good ventilation, the ETI group showed a higher AOR, and the SGA group showed a lower AOR compared to the BVM group (AOR [95% CIs] 1.33 [1.02-1.74] in the ETI and 0.83 (0.70-0.99) in the SGA groups). There was no significant difference in survival to discharge. CONCLUSIONS ETI was significantly associated with good oxygenation and good ventilation compared to BVM in patients with OHCA, particularly during longer transports. This should be taken into consideration when deciding the prehospital advanced airway management in patients with OHCA.
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Affiliation(s)
- So Ra Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
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16
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Nishiyama C, Kiguchi T, Okubo M, Alihodžić H, Al-Araji R, Baldi E, Beganton F, Booth S, Bray J, Christensen E, Cresta R, Finn J, Grasner JT, Jouven X, Kern KB, Maconochie I, Masterson S, McNally B, Nolan JP, Eng Hock Ong M, Perkins GD, Ho Park J, Ristau P, Savastano S, Shahidah N, Do Shin S, Soar J, Tjelmeland I, Quinn MO, Wnent J, Wyckoff MH, Iwami T. Three-year trends in out-of-hospital cardiac arrest across the world: second report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation 2023; 186:109757. [PMID: 36868553 DOI: 10.1016/j.resuscitation.2023.109757] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. METHODS We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. RESULTS Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0-97.1 individuals per 100,000 population in 2015, 36.4-97.3 in 2016, and 40.8-100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. CONCLUSION We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.
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Affiliation(s)
- Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tekeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hajriz Alihodžić
- Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' and Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Rabab Al-Araji
- Emory University Woodruff Health Sciences Center, Atlanta, GA, USA
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), Paris, France; Paris Sudden Death Expertise Center, Paris, France
| | - Scott Booth
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia; School of Nursing, Curtin University, WA, Australia
| | - Erika Christensen
- Center for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia; School of Nursing, Curtin University, WA, Australia; Medical School, University of Western Australia, WA, Australia
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, Paris, France; Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karl B Kern
- Division of Cardiology, University of Arizona, Sarver Heart Center, Tucson, AZ, USA
| | - Ian Maconochie
- Department of Emergency Medicine, Division of Medicine, Imperial College London, London, UK
| | - Siobhán Masterson
- Clinical Directorate, HSE National Ambulance Service, Ireland; Discipline of General Practice, National University of Ireland Galway, Ireland
| | - Bryan McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jerry P Nolan
- Warwick Medical School, University of Warwick, Coventry and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Gavin D Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, UK
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo(3), Pavia, Italy
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jasmeet Soar
- Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, UK
| | - Ingvild Tjelmeland
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Martin O Quinn
- Out-of-Hospital Cardiac Arrest Register Steering Group, National Ambulance Service, Health Service Executive, Ireland
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan.
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Donner DG, Bloom JE, Shihata WA, Brown AA, Cook R, Yee Tai T, Lambert GW, Chu PY, Chan W, Stub D, Wang BH, Kaye DM. A randomised preclinical trial of adrenaline use during cardiac arrest in mice. Resusc Plus 2022; 11:100292. [PMID: 36059384 PMCID: PMC9436797 DOI: 10.1016/j.resplu.2022.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adrenaline is routinely administered during cardiac arrest resuscitation. Using a novel murine model of cardiac arrest, this study evaluates the effects of adrenaline use on survival and end-organ injury. Methods A total of 58 mice, including cardiac arrest (CA) and sham (SHAM) groups received intravenous potassium chloride either as a bolus (CA) or slow infusion (SHAM), inducing ECG-confirmed asystole (in CA only) for 4-minutes prior to intravenous adrenaline (+ADR;250 ul,32 ug/ml) or saline (-ADR;250 ul) and manual chest compressions (300 BPM) for 4-minutes. Mice with return of spontaneous circulation (ROSC) were assessed at 24- or 72-h timepoints. Results Among animals that underwent CA, rates of ROSC (n = 21 (95 %) vs n = 14 (82 %), P = 0.18) and survival to the planned endpoint (n = 11 (50 %) vs n = 12 (71 %), P = 0.19) were similar when comparing those treated with (CA+ADR) and without (CA-ADR) adrenaline. However, in CA animals that initially achieved ROSC, subsequent mortality was approximately 3-fold greater with adrenaline treatment (48 % vs 14 %, P = 0.042). Among SHAM animals, adrenaline use had no impact on survival rates or other endpoints. Greater myocardial injury occurred in CA+ADR vs CA-ADR, with increased Hs-Troponin levels measured at 24- (26.0 ± 0.9 vs 9.4 ± 5.3 ng/mL, P = 0.015) and 72-h (20.9 ± 8.3 vs 5.0 ± 2.4 ng/mL, P = 0.012), associated with increased expression of pro-inflammatory and fibrotic genes within cardiac and renal tissue. Conclusion Adrenaline did not improve ROSC or overall survival but following successful ROSC, its use resulted in 3-fold greater mortality rates. Adrenaline was also associated with increased myocardial injury, end-organ inflammation, and fibrosis. These findings underscore the need for further preclinical evaluation of alternate pharmacologic adjuncts for cardiopulmonary resuscitation that improve survival and limit end-organ injury.
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Affiliation(s)
- Daniel G. Donner
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jason E. Bloom
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | | | | | - Rosalind Cook
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tsin Yee Tai
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Gavin W. Lambert
- Iverson Health Innovation Research Institute and School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Po-Yin Chu
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - William Chan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bing H. Wang
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - David M. Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
- Corresponding author at: Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
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Perera N, Riou M, Ball S, Whiteside A, Finn J. Enhancing emergency dispatch communication as part of innovative approaches to public-access defibrillation. Resuscitation 2022; 175:169-170. [PMID: 35595496 DOI: 10.1016/j.resuscitation.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Nirukshi Perera
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Australia.
| | - Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Australia; Centre de Recherche en Linguistique Appliquée (CeRLA), Université Lumière Lyon 2, France
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Australia; St John WA, Australia
| | - Austin Whiteside
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Australia; St John WA, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Australia; St John WA, Australia; Emergency Medicine, The University of Western Australia, Australia
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Mellor E, Couper K. Police response to out-of-hospital cardiac arrest: The importance of confidence. Resuscitation 2022; 175:1-2. [DOI: 10.1016/j.resuscitation.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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