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Liu B, Li M, Wang J, Zhang F, Wang F, Jin C, Li J, Wang Y, Sanderson TH, Zhang R. The role of magnesium in cardiac arrest. Front Nutr 2024; 11:1387268. [PMID: 38812935 PMCID: PMC11133868 DOI: 10.3389/fnut.2024.1387268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiac arrest is a leading cause of death globally. Only 25.8% of in-hospital and 33.5% of out-of-hospital individuals who achieve spontaneous circulation following cardiac arrest survive to leave the hospital. Respiratory failure and acute coronary syndrome are the two most common etiologies of cardiac arrest. Effort has been made to improve the outcomes of individuals resuscitated from cardiac arrest. Magnesium is an ion that is critical to the function of all cells and organs. It is often overlooked in everyday clinical practice. At present, there have only been a small number of reviews discussing the role of magnesium in cardiac arrest. In this review, for the first time, we provide a comprehensive overview of magnesium research in cardiac arrest focusing on the effects of magnesium on the occurrence and prognosis of cardiac arrest, as well as in the two main diseases causing cardiac arrest, respiratory failure and acute coronary syndrome. The current findings support the view that magnesium disorder is associated with increased risk of cardiac arrest as well as respiratory failure and acute coronary syndrome.
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Affiliation(s)
- Baoshan Liu
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Muyuan Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jian Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fengli Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fangze Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Caicai Jin
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jiayi Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Yanran Wang
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- School of Anesthesiology, Shandong Second Medical University, Weifang, China
| | - Thomas Hudson Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Rui Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
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Singh A, Heeney M, Montgomery ME. The Pharmacologic Management of Cardiac Arrest. Cardiol Clin 2024; 42:279-288. [PMID: 38631795 DOI: 10.1016/j.ccl.2024.02.012] [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: 04/19/2024]
Abstract
The effectiveness of pharmacologic management of cardiac arrest patients is widely debated; however, several studies published in the past 5 years have begun to clarify some of these issues. This article covers the current state of evidence for the effectiveness of the vasopressor epinephrine and the combination of vasopressin-steroids-epinephrine and antiarrhythmic medications amiodarone and lidocaine and reviews the role of other medications such as calcium, sodium bicarbonate, magnesium, and atropine in cardiac arrest care. We additionally review the role of β-blockers for refractory pulseless ventricular tachycardia/ventricular fibrillation and thrombolytics in undifferentiated cardiac arrest and suspected fatal pulmonary embolism.
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Affiliation(s)
- Amandeep Singh
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Megan Heeney
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Martha E Montgomery
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
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Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2024; 149:e254-e273. [PMID: 38108133 DOI: 10.1161/cir.0000000000001194] [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: 12/19/2023]
Abstract
Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This "2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support" summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.
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Holmberg MJ, Granfeldt A, Andersen LW. Bicarbonate, calcium, and magnesium for in-hospital cardiac arrest - An instrumental variable analysis. Resuscitation 2023; 191:109958. [PMID: 37661011 DOI: 10.1016/j.resuscitation.2023.109958] [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: 07/06/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Bicarbonate, calcium, and magnesium are commonly used during in-hospital cardiac arrest. Whether these drugs are associated with survival in cardiac arrest patients is uncertain. METHODS This was an observational study using data from the Get With The Guidelines registry. Adult patients with an in-hospital cardiac arrest between January 2008 and December 2021 were included. An instrumental variable approach was used based on hospital preferences for bicarbonate, calcium, and magnesium, respectively. The primary outcome was survival to hospital discharge. RESULTS A total of 319,230 patients were included. The median age was 66 years, 59% patients were male, and 85% patients presented with a non-shockable rhythm. Bicarbonate was administered in 58% patients, calcium in 33% patients, and magnesium in 10% patients. When considering drug use in the previous cardiac arrest patient at a given hospital as an instrument, the absolute difference in survival to hospital discharge was estimated at -14.2% (95% CI, -19.9 to -8.6) for bicarbonate, -3.0% (95% CI, -8.6 to 2.6) for calcium, and 10.7% (95% CI, -0.8 to 22.2) for magnesium as compared to no drug. When considering the proportion of drug use within the past year at a given hospital as an instrument, the confidence intervals were very wide, making the results difficult to interpret. CONCLUSIONS In this analysis, the results for bicarbonate, calcium, and magnesium were inconclusive due to wide confidence intervals and inconsistencies in estimates across instrumental variables. Randomized trials are needed to investigate the effect of these drugs on patient outcomes.
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Affiliation(s)
- Mathias J Holmberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Asger Granfeldt
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Region Denmark, Denmark.
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Singh A, Heeney M, Montgomery ME. The Pharmacologic Management of Cardiac Arrest. Emerg Med Clin North Am 2023; 41:559-572. [PMID: 37391250 DOI: 10.1016/j.emc.2023.03.010] [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
The effectiveness of pharmacologic management of cardiac arrest patients is widely debated; however, several studies published in the past 5 years have begun to clarify some of these issues. This article covers the current state of evidence for the effectiveness of the vasopressor epinephrine and the combination of vasopressin-steroids-epinephrine and antiarrhythmic medications amiodarone and lidocaine and reviews the role of other medications such as calcium, sodium bicarbonate, magnesium, and atropine in cardiac arrest care. We additionally review the role of β-blockers for refractory pulseless ventricular tachycardia/ventricular fibrillation and thrombolytics in undifferentiated cardiac arrest and suspected fatal pulmonary embolism.
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Affiliation(s)
- Amandeep Singh
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Megan Heeney
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Martha E Montgomery
- Alameda Health System, Highland Hospital Emergency Department, 1411 East 31st Street, Oakland, CA 94602, USA
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Lian R, Zhang G, Yan S, Sun L, Gao W, Yang J, Li G, Huang R, Wang X, Liu R, Cao G, Wang Y, Zhang G. The first case series analysis on efficacy of esmolol injection for in-hospital cardiac arrest patients with refractory shockable rhythms in China. Front Pharmacol 2022; 13:930245. [PMID: 36249764 PMCID: PMC9561246 DOI: 10.3389/fphar.2022.930245] [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: 04/27/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: This study assessed the effects of esmolol injection in patients with in-hospital cardiac arrest (IHCA) with refractory ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT). Methods: From January 2018 to December 2021, 29 patients with IHCA with refractory shockable rhythm were retrospectively reviewed. Esmolol was administered after advanced cardiovascular life support (ACLS)-directed procedures, and outcomes were assessed. Results: Among the 29 cases, the rates of sustained return of spontaneous circulation (ROSC), 24-h ROSC, and 72-h ROSC were 79%, 62%, and 59%, respectively. Of those patients, 59% ultimately survived to discharge. Four patients with cardiac insufficiency died. The duration from CA to esmolol infusion was significantly shorter for patients in the survival group (SG) than for patients in the dead group (DG) (12 min, IQR: 8.5–19.5 vs. 23.5 min, IQR: 14.4–27 min; p = 0.013). Of those patients, 76% (22 of 29) started esmolol administration after the second dose of amiodarone. No significant difference was observed in the survival rate between this group and groups administered an esmolol bolus simultaneously or before the second dose of amiodarone (43% vs. 64%, p = 0.403). Of those patients, 31% (9 of 29) were administered an esmolol bolus for defibrillation attempts ≤ 5, while the remaining 69% of patients received an esmolol injection after the fifth defibrillation attempt. No significant differences were observed in the rates of ≥ 24-h ROSC (67% vs. 60%, p = 0.73), ≥ 72-h ROSC (67% vs. 55%, p = 0.56), and survival to hospital discharge (67% vs. 55%, p = 0.56) between the groups administered an esmolol bolus for defibrillation attempts ≤ 5 and defibrillation attempts > 5. Conclusion: IHCA patients with refractory shockable rhythms receiving esmolol bolus exhibited a high chance of sustained ROSC and survival to hospital discharge. Patients with end-stage heart failure tended to have attenuated benefits from beta-blockers. Further large-scale, prospective studies are necessary to determine the effects of esmolol in patients with IHCA with refractory shockable rhythms.
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Affiliation(s)
- Rui Lian
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Guochao Zhang
- General Surgery Department, China-Japan Friendship Hospital, Beijing, China
| | - Shengtao Yan
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Lichao Sun
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Wen Gao
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Jianping Yang
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Guonan Li
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Rihong Huang
- Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaojie Wang
- Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Renyang Liu
- Intensive Care Unit, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Guangqing Cao
- Cardiac Surgery Department, Qilu Hospital of ShanDong University, Jinan, China
| | - Yong Wang
- Cardiac Care Unit, XiangTan Central Hospital, Xiangtan, China
| | - Guoqiang Zhang
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Guoqiang Zhang,
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Gatson BJ, Swift S, Paranjape V. Successful treatment of prolonged refractory ventricular fibrillation in an anesthetized dog. J Vet Emerg Crit Care (San Antonio) 2021; 32:129-134. [PMID: 34499802 DOI: 10.1111/vec.13132] [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: 02/21/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a case of successful return of spontaneous circulation in an anesthetized dog that developed spontaneous ventricular fibrillation during CPR that was refractory to multiple defibrillation attempts by utilizing pharmacological antiarrhythmic therapy. CASE SUMMARY Cardiopulmonary arrest occurred during surgical preparation in a 1-year-old German Shepherd Dog under general anesthesia for fluoroscopic implantation of an Amplatz canine duct occluder for treatment of a patent ductus arteriosus. Pulseless electrical activity was initially diagnosed, and resuscitative efforts were immediately initiated, including basic cardiac life support, discontinuation of anesthesia with administration of reversal agents, and low-dose epinephrine administration (0.01 mg/kg, IV). After 10 minutes of CPR, the patient developed ventricular fibrillation and single-dose monophasic defibrillation attempts of escalating energy were performed. Despite these efforts, return of spontaneous circulation was unable to be achieved. However, administration of magnesium sulfate (20 mg/kg, IV) along with an additional single monophasic defibrillation attempt was successful in achieving return of spontaneous circulation. NEW OR UNIQUE INFORMATION PROVIDED Under current advanced cardiac life support guidelines, the best resuscitation strategy for refractory ventricular fibrillation, in which the arrhythmia persists despite multiple defibrillation attempts, remains unclear. This is especially true for veterinary patients, where refractory ventricular fibrillation is an uncommon cardiac arrest rhythm. Although guidelines for the use of antiarrhythmic therapy during cardiac arrest are well established in human medicine, evidence-based guidelines to support best practices in companion animals do not exist due to sparse data gathered through experimental studies. Only a few case reports describe successful return of spontaneous circulation following prolonged ventricular fibrillation in clinical veterinary patients. Although the use of magnesium sulfate as an antiarrhythmic agent during refractory ventricular fibrillation has been previously reported in people, this is the first case to our knowledge of refractory ventricular fibrillation in a dog that responded to magnesium sulfate.
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Affiliation(s)
- Bonnie J Gatson
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Simon Swift
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Vaidehi Paranjape
- Department of Comparative, Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Srisurapanont K, Thepchinda T, Kwangsukstith S, Saetiao S, Kasirawat C, Janmayka W, Wongtanasarasin W. Comparing Drugs for Out-of-hospital, Shock-refractory Cardiac Arrest: Systematic Review and Network Meta-analysis of Randomized Controlled Trials. West J Emerg Med 2021; 22:834-841. [PMID: 35354019 PMCID: PMC8328185 DOI: 10.5811/westjem.2021.2.49590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The benefit of medications used in out-of-hospital, shock-refractory cardiac arrest remains controversial. This study aims to compare the treatment outcomes of medications for out-of-hospital, shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). METHODS The inclusion criteria were randomized controlled trials of participants older than eight years old who had atraumatic, out-of-hospital, shock-refractory VF/pVT in which at least one studied group received a medication. We conducted a database search on October 28, 2019, that included PubMed, Scopus, Web of Science, CINAHL Complete, and Cochrane CENTRAL. Citations of relevant meta-analyses were also searched. We performed frequentist network meta-analysis (NMA) to combine the comparisons. The outcomes were analyzed by using odds ratios (OR) and compared to placebo. The primary outcome was survival to hospital discharge. The secondary outcomes included the return of spontaneous circulation (ROSC), survival to hospital admission, and the neurological outcome at discharge. We ranked all outcomes using surface under the cumulative ranking score. RESULTS We included 18 studies with 6,582 participants. The NMA of 20 comparisons included 12 medications and placebo. Only norepinephrine showed a significant increase of ROSC (OR = 8.91, 95% confidence interval [CI], 1.88-42.29). Amiodarone significantly improved survival to hospital admission (OR = 1.53, 95% CI, 1.01-2.32). The ROSC and survival-to-hospital admission data were significantly heterogeneous with the I2 of 55.1% and 59.1%, respectively. This NMA satisfied the assumption of transitivity. CONCLUSION No medication was associated with improved survival to hospital discharge from out-of-hospital, shock-refractory cardiac arrest. For the secondary outcomes, norepinephrine was associated with improved ROSC and amiodarone was associated with an increased likelihood of survival to hospital admission in the NMA.
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Affiliation(s)
| | | | | | - Suchada Saetiao
- Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| | | | - Worawan Janmayka
- Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| | - Wachira Wongtanasarasin
- Chiang Mai University, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai, Thailand
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, Berg KM, Bingham R, Böttiger BW, Callaway CW, Couper K, Couto TB, de Caen AR, Deakin CD, Drennan IR, Guerguerian AM, Lavonas EJ, Meaney PA, Nadkarni VM, Neumar RW, Ng KC, Nicholson TC, Nuthall GA, Ohshimo S, O'Neil BJ, Ong GYK, Paiva EF, Parr MJ, Reis AG, Reynolds JC, Ristagno G, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Tijssen JA, Van de Voorde P, Wang TL, Welsford M, Hazinski MF, Nolan JP, Morley PT. 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Circulation 2019; 138:e714-e730. [PMID: 30571263 DOI: 10.1161/cir.0000000000000611] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria. The statements include consensus treatment recommendations approved by members of the relevant task forces. Insights into the deliberations of each task force are provided in the Values and Preferences and Task Force Insights sections. Finally, the task force members have listed the top knowledge gaps for further research.
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Panchal AR, Berg KM, Kudenchuk PJ, Del Rios M, Hirsch KG, Link MS, Kurz MC, Chan PS, Cabañas JG, Morley PT, Hazinski MF, Donnino MW. 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 138:e740-e749. [PMID: 30571262 DOI: 10.1161/cir.0000000000000613] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, it is unclear whether these medications improve patient outcomes. This 2018 American Heart Association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. This article includes the revised recommendation that providers may consider either amiodarone or lidocaine to treat shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest.
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Sharma A, Arora L, Subramani S, Simmons J, Mohananey D, Ramakrishna H. Analysis of the 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest. J Cardiothorac Vasc Anesth 2019; 34:537-544. [PMID: 31097339 DOI: 10.1053/j.jvca.2019.03.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Archit Sharma
- Divisions of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Lovkesh Arora
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sudhakar Subramani
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jonathan Simmons
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, Berg KM, Bingham R, Böttiger BW, Callaway CW, Couper K, Couto TB, de Caen AR, Deakin CD, Drennan IR, Guerguerian AM, Lavonas EJ, Meaney PA, Nadkarni VM, Neumar RW, Ng KC, Nicholson TC, Nuthall GA, Ohshimo S, O’Neil BJ, Ong GYK, Paiva EF, Parr MJ, Reis AG, Reynolds JC, Ristagno G, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Tijssen JA, Van de Voorde P, Wang TL, Welsford M, Hazinski MF, Nolan JP, Morley PT. 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Resuscitation 2018; 133:194-206. [DOI: 10.1016/j.resuscitation.2018.10.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Drugs in Out-of-Hospital Cardiac Arrest. Cardiol Clin 2018; 36:357-366. [PMID: 30293602 DOI: 10.1016/j.ccl.2018.03.003] [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: 11/22/2022]
Abstract
Managing out-of-hospital cardiac arrest involves unique challenges, including delays in the initiation of advanced interventions and a limited number of trained personnel on scene. Recent out-of-hospital randomized controlled trials, systematic reviews, and metaanalyses provide key insights into what interventions are best proven to positively impact patient outcomes from out-of-hospital cardiac arrest. We review the literature on medications used in out-of-hospital cardiac arrest and summarize evidence-based guidelines from the American Heart Association that form the basis for most emergency medical services cardiac arrest protocols across the United States.
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Shanmugasundaram M, Lotun K. Refractory Out of Hospital Cardiac Arrest. Curr Cardiol Rev 2018; 14:109-114. [PMID: 29737259 PMCID: PMC6088448 DOI: 10.2174/1573403x14666180507155622] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/31/2018] [Accepted: 04/25/2018] [Indexed: 01/14/2023] Open
Abstract
Refractory out of hospital cardiac arrest is a common problem that is associated with poor overall survival rates and neurological outcomes. There are various definitions that have been used but the most accepted one is cardiac arrest that requires more than 10 minutes of Cardiopulmonary Resuscitation (CPR) efforts or more than 3 defibrillation attempts. There have been different pharmacologic and non-pharmacologic therapies that were studied in these patients. None of the antiarrhythmic or vasopressor medications have been consistently shown to improve survival or neurological outcomes in this subset of patients. This has led to the introduction of various devices aimed at improving outcomes such as mechanical CPR devices, Extracorporeal Cardiopulmonary Resuscitation (ECPR), targeted temperature management and early invasive approach. There is accumulating evidence that there seems to be an improvement in outcomes when these devices are used in refractory cardiac arrest patients. But none of these devices have been shown to improve outcomes when used in isolation. This underscores the importance of systematic approach to these complex patients and using these therapies in combination. There has been a paradigm shift in the approach to these patients. Instead of repeated and prolonged CPR attempts in the field, it is suggested that these patients need to be moved to cardiac arrest centers with a mechanical CPR device in place, so a percutaneous Extracorporeal Membrane Oxygenator (ECMO) can be placed to “buy” time for other therapies such as therapeutic hypothermia and early coronary angiography followed by intervention as indicated. Careful selection of patients who might potentially benefit from this approach is critical to the success of these programs.
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Affiliation(s)
- Madhan Shanmugasundaram
- The University of Arizona College of Medicine, Tucson, AZ, United States.,Southern Arizona VA Health Care System, Tucson, AZ, United States
| | - Kapildeo Lotun
- The University of Arizona College of Medicine, Tucson, AZ, United States
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Ali MU, Fitzpatrick-Lewis D, Kenny M, Raina P, Atkins DL, Soar J, Nolan J, Ristagno G, Sherifali D. Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation 2018; 132:63-72. [PMID: 30179691 DOI: 10.1016/j.resuscitation.2018.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiac arrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations. METHODS A search was conducted in electronic databases Medline, Embase, and Cochrane Library from inception to August 15, 2017. RESULTS Of the 9371 citations reviewed, a total of 14 RCTs and 17 observational studies met our inclusion criteria for adult population and only 1 observational study for pediatric population. Based on RCT level evidence for adult population, none of the anti-arrhythmic drugs showed any difference in effect compared with placebo, or with other anti-arrhythmic drugs for the critical outcomes of survival to hospital discharge and discharge with good neurological function. For the outcome of return of spontaneous circulation, the results showed a significant increase for lidocaine compared with placebo (RR = 1.16; 95% CI, 1.03-1.29, p = 0.01). CONCLUSION The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiac arrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering antiarrhythmic drugs in children with shockable cardiac arrest, and in adults immediately after ROSC.
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Affiliation(s)
- Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Donna Fitzpatrick-Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Meghan Kenny
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | | | - Jerry Nolan
- University of Bristol and Royal United Hospital, Bath, BA1 3NG, UK
| | - Giuseppe Ristagno
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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Antiarrhythmics in Cardiac Arrest: A Systematic Review and Meta-Analysis. Heart Lung Circ 2018; 27:280-290. [DOI: 10.1016/j.hlc.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 06/10/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
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Chen F, Lin Q, Chen G, Wang X, Lin S. Does Intravenous Magnesium Benefit Patients of Cardiac Arrest? a Meta-Analysis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective Evidence shows that magnesium has anti-arrhythmic roles. However, clinical trials suggest that there are conflicting outcomes of cardiac arrest patients given magnesium. The study aimed to examine the effects of magnesium sulfate therapy on cardiac arrest patients using a meta-analysis. Methods We searched the MEDLINE (1966-July 2011), OVID (1980-July 2011), EMBASE (1980-July 2011), Chinese bio-medical literature & retrieval system (1978-July 2011), Chinese medical current contents (1995-July 2011), and Chinese medical academic conference (1994-July 2011). Studies were included if (1) the study design was a randomised controlled trial (RCT); (2) the study population included cardiac arrest patients who received cardiopulmonary resuscitation and either intravenous magnesium or placebo (0.9% normal saline); (3) the study provided data on return of spontaneous circulation (ROSC) and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect. Results The study included six RCTs with a total of 531 participants from cardiac arrest. The pooled data demonstrated that ROSC and hospital discharge rates in patients treated with magnesium were 35.5% (95% CI=29.7%-41.3%) and 10.4% (95% CI=6.7%-14.1%) compared with placebo (ROSC rate: 31.3%, 95% CI=25.8%-36.8%; hospital discharge rate: 8.5%, 95% CI=5.2%-11.8%). Administration of intravenous magnesium sulfate could not significantly increase ROSC (RR=1.14, 95% CI=0.91-1.43, P=0.26) and survival to hospital discharge (RR=1.22, 95% CI=0.74-2.02, P=0.43) compared with placebo. Conclusions Administration of magnesium sulfate does not improve ROSC and survival to hospital discharge in patients of cardiac arrest.
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McLeod SL, Brignardello-Petersen R, Worster A, You J, Iansavichene A, Guyatt G, Cheskes S. Comparative effectiveness of antiarrhythmics for out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Resuscitation 2017; 121:90-97. [DOI: 10.1016/j.resuscitation.2017.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/04/2017] [Accepted: 10/13/2017] [Indexed: 01/18/2023]
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Khan SU, Winnicka L, Saleem MA, Rahman H, Rehman N. Amiodarone, lidocaine, magnesium or placebo in shock refractory ventricular arrhythmia: A Bayesian network meta-analysis. Heart Lung 2017; 46:417-424. [PMID: 28958592 DOI: 10.1016/j.hrtlng.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/17/2022]
Abstract
Recent evidence challenges, the superiority of amiodarone, compared to other anti-arrhythmic medications, as the agent of choice in pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). We conducted Bayesian network and traditional meta-analyses to investigate the relative efficacies of amiodarone, lidocaine, magnesium (MgSO4) and placebo as treatments for pulseless VT or VF. Eleven studies [5200 patients, 7 randomized trials (4, 611 patients) and 4 non-randomized studies (589 patients)], were included in this meta-analysis. The search was conducted, from 1981 to February 2017, using MEDLINE, EMBASE and The Cochrane Library. Estimates were reported as odds ratio (OR) with 95% Credible Interval (CrI). Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each treatment group based on surface under cumulative ranking curve (SUCRA). Bayesian analysis demonstrated that lidocaine had superior effects on survival to hospital discharge, compared to amiodarone (OR, 2.18, 95% Cr.I 1.26-3.13), MgSO4 (OR, 2.03, 95% Cr.I 0.74-4.82) and placebo (OR, 2.42, 95% Cr.I 1.39-3.54). There were no statistical differences among treatment groups regarding survival to hospital admission/24 h (hrs) and return of spontaneous circulation (ROSC). Probability analysis revealed that lidocaine was the most effective therapy for survival to hospital discharge (SUCRA, 97%). We conclude that lidocaine may be the most effective anti-arrhythmic agent for survival to hospital discharge in patients with pulseless VT or VF.
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Affiliation(s)
- Safi U Khan
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA.
| | | | | | - Hammad Rahman
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA
| | - Najeeb Rehman
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Pearce A, Lockwood C, van den Heuvel C, Pearce J. The use of therapeutic magnesium for neuroprotection during global cerebral ischemia associated with cardiac arrest and cardiac surgery in adults: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:86-118. [PMID: 28085730 DOI: 10.11124/jbisrir-2016-003236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Global cerebral ischemia occurs due to reduced blood supply to the brain. This is commonly caused by a cessation of myocardial activity associated with cardiac arrest and cardiac surgery. Survival is not the only important outcome because neurological dysfunction impacts on quality of life, reducing independent living. Magnesium has been identified as a potential neuroprotective agent; however, its role in this context is not yet clear. OBJECTIVES The objective of this review was to present the best currently available evidence related to the neuroprotective effects of magnesium during a period of global cerebral ischemia in adults with cardiac arrest or cardiac surgery. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered adults aged over 18 years who were at risk of global cerebral ischemia associated with cardiac arrest or cardiac surgery. Studies of patients with existing neurological deficits or under the age of 18 years were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The intervention of interest was magnesium administered in doses of at least of 2 g compared to placebo to adult patients within 24 hours of cardiac arrest or cardiac surgery. TYPES OF STUDIES The current review considered experimental designs including randomized controlled trials, non-randomized controlled trials and quasi-experimental designs. OUTCOMES The outcome of interest were neurological recovery post-cardiac arrest or cardiac surgery, as measured by objective scales, such as but not limited to, cerebral performance category, brain stem reflexes, Glasgow Coma Score and independent living or dependent living status. To enable assessment of the available data, neuroprotection was examined by breaking down neurological outcomes into three domains - functional neurological outcomes, neurophysiological outcomes and neuropsychological outcomes. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies between January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI) three-step search strategy. Databases searched included PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Australian Clinical Trials Register, Australian and New Zealand Clinical Trials Register, Clinical Trials, European Clinical Trials Register and ISRCTN Registry. METHODOLOGICAL QUALITY The studies included in this review were of moderate-to-good-quality randomized controlled trials. Studies included measured neurological outcome using functional neurological assessment, neuropsychiatric assessment or neurophysiological assessment. DATA EXTRACTION Data were extracted using standardized templates provided by the JBI Meta-analysis of Statistics Assessment and Review Instrument software. DATA SYNTHESIS Quantitative data were, where possible, pooled in statistical meta-analysis using Review Manager 5.3 (The Nordic Cochrane Centre, Cochrane; Copenhagen, Denmark). Where statistical pooling was not possible, the findings were presented in narrative form, including tables and figures, to aid in data presentation, where appropriate. RESULTS Seven studies with a total of 1164 participants were included in this review. Neurological outcome was categorized into three domains: functional neurological, neurophysiological and neuropsychological outcomes. Meta-analysis of three studies assessing the neuroprotective properties of magnesium administration post cardiac arrest found improved functional neurological outcome (odds ratio 0.44; 95% confidence interval 0.24-0.81). CONCLUSION Magnesium may improve functional neurological outcome in patients who suffer global cerebral ischemia associated with cardiac surgery and cardiac arrest. Magnesium does not decrease neuropsychological decline.Further testing of neurological outcomes in the domains of functional outcomes, neurophysiological markers and neuropsychological tests are required to further understanding of the neuroprotective effects of magnesium. Suitable dosing regimens should be investigated prior to introduction into clinical practice. Further research is required to investigate the optimal magnesium dose.
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Affiliation(s)
- Anna Pearce
- 1Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 2School of Medical Sciences, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 3School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australia
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 916] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Karcher JC, Kouraki K, Zeymer U. Antiarrhythmische Therapie im Notarztwagen. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim DK, Jhang WK, Ahn JY, Lee JS, Kim YH, Lee B, Kim GB, Kim JT, Huh J, Park JD, Chung SP, Hwang SO. Part 6. Pediatric advanced life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S48-S61. [PMID: 27752646 PMCID: PMC5052919 DOI: 10.15441/ceem.16.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 01/11/2023] Open
Affiliation(s)
- Do Kyun Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Ji Yun Ahn
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ji Sook Lee
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei Universtiy College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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[Which drugs are useful during resuscitation? Which are not?]. Herzschrittmacherther Elektrophysiol 2016; 27:15-9. [PMID: 26841960 DOI: 10.1007/s00399-016-0417-7] [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: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation represents a therapeutic challenge. Evidence-based guidelines, which were updated in 2015, give detailed advice on how to treat the patient. METHODS Basic life support consists of cardiopulmonary resuscitation (30 chest compressions interrupted briefly to provide to 2 ventilations) and, if ventricular tachyarrhythmia is present, urgent cardiac defibrillation. Administration of drugs is one of the aspects of advanced life support. Vasopressors (adrenaline, vasopressin) aim to optimize coronary and cerebral perfusion. Antiarrhythmic drugs (amiodarone or lidocaine, when amiodarone is not available) are given during cardiac arrest to treat specific cardiac arrhythmias, mainly ventricular fibrillation and ventricular tachycardia. CONCLUSION However, even in current guidelines, there is growing ambivalence towards drug treatment in the setting of cardiopulmonary resuscitation. This is mainly due to a paucity of robust clinical data. Most of the studies that have addressed the efficacy and safety of drugs during resuscitation are observational studies; however, a few small randomized controlled studies also exist. Recently, two large randomized controlled studies addressing the efficacy and safety of adrenaline versus placebo and amiodarone or lidocaine versus placebo have started. Both are currently recruiting patients. The hope is that the results of these studies will help to better define the role of drugs administered during cardiopulmonary resuscitation.
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Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O'Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J. Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S84-145. [PMID: 26472860 DOI: 10.1161/cir.0000000000000273] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S444-64. [PMID: 26472995 DOI: 10.1161/cir.0000000000000261] [Citation(s) in RCA: 794] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Beavers CJ, Pandya KA. Pharmacotherapy Considerations for the Management of Advanced Cardiac Life Support. Nurs Clin North Am 2016; 51:69-82. [PMID: 26897425 DOI: 10.1016/j.cnur.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Health care providers should be aware of the pharmacotherapy considerations in the American Heart Association's guidelines for advanced cardiac life support (ACLS). Current evidence does not suggest a reduction in mortality with ACLS medications; however, these medications can improve return of spontaneous circulation. Proper agent selection and dosing are imperative to maximize benefit and minimize harm. The latest guideline update included major changes to the ventricular fibrillation/pulseless ventricular tachycardia and pulseless electrical activity/asystole algorithms, which providers should adopt. It is critical that providers be prepared for post-code management. Health care professionals should remain abreast of changing evidence and guidelines.
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Affiliation(s)
- Craig J Beavers
- Department of Pharmacy Practice and Science, University of Kentucky UK Healthcare, Room H-110, 800 Rose Street, Lexington, KY 40536, USA.
| | - Komal A Pandya
- Department of Pharmacy Practice and Science, University of Kentucky UK Healthcare, Room H-110, 800 Rose Street, Lexington, KY 40536, USA
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bellomo R, Märtensson J, Eastwood GM. Metabolic and electrolyte disturbance after cardiac arrest: How to deal with it. Best Pract Res Clin Anaesthesiol 2015; 29:471-84. [DOI: 10.1016/j.bpa.2015.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/02/2015] [Accepted: 10/05/2015] [Indexed: 12/15/2022]
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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]
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 564] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Soar J, Callaway CW, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J, Andersen LW, Berg KM, Sandroni C, Lin S, Lavonas EJ, Golan E, Alhelail MA, Chopra A, Cocchi MN, Cronberg T, Dainty KN, Drennan IR, Fries M, Geocadin RG, Gräsner JT, Granfeldt A, Heikal S, Kudenchuk PJ, Lagina AT, Løfgren B, Mhyre J, Monsieurs KG, Mottram AR, Pellis T, Reynolds JC, Ristagno G, Severyn FA, Skrifvars M, Stacey WC, Sullivan J, Todhunter SL, Vissers G, West S, Wetsch WA, Wong N, Xanthos T, Zelop CM, Zimmerman J. Part 4: Advanced life support. Resuscitation 2015; 95:e71-120. [DOI: 10.1016/j.resuscitation.2015.07.042] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Huang Y, He Q, Yang M, Zhan L. Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis. Crit Care 2013; 17:R173. [PMID: 23938138 PMCID: PMC4056084 DOI: 10.1186/cc12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 07/19/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Antiarrhythmia agents have been used in the treatment of cardiac arrest, and we aimed to review the relevant clinical controlled trials to assess the effects of antiarrhythmics during cardiopulmonary resuscitation. METHODS We searched databases including Cochrane Central Register of Controlled Trials; MEDLINE, and EMBASE. Clinical controlled trials that addressed the effects of antiarrhythmics (including amiodarone, lidocaine, magnesium, and other new potassium-channel blockers) on the outcomes of cardiac arrest were included. Data were collected independently by two authors. The risk ratio of each outcome was collected, and meta-analysis was used for data synthesis if appropriate. Heterogeneity was assessed with the χ² test and the I² test. RESULTS Ten randomized controlled trials and seven observational trials were identified. Amiodarone (relative risk (RR), 0.82; 95% confidence interval (CI), 0.54 to 1.24), lidocaine (RR, 2.26; 95% CI, 0.93 to 5.52), magnesium (RR, 0.82; 95% CI, 0.54 to 1.24) and nifekalant were not shown to improve the survival to hospital discharge compared with placebo, but amiodarone, lidocaine, and nifekalant were shown to be beneficial to initial resuscitation, assessed by the rate of return of spontaneous circulation and survival to hospital admission, with amiodarone being superior to lidocaine (RR, 1.28; 95% CI, 0.57 to 2.86) and nifekalant (RR, 0.50; 95% CI, 0.19 to 1.31). Bretylium and sotalol were not shown to be beneficial. CONCLUSIONS Our review suggests that when administered during resuscitation, antiarrhythmia agents might not improve the survival to hospital discharge, but they might be beneficial to initial resuscitation. This is consistent with the AHA 2010 guidelines for resuscitation and cardiovascular emergency, but more studies with good methodologic quality and large numbers of patients are still needed to make further assessment.
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Affiliation(s)
- Yu Huang
- The Third People’s Hospital of Chengdu, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
| | - Qing He
- The Third People’s Hospital of Chengdu, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
- Emergency Department of West China Hospital of Sichuan University, Chengdu 610041, China
| | - Min Yang
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
- Department of Intensive Care Unit, The Second Hospital of Anhui Medical University, Anhui, China
| | - Lei Zhan
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
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Clinical trials in cardiac arrest and subarachnoid hemorrhage: lessons from the past and ideas for the future. Stroke Res Treat 2013; 2013:263974. [PMID: 23533956 PMCID: PMC3606808 DOI: 10.1155/2013/263974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH). Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest) met the review criteria (103 published, 39 ongoing). The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%), while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.
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Schnüriger B, Talving P, Inaba K, Barmparas G, Branco BC, Lam L, Demetriades D. Biochemical profile and outcomes in trauma patients subjected to open cardiopulmonary resuscitation: a prospective observational pilot study. World J Surg 2012; 36:1772-8. [PMID: 22488327 DOI: 10.1007/s00268-012-1583-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The predictive factors to regain a heartbeat following emergency department resuscitative thoracotomy (EDT) for trauma are poorly understood. The objective of the present study was to prospectively assess the electrolyte profile, coagulation parameters, and acid-base status from intracardiac blood samples in trauma patients subjected to open cardiopulmonary resuscitation (CPR) in the presence of established cardiac arrest. METHODS All patients who underwent EDT following trauma were considered for inclusion. Prior to the injection of any resuscitative medications, a sample of intracardiac blood from the right ventricle was obtained for analysis. RESULTS During the study period, a total of 22 patients had intracardiac blood samples obtained and were eligible for analysis. Twelve patients never regained cardiac activity, and 10 patients transiently regained a heartbeat for a mean of 51 ± 69 min, but ultimately died. Some 91 % (20/22) of patients presented with severe acidosis (pH < 7.20). The pCO(2) was <45 mmHg in 68 % (15/22) of patients, and the pO(2) level was >75 mmHg in 77 % (17/22) of patients. Patients who never regained cardiac activity had a significantly higher lactate level than those with a return of cardiac rhythm (17.1 ± 2.6 vs. 10.6 ± 4.9 mmol/L, p = 0.018). The sodium and potassium levels were higher for those who never regained a rhythm than for those who did regain a pulse (sodium: 155 ± 14 vs. 147 ± 9 mmol/L, p = 0.094; potassium: 6.0 ± 1.1 vs. 4.6 ± 1.0 mmol/L, p = 0.014). Severe hyperkalemia (potassium > 5.5 mmol/L) occurred significantly more often in patients who did not regain a heart beat (p = 0.030). Coagulopathy (INR > 1.2 and/or prothrombin time >15 s and/or platelet count <100,000/μL) was noted in 96 % of patients. CONCLUSIONS Most patients undergoing open CPR have normal blood gas levels. Severe lactic acidosis, hyperkalemia, and hypernatremia are associated with decreased probability for return of cardiac function. Calcium and magnesium levels were not significantly different between the two groups, making the therapeutic role of these electrolytes very questionable.
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Affiliation(s)
- Beat Schnüriger
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Los Angeles County Medical Center, University of Southern California, Keck School of Medicine, LAC + USC Medical Center, 1200 North State Street, Los Angeles, CA 90033-4525, USA
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Rozanski EA, Rush JE, Buckley GJ, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S44-64. [DOI: 10.1111/j.1476-4431.2012.00755.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - John E. Rush
- Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA
| | - Gareth J. Buckley
- College of Veterinary Medicine, University of Florida; Gainesville; FL
| | - Daniel J. Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies, School of Veterinary Medicine and the Department of Emergency Medicine, School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Current pharmacological advances in the treatment of cardiac arrest. Emerg Med Int 2011; 2012:815857. [PMID: 22145080 PMCID: PMC3226361 DOI: 10.1155/2012/815857] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 09/06/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated) and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2011; 81:1219-76. [PMID: 20956052 DOI: 10.1016/j.resuscitation.2010.08.021] [Citation(s) in RCA: 847] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
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European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2011; 81:1305-52. [PMID: 20956049 DOI: 10.1016/j.resuscitation.2010.08.017] [Citation(s) in RCA: 832] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ong MEH, Pellis T, Link MS. The use of antiarrhythmic drugs for adult cardiac arrest: a systematic review. Resuscitation 2011; 82:665-70. [PMID: 21444143 DOI: 10.1016/j.resuscitation.2011.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 11/28/2022]
Abstract
AIMS In adult cardiac arrest, antiarrhythmic drugs are frequently utilized in acute management and legions of medical providers have memorized the dosage and timing of administration. However, data supporting their use is limited and is the focus of this comprehensive review. METHODS Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. RESULTS Of 185 articles found, only 25 studies met the inclusion criteria for further review. Of these, 9 were randomised controlled trials. Nearly all trials solely evaluated Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF), and excluded Pulseless Electrical Activity (PEA) and asystole. In VT/VF patients, amiodarone improved survival to hospital admission, but not to hospital discharge when compared to lidocaine in two randomized controlled trials. CONCLUSION Amiodarone may be considered for those who have refractory VT/VF, defined as VT/VF not terminated by defibrillation, or VT/VF recurrence in out of hospital cardiac arrest or in-hospital cardiac arrest. There is inadequate evidence to support or refute the use of lidocaine and other antiarrythmic agents in the same settings.
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Affiliation(s)
- Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, Lavonas EJ, Link MS, Neumar RW, Otto CW, Parr M, Shuster M, Sunde K, Peberdy MA, Tang W, Hoek TLV, Böttiger BW, Drajer S, Lim SH, Nolan JP. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e93-e174. [PMID: 20956032 DOI: 10.1016/j.resuscitation.2010.08.027] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S729-67. [PMID: 20956224 DOI: 10.1161/circulationaha.110.970988] [Citation(s) in RCA: 880] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
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