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Atiksawedparit P, Sathapornthanasin T, Chalermdamrichai P, Sanguanwit P, Saksobhavivat N, Saelee R, Phattharapornjaroen P. Using computed tomography to evaluate proper chest compression depth for cardiopulmonary resuscitation in Thai population: A retrospective cross-sectional study. PLoS One 2023; 18:e0279056. [PMID: 36735661 PMCID: PMC9897514 DOI: 10.1371/journal.pone.0279056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/13/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The effectiveness of cardiopulmonary resuscitation is determined by appropriate chest compression depth and rate. The American Heart Association recommended CC depth at 5-6 cm to indicate proper cardiac output during cardiac arrest. However, many studies showed the differences in the body builds between Caucasians and Asians. Therefore, this study aimed to determine heart compression fraction (HCF) in the Thai population by using contrast-enhanced computed tomography (CT) scan of the chest and a mathematical model. MATERIALS AND METHODS Consecutive contrast-enhanced CT scans of the chest performed at Ramathibodi Hospital were retrospectively reviewed from January to March 2018 by two independent radiologists. Patients' characteristics, including gender, age, weight, height, and pre-existing diseases, were recorded, and the chest parameters were measured from a CT scan. The heart compression fraction (HCF) was subsequently calculated. RESULTS Of 306 subjects, there were 139 (45.4%) males, 148 (47.4%) lung diseases and 10 (3.3%) heart diseases. Mean age and BMI were 60.4 years old and 23.8 kg/m2, respectively. Chest diameter, heart diameter, and non-cardiac soft tissue were significantly smaller in females compared to males. Mean (SD) HCF proportional with 50 mm and 60 mm depth were 38.3% (13.3%) and 50% (14.3%), respectively. There were significant differences of HCF proportional by 50 mm and 60 mm depth between men and women (33.2% vs 42.6% and 44% vs 54.9%, respectively (P<0.001)). In addition, a decrease in HCF was significantly observed among higher BMI groups. CONCLUSION The CT scan and mathematical model showed that 38% and 50% HCF proportions were generated by 50 mm and 60 mm CC depth. HCF proportions were significantly different between genders and among BMI groups. The recommended depth of 5-6 cm is likely to provide sufficient CC depth in the population of Thailand.
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Affiliation(s)
- Pongsakorn Atiksawedparit
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand
| | - Thanaporn Sathapornthanasin
- Faculty of Medicine Ramathibodi Hospital, Department of Emergency Medicine, Mahidol University, Bangkok, Thailand
| | - Phanorn Chalermdamrichai
- Faculty of Medicine Ramathibodi Hospital, Department of Emergency Medicine, Mahidol University, Bangkok, Thailand
| | - Pitsucha Sanguanwit
- Faculty of Medicine Ramathibodi Hospital, Department of Emergency Medicine, Mahidol University, Bangkok, Thailand
| | - Nitima Saksobhavivat
- Faculty of Medicine Ramathibodi Hospital, Department of Diagnostic and Therapeutic Radiology, Mahidol University, Bangkok, Thailand
| | - Ratchanee Saelee
- Faculty of Medicine Ramathibodi Hospital, Department of Internal Medicine, Mahidol University, Bangkok, Thailand
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Pan DF, Li ZJ, Ji XZ, Yang LT, Liang PF. Video-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions during simulated cardiac arrests: A systemic review and meta-analysis. World J Clin Cases 2022; 10:11442-11453. [PMID: 36387811 PMCID: PMC9649565 DOI: 10.12998/wjcc.v10.i31.11442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation (CPR).
AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.
METHODS The systematic review was conducted according to the PRISMA guidelines. All relevant studies were searched through PubMed, EMBASE, Medline and Cochrane Library databases. The risk of bias was evaluated using the Cochrane collaboration tool.
RESULTS A total of 259 studies were eligible for inclusion, and 6 randomised controlled trial studies were ultimately included. The results of meta-analysis indicated that video-assisted CPR (V-CPR) was significantly associated with the improved mean chest compression rate [OR = 0.66 (0.49-0.82), P < 0.001], and the proportion of chest compression with correct hand positioning [OR = 1.63 (0.71-2.55), P < 0.001]. However, the difference in mean chest compression depth was not statistically significant [OR = 0.18 (-0.07-0.42), P = 0.15], and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR [OR = -0.12 (-0.88-0.63), P = 0.75].
CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent. However, the quality is still not ideal, and there is a lack of guidance caused by poor video signal or inadequate interaction.
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Affiliation(s)
- Dong-Feng Pan
- Department of Emergency Medicine, The First Affiliated Hospital of Northwest Minzu University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Zheng-Jun Li
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Zhong Ji
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Li-Ting Yang
- Department of Emergency Medicine, The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
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Carlson JN, Colella MR, Daya MR, J De Maio V, Nawrocki P, Nikolla DA, Bosson N. Prehospital Cardiac Arrest Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:54-63. [PMID: 35001831 DOI: 10.1080/10903127.2021.1971349] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. Multiple cardiac arrest airway management techniques are available to EMS clinicians including bag-valve-mask (BVM) ventilation, supraglottic airways (SGAs), and endotracheal intubation (ETI). Important goals include achieving optimal oxygenation and ventilation while minimizing negative effects on physiology and interference with other resuscitation interventions. NAEMSP recommends:Based on the skill of the clinician and available resources, BVM, SGA, or ETI may be considered as airway management strategies in OHCA.Airway management should not interfere with other key resuscitation interventions such as high-quality chest compressions, rapid defibrillation, and treatment of reversible causes of the cardiac arrest.EMS clinicians should take measures to avoid hyperventilation during cardiac arrest resuscitation.Where available for clinician use, capnography should be used to guide ventilation and chest compressions, confirm and monitor advanced airway placement, identify return of spontaneous circulation (ROSC), and assist in the decision to terminate resuscitation.
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Abstract
Cardiac arrest results from a broad range of etiologies that can be broadly grouped as sudden and asphyxial. Animal studies point to differences in injury pathways invoked in the heart and brain that drive injury and outcome after these different forms of cardiac arrest. Present guidelines largely ignore etiology in their management recommendations. Existing clinical data reveal significant heterogeneity in the utility of presently employed resuscitation and postresuscitation strategies based on etiology. The development of future neuroprotective and cardioprotective therapies should also take etiology into consideration to optimize the chances for successful translation.
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To ventilate or not to ventilate during bystander CPR - A EuReCa TWO analysis. Resuscitation 2021; 166:101-109. [PMID: 34146622 DOI: 10.1016/j.resuscitation.2021.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). METHOD In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. RESULTS A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17-1.83). CONCLUSION In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.
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Eberhard KE, Linderoth G, Gregers MCT, Lippert F, Folke F. Impact of dispatcher-assisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:70. [PMID: 34030706 PMCID: PMC8147398 DOI: 10.1186/s13049-021-00875-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases neurologically intact survival in out-of-hospital cardiac arrest (OHCA) according to several studies. This systematic review summarizes neurologically intact survival outcomes of DA-CPR in comparison with bystander-initiated CPR and no bystander CPR in OHCA. Methods The systematic review was conducted according to the PRISMA guidelines. All studies including adult and/or pediatric OHCAs that compared DA-CPR with bystander-initiated CPR or no bystander CPR were included. Primary outcome was neurologically intact survival at discharge, one-month or longer. Studies were searched for in PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Results The search string generated 4742 citations of which 33 studies were eligible for inclusion. Due to overlapping study populations, the review included 14 studies. All studies were observational. The study populations were heterogeneous and included adult, pediatric and mixed populations. Some studies reported only witnessed cardiac arrests, arrests of cardiac ethiology, and/or shockable rhythm. The individual studies scored between six and nine on the Newcastle-Ottawa Scale of risk of bias. The median neurologically intact survival at hospital discharge with DA-CPR was 7.0% (interquartile range (IQR): 5.1–10.8%), with bystander-initiated CPR 7.5% (IQR: 6.6–10.2%), and with no bystander CPR 4.4% (IQR: 2.0–9.0%) (four studies). At one-month neurologically intact survival with DA-CPR was 3.1% (IQR: 1.6–3.4%), with bystander-initiated CPR 5.7% (IQR: 5.0–6.0%), and with no bystander CPR 2.5% (IQR: 2.1–2.6%) (three studies). Conclusion Both DA-CPR and bystander-initiated CPR increase neurologically intact survival compared with no bystander CPR. However, DA-CPR demonstrates inferior outcomes compared with bystander-initiated CPR. Early CPR is crucial, thus in cases where bystanders have not initiated CPR, DA-CPR provides an opportunity to improve neurologically intact survival following OHCA. Variability in OHCA outcomes across studies and multiple confounding factors were identified. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00875-5.
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Affiliation(s)
| | - Gitte Linderoth
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hopsital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mads Christian Tofte Gregers
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Wong XY, Fan Q, Shahidah N, De Souza CR, Arulanandam S, Ng YY, Ng WM, Leong BSH, Chia MYC, Ong MEH. Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:212-221. [PMID: 33855317 DOI: 10.47102/annals-acadmedsg.2020458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-of hospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR. METHODS The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR. RESULTS A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79-2.88; trend OR 1.03, 95% CI 1.01-1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82-1.11; trend OR 0.99, 95% CI 0.98-1.00). CONCLUSION B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.
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Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation? Am J Emerg Med 2020; 39:129-131. [PMID: 33039236 DOI: 10.1016/j.ajem.2020.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chest compressions have been suggested to provide passive ventilation during cardiopulmonary resuscitation. Measurements of this passive ventilatory mechanism have only been performed upon arrival of out-of-hospital cardiac arrest patients in the emergency department. Lung and thoracic characteristics rapidly change following cardiac arrest, possibly limiting the effectiveness of this mechanism after prolonged resuscitation efforts. Goal of this study was to quantify passive inspiratory tidal volumes generated by manual chest compression during prehospital cardiopulmonary resuscitation. MATERIALS AND METHODS A flowsensor was used during adult out-of-hospital cardiac arrest cases attended by a prehospital medical team. Adult, endotracheally intubated, non-traumatic cardiac arrest patients were eligible for inclusion. Immediately following intubation, the sensor was connected to the endotracheal tube. The passive inspiratory tidal volumes generated by the first thirty manual chest compressions performed following intubation (without simultaneous manual ventilation) were calculated. RESULTS 10 patients (5 female) were included, median age was 64 years (IQR 56, 77 years). The median compression frequency was 111 compression per minute (IQR 107, 116 compressions per minute). The median compression depth was 5.6 cm (IQR 5.4 cm, 6.1 cm). The median inspiratory tidal volume generated by manual chest compressions was 20 mL (IQR 13, 28 mL). CONCLUSION Using a flowsensor, passive inspiratory tidal volumes generated by manual chest compressions during prehospital cardiopulmonary resuscitation, were quantified. Chest compressions alone appear unable to provide adequate alveolar ventilation during prehospital treatment of cardiac arrest.
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Ivan I, Budiman F, Ruby R, Wendi IP, Ridjab DA. Current evidence of survival benefit between chest-compression only versus standard cardiopulmonary resuscitation in out-of-hospital cardiac arrest : Updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Herz 2020; 46:198-208. [PMID: 32975628 DOI: 10.1007/s00059-020-04982-4] [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: 04/24/2020] [Revised: 07/11/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence to support a better cardiopulmonary resuscitation method between standard vs. continuous chest compression (STD-CPR vs. CCC-CPR) is lacking. MATERIALS AND METHODS Our systematic review followed PRISMA guidelines. We searched PubMed, ScienceDirect, EBSCOhost, and ProQuest database from 1985 to 26 September 2019 restricted to randomized controlled trial, human study, and English articles. Quality assessment of between-study heterogeneity and a trial sequential analysis (TSA) were conducted. We estimated overall significance with 80% power and adjusted Z values thresholds using O'Brien-Fleming α‑spending function. Required information size with 21% relative risk using the estimation between-group incidences provided from the median rate across trials was determined. Inconclusive TSA result will lead to size estimation of future RCT. Quality of evidence was analyzed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Handbook and TSA. RESULTS Based on three trials in OHCA with dispatcher-guided and bystander-initiated CPR, our meta-analysis favors CCC-CPR for survival to hospital discharge, compared to STD-CPR (RR [Risk Ratio] = 1.21[1.01-1.46], 95% CI, p = 0.68, I2 = 0). However, current meta-analyses with 3031 patients appeared to be inconclusive. There is a significant risk of type 1 error and therefore, results are potentially false positive. It is estimated that a minimal of 4331 patients needed to deem a conclusive result and a total of 5894 patients with similar risk profile required to stabilize statistic results in future trials. Quality of evidence is downgraded to moderate due to serious imprecision based on TSA. CONCLUSION Based on these analyses, evidence is inadequate to conclude the superiority of one CPR method over the other. Further trials with larger numbers of patients are needed to deem a conclusive and stable meta-analysis.
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Affiliation(s)
- I Ivan
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - F Budiman
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - R Ruby
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - I P Wendi
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - D A Ridjab
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
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Anderson KL, Niknam K, Laufman L, Sebok-Syer SS, Andrabi S. Multi-Community Cardiopulmonary Resuscitation Education by Medical Students. Cureus 2020; 12:e8647. [PMID: 32685315 PMCID: PMC7366050 DOI: 10.7759/cureus.8647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction One purpose of the hands-only cardiopulmonary resuscitation (HOCPR) program is to simplify CPR instruction to encourage more bystanders to take action during cardiac arrest. Although the program has been successfully implemented in traditional classroom settings, the utility of large-scale training events has not been well-explored. We hypothesized that CPR knowledge and comfort levels would increase through a large-scale, multi-community HOCPR training event. We also explored what effect this training event had on perceived barriers to bystander-performed CPR. Methods A convenience sample participated in HOCPR training on a single day across 10 Texas cities. A sub-sample completed training questionnaires, including a five-item CPR pre- and post-test. A follow-up questionnaire was conducted two years after the event. The primary outcome of interest was the difference in cardiopulmonary resuscitation (CPR) knowledge and comfort level between pre- and post-event questionnaires. Demographic contributions were also assessed. Results A total of 4,253 participants were trained, 1,416 were enrolled upon submitting matching pre- and post-event questionnaires, and 101 (14%) submitted follow-up questionnaires. Mean knowledge scores increased from pre-training (2.7 ± 1.6 standard deviation (SD)) to post-training (4.7 ± 0.76 SD) (p < 0.001). Follow-up test scores (3.8 ± 1.1 SD) remained higher than pre-test scores (p < 0.001). Comfort with HOCPR increased from 59% (95% confidence interval (CI) 56 - 61) to 96% (95% CI 95 - 97). Pre- and post-knowledge scores differed significantly by education level (p < 0.001), ethnicity (p < 0.001), and income (p < 0.001). Education contributed significantly to comfort at both pre- (p = 0.015) and post-training (p = 0.026), but ethnicity and income did not. Before training, the most common barrier to performing CPR was lack of knowledge 59% (95% CI 55 - 62); after training, the most common barrier was fear of causing harm 34% (95% CI 29 - 40). Conclusions This study demonstrated that medical students were successfully able to conduct large-scale HOCPR training that improved CPR knowledge and comfort levels among participants across multiple metropolitan areas. Knowledge retention remained higher at two-years for participants of a follow-up questionnaire. Medical students can use the experiences from this training event as a template to organize similar large-scale training events in the future.
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Affiliation(s)
- Kenton L Anderson
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Kian Niknam
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | | | | | - Sara Andrabi
- Emergency Medicine, Baylor College of Medicine, Houston, USA
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Abstract
PURPOSE OF REVIEW There is a need for an early assessment of outcome in patients with return of spontaneous circulation after cardiac arrest. During the last decade, several models were developed in order to identify predictive factors that may facilitate prognostication and stratification of outcome. RECENT FINDINGS In addition to prognostication tools that are used in intensive care, at least five scores were recently developed using large datasets, based on simple and immediately available parameters, such as circumstances of arrest and early in-hospital indicators. Regarding neurological outcome, predictive performance of these models is good and even excellent for some of them. These scores perform very well for identifying patients at high-risk of unfavorable outcome. The most important limitation of these scores remains the lack of replication in different communities. In addition, these scores were not developed for individual decision- making, but they could instead be useful for the description and comparison of different cohorts, and also to design trials targeting specific categories of patients regarding outcome. Finally, the recent development of big data allows extension of research in epidemiology of cardiac arrest, including the identification of new prognostic factors and the improvement of prediction according to the profile of populations. SUMMARY In addition to the development of artificial intelligence, the prediction approach based on adequate scores will further increase the knowledge in prognostication after cardiac arrest. This strategy may help to develop treatment strategies according to the predicted severity of the outcome.
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Kurz MC, Bobrow BJ, Buckingham J, Cabanas JG, Eisenberg M, Fromm P, Panczyk MJ, Rea T, Seaman K, Vaillancourt C. Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association. Circulation 2020; 141:e686-e700. [PMID: 32088981 DOI: 10.1161/cir.0000000000000744] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.
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Zhou GJ, Jin P, Jiang SY. Gastric perforation following improper cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Pak J Med Sci 2020; 36:296-298. [PMID: 32063979 PMCID: PMC6994888 DOI: 10.12669/pjms.36.2.1363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
Gastric perforation is a rare complication of cardiopulmonary resuscitation (CPR), mostly resulting from incorrect airway management. If left unrecognized, it is associated with high mortality and morbidity. We present a case of gastric perforation after improper CPR. A 56-year-old drunken male was sent to the emergency department due to coma after fall onto the ground. He was thought to have cardiac arrest at scene and was saved with CPR maneuver by his friends who has never been trained before. He was taken to the hospital by emergency medical service personnel and presented with abdominal distention and extensive pneumoperitoneum. Emergency laparotomy was performed which revealed gastric perforation at the lesser curvature of the stomach. The laceration was repaired without any difficulty and the patient was discharged home without any neurological deficit. The aim of this report is to remind the public and emergency physicians that gastric perforation should be suspected in patients with distended abdomen and pneumoperitoneum after CPR. Because the most common risk factor for CPR-related gastric perforation is the bystander-provided resuscitation, it is encouraged for the public to take formal CPR training.
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Affiliation(s)
- Guang-Ju Zhou
- Guang-Ju Zhou, Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ping Jin
- Ping Jin, Department of Emergency Medicine, Zhejiang Yuyao People’s Hospital, Yuyao 315400, China
| | - Shou-Yin Jiang
- Shou-Yin Jiang. Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine; Research Institute of Emergency Medicine, Zhejiang University, Hangzhou 310009, China
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Mosesso VN. Ventilation during cardiopulmonary resuscitation-Only mostly dead! Resuscitation 2019; 141:200-201. [PMID: 31238035 DOI: 10.1016/j.resuscitation.2019.06.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Vincent N Mosesso
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States.
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Chang MP, Lu Y, Leroux B, Aramendi Ecenarro E, Owens P, Wang HE, Idris AH. Association of ventilation with outcomes from out-of-hospital cardiac arrest. Resuscitation 2019; 141:174-181. [PMID: 31112744 DOI: 10.1016/j.resuscitation.2019.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 12/29/2022]
Abstract
AIM OF STUDY To determine the association between bioimpedence-detected ventilation and out-of-hospital cardiac arrest (OHCA) outcomes. METHODS This is a retrospective, observational study of 560 OHCA patients from the Dallas-Fort Worth site enrolled in the Resuscitation Outcomes Consortium Trial of Continuous or Interrupted Chest Compressions During CPR from 4/2012 to 7/2015. We measured bioimpedance ventilation (lung inflation) waveforms in the pause between chest compression segments (Physio-Control LIFEPAK 12 and 15, Redmond, WA) recorded through defibrillation pads. We included cases ≥18 years with presumed cardiac cause of arrest assigned to interrupted 30:2 chest compressions with bag-valve-mask ventilation and ≥2 min of recorded cardiopulmonary resuscitation. We compared outcomes in two a priori pre-specified groups: patients with ventilation waveforms in <50% of pauses (Group 1) versus those with waveforms in ≥50% of pauses (Group 2). RESULTS Mean duration of 30:2 CPR was 13 ± 7 min with a total of 7762 pauses in chest compressions. Group 1 (N = 424) had a median 11 pauses and 3 ventilations per patient vs. Group 2 (N = 136) with a median 12 pauses and 8 ventilations per patient, which was associated with improved return of spontaneous circulation (ROSC) at any time (35% vs. 23%, p < 0.005), prehospital ROSC (19.8% vs. 8.7%, p < 0.0009), emergency department ROSC (33% vs. 21%, p < 0.005), and survival to hospital discharge (10.3% vs. 4.0%, p = 0.008). CONCLUSIONS This novel study shows that ventilation with lung inflation occurs infrequently during 30:2 CPR. Ventilation in ≥50% of pauses was associated with significantly improved rates of ROSC and survival.
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Affiliation(s)
- Mary P Chang
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8579, United States
| | - Yuanzheng Lu
- Emergency and Disaster Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Brian Leroux
- Department of Biostatistics and Oral Health Sciences, University of Washington, Seattle, WA, United States
| | | | - Pamela Owens
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8579, United States
| | - Henry E Wang
- University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, TX, United States
| | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8579, United States.
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16
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Yoo KH, Oh J, Lee H, Lee J, Kang H, Lim TH, Song SY, Kim S. Comparison of Heart Proportions Compressed by Chest Compressions Between Geriatric and Nongeriatric Patients Using Mathematical Methods and Chest Computed Tomography: A Retrospective Study. Ann Geriatr Med Res 2018; 22:130-136. [PMID: 32743262 PMCID: PMC7387584 DOI: 10.4235/agmr.2018.22.3.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022] Open
Abstract
Background Current guidelines recommended that chest compression depths during car-diopulmonary resuscitation (CPR) should be at least one-fifth of the external chest ante-riorposterior (AP) diameter. The chest AP diameter increases because of dorsal kyphosis, senile emphysema, and poor lung compliance associated with aging. This study aimed to compare the proportion of the heart compressed by chest compression (based on the ejection fraction [EF]) in geriatric and nongeriatric patients. Methods We performed a retrospective analysis of the chest computed tomography findings obtained between January 2010 and August 2016 and measured the chest anatomical parameters such as the perpendicular external and internal chest AP diameters with the heart AP diameter. Based on values of these parameters, EFs with 50- and 60-mm depths were obtained. In addition, we investigated and compared the proportion of 50- and 60-mm depths and heart AP to external chest AP diameter between the 2 groups. Results We randomly selected and analyzed 100 of 1,921 geriatric and 100 of 22,090 nongeriatric populations from a database. The means±standard deviations of EFs with 50- and 60-mm depths for geriatric and nongeriatric people were 37.1%±12.1% vs. 43.2%±13.8% and 47.5%±12.8% vs. 54.6%±14.8%, respectively (all p<0.001). The proportion of 50- and 60-mm depths and heart AP to external chest AP diameter were significantly different between the 2 groups (all p<0.05). Conclusion Chest compression depths based on current guidelines are not sufficient for geriatric patients during CPR; hence, deeper chest compressions would be considered.
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Affiliation(s)
- Kyung Hun Yoo
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.,Convergence Technology Centre for Disaster Preparedness, Hanyang University, Seoul, Korea
| | - Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.,Department of Emergency Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.,Convergence Technology Centre for Disaster Preparedness, Hanyang University, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea.,Convergence Technology Centre for Disaster Preparedness, Hanyang University, Seoul, Korea
| | - Soon Young Song
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea
| | - Solji Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
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17
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Abstract
The care for victims of out-of-hospital cardiac arrest is evolving and will be influenced by future and emerging technologies that will play a role in the systems of care for these patients. Recent advances in extracorporeal life support and point-of-care ultrasound imaging, both in-hospital and out-of-hospital, may offer a therapeutic solution in some systems for patients with refractory or recurrent cardiac arrest. Drones capable of delivering automated external defibrillators to the scene of an out-of-hospital cardiac arrest, advances in digital and mobile technologies to notify and leverage bystander response, and wearable life detection technologies may improve survival.
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Affiliation(s)
- Andrew J Latimer
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
| | - Andrew M McCoy
- Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
| | - Michael R Sayre
- Department of Emergency Medicine, University of Washington, Box 359727, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; Seattle Fire Department, Box 359702, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
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18
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Neumar RW. Future Directions: Management of Sudden Cardiac Death. Card Electrophysiol Clin 2017; 9:785-790. [PMID: 29173418 DOI: 10.1016/j.ccep.2017.08.008] [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: 11/16/2022]
Abstract
There will always be a need to optimize early recognition and treatment of sudden cardiac arrest. For out-of-hospital cardiac arrest, this requires a complex system of care involving bystanders, 911 dispatchers, and emergency medical service and hospital-based providers. Optimizing this system is fundamental to improving outcomes. In addition, personnel and resources are needed to develop and sustain a research pipeline that will bring new scientific discoveries and technologies to the field. The 2015 Institute of Medicine report, "Strategies to Improve Cardiac Arrest Survival: A Time to Act," provides a roadmap.
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Affiliation(s)
- Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Room TC B1220, Ann Arbor, MI 48109, USA.
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19
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Huang CH, Fan HJ, Chien CY, Seak CJ, Kuo CW, Ng CJ, Li WC, Weng YM. Validation of a Dispatch Protocol with Continuous Quality Control for Cardiac Arrest: A Before-and-After Study at a City Fire Department-Based Dispatch Center. J Emerg Med 2017; 53:697-707. [DOI: 10.1016/j.jemermed.2017.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/14/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
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20
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Garg R, Ahmed SM, Kapoor MC, Rao SSCC, Mishra BB, Kalandoor MV, Singh B, Divatia JV. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth 2017; 61:883-894. [PMID: 29217853 PMCID: PMC5703001 DOI: 10.4103/ija.ija_664_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The cardiopulmonary resuscitation (CPR) guideline of comprehensive cardiopulmonary life support (CCLS) for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care.
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Affiliation(s)
- Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, J N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | | | - SSC Chakra Rao
- Department of Anaesthesiology, Care Emergency Hospital, Kakinada, Andhra Pradesh, India
| | - Bibhuti Bhusan Mishra
- Department of Anaesthesiology, Indian College of Anaesthesiologists, Bhubaneswar, Odisha, India
| | | | - Baljit Singh
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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21
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Viewing an ultra-brief chest compression only video improves some measures of bystander CPR performance and responsiveness at a mass gathering event. Resuscitation 2017; 118:96-100. [DOI: 10.1016/j.resuscitation.2017.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022]
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22
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Abstract
Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes. Additionally, in younger children, differences in pre-hospital response and the activation of developmental apoptosis may explain more severe outcomes after OHCA. These require us to consider whether present practices are in line with the science. The present recommendations for compression-only cardiopulmonary resuscitation in young adults, normothermia as opposed to hypothermia (33°C) after asphyxial arrests, and paramedic training are considered within this review in light of existing evidence. Modifications in present standards of care may help restore the benefits of youth after brain injury to the young survivor of OHCA.
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Affiliation(s)
- Brian Griffith
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cameron Dezfulian
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Clinical and Translational Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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23
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Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity. Resuscitation 2016; 107:88-93. [DOI: 10.1016/j.resuscitation.2016.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
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24
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Beskind DL, Stolz U, Thiede R, Hoyer R, Burns W, Brown J, Ludgate M, Tiutan T, Shane R, McMorrow D, Pleasants M, Panchal AR. Viewing a brief chest-compression-only CPR video improves bystander CPR performance and responsiveness in high school students: A cluster randomized trial. Resuscitation 2016; 104:28-33. [DOI: 10.1016/j.resuscitation.2016.03.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/12/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
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25
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Jentzer JC, Clements CM, Wright RS, White RD, Jaffe AS. Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges. Ann Emerg Med 2016; 68:678-689. [PMID: 27318408 DOI: 10.1016/j.annemergmed.2016.05.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 12/13/2022]
Abstract
Cardiac arrest is a common and lethal condition frequently encountered by emergency medicine providers. Resuscitation of persons after cardiac arrest remains challenging, and outcomes remain poor overall. Successful resuscitation hinges on timely, high-quality cardiopulmonary resuscitation. The optimal method of providing chest compressions and ventilator support during cardiac arrest remains uncertain. Prompt and effective defibrillation of ventricular arrhythmias is one of the few effective therapies available for treatment of cardiac arrest. Despite numerous studies during several decades, no specific drug delivered during cardiac arrest has been shown to improve neurologically intact survival after cardiac arrest. Extracorporeal circulation can rescue a minority of highly selected patients with refractory cardiac arrest. Current management of pulseless electrical activity is associated with poor outcomes, but it is hoped that a more targeted diagnostic approach based on electrocardiography and bedside cardiac ultrasonography may improve survival. The evolution of postresuscitation care appears to have improved cardiac arrest outcomes in patients who are successfully resuscitated. The initial approach to early stabilization includes standard measures, such as support of pulmonary function, hemodynamic stabilization, and rapid diagnostic assessment. Coronary angiography is often indicated because of the high frequency of unstable coronary artery disease in comatose survivors of cardiac arrest and should be performed early after resuscitation. Optimizing and standardizing our current approach to cardiac arrest resuscitation and postresuscitation care will be essential for developing strategies for improving survival after cardiac arrest.
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Affiliation(s)
- Jacob C Jentzer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | | | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Roger D White
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Cardiovascular and Thoracic Anesthesia, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Clinical Core Laboratory Services, Mayo Clinic, Rochester, MN
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26
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Krikscionaitiene A, Dambrauskas Z, Barron T, Vaitkaitiene E, Vaitkaitis D. Are two or four hands needed for elderly female bystanders to achieve the required chest compression depth during dispatcher-assisted CPR: a randomized controlled trial. Scand J Trauma Resusc Emerg Med 2016; 24:47. [PMID: 27067836 PMCID: PMC4827183 DOI: 10.1186/s13049-016-0238-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/04/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rescuers are often unable to achieve the recommended 5-6 cm CC depth. The physical limitations of elderly bystanders may affect the quality of CC; thus, we investigated new strategies to improve CC performance. METHODS We performed a randomized controlled trial in December 2013. Sixty-eight lay rescuers aged 50-75 were randomized to intervention or control pairs (males and females separately). Each pair performed 8 min of DA-CPR on a manikin connected to a PC. Each participant in every pair took turns performing CCs in cycles of 2 min and switched as advised by the dispatcher. In the middle of every 2-min cycle, the dispatcher asked the participants of the intervention group to perform the Andrew's manoeuvre (to push on the shoulders of the person while he/she performed CCs to achieve deeper CC). Data on the quality of the CCs were analysed for each participant and pair. RESULTS The CC depth in the intervention group increased by 6.4 mm (p = 0.002) compared to the control group (54.2 vs. 47.8 mm) due to a significant difference in the female group. The CC depth in the female intervention and control groups was 51.5 and 44.9 mm. DISCUSSION The largest group of out-of-hospital cardiac arrest occurred in males over the age of 60 at home, and accordingly, the most likely witness, if any, is the spouse or family member, most frequently an older woman. There is a growing body of evidence that female rescuers are frequently unable to achieve sufficient CC depth compared to male rescuers. In some instances, the adequate depth of the CCs could only be reached using four hands, with the second pair of hands placed on the shoulders of the rescuer performing CPR. CONCLUSION Andrew's manoeuvre (four-hands CC) during the simulated DA-CPR significantly improved the performance of elderly female rescuers and helped them to achieve the recommended CC depth.
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Affiliation(s)
- Asta Krikscionaitiene
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu 4-512, Kaunas, LT, 50161, Lithuania.
| | - Zilvinas Dambrauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tracey Barron
- International Academies of Emergency Dispatch, Bristol, UK
| | - Egle Vaitkaitiene
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu 4-512, Kaunas, LT, 50161, Lithuania
| | - Dinas Vaitkaitis
- Department of Disaster Medicine, Lithuanian University of Health Sciences, Eiveniu 4-512, Kaunas, LT, 50161, Lithuania
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27
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González-Salvado V, Fernández-Méndez F, Barcala-Furelos R, Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A. Very brief training for laypeople in hands-only cardiopulmonary resuscitation. Effect of real-time feedback. Am J Emerg Med 2016; 34:993-8. [PMID: 26964823 DOI: 10.1016/j.ajem.2016.02.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest, but rates and performance quality remain low. Although training laypeople is a primary educational goal, the optimal strategy is not well defined. This study aimed to determine whether a short training with real-time feedback was able to improve hands-only CPR among untrained citizens. METHODS On the occasion of the 2015 World Heart Day and the European Restart a Heart Day, a pilot study involving 155 participants (81 laypeople, 74 health care professionals) was conducted. Participants were invited to briefly practice hands-only CPR on a manikin and were after evaluated during a 2-minute chest compression (CC) test. During training brief instructions regarding hand position, compression rate and depth according to the current guidelines were given and real-time feedback was provided by a Laerdal SkillReporting System. RESULTS Mean CC rate was significantly higher among health care professionals than among laypeople (119.07 ± 12.85 vs 113.02 ± 13.90 min(-1); P = .006), although both met the 100-120 CC min(-1) criterion. Laypeople achieved noninferior results regarding % of CC at adequate rate (51.46% ± 35.32% vs health care staff (55.97% ± 36.36%; P = .43) and depth (49.88% ± 38.58% vs 50.46% ± 37.17%; P = .92), % of CC with full-chest recoil (92.77% ± 17.17% vs 0.91% ± 18.84; P = .52), and adequate hand position (96.94% ± 14.78% vs 99.74 ± 1.98%; P = .11). The overall quality performance was greater than 70%, noninferior for citizens (81.23% ± 20.10%) vs health care staff (85.95% ± 14.78%; P = .10). CONCLUSION With a very brief training supported by hands-on instructor-led advice and visual feedback, naïve laypeople are able to perform good-quality CC-CPR. Simple instructions, feedback, and motivation were the key elements of this strategy, which could make feasible to train big numbers of citizens.
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Affiliation(s)
- Violeta González-Salvado
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Felipe Fernández-Méndez
- University School of Nursing, Universidade de Vigo, Pontevedra, Spain; CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; School of Nursing, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain; REMOSS Research Group, Universidade de Vigo, Pontevedra, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Institute of Health Research of Santiago (IDIS), A Coruña, Spain
| | - José Ramón González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Institute of Health Research of Santiago (IDIS), A Coruña, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; School of Nursing, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Institute of Health Research of Santiago (IDIS), A Coruña, Spain; Paediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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28
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Arntz HR, Breckwoldt J. [The supraglottic airway in the prehospital setting]. Med Klin Intensivmed Notfmed 2015; 111:107-12. [PMID: 26340800 DOI: 10.1007/s00063-015-0072-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/21/2015] [Accepted: 06/14/2015] [Indexed: 12/26/2022]
Abstract
The supraglottic airway (SGA) is increasingly considered as a more effective alternative for emergency ventilation compared to bag mask ventilation and is propagated as an "easily" manageable method, compared to endotracheal intubation especially under the often adverse out-of-hospital conditions. Since the skill can easily be acquired during mannequin training, more and more rescue services train their personnel in the use of SGA devices and allow or even recommend their application also by nonphysicians. This recommendation, however, is not unequivocally supported by properly designed and conducted trials. Moreover, the solely available observational studies show contradictory results. Neither superiority nor inferiority of SGAs has been shown. They may, however, be accepted as an addendum to other prehospital ventilation approaches. The SGA airway comprises various problems and inherited risks similar to other ventilation techniques. Randomized studies investigating different techniques for prehospital emergency ventilation are lacking, as are controlled studies comparing SGA devices.
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Affiliation(s)
- H-R Arntz
- Med. Klinik, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - J Breckwoldt
- Medizinische Fakultät, Universität Zürich, Pestalozzistr. 3/5, 8091, Zürich, Schweiz
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29
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Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis. Resuscitation 2015; 94:55-60. [DOI: 10.1016/j.resuscitation.2015.06.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022]
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30
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Chen SQ. Advances in clinical studies of cardiopulmonary resuscitation. World J Emerg Med 2015; 6:85-93. [PMID: 26056537 DOI: 10.5847/wjem.j.1920-8642.2015.02.001] [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] [Received: 12/25/2014] [Accepted: 04/03/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The survival rate of patients after cardiac arrest (CA) remains lower since 2010 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) was published. In clinical trials, the methods and techniques for CPR have been overly described. This article gives an overview of the progress in methods and techniques for CPR in the past years. DATA SOURCES Original articles about cardiac arrest and CPR from MEDLINE (PubMed) and relevant journals were searched, and most of them were clinical randomized controlled trials (RCTs). RESULTS Forty-two articles on methods and techniques of CPR were reviewed, including chest compression and conventional CPR, chest compression depth and speed, defibrillation strategies and priority, mechanical and manual chest compression, advanced airway management, impedance threshold device (ITD) and active compression-decompression (ACD) CPR, epinephrine use, and therapeutic hypothermia. The results of studies and related issues described in the international guidelines had been testified. CONCLUSIONS Although large multicenter studies on CPR are still difficult to carry out, progress has been made in the past 4 years in the methods and techniques of CPR. The results of this review provide evidences for updating the 2015 international guidelines.
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Affiliation(s)
- Shou-Quan Chen
- Department of Emergency Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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31
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Kern KB. Usefulness of cardiac arrest centers - extending lifesaving post-resuscitation therapies: the Arizona experience - . Circ J 2015; 79:1156-63. [PMID: 25877829 DOI: 10.1253/circj.cj-15-0309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The post-cardiac arrest syndrome is a complex, multisystems response to the global ischemia and reperfusion injury that occurs with the onset of cardiac arrest, its treatment (cardiopulmonary resuscitation) and the re-establishment of spontaneous circulation. Regionalization of post-cardiac arrest care, utilizing specified cardiac arrest centers (CACs), has been proposed as the best solution to providing optimal care for those successfully resuscitated after out-of-hospital cardiac arrest. A multidisciplinary team of intensive care specialists, including critical care/pulmonologists, cardiologists (general, interventional, and electrophysiology), neurologists, and physical medicine/rehabilitation experts, is crucial for such centers. Particular attention to the timely initiation of targeted temperature management and early coronary angiography/percutaneous coronary intervention is best provided by such CACs. A State-wide program of CACs was started in Arizona in 2007. This is a voluntary program, whereby medical centers agree to provide all resuscitated cardiac arrest patients brought to their facility with state-of-the-art post-resuscitation care, including targeted temperature management for comatose patients and strong consideration for emergent coronary angiography for all patients with a likely cardiac etiology for their cardiac arrest. Survival improved by more than 50% at facilities that became CACs with a commitment to provide aggressive post-resuscitation care to all such patients. Providing aggressive, post-resuscitation care is the next real opportunity to increase long-term survival for cardiac arrest patients.
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Rodríguez-Núñez A, Regueiro-García A, Jorge-Soto C, Cañas-González J, Leboráns-Iglesias P, García-Crespo O, Barcala-Furelos R. Quality of chest compressions by Down syndrome people: a pilot trial. Resuscitation 2015; 89:119-22. [PMID: 25637696 DOI: 10.1016/j.resuscitation.2015.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/17/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival after out-of-hospital cardiac arrest. Down syndrome (DS) citizens have improved their active engagement in society. The objective of this pilot trial was to investigate if they are able to perform quality chest compression-only CPR after a brief training. METHODS Nineteen DS young people (15-30 year old) and 20 University level subjects (18-29 year old) were trained by means of a short video and a brief hands-on session on manikins, to perform chest compression-only CPR. All participants were naïve in CPR. Chest compression (CC) quality (percentage of correct CC, CC rate and depth and chest complete release) was measured during a 2min test. CPR quality goal was according to 2010 European Resuscitation Council guidelines. RESULTS DS people had similar weight, lower height and a higher BMI than controls. They were able to deliver chest compression-only CPR but with higher mean CC rate (140±30 vs 123±12CC/min, p=0.03), less mean CC depth (35.4±10.3 vs 47.2±9.6mm, p=0.03) and lower % of full correct CC (13±18 vs 39±37, p=0.02) than controls. Differences were maintained when first and second minute of test were compared. CONCLUSIONS After a short instruction based on a brief video and hands-on session DS people were able to deliver CC but with poor quality.
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Affiliation(s)
- Antonio Rodríguez-Núñez
- Pediatric Area, Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Institute of Investigation of Santiago (IDIS), Santiago de Compostela, Spain; Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
| | - Alexandra Regueiro-García
- Pediatric Area, Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Jorge-Soto
- School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Janali Cañas-González
- Education and Sports Sciences University School, University of Vigo, Pontevedra, Spain
| | - Pilar Leboráns-Iglesias
- Pediatric Area, Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Down Compostela Foundation, Santiago de Compostela, Spain
| | | | - Roberto Barcala-Furelos
- School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Education and Sports Sciences University School, University of Vigo, Pontevedra, Spain
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Standardisierte Telefonanweisungen zur Wiederbelebung durch Laienhelfer. Anaesthesist 2014; 63:919-31. [DOI: 10.1007/s00101-014-2391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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Rea T, Olsufka M, Yin L, Maynard C, Cobb L. The relationship between chest compression fraction and outcome from ventricular fibrillation arrests in prolonged resuscitations. Resuscitation 2014; 85:879-84. [DOI: 10.1016/j.resuscitation.2014.02.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
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Characteristics and prognosis of sudden cardiac death in Greater Paris. Intensive Care Med 2014; 40:846-54. [DOI: 10.1007/s00134-014-3252-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
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Murugiah K, Chen SI, Dharmarajan K, Nuti SV, Wayda B, Shojaee A, Ranasinghe I, Dreyer RP. Most important outcomes research papers on cardiac arrest and cardiopulmonary resuscitation. Circ Cardiovasc Qual Outcomes 2014; 7:335-45. [PMID: 24619323 DOI: 10.1161/circoutcomes.114.000957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Nagata T, Abe T, Noda E, Hasegawa M, Hashizume M, Hagihara A. Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan. BMJ Open 2014; 4:e003481. [PMID: 24525386 PMCID: PMC3927934 DOI: 10.1136/bmjopen-2013-003481] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA). DESIGN A population-based, observational study. SETTING The National Japan Utstein Registry. PARTICIPANTS 2900 children aged 5-17 years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or 2. A validation study was conducted to verify the model. RESULTS OHCA was identified as cardiac origin in 706 participants and non-cardiac origin in 2194 participants. Rates of CPC 1 or 2 for cardiac and non-cardiac causes were 20% and 6.4%, respectively. Cardiac origin arrest was categorised following signal detection into six subgroups defined by public automated external defibrillator use, defibrillation by emergency medical service, age, initial ECG rhythm and eye-witness to arrest; the ranges of CPC 1 or 2 in the six subgroups were between 87.5% and 0.7%. Non-cardiac origin arrest was categorised into four subgroups. Bystander rescue breathing was the most significant factor contributing to outcome; additionally, two other factors-eye-witness to arrest and age-were also significant. CPC 1 or 2 rates ranged between 38.5% and 4% across the four subgroups. Rates of CPC 1 or 2 in the validation study did not differ among any subgroup. CONCLUSIONS For children who have OHCA from non-cardiac origin, bystander rescue breathing is mandatory to achieve CPC 1 or 2.
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Affiliation(s)
- Takashi Nagata
- Faculty of Medical Sciences, Department of Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan
| | - Takeru Abe
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Eiichiro Noda
- Department of Emergency and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Manabu Hasegawa
- Ambulance Service Planning Division, Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Tokyo, Japan
| | - Makoto Hashizume
- Faculty of Medical Sciences, Department of Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan
| | - Akihito Hagihara
- Department of Health Services Management and Policy, Kyusyu University Graduate School of Medicine, Fukuoka, Japan
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3572] [Impact Index Per Article: 324.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Rhythm analysis during cardiopulmonary resuscitation: past, present, and future. BIOMED RESEARCH INTERNATIONAL 2014; 2014:386010. [PMID: 24527445 PMCID: PMC3910663 DOI: 10.1155/2014/386010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
Abstract
Survival from out-of-hospital cardiac arrest depends largely on two factors: early cardiopulmonary resuscitation (CPR) and early defibrillation. CPR must be interrupted for a reliable automated rhythm analysis because chest compressions induce artifacts in the ECG. Unfortunately, interrupting CPR adversely affects survival. In the last twenty years, research has been focused on designing methods for analysis of ECG during chest compressions. Most approaches are based either on adaptive filters to remove the CPR artifact or on robust algorithms which directly diagnose the corrupted ECG. In general, all the methods report low specificity values when tested on short ECG segments, but how to evaluate the real impact on CPR delivery of continuous rhythm analysis during CPR is still unknown. Recently, researchers have proposed a new methodology to measure this impact. Moreover, new strategies for fast rhythm analysis during ventilation pauses or high-specificity algorithms have been reported. Our objective is to present a thorough review of the field as the starting point for these late developments and to underline the open questions and future lines of research to be explored in the following years.
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Abstract
Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.
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Affiliation(s)
- PE Jacobs
- University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104
| | - A Grabinsky
- University of Washington/Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, WA 98104
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The Year in Review of Clinical Cardiac Electrophysiology. J Am Coll Cardiol 2013; 62:2433-2447. [DOI: 10.1016/j.jacc.2013.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/29/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022]
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