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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Abstract
Introduction Failure to restore spontaneous circulation remains a major cause of death for cardiac arrest (CA) patients. Mechanical circulatory support, specifically extracorporeal cardiopulmonary resuscitation (ECPR), has emerged as a feasible and efficacious rescue strategy for selected refractory CA patients. Methods Mechanical Circulatory Support was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17, 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of CA resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top 5 knowledge gaps included optimal patient selection, pre-ECPR treatments, logistical and programmatic characteristics of ECPR programs, generalizability and effectiveness of ECPR, and prevention of reperfusion injury. Top 5 barriers to translation included cost/resource limitations, technical challenges, collaboration across multiple disciplines, limited patient population, and early identification of eligible patients. Top 5 research priorities focused on comparing the outcomes of prehospital/rapid transport strategies vs in-hospital ECPR initiation, implementation of high-performing ECPR system vs standard care, rapid patient identification tools vs standard clinical judgment, post-cardiac arrest bundled care vs no bundled care, and standardized ECPR clinical protocol vs routine care. Conclusion This overview can serve as an innovative guide to transform the care and outcome of patients with refractory CA.
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Affiliation(s)
- Cindy H. Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - George Trummer
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany
| | - Jan Belohlavek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Demetris Yannopoulos
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Jason A. Bartos
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
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Gottula AL, McCracken BM, Nakashima T, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW, Hakam Tiba M, Hsu CH. Percutaneous left ventricular assist devices in refractory cardiac arrest: The role of chest compressions. Resusc Plus 2023; 16:100488. [PMID: 38143529 PMCID: PMC10746849 DOI: 10.1016/j.resplu.2023.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 12/26/2023] Open
Abstract
Background Recent studies describe an emerging role for percutaneous left ventricular assist devices such as Impella CP® as rescue therapy for refractory cardiac arrest. We hypothesized that the addition of mechanical chest compressions to percutaneous left ventricular assist device assisted CPR would improve hemodynamics by compressing the right ventricle and augmenting pulmonary blood flow and left ventricular filling. We performed a pilot study to test this hypothesis using a swine model of prolonged cardiac arrest. Methods Eight Yorkshire swine were anesthetized, intubated, and instrumented for hemodynamic monitoring. They were subjected to untreated ventricular fibrillation for 5.75 (SD 2.90) minutes followed by mechanical chest compressions for a mean of 20.0 (SD 5.0) minutes before initiation of percutaneous left ventricular assist device. After percutaneous left ventricular assist device initiation, mechanical chest compressions was stopped (n = 4) or continued (n = 4). Defibrillation was attempted 4, 8 and 12 minutes after initiating percutaneous left ventricular assist device circulatory support. Results The percutaneous left ventricular assist device + mechanical chest compressions group had significantly higher percutaneous left ventricular assist device flow prior to return of spontaneous heartbeat at four- and twelve-minutes after percutaneous left ventricular assist device initiation, and significantly higher end tidal CO2 at 4-minutes after percutaneous left ventricular assist device initiation, when compared with the percutaneous left ventricular assist device alone group. Carotid artery flow was not significantly different between the two groups. Conclusion The addition of mechanical chest compressions to percutaneous left ventricular assist device support during cardiac arrest may generate higher percutaneous left ventricular assist device and carotid artery flow prior to return of spontaneous heartbeat compared to percutaneous left ventricular assist device alone. Further studies are needed to determine if this approach improves other hemodynamic parameters or outcomes after prolonged cardiac arrest.
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Affiliation(s)
- Adam L. Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Brendan M. McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Takahiro Nakashima
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nicholas L. Greer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Traci A. Cramer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nadia R. Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Kevin R. Ward
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Robert W. Neumar
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Cindy H. Hsu
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
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Zhang B, McCracken BM, Mahmood CC, Leander D, Greer N, Cranford JA, Hsu CH, Tiba MH, Neumar RW, Greineder CF. Coagulofibrinolytic effects of recombinant soluble thrombomodulin in prolonged porcine cardiac arrest. Resusc Plus 2023; 16:100477. [PMID: 37811363 PMCID: PMC10550843 DOI: 10.1016/j.resplu.2023.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Aim To evaluate coagulofibrinolytic abnormalities and the effects of ART-123 (recombinant human thrombomodulin alpha) in a porcine model of cardiac arrest and prolonged cardiopulmonary resuscitation (CA/CPR). Methods Fifteen pigs (n = 5 per group) underwent 8 minutes of no-flow CA followed by 50 minutes of mechanical CPR, while 2 pigs underwent sham arrest. CA/CPR animals were randomized to receive saline or 1 mg/kg ART-123 pre-arrest (5 minutes prior to ventricular fibrillation) or post-arrest (2 minutes after initiation of CPR). Arterial and venous blood samples were drawn at multiple time points for blood gas analysis and measurement of plasma and whole blood markers of coagulation and fibrinolysis. Results In saline-treated CA/CPR, but not sham animals, robust and persistent activation of coagulation and fibrinolysis was observed throughout resuscitation. After 50 minutes of CPR, plasma tests and thromboelastography indicated a mix of hypercoagulability and consumptive coagulopathy. ART-123 had a robust anticoagulant effect, reducing both thrombin-antithrombin (TAT) complexes and d-dimer (p < 0.05 for each). The duration of anticoagulant effect varied depending on the timing of ART-123 administration. Similarly, ART-123 when given prior to cardiac arrest was found to have pro-fibrinolytic effects, increasing free tissue plasminogen activator (tPA, p = 0.02) and decreasing free plasminogen activator inhibitor-1 (PAI-1, p = 0.04). Conclusion A porcine model of prolonged CA/CPR reproduces many of the coagulofibrinolytic abnormalities observed in human cardiac arrest patients. ART-123 demonstrates a combination of anticoagulant and profibrinolytic effects, depending on the timing of its administration relative to cardiac arrest.
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Affiliation(s)
- Boya Zhang
- Departments of Emergency Medicine, University of Michigan, United States
- Pharmacology, University of Michigan, United States
| | - Brendan M. McCracken
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - Carmen Colmenero Mahmood
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - Danielle Leander
- Departments of Emergency Medicine, University of Michigan, United States
| | - Nicholas Greer
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - James A. Cranford
- Departments of Emergency Medicine, University of Michigan, United States
| | - Cindy H. Hsu
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - Mohamad Hakam Tiba
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - Robert W. Neumar
- Departments of Emergency Medicine, University of Michigan, United States
- The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, United States
| | - Colin F. Greineder
- Departments of Emergency Medicine, University of Michigan, United States
- Pharmacology, University of Michigan, United States
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Nakashima T, Hakam Tiba M, McCracken BM, Hsu CH, Gottula AL, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW. Effect of percutaneous ventricular assisted device on post-cardiac arrest myocardial dysfunction in swine model with prolonged cardiac arrest. Resuscitation 2023; 193:110010. [PMID: 37884220 DOI: 10.1016/j.resuscitation.2023.110010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND It remains unclear if percutaneous left ventricular assist device (pLVAD) reduces post-cardiac arrest myocardial dysfunction. METHODS This is a prespecified analysis of a subset of swine that achieved return of spontaneous circulation (ROSC) in a study comparing pLVAD, transient aortic occlusion (AO), or both during cardiopulmonary resuscitation (CPR). Devices were initiated after 24 minutes of ventricular fibrillation cardiac arrest (8 min no-flow and 16 min mechanical CPR). AO was discontinued post-ROSC, and pLVAD support or standard care were continued. Beginning 60 minutes post-ROSC, pLVAD support was weaned to < 1.0 L/min and subsequently removed at 240 minutes. The primary outcome was cardiac index (CI), stroke volume index (SVI), and left ventricular ejection fraction (LVEF) at 240 minutes post-ROSC. Data are shown as mean (standard error). RESULTS Seventeen swine achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 and standard care group, n = 6). For the primary outcomes, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m2 (p = 0.043) and LVEF 60(3) vs. 49(4) % (p = 0.029) at 240 minutes after ROSC when compared with the standard care group, while SVI was not statistically significantly different (32[3] vs. 23[4] mL/min/m2, p = 0.054). During the first 60 minutes post-ROSC, the pLVAD group had significantly higher coronary perfusion pressure, lower LV stroke work index, and total pulmonary resistance index. CONCLUSION These results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.
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Affiliation(s)
- Takahiro Nakashima
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Brendan M McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Adam L Gottula
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas L Greer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Traci A Cramer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, MI, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, MI, United States
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
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Hsu FM, Huang TC, Guo JC, Hsu CH, Lee JM, Huang PM, Chang YL, Cheng JCH. A Prospective Study of Bevacizumab and Neoadjuvant Concurrent Chemoradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: Paradoxical Increase in Circulating Vascular Endothelial Growth Factor-A and Effect on Outcome. Int J Radiat Oncol Biol Phys 2023; 117:e302-e303. [PMID: 37785104 DOI: 10.1016/j.ijrobp.2023.06.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the prior prospective biomarker study, high serum vascular endothelial growth factor-A (VEGF-A) was associated with a poor prognosis. We conducted a prospective phase II trial of adding Bevacizumab, an anti-VEGF-A monoclonal antibody, to neoadjuvant concurrent chemoradiation (neoCCRT) for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This prospective biomarker study aims to evaluate the expressions of angiogenesis-associated circulating biomarkers before and after neoCCRT and compare clinical outcomes for patients receiving platinum/5-fluorouracil (PF) with or without Bevacizumab. MATERIALS/METHODS Patients with biopsy-proven resectable non-T4 LA-ESCC were enrolled for the prospective phase II trial investigating PF-neoCCRT plus Bevacizumab (BPF group). A parallel patient cohort enrolled in a prospective biomarker study receiving PF-neoCCRT was included in the present analysis as the control group (PF group). Radiotherapy was delivered with 40 Gy in 20 fractions. All patients had restaging workups after enoCCRT and underwent radical esophagectomy if the disease remained resectable. Serums were collected before and after neoCCRT. The serum concentrations of angiogenesis-associated biomarkers were determined by the multiplex enzyme-linked immunosorbent assay. Survival analyses were performed by the Kaplan-Meier method. The t-test and log-rank test were used to compare differences in biomarker expression and survival between groups. RESULTS From 2016 to 2019, 43 patients (BPF/PF group: 21/22) were enrolled in the study. Twenty patients in each group had serum samples available for biomarker analysis. 15 out of 21 patients in the BPF group and 20 out of 22 patients in the PF group underwent radical esophagectomy. Six patients in the BPF group and nine patients in the PF group achieved pathological complete responses. The median overall survival for the BPF and PF group was 20.8 months and not-reached, respectively (hazard ratio = 1.33, long rank p = 0.58). In the BPF group, the serum VEGF-A level was significantly increased from an average value of 446 pg/mL to 723 pg/mL after neoCCRT (p = 0.037), while its level was decreased from 815 ng/mL to 380 pg/mL in the PF group (p = 0.104). In addition, the expression value of circulating Angiopoietin-1 was not changed in the BPF group (before neoCCRT, mean value = 828 pg/mL; after neoCCRT, mean value 762 pg/mL, p = 0.67). In contrast, serum Angiopoietin-1 level was reduced from an average value of 659 pg/mL before neoCCRT to 271 pg/mL after neoCCRT (p = 0.002) in the PF group. CONCLUSION The addition of Bevacizumab to PF-neoCCRT did not improve pathological or survival outcomes in patients with resectable LA-ESCC. Adding a single dose of Bevacizumab paradoxically increases circulating VEGF-A while maintaining the Angiopoietin-1 serum level after neoCCRT. Further investigation by using additional VEGF-A inhibition may be required to achieve sustained angiogenesis blocked for tumor control.
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Affiliation(s)
- F M Hsu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - T C Huang
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C Guo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - C H Hsu
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J M Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - P M Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Y L Chang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C H Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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Tiba MH, Nakashima T, McCracken BM, Hsu CH, Gottula AL, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW. Haemodynamic impact of aortic balloon occlusion combined with percutaneous left ventricular assist device during cardiopulmonary resuscitation in a swine model of cardiac arrest. Resuscitation 2023; 189:109885. [PMID: 37385400 DOI: 10.1016/j.resuscitation.2023.109885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
AIM To investigate the effect of tandem use of transient balloon occlusion of the descending aorta (AO) and percutaneous left ventricular assist device (pl-VAD) during cardiopulmonary resuscitation in a large animal model of prolonged cardiac arrest. METHODS Ventricular fibrillation was induced and left untreated for 8 minutes followed by 16 minutes of mechanical CPR (mCPR) in 24 swine, under general anesthesia. Animals were randomized to 3 treatment groups (n = 8 per group): A) pL-VAD (Impella CP®) B) pL-VAD+AO, and C) AO. Impella CP® and the aortic balloon catheter were inserted via the femoral arteries. mCPR was continued during treatment. Defibrillation was attempted 3 times starting at minute 28 and then every 4 minutes. Haemodynamic, cardiac function and blood gas measurements were recorded for up to 4 hours. RESULTS Coronary perfusion pressure (CoPP) in the pL-VAD+AO Group increased by a mean (SD) of 29.2(13.94) mmHg compared to an increase of 7.1(12.08) and 7.1(5.95) mmHg for groups pL-VAD and AO respectively (p = 0.02). Similarly, cerebral perfusion pressure (CePP) in pL-VAD+AO increased by a mean (SD) of 23.6 (6.11), mmHg compared with 0.97 (9.07) and 6.9 (7.98) mmHg for the other two groups (p < 0.001). The rate of return of spontaneous heartbeat (ROSHB) was 87.5%, 75%, and 100% for pL-VAD+AO, pL-VAD, and AO. CONCLUSION Combined AO and pL-VAD improved CPR hemodynamics compared to either intervention alone in this swine model of prolonged cardiac arrest.
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Affiliation(s)
- Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Takahiro Nakashima
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Brendan M McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States.
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Adam L Gottula
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Nicholas L Greer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Traci A Cramer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
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9
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Hsu CH, Couper K, Nix T, Drennan I, Reynolds J, Kleinman M, Berg KM. Calcium during cardiac arrest: A systematic review. Resusc Plus 2023; 14:100379. [PMID: 37025978 PMCID: PMC10070937 DOI: 10.1016/j.resplu.2023.100379] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Aim To perform a systematic review of administration of calcium compared to no calcium during cardiac arrest. Methods The search included Medline (PubMed), Embase, Cochrane, Web of Science, and CINAHL Plus and was conducted on September 30, 2022. The population included adults and children in any setting with cardiac arrest. The outcomes included return of spontaneous circulation, survival, survival with favourable neurologic outcome to hospital discharge and 30 days or longer, and quality of life outcome. Cochrane Risk of Bias 2 and ROBINS-I were performed to assess risk of bias for controlled and observational studies, respectively. Results The systematic review identified 4 studies on 3 randomised controlled trials on 554 adult out-of-hospital cardiac arrest (OHCA) patients, 8 observational studies on 2,731 adult cardiac arrest patients, and 3 observational studies on 17,449 paediatric in-hospital cardiac arrest (IHCA) patients. The randomised controlled and observational studies showed that routine calcium administration during cardiac arrest did not improve the outcome of adult OHCA or IHCA or paediatric IHCA. The risk of bias for the adult trials was low for one recent trial and high for two earlier trials, with randomization as the primary source of bias. The risk of bias for the individual observational studies was assessed to be critical due to confounding. The certainty of evidence was assessed to be moderate for adult OHCA and low for adult and paediatric IHCA. Heterogeneity across studies precluded any meaningful meta-analyses. Conclusions This systematic review found no evidence that routine calcium administration improves the outcomes of cardiac arrest in adults or children.PROSPERO Registration: CRD42022349641.
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10
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VanZalen JJ, Harvey S, Hála P, Phillips A, Nakashima T, Gok E, Tiba MH, McCracken BM, Hill JE, Liao J, Jung J, Mergos J, Stacey WC, Bartlett RH, Hsu CH, Rojas-Peña A, Neumar RW. Therapeutic Effect of Argatroban During Cardiopulmonary Resuscitation and Streptokinase During Extracorporeal Cardiopulmonary Resuscitation in a Porcine Model of Prolonged Cardiac Arrest. Crit Care Explor 2023; 5:e0902. [PMID: 37181541 PMCID: PMC10174369 DOI: 10.1097/cce.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Prolonged cardiac arrest (CA) causes microvascular thrombosis which is a potential barrier to organ reperfusion during extracorporeal cardiopulmonary resuscitation (ECPR). The aim of this study was to test the hypothesis that early intra-arrest anticoagulation during cardiopulmonary resuscitation (CPR) and thrombolytic therapy during ECPR improve recovery of brain and heart function in a porcine model of prolonged out-of-hospital CA. DESIGN Randomized interventional trial. SETTING University laboratory. SUBJECTS Swine. INTERVENTIONS In a blinded study, 48 swine were subjected to 8 minutes of ventricular fibrillation CA followed by 30 minutes of goal-directed CPR and 8 hours of ECPR. Animals were randomized into four groups (n = 12) and given either placebo (P) or argatroban (ARG; 350 mg/kg) at minute 12 of CA and either placebo (P) or streptokinase (STK, 1.5 MU) at the onset of ECPR. MEASUREMENTS AND MAIN RESULTS Primary outcomes included recovery of cardiac function measured by cardiac resuscitability score (CRS: range 0-6) and recovery of brain function measured by the recovery of somatosensory-evoked potential (SSEP) cortical response amplitude. There were no significant differences in recovery of cardiac function as measured by CRS between groups (p = 0.16): P + P 2.3 (1.0); ARG + P = 3.4 (2.1); P + STK = 1.6 (2.0); ARG + STK = 2.9 (2.1). There were no significant differences in the maximum recovery of SSEP cortical response relative to baseline between groups (p = 0.73): P + P = 23% (13%); ARG + P = 20% (13%); P + STK = 25% (14%); ARG + STK = 26% (13%). Histologic analysis demonstrated reduced myocardial necrosis and neurodegeneration in the ARG + STK group relative to the P + P group. CONCLUSIONS In this swine model of prolonged CA treated with ECPR, early intra-arrest anticoagulation during goal-directed CPR and thrombolytic therapy during ECPR did not improve initial recovery of heart and brain function but did reduce histologic evidence of ischemic injury. The impact of this therapeutic strategy on the long-term recovery of cardiovascular and neurological function requires further investigation.
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Affiliation(s)
- Jensyn J VanZalen
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Stephen Harvey
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Pavel Hála
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Annie Phillips
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Takahiro Nakashima
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Emre Gok
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Brendan M McCracken
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Joseph E Hill
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Jinhui Liao
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Joshua Jung
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Joshua Mergos
- Movement Science, University of Michigan School of Kinesiology, Ann Arbor, MI
| | - William C Stacey
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI
| | - Robert H Bartlett
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Cindy H Hsu
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Alvaro Rojas-Peña
- Department of Surgery and Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
- Department of Surgery Section of Transplantation, University of Michigan Medical School, Ann Arbor, MI
| | - Robert W Neumar
- Department of Emergency Medicine and The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan Medical School, Ann Arbor, MI
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11
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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12
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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13
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Stefano Palazzo F, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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14
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Gottula AL, Shaw CR, Gorder KL, Lane BH, Latessa J, Qi M, Koshoffer A, Al-Araji R, Young W, Bonomo J, Langabeer JR, Yannopoulos D, Henry TD, Hsu CH, Benoit JL. Eligibility of out-of-hospital cardiac arrest patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system model. Resuscitation 2022; 180:111-120. [PMID: 36183812 DOI: 10.1016/j.resuscitation.2022.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence suggest that extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers. METHODS We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. The combined model was used to estimate the total number of ECPR candidates. RESULTS There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were deemed eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model. CONCLUSIONS Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine, University of Michigan, United States; Department of Anesthesiology, University of Michigan, United States; Max Harry Weil Institute for Critical Care Research and Innovation, United States.
| | - Christopher R Shaw
- Department of Medicine Division of Pulmonary and Critical Care, Oregon Health and Science University, United States
| | - Kari L Gorder
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, United States.
| | - Bennett H Lane
- Department of Emergency Medicine, University of Cincinnati, United States.
| | - Jennifer Latessa
- Department of Planning, The University of Cincinnati, United States.
| | - Man Qi
- Department of Geography and Geographic Information System, The University of Cincinnati, United States.
| | - Amy Koshoffer
- University of Cincinnati Libraries, The University of Cincinnati, United States.
| | - Rabab Al-Araji
- Department of Emergency Medicine, Emory University, United States; The Cardiac Arrest Registry to Enhance Survival, United States.
| | - Wesley Young
- College of Medicine, The University of Cincinnati, United States
| | - Jordan Bonomo
- Department of Emergency Medicine, University of Cincinnati, United States; Department of Neurosurgery, University of Cincinnati, United States.
| | - James R Langabeer
- Department of Emergency, Medicine McGovern School of Medicine, The University of Texas Health Center, United States; UT School of Public Health, The University of Texas Health Center, United States; School of Biomedical Informatics, The University of Texas Health Center, United States.
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, United States.
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, United States; Max Harry Weil Institute for Critical Care Research and Innovation, United States; Department of Surgery, University of Michigan, United States.
| | - Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati, United States.
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15
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Schmitzberger FF, Haas NL, Coute RA, Bartos J, Hackmann A, Haft JW, Hsu CH, Hutin A, Lamhaut L, Marinaro J, Nagao K, Nakashima T, Neumar R, Pellegrino V, Shinar Z, Whitmore SP, Yannopoulos D, Peterson WJ. ECPR 2: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation. Resuscitation 2022; 179:214-220. [PMID: 35817270 DOI: 10.1016/j.resuscitation.2022.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 12/22/2022]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ECPR initiation after OHCA. METHODS We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale. RESULTS Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and five primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 207 items. The panel reached consensus on 101 items meeting final criteria for inclusion: Prior to Patient Arrival (13 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (18), and Post-Cannulation (26). CONCLUSION We present a list of items for ECPR initiation following adult nontraumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings may benefit centers currently performing ECPR in quality assurance and serve as a template for new ECPR programs.
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Affiliation(s)
| | - Nathan L Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Ryan A Coute
- Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jason Bartos
- Division of Cardiology, Department of Medicine, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Amy Hackmann
- Department of Cardiovascular and Thoracic Surgery, UTSouthwestern, Parkland Hospital, Dallas, TX, USA
| | - Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Alice Hutin
- SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Necker University Hospital, Paris, France
| | - Lionel Lamhaut
- SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Necker University Hospital, Paris, France
| | - Jon Marinaro
- Department of Emergency Medicine, Division of Critical Care, University of New Mexico, Albuquerque, NM, USA
| | - Ken Nagao
- Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Takahiro Nakashima
- Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | - Robert Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA
| | | | - Zack Shinar
- Department of Emergency Medicine, Sharp Memorial Hospital, San Diego CA, USA
| | - Sage P Whitmore
- Critical Care Medicine, TriStar Centennial Medical Center, Nashville, TN, USA
| | - Demetri Yannopoulos
- Division of Cardiology, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN
| | - William J Peterson
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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16
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Nakashima T, Ogata S, Noguchi T, Nishimura K, Hsu CH, Sefa N, Haas NL, Bĕlohlávek J, Pellegrino V, Tonna JE, Haft J, Neumar RW. Association of intentional cooling, achieved temperature and hypothermia duration with in-hospital mortality in patients treated with extracorporeal cardiopulmonary resuscitation: An analysis of the ELSO Registry. Resuscitation 2022; 177:43-51. [PMID: 35788020 DOI: 10.1016/j.resuscitation.2022.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/29/2022] [Accepted: 06/26/2022] [Indexed: 12/12/2022]
Abstract
AIM To investigate whether intentional cooling, achieved temperature and hypothermia duration were associated with in-hospital death in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. METHODS This is a retrospective analysis of the Extracorporeal Life Support Organization Registry. Patients 18-79 years of age who received ECPR between 2010 and 2019 were included. We compared outcomes for intentional cooling versus no intentional cooling. Then, among those who completed intentional cooling, we compared the outcomes between i) achieved temperature ≤34℃, 34-36℃, and >36℃, and ii) duration ≤36℃ for <12 hours, 12-48 hours, and ≥48 hours. The primary outcome was in-hospital mortality within 90 days. Cox proportional hazard models were generated with adjustment for covariates. RESULTS Among 4,214 ECPR patients, 1,511 patients were included in the final analysis. After multivariable adjustment, there was no significant difference in in-hospital mortality between patients with intentional cooling and no intentional cooling (hazard ratio [HR], 1.06 [95% CI 0.92-1.21]; p=0.395). In the 609 patients who completed intentional cooling, temperature at 34-36℃ had a significantly lower adjusted HR for in-hospital mortality compared with >36℃ (HR, 0.73 [0.55-0.96]; p=0.025). Moreover, temperature ≤36℃ for 12-48 hours had a significantly lower adjusted HR for in-hospital mortality compared with ≤36℃ for <12 hours (HR, 0.69 [0.53-0.90]; p=0.005). CONCLUSION Intentional cooling was not associated with lower in-hospital mortality in ECPR patients. However, among patients with intentional cooling, achieving temperature of 34-36℃ for 12-48 hours was associated with lower in-hospital mortality.
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Affiliation(s)
- Takahiro Nakashima
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, United States; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Cindy H Hsu
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, United States
| | - Nana Sefa
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, United States
| | - Nathan L Haas
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, United States
| | - Jan Bĕlohlávek
- 2nd Department of Internal Medicine, Cardiovascular Medicine, General University Hospital, Prague, Czech Republic
| | | | - Joseph E Tonna
- Department of Surgery, University of Utah, Salt Lake City, United States
| | - Jonathan Haft
- Department of Thoracic Surgery, University of Michigan, Ann Arbor, United States
| | - Robert W Neumar
- Department of Emergency Medicine and the Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, United States
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17
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Gottula AL, Neumar RW, Hsu CH. Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest - who, when, and where? Curr Opin Crit Care 2022; 28:276-283. [PMID: 35653248 DOI: 10.1097/mcc.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Extracorporeal cardiopulmonary resuscitation (ECPR) is an invasive and resource-intensive therapy used to care for patients with refractory cardiac arrest. In this review, we highlight considerations for the establishment of an ECPR system of care for patients suffering refractory out-of-hospital cardiac arrest (OHCA). RECENT FINDINGS ECPR has been shown to improve neurologically favorable outcomes in patients with refractory cardiac arrest in numerous studies, including a single randomized control trial. Successful ECPR programs are typically part of a comprehensive system of care that optimizes all phases of OHCA management. Given the resource-intensive and time-sensitive nature of ECPR, patient selection criteria, timing of ECPR, and location must be well defined. Many knowledge gaps remain within ECPR systems of care, postcardiac arrest management, and neuroprognostication strategies for ECPR patients. SUMMARY To be consistently successful, ECPR must be a part of a comprehensive OHCA system of care that optimizes all phases of cardiac arrest management. Future investigation is needed for the knowledge gaps that remain.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine
- Department of Anesthesiology
| | - Robert W Neumar
- Department of Emergency Medicine
- Max Harry Weil Institute for Critical Care Research and Innovation
| | - Cindy H Hsu
- Department of Emergency Medicine
- Max Harry Weil Institute for Critical Care Research and Innovation
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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18
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Hsu CH, Fowler J, Cranford JA, Thomas MP, Neumar RW. Integration of social media with targeted emails and in-person outreach for exception from informed consent community consultation. Acad Emerg Med 2022; 29:217-227. [PMID: 34416069 DOI: 10.1111/acem.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exception from informed consent (EFIC) enables the enrollment of research subjects with emergent conditions to clinical trials without prior consent. EFIC study approval requires community consultation and public disclosure. We hypothesized that the integration of social media with targeted emails and in-person outreach is an effective community consultation strategy. METHODS We utilized social media with targeted emails and in-person outreach for the community consultation of the ACCESS cardiac arrest trial. Study advertisements were disseminated using Facebook and Instagram, and targeted emails were sent to emergency medicine, prehospital, and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Participants were asked to complete a survey about their opinions about the study. RESULTS We collected 559 surveys over an 8-week period, and 70.5% of the surveys were obtained using social media. The median (IQR) age of survey respondents was 44 (33-57) years; 89.9% were White and 60.1% were women. A total of 91.3% believed ACCESS was an important study. Compared to the in-person group, more from social media (81.8% vs. 63.3%, p < 0.05) and targeted email (77.4% vs. 63.3%, p < 0.05) groups said they would include their loved ones in the study. More from the in-person group believed that their opinion would be considered seriously compared to the social media (75.9% vs. 62.6%, p < 0.05) and targeted email (75.9% vs. 54.5%, p < 0.05) groups. The incorporation of social media and targeted emails for community consultation reduced the cost per survey by fourfold compared to an in-person-only strategy. CONCLUSIONS The integration of social media with targeted emails and in-person outreach was a feasible and cost-saving approach for EFIC community consultation. Future work is necessary to determine the perception and best utilization of social media for community consultation.
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Affiliation(s)
- Cindy H. Hsu
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
- Michigan Center for Integrative Research in Critical Care University of Michigan Ann Arbor Michigan USA
| | - Jennifer Fowler
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
| | - James A. Cranford
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
| | - Michael P. Thomas
- Division of Cardiovascular Medicine Interventional Cardiology University of Michigan Ann Arbor Michigan USA
| | - Robert W. Neumar
- Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA
- Michigan Center for Integrative Research in Critical Care University of Michigan Ann Arbor Michigan USA
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19
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Hsu CH, Considine J, Pawar RD, Cellini J, Schexnayder SM, Soar J, Olasveengen TM, Berg KM. Cardiopulmonary resuscitation and defibrillation for cardiac arrest when patients are in the prone position: A systematic review. Resusc Plus 2021; 8:100186. [PMID: 34934996 PMCID: PMC8654624 DOI: 10.1016/j.resplu.2021.100186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022] Open
Abstract
AIM To perform a systematic review of cardiopulmonary resuscitation (CPR) and/or defibrillation in the prone position compared to turning the patient supine prior to starting CPR and/or defibrillation. METHODS The search included PubMed, Embase, Web of Science, Cochrane, CINAHL Plus, and medRxiv on December 9, 2020. The population included adults and children in any setting with cardiac arrest while in the prone position. The outcomes included arterial blood pressure and end-tidal capnography during CPR, time to start CPR and defibrillation, return of spontaneous circulation, survival and survival with favorable neurologic outcome to discharge, 30 days or longer. ROBINS-I was performed to assess risk of bias for observational studies. RESULTS The systematic review identified 29 case reports (32 individual cases), two prospective observational studies, and two simulation studies. The observational studies enrolled 17 patients who were declared dead in the supine position and reported higher mean systolic blood pressure from CPR in prone position (72 mmHg vs 48 mmHg, p < 0.005; 79 ± 20 mmHg vs 55 ± 20 mmHg, p = 0.028). One simulation study reported a faster time to defibrillation in the prone position. Return of spontaneous circulation, survival to discharge or 30 days were reported in adult and paediatric case reports. Critical risk of bias limited our ability to perform pooled analyses. CONCLUSIONS We identified a limited number of observational studies and case reports comparing prone versus supine CPR and/or defibrillation. Prone CPR may be a reasonable option if immediate supination is difficult or poses unacceptable risks to the patient.
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Affiliation(s)
- Cindy H. Hsu
- Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, and Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia, Centre for Quality and Patient Safety Research – Eastern Health Partnership, Box Hill, Australia
| | - Rahul D. Pawar
- Center for Resuscitation Science, Division of Hospital Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jacqueline Cellini
- Countway Library, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Stephen M. Schexnayder
- University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, Little Rock, AR, USA
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | | | - Katherine M. Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Department of Medicine, Division of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Advanced Life Support, Basic Life Support, Paediatric Life Support Task Forces at the International Liaison Committee on Resuscitation ILCOR
- Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, and Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia, Centre for Quality and Patient Safety Research – Eastern Health Partnership, Box Hill, Australia
- Center for Resuscitation Science, Division of Hospital Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Countway Library, Harvard Medical School, Harvard University, Boston, MA, USA
- University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, Little Rock, AR, USA
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
- Division of Emergencies and Critical Care, University of Oslo, Oslo, Norway
- Center for Resuscitation Science, Department of Emergency Medicine, Department of Medicine, Division of Pulmonary Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
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20
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Circulation 2021; 145:e645-e721. [PMID: 34813356 DOI: 10.1161/cir.0000000000001017] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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21
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami M, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2021; 169:229-311. [PMID: 34933747 PMCID: PMC8581280 DOI: 10.1016/j.resuscitation.2021.10.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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22
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Bessen B, Coult J, Blackwood J, Hsu CH, Kudenchuk P, Rea T, Kwok H. Insights From the Ventricular Fibrillation Waveform Into the Mechanism of Survival Benefit From Bystander Cardiopulmonary Resuscitation. J Am Heart Assoc 2021; 10:e020825. [PMID: 34569292 PMCID: PMC8649127 DOI: 10.1161/jaha.121.020825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival. Methods and Results We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P<0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude. Conclusions Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.
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Affiliation(s)
- Brooke Bessen
- School of Medicine University of Washington Seattle WA
| | - Jason Coult
- Department of Medicine University of Washington Seattle WA.,Center for Progress in Resuscitation University of Washington Seattle WA
| | - Jennifer Blackwood
- Center for Progress in Resuscitation University of Washington Seattle WA.,Seattle-King County Department of Public Health King County Emergency Medical Services Seattle WA
| | - Cindy H Hsu
- Department of Emergency Medicine University of Michigan Medical School Ann Arbor MI.,Michigan Center for Integrative Research in Critical Care University of Michigan Medical School Ann Arbor MI
| | - Peter Kudenchuk
- Department of Medicine University of Washington Seattle WA.,Center for Progress in Resuscitation University of Washington Seattle WA.,Seattle-King County Department of Public Health King County Emergency Medical Services Seattle WA
| | - Thomas Rea
- Department of Medicine University of Washington Seattle WA.,Center for Progress in Resuscitation University of Washington Seattle WA.,Seattle-King County Department of Public Health King County Emergency Medical Services Seattle WA
| | - Heemun Kwok
- Center for Progress in Resuscitation University of Washington Seattle WA.,Department of Emergency Medicine University of Washington Seattle WA
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23
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Peterson WJ, Munzer BW, Tucker RV, Losman ED, Harvey C, Hatton C, Sefa N, Bassin BS, Hsu CH. Rapid Dissemination of a COVID-19 Airway Management Simulation Using a Train-the-Trainers Curriculum. Acad Med 2021; 96:1414-1418. [PMID: 33856362 PMCID: PMC8475643 DOI: 10.1097/acm.0000000000004120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The most effective way to train clinicians to safely don and doff personal protective equipment (PPE) and perform aerosol-generating procedures (AGPs), such as intubations, is unknown when clinician educators are unavailable, as they have been during the COVID-19 pandemic. Proper PPE and airway management techniques are critical to prevent the transmission of respiratory illnesses such as COVID-19. APPROACH In March 2020, the authors implemented a structured train-the-trainers curriculum to teach PPE techniques and a modified airway management algorithm for suspected COVID-19 patients. A single emergency medicine physician trainer taught 17 subsequent emergency medicine and critical care physician trainers the proper PPE and airway management techniques. The initial trainer and 7 of the subsequent trainers then instructed 99 other emergency medicine resident and attending physicians using in situ simulation. Trainers and learners completed retrospective pre-post surveys to assess their comfort teaching the material and performing the techniques, respectively. OUTCOMES The surveys demonstrated a significant increase in the trainers' comfort in teaching simulation-based education, from 4.00 to 4.53 on a 5-point Likert scale (P < .005), and in teaching the airway management techniques through simulation, from 2.47 to 4.47 (P < .001). There was no difference in the change in comfort level between those learners who were taught by the initial trainer and those who were taught by the subsequent trainers. These results suggest that the subsequent trainers were as effective in teaching the simulation material as the initial trainer. NEXT STEPS Work is ongoing to investigate clinician- and patient-specific outcomes, including PPE adherence, appropriate AGP performance, complication rate, and learners' skill retention. Future work will focus on implementing similar train-the-trainers strategies for other health professions, specialties, and high-risk or rare procedures.
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Affiliation(s)
- William J. Peterson
- W.J. Peterson is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-3950-3054
| | - Brendan W. Munzer
- B.W. Munzer is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ryan V. Tucker
- R.V. Tucker is clinical lecturer, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eve D. Losman
- E.D. Losman is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Carrie Harvey
- C. Harvey is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Colman Hatton
- C. Hatton is a resident, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nana Sefa
- N. Sefa is assistant professor, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8693-8080
| | - Ben S. Bassin
- B.S. Bassin is assistant professor, Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, Michigan
| | - Cindy H. Hsu
- C.H. Hsu is assistant professor, Departments of Emergency Medicine and Surgery and Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8192-6969
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Horowitz JM, Owyang C, Perman SM, Mitchell OJL, Yuriditsky E, Sawyer KN, Blewer AL, Rittenberger JC, Ciullo A, Hsu CH, Kotini-Shah P, Johnson N, Morgan RW, Moskowitz A, Dainty KN, Fleitman J, Uzendu AI, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2020 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2021; 10:e021575. [PMID: 34369175 PMCID: PMC8475047 DOI: 10.1161/jaha.121.021575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Clark Owyang
- Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine Weill Cornell Medicine New York City NY
| | - Sarah M Perman
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Oscar J L Mitchell
- Division of Pulmonary and Critical Care Department of Medicine University of Pennsylvania Philadelphia PA
| | | | - Kelly N Sawyer
- Department of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health Duke University Durham NC
| | - Jon C Rittenberger
- Guthrie-Robert Packer Hospital Emergency Medicine Residency Geisinger Commonwealth Medical College Sayre PA
| | - Anna Ciullo
- Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
| | - Cindy H Hsu
- Department of Emergency Medicine Department of Surgery Michigan Center for Integrative Research in Critical Care Michigan Medicine University of Michigan Ann Arbor MI
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago Chicago IL
| | - Nicholas Johnson
- Division of Pulmonary, Critical Care, & Sleep Medicine Department of Emergency Medicine University of Washington Seattle WA
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia Philadelphia PA
| | - Ari Moskowitz
- Division of Critical Care Medicine Montefiore Medical Center Bronx, New York NY
| | - Katie N Dainty
- North York General Hospital University of Toronto Toronto Canada
| | - Jessica Fleitman
- Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Anezi I Uzendu
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Benjamin S Abella
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Felipe Teran
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
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25
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Khan S, Hsu CH. The who, where, and when of REBOA for refractory out-of-hospital cardiac arrest. Resuscitation 2021; 165:179-181. [PMID: 34242736 DOI: 10.1016/j.resuscitation.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sharaf Khan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA.
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26
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Hsu CH, Meurer WJ, Domeier R, Fowler J, Whitmore SP, Bassin BS, Gunnerson KJ, Haft JW, Lynch WR, Nallamothu BK, Havey RA, Kidwell KM, Stacey WC, Silbergleit R, Bartlett RH, Neumar RW. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport. Ann Emerg Med 2021; 78:92-101. [PMID: 33541748 PMCID: PMC8238799 DOI: 10.1016/j.annemergmed.2020.11.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVE Outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest depend on time to therapy initiation. We hypothesize that it would be feasible to select refractory out-of-hospital cardiac arrest patients for expedited transport based on real-time estimates of the 911 call to the emergency department (ED) arrival interval, and for emergency physicians to rapidly initiate ECPR in eligible patients. METHODS In a 2-tiered emergency medical service with an ECPR-capable primary destination hospital, adults with refractory shockable or witnessed out-of-hospital cardiac arrest were randomized 4:1 to expedited transport or standard care if the predicted 911 call to ED arrival interval was less than or equal to 30 minutes. The primary outcomes were the proportion of subjects with 911 call to ED arrival less than or equal to 30 minutes and ED arrival to ECPR flow less than or equal to 30 minutes. RESULTS Of 151 out-of-hospital cardiac arrest 911 calls, 15 subjects (10%) were enrolled. Five of 12 subjects randomized to expedited transport had an ED arrival time of less than or equal to 30 minutes (overall mean 32.5 minutes [SD 7.1]), and 5 were eligible for and treated with ECPR. Three of 5 ECPR-treated subjects had flow initiated in less than or equal to 30 minutes of ED arrival (overall mean 32.4 minutes [SD 10.9]). No subject in either group survived with a good neurologic outcome. CONCLUSION The Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest trial did not meet predefined feasibility outcomes for selecting out-of-hospital cardiac arrest patients for expedited transport and initiating ECPR in the ED. Additional research is needed to improve the accuracy of predicting the 911 call to ED arrival interval, optimize patient selection, and reduce the ED arrival to ECPR flow interval.
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Affiliation(s)
- Cindy H Hsu
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI; Department of Neurology, University of Michigan Medical School, Ann Arbor, MI
| | - Robert Domeier
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Saint Joseph Hospital, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer Fowler
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Sage P Whitmore
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Benjamin S Bassin
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI
| | - Kyle J Gunnerson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI
| | - Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - William R Lynch
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Renee A Havey
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan Medical School, Ann Arbor, MI
| | - William C Stacey
- Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Robert Silbergleit
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Robert H Bartlett
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI; Extracorporeal Life Support Laboratory, University of Michigan Medical School, Ann Arbor, MI
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27
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Algotar AM, Kumar R, Babiker HM, Dougherty ST, Hsu CH, Chow HH, Smith TE, Marrero DG, Courneya KS, Abraham I, Ligibel JA, Thomson CA. Protocol for a feasibility and early efficacy study of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2). Contemp Clin Trials Commun 2021; 21:100701. [PMID: 33511299 PMCID: PMC7815988 DOI: 10.1016/j.conctc.2021.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/18/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although androgen deprivation therapy (ADT) for prostate cancer demonstrates improved overall and disease-free survival, it is associated with adverse effects such as obesity and metabolic syndrome that increase risk of cardiometabolic disease and diabetes type 2. ADT also leads to fatigue, depression and erectile dysfunction, which reduce quality of life (QoL). Lifestyle modification has shown promise in reducing obesity, metabolic syndrome and diabetes type 2 in other disease types. However, there is a paucity of data regarding the utility of lifestyle modification in men receiving ADT for prostate cancer. Methods The primary aim of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2) is to test the feasibility of conducting a 24-week lifestyle modification intervention in men on ADT for prostate cancer. Additionally, it will also determine the effect of this intervention on weight loss, cardiometabolic markers (secondary aim and markers of interest: serum glucose, insulin resistance, hemoglobin A1C and lipid panel), and QoL (tertiary aim). The intervention will be delivered weekly via telephone for the first 10 weeks and bi-weekly for the remaining 14 weeks. Questionnaires and serum samples will be collected at baseline, week 12, and week 24. Anthropometric measurements will be collected at baseline, week 6, week 12, week 18 and week 24. Results We hypothesize that the CLIPP2 intervention will produce a 7% weight loss that will result in improved markers associated with cardiometabolic disease and type 2 diabetes in the study population. Conclusion Results will provide insight into the role of lifestyle modification in addressing ADT adverse effects as well as provide preliminary data to inform the development of future lifestyle interventions in this area. Trial registration NCT04228055 Clinicaltrials. gov.
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Affiliation(s)
- A M Algotar
- Department of Family and Community Medicine, University of Arizona, USA.,The University of Arizona Cancer Center, USA
| | - R Kumar
- Radiation Oncology, Banner MD Anderson Cancer Center, USA
| | - H M Babiker
- The University of Arizona Cancer Center, USA.,Department of Hematology-Oncology, University of Arizona, USA
| | - S T Dougherty
- The University of Arizona Cancer Center, USA.,Department of Radiation Oncology, University of Arizona, USA
| | - C H Hsu
- The University of Arizona Cancer Center, USA.,Department of Epidemiology and Biostatistics, Mel and Enid College of Public Health, University of Arizona, USA
| | - H-H Chow
- The University of Arizona Cancer Center, USA
| | - T E Smith
- Department of Family and Community Medicine, University of Arizona, USA
| | - D G Marrero
- Department of Health Promotion Science, Mel and Enid College of Public Health, University of Arizona, USA
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - I Abraham
- Department of Family and Community Medicine, University of Arizona, USA.,College of Pharmacy, University of Arizona, USA
| | - J A Ligibel
- Dana Farber Cancer Institute, Harvard Medical School, USA
| | - C A Thomson
- The University of Arizona Cancer Center, USA.,Department of Health Promotion Science, Mel and Enid College of Public Health, University of Arizona, USA
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Hsu CH, Tiba MH, Boehman AL, McCracken BM, Leander DC, Francalancia SC, Pickell Z, Sanderson TH, Ward KR, Neumar RW. Aerosol generation during chest compression and defibrillation in a swine cardiac arrest model. Resuscitation 2020; 159:28-34. [PMID: 33338570 PMCID: PMC7833865 DOI: 10.1016/j.resuscitation.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/04/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
Aim It remains unclear whether cardiac arrest (CA) resuscitation generates aerosols that can transmit respiratory pathogens. We hypothesize that chest compression and defibrillation generate aerosols that could contain the SARS-CoV-2 virus in a swine CA model. Methods To simulate witnessed CA with bystander-initiated cardiopulmonary resuscitation, 3 female non-intubated swine underwent 4 min of ventricular fibrillation without chest compression or defibrillation (no-flow) followed by ten 2-min cycles of mechanical chest compression and defibrillation without ventilation. The diameter (0.3–10 μm) and quantity of aerosols generated during 45-s intervals of no-flow and chest compression before and after defibrillation were analyzed by a particle analyzer. Aerosols generated from the coughs of 4 healthy human subjects were also compared to aerosols generated by swine. Results There was no significant difference between the total aerosols generated during chest compression before defibrillation compared to no-flow. In contrast, chest compression after defibrillation generated significantly more aerosols than chest compression before defibrillation or no-flow (72.4 ± 41.6 × 104 vs 12.3 ± 8.3 × 104 vs 10.5 ± 11.2 × 104; p < 0.05), with a shift in particle size toward larger aerosols. Two consecutive human coughs generated 54.7 ± 33.9 × 104 aerosols with a size distribution smaller than post-defibrillation chest compression. Conclusions Chest compressions alone did not cause significant aerosol generation in this swine model. However, increased aerosol generation was detected during chest compression immediately following defibrillation. Additional research is needed to elucidate the clinical significance and mechanisms by which aerosol generation during chest compression is modified by defibrillation.
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Affiliation(s)
- Cindy H Hsu
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Department of Surgery, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Mohamad H Tiba
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - André L Boehman
- Department of Mechanical Engineering, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Brendan M McCracken
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Danielle C Leander
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Stephanie C Francalancia
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Zachary Pickell
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; College of Literature Science and the Arts, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Thomas H Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Department of Molecular and Integrative Physiology, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Department of Biomedical Engineering, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
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Soar J, Berg KM, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D'Arrigo S, Deakin CD, Donnino MW, Drennan IR, Granfeldt A, Hoedemaekers CWE, Holmberg MJ, Hsu CH, Kamps M, Musiol S, Nation KJ, Neumar RW, Nicholson T, O'Neil BJ, Otto Q, de Paiva EF, Parr MJA, Reynolds JC, Sandroni C, Scholefield BR, Skrifvars MB, Wang TL, Wetsch WA, Yeung J, Morley PT, Morrison LJ, Welsford M, Hazinski MF, Nolan JP. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2020; 156:A80-A119. [PMID: 33099419 PMCID: PMC7576326 DOI: 10.1016/j.resuscitation.2020.09.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.
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Berg KM, Soar J, Andersen LW, Böttiger BW, Cacciola S, Callaway CW, Couper K, Cronberg T, D’Arrigo S, Deakin CD, Donnino MW, Drennan IR, Granfeldt A, Hoedemaekers CW, Holmberg MJ, Hsu CH, Kamps M, Musiol S, Nation KJ, Neumar RW, Nicholson T, O’Neil BJ, Otto Q, de Paiva EF, Parr MJ, Reynolds JC, Sandroni C, Scholefield BR, Skrifvars MB, Wang TL, Wetsch WA, Yeung J, Morley PT, Morrison LJ, Welsford M, Hazinski MF, Nolan JP, Issa M, Kleinman ME, Ristagno G, Arafeh J, Benoit JL, Chase M, Fischberg BL, Flores GE, Link MS, Ornato JP, Perman SM, Sasson C, Zelop CM. Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S92-S139. [DOI: 10.1161/cir.0000000000000893] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This
2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Munzer BW, Bassin BS, Peterson WJ, Tucker RV, Doan J, Harvey C, Sefa N, Hsu CH. In-situ Simulation Use for Rapid Implementation and Process Improvement of COVID-19 Airway Management. West J Emerg Med 2020; 21:99-106. [PMID: 33052819 PMCID: PMC7673893 DOI: 10.5811/westjem.2020.7.48159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges to frontline healthcare workers. In order to safely care for patients new processes, such as a plan for the airway management of a patient with COVID-19, must be implemented and disseminated in a rapid fashion. The use of in-situ simulation has been used to assist in latent problem identification as part of a Plan-Do-Study-Act cycle. Additionally, simulation is an effective means for training teams to perform high-risk procedures before engaging in the actual procedure. This educational advance seeks to use and study in-situ simulation as a means to rapidly implement a process for airway management in patients with COVID-19. METHODS Using an airway algorithm developed by the authors, we designed an in-situ simulation scenario to train physicians, nurses, and respiratory therapists in best practices for airway management of patients with COVID-19. Physician participants were surveyed using a five-point Likert scale with regard to their comfort level with various aspects of the airway algorithm both before and after the simulation in a retrospective fashion. Additionally, we obtained feedback from all participants and used it to refine the airway algorithm. RESULTS Over a two-week period, 93 physicians participated in the simulation. We received 81 responses to the survey (87%), which showed that the average level of comfort with personal protective equipment procedures increased significantly from 2.94 (95% confidence interval, 2.71-3.17) to 4.36 (4.24-4.48), a difference of 1.42 (1.20-1.63, p < 0.001). There was a significant increase in average comfort level in understanding the physician role with scores increasing from 3.51 (3.26-3.77) to 4.55 (2.71-3.17), a difference of 1.04 (0.82-1.25, p < 0.001). There was also increased comfort in performing procedural tasks such as intubation, from 3.08 (2.80-3.35) to 4.38 (4.23-4.52) after the simulation, a difference of 1.30 points (1.06-1.54, p < 0.001). Feedback from the participants also led to refinement of the airway algorithm. CONCLUSION We successfully implemented a new airway management guideline for patients with suspected COVID-19. In-situ simulation is an essential tool for both dissemination and onboarding, as well as process improvement, in the context of an epidemic or pandemic.
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Affiliation(s)
- Brendan W Munzer
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Benjamin S Bassin
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, Michigan
| | - William J Peterson
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Ryan V Tucker
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Jessica Doan
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Carrie Harvey
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Nana Sefa
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Cindy H Hsu
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, Michigan
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Abstract
There are approximately 350,000 out-of-hospital cardiac arrests and 200,000 in-hospital cardiac arrests annually in the United States, with survival rates of approximately 5% to 10% and 24%, respectively. The critical factors that have an impact on cardiac arrest survival include prompt recognition and activation of prehospital care, early cardiopulmonary resuscitation, and rapid defibrillation. Advanced life support protocols are continually refined to optimize intracardiac arrest management and improve survival with favorable neurologic outcome. This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management.
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Affiliation(s)
- Vivian Lam
- Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, B1-380 Taubman Center, SPC 5305, Ann Arbor, MI 48109-5305, USA
| | - Cindy H Hsu
- Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, NCRC B026-309N, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA; Department of Surgery, Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, NCRC B026-309N, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA.
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Hsu CH, Tiba MH, McCracken BM, Colmenero CI, Pickell Z, Leander DC, Weitzel AM, Raghunayakula S, Liao J, Jinka T, Cummings BC, Pai MP, Alam HB, Ward KR, Sanderson TH, Neumar RW. Dose optimization of early high-dose valproic acid for neuroprotection in a swine cardiac arrest model. Resusc Plus 2020; 1-2:100007. [PMID: 34223294 PMCID: PMC8244526 DOI: 10.1016/j.resplu.2020.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 10/31/2022] Open
Abstract
Aim High-dose valproic acid (VPA) improves the survival and neurologic outcomes after asphyxial cardiac arrest (CA) in rats. We characterized the pharmacokinetics, pharmacodynamics, and safety of high-dose VPA in a swine CA model to advance clinical translation. Methods After 8 min of untreated ventricular fibrillation CA, 20 male Yorkshire swine were resuscitated until return of spontaneous circulation (ROSC). They were block randomized to receive placebo, 75 mg/kg, 150 mg/kg, or 300 mg/kg VPA as 90-min intravenous infusion (n = 5/group) beginning at ROSC. Animals were monitored for 2 additional hours then euthanized. Experimental operators were blinded to treatments. Results The mean(SD) total CA duration was 14.8(1.2) minutes. 300 mg/kg VPA animals required more adrenaline to maintain mean arterial pressure ≥80 mmHg and had worse lactic acidosis. There was a strong linear correlation between plasma free VPA Cmax and brain total VPA (r2 = 0.9494; p < 0.0001). VPA induced dose-dependent increases in pan- and site-specific histone H3 and H4 acetylation in the brain. Plasma free VPA Cmax is a better predictor than peripheral blood mononuclear cell histone acetylation for brain H3 and H4 acetylation (r2 = 0.7189 for H3K27ac, r2 = 0.7189 for pan-H3ac, and r2 = 0.7554 for pan-H4ac; p < 0.0001). Conclusions Up to 150 mg/kg VPA can be safely tolerated as 90-min intravenous infusion in a swine CA model. High-dose VPA induced dose-dependent increases in brain histone H3 and H4 acetylation, which can be predicted by plasma free VPA Cmax as the pharmacodynamics biomarker for VPA target engagement after CA.
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Affiliation(s)
- Cindy H Hsu
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mohamad H Tiba
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brendan M McCracken
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Carmen I Colmenero
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zachary Pickell
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,College of Literature Science and the Arts, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Danielle C Leander
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anne M Weitzel
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarita Raghunayakula
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jinhui Liao
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tulasi Jinka
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brandon C Cummings
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Manjunath P Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hasan B Alam
- Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Thomas H Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
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Abstract
Ischemia/reperfusion injury is a complex molecular cascade that causes deleterious cellular damage and organ dysfunction. Stroke, sudden cardiac arrest, and acute myocardial infarction are the most common causes of ischemia/reperfusion injury without effective pharmacologic therapies. Existing preclinical evidence suggests that histone deacetylase inhibitors may be an efficacious, affordable, and clinically feasible therapy that can improve neurologic and cardiac outcomes following ischemia/reperfusion injury. In this review, we discuss the pathophysiology and epigenetic modulations of ischemia/reperfusion injury and focus on the neuroprotective and cardioprotective effects of histone deacetylase inhibitors. We also summarize the protective effects of histone deacetylase inhibitors for other vital organs and highlight the key research priorities for their successful translation to the bedside.
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Affiliation(s)
- Zachary Pickell
- College of Literature Science and the Arts University of Michigan Ann Arbor MI.,Department of Emergency Medicine Michigan Medicine University of Michigan Ann Arbor MI
| | - Aaron M Williams
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor MI
| | - Hasan B Alam
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor MI
| | - Cindy H Hsu
- Department of Emergency Medicine Michigan Medicine University of Michigan Ann Arbor MI.,Department of Surgery Michigan Medicine University of Michigan Ann Arbor MI.,Michigan Center for Integrative Research in Critical Care University of Michigan Ann Arbor MI
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Teran F, Perman SM, Mitchell OJL, Sawyer KN, Blewer AL, Rittenberger JC, Del Rios Rivera M, Horowitz JM, Tonna JE, Hsu CH, Kotini-Shah P, McGovern SK, Abella BS. Highlights From the American Heart Association's 2019 Resuscitation Science Symposium. J Am Heart Assoc 2020; 9:e016153. [PMID: 32394769 PMCID: PMC7660871 DOI: 10.1161/jaha.120.016153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Felipe Teran
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Sarah M Perman
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Oscar J L Mitchell
- Division of Pulmonary and Critical Care Department of Medicine University of Pennsylvania Philadelphia PA
| | - Kelly N Sawyer
- Department of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health Duke University Durham NC
| | - Jon C Rittenberger
- Guthrie-Robert Packer Hospital Emergency Medicine Residency Geisinger Commonwealth Medical College Sayre PA
| | - Marina Del Rios Rivera
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago IL
| | | | - Joseph E Tonna
- Division of Cardiothoracic Surgery and Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
| | - Cindy H Hsu
- Department of Emergency Medicine Department of Surgery Michigan Center for Integrative Research in Critical Care Michigan Medicine University of Michigan Ann Arbor MI
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago IL
| | - Shaun K McGovern
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Benjamin S Abella
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
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37
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Khatri UG, Love J, Zeidan A, Hsu CH, Mills AM. #Shemergency: Use of a Professional Development Group to Promote Female Resident Recruitment and Retention. Acad Med 2020; 95:216-220. [PMID: 31464733 DOI: 10.1097/acm.0000000000002969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PROBLEM Gender inequity in academic medicine is a pervasive challenge. Recommendations have been implemented to reduce inequities for female faculty. However, there are no well-established guidelines for the recruitment and retention of female residents. APPROACH To address challenges faced by female physicians and support the recruitment and retention of female residents, female emergency medicine residents and attending physicians at the Hospital of the University of Pennsylvania formed a professional development group (PDG), #Shemergency, in July 2017. From July 2017 to July 2018, this PDG developed events and initiatives for female residents that addressed methods to improve awareness of and develop skills relevant to well-described gender disparities in mentorship, speakership and conference representation, compensation, evaluations, wellness and service, and award recognition. OUTCOMES Over its first year (July 2017-July 2018), the PDG created a professional community and enhanced mentorship through a number of events and initiatives. The PDG secured funding for 5 residents to attend a national conference and nominated 5 residents and 2 attending physicians for professional organization awards (4 nominees won). NEXT STEPS After the first year, the PDG expanded the number of joint activities with both male and female colleagues and organized a citywide event for female residents and faculty representing 5 different residency programs. Future work will focus on sustainability (e.g., holding fundraising events), generalizability (e.g., expanding the gender-disparity areas addressed as well as spreading the model to other programs), developing additional events and initiatives (e.g., expanding the number of joint activities with male colleagues), and outcome assessments (e.g., distributing pre- and postevent surveys).
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Affiliation(s)
- Utsha G Khatri
- U.G. Khatri is currently a fellow, National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania. At the time of writing, she was a postgraduate year 4 emergency medicine resident, University of Pennsylvania, Philadelphia, Pennsylvania. J. Love is currently a fellow, Medical Toxicology Fellowship Program, Oregon Health & Science University, Portland, Oregon. At the time of writing, she was attending physician, University of Pennsylvania, Philadelphia, Pennsylvania. A. Zeidan is currently assistant professor, Department of Emergency Medicine, Emory School of Medicine, Atlanta, Georgia. At the time of writing, she was an emergency ultrasound fellow, University of Kentucky, Lexington, Kentucky; ORCID: https://orcid.org/0000-0003-1274-996X. C.H. Hsu is assistant professor, Departments of Emergency Medicine and Surgery, and member, Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-8192-6969. A.M. Mills is J.E. Beaumont Professor and Chair, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0003-0798-6848
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Gunnerson KJ, Bassin BS, Havey RA, Haas NL, Sozener CB, Medlin RP, Gegenheimer-Holmes JA, Laurinec SL, Boyd C, Cranford JA, Whitmore SP, Hsu CH, Khan R, Vazirani NN, Maxwell SG, Neumar RW. Association of an Emergency Department-Based Intensive Care Unit With Survival and Inpatient Intensive Care Unit Admissions. JAMA Netw Open 2019; 2:e197584. [PMID: 31339545 PMCID: PMC6659143 DOI: 10.1001/jamanetworkopen.2019.7584] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Increased patient acuity, decreased intensive care unit (ICU) bed availability, and a shortage of intensivist physicians have led to strained ICU capacity. The resulting increase in emergency department (ED) boarding time for patients requiring ICU-level care has been associated with worse outcomes. OBJECTIVE To determine the association of a novel ED-based ICU, the Emergency Critical Care Center (EC3), with 30-day mortality and inpatient ICU admission. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used electronic health records of all ED visits between September 1, 2012, and July 31, 2017, with a documented clinician encounter at a large academic medical center in the United States with approximately 75 000 adult ED visits per year. The pre-EC3 cohort included ED patients from September 2, 2012, to February 15, 2015, when the EC3 opened, and the post-EC3 cohort included ED patients from February 16, 2015, to July 31, 2017. Data analyses were conducted from March 2, 2018, to May 28, 2019. EXPOSURES Implementation of EC3, an ED-based ICU designed to provide rapid initiation of ICU-level care in the ED setting and seamless transition to inpatient ICUs. MAIN OUTCOMES AND MEASURES The main outcomes were 30-day mortality among ED patients and rate of ED to ICU admission. RESULTS A total of 349 310 visits from a consecutive sample of ED patients (mean [SD] age, 48.5 [19.7] years; 189 709 [54.3%] women) were examined; the pre-EC3 cohort included 168 877 visits and the post-EC3 cohort included 180 433 visits. Implementation of EC3 was associated with a statistically significant reduction in risk-adjusted 30-day mortality among all ED patients (pre-EC3, 2.13%; post-EC3, 1.83%; adjusted odds ratio, 0.85; 95% CI, 0.80-0.90; number needed to treat, 333 patient encounters; 95% CI, 256-476). The risk-adjusted rate of ED admission to ICU decreased with implementation of EC3 (pre-EC3, 3.2%; post-EC3, 2.7%; adjusted odds ratio, 0.80; 95% CI, 0.76-0.83; number needed to treat, 179 patient encounters; 95% CI, 149-217). CONCLUSIONS AND RELEVANCE Implementation of a novel ED-based ICU was associated with improved 30-day survival and reduced inpatient ICU admission. Additional research is warranted to further explore the value of this novel care delivery model in various health care systems.
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Affiliation(s)
- Kyle J. Gunnerson
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Michigan Center for Integrative Research in Critical Care, Ann Arbor
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Benjamin S. Bassin
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Michigan Center for Integrative Research in Critical Care, Ann Arbor
| | - Renee A. Havey
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
| | - Nathan L. Haas
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
| | - Cemal B. Sozener
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
| | - Richard P. Medlin
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Stephanie L. Laurinec
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Michigan Center for Integrative Research in Critical Care, Ann Arbor
| | - Caryn Boyd
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - James A. Cranford
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Sage P. Whitmore
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Cindy H. Hsu
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Michigan Center for Integrative Research in Critical Care, Ann Arbor
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | - Reham Khan
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Neha N. Vazirani
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- School of Dentistry, University of Michigan, Ann Arbor
| | - Stephen G. Maxwell
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Robert W. Neumar
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Division of Emergency Critical Care, Michigan Medicine, University of Michigan, Ann Arbor
- Michigan Center for Integrative Research in Critical Care, Ann Arbor
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39
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Affiliation(s)
- Cindy H. Hsu
- Department of Emergency Medicine,University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Surgery,University of Michigan Medical School, Ann Arbor, MI, USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert W. Neumar
- Department of Emergency Medicine,University of Michigan Medical School, Ann Arbor, MI, USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA
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40
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Leibner E, Spiegel R, Hsu CH, Wright B, Bassin BS, Gunnerson K, O’Connor J, Stein D, Weingart S, Greenwood JC, Rubinson L, Menaker J, Scalea TM. Anatomy of resuscitative care unit: expanding the borders of traditional intensive care units. Emerg Med J 2019; 36:364-368. [PMID: 30940715 PMCID: PMC6568315 DOI: 10.1136/emermed-2019-208455] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/03/2022]
Abstract
Resuscitation lacks a place in the hospital to call its own. Specialised intensive care units, though excellent at providing longitudinal critical care, often lack the flexibility to adapt to fluctuating critical care needs. We offer the resuscitative care unit as a potential solution to ensure that patients receive appropriate care during the most critical hours of their illnesses. These units offer an infrastructure for resuscitation and can meet the changing needs of their institutions.
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Affiliation(s)
- Evan Leibner
- Institute of Critical Care Medicine, Mount Sinai Hospital, New York, New York, USA
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, Mount Sinai Hospital, New York, New York
| | - Rory Spiegel
- Department of Emergency Medicine, The University of Maryland Medical Center, Baltimore, New York, USA
- Department of Pulmonary Critical Care, The University of Maryland Medical Center, Baltimore, New York, USA
| | - Cindy H Hsu
- Department of Emergency Medicine, Division of Emergency Critical Care, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Wright
- Departments of Neurosurgery, Stony Brook University School of Medicine, New York, USA
- Department of Emergency Medicine, Stony Brook University School of Medicine, New York, USA
| | - Benjamin S Bassin
- Department of Emergency Medicine, Division of Emergency Critical Care, University of Michigan, Ann Arbor, Michigan, USA
| | - Kyle Gunnerson
- Department of Emergency Medicine, Division of Emergency Critical Care, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology/Critical Care, University of Michigan, Ann Arbor, Michigan, USA
| | - James O’Connor
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Deborah Stein
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Scott Weingart
- Department of Emergency Medicine, Stony Brook University School of Medicine, New York, USA
| | - John C Greenwood
- Department of Emergency Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lewis Rubinson
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jay Menaker
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Thomas M Scalea
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Tiba MH, McCracken BM, Cummings BC, Colmenero CI, Rygalski CJ, Hsu CH, Sanderson TH, Nallamothu BK, Neumar RW, Ward KR. Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest. Resuscitation 2019; 140:106-112. [PMID: 31121206 DOI: 10.1016/j.resuscitation.2019.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Abstract
AIM We examined the use of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter during cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) to assess its effect on haemodynamics such as coronary perfusion pressure (CPP), common carotid artery blood flow (CCA-flow) and end-tidal CO2 (PetCO2) which are associated with increased return of spontaneous circulation (ROSC). METHODS Six male swine were instrumented to measure CPP, CCA-Flow, and PetCO2. A 7Fr REBOA was advanced into zone-1 of the aorta through the femoral artery. Ventricular fibrillation was induced and untreated for 8 min. CPR (manual then mechanical) was initiated for 24 min. Continuous infusion of adrenaline (epinephrine) was started at minute-4 of CPR. The REBOA balloon was inflated at minute-16 for 3 min and then deflated/inflated every 3 min for 3 cycles. Animals were defibrillated up to 6 times after the final cycle. Animals achieving ROSC were monitored for 25 min. RESULTS Data showed significant differences between balloon deflation and inflation periods for CPP, CCA-Flow, and PetCO2 (p < 0.0001) with an average difference (SD) of 13.7 (2.28) mmHg, 15.5 (14.12) mL min-1 and -4 (2.76) mmHg respectively. Three animals achieved ROSC and had significantly higher mean CPP (54 vs. 18 mmHg), CCA-Flow (262 vs. 135 mL min-1) and PetCO2 (16 vs. 8 mmHg) (p < 0.0001) throughout inflation periods than No-ROSC animals. Aortic histology did not reveal any significant changes produced by balloon inflation. CONCLUSION REBOA significantly increased CPP and CCA-Flow in this model of prolonged CA. These increases may contribute to the ability to achieve ROSC.
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Affiliation(s)
- Mohamad Hakam Tiba
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Brendan M McCracken
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Brandon C Cummings
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Carmen I Colmenero
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Chandler J Rygalski
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Molecular and Integrative Physiology, United States.
| | - Cindy H Hsu
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States; University of Michigan, Department of Surgery.
| | - Thomas H Sanderson
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Molecular and Integrative Physiology, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Brahmajee K Nallamothu
- University of Michigan, Department of Internal Medicine, Division of Cardiology, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Robert W Neumar
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
| | - Kevin R Ward
- University of Michigan, Department of Emergency Medicine, United States; University of Michigan, Department of Biomedical Engineering, United States; University of Michigan, Department of Michigan Center for Integrative Research in Critical Care, United States.
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Hsu CH, Haac BE, Drake M, Bernard AC, Aiolfi A, Inaba K, Hinson HE, Agarwal C, Galante J, Tibbits EM, Johnson NJ, Carlbom D, Mirhoseini MF, Patel MB, O’Bosky KR, Chan C, Udekwu PO, Farrell M, Wild JL, Young KA, Cullinane DC, Gojmerac DJ, Weissman A, Callaway C, Perman SM, Guerrero M, Aisiku IP, Seethala RR, Co IN, Madhok DY, Darger B, Kim DY, Spence L, Scalea TM, Stein DM. EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest. J Trauma Acute Care Surg 2018; 85:37-47. [PMID: 29677083 PMCID: PMC6026030 DOI: 10.1097/ta.0000000000001945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome. RESULTS A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy. CONCLUSION Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models. LEVEL OF EVIDENCE Therapeutic study, level IV; prognostic study, level III.
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Affiliation(s)
- Cindy H. Hsu
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
- University of Michigan, Ann Arbor, Michigan
| | - Bryce E. Haac
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mack Drake
- University of Kentucky, Lexington, Kentucky
| | | | - Alberto Aiolfi
- Los Angeles County/University of Southern California Medical Center, Los Angeles, CA
| | - Kenji Inaba
- Los Angeles County/University of Southern California Medical Center, Los Angeles, CA
| | | | | | - Joseph Galante
- University of California Davis Medical Center, Davis, California
| | - Emily M. Tibbits
- University of California Davis Medical Center, Davis, California
| | | | - David Carlbom
- University of Washington/Harborview Medical Center, Seattle, Washington
| | | | - Mayur B. Patel
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Christian Chan
- Loma Linda University Medical Center, Loma Linda, California
| | | | | | | | | | | | | | | | - Clifton Callaway
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | - Ivan N. Co
- University of Michigan, Ann Arbor, Michigan
| | - Debbie Y. Madhok
- San Francisco General Hospital/University of California San Francisco, San Francisco, California
| | - Bryan Darger
- San Francisco General Hospital/University of California San Francisco, San Francisco, California
| | | | - Lara Spence
- Harbor UCLA Medical Center, Torrance, California
| | - Thomas M. Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Deborah M. Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Haas NL, Coute RA, Hsu CH, Cranford JA, Neumar RW. Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study. Resuscitation 2017; 119:56-62. [PMID: 28789990 DOI: 10.1016/j.resuscitation.2017.08.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/02/2017] [Indexed: 11/12/2022]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for refractory cardiac arrest. The purpose of this study was to analyze and report characteristics and outcomes of adult patients treated with ECPR after out-of-hospital cardiac arrest (OHCA) in a large international registry. METHODS The Extracorporeal Life Support Organization's Extracorporeal Life Support Registry was queried for adult cardiac arrests with arrest location of "EMT Transport" or "Outside Hospital." RESULTS From 2010-2016, 217 cases of ECPR following OHCA were reported in Europe (47%), Asia-Pacific (29%), and North America (24%). The median age was 52 years (IQR 45-62, range 18-87); 73% were male. The median duration of ECPR was 47h (IQR 17-94, range 0-711). Reported complications included hemorrhage (31.3%), limb complications (11.1%), circuit complications (8.8%), infection (7.4%), and seizures (5.5%). The rate of percutaneous coronary intervention (PCI) was higher in Europe (35.6%) and Asia-Pacific (25.8%) than North America (9.4%; p<0.01). Survival to hospital discharge was 27.6% (95% CI 22.1-34.0%), and male gender was independently associated with mortality (adjusted odds ratio 2.1 [95% CI 1.1-4.2], p<0.05). Survival did not differ by region, race, age, or year. Brain death was reported in 16.6% [95% CI 12.2-22.1%]; organ donation rate was not reported. CONCLUSION This international analysis of ECPR for refractory OHCA reveals a survival rate of 27.6%, demonstrates association of male gender with mortality, and highlights regional differences in PCI utilization. These results will help inform implementation and research of this potentially life-saving strategy for refractory OHCA.
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Affiliation(s)
- Nathan L Haas
- University of Michigan, Department of Emergency Medicine, 1500 East Medical Center Drive, B1-380 Taubman Center, SPC 5305, Ann Arbor, MI, 48109, United States.
| | - Ryan A Coute
- Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO, 64106, United States
| | - Cindy H Hsu
- Department of Emergency Medicine, Division of Emergency Critical Care, Department of Surgery, Division of Acute Care Surgery, Michigan Center for Integrative Research in Critical Care, University of Michigan, NCRC B026-319N, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, United States
| | - James A Cranford
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48105, United States
| | - Robert W Neumar
- University of Michigan, Department of Emergency Medicine, Michigan Center for Integrative Research in Critical Care, 1500 E. Medical Center Drive, TC B1220, Ann Arbor, MI, 48109-5301, United States
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Hsu CH, Brown CM, Murphy JM, Haskell MG, Williams C, Feldman K, Mitchell K, Blanton JD, Petersen BW, Wallace RM. Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies. Zoonoses Public Health 2016; 64:127-136. [PMID: 27389926 PMCID: PMC5525325 DOI: 10.1111/zph.12289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 12/25/2022]
Abstract
Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.
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Affiliation(s)
- C H Hsu
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA.,Epidemic Intelligence Service, Atlanta, GA, USA
| | - C M Brown
- Massachusetts Department of Public Health State Laboratory Institute, Jamaica Plain, MA, USA
| | - J M Murphy
- Virginia Department of Health, Office of Epidemiology, Richmond, VA, USA
| | - M G Haskell
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - C Williams
- Division of Public Health, Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - K Feldman
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - K Mitchell
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - J D Blanton
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - B W Petersen
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - R M Wallace
- Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
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Abstract
A cross-sectional cohort study was conducted to investigate whether ghrelin level in obese women predicts the quality of life (QOL). A total of 307 subjects fulfilled the criteria: (1) age between 20 and 65 years old, (2) body mass index ≥27 kg/m2 (3) waist circumference ≥80 cm were enrolled in the study. All subjects were assigned to one of the plasma ghrelin level categories according to the quartiles. The median of age and BMI of the 307 obese women were 45 ± 18 years and 29.9 ± 4.1 kg/m2, respectively. The main outcome evaluated is the associations of plasma ghrelin level and QOL, which were evaluated using multiple linear regression analysis. Results of linear trend test show significant statistical difference in plasma lipoproteins (triglyceride, cholesterol, HDL-cholestero and LDL-cholesterol = and levels of obesity-related hormone peptides, including leptin, adiponectin, insulin among quartiles of ghrelin. Multiple liner regression analysis of serum obesity-related hormone peptide level and QOL using stepwise method shows ghrelin concentration was the only predictor of QOL, including PCS-12 level (β = -0.18, p = 0.001), MCS-12 level (β = -0.14, p = 0.009), WHOQOL-BREF scores: physical (β = -0.13, p = 0.03), psychological (β = -0.16, p = 0.007), social (β = -0.21, p = < 0.001), and environmental (β = -0.22, p = <0.001), after adjusting other factors for obese female subjects. This study demonstrated that ghrelin concentration is strongly associated with QOL level among obese women. Hence, ghrelin concentration might be a valuable marker to be monitored in obese women.
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Affiliation(s)
- P H Lu
- a School of Medicine, Institute of Traditional Medicine , National Yang-Ming University , Taipei , Taiwan.,b Department of Dermatology , Far Eastern Memorial Hospital , New Taipei City , Taiwan
| | - Y L Song
- a School of Medicine, Institute of Traditional Medicine , National Yang-Ming University , Taipei , Taiwan
| | - C H Hsu
- a School of Medicine, Institute of Traditional Medicine , National Yang-Ming University , Taipei , Taiwan.,c Branch of Linsen and Chinese Medicine , Taipei City Hospital , Taipei , Taiwan
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Algotar AM, Behnejad R, Singh P, Thompson PA, Hsu CH, Stratton SP. EFFECT OF SELENIUM SUPPLEMENTATION ON PROTEOMIC SERUM BIOMARKERS IN ELDERLY MEN. J Frailty Aging 2016; 4:107-10. [PMID: 26366377 DOI: 10.14283/jfa.2015.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To determine the effect of selenium supplementation on the human proteomic profile. DESIGN Serum samples were collected in this pilot study from a randomized placebo controlled Phase 2 clinical trial (Watchful Waiting (WW)). SETTING Subjects were followed every three months for up to five years at the University of Arizona Prostate Cancer Prevention Program. PARTICIPANTS One hundred and forty men (age < 85 years) had biopsy-proven prostate cancer, a Gleason sum score less than eight, no metastatic cancer, and no prior treatment for prostate cancer. INTERVENTION As part of the WW trial, men were randomized to placebo, selenium 200 μg/day or selenium 800 μg/day. For the purpose of the current study, 40 subjects enrolled in the WW study (20 from the placebo group and 20 from Se 800 μg/day group) were selected. MEASUREMENTS Baseline serum samples were collected at each follow-up visit and stored at -80 degrees Celsius. A multiplexed proteomic panel investigated changes in 120 proteins markers simultaneously. RESULTS Thirteen proteins (Apolipoprotein J, IL-10, IL-1 alpha, MMP-3, IL-12p70, IL-2 receptor alpha, cathepsin B, eotaxin, EGFR, FGF-basic, myeloperoxidase, RANTES, TGF-beta) were determined to be either statistically (p-value < 0.05) or marginally significantly (0.05 < p-value <0.1) changed in the selenium supplemented group as compared to placebo. CONCLUSION Although independent validation of these results is needed, this study is the first of its kind to utilize high throughput fluorescence based protein multiplex panel in analyzing changes in the proteomic profile due to selenium supplementation. Results from this study provide insight into the ability of selenium to modulate numerous protein markers and thus impact various biological processes in humans.
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Affiliation(s)
- A M Algotar
- Department of Preventive Medicine, Loma Linda University Medical Center, Loma Linda, CA ; University of Arizona Cancer Center, Tucson, AZ
| | - R Behnejad
- University of Arizona Cancer Center, Tucson, AZ
| | - P Singh
- Department of Hematology-Oncology, University of Arizona, Tucson, AZ
| | - P A Thompson
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - C H Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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Lu PH, Hsu CH. Does supplementation with green tea extract improve acne in post-adolescent women? A randomized, double-blind, and placebo-controlled clinical trial. Complement Ther Med 2016; 25:159-63. [PMID: 27062963 DOI: 10.1016/j.ctim.2016.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Green tea is believed to have beneficial effects in the prevention and treatment of acne. OBJECTIVE To examine the effects of a decaffeinated green tea extract (GTE), providing a daily dose of 856 mg of epigallocatechin gallate (EGCG) upon women with post-adolescent acne. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted from May 2012 through October 2013. A final group of 80 subjects were randomly assigned to receive either 1500 mg of decaffeinated GTE or placebo (cellulose) daily for 4 weeks. Inflammatory lesion counts were used as the major outcome measurement. At baseline and after 4 weeks of treatment, anthropometric measurements, fasting glucose levels and a lipid profile were measured from both groups. RESULTS Sixty-four of 80 women, from 25 to 45 years of age with moderate-to-severe acne completed the study. Statistically significant differences were noted in inflammatory lesion counts distributed on the nose, periorally and on the chin between the two groups. However, there were no significant differences between groups for total lesion counts. Within-group comparison revealed that the GTE group had significant reductions in inflammatory lesions distributed on the forehead and cheek, and significant reductions in total lesion counts. GTE resulted in significant reductions in total cholesterol levels within the GTE group. CONCLUSIONS GTE resulted in significant reductions in lesions located on the nose, perioral area and chin. More research is required to determine whether a decaffeinated GTE standardized for EGCG content will provide clinical benefits in women with post-adolescent acne.
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Affiliation(s)
- P H Lu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taiwan; Department of Dermatology, Far Eastern Memorial Hospital, Taiwan
| | - C H Hsu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taiwan; Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taiwan.
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48
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Trueger NS, Thoma B, Hsu CH, Sullivan D, Peters L, Lin M. The Altmetric Score: A New Measure for Article-Level Dissemination and Impact. Ann Emerg Med 2015; 66:549-53. [PMID: 26004769 DOI: 10.1016/j.annemergmed.2015.04.022] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- N Seth Trueger
- Section of Emergency Medicine, University of Chicago, Chicago, IL.
| | - Brent Thoma
- Emergency Medicine University of Saskatchewan Saskatoon, SK, Canada, and the MedEdLIFE Research Collaborative San Francisco, CA
| | - Cindy H Hsu
- Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | | | | | - Michelle Lin
- Department of Emergency Medicine, University of California, and the MedEdLIFE Research Collaborative, San Francisco, CA
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49
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Lin HT, Hsu CH, Tsai HJ, Lin CH, Lo PY, Wang SL, Wang LC. Influenza A plasma and serum virus antibody detection comparison in dogs using blocking enzyme-linked immunosorbent assay. Vet World 2015; 8:580-3. [PMID: 27047138 PMCID: PMC4774716 DOI: 10.14202/vetworld.2015.580-583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background and Aim: The influenza A virus (IAV) is an important zoonotic pathogen with infections also reported in dogs. IAV infections can be detected through the presence of antibodies using the enzyme-linked immunosorbent assay (ELISA). Serum is the only standard sample source; however, there is no information on the availability of other sample sources for IAV antibody detection in dogs. Compared with serum, plasma is more widely employed in most animal hospitals. The object of this study is to investigate whether plasma collected in ethylenediaminetetraacetic acid (EDTA) tubes (EDTA plasma) or heparin tubes (heparin plasma) could be used in the ELISA protocol instead of serum for IAV antibody detection in dogs. Materials and Methods: Totally, 82 matched EDTA plasma and serum sample pairs and 79 matched heparin plasma and serum sample pairs were employed using blocking enzyme-linked immunosorbent assay (bELISA). The agreement and correlation between the plasma (EDTA or heparin plasma) and serum were assessed using the agreement index kappa (kD) calculation and Pearson correlation coefficient, respectively. Results: The agreement index kD of EDTA plasma and serum was 1.0, and that of heparin plasma and serum was 0.85. The Pearson correlation coefficient of EDTA plasma and serum was 0.87 (p<0.01), and that of heparin plasma and serum was 0.82 (p<0.01). Conclusion: The results proved that plasma, especially EDTA plasma, could be substituted for serum in the bELISA test. This might greatly expand the clinical applicability of IAV antibody detection in dogs.
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Affiliation(s)
- H T Lin
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - C H Hsu
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - H J Tsai
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - C H Lin
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - P Y Lo
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - S L Wang
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - L C Wang
- Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, 1 Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
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50
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Nguyen HQ, Yu HW, Luc QH, Tang YZ, Phan VTH, Hsu CH, Chang EY, Tseng YC. Control of metamorphic buffer structure and device performance of In(x)Ga(1-x)As epitaxial layers fabricated by metal organic chemical vapor deposition. Nanotechnology 2014; 25:485205. [PMID: 25396303 DOI: 10.1088/0957-4484/25/48/485205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Using a step-graded (SG) buffer structure via metal-organic chemical vapor deposition, we demonstrate a high suitability of In0.5Ga0.5As epitaxial layers on a GaAs substrate for electronic device application. Taking advantage of the technique's precise control, we were able to increase the number of SG layers to achieve a fairly low dislocation density (∼10(6) cm(-2)), while keeping each individual SG layer slightly exceeding the critical thickness (∼80 nm) for strain relaxation. This met the demanded but contradictory requirements, and even offered excellent scalability by lowering the whole buffer structure down to 2.3 μm. This scalability overwhelmingly excels the forefront studies. The effects of the SG misfit strain on the crystal quality and surface morphology of In0.5Ga0.5As epitaxial layers were carefully investigated, and were correlated to threading dislocation (TD) blocking mechanisms. From microstructural analyses, TDs can be blocked effectively through self-annihilation reactions, or hindered randomly by misfit dislocation mechanisms. Growth conditions for avoiding phase separation were also explored and identified. The buffer-improved, high-quality In0.5Ga0.5As epitaxial layers enabled a high-performance, metal-oxide-semiconductor capacitor on a GaAs substrate. The devices displayed remarkable capacitance-voltage responses with small frequency dispersion. A promising interface trap density of 3 × 10(12) eV(-1) cm(-2) in a conductance test was also obtained. These electrical performances are competitive to those using lattice-coherent but pricey InGaAs/InP systems.
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Affiliation(s)
- H Q Nguyen
- Department of Materials Science and Engineering, National Chiao Tung University, 1001 University Road, Hsinchu, Taiwan
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