Regular pulse checks for patients with non-cardioembolic stroke in rehabilitation hospitals to improve recognition and detection of atrial fibrillation (the ESCORT study): protocol for a prospective multicenter observational study

Background

Cryptogenic stroke (CS) are heterogeneous in origin; however, most CS are embolic mechanism. Paroxysmal atrial fibrillation (AF) is suspected to be a major type of CS that leads to severe cerebral infarction without anticoagulant use. Therefore, the identification of AF is vital in patients with CS. However, patients are often unaware of AF because they have no symptoms, and AF may not be detected on an electrocardiogram (ECG) or Holter ECG on admission. After patients with stroke are treated in the acute phase, they are promptly transferred to a rehabilitation hospital for functional recovery. Once the patient is transferred to a hospital, a few attempts are made to detect AF. In addition, rehabilitation therapists are considered to have insufficient awareness of the possibility of undiagnosed AF.

Objective

This study aimed to increase the understanding of the importance of AF detection in patients with ischemic stroke among therapists in rehabilitation hospitals and to investigate whether regular pulse screening can aid in the detection of AF. If AF was detected, we determined the rate and timing of AF detection and identified the patient characteristics.

Methods

This multicenter prospective observational study aimed to detect AF in patients with non-cardiac stroke at rehabilitation hospitals. Therapists performed pulse checks before, during, and after rehabilitation. If arrhythmia or tachycardia was detected, an ECG was performed, and the physician checked for AF. If the patient complained of chest symptoms, electrocardiography (ECG) was performed to check for AF. We investigated the characteristics, laboratory data, cognitive status, complications, such as stroke recurrence, and functional outcomes of patients with AF.

Results

The study is in the enrollment phase. Recruitment began in September 2022 and will end in August 2023. Patients have provided written informed consent. The main results have been submitted for publication in your journal.

Conclusion

The findings of this study will help identify patients with AF in rehabilitation hospitals and improve awareness among therapists.

Validation of MyDiagnostick tool to identify atrial fibrillation in a multi-ethnic Asian population

Introduction

MyDiagnostick is an atrial fibrillation (AF) screening tool that has been validated in the Caucasian population in the primary care setting.

Methods

In our study, we compared MyDiagnostick with manual pulse check for AF screening in the community setting.

Results

In our cohort of 671 candidates from a multi-ethnic Asian population, AF prevalence was found to be 1.78%. Of 12 candidates, 6 (50.0%) had a previous history of AF and another 6 (50.0%) were newly diagnosed with AF. Candidates found to have AF during the screening were older (72.0 ± 11.7 years vs. 56.0 ± 13.0 years, P < 0.0001) and had a higher CHADSVASC risk score (2.9 ± 1.5 vs. 1.5 ± 1.1, P = 0.0001). MyDiagnostick had a sensitivity of 100.0% and a specificity of 96.2%. In comparison, manual pulse check had a sensitivity of 83.3% and a specificity of 98.9%.

Conclusion

MyDiagnostick is a simple AF screening device that can be reliably used by non-specialist professionals in the community setting. Its sensitivity and specificity are comparable and validated across various studies performed in different population cohorts.

Point-of-Care Ultrasound Compression of the Carotid Artery for Pulse Determination in Cardiopulmonary Resuscitation

AIM

To identify whether a novel pulse check technique, carotid artery compression using an ultrasound probe, can reduce pulse check times compared to manual palpation (MP).

METHODS

This prospective study was conducted in an emergency department between February and December 2021. A physician applied point-of-care ultrasound-carotid artery compression (POCUS-CAC) and assessed the carotid artery compressibility and pulsatility by probe compression during rhythm check time. Another clinician performed MP of the femoral artery. The primary outcome was the difference in the average time for pulse assessment between POCUS-CAC and MP. The secondary outcomes included the time difference in each pulse check between methods, the proportion of times greater than 5 s and 10 s, and the prediction of return of spontaneous circulation (ROSC) during ongoing chest compression.

RESULTS

25 cardiac arrest patients and 155 pulse checks were analyzed. The median (interquartile range) average time to carotid pulse identification per patient using POCUS-CAC was 1.62 (1.14-2.14) s compared to 3.50 (2.99-4.99) s with MP. In all 155 pulse checks, the POCUS-CAC time to determine ROSC was significantly shortened to 0.44 times the MP time (P < 0.001). The POCUS-CAC approach never exceeded 10 s, and the number of patients who required more than 5 s was significantly lower (5 vs. 37, P < 0.001). Under continuous chest compression, six pulse checks predicted the ROSC.

CONCLUSIONS

We found that emergency physicians could quickly determine pulses by applying simple POCUS compression of the carotid artery in cardiac arrest patients.

Manual Palpation vs. Femoral Arterial Doppler Ultrasound for Comparison of Pulse Check Time During Cardiopulmonary Resuscitation in the Emergency Department: A Pilot Study

BACKGROUND

Manual palpation (MP) is frequently employed for pulse checks, but studies have shown that trained medical personnel have difficulty accurately identifying pulselessness or return of spontaneous circulation (ROSC) using MP. Any delays in identifying pulselessness can lead to significant delays in starting or resuming high-quality chest compressions.

OBJECTIVES

This study explored whether femoral arterial Doppler ultrasound (FADU) decreases pulse check duration during cardiopulmonary resuscitation (CPR) compared with MP among patients in the emergency department (ED) receiving CPR directed by emergency medicine physicians who had received minimal additional didactic ultrasound training.

METHODS

We performed a prospective observational cohort study from October 2018 to May 2019 at an urban community ED. Using convenience sampling, we enrolled patients arriving at our ED or who decompensated during their ED stay and received CPR. For continuous data, median (interquartile range [IQR]) were calculated, and medians were compared using Kruskal-Wallis test.

RESULTS

Fifty-two eligible patients were enrolled and 135 pulse checks via MP and 35 via FADU were recorded. MP observations had a median (IQR) of 11.00 (7.36-15.48) s, whereas FADU had a median (IQR) of 8.98 (5.45-13.85) s. There was a difference between the two medians of 2.02 s (p = 0.05).

CONCLUSIONS

In this study, the use of FADU was superior to MP in achieving shorter pulse check times. Further research is needed to confirm the accuracy of FADU for identifying ROSC as well as to determine whether FADU can improve clinical outcomes.

Pulse check as a tool to raise awareness of atrial fibrillation in pharmacies in the Czech Republic - a pilot project

OBJECTIVE

The aim of the study was to raise the awareness of atrial fibrillation (AF) and the importance of pulse check in Czech pharmacies as well as to point out further possibilities of developing consulting activities in pharmacies.

METHOD

Our project was performed as part of a worldwide campaign during three weeks: Heart Rhythm Week (06/2017) and Atrial Fibrillation Awareness Week (11/2017, 11/2018). Pharmacies actively providing indi-vidual counselling offered manual pulse check to patients aged  40 years without chronic anticoagulant therapy. Whenever high risk of AF was observed, patients were referred to a physician for further evaluation.

RESULTS

Pharmacists undertook pulse checks in 187 patients (mean age 59.0 ± 12.3 years; 70.6% women) in 14 participating pharmacies. The most common symptoms were fatigue (42.2%) and palpitations (20.9%), however, 40.6% of patients were asymptomatic. The mean heart rate was 73.2 ± 11.3 beats per minute (min. 51; max. 135) and irregular pulse was observed in 4.3% patients. The average CHA2DS2-VASc score was 2.0 ± 1.3. Eight (4.3%) patients were referred to a physician and in 5 patients (2.7%) the arrhythmia was diagnosed.

CONCLUSION

Czech pharmacies have successfully adopted this campaign, are interested in continuity of the project and may thus contribute to raise awareness of AF.

Basic Cardiac Life Support: 2016 Singapore Guidelines

Basic Cardiac Life Support (BCLS) or cardiopulmonary resuscitation (CPR) refers to the skills required (without use of equipment) in the resuscitation of cardiac arrest individuals. On recognising cardiac arrest, chest compressions should be initiated. Good quality compressions are with arms extended, elbows locked, shoulders directly over the casualty's chest and heel of the palm on the lower half of the sternum. The rescuer pushes hard and fast, compressing 4-6 cm deep for adults at 100-120 compressions per minute with complete chest recoil. Two quick mouth-to-mouth ventilations (each 400-600 mL tidal volume) should be delivered after every 30 chest compressions. Chest compression-only CPR is recommended for lay rescuers, dispatcher-assisted CPR and those unable or unwilling to give ventilations. CPR should be stopped when the casualty wakes up, an emergency team takes over casualty care or if an automated external defibrillator prompts for analysis of heart rhythm or delivery of shock.