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Latest & greatest articles for cardiac arrest
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Pre-hospital advanced airway management for adults with out-of-hospital cardiacarrest: nationwide cohort study. To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest.Cohort study between January 2014 and December 2016.Nationwide, population based registry in Japan (All-Japan Utstein Registry).Consecutive adult patients with out-of-hospital cardiacarrest, separated into two sub-cohorts by their first (...) ). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35).In the time dependent propensity score sequential matching for out-of-hospital cardiacarrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.Published by the BMJ Publishing Group Limited. For permission
Performance of clinical risk scores to predict mortality and neurological outcome in cardiacarrest patients Several scores are available to predict mortality and neurological outcome in cardiacarrest patients admitted to the intensive care unit (ICU). The aim of the study was to externally validate the prognostic value of four previously published risk scores.For this observational, single-center study, we prospectively included 349 consecutive adult cardiacarrest patients upon ICU admission (...) . We calculated two cardiacarrest specific risk scores (OHCA and CAHP) and two general severity of illness scores (APACHE II and SAPS II). The primary endpoint was in-hospital mortality. Secondary endpoints were neurological outcome at hospital discharge and 30-day mortality.170 patients (49%) died until hospital discharge. All scores were independently associated with outcomes in logistic regression analysis and showed acceptable discrimination for in-hospital mortality with highest AUCs
Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiacarrest: A systematic review and meta-analysis Double sequential external defibrillation (DSED) is a novel intervention which has shown potential in the management of refractory ventricular fibrillation (VF). This review aims to identify the literature surrounding the use of DSED in out-of-hospital refractory VF and assess whether this intervention improves survival outcomes.The databases (...) differed across studies. Over half of cases were witnessed cardiacarrests (58.7%, n = 293) and bystander CPR was initiated in 53.3% (n = 266) of cases. In the meta-analysis, DSED had no effect on survival to hospital discharge (OR 0.69, 95% CI: 0.30, 1.60), event survival (OR 0.98, CI: 0.59, 1.62) or ROSC (OR 0.86, 95% CI: 0.49-1.48).The effectiveness of DSED remains unclear. Further well-designed prospective studies are needed to determine whether DSED has a role in the treatment of refractory
Revised Cardiac Risk Index as a Predictor for Myocardial Infarction and CardiacArrest Following Posterior Lumbar Decompression A retrospective analysis of prospectively collected data.The aim of this study was to determine the ability of Revised Cardiac Risk Index (RCRI) to predict adverse cardiac events following posterior lumbar decompression (PLD).PLD is an increasingly common procedure used to treat a variety of degenerative spinal conditions. The RCRI is used to predict risk for cardiac (...) complications.Membership in the RCRI=1 cohort was a predictor for myocardial infarction (MI) [odds ratio (OR) = 3.3, P = 0.002] and cardiacarrest requiring cardiopulmonary resuscitation (CPR) (OR = 3.4, P = 0.013). Membership in the RCRI = 2 cohort was a predictor for MI (OR = 5.9, P = 0.001) and cardiacarrest requiring CPR (OR = 12.5), Membership in the RCRI = 3 cohort was a predictor for MI (OR = 24.9) and cardiacarrest requiring CPR (OR = 26.9, P = 0.006). RCRI had a good discriminative ability to predict both
Use of public defibrillators linked to out-of-hospital cardiacarrest survival Use of public defibrillators linked to out-of-hospital cardiacarrest survival Discover Portal Discover Portal Use of public defibrillators linked to out-of-hospital cardiacarrest survival Published on 5 September 2017 doi: Providing a shock using a defibrillator to people with out-of-hospital cardiacarrest before the arrival of emergency medical services increases their chance of survival. The UK survival rate (...) response time, although time to intervention was not reported by the researchers. Whether it was the speed of first response or cause of cardiacarrest that accounted for these differences, it is clear that members of the public have an important role to play. Although this review did not examine training, pilot studies are investigating the potential of medical dispatch alerts for public first aiders. Overall, the review findings support the current installation of publicly available defibrillators so
Routine use of a mechanical compression device is no better than manual chest compression in cardiacarrest Mechanical versus manual chest compression in cardiacarrest Discover Portal Discover Portal Routine use of a mechanical compression device is no better than manual chest compression in cardiacarrest Published on 27 November 2018 doi: Compared with manual compression, mechanical chest compression does not improve survival rates after cardiacarrest. However, in situations where manual (...) compression may be difficult, such as in a moving ambulance, mechanical compression may still be an option. Each minute that a person waits for treatment after a cardiacarrest can make a difference of up to 10% to their chance of survival. Cardiopulmonary resuscitation (CPR) is the crucial first step to keep oxygen circulating to vital organs such as the heart and brain. While in theory, the use of automated chest compression could ensure optimum CPR delivery, this is not supported convincingly
Adrenaline and vasopressin for cardiacarrest. Adrenaline and vasopressin are widely used to treat people with cardiacarrest, but there is uncertainty about the safety, effectiveness and the optimal dose.To determine whether adrenaline or vasopressin, or both, administered during cardiacarrest, afford any survival benefit.We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and DARE from their inception to 8 May 2018, and the International Liaison Committee (...) on Resuscitation 2015 Advanced Life Support Consensus on Science and Treatment Recommendations. We also searched four trial registers on 5 September 2018 and checked the reference lists of the included studies and review papers to identify potential papers for review.Any randomised controlled trial comparing: standard-dose adrenaline versus placebo; standard-dose adrenaline versus high-dose adrenaline; and adrenaline versus vasopressin, in any setting, due to any cause of cardiacarrest, in adults and children
Induced hypothermia is associated with reduced circulating subunits of mitochondrial DNA in cardiacarrest patients. Induced hypothermia may protect from ischemia reperfusion injury. The mechanism of protection is not fully understood and may include an effect on mitochondria. Here we describe the effect of hypothermia on circulating mitochondrial (mt) DNA in a substudy of a multicenter randomized trial (the Target Temperature Management trial). Circulating levels of mtDNA were elevated (...) in patients with cardiacarrest at all-time points compared to healthy controls. After 24 h of temperature management, patients kept at 33 °C had significantly lower levels of COX3, NADH1 and NADH2 compared to baseline, in contrast to those kept at 36 °C. After regain of temperature, cytochrome - B was significantly reduced in patients kept at 33 °C with cardiacarrest. Cardiacarrest results in circulating mtDNA levels, which reduced during a temperature management protocol in patients with a target
2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After CardiacArrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Em Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation/pulseless ventricular tachycardia cardiacarrest. However, it is unclear whether these medications improve patient outcomes. This 2018 (...) American Heart Association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiacarrest. This article includes the revised recommendation that providers may consider either amiodarone or lidocaine to treat shock-refractory ventricular fibrillation/pulseless ventricular
Incidence, outcomes and guideline compliance of out-of-hospital maternal cardiacarrest resuscitations: A population-based cohort study Incidence and survival rates after cardiacarrest among pregnant women are reported for in-hospital cardiacarrests; the incidence and outcomes of maternal out-of-hospital cardiacarrest (OHCA) are unknown. Current cardiopulmonary resuscitation guidelines contain recommendations specific to this population; compliance with these has not been investigated.To
Which Compression-to-Ventilation Ratio Yields Better CardiacArrest Outcomes? (SRS therapy) TAKE-HOME MESSAGE Continuous compressions with asynchronous ventilations and a compression-to- ventilation ratio of 30:2 resulted in improved outcomes in adults in cardiopulmonary arrest, whereas either 30:2 or 15:2 improved outcomes in children. Which Compression-to-Ventilation Ratio Yields Better CardiacArrest Outcomes? EBEM Commentators Dhimitri A. Nikolla, DO Jestin N. Carlson, MD, MS Department (...) evidence has suggested harm from long pauses in chest compressions, 1,2 greater emphasis has been placed on bystander compression-only CPR and continuous-compression CPR by out-of-hospital providers. 3 In addition, hyperventilation may negatively affect outcomes. 4,5 As such, there is equipoise in regard to the ideal compression-to- ventilation ratio in cardiacarrest, and limited high-quality data exist. The study by Nichol et al 6 comparing continuous- compression CPR to 30:2 CPR represents
Does Spontaneous Cardiac Motion, Identified With Point-of-Care Echocardiography During CardiacArrest, Predict Survival? (SRS prognosis) TAKE-HOME MESSAGE Point-of-care echocardiography demonstrating no spontaneous cardiac motion is associated with lower likelihood of return of spontaneous circulation and survival to hospital admission. This may be used to assist with decisionmaking about resuscitation termination. Does Spontaneous Cardiac Motion, Identi?ed With Point-of-Care Echocardiography (...) During CardiacArrest, Predict Survival? EBEM Commentators Michael D. April, MD, DPhil Brit Long, MD Department of Emergency Medicine SAUSHEC Fort Sam Houston, TX Results Summary of meta-analysis outcomes for 1,695 patients and 15 studies. Outcome No. Studies No. Patients* Sensitivity (95% CI) Speci?city (95% CI) LRD (95% CI) LR– (95% CI) AUROC (95% CI) I 2 (95% CI) ROSC 8 543 95 (72–99) 80 (63–91) 4.8 (2.5–9.4) 0.06 (0.01–0.39) 0.93 (0.91–0.95) 98 (97–99) Survival to hospital admission 10 1,018 90
Effectiveness of antiarrhythmic drugs for shockable cardiacarrest: A systematic review The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiacarrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations.A search was conducted in electronic databases Medline, Embase, and Cochrane Library from inception to August 15, 2017.Of the 9371 citations (...) , the results showed a significant increase for lidocaine compared with placebo (RR = 1.16; 95% CI, 1.03-1.29, p = 0.01).The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiacarrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering
The CPR Coach – A Paradigm Shift in Resuscitation Teams for CardiacArrest Management The CPR Coach – A Paradigm Shift in Resuscitation Teams for CardiacArrest Management - CanadiEM The CPR Coach – A Paradigm Shift in Resuscitation Teams for CardiacArrest Management In , by Adam Cheng September 10, 2018 Survival outcomes from cardiacarrest remain poor despite recent advancements in resuscitation science and education. The delivery of high quality cardiopulmonary resuscitation (CPR) during (...) cardiacarrest is a key component of clinical care. The delivery of high quality CPR is associated with improved survival outcomes. Unfortunately, many studies have demonstrated that providers consistent struggle to provide guideline compliant CPR during cardiacarrest care 1 , 2 . The formula for survival in cardiacarrest outlines three key components that contribute to survival outcomes: medical science, educational efficiency, and local implementation 3 . Various research groups have explored
Efficacy and Safety of Combination Therapy of Shenfu Injection and Postresuscitation Bundle in Patients With Return of Spontaneous Circulation After In-Hospital CardiacArrest PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Survival and Long-Term Functional Outcomes for Children With CardiacArrest Treated With Extracorporeal Cardiopulmonary Resuscitation PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Efficacy and safety of mechanical versus manual compression in cardiacarrest - A Bayesian network meta-analysis To compare relative efficacy and safety of mechanical compression devices (AutoPulse and LUCAS) with manual compression in patients with cardiacarrest undergoing cardiopulmonary resuscitation (CPR).For this Bayesian network meta-analysis, seven randomized controlled trials (RCTs) were selected using PubMed/Medline, EMBASE, and CENTRAL (Inception- 31 October 2017). For all (...) the outcomes, median estimate of odds ratio (OR) from the posterior distribution with corresponding 95% credible interval (Cr I) was calculated. Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each intervention based on surface under the cumulative ranking curve (SUCRA).In analysis of 12, 908 patients with cardiacarrest [AutoPulse (2, 608 patients); LUCAS (3, 308 patients) and manual compression (6, 992 patients)], manual compression improved survival
Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital CardiacArrest: A Randomized Clinical Trial. Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiacarrest (OHCA). The optimal method for OHCA advanced airway management is unknown.To compare the effectiveness of a strategy
Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital CardiacArrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. The optimal approach to airway management during out-of-hospital cardiacarrest is unknown.To determine whether a supraglottic airway device (SGA) is superior to tracheal intubation (TI) as the initial advanced airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest.Multicenter, cluster (...) randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiacarrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018.Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced airway