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Latest & greatest articles for cardiac arrest
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Therapeutic hypothermia following cardiac arrest (IPG386) Therapeutic hypothermia following cardiac arrest | Guidance and guidelines | NICE Therapeutic hypothermia following cardiac arrest Interventional procedures guidance [IPG386] Published date: March 2011 Share Save Guidance and for this guidance. Your responsibility This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals
Automated External Defibrillators and Survival After In-Hospital Cardiac Arrest. CONTEXT: Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiacarrests, but data on their effectiveness in hospitalized patients are limited. OBJECTIVE: To evaluate the association between AED use and survival for in-hospital cardiac arrest. DESIGN, SETTING, AND PATIENTS: Cohort study of 11,695 hospitalized patients with cardiacarrests between January 1, 2000, and August 26, 2008 (...) , at 204 US hospitals following the introduction of AEDs on general hospital wards. MAIN OUTCOME MEASURE: Survival to hospital discharge by AED use, using multivariable hierarchical regression analyses to adjust for patient factors and hospital site. RESULTS: Of 11,695 patients, 9616 (82.2%) had nonshockable rhythms (asystoleand pulseless electrical activity) and 2079 (17.8%) had shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used in 4515 patients (38.6
Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. CONTEXT: Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest. OBJECTIVE: To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR. DESIGN, SETTING, AND PATIENTS: A 5-year prospective observational cohort (...) study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression. MAIN OUTCOME MEASURE: Survival to hospital discharge. RESULTS: Among 5272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded
Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest. A Randomized Controlled Trial 20679551 2010 08 17 2010 09 15 2010 08 17 1524-4539 122 7 2010 Aug 17 Circulation Circulation Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. 737-42 10.1161/CIRCULATIONAHA.109.906859 Therapeutic hypothermia (...) is recommended for the treatment of neurological injury after resuscitation from out-of-hospital cardiac arrest. Laboratory studies have suggested that earlier cooling may be associated with improved neurological outcomes. We hypothesized that induction of therapeutic hypothermia by paramedics before hospital arrival would improve outcome. In a prospective, randomized controlled trial, we assigned adults who had been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm
Laryngeal mask airway versus endotracheal intubation or bag-mask ventilation for cardiac arrest in adults BestBets: Laryngeal mask airway versus endotracheal intubation or bag-mask ventilation for cardiac arrest in adults Laryngeal mask airway versus endotracheal intubation or bag-mask ventilation for cardiac arrest in adults Report By: Mithun Biswas, Adam Zenkner and Sajid Aziz - Medical students Search checked by Adam Zenkner - Medical student Institution: University of Warwick Date Submitted (...) : 9th November 2009 Date Completed: 9th July 2010 Last Modified: 9th July 2010 Status: Green (complete) Three Part Question In [adults with cardiac arrest requiring airway management] is the [classic laryngeal mask airway (LMA) optimal to endotracheal intubation (ETI) or bag-mask ventilation] in terms of [improved outcomes]? Clinical Scenario A 30-year-old woman suffers a witnessed out-of-hospital cardiac arrest. You lack experience with ETI and wonder what evidence supports routine use of LMA
Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. CONTEXT: Laboratory investigations suggest that exposure to hyperoxia after resuscitation from cardiac arrest may worsen anoxic brain injury; however, clinical data are lacking. OBJECTIVE: To test the hypothesis that postresuscitation hyperoxia is associated with increased mortality. DESIGN, SETTING, AND PATIENTS: Multicenter cohort study using the Project IMPACT critical care database (...) of intensive care units (ICUs) at 120 US hospitals between 2001 and 2005. Patient inclusion criteria were age older than 17 years, nontraumatic cardiac arrest, cardiopulmonary resuscitation within 24 hours prior to ICU arrival, and arterial blood gas analysis performed within 24 hours following ICU arrival. Patients were divided into 3 groups defined a priori based on PaO(2) on the first arterial blood gas values obtained in the ICU. Hyperoxia was defined as PaO(2) of 300 mm Hg or greater; hypoxia, PaO(2
Small Area Variations in Out-of-Hospital Cardiac Arrest: Does the Neighborhood Matter? BACKGROUND: The incidence and outcomes of out-of-hospital cardiac arrest vary widely across cities. It is unknown whether similar differences exist at the neighborhood level. OBJECTIVE: To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR). DESIGN: Multilevel Poisson regression of 1108 cardiacarrests from (...) 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES). SETTING: Fulton County, Georgia, between 1 October 2005 to 30 November 2008. MEASUREMENTS: Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR. RESULTS: Adjusted rates of cardiac arrest varied across neighborhoods (interquartile range [IQR], 0.57 to 0.73 per 1000 persons; mean, 0.64 per 1000 persons [SD, 0.11]) but were stable from year to year (intraclass correlation, 0.36 [95
Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiacarrests: a prospective, nationwide, population-based cohort study. BACKGROUND: The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiacarrests, but not for children. We assessed the effect of CPR (conventional with rescue breathing or chest compression only) by bystanders (...) on outcomes after out-of-hospital cardiacarrests in children. METHODS: In a nationwide, prospective, population-based, observational study, we enrolled 5170 children aged 17 years and younger who had an out-of-hospital cardiac arrest from Jan 1, 2005, to Dec 31, 2007. Data collected included age, cause, and presence and type of CPR by bystander. The primary endpoint was favourable neurological outcome 1 month after an out-of-hospital cardiac arrest, defined as Glasgow-Pittsburgh cerebral performance
Delayed versus immediate defibrillation for out-of-hospital cardiac arrest due to ventricular fibrillation: a systematic review and meta-analysis of randomised controlled trials Delayed versus immediate defibrillation for out-of-hospital cardiac arrest due to ventricular fibrillation: a systematic review and meta-analysis of randomised controlled trials Delayed versus immediate defibrillation for out-of-hospital cardiac arrest due to ventricular fibrillation: a systematic review and meta (...) -analysis of randomised controlled trials Simpson PM, Goodger MS, Bendall JC CRD summary This generally well-conducted review concluded that delaying initial defibrillation to allow a short period of cardiopulmonary resuscitation in out-of-hospital cardiac arrest due to ventricular defibrillation demonstrated no benefit or harm over immediate defibrillation for survival to hospital discharge, irrespective of response time. These conclusions appear likely to be reliable. Authors' objectives To compare
Chest compressions before defibrillation for out-of-hospital cardiac arrest: a meta-analysis of randomized controlled clinical trials Chest compressions before defibrillation for out-of-hospital cardiac arrest: a meta-analysis of randomized controlled clinical trials Chest compressions before defibrillation for out-of-hospital cardiac arrest: a meta-analysis of randomized controlled clinical trials Meier P, Baker P, Jost D, Jacobs I, Henzi B, Knapp G, Sasson C CRD summary This review concluded (...) that evidence suggested that chest compression first (prior to defibrillation) and defibrillation first had similar survival rates in people with out-of-hospital cardiac arrest. Although the treatments were equivalent, subgroup analysis indicated that chest compression first may be beneficial in cardiacarrests with prolonged response time. The review was well conducted and the conclusions appear reasonable. Authors' objectives To compare the effects of chest compression first (as compared to defibrillation
Hypothermia after cardiac arrest Hypothermia after cardiac arrest Hypothermia after cardiac arrest Flynn K Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Flynn K. Hypothermia after cardiac arrest. Boston: VA Technology Assessment Program (VATAP). 2010 Authors' objectives VHA’s TAAG asked TAP for a review of the literature as support (...) for use of hypothermia after cardiac arrest, initially in 2008 and again in 2010. TAP approached its charge through available systematic reviews, guidelines or technology assessments based on such reviews, and economic evaluations using high quality primary studies or reviews as sources of effectiveness data. This document will refer collectively to these synthesis publication types as “reviews”. We then updated review searches to the present to confirm the presence or absence of subsequently review
Defibrillation for Cardiac Arrest Defibrillation for Cardiac Arrest – TheNNTTheNNT Rapid Defibrillation for Cardiac Arrest 2.5 for mortality In Summary, for those who received the defibrillation: Benefits in NNT 62% saw no benefit 38% were saved from death 1 in 2.5 were helped (prevented death) Harms in NNT 0% were harmed None were identifiably harmed* *Side effects from cardioversion/electricity View As: NNT % Source: Efficacy Endpoints: Mortality Harm Endpoints: Mortality Narrative: Hundreds (...) of thousands of individuals suffer sudden cardiac arrest (SCA) each year in the United States and abroad. Rapid defibrillation has been thought highly effective for SCA, but data have been sparse. This review examined the utility of rapid defibrillation under the best of possible circumstances: in a public location, with otherwise relatively healthy patients who suffer witnessed, sudden cardiac arrest, and in whom defibrillation is typically available within 3-4 minutes. Under these unusual circumstances
ACLS Medications for Cardiac Arrest ACLS Medications for Cardiac Arrest – TheNNTTheNNT Advanced Cardiac Life Support Medications for Cardiac Arrest No benefit found In Summary, for those who received the cardiac medications: Benefits in NNT 100% saw no benefit None were helped Harms in NNT 0% were identifiably harmed* None were identifiably harmed* View As: NNT % Source: Efficacy Endpoints: Mortality Harm Endpoints: Mortality Narrative: Hundreds of thousands of individuals suffer sudden (...) cardiac arrest (SCA) each year in the United States and abroad. Advanced Cardiac Life Support (ACLS) is an algorithm-based set of recommendations and instructions assembled by the American Heart Association for the management of this condition. While rapid defibrillation appears highly effective for SCA, the role of intravenous agents is unproven. This review examined the utility of the ACLS algorithms in the only two high quality trials to test them. The first used historical controls during the ‘phase
Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis Jing XL, Wang DP, Li X, Li H, Liao XX, Xiong Y, Wang XF CRD summary This review concluded that there was no evidence that vasopressin and epinephrine was more effective (...) in treating cardiac arrest than epinephrine alone, except for reported 24-hour survival rate in one small study; further research was needed. The methods of the review and quality of included data were unclear and so the conclusions may be unreliable. Authors' objectives To assess the effectiveness of vasopressin and epinephrine in people with cardiac arrest. Searching MEDLINE (1966 to December 2008) and EMBASE (1950 to December 2008) were searched. Search terms were reported. Only studies published