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Latest & greatest articles for cardiac arrest
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Advanced airway management during adult cardiacarrest: A systematic review To systematically review the literature on advanced airway management during adult cardiacarrest in order to inform the International Liaison Committee of Resuscitation (ILCOR) consensus on science and treatment recommendations.The review was performed according to PRISMA guidelines and registered on PROSPERO (CRD42018115556). We searched Medline, Embase, and Evidence-Based Medicine Reviews for controlled trials (...) and observational studies published before October 30, 2018. The population included adult patients with cardiacarrest. Two investigators reviewed studies for relevance, extracted data, and assessed the risk of bias of individual studies.We included 78 observational studies and 11 controlled trials. Most of the observational studies and all of the controlled trials only included patients with out-of-hospital cardiacarrest. The risk of bias for individual observational studies was overall assessed as critical
Vasopressors during adult cardiacarrest: A systematic review and meta-analysis To systematically review the literature on the use of vasopressors during adult cardiacarrest to inform an update of international guidelines.PRISMA guidelines were followed. We searched Medline, Embase, Web of Science, CINAHL, and the Cochrane Library for controlled trials and observational studies. The population included adults with cardiacarrest in any setting. Pairs of investigators reviewed studies (...) for relevance, extracted data, and assessed the risk of bias for individual studies. Certainty of evidence was evaluated using GRADE for controlled trials and meta-analyses were performed when at least two studies could be pooled.We included 15 controlled trials and 67 observational studies. The majority of studies included out-of-hospital cardiacarrest only. Meta-analyses were performed for two controlled trials comparing epinephrine to placebo, three comparing vasopressin to epinephrine, and three
Chiefs’ inquiry corner: monoclonal antibodies and clostridium difficile infection, outcomes after in-hospital cardiacarrest v out-of-hospital, dermatomyositis and malignancy, malignancy work up in unprovoked VTE. Chiefs’ Inquiry Corner – Clinical Correlations Search Chiefs’ Inquiry Corner June 10, 2019 3 min read Clostridium difficile (C diff) is the most common pathogen implicated in infectious diarrhea among hospitalized patients. Several antimicrobials, chief among them an oral formulation (...) was discontinued after interim analysis). Patients receiving bezlotoxumab-containing regimens demonstrated significantly reduced rates of recurrence within 12 weeks compared to placebo, suggesting a possible role for this monoclonal antibody in the prevention of recurrence when added to standard antimicrobial therapy. References: The epidemiology, etiology, and outcomes of in-hospital cardiacarrest (IHCA) are quite different from those of out-of-hospital cardiacarrest (OHCA). In contrast to OHCA, survival
Accuracy of nature of call screening tool in identifying patients requiring treatment for out of hospital cardiacarrest A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiacarrest (OHCA) and withholding dispatch for other calls while
Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital CardiacArrest: The PRINCESS Randomized Clinical Trial. Therapeutic hypothermia may increase survival with good neurologic outcome after cardiacarrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest).To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves (...) survival with good neurologic outcome compared with cooling initiated after hospital arrival.The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiacarrest were enrolled.Patients were randomly assigned
Paediatric targeted temperature management post cardiacarrest: A systematic review and meta-analysis The International Liaison Committee on Resuscitation prioritized the need to update the review on the use of targeted temperature management (TTM) in paediatric post cardiacarrest care. In this meta-analysis, the effectiveness of TTM at 32-36 °C was compared with no target or a different target for comatose children who achieve a return of sustained circulation after cardiac arrest.Electronic (...) at 32-34 °C compared with a target at 36-37.5 °C did not statistically improve long-term good neurobehavioural survival (risk ratio: 1.15; 95% CI: 0.69-1.93), long-term survival (RR: 1.14; 95% CI: 0.93-1.39), or short-term survival (risk ratio: 1.14; 95% CI: 0.96-1.36). TTM at 32-34 °C did not show statistically increased risks of infection, recurrent cardiacarrest, serious bleeding, or arrhythmias. A novel analysis suggests that another small RCT might provide enough evidence to show benefit
Advanced airway interventions for paediatric cardiacarrest: A systematic review and meta-analysis To assess the use of advanced airway interventions (tracheal intubation (TI) or supraglottic airway (SGA) placement), compared with bag mask ventilation (BMV) alone, for resuscitation of children in cardiac arrest.We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) for human trials and observational studies published before September 24, 2018 for clinical trials (...) studies suitable for meta-analysis. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge results suggested better outcomes achieved with BMV than either TI or SGA; limited data favored SGA over TI. The majority of studies involved out-of-hospital cardiacarrest, with few studies of in-hospital cardiac arrest.TI or SGA are not superior to BMV for resuscitation
Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiacarrest: the Neuroprotect post-cardiacarrest trial During the first 6-12 h of intensive care unit (ICU) stay, post-cardiacarrest (CA) patients treated with a mean arterial pressure (MAP) 65 mmHg target experience a drop of the cerebral oxygenation that may cause additional cerebral damage. Therefore, we investigated whether an early goal directed haemodynamic optimization strategy (EGDHO
Does care at a cardiacarrest centre improve outcome after out-of-hospital cardiacarrest? - A systematic review To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiacarrest does care at a specialised cardiacarrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiacarrest centre improve patient outcomes?'The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE (...) neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTS: We included data from 17 observational studies on out-of-hospital cardiacarrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC
In-Hospital CardiacArrest: A Review. In-hospital cardiacarrest is common and associated with a high mortality rate. Despite this, in-hospital cardiacarrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest.In-hospital cardiacarrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital (...) cardiacarrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiacarrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiacarrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiacarrest include chest
Coronary Angiography after CardiacArrest without ST-Segment Elevation. Ischemic heart disease is a major cause of out-of-hospital cardiacarrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiacarrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain.In this multicenter trial, we randomly assigned 552 patients who had cardiacarrest (...) angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points.Among patients who had been successfully resuscitated after out-of-hospital cardiacarrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days. (Funded by the Netherlands Heart Institute and others; COACT Netherlands
Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and CardiacArrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain.To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF.The Catheter Ablation vs (...) at the discretion of site investigators. The drug therapy group (n = 1096) received standard rhythm and/or rate control drugs guided by contemporaneous guidelines.The primary end point was a composite of death, disabling stroke, serious bleeding, or cardiacarrest. Among 13 prespecified secondary end points, 3 are included in this report: all-cause mortality; total mortality or cardiovascular hospitalization; and AF recurrence.Of the 2204 patients randomized (median age, 68 years; 37.2% female; 42.9% had
North American validation of the Bokutoh criteria for withholding professional resuscitation in non-traumatic out-of-hospital cardiacarrest Certain subgroups of patients with out-of-hospital cardiacarrest (OHCA) may not benefit from treatment. Early identification of this cohort in the prehospital (EMS) setting prior to any resuscitative efforts would prevent futile medical therapy and more appropriately allocate EMS and hospital resources. We sought to validate a clinical criteria from (...) Bokutoh, Japan that identified a subgroup of OHCAs for whom withholding resuscitation may be appropriate.We performed a secondary analysis of the "Trial of Continuous or Interrupted Chest Compressions during CPR", which enrolled EMS-treated adult non-traumatic OHCA. We classified patients as per the Bokutoh criteria ("Bokutoh Positive": age ≥ 73, unwitnessed arrest, non-shockable initial rhythm) and calculated test performance for the primary outcome of favourable neurologic outcome (mRS ≤ 3
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
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
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
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
members of the public can assist those with cardiacarrest until emergency medical services arrive. Share your views on the research. Why was this study needed? Cardiacarrest happens when a person’s heart stops pumping blood. Defibrillators can be used to shock the heart to restore a heart rhythm, but only about 20% of all out-of-hospital cardiacarrest cases are treatable by defibrillation by the time emergency services arrive. Around 60,000 out-of-hospital cardiacarrests occur in the UK every year (...) improve out-of-hospital cardiacarrest survival rates. Citation and Funding Bækgaard J, Viereck S, Møller T, et al. . Circulation. 2017. [Epub ahead of print]. This project was funded by the Danish foundation TrygFonden. Bibliography British Heart Foundation, Resuscitation Council (UK), NHS England. . London: British Heart Foundation, Resuscitation Council (UK), NHS England; 2014, revised 2015. NHS England. . London: NHS England; 2017. Perkins GD, Brace-McDonnell SJ. T . BMJ Open. 2015;5(10):e008736
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 (...) . 2018;8:CD007260. Cochrane UK and the Cochrane Heart Review Group are supported by NIHR infrastructure funding. Bibliography British Heart Foundation, NHS England, Resuscitation Council. London: British Heart Foundation; updated 2015. Soar J, Deakin C, Lockey A, Nolan J, Perkins G. . London: Resuscitation Council; 2015. Mechanical versus manual chest compressions for cardiacarrest Published on 21 August 2018 Wang, P. L.,Brooks, S. C. Cochrane Database Syst Rev Volume 8 , 2018 BACKGROUND: Mechanical
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